1
|
Croke K, Moshabela M, Kapoor NR, Doubova SV, Garcia-Elorrio E, HaileMariam D, Lewis TP, Mfeka-Nkabinde GN, Mohan S, Mugo P, Nzinga J, Prabhakaran D, Tadele A, Wright KD, Kruk ME. Primary health care in practice: usual source of care and health system performance across 14 countries. Lancet Glob Health 2024; 12:e134-e144. [PMID: 38096885 PMCID: PMC10716626 DOI: 10.1016/s2214-109x(23)00513-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/17/2023]
Abstract
Primary health care (PHC) is central to attainment of the Sustainable Development Goals, yet comparable cross-country data on key aspects of primary care have not been widely available. This study analysed data from the People's Voice Survey, which was conducted in 2022 and 2023 in 14 countries. We documented usual source of care across countries and examined associations of usual source of care with core PHC services, quality ratings, and health system confidence. We found that 75% of respondents had a usual source of care, and that 40% of respondents accessed usual care in the public sector at primary level. 44% rated their usual source of care as very good or excellent. Access to PHC-linked screenings and treatments varied widely within and across countries. Having any usual source of care was associated with higher take-up of preventive services, greater access to treatment including mental health services, and greater health system endorsement. Strengthening links between health system users and primary care providers could improve take-up of preventive care and increase user satisfaction with health system performance.
Collapse
Affiliation(s)
- Kevin Croke
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Mosa Moshabela
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Neena R Kapoor
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Svetlana V Doubova
- Epidemiology and Health Services Research Unit, Mexican Social Security Institute, Mexico City, Mexico
| | | | - Damen HaileMariam
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Todd P Lewis
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Sailesh Mohan
- Public Health Foundation of India, Gurugram, India; Centre for Chronic Conditions and Injuries, Gurgaon, Haryana, India; Deakin University, Geelong, VIC, Australia; Centre for Chronic Disease Control, New Delhi, India
| | - Peter Mugo
- Health Policy and Systems Department, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacinta Nzinga
- Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, Gurugram, India; Centre for Chronic Disease Control, New Delhi, India
| | - Ashenif Tadele
- Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Katherine D Wright
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
2
|
Hamilton DT, Agutu C, Babigumira JB, van der Elst E, Hassan A, Gichuru E, Mugo P, Farquhar C, Ndung'u T, Sirengo M, Chege W, Goodreau SM, Elder A, Sanders EJ, Graham SM. Modeling the Impact of HIV-1 Nucleic Acid Testing Among Symptomatic Adult Outpatients in Kenya. J Acquir Immune Defic Syndr 2022; 90:553-561. [PMID: 35510854 PMCID: PMC9259037 DOI: 10.1097/qai.0000000000003013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 04/07/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Up to 69% of adults who acquire HIV in Kenya seek care before seroconversion, providing an important opportunity for early diagnosis and treatment. The Tambua Mapema Plus (TMP) trial tested a combined HIV-1 nucleic acid testing, linkage, treatment, and partner notification intervention for adults aged 18-39 years with symptoms of acute HIV infection presenting to health facilities in coastal Kenya. We estimated the potential impact of TMP on the Kenyan HIV epidemic. METHODS We developed an agent-based network model of HIV-1 transmission using TMP data and Kenyan statistics to estimate potential population-level impact of targeted facility-based testing over 10 years. Three scenarios were modeled: standard care [current use of provider-initiated testing and counseling (PITC)], standard HIV rapid testing scaled to higher coverage obtained in TMP (scaled-up PITC), and the TMP intervention. RESULTS Standard care resulted in 90.7% of persons living with HIV (PLWH) knowing their status, with 67.5% of those diagnosed on treatment. Scaled-up PITC resulted in 94.4% of PLWH knowing their status and 70.4% of those diagnosed on treatment. The TMP intervention achieved 97.5% of PLWH knowing their status and 80.6% of those diagnosed on treatment. The percentage of infections averted was 1.0% (95% simulation intervals: -19.2% to 19.9%) for scaled-up PITC and 9.4% (95% simulation intervals: -8.1% to 24.5%) for TMP. CONCLUSION Our study suggests that leveraging new technologies to identify acute HIV infection among symptomatic outpatients is superior to scaled-up PITC in this population, resulting in >95% knowledge of HIV status, and would reduce new HIV infections in Kenya.
Collapse
Affiliation(s)
- Deven T. Hamilton
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA
| | - Clara Agutu
- KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya;
| | | | | | - Amin Hassan
- KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya;
| | | | - Peter Mugo
- KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya;
| | - Carey Farquhar
- Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA
| | | | - Martin Sirengo
- National AIDS and STI Control Programme, Nairobi, Kenya;
| | - Wairimu Chege
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD
| | | | - Adam Elder
- Biostatistics, University of Washington, Seattle, WA; and
| | - Eduard J. Sanders
- KEMRI—Wellcome Trust Research Programme, Kilifi, Kenya;
- University of Oxford, Headington, United Kingdom.
| | - Susan M. Graham
- Medicine, Global Health, and Epidemiology, University of Washington, Seattle, WA
| |
Collapse
|
3
|
Mbau L, Mutai C, Kimeu R, Karau B, Mugo P, Mburu H, Samia B, Gitura B, Mathenge N, Sliwa K, Suliman A, Zühlke L, Ntsekhe M, Barasa A, Dzudie A, Ojji D, Ibrahim AT, Nel G, Ntusi N, Thienemann F, Sani M, Mohamed A, Ogola E, Jeilan M. The joint 15th Pan-African Society of Cardiology and Kenya Cardiac Society congress proceedings, 2021. Cardiovasc J Afr 2022; 33:88-94. [PMID: 35904517 PMCID: PMC9364478 DOI: 10.5830/cvja-2022-020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The 15th biennial Pan-African Society of Cardiology (PASCAR) congress held in Mombasa, Kenya, in November 2021, convened in its legacy of being the largest Pan-African conference on cardiovascular diseases (CVDs). The congress brough together members of cardiovascular societies from across the continent in the shared mission of advancing cardiovascular health in Africa. In partnership with the Kenyan Cardiac Society (KCS), the specific aims of the PASCAR conference were to (1) advance knowledge on CVDs in the region; (2) share local data, clinical cases, challenges and solutions and reinforce collaborative capacity initiatives in research and workforce training; (3) engage with policy makers to address health-system issues affecting access to CVD care in Africa; and (4) bring together local and international thought leaders in cardiovascular medicine to strengthen the partnerships between PASCAR, KCS, other African cardiac societies and key global stakeholders. Due to the COVID-19 pandemic, this congress demonstrated great success in providing both an in-person and a virtual platform of attendance, therefore making this an inaugural hybrid PASCAR congress, with inclusive and widespread participation from across the globe. We highlight the key areas of focus, various educational programmes and innovative initiatives that shaped the 15th PASCAR congress, including expert consensus on the future directions for advancing CVD care in Africa.
Collapse
|
4
|
Farquhar C, Masyuko S, Mugo P. Social Network-Based Strategies to Improve Uptake of HIV Testing and Linkage to Care Among Men Who Have Sex With Men in Sub-Saharan Africa. JAMA Netw Open 2022; 5:e220155. [PMID: 35191974 DOI: 10.1001/jamanetworkopen.2022.0155] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Carey Farquhar
- Department of Global Health, University of Washington, Seattle
- Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Sarah Masyuko
- Department of Global Health, University of Washington, Seattle
- National AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Peter Mugo
- Kenya Medical Research Institute Wellcome Trust Research Programme, Nairobi
| |
Collapse
|
5
|
Sanders EJ, Agutu C, van der Elst E, Hassan A, Gichuru E, Mugo P, Farquhar C, Babigumira JB, Goodreau SM, Hamilton DT, Ndung'u T, Sirengo M, Chege W, Graham SM. Effect of an opt-out point-of-care HIV-1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial. HIV Med 2022; 23:16-28. [PMID: 34431196 PMCID: PMC9204714 DOI: 10.1111/hiv.13157] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/23/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND In sub-Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare. METHODS Adult symptomatic outpatients aged 18-39 years were evaluated by a consensus AHI risk score. Patients with a risk score ≥ 2 and no previous HIV diagnosis were enrolled in a stepped-wedge trial of opt-out delivery of point-of-care (POC) HIV-1 nucleic acid testing (NAAT), compared with standard provider-initiated HIV testing using rapid tests in the observation period. The primary outcome was the number of new diagnoses in each study period. Generalized estimating equations with a log-binomial link and robust variance estimates were used to account for clustering by health facility. The trial is registered with ClinicalTrials.gov NCT03508908. RESULTS Between 2017 and 2020, 13 (0.9%) out of 1374 participants in the observation period and 37 (2.5%) out of 1500 participants in the intervention period were diagnosed with HIV infection. Of the 37 newly diagnosed cases in the intervention period, two (5.4%) had AHI. Participants in the opt-out intervention had a two-fold greater odds of being diagnosed with HIV (odds ratio = 2.2, 95% confidence interval: 1.39-3.51) after adjustment for factors imbalanced across study periods. CONCLUSIONS Among symptomatic adults aged 18-39 years targeted by our POC NAAT intervention, we identified one chronic HIV infection for every 40 patients and one AHI patient for every 750 patients tested. Although AHI yield was low in this population, routinely offered opt-out testing could diagnose twice as many patients as an approach relying on provider discretion.
Collapse
Affiliation(s)
- Eduard J. Sanders
- KEMRI ‐ Wellcome Trust Research ProgrammeKilifiKenya,University of OxfordHeadingtonUK
| | - Clara Agutu
- KEMRI ‐ Wellcome Trust Research ProgrammeKilifiKenya
| | | | - Amin Hassan
- KEMRI ‐ Wellcome Trust Research ProgrammeKilifiKenya
| | | | - Peter Mugo
- KEMRI ‐ Wellcome Trust Research ProgrammeKilifiKenya
| | - Carey Farquhar
- Department of Medicine, Global Health, and EpidemiologyUniversity of WashingtonSeattleWAUSA
| | | | - Steven M. Goodreau
- Department of Anthropology and EpidemiologyUniversity of WashingtonSeattleWAUSA
| | - Deven T. Hamilton
- Center for Studies in Demography & EcologyUniversity of WashingtonSeattleWAUSA
| | | | | | - Wairimu Chege
- National Institutes of Allergy & Infectious DiseasesNational Institutes of HealthRockvilleMDUSA
| | - Susan M. Graham
- University of OxfordHeadingtonUK,Department of Medicine, Global Health, and EpidemiologyUniversity of WashingtonSeattleWAUSA
| |
Collapse
|
6
|
Van Der Elst EM, Kombo B, Mugo P, Thiong'o A, Kanungi J, Wahome E, Chirro O, Graham SM, Operario D, Sanders EJ. Adjustment to acute or early HIV-1 infection diagnosis to prompt linkage to care and ART initiation: qualitative insights from coastal Kenya. PSYCHOL HEALTH MED 2018; 24:631-641. [PMID: 30468392 PMCID: PMC6425912 DOI: 10.1080/13548506.2018.1549736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Diagnosing and treating patients with acute or early HIV-1 infection (AEHI) is an important strategy to prevent HIV-1 transmission. We used qualitative methods to understand factors that facilitate adjustment to AEHI diagnosis, prompt linkage to care and initiation of antiretroviral treatment (ART). Twenty-three AEHI patients (12 women, 11 men) included 18 participants identified at health facilities, and 5 participants identified in a sex worker cohort. Of these, 17 participants (9 women, 8 men) participated in qualitative interviews about their AEHI status 2 weeks after diagnosis. Thirteen participants (7 women, 6 men) returned for a second interview 12 weeks after diagnosis. Interviews explored participants’ experiences at the time of and following their diagnosis, and examined perceptions about ART initiation and behavior change recommendations, including disclosure and partner notification. A grounded theory framework was used for analysis, eliciting three important needs that should be addressed for AEHI patients: 1) the need to better understand AEHI and accept one’s status; 2) the need to develop healthy strategies and adjust to the reality of AEHI status; and 3) the need to protect self and others through ART initiation, adherence, safer sex, and disclosure. A preliminary conceptual framework to guide further intervention and research with AEHI populations is proposed.
Collapse
Affiliation(s)
- E M Van Der Elst
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya.,b Department of Global Health , Academic Medical Centre, University of Amsterdam , Amsterdam , Netherlands
| | - B Kombo
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya
| | - P Mugo
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya
| | - A Thiong'o
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya
| | - J Kanungi
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya
| | - E Wahome
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya
| | - O Chirro
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya
| | - S M Graham
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya.,c Departments of Medicine, Global Health, and Epidemiology , University of Washington , Seattle , WA , USA
| | - D Operario
- d Department of Behaviour and Social Sciences , Brown University School of Public Health , RI , USA
| | - E J Sanders
- a Kenya Medical Research Institute-Wellcome Trust Research Programme , Kilifi , Kenya.,b Department of Global Health , Academic Medical Centre, University of Amsterdam , Amsterdam , Netherlands.,e Centre for Topical Medicine and Global Health, Nuffield Department of Medicine , University of Oxford , Oxford , UK
| |
Collapse
|
7
|
Micheni M, Kombo BK, Secor A, Simoni JM, Operario D, van der Elst EM, Mugo P, Kanungi J, Sanders EJ, Graham SM. Health Provider Views on Improving Antiretroviral Therapy Adherence Among Men Who Have Sex with Men in Coastal Kenya. AIDS Patient Care STDS 2017; 31:113-121. [PMID: 28282249 PMCID: PMC5359680 DOI: 10.1089/apc.2016.0213] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV-positive Kenyan men who have sex with men (MSM) are a highly stigmatized group facing barriers to care engagement and antiretroviral therapy (ART) adherence. Because care providers' views are important in improving outcomes, we sought the perspective of those serving MSM patients on how to optimize ART adherence in a setting where same-sex behavior is criminalized. We conducted 4 focus group discussions with a total of 29 healthcare workers (HCWs) experienced in providing HIV care to MSM. The semistructured, open-ended topic guide used was based on an access-information-motivation-proximal cues model of adherence, with added focus on trust in providers, stigma, and discrimination. Detailed facilitator notes and transcripts were translated into English and reviewed for common themes. The HCW identified adherence challenges of MSM patients that are similar to those of the general population, including HIV-related stigma and lack of disclosure. In addition, HCWs noted challenges specific to MSM, such as lack of access to MSM-friendly health services, economic and social challenges due to stigma, difficult relationships with care providers, and discrimination at the clinic and in the community. HCWs recommended clinic staff sensitivity training, use of trained MSM peer navigators, and stigma reduction in the community as interventions that might improve adherence and health outcomes for MSM. Despite noting MSM-specific barriers, HCWs recommended strategies for improving HIV care for MSM in rights-constrained settings that merit future research attention. Most likely, multilevel interventions incorporating both individual and structural factors will be necessary.
Collapse
Affiliation(s)
- Murugi Micheni
- Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Bernadette K. Kombo
- Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | | | - Jane M. Simoni
- Department of Psychology and Global Health, University of Washington, Seattle, Washington
| | - Don Operario
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island
| | - Elise M. van der Elst
- Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Peter Mugo
- Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Jennifer Kanungi
- Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Eduard J. Sanders
- Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Susan M. Graham
- Centre for Geographic Medicine and Research, Coast, Kenya Medical Research Institute, Kilifi, Kenya
- Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, Washington
| |
Collapse
|
8
|
Ngoi CN, Siqueira J, Li L, Deng X, Mugo P, Graham SM, Price MA, Sanders EJ, Delwart E. Corrigendum: The plasma virome of febrile adult Kenyans shows frequent parvovirus B19 infections and a novel arbovirus (Kadipiro virus). J Gen Virol 2017; 98:517. [PMID: 28366188 DOI: 10.1099/jgv.0.000762] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Carolyne N Ngoi
- Blood Systems Research Institute, San Francisco, CA, USA.,Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Juliana Siqueira
- Programa de Oncovirologia, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.,Blood Systems Research Institute, San Francisco, CA, USA
| | - Linlin Li
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Xutao Deng
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Peter Mugo
- Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Susan M Graham
- University of Washington, Seattle, WA, USA.,Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Matt A Price
- Department of Epidemiology and Biostatistics, University of California at San Francisco, CA, USA.,International AIDS Vaccine Initiative, New York, NY, USA
| | - Eduard J Sanders
- Nuffield Department of Medicine, University of Oxford, Headington, UK.,Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Eric Delwart
- Department of Laboratory Medicine, University of California at San Francisco, CA, USA.,Blood Systems Research Institute, San Francisco, CA, USA
| |
Collapse
|
9
|
Ngoi CN, Price MA, Fields B, Bonventure J, Ochieng C, Mwashigadi G, Hassan AS, Thiong’o AN, Micheni M, Mugo P, Graham S, Sanders EJ. Dengue and Chikungunya Virus Infections among Young Febrile Adults Evaluated for Acute HIV-1 Infection in Coastal Kenya. PLoS One 2016; 11:e0167508. [PMID: 27942016 PMCID: PMC5152832 DOI: 10.1371/journal.pone.0167508] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 11/15/2016] [Indexed: 01/24/2023] Open
Abstract
Background Fever is common among patients seeking care in sub-Saharan Africa (sSA), but causes other than malaria are rarely diagnosed. We assessed dengue and chikungunya virus infections among young febrile adults evaluated for acute HIV infection (AHI) and malaria in coastal Kenya. Methods We tested plasma samples obtained in a cross-sectional study from febrile adult patients aged 18–35 years evaluated for AHI and malaria at urgent care seeking at seven health facilities in coastal Kenya in 2014–2015. Dengue virus (DENV) and chikungunya virus (CHIKV) were amplified using quantitative real-time reverse-transcription polymerase chain reaction. We conducted logistic regression analyses to determine independent predictors of dengue virus infection. Results 489 samples that were negative for both AHI and malaria were tested, of which 43 (8.8%, 95% confidence interval [CI]: 6.4–11.7) were positive for DENV infection. No participant was positive for CHIKV infection. DENV infections were associated with clinic visits in the rainy season (adjusted odds ratio (AOR) = 3.0, 95% CI: 1.3–6.5) and evaluation at a private health facility (AOR 5.2, 95% CI: 2.0–13.1) or research health facility (AOR = 25.6, 95% CI: 8.9–73.2) instead of a public health facility. Conclusion A high prevalence of DENV infections was found in febrile young adult patients evaluated for AHI. Our data suggests that DENV, along with AHI and malaria, should be considered in the differential diagnosis of the adult patient seeking care for fever in coastal Kenya.
Collapse
Affiliation(s)
- Carolyne N. Ngoi
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- * E-mail:
| | - Matt A. Price
- International AIDS Vaccine Initiative (IAVI) New York, New York, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, United States of America
| | - Barry Fields
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | - Juma Bonventure
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention (CDC), Nairobi, Kenya
| | | | - Grace Mwashigadi
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Amin S. Hassan
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Alexander N. Thiong’o
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Murugi Micheni
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Peter Mugo
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Susan Graham
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Departments of Medicine, Global Health, and Epidemiology, University of Washington, Seattle, United States of America
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research – Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, United Kingdom
| |
Collapse
|
10
|
Ngoi CN, Siqueira J, Li L, Deng X, Mugo P, Graham SM, Price MA, Sanders EJ, Delwart E. The plasma virome of febrile adult Kenyans shows frequent parvovirus B19 infections and a novel arbovirus (Kadipiro virus). J Gen Virol 2016; 97:3359-3367. [PMID: 27902331 DOI: 10.1099/jgv.0.000644] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Viral nucleic acids present in the plasma of 498 Kenyan adults with unexplained fever were characterized by metagenomics analysis of 51 sample pools. The highest to lowest fraction of plasma pools was positive for parvovirus B19 (75 %), pegivirus C (GBV-C) (67 %), alpha anellovirus (59 %), gamma anellovirus (55 %), beta anellovirus (41 %), dengue virus genotype 2 (DENV-2) (16 %), human immunodeficiency virus type 1 (6 %), human herpesvirus 6 (6 %), HBV (4 %), rotavirus (4 %), hepatitis B virus (4 %), rhinovirus C (2 %), Merkel cell polyomavirus (MCPyV; 2 %) and Kadipiro virus (2 %). Ranking by overall percentage of viral reads yielded similar results. Characterization of viral nucleic acids in the plasma of a febrile East African population showed a high frequency of parvovirus B19 and DENV infections and detected a reovirus (Kadipiro virus) previously reported only in Asian Culex mosquitoes, providing a baseline to compare with future virome studies to detect emerging viruses in this region.
Collapse
Affiliation(s)
- Carolyne N Ngoi
- Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Juliana Siqueira
- Blood Systems Research Institute, San Francisco, CA, USA
- Programa de Oncovirologia, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
| | - Linlin Li
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Xutao Deng
- Blood Systems Research Institute, San Francisco, CA, USA
| | - Peter Mugo
- Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
| | - Susan M Graham
- Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
- University of Washington, Seattle, WA, USA
| | - Matt A Price
- International AIDS Vaccine Initiative, New York, NY, USA
- Department of Epidemiology and Biostatistics, University of California at San Francisco, CA, USA
| | - Eduard J Sanders
- Centre for Geographic Medicine Research - Coast, Kenya Medical Research Institute, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, UK
| | - Eric Delwart
- Department of Laboratory Medicine, University of California at San Francisco, CA, USA
- Blood Systems Research Institute, San Francisco, CA, USA
| |
Collapse
|
11
|
Gichuru E, Sariola S, Van der Elst EM, Mugo P, Micheni M, Graham SM, Molyneux C, Sanders EJ. ‘Facing our Fears’: Facilitated Film Viewings as a Community Engagement Tool in Research Involving MSM in Kenya. AIDS Res Hum Retroviruses 2014. [DOI: 10.1089/aid.2014.5263.abstract] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Evans Gichuru
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | | | - Peter Mugo
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
| | | | - Susan M. Graham
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of Washington, Seattle, WA, United States
| | - Catherine Molyneux
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of Oxford, Headington, United Kingdom
| | - Eduard J. Sanders
- KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- University of Oxford, Headington, United Kingdom
| |
Collapse
|
12
|
Prins HAB, Mugo P, Wahome E, Mwashigadi G, Thiong'o A, Smith A, Sanders EJ, Graham SM. Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice. Int Health 2014; 6:82-92. [PMID: 24842982 PMCID: PMC4049276 DOI: 10.1093/inthealth/ihu024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003–2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18–29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis.
Collapse
Affiliation(s)
- Henrieke A B Prins
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Peter Mugo
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Elizabeth Wahome
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Grace Mwashigadi
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Alexander Thiong'o
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya
| | - Adrian Smith
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7BN, UK
| | - Eduard J Sanders
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya Nuffield Department of Clinical Medicine, University of Oxford, Oxford OX3 7BN, UK
| | - Susan M Graham
- Kenya Medical Research Institute, Centre for Geographic Medicine Research-Coast, P.O. Box 230, Kilifi, Kenya University of Washington, Seattle, WA 98195, USA
| |
Collapse
|
13
|
Van der Elst EM, Mbogua J, Operario D, Mutua G, Kuo C, Mugo P, Kanungi J, Singh S, Haberer J, Priddy F, Sanders EJ. High acceptability of HIV pre-exposure prophylaxis but challenges in adherence and use: qualitative insights from a phase I trial of intermittent and daily PrEP in at-risk populations in Kenya. AIDS Behav 2013; 17:2162-72. [PMID: 23080358 DOI: 10.1007/s10461-012-0317-8] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This paper used qualitative methods to explore experiences of men who have sex with men and female sex workers in Nairobi and Mtwapa, Kenya, who used oral pre-exposure prophylaxis (PrEP) for HIV prevention as part of a four-month trial of safety, acceptability and adherence. Fifty-one of 72 volunteers who took part in a randomized, placebo-controlled, blinded trial that compared daily and intermittent dosage of PrEP underwent qualitative assessments after completing the trial. Analyses identified three themes: (i) acceptability of PrEP was high, i.e. side effects were experienced early in the study but diminished over time, however characteristics of pills could improve comfort and use; (ii) social impacts such as stigma, rumors, and relationship difficulties due to being perceived as HIV positive were prevalent; (iii) adherence was challenged by complexities of daily life, in particular post-coital dosing adherence suffered from alcohol use around time of sex, mobile populations, and transactional sex work. These themes resonated across dosing regimens and gender, and while most participants favored the intermittent dosing schedule, those in the intermittent group noted particular challenges in adhering to the post-coital dose. Culturally appropriate and consistent counseling addressing these issues may be critical for PrEP effectiveness.
Collapse
|
14
|
Graham SM, Mugo P, Gichuru E, Thiong'o A, Macharia M, Okuku HS, van der Elst E, Price MA, Muraguri N, Sanders EJ. Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in coastal Kenya. AIDS Behav 2013; 17:1255-65. [PMID: 23494223 PMCID: PMC3633780 DOI: 10.1007/s10461-013-0445-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
African men who have sex with men (MSM) face significant stigma and barriers to care. We investigated antiretroviral therapy (ART) adherence among high-risk adults, including MSM, participating in a clinic-based cohort. Survival analysis was used to compare attrition across patient groups. Differences in adherence, weight gain, and CD4 counts after ART initiation were assessed. Among 250 HIV-1-seropositive adults, including 108 MSM, 15 heterosexual men, and 127 women, patient group was not associated with attrition. Among 58 participants who were followed on ART, 40 % of MSM had less than 95 % adherence, versus 28.6 % of heterosexual men and 11.5 % of women. Although MSM gained less weight after ART initiation than women (adjusted difference −3.5 kg/year), CD4 counts did not differ. More data are needed on barriers to adherence and clinical outcomes among African MSM, to ensure that MSM can access care and derive treatment and prevention benefits from ART.
Collapse
Affiliation(s)
- Susan M Graham
- Departments of Medicine and Global Health, University of Washington, Box 359909, 325 Ninth Avenue, Seattle, WA 98104-2499, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Ngongo BP, Priddy F, Park H, Bender B, Fast P, Anzala O, Mutua G, Ruzagira E, Kamali A, Karita E, Mugo P, Chomba E, Bekker L, Roux S, Nanvubya A, Mebrahtu T. Developing standards of care for HIV prevention research in developing countries – a case study of ten research centers in Eastern and Southern Africa. Retrovirology 2012. [PMCID: PMC3442024 DOI: 10.1186/1742-4690-9-s2-p117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
16
|
Mutua G, Sanders E, Mugo P, Anzala O, Haberer JE, Bangsberg D, Barin B, Rooney JF, Mark D, Chetty P, Fast P, Priddy FH. Safety and adherence to intermittent pre-exposure prophylaxis (PrEP) for HIV-1 in African men who have sex with men and female sex workers. PLoS One 2012; 7:e33103. [PMID: 22511916 PMCID: PMC3325227 DOI: 10.1371/journal.pone.0033103] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 02/03/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known about safety of and adherence to intermittent HIV PrEP regimens, which may be more feasible than daily dosing in some settings. We present safety and adherence data from the first trial of an intermittent PrEP regimen among Kenyan men who have sex with men (MSM) and female sex workers (FSW). METHODS/PRINCIPAL FINDINGS MSM and FSW were randomized to daily oral FTC/TDF or placebo, or intermittent (Monday, Friday and within 2 hours after sex, not to exceed one dose per day) oral FTC/TDF or placebo in a 2:1:2:1 ratio; volunteers were followed monthly for 4 months. Adherence was assessed with the medication event monitoring system (MEMS). Sexual activity data were collected via daily text message (SMS) queries and timeline followback interviews with a one-month recall period. Sixty-seven men and 5 women were randomized into the study. Safety was similar among all groups. Median MEMS adherence rates were 83% [IQR: 63-92] for daily dosing and 55% [IQR:28-78] for fixed intermittent dosing (p = 0.003), while adherence to any post-coital doses was 26% [IQR:14-50]. SMS response rates were low, which may have impaired measurement of post-coital dosing adherence. Acceptability of PrEP was high, regardless of dosing regimen. CONCLUSIONS/SIGNIFICANCE Adherence to intermittent dosing regimens, fixed doses, and in particular coitally-dependent doses, may be more difficult than adherence to daily dosing. However, intermittent dosing may still be appropriate for PrEP if intracellular drug levels, which correlate with prevention of HIV acquisition, can be attained with less than daily dosing and if barriers to adherence can be addressed. Additional drug level data, qualitative data on adherence barriers, and better methods to measure sexual activity are necessary to determine whether adherence to post-coital PrEP could be comparable to more standard regimens. TRIAL REGISTRATION ClinicalTrials.gov NCT00971230.
Collapse
Affiliation(s)
- Gaudensia Mutua
- Kenya AIDS Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | - Eduard Sanders
- Kenya Medical Research Institute, Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, United Kingdom
| | - Peter Mugo
- Kenya Medical Research Institute, Kilifi, Kenya
| | - Omu Anzala
- Kenya AIDS Vaccine Initiative, University of Nairobi, Nairobi, Kenya
| | - Jessica E. Haberer
- Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, United States of America
| | - David Bangsberg
- Massachusetts General Hospital Center for Global Health, Boston, Massachusetts, United States of America
| | - Burc Barin
- The EMMES Corporation, Rockville, Maryland, United States of America
| | | | - David Mark
- International AIDS Vaccine Initiative, New York, New York, United States of America
| | - Paramesh Chetty
- International AIDS Vaccine Initiative, Johannesburg, South Africa
| | - Patricia Fast
- International AIDS Vaccine Initiative, New York, New York, United States of America
| | - Frances H. Priddy
- International AIDS Vaccine Initiative, New York, New York, United States of America
- * E-mail:
| |
Collapse
|
17
|
Ngongo PB, Priddy F, Park H, Becker J, Bender B, Fast P, Anzala O, Mutua G, Ruzagira E, Kamali A, Karita E, Mugo P, Chomba E, Bekker LG, Roux S, Nanvubya A, Mebrahtu T. Developing standards of care for HIV prevention research in developing countries -- a case study of 10 research centers in Eastern and Southern Africa. AIDS Care 2012; 24:1277-89. [PMID: 22452384 DOI: 10.1080/09540121.2012.656572] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Standards of care provided to volunteers in HIV prevention research in developing countries are evolving. Inconsistency in standards, particularly within a research network highlights the need to balance volunteers' health and wellness with the efficient conduct of research. Ten research centers (RC's) in East and Southern Africa affiliated with the International AIDS Vaccine Initiative (IAVI) were studied using a mixed methods approach to understand variations, similarities and gaps in services provided, recipients of services, referral systems, and barriers to referral uptake. These data were then used to develop expected standards across the 10 RCs. Findings indicated that RCs consistently provided HIV risk reduction and family planning (FP) counseling, male condoms, management of sexually transmitted infections, CD-4 counts, and general medical care to volunteers and non-research volunteers. Services that were less consistently provided on-site included: female condoms, adult male circumcision (AMC), antiretroviral therapy (ART) and post-exposure prophylaxis (PEP) in case of rape. The FP options provided on-site varied, with few providing implants, intrauterine devices, tubal ligation, and vasectomy. Most RCs had established referral systems for ART, AMC, PEP, and FP, but few had referral points for psychosocial services. Few RCs had comprehensive guidelines on referrals other than those related to adverse events. Findings indicate that the greatest challenges for referral uptake were transportation and health care costs, poor quality and inconsistency of services at some referral points. Few RCs covered the cost of referrals for non-study related adverse events. A collaborative process between IAVI and the RCs was undertaken to reach consensus on expected standards of care. A set of required and recommended services to be provided on-site or by referral was developed. In developing such standards, we tried to balance scientific priorities, equity, contextual realities, community expectations, and cost-effectiveness.
Collapse
Affiliation(s)
- Prince Bahati Ngongo
- International AIDS Vaccine Initiative, Country and Regional Programs, New York, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|