Search

Background: The Fogarty International Center-led Adolescent HIV Implementation Science Alliance (AHISA) supports region-/country-specific implementation science (IS) alliances that build collaborations between research, policy, and program partners that respond to local implementation challenges. AHISA supported the development of seven locally-led IS alliances: five countryspecific (i.e., Kenya, South Africa, Tanzania, Uganda, and Zambia), one in Central and West Africa, and one with youth researchers. This article outlines the aims, activities, and outcomes of local alliances, demonstrating how they enhance sustainable IS activities to address local challenges. Methods: We conducted a desk review of each alliance's funding applications, reports, and data from the initial findings of a larger AHISA evaluation. The review analyzes common approaches, highlights their local relevance, and summarizes initial outcomes. Results: The local alliances have a common goal: to expand implementation of successful interventions to improve adolescent HIV. We identified four overarching themes across the local alliances' activities: capacity building, priority setting, stakeholder engagement, and knowledge dissemination. Research capacity building activities include long-term mentorship between junior and senior researchers and short-term training for non-research partners. Setting priorities with members identifies local research needs and streamlines activities. Alliances incorporate substantial engagement between partners, particularly youth, who may serve as leaders and co-create activities. Dissemination shares activities and results broadly. Conclusion: Local IS alliances play a key role in building sustainable IS learning and collaboration platforms, enabling improved uptake of evidence into policy and programs, increased IS research capacity, and shared approaches to addressing implementation challenges. [ABSTRACT FROM AUTHOR]

Objectives: This study investigates the prevalence of the use of reusable menstrual materials in LMICs, examines differences in prevalence between countries and areas, and identifies individual and country-level factors associated with their use. Methods: Data from Multiple Indicator Cluster surveys conducted between 2017 and 2020 in LMICs were used. Prevalence estimates and 95% CIs were calculated for overall, rural, and urban areas. Multivariable logistic regression was used to identify individual and country-level factors associated with the use of reusable menstrual materials. Results: The study included 42 surveys from LMICs, with 1653850 weighted women and girls aged 15–49 years. The overall prevalence of the use of reusable menstrual materials was 12.1% (95% CI 12.1–12.2), with significant variation between and within countries, ranging from 0.5% (0.3–0.8) in Serbia to 97.2% (96.5–97.9) in Sao Tome and Principe. The prevalence was higher in rural areas (23.9% [23.8–24.0]) than in urban areas (6.2% [6.2–6.2]), with significant differences between most countries. Use of reusable menstrual materials was associated with lower education levels, being married, low economic status, living in Asia and Africa, living in countries with lower GDP, living in rural areas, and limited availability of private places to wash menstrual materials. The prevalence of the use of reusable menstrual materials had an inverse linear relationship with the country's GDP. Conclusions: The study found that the use of reusable menstrual materials is more prevalent among women and girls in rural areas, those with lower education levels, lower economic status, and those living in countries with lower GDP. Given these disparities, policies and initiatives targeted at improving menstrual health in LMICs should focus on socioeconomically disadvantaged groups to ensure they have access to safe and appropriate menstrual materials. [ABSTRACT FROM AUTHOR]

We examined the association between serum aflatoxin B1‐lysine adduct (AFB1‐lys) levels in pregnant women and adverse pregnancy outcomes (low birthweight, miscarriage and stillbirth) through a nested matched case–control study of pregnant women enroled at ≤28 weeks' gestation in Mombasa, Kenya, from 2017 to 2019. Cases comprised women with an adverse birth outcome, defined as either delivery of a singleton infant weighing <2500 g, or a miscarriage, or a stillbirth, while controls were women who delivered a singleton live infant with a birthweight of ≥2500 g. Cases were matched to controls at a ratio of 1:2 based on maternal age at enrolment, gestational age at enrolment and study site. The primary exposure was serum AFB1‐lys. The study included 125 cases and 250 controls. The median gestation age when serum samples were collected was 23.0 weeks (interquartile range [IQR]: 18.1–26.0) and 23.5 (IQR: 18.1–26.5) among cases and controls, respectively. Of the 375 tested sera, 145 (38.7%) had detectable serum AFB1‐lys: 36.0% in cases and 40.0% in controls. AFB1‐lys adduct levels were not associated with adverse birth outcomes on multivariable analysis. Mid‐upper arm circumference was associated with a 6% lower odds of adverse birth outcome for every unit increase (p = 0.023). Two‐fifths of pregnant women had detectable levels of aflatoxin midway through pregnancy. However, we did not detect an association with adverse pregnancy outcomes, likely because of low serum AFB1‐lys levels and low power, restricting meaningful comparison. More research is needed to understand the public health risk of aflatoxin in pregnant women to unborn children. Key messages: Aflatoxin B1 (AFB1), a commonly ingested toxin, can cross the placental barrier and cause adverse pregnancy outcomes.Two‐fifths of participants had detectable serum AFB1‐lys levels, a marker of aflatoxin exposure, but the low levels recorded were not associated with adverse pregnancy outcomes.Every unit increase in mid‐upper arm circumference (MUAC) during pregnancy was associated with a 6% reduced likelihood of adverse pregnancy outcomes, highlighting the potential protective role of adequate maternal nutrition.There is need for additional studies in different settings on the determinants and mechanisms of the relationship between aflatoxin exposure and adverse pregnancy outcomes. [ABSTRACT FROM AUTHOR]

Expansion of access to diagnosis and treatment for human immunodeficiency virus (HIV) and a high incidence of HIV infection in adolescence has resulted in a growing population of adolescents and young adults living with HIV. The prevalence of poor retention in care, insufficient viral suppression and loss to follow-up are higher among adolescents and young adults compared with other age groups. Poor outcomes could be attributed to psychosocial changes during adolescence, but also to poor transitional care from paediatric to adult HIV services. In many countries, transition processes remain poorly defined and unstructured, which may jeopardize treatment adherence and retention. We describe existing definitions of transition and transition frameworks, and key elements of transition as proposed by key national stakeholders in Kenya. Our consensus definition of transition is 'a planned process by which adolescents and young adults living with HIV, and their caregivers, are empowered with knowledge and skills to enable them to independently manage their health.' Transition should begin soon after disclosure of HIV status until an adolescent gains the necessary knowledge and skills and is willing to move to adult services, or by 25 years of age. Proposed key elements of transition are: target ages for milestone achievement; readiness assessment; caregiver involvement and communication with adult clinics; flexibility to return to adolescent or paediatric clinics; group transition; and considerations for adolescents with special needs. Retention in care, linkage to care and viral suppression are important markers of transition success. Proposed definitions and key elements could provide a framework for structuring transition programmes in other countries. L'acces elargi au diagnostic et au traitement du virus de I'immunodeficience humaine (VIH) et l'incidence elevee de l'infection par le VIH a l'adolescence ont entraine une hausse de la population d'adolescents et de jeunes adultes atteints du VIH. La prevalence de mauvais continuums de soins, de suppressions virales insuffisantes et d'interruptions du suivi est plus elevee chez les adolescents et les jeunes adultes que dans d'autres groupes d'age. Ces mauvais resultats peuvent etre attribues aux changements psychosociaux qui interviennent a l'adolescence, mais aussi a la mediocrite de la transition entre les services de soins pediatriques et adultes du VIH. En Afrique subsaharienne, les processus de transition sont mal definis et peu structures, ce qui peut nuire au respect et a la poursuite des traitements. Nous decrivons ici les definitions existantes de la transition et des cadres de transition, ainsi que les elements cles de la transition proposes par les principales parties prenantes nationales du Kenya. Notre definition consensuelle de la transition est: << processus planifie qui permet aux adolescents et aux jeunes adultes atteints du VIH, ainsi qu'a leurs aidants, de disposer des connaissances et competences necessaires pour gerer leur sante de maniere autonome >>. La transition devrait debuter peu apres la communication de la seropositivite et durer jusqu'a ce que l'adolescent ait acquis les connaissances et competences necessaires et qu'il souhaite passer a des services pour adultes, ou jusqu'a l'age de 25 ans. Les elements cles proposes de la transition sont: ages cibles pour le franchissement de certaines etapes; evaluation de la maturite; implication des aidants et communication avec les services pour adultes; possibility de revenir a des services pediatriques ou pour adolescents; transition de groupe; prise en compte des adolescents ayant des besoins speciaux. Le continuum de soins, le lien entre les soins et la suppression virale sont d'importants marqueurs de la reussite de la transition. Les definitions et elements cles proposes peuvent offrir un cadre pour structurer les programmes de transition dans d'autres pays. La ampliacion del acceso al diagnostico y tratamiento del virus de la inmunodeficiencia humana (VIH) y la alta incidencia de la infeccion por el VIH en la adolescencia han dado lugar a una poblacion creciente de adolescentes y adultos jovenes que viven con el VIH. La prevalencia de una retencion inadecuada en la atencion, la supresion viral insuficiente y la perdida de seguimiento son mayores entre los adolescentes y los adultos jovenes en comparacion con otros grupos de edad. Los resultados negativos pueden atribuirse a cambios psicosociales durante la adolescencia, pero tambien a una atencion de transicion deficiente de los servicios pediatricos a los servicios para adultos con VIH. En Africa subsahariana, los procesos de transicion siguen siendo mal definidos y desestructurados, lo que puede suponer un riesgo para el cumplimiento y la retencion del tratamiento. Describimos las definiciones existentes de transicion y los marcos de transicion, asi como los elementos clave de la transicion propuestos por las principales partes interesadas a nivel nacional en Kenia. Nuestra definicion consensuada de transicion es 'un proceso planificado mediante el cual los adolescentes y adultos jovenes que viven con el VIH, y sus cuidadores, son capacitados con conocimientos y habilidades que les permiten manejar su salud de manera independiente'. La transicion debe comenzar poco despues de la revelacion del estado serologico respecto al VIH hasta que el adolescente adquiera el conocimiento y las habilidades necesarias y este dispuesto a trasladarse a los servicios para adultos, o a la edad de 25 anos. Los elementos clave de la transicion propuestos son: edades objetivo para el logro de los hitos; evaluacion de la preparacion; participacion de los cuidadores y comunicacion con las clinicas para adultos; flexibilidad para regresar a las clinicas para adolescentes o pediatricas; transicion de grupos; y consideraciones para los adolescentes con necesidades especiales. La retencion en la atencion, la vinculacion a la atencion y la supresion viral son marcadores importantes del exito de la transicion. Las definiciones propuestas y los elementos clave podrian proporcionar un marco para estructurar los programas de transicion en otros paises., Introduction Expansion of paediatric antiretroviral therapy (ART) and treatment services has improved survival among children living with human immunodeficiency virus (HIV). However, globally, HIV-associated mortality among adolescents 15-19 years of [...]

Introduction: Adverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya. Methods: From October 2017 to July 2019, pregnant women < 28 weeks gestation were enrolled and followed up until delivery in three hospitals in coastal Kenya. Newborns were examined at delivery. Among women with birth outcome data, we assessed the frequency of congenital anomalies defined as gastroschisis, umbilical hernia, limb abnormalities and Trisomy 21, and adverse birth outcomes, defined as either stillbirth, miscarriage, preterm birth, small for gestational age, or microcephaly. We used log-binomial regression to identify maternal characteristics associated with the presence of at least one adverse outcome. Results: Among the 2312 women enrolled, 1916 (82.9%) had birth outcome data. Overall, 402/1916 (20.9%; 95% confidence interval (CI): 19.1–22.8) pregnancies had adverse birth outcomes. Specifically, 66/1916 (3.4%; 95% CI: 2.7–4.4) were stillbirths, 34/1916 (1.8%; 95% CI: 1.2–2.4) were miscarriages and 23/1816 (1.2%; 95% CI: 0.8–1.9) had congenital anomalies. Among the participants with anthropometric measurements data, 142/1200 (11.8%; 95% CI: 10.1 − 13.8) were small for gestational age and among the participants with ultrasound records, 143/1711 (8.4%; 95% CI: 7.1–9.8) were preterm. Febrile illnesses in current pregnancy (adjusted risk ratio (aRR): 1.7; 95% CI: 1.1–2.8), a history of poor birth outcomes in prior pregnancy (aRR: 1.8; 95% CI: 1.3–2.4) and high blood pressure in pregnancy (aRR: 3.9, 95% CI: (1.7–9.2) were independently associated with adverse birth outcomes in a model that included age, education, human immunodeficiency virus status and high blood pressure at enrolment. Conclusion: We found similar rates of overall adverse birth outcomes, congenital anomalies, and small for gestational age but higher rates of stillbirths and lower rates of prematurity compared to the rates that have been reported in the sub-Saharan Africa region. However, the rates of adverse birth outcomes in this study were comparable to other studies conducted in Kenya. Febrile illnesses during the current pregnancy, previous history of poor birth outcomes and high blood pressure in pregnancy are predictive of an increased risk of adverse birth outcomes. [ABSTRACT FROM AUTHOR]

Objectives: With optimized antiretroviral treatment youth living with HIV (YLH) now spend most of their time in schools, making schools an important venue to optimize outcomes. We evaluated school support for YLH. Methods: We conducted surveys with public secondary/high schools in 3 Kenyan counties (Nairobi, Homa Bay, and Kajiado) to determine policies and training related to HIV. Chi‐squared tests and Poisson regression were used to compare policy availability and staff training by county HIV prevalence and school type. Results: Of 512 schools in the 3 counties, we surveyed 100. The majority (60%) of schools surveyed had boarding facilities. The median student population was 406 (IQR: 200, 775). Only half (49%) of schools had medication use policies; more in boarding than day schools (65% vs 30%, p =.003). While most schools (82%) had clinic attendance policies; policy availability was higher in higher HIV prevalence counties (Homa Bay [100%], Nairobi [82%], Kajiado [56%], p <.05). Overall, 64% had confidentiality policies with higher policy availability in higher HIV prevalence regions (p <.05). Few schools had staff trained in HIV‐related topics: HIV prevention (37%), HIV treatment (18%), HIV stigma reduction (36%). Few were trained in confidentiality (41%), psychosocial support (40%), or mental health (26%). Compared to day schools, boarding school were more likely to have staff trained in HIV prevention (prevalence ratio: 2.1 [95% confidence interval 1.0, 4.0], p =.037). Conclusion: In this survey of Kenyan schools, there were notable gaps in HIV care policy availability and training, despite high HIV burden. Development and implementation of national school HIV policies and staff training as well as strengthening clinic and family support may improve outcomes for YLH. [ABSTRACT FROM AUTHOR]

Differentiated service delivery (DSD) and multi-month dispensing (MMD) of antiretroviral therapy (ART) have improved treatment adherence and viral suppression among people living with HIV (PLHIV), and service delivery efficiency. We assessed the experiences of PLHIV and providers with DSD and MMD in Northern Nigeria. We conducted in-depth interviews (IDI) with 40 PLHIV and 6 focus group discussions (FGD) with 39 health care providers across 5 states, exploring their experiences with 6 DSD models. Qualitative data were analyzed using NVivo®1.6.1. Most PLHIV and providers found the models acceptable and expressed satisfaction with service delivery. The DSD model preference of PLHIV was influenced by convenience, stigma, trust, and cost of care. Both PLHIV and providers indicated improvements in adherence and viral suppression; they also raised concerns about quality of care within community-based models. PLHIV and provider experiences suggest that DSD and MMD have the potential to improve patient retention rates and service delivery efficiency. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is Available in the Text. Background: Few studies in sub-Saharan Africa have assessed the impact of multimonth dispensing (MMD) of antiretroviral therapy (ART) and dolutegravir (DTG) beyond clinical trials among children with HIV (CWHIV). We assessed the effect of the 2 interventions on achieving undetectable viral load (VL) among CWHIV in the age group of 0–15 years in Nigeria. Methods: We used longitudinal routine records and cross-sectional survey data from caregivers of a subsample of children. VLs were considered suppressed at <1000 copies/mL and undetectable at <50 copies/mL. Multimonth dispensing (MMD) was defined as ART refill for >84 days. The effect of MMD and DTG on VL levels and associations between social factors and VL were estimated using generalized linear models, reporting adjusted relative risks/prevalence ratios and 95% confidence intervals (CIs). Results: Of 2490 CWHIV, 52% were male, with a median age of 10 years (interquartile ranges: 6–13) and a median duration on ART of 4.6 years (interquartile ranges: 2.8–7.1). Overall, 73% were on DTG and 55% received MMD. At baseline, 63% were suppressed, while 79% and 56% were suppressed and undetectable in their last VL, respectively. We found no differences in undetectable VL between those on MMD and not on MMD (adjusted relative risks: 1.05 [95% CI: 0.94–1.18]) and between those on DTG and not on DTG (1.07 [0.92–1.25]). In secondary analyses, poor adherence and being in a support group were associated with a lower likelihood of undetectable VL (adjusted prevalence ratios: 0.85 [95% CI: 0.74–0.96] and 0.81 [0.68–0.96], respectively). Conclusion: MMD did not compromise treatment outcomes for CWHIV. Poor adherence, however, remains a barrier to achieving treatment targets. [ABSTRACT FROM AUTHOR]

Mortality and loss to follow-up (LTFU) among adolescents and youth living with HIV (AYLHIV) remain high. We evaluated mortality and LTFU during the test and treat era. We abstracted medical records of AYLHIV for 10–24 years between January 2016 and December 2017 in 87 HIV clinics in Kenya. Using competing risk survival analysis, we compared incidence rates and determined correlates of mortality and LTFU among newly enrolled [<2 years since antiretroviral therapy (ART) initiation] and AYLHIV on ART for ≥2 years. Among 4201 AYLHIV, 1452 (35%) and 2749 (65%) were new enrollments and on ART for ≥2 years, respectively. AYLHIV on antiretroviral therapy (ART) for ≥2 years were younger and more likely to have perinatally acquired HIV (p < 0.001). Incidence of mortality and LTFU per 100 person-years were 2.32 [95% confidence interval (CI): 1.64–3.28] and 37.8 (95% CI: 34.7–41.3), respectively, among new enrollments and 1.22 (95% CI: 0.94–1.59) and 10.2 (95% CI: 9.3–11.1), respectively, among those on ART for ≥2 years. New enrollments had almost twice higher risk of mortality [subdistribution hazard ratio (sHR) 1.92 (1.30, 2.84), p = 0.001] and sevenfold higher risk of LTFU [sHR 7.71 (6.76, 8.79), p < 0.001] than those on ART for ≥2 years. Among new enrollments, mortality was higher in males and those with World Health Organization (WHO) stage III/IV disease at enrollment, and LTFU was associated with pregnancy, older age, and nonperinatal acquisition. Female sex and WHO stage (I/II) were associated with LTFU among those on ART for ≥2 years. During the study period from January 1, 2016, to December 31, 2017, the mortality incidence observed did not demonstrate improvement from earlier studies despite universal test and treat and better ART regimens. This trial was registered with ClinicalTrials.gov, NCT03574129. [ABSTRACT FROM AUTHOR]