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Introduction The relationship between food insecurity and access to healthcare in low-resource settings remains unclear. Some studies find that food insecurity is a barrier to accessing care, while others report that food insecurity is associated with a greater need for care, leading to more care utilisation. We use data from the Harambee study in western Kenya to assess the association between food insecurity and difficulty accessing care among people living with HIV (PLWH) with or without comorbid non-communicable diseases (NCDs).Methods The Harambee study is a cluster randomised trial that tested the effectiveness of delivering integrated HIV and NCD care for PLWH. In this cross-sectional analysis, we examined baseline data from Harambee participants to investigate the relationship between household food insecurity and difficulty accessing care, using multivariable logistic regression models, controlling for sociodemographic factors and care satisfaction. We tested for effect measure modification by gender and household wealth and stratified analyses by NCD status.Results Among 1039 participants, 11.1% reported difficulty accessing care, and 18.9% and 51.9% of participants had moderate and severe food insecurity, respectively. Among those with difficulty accessing care, 73.9% cited transportation issues as the major barrier. Difficulty accessing care was greater with higher levels of food insecurity: among participants with low, moderate and severe food insecurity, 5.9%, 9.7% and 14.4% reported difficulty accessing care, respectively. After adjusting for confounders, severe food insecurity was independently associated with difficulty accessing care (adjusted OR=2.5, 95% CI 1.4 to 4.4). There was no statistical evidence for effect measure modification by gender or wealth.Conclusions We found that greater food insecurity was associated with greater difficulty accessing care among PLWH with or without NCDs in rural western Kenya. These findings suggest that addressing social determinants of health may be necessary when implementing integrated HIV and NCD care programmes.

Introduction During the COVID-19 response, Kenya experienced widespread regional floods, resulting in the displacement of communities and agricultural loss. This study aimed to characterise food insecurity and other social and economic impacts of these emergencies on people living with HIV and to investigate whether and how existing microfinance activities in place before the events influenced social and economic instability.Methods We used sequential explanatory mixed methods guided by a conceptual model. Interviewer-administered surveys (n=200) and follow-up in-depth interviews (n=40) were conducted by phone with people living with HIV in Busia and Trans Nzoia counties between October and December 2020. Socioeconomic factors (microfinance participation, income and social support) and food insecurity were examined with Poisson regression using survey data. Qualitative data were analysed using content analysis to contextualise quantitative findings.Results Among 200 participants, 59.0% were female, median age was 45 years and 73.0% reported being severely food insecure. Microfinance participation was not associated with severe food insecurity (adjusted prevalence ratio, aPR 0.98; 95% CI 0.82, 1.18), but income loss (aPR 1.94; 95% CI 1.13, 3.30; p=0.015) and loss of social support (aPR 1.48; 95% CI 1.18, 1.84; p=0.001) were associated with severe food insecurity. Three main themes emerged: compounding effects of COVID-19 and flooding on food and economic insecurity are early indicators of upstream barriers to HIV treatment; microfinance groups may not have mitigated socioeconomic consequences of COVID-19 and flooding because of unexpected income loss and limits on gathering and displacement; and social support bolsters mental health and medication adherence among microfinance members despite lack of in-person activities.Conclusions In the context of coinciding public health and environmental emergencies, people living with HIV in Kenya experienced widespread food insecurity. Programmatic efforts to support HIV treatment disbursement, coverage and adherence alone are not sufficient during an economic crisis affecting food insecurity. Integrating antiretroviral therapy (ART) dispensing efforts alongside interventions to support food security for people living with HIV could improve ART adherence and reduce mortality during widespread emergencies.

هدفت الدراسة التعرف على دور محددات الأمن السيبراني في الاشتمال المالي في البنوك الإسلامية العاملة في الأردن، والتعرف على الأمن السيبراني ومحددات الأمن السيبراني (حوكمة الأمن السيبراني، أمنية البرامج السيبرانية، سياسة الأمن السيبراني)، والأمن السيبراني في البنوك الإسلامية في الأردن، وكذلك التعرف على الاشتمال المالي في الأردن ودور البنوك الإسلامية في الأردن في تحقيق الاشتمال المالي، وفاعلية الأمن السيبراني على الاشتمال المالي، من خلال خطوات الإستراتيجية الوطنية للاشتمال المالي، وأهدافها، وأدوار البنوك الإسلامية العاملة في الأردن في الاشتمال المالي، وتوصلت الدراسة بشكل عام ، أن إدارة الأمن السيبراني في البنوك الإسلامية العاملة في الأردن يتطلب التركيز على تبني أفضل الممارسات والسياسات والإجراءات الفعالة لحماية البيانات المالية والشخصية للعملاء، وتوفير التدريب والتوعية المستمرة للموظفين والعملاء حول مخاطر الأمن السيبراني وكيفية حماية البيانات المالية والشخصية، نتج عن البحث مجموعة من النتائج أبرزها أن الأمن السيبراني أحد أهم التحديات التي تواجه البنوك الإسلامية في الأردن، و ساهمت البنوك الإسلامية العاملة في الأردن في تعزيز الشمول المالي من خلال تقديم مجموعة متنوعة من المنتجات والخدمات المالية التي تلبي احتياجات مختلف شرائح المجتمع، بما في ذلك الحسابات المصرفية والقروض والتأمينات، كما ساهمت البنوك الإسلامية في الأردن في تنمية الاقتصاد الوطني من خلال تمويل المشاريع الصغيرة والمتوسطة ودعم التجارة والاستثمار، والوصول الإلكتروني لأغلب مناطق في الأردن، وبناء على نتائج الدراسة فقد تم صياغة عدد من التوصيات من أهمها: تحديث البرمجيات والأجهزة الخاصة بأدوات الأمن السيبراني في البنك، وتدريب والتوعية الموظفين والعملاء على كيفية التعامل مع الأمن السيبراني، وتوعيتهم حول أهمية حماية البيانات المالية والشخصية، التنويع في المنتجات المالية، والوصول الجغرافي الواسع.

Abstract Background The Harambee study is a cluster randomized trial in Western Kenya that tests the effect, mechanisms, and cost-effectiveness of integrating community-based HIV and non-communicable disease care within microfinance groups on chronic disease treatment outcomes. This paper documents the stages of our feasibility study conducted in preparation for the Harambee trial, which include (1) characterizing the target population and gauging recruitment capacity, (2) determining community acceptability of the integrated intervention and study procedures, and (3) identifying key implementation considerations prior to study start. Methods Feasibility research took place between November 2019 and February 2020 in Western Kenya. Mixed methods data collection included surveys administered to 115 leaders of 105 community-based microfinance groups, 7 in-person meetings and two workshops with stakeholders from multiple sectors of the health system, and ascertainment of field notes and geographic coordinates for group meeting locations and HIV healthcare facilities. Quantitative survey data were analyzed using STATA IC/13. Longitude and latitude coordinates were mapped to county boundaries using Esri ArcMap. Qualitative data obtained from stakeholder meetings and field notes were analyzed thematically. Results Of the 105 surveyed microfinance groups, 77 met eligibility criteria. Eligible groups had been in existence from 6 months to 18 years and had an average of 22 members. The majority (64%) of groups had at least one member who owned a smartphone. The definition of “active” membership and model of saving and lending differed across groups. Stakeholders perceived the community-based intervention and trial procedures to be acceptable given the minimal risks to participants and the potential to improve HIV treatment outcomes while facilitating care integration. Potential challenges identified by stakeholders included possible conflicts between the trial and existing community-based interventions, fear of group disintegration prior to trial end, clinicians’ inability to draw blood for viral load testing in the community, and deviations from standard care protocols. Conclusions This study revealed that it was feasible to recruit the number of microfinance groups necessary to ensure that our clinical trial was sufficient powered. Elicitation of stakeholder feedback confirmed that the planned intervention was largely acceptable and was critical to identifying challenges prior to implementation. Trial registration The original trial was prospectively registered with ClinicalTrials.gov (NCT04417127) on 4 June 2020.

During public health crises, people living with HIV (PLWH) may become disengaged from care. The goal of this study was to understand the impact of the COVID-19 pandemic and recent flooding disasters on HIV care delivery in western Kenya. We conducted ten individual in-depth interviews with HIV providers across four health facilities. We used an iterative and integrated inductive and deductive data analysis approach to generate four themes. First, increased structural interruptions created exacerbating strain on health facilities. Second, there was increased physical and psychosocial burnout among providers. Third, patient uptake of services along the HIV continuum decreased, particularly among vulnerable patients. Finally, existing community-based programs and teleconsultations could be adapted to provide differentiated HIV care. Community-centric care programs, with an emphasis on overcoming the social, economic, and structural barriers will be crucial to ensure optimal care and limit the impact of public health disruptions on HIV care globally.

Abstract Serum vitamin D status exerts effects on glucose-insulin-homeostatic states underlying Diabetes-Mellitus, Type 2 (T2DM). This has been described in white and Asian population where low Vitamin D levels predicted future impairments in beta cell function and worsening of insulin resistance. This study aimed to examine the relationship between serum vitamin D, insulin resistance and beta cell function in a sub population of black Kenyan T2DM patients. The primary objective was to determine the levels of serum 25 hydroxy (25-OH) vitamin D, and estimate the insulin resistance, and beta cell function among T2DM patients at Moi Teaching and Referral Hospital (MTRH). This was a cross sectional study. 124 T2DM patients attending the MTRH Diabetes clinic between February and May 2016 were enrolled. Patients on insulin therapy and/or thiazolidinediones were excluded. Anthropometric, clinical and demographic data was obtained. Samples were drawn for estimation of serum 25-OH vitamin D, fasting insulin levels and fasting blood glucose levels. HOMA (Homeostatic model of assessment) model was used to estimate Beta cell secretion (HOMA-B) and insulin resistance (HOMA-IR); while the Disposition index {(DI) hyperbola product of insulin sensitivity (1/HOMA-IR) and beta cell secretion} was used to estimate the beta cell function. The relationships between serum vitamin D, insulin resistance and beta cell function were explored using a linear regression model. The study participants had a mean age of 56.2 (± 9.2) years, and a mean BMI of 26.9 kg/m2 (4.3). Forty nine percent (n = 61) were males. Vitamin D deficiency was present in 71.1% (n = 88) of the respondents. Relatively low levels of insulin resistance and higher levels of beta cell dysfunction were observed {median HOMA-IR of 2.3 (0.7, 6.5) and Disposition Index (DI) of 25.5 (14.3, 47.2)}. Vitamin D levels exhibited a low positive correlation with DI [r = 0.22 (95% CI: 0.03, 0.37)], but was not significantly correlated with HOMA-IR [r = 0.07(95% CI: − 0.11, 0.25)]. These results indicate that beta cell dysfunction rather than insulin resistance as the predominant defect among black T2DM patients seeking care at the MTRH diabetes clinic. Vitamin D deficiency is also prevalent among them and exhibits a low positive correlation with beta cell dysfunction. There was no correlation observed between Vitamin D deficiency and insulin resistance.

Objective: To describe the patterns and burden of neurological and neurosurgical disorders at a national tertiary level referral hospital in western Kenya. Methods: We conducted a three-month period prevalence study. We recruited consecutive adult patients seeking neurological-neurosurgical care in both inpatient and outpatient settings at Moi Teaching and Referral Hospital. Results: 833 participants were included. The age range was between 19 year and 99 years (mean age = 45.3 years). The most common diagnoses among neurology inpatients were meningitis (12%), ischemic stroke (11.0%) and epilepsy/seizure (6.7%). Among neurology outpatients, epilepsy (35.1%) and ischemic stroke (18.8%) were the most common diagnoses. The most common neurosurgery inpatient diagnosis was hemorrhagic stroke (16.3%) and among outpatients, the most common diagnoses were traumatic brain injury (17.4%) and hemorrhagic stroke (16.3%). Overall, 471 (56.5%) patients underwent HIV testing, of which, 89 (18.9%) were HIV positive and 382 (81.1%) were HIV negative. Thirty-one inpatient deaths (male 58%), attributable to neurological and neurosurgical disorders, occurred during the study period. Meningitis was the most common cause of death. Conclusions: The findings suggest that meningitis, stroke, epilepsy, and traumatic brain injury were the most common diagnosis. More resources and efforts should be directed towards prevention, diagnosis and management of these conditions in the region.

The study aimed to identify the role of cybersecurity determinants of cybersecurity in financial inclusion in Islamic banks operating in Jordan. It also aimed to identify cybersecurity and its determinants (cybersecurity governance, cybersecurity program integrity, and cybersecurity policy), cybersecurity in Islamic banks in Jordan, as well as to understand financial inclusion in Jordan and the role of Islamic banks in achieving financial inclusion Additionally, the study examined the effectiveness of cybersecurity on financial inclusion through the steps of the National Strategy for Financial Inclusion and its objectives, the roles of Islamic banks operating in Jordan in financial inclusion, and concluded that managing cybersecurity in Islamic banks operating in Jordan requires a focus on adopting the best practices, policies, and effective procedures for protecting the financial and personal data of customers. The study also emphasized the need for providing continuous training and awareness to employees and customers regarding cybersecurity risks and how to protect financial and personal data. [ABSTRACT FROM AUTHOR]