A5047995066- HIV/AIDS Research and Interventions
- HIV, Drug Use, Sexual Risk
- Global Maternal and Child Health
- Global Health and Surgery
- Adolescent Sexual and Reproductive Health
- Palliative Care and End-of-Life Issues
- Family and Patient Care in Intensive Care Units
- Travel-related health issues
- Pneumocystis jirovecii pneumonia detection and treatment
- Tuberculosis Research and Epidemiology
- Patient-Provider Communication in Healthcare
- Patient Safety and Medication Errors
- Global Health Workforce Issues
- Medical Malpractice and Liability Issues
- Healthcare Decision-Making and Restraints
- HIV/AIDS Impact and Responses
- Ethics in medical practice
- Adolescent and Pediatric Healthcare
- Patient Satisfaction in Healthcare
- Pneumonia and Respiratory Infections
- Diversity and Career in Medicine
- HIV Research and Treatment
- Musculoskeletal Disorders and Rehabilitation
- Interpreting and Communication in Healthcare
- Innovation Policy and R&D
Fred Hutch Cancer Center
2022-2025
Seattle University
2020-2025
Cape Town HVTN Immunology Laboratory / Hutchinson Centre Research Institute of South Africa
2022-2025
University of Washington
2018-2022
Beth Israel Deaconess Medical Center
2016-2022
National Clinical Research
2020
Hunter College
2020
City University of New York
2020
Bellevue Hospital Center
2020
University of Cape Town
2019
Introduction HIV self-testing (HIVST) is highly sensitive and specific, addresses known barriers to testing (such as stigma), recommended by the World Health Organization a option for delivery of pre-exposure prophylaxis (PrEP). Nevertheless, HIVST remains underutilized diagnostic tool in community-based, differentiated service models, possibly due concerns about result misinterpretation, which could lead inadvertent onward transmission HIV, delays antiretroviral therapy (ART) initiation,...
Background Little is known about patient/family comfort voicing care concerns in real time, especially the intensive unit (ICU) where stakes are high and time compressed. Experts advocate patient family engagement safety, which will require that patients/families be able to voice concerns. Data on attitudes experiences regarding speaking up sparse, mostly include reporting events retrospectively, rather than pre-emptively, try prevent harm. We aimed (1) assess common ICU concerns; (2)...
In 2012, Peru's National TB Program (NTP) reported approximately 2400 incident cases of tuberculosis (TB) disease in children aged <15 years. burden is concentrated the Lima metropolitan area, particularly poor districts such as El Agustino and La Victoria, where this study was conducted.To identify barriers to treatment childhood tuberculous infection from perspective front-line providers patients' families.We conducted 10 semi-structured focus groups with 53 purposefully sampled primary...
Abstract Introduction In Kenya, pre-exposure prophylaxis (PrEP) for HIV prevention is almost exclusively delivered at clinics. Developing novel PrEP delivery models important increasing the reach of PrEP. Delivery through pharmacies one approach utilized in US to improve accessibility. Retail are commonly used as a first-line access point medical care but have not been delivery. We conducted collaborative consultative meeting stakeholders develop pathway pharmacy-based Kenya. Methods January...
As countries scale up pre-exposure prophylaxis (PrEP) for HIV prevention, diverse PrEP delivery models are needed to expand access populations at risk that unwilling or unable clinic-based care. To identify factors may influence implementation of retail pharmacy-based in Kenya, we conducted in-depth interviews with 40 pharmacy clients, 16 providers, and 10 providers from two provinces. Most participants expressed strong support expanding pharmacies, though conditioned their acceptance on...
The delivery of daily, oral HIV pre-exposure prophylaxis (PrEP) at private pharmacies may overcome barriers to PrEP public healthcare facilities, including HIV-associated stigma, long wait times and overcrowding.At five private, community-based in Kenya, a care pathway for (ClinicalTrials.gov: NCT04558554) was piloted-the first its kind Africa. Pharmacy providers screened clients interested risk, then used prescribing checklist identify without medical conditions that might contraindicate...
To promote communication with patients after medical injuries and improve patient safety, numerous hospitals have implemented communication-and-resolution programs (CRPs). Through these programs, communicate transparently adverse events; investigate what happened offer an explanation; and, when warranted, apologize, take responsibility, proactively compensation. Despite growing consensus that CRPs are the right thing to do, concerns over liability risks remain. We evaluated effects of CRP...
Most health care organizations' efforts to reduce harm focus on physical harm, but other forms of are both prevalent and important. These "nonphysical" harms can be framed using the concepts respect dignity: Disrespect is an affront dignity cause harm. Organizations should strive eliminate disrespect patients, families, among professionals.A diverse, interdisciplinary panel experts was convened discuss strategies guide systems embrace expanded definition patient that includes nonphysical...
Introduction: Maximizing the impact of new and forthcoming long-acting injectable HIV pre-exposure prophylaxis (PrEP) products will require novel delivery approaches that widen accessibility prioritize clients needs preferences. To understand potential barriers facilitators to delivering PrEP via private pharmacies in Kenya, we conducted qualitative formative research. Methods: From July September 2023, interviewed pharmacy providers, clients, other key stakeholders service Central Western...
Background: In Kenya, as in many African countries, private pharmacies are ubiquitous, frequently accessed, and underutilized for the delivery of HIV prevention services. Whether enabling to initiate manage clients on pre- post-exposure prophylaxis (PrEP PEP) leads greater uptake continuation than current standard-pharmacy referral clinic-based PrEP/PEP-is unknown. To address this gap inform how might partner with public sector, we testing several models pharmacy-delivered PrEP/PEP...
In 2012, Peru's National Tuberculosis Program (NTP) reported that children aged 0-14 years accounted for 7.9% of the country's tuberculosis (TB) incidence. This figure is likely an underestimate due to suboptimal diagnosis childhood TB.To identify barriers TB in Lima, Peru.Using semi-structured guides, moderators conducted in-depth interviews with four NTP administrators and five pulmonologists specializing 10 focus groups 53 primary care providers, community health workers (CHWs), parents...
Background For individuals who face challenges accessing clinic-based HIV pre-exposure prophylaxis (PrEP), differentiated service delivery models are needed to expand access and reach. During a pilot study testing novel pharmacy-delivered oral PrEP model in Kenya, we used routine programmatic data identify early implementation barriers actions that providers staff took response the barriers. Methods We trained pharmacy at five private pharmacies Kisumu Kiambu Counties initiate continue...
Through communication-and-resolution programs, hospitals and liability insurers communicate with patients when adverse events occur; investigate explain what happened; and, where appropriate, apologize proactively offer compensation. Using data recorded by program staff members from surveys of involved clinicians, we examined case outcomes a used two academic medical centers their community in Massachusetts the period 2013–15. The demonstrated good adherence to protocol. Ninety-one percent...
Rationale: The quality of communication with patients and family members in intensive care units (ICUs) is a focus current interest for clinical improvement. Electronic portals are commonly used other healthcare settings to improve communication. We do not know whether desire such ICUs, if so, what functionality they should provide.Objectives: To define desired elements an electronic portal among potential ICU their members.Methods: surveyed, via Internet panel, 1,050 English-speaking adults...
Abstract Background and aims We characterized the extent quality of respiratory sensations sensory-related smoking cues associated with e-cigarette use among those who failed to quit combustible tobacco cigarette (CTC) traditional FDA approved medications but succeeded in doing so e-cigarettes. Further, we sought understand former smokers’ perceptions about influence sensory experience on CTC cessation outcomes. Methods A nonrandom purposive sample 156 participants recruited USA through...
Abstract Introduction Across sub-Saharan Africa, ministries of health have proposed integrating pre-exposure prophylaxis (PrEP) for HIV prevention into family planning (FP) services to reach adolescent girls and young women (AGYW); however, evidence on effective implementation strategies is still limited. We conducted a qualitative study integrated PrEP-FP service at two FP clinics in Kisumu, Kenya. Methods From June 2017 May 2020, the Prevention Options Women Evaluation Research (POWER)...
In public clinics in Kenya, separate, sequential delivery of the component services pre-exposure prophylaxis (PrEP) (e.g. HIV testing, counselling, and dispensing) creates long wait times that hinder clients' ability desire to access continue PrEP. We conducted a mixed methods study four western Kenya identify strategies for operationalizing one-stop shop (OSS) model evaluate whether this could improve client time care acceptability among clients providers without negatively impacting uptake...
Female sex workers (FSWs) have tightly connected peer networks and remain at high risk of HIV acquisition. Peer delivery prevention interventions, such as self-testing (HIVST), is a recommended implementation strategy for increasing intervention uptake continuation among FSWs. We analyzed qualitative data from peer-delivered HIVST FSWs in urban Uganda to understand the ways social support within this network can motivate or discourage HIVST.Between February April 2017, we conducted in-depth...
To understand the perspectives of adolescents (10-19 years old), their caregivers and healthcare providers regarding factors that impact adherence to tuberculosis (TB) treatment among adolescents. We conducted in-depth interviews using semistructured interview guides based on World Health Organization (WHO)'s Five Dimensions Adherence framework, which conceptualises as being related health system, socioeconomic factors, patient, condition. applied framework thematic analysis. Between August...
Background Communication-and-resolution programmes (CRP) aim to increase transparency surrounding adverse events, improve patient safety and promote reconciliation by proactively meeting injured patients’ needs. Although early adopters of CRP models reported relatively smooth implementation, other organisations have struggled achieve the same. However, two Massachusetts hospital systems implementing a demonstrated high fidelity protocol without raising liability costs. Study question What...
Background: Successful integration of pre-exposure prophylaxis (PrEP) with existing reproductive health services will require iterative learning and adaptation. The interaction between the problem-solving required to implement new interventions worker motivation has been well-described in public literature. This study describes structural motivational challenges faced by care providers delivering PrEP adolescent girls young women (AGYW) alongside other SRH services, strategies used overcome...