A5039352548- HIV/AIDS Research and Interventions
- HIV-related health complications and treatments
- Global Maternal and Child Health
- HIV, Drug Use, Sexual Risk
- HIV Research and Treatment
- HIV/AIDS drug development and treatment
- Medication Adherence and Compliance
- Global Health and Surgery
- Global Cancer Incidence and Screening
- Adolescent Sexual and Reproductive Health
- Chronic Disease Management Strategies
- Pneumocystis jirovecii pneumonia detection and treatment
- Global Health Workforce Issues
- Healthcare Systems and Reforms
- Mobile Health and mHealth Applications
- Healthcare Policy and Management
- Health Systems, Economic Evaluations, Quality of Life
- Malaria Research and Control
- Lipoproteins and Cardiovascular Health
- Economic and Financial Impacts of Cancer
- Telemedicine and Telehealth Implementation
- Pharmaceutical Economics and Policy
- Hepatitis Viruses Studies and Epidemiology
- Health Policy Implementation Science
- Social Media in Health Education
Duke University
2016-2025
Kenya Medical Research Institute
2023-2025
Duke Institute for Health Innovation
2015-2024
Duke Medical Center
2011-2024
Kilimanjaro Christian Medical Centre
2014-2024
Tumaini University
2024
Health Affairs
2024
Clinical Research Institute
2024
University of North Carolina at Chapel Hill
2014
Duke University Hospital
2014
Introduction The syndrome of fever is a commonly presenting complaint among persons seeking healthcare in low-resource areas, yet the public health community has not approached comprehensive manner. In many malaria over-diagnosed, and patients without have poor outcomes. Methods Findings We prospectively studied cohort 870 pediatric adult febrile admissions to two hospitals northern Tanzania over period one year using conventional standard diagnostic tests establish etiology. Malaria was...
BackgroundRecently, we found that a new malaria vaccine, R21/Matrix-M, had over 75% efficacy against clinical with seasonal administration in phase 2b trial Burkina Faso. Here, report on safety and of the vaccine 3 enrolling 4800 children across four countries followed for up to 18 months at sites 12 standard sites.MethodsWe did double-blind, randomised, R21/Matrix-M five African differing transmission intensities seasonality. Children (aged 5–36 months) were enrolled randomly assigned (2:1)...
Importance Despite higher atherosclerotic cardiovascular disease (ASCVD) risk, people with HIV (PWH) experience unique barriers to ASCVD prevention, such as changing models of primary care. Objective To test whether a multicomponent nurse-led strategy would improve systolic blood pressure (SBP) and non–high-density lipoprotein (HDL) cholesterol level in diverse population PWH receiving antiretroviral therapy (ART). Design, Setting, Participants This randomized clinical trial enrolled at 3...
Background Optimally, expanded HIV testing programs should reduce barriers to while attracting new and high-risk testers. We assessed risk among clients participating in mobile voluntary counseling (MVCT) campaigns four rural villages the Kilimanjaro Region of Tanzania. Methods Between December 2007 April 2008, 878 MVCT participants 506 randomly selected community residents who did not access were surveyed. Gender-specific logistic regression models used describe differences socioeconomic...
Introduction Leptospirosis is a major cause of febrile illness in Africa but little known about risk factors for human infection. We conducted cross-sectional study to investigate acute leptospirosis and Leptospira seropositivity among patients with fever attending referral hospitals northern Tanzania. Methods enrolled from two Moshi, Tanzania, 2012–2014, performed microscopic agglutination testing on convalescent serum. Cases were participants four-fold rise antibody titers, or single...
Little is known about the epidemiology of human brucellosis in sub-Saharan Africa. This hampers prevention and control efforts at individual population levels. To evaluate risk factors for northern Tanzania, we conducted a study patients presenting with fever to two hospitals Moshi, Tanzania. Serum taken enrollment 4-6 week follow-up was tested by
To examine the relationship between pregnancy history and use of contraception among women reproductive age (15-49 years) in East Africa.
<ns3:p>Introduction Malaria in pregnancy remains a public health problem. The World Health Organization (WHO) recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) to all pregnant women moderate high malaria transmission areas. Kenya's Ministry of at least three doses IPTp-SP (IPTp-SP3 +) regions where is endemic. Although SP cost-effective and effective for IPTp, there are two main challenges the use SP: i) widespread can lead an increase prevalence drug...
People with HIV are at increased risk of cardiovascular events; thus, care delivery strategies that increase access to comprehensive disease (CVD) management a priority. We report the results multi-component telemedicine-based strategy improve blood pressure control among people HIV—Assess and Adapt Impact COVID-19 on CVD Self-Management Prevention Care in Adults Living (AAIM-High). The AAIM High is virtual adaptation our previously published EXTRA-CVD consisted hypertension education six...
The increased incidence of chronic diseases among people with HIV (PWH) is poised to increase the need for specialty care outside treatment settings. To reduce outcome disparities HIV-associated comorbidities in United States, it critical optimize access and quality underrepresented racial ethnic minority (URM) individuals HIV. We explored experiences URM other setting during their initial follow-up appointments. conducted qualitative interviews participants at three large academic medical...
Objectives: Using a clinical research laboratory as case study, we sought to characterize barriers maintaining Good Clinical Laboratory Practice (GCLP) services in developing world setting. Methods: US Centers for Disease Control and Prevention framework program evaluation public health, performed an of the Kilimanjaro Christian Medical Centre–Duke University Health Collaboration sections Research Institute Moshi, Tanzania. records from November 2012 through October 2014 were reviewed this...
Communicable diseases are the leading causes of death in Tanzania despite existence effective treatment tools. We aimed to assess sociocultural and health system factors associated with mortality from febrile illness northern Tanzania.We interviewed inpatients determine prevalence barriers seeking or receiving care grouped these using Three Delays model (delays at home, transport healthcare facilities). assessed 6-week and, after matching on age, gender severity illness, measured association...
An important component of cancer control programs for the growing burden in sub-Saharan Africa is a population's awareness risk factors. Studies thereof have focused on single rather than multiple cancers and carcinogens. During March April 2015, we undertook survey to assess factors symptoms Kilimanjaro Region, North Tanzania. General population (n = 620) attendees at HIV care-and-treatment clinics (CTCs) were included 207). Participants' mean age was 43.8 (interquartile range 30–52) years;...
In many low- and middle-income countries, community health workers (CHWs) support multiple aspects of HIV care, including patient education counseling, adherence support, re-engaging patients lost to care. Tanzania, the Community-Based Services program is a nationwide cohort CHWs supporting care engagement. We enrolled prospective study 80 people initiating at two Tanzanian clinics conducted baseline 3-month follow-up assessments examine potential influence CHW other factors on early...
Objective This study reports on food insecurity (FI) amidst the COVID-19 pandemic.Participants and methods College students in four regions of US completed two-item validated Hunger Vital Sign™ screening tool Qualtrics.Results FI increased significantly after March 2020 among (worry about running out: 25% to 35%; did not last: 17% 21%) with significant regional increase Midwest South. An adjusted multivariable logistic regression model indicated that ran out were at greater odds experiencing...
Abstract Background Underrepresented racial and ethnic groups (UREGs) with HIV have a higher risk of cardiovascular disease (CVD) compared the general population. Referral to specialist improves CVD factor management in high-risk individuals. However, patient provider factors impacting likelihood UREGs an encounter cardiologist are unknown. Methods We evaluated cohort borderline (10-year ≥ 5% by pooled equations or 7.5% Framingham score). Participants received HIV-related care from 2014–2020...
Mal-distribution of health care workers is a global challenge that exacerbates disparities, especially in resource-limited settings. Interventions to mitigate the problem have targeted qualified personnel with little focus on medical students. However, studies demonstrated rural rotations positively influence students practice settings upon graduation. To evaluate peripheral setting, Kilimanjaro Christian Medical University College introduced 12-week clerkship rotation hospitals for...
Infectious diseases are a leading cause of mortality in low- and middle-income countries (LMICs) despite effective treatments. To study the sociocultural health system barriers to care, we conducted qualitative social autopsy patients who died from febrile illness northern Tanzania. From December 2016 through July 2017, in-depth interviews Arusha Kilimanjaro regions with purposive sample 20 family members had at two regional referral hospitals. Of deceased included this study, 14 (70%) were...
Adherence to Antiretroviral Therapy (ART) is critical piece in the management of HIV infected patients. Despite benefits ART, non-adherence ART persists. This study explores association between patient’s knowledge line treatment, availability future treatment options and adherence. A cross sectional survey adolescent adults was conducted. Cumulative optimal sub-optimal adherence defined as percentage ≥ 95 % < %, respectively. Binomial regression models were used assess Of 402 patients...
Background While clinical practice guidelines underscore the need to incorporate patient preferences in decision making, incorporating meaningful assessment of encounters is challenging. Structured approaches that combine quantitative and evidence could facilitate effective patient-provider communication more patient-centric health care decisions. Adaptive conjoint or stated-preference can identify individual preference parameters, but they require a relatively large number choice questions...
Background: Viperidae snakes are responsible for many of the 94,000 deaths caused by snakebite envenoming each year. The most pathological venom component this globally diverse family zinc-dependent snake metalloproteinase (SVMP) enzymes, which can be inhibited metal chelator, unithiol. A short-course oral regimen, readily available and rapidly deployed ahead hospital admission is needed. Methods: This open-label, phase 1 clinical trial assessed safety single ascending oral, multiple...
Abstract Long Acting Injectable (LAI) therapy to treat HIV is an alternative daily oral medications. The success of early roll-out LAI eligible patients requires a better understanding patients’ awareness and interest in this novel therapy. We administered electronic survey attending urban clinic the US South. Eligible participants were 18 + years old with most recent HIV-1 viral load < 200 copies/ml, without any evidence genotypic resistance components or chronic hepatitis B. Survey...