A5021447658- HIV/AIDS Research and Interventions
- Adolescent Sexual and Reproductive Health
- HIV Research and Treatment
- Global Maternal and Child Health
- HIV, Drug Use, Sexual Risk
- Adolescent and Pediatric Healthcare
- Poverty, Education, and Child Welfare
- HIV-related health complications and treatments
- Family Support in Illness
- HIV/AIDS oral health manifestations
- Child Nutrition and Water Access
- Immune Cell Function and Interaction
- HIV/AIDS drug development and treatment
- Mosquito-borne diseases and control
- Cytomegalovirus and herpesvirus research
- COVID-19 Impact on Reproduction
- HIV/AIDS Impact and Responses
- Health Policy Implementation Science
- Vaccine Coverage and Hesitancy
- Infant Nutrition and Health
- Viral Infections and Vectors
- Food Security and Health in Diverse Populations
- COVID-19 and Mental Health
- Ethics in Clinical Research
University of Washington
2017-2025
Seattle University
2019-2023
Abstract The objective of this study was to assess psychosocial effects COVID-19 among adolescents living with HIV (ALHIV) in Kenya and the feasibility conducting behavioral surveys by phone. We adapted our protocol administer telephone rather than in-person follow-up included questions about COVID-19. majority participants (99%) reported having heard COVID-19; 23% no longer being able go outside, 17% that they could their regular clinic for medical care, 3% get medication refills. PHQ-9...
Objectives: To determine clinic-level and individual-level correlates of viral suppression among HIV-positive adolescents young adult (AYA) aged 10–24 years receiving antiretroviral treatment (ART). Design: Multilevel cross-sectional analysis using load data facility surveys from HIV programs throughout Kenya. Methods: We abstracted medical records AYA in care, analyzed the subset on ART for more than 6 months between January 2016 December 2017, collected information services at each clinic....
To inform cure in children living with HIV (CWH), we elucidated the dynamics and mechanisms underlying persistence during antiretroviral therapy (ART). In 120 Kenyan CWH who initiated ART between 1-12 months of age, 55 had durable viral load suppression, 65 experienced interruptions. We measured plasma RNA levels, CD4+ T cell count, levels intact defective DNA proviruses via cross-subtype proviral assay (CS-IPDA). By modeling data from durably suppressed subset, found that early (year 0-1 on...
<title>Abstract</title> <bold>Background</bold>: Cervical cancer is the second leading malignancy among women in sub-Saharan Africa. Early detection through screening and treatment of pre-cancerous cervical lesions paramount preventing cancer. We sought to examine factors associated with ever being screened for attending infant immunization clinics Kenya. <bold>Methods:</bold> conducted secondary data analysis from a cross-sectional survey that enrolled mother-infant pairs 55 Kenya between...
Background Delivery of PrEP to adolescent girls and young women (AGYW) pregnant through maternal child health (MCH) family planning (FP) clinics is scaling up in Kenya. Evaluation implementation challenges strategies critical optimize delivery. Methods We conducted focus group discussions (FGDs) with healthcare workers (HCWs) MCH FP offering a large project Kisumu, Discussion guides were based on the Consolidated Framework for Implementation Research (CFIR). FGDs audio recorded transcribed....
With the growing population of HIV-exposed uninfected (HEU) children globally, it is important to determine population-level growth differences between HEU and HIV-unexposed (HUU) children.We analyzed data from a survey enrolling mother-infant pairs attending 6-week 9-month immunizations in 140 clinics across Kenya. Weight-for-age (WAZ), length-for-age (LAZ), head circumference-for-age (HCAZ) z-scores underweight (WAZ < -2), stunting (LAZ microcephaly (HCAZ were compared HUU. Correlates...
Expansion of access to diagnosis and treatment for human immunodeficiency virus (HIV) a high incidence HIV infection in adolescence has resulted growing population adolescents young adults living with HIV. The prevalence poor retention care, insufficient viral suppression loss follow-up are higher among compared other age groups. Poor outcomes could be attributed psychosocial changes during adolescence, but also transitional care from paediatric adult services. In many countries, transition...
Introduction Successfully transitioning adolescents to adult HIV care is critical for optimising outcomes. Disclosure of status, a prerequisite transition, remains suboptimal in sub-Saharan Africa. Few interventions have addressed both disclosure and transition. An adolescent transition package (ATP) that combines tools could support improve Methods analysis In this hybrid type 1 effectiveness-implementation cluster randomised controlled trial, 10 clinics with an estimated ≥100 young adults...
<h3>ABSTRACT</h3> <h3>Introduction:</h3> HIV retesting during pregnancy/postpartum can identify incident maternal infection and prevent mother-to-child transmission (MTCT). Guidelines recommend HIV-negative peripartum women, but data on implementation are limited. We conducted a cross-sectional study in Kenya to measure the prevalence of programs incidence. <h3>Methods:</h3> Programmatic was abstracted from child health booklets among women enrolled and/or seeking services pregnancy,...
To determine whether continuous quality improvement (CQI) improves of HIV testing services for adolescents and young adults (AYA).CQI was introduced at two settings: Youth Centre Voluntary Counseling Testing (VCT) Center, a national referral hospital in Nairobi, Kenya.Primary outcomes were AYA satisfaction with services, intent to return, accurate prevention transmission knowledge. Healthcare worker (HCW) assessed staff morale. T tests interrupted time series analysis using Prais-Winsten...
Abstract Objective Tailored services for adolescents and young adults (AYA) living with HIV may improve treatment outcomes. We surveyed clinics throughout Kenya to determine AYA clinic practices, disclosure transition services. Methods deployed a mobile team conduct surveys in random sample of 102 public with> 300 total clients. Data were collected from healthcare workers offering who had >6 months experience delivering care. Results Of clinics, almost all (101/102) the same staff...
Introduction Predictors of neurodevelopment among children who are HIV‐exposed uninfected (CHEU) poorly understood. Methods Mothers with and without HIV their were enrolled during 6‐week postnatal care visits across seven sites in Kenya between March 2021 June 2022. Infant was assessed using the Malawi Developmental Assessment Tool, including social, language, fine motor gross domains. We used multivariate linear mixed effects models to identify associations 1‐year scores, antiretroviral...
Introduction Index case testing (ICT) to identify HIV-infected children is efficient but has suboptimal uptake. Financial incentives (FI) have overcome financial barriers in other populations by offsetting direct and indirect costs. A pilot study found FI be feasible for motivating paediatric ICT among female caregivers. This randomised trial will determine the effectiveness of increase uptake ICT. Methods analysis The Incentives Increase Uptake Pediatric HIV Testing a five-arm, unblinded,...
Gaps persist in HIV testing for children who were not tested prevention of mother-to-child transmission programs. Oral mucosal transudate (OMT) rapid tests have been shown to be highly sensitive adults, but their performance has established children.Antiretroviral therapy-naive aged 18 months years Kenya and Zimbabwe using OraQuick ADVANCE Rapid HIV-1/2 Antibody test on oral fluids blood-based diagnostic (BBT). BBT followed Kenyan Zimbabwean national algorithms. Sensitivity specificity...
Background: Financial incentives can motivate desirable health behaviors, including adult HIV testing. Data regarding the effectiveness of financial for testing in children, who require urgent to prevent mortality, are lacking. Methods: In a five-arm unblinded randomized controlled trial, adults living with attending 19 clinics Western Kenya, children 0–12 years unknown status, were equal allocation $0, $1.25, $2.50, $5 or $10. Payment was conditional on child within 2 months. Block...
HIV incidence and mortality are high among adolescents young adults (AYA) in sub-Saharan Africa, but testing rates low. Understanding how support people (SP), such as peers, partners, or parents, influence AYA may improve uptake. aged 14–24 seeking at a referral hospital Nairobi, Kenya completed post-test survey assessing the role of SP. Among 1062 AYA, median age was 21. Overall, 12% reported their decision to test influenced by parent, 20% partner, 22% peer. Young (20–24 years old) were...
Background: Pediatric HIV testing remains suboptimal. The OraQuick test [saliva-based (SBT)] is validated in pediatric populations ≥18 months. Understanding caregiver and health care worker (HCW) acceptability of SBT critical for implementation. Methods: A trained qualitative interviewer conducted 8 focus group discussions (FGDs): 4 with HCWs caregivers children seeking services western Kenya. FGDs explored home- facility-based use. Two reviewers consensus coding thematic analyses...
The acceptability of financial incentives for pediatric HIV testing was evaluated in Kenya. Sixty HIV-positive women with children unknown status were randomized to receive $5, $10 or $15 conditional upon testing. Forty-four (73%) completed child testing, similar rates across arms. Uptake significantly higher than a cohort procedures but no (73% vs. 14%, P < 0.001).
A prior randomized control trial showed financial incentives increase HIV testing rates for children of unknown status. Translating evidence-based interventions such as these to scale requires an implementation science approach.A qualitative study evaluating health care providers' perceptions barriers and facilitators a previously completed intervention pediatric was conducted at facilities in Kisumu, Kenya. Six focus group discussions with 52 providers explored determinants acceptability,...
Background: To improve holistic care for adolescents living with HIV (ALHIV), including integration of sexual and reproductive health services (SRHS), the Kenya Ministry Health implemented an adolescent package (APOC). inform optimized SRH service delivery, we sought to understand experiences SRHS ALHIV, their primary caregivers, workers (HCWs) following APOC implementation. Methods: We completed a mixed methods evaluation characterize provided personal access uptake using surveys conducted...
Objective: We determined predictors of both intact (estimate replication-competent) and total (intact defective) HIV DNA in the reservoir among children with HIV. Design: was quantified longitudinally who initiated antiretroviral therapy (ART) at less than 1 year age using a novel cross-subtype proviral assay that measures proviruses. Quantitative PCR used to measure pre-ART cytomegalovirus (CMV) viral load. Linear mixed effects models were determine levels (log 10 copies/million). Results:...
Mortality and loss to follow-up (LTFU) among adolescents youth living with HIV (AYLHIV) remain high. We evaluated mortality LTFU during the test treat era. abstracted medical records of AYLHIV for 10–24 years between January 2016 December 2017 in 87 clinics Kenya. Using competing risk survival analysis, we compared incidence rates determined correlates newly enrolled [<2 since antiretroviral therapy (ART) initiation] on ART ≥2 years. Among 4201 AYLHIV, 1452 (35%) 2749 (65%) were new...