Utilization of PMTCT services at Juba Teaching Hospital, South Sudan

Objective: To determine the uptake of PMTCT services by mothers attending postnatal services at Juba Teaching Hospital.Study Design: A cross-sectional study conducted at the Mother and Child Health (MCH) clinic between May and August 2012Results: All 300 women recruited had at least one antenatal care visit and 246 (82%) received antenatal counselling for HIV: 201 (67%) were tested and 15 (7.5%) were positive. Thirteen of these HIV positive mothers delivered in a health facility. CD4 tests were not done. Three mothers were put on single dose Nevirapine and two on a more efficacious ARV combination, the rest did not receive an ARV. Ten of HIV exposed infants received Nevirapine after delivery. Not all of the HIV-exposed babies were tested by polymerase chain reaction/deoxyribonucleic acid (PCR/DNA). Six babies were on exclusive breastfeeding for the first six months with four on formula and five on mixed feeding. Six mothers were not using any mode of family planning, one used condoms, one had an IUCD and one used dates (natural) method.Conclusion: Although the majority of the mothers received HIV counselling during the antenatal period less than 70% were tested for HIV. CD4 count testing was not routinely done and the use of HAART and other more efficacious ARV combinations were rarely used. DNA/PCR was not routinely done for HIV exposed infants. Safe infant feeding practices were limited. A majority of those with HIV positive partners did not practice safe family planning methods

Factors influencing TB treatment interruption and treatment outcomes among patients in Kiambu County, 2016-2019

Tuberculosis (TB) is the leading cause of mortality as a single infectious agent globally with increasing numbers of case notification in developing countries. This study seeks to investigate the clinical and socio-demographic factors of time to TB treatment interruption among Tuberculosis patients in Kiambu County, 2016–2019. We retrospectively analyzed data for all treatment outcomes patients obtained from TB tracing form linked with the Tuberculosis Information Basic Unit (TIBU) of patients in Kiambu County health facilities using time to treatment interruption as the main outcome. Categorical variables were presented using frequency and percentages. Kaplan-Meir curve was used to analyze probabilities of time to treatment interruptions between intensive and continuation phases. Log-rank test statistics was used to compare the equality of the curves. Cox proportion model was used to determine determinants of treatment interruption. A total of 292 participants were included in this study. Males were 68%, with majority (35%) of the participants were aged 24–35 years; 5.8% were aged 0–14 years and 5.1% aged above 55 years. The overall treatment success rate was 66.8% (cured, 34.6%; completed 32.2%), 60.3% were on intensive phase of treatment. Lack of knowledge and relocation were the major reasons of treatment interruptions. Patients on intensive phase were 1.58 times likely to interrupt treatment compared to those on continuation phase (aHR: 1.581; 95%CI: 1.232–2.031). There is need to develop TB interventions that target men and middle aged population in order to reduce treatment interruption and increase the treatment success rates in the County and Country

Retention of pediatric patients in care: a study of the Kibera Community Health Center HIV/AIDS Program

Background: In 2011, 3.4 million children were living with HIV worldwide1. Objectives: Describe the characteristics of pediatric patients enrolled into the HIV program at the Kibera community health center between January 2012 and March 2013. Determine the proportion of enrolled paediatric patients lost to follow up. Determine the correlates associated with retention and loss to follow up Methods: The study was a retrospective cohort study of program data of all pediatric patients enrolled into the HIV program in the facility between January 2012 and March 2013. The data was analyzed using SPSS. Results: Of the 100 pediatric patients enrolled during the study period, 79 and 21 were HIV negative and positive respectively. Only 4 (5%) of the HIV exposed Infants and 11 (52%) of the HIV positive children were started on ART within the study period. The retention rate of the children at 3 months was 87% while the retention at both 12 and 15 months was 79%. There was an association between the mother or guardian disclosing their status and the retention of the child (p-value 0.026) Conclusion: The disclosure of the HIV status by parent/guardian to the child was associated with better retention of the children in the program

Uptake and outcomes of early infant male circumcision services in four counties in Western Kenya

Background: Early Infant Male Circumcision (EIMC) is part of sustainable HIV prevention strategies in Kenya. The goals of the national EIMC program are to circumcise at least 40% of all newborn male infants delivered at hospitals offering the service and keep the rate of moderate and adverse events below 2%. Objectives: To determine the proportion of early male infants (age less than 60 days) born at hospitals in four counties of western Kenya who got circumcised and document the prevalence of adverse events (AEs) among those circumcised. Methods: A retrospective descriptive study involving all records for EIMC from 1st March 2014 through 31st March 2018 in four counties of western Kenya. Data analysis was done using EXEL to document proportion of facilities offering EIMC and compare EIMC uptake and outcomes in the four counties against the national goals for the program. Results: A mean of 4.3% of total health facilities offer EIMC in the region. Siaya had the highest proportion of facilities offering EIMC while Migori had the lowest proportion. Uptake of EIMC was low at 17.4% for all male infants born, far less than the anticipated target of 40%. Average adverse event rates were 0.3%. Conclusion: EIMC uptake remains low in this region of Kenya due to small number of health facilities offering the service. The proportion of circumcised early male infants born at the target health facilities is below the national target of 40% even though the rate of adverse events among those circumcised is acceptable

Factors affecting adherence to antiretroviral therapy among children and adolescents living with HIV in the Mbita Sub-County Hospital, Homa Bay- Kenya

Background: Adequate adherence to antiretroviral therapy (ART) is key to the successful treatment of children and adolescents living with HIV. Continuous ART Adherence is the key factor for virologic suppression and stability of the immune system and prevents the occurrence of opportunistic infections. Children and adolescents struggle with adherence to ART for various reasons, including a poor psychosocial support system and clinic attendance. Objectives: To describe the uptake of HIV treatment services among children and adolescents in the Mbita Sub-County Hospital, Homa Bay and determine how schooling, clinic attendance, and type of pill/regimen affect adherence to ART and viral suppression. Methods: This retrospective study was conducted at the Mbita Sub-County Hospital. Medical chart data was abstracted from the hospital files of children and adolescents between the ages of 0-19 years on antiretroviral therapy, between the periods of October 2016 and September, 2017. Data was analyzed using measures of central tendency, and cross-tabulations were done to compare schooling, clinic attendance, type of pill/regimen and viral suppression. Univariate and multivariate logistic regression analyses were conducted to determine associations between groups. Results: According to patient files reviewed, majority of patients, 244(91.4%) were enrolled into care within 2 weeks of HIV diagnosis according to guidelines, and 193(73.1 %) remained enrolled in care at end of study period. An overall viral suppression of 74.2 %( 132) was recorded. Of all the files reviewed, 121(74.7%) of patients attending school suppressed against 11(68.8 %) out of school, p=0.280. Suppression among Day and boarding reported at 78.6 %( 11) and 74.8 %( 113) of those out of school, respectively, p=0.533. Participants in primary school, 17(85.0%) suppressed better than those in secondary school, 102(73.4%), p=0.263. Keeping clinic appointments among eligible patient files reviewed decreased from 83.1% at 3 months, p=0.016, to 76.6%, p=0.526 at 6 months and to 52.9% at 12 months, p=0.278. Only 3- month clinic appointment return rates and Enhanced Adherence Counseling (EAC) were significant predictors of viral supression \u3c72 (2) = 0.280, p = 0.869 (> 0.05). Conclusion: The clinic attendance rate within the first 3 months, and Enhanced Adherence Counseling (EAC) were significant predictors of viral suppression, and therefore adherence to antiretroviral therapy

Prevalence and risk factors associated with depression in pregnant adolescents in Nairobi, Kenya

Background: Adolescent parenthood can be associated with a range of adverse outcomes for young mothers such as depression, substance abuse, and posttraumatic stress disorder. Identification of depression and understanding risk factors among pregnant adolescents is important for development of appropriate interventions and programs focused on adolescent mental health. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant adolescents in Nairobi, Kenya. Methods: We recruited 153 pregnant adolescent (14-18 years) who were accessing maternal health services in one of two Nairobi County primary health care facilities in the cross-sectional survey conducted in 2021. The Patient Health Questionnaire 9 was used to screen for depression. Multivariate Stepwise linear regression modelling was used to identify key predictors of depression. Results: Using a cut off of 10 and above on PHQ-9, we found that 43.1% of the respondents were depressed. Depressive symptoms in were independently associated with being in school, experience of intimate partner violence, substance use within the family and having experienced pressure to use substances by family or peers. Limitations: Cross-sectional by design and the applications of our findings are limited to settings that are similar to our study population. The PHQ-9 used has not been psychometrically validated locally in this sample. Conclusion: We found a high prevalence of depressive symptoms among respondents. These risk factors identified merit further investigation. Comprehensive mental health screening needs to be integrated in primary and community health services on the possible presence of depression

Antiretroviral therapy outcomes among adolescents and young adults in a Tertiary hospital in Kenya

Background: Limited data is available on the treatment outcomes of HIV infected adolescents and young adults (AYA) in sub-Saharan Africa. HIV-infected adolescents and young adults (AYA) are at high risk of developing antiretroviral treatment failure. Objective: To determine the clinical, immunological and virologic outcomes of AYA at a tertiary hospital in Kenya. Methodology: A longitudinal study was conducted among AYA age 10-24 years attending Kenyatta National Hospital comprehensive care center. Clinical data was abstracted from electronic medical records for study participants with at least 6 months of follow-up using a structured data abstraction sheet. Results: A total of 250 AYA age 10 to 24 years were included. The median age was 16 years. The median CD4 cell count was 650.6 cells/mm3 (IQR 350.7-884.0). More than half (60.6%) of AYA had a CD4 cell count higher than 500 cells/mm3. Overall, 76.9% of AYA had achieved viral suppression (viral load <1000 copies/ml). There was a significant increase in virologic failure with higher age and late adolescents and young adults were more likely to have a viral load > 1000 copies/ ml p<0.012. Conclusion: The overall virologic suppression in this cohort of AYA was sub-optimal. Both immunological and virologic outcomes were worse among late adolescents (18-19 years) and young adults (20-24 years)

Mapping services at two Nairobi County primary health facilities: identifying challenges and opportunities in integrated mental health care as a Universal Health Coverage (UHC) priority

Abstract: Introduction There is a need to scale-up mental health service provision in primary health care. The current extent of integration of mental health in primary care is pertinent to promoting and augmenting mental health at this level. We describe a facility mapping exercise conducted in two low-income/primary health facilities in Kenya to identify existing barriers and facilitators in the delivery of mental health services in general and specifically for peripartum adolescents in primary health care as well as available service resources, cadres, and developmental partners on the ground. Method and measures This study utilized a qualitative evidence synthesis through mapping facility-level services and key-stakeholder interviews. Services-related data were collected from two facility in-charges using the Nairobi City County Human Resource Health Strategy record forms. Additionally, we conducted 10 key informant interviews (KIIs) with clinical officers (Clinicians at diploma level), Nurses, Community Health Assistants (CHAs), Prevention of Mother-to-child Transmission of HIV Mentor Mothers (PMTCTMs), around both general and adolescent mental health as well as psychosocial services they offered. Using the World Health Organization Assessments Instrument for Mental Health Systems (WHO-AIMS) as a guideline for the interview, all KII questions were structured to identify the extent of mental health integration in primary health care services. Interview transcripts were then systematically analyzed for common themes and discussed by the first three authors to eliminate discrepancies. Results Our findings show that health care services centered around physical health were offered daily while the mental health services were still vertical, offered weekly through specialist services by the Ministry of Health directly or non-governmental partners. Despite health care workers being aware of the urgent need to integrate mental health services into routine care, they expressed limited knowledge about mental disorders and reported paucity of trained mental health personnel in these sites. Significantly, more funding and resources are needed to provide mental health services, as well as the need for training of general health care providers in the identification and treatment of mental disorders. Our stakeholders underscored the urgency of integrating mental health treatment, prevention, and well-being promotive activities targeting adolescents especially peripartum adolescent girls. Conclusion There is a need for further refining of the integrated care model in mental health services and targeted capacity-building for health care providers to deliver quality services

The Medical Education Partnership Initiative (MEPI): Innovations and Lessons for Health Professions Training and Research in Africa

MEPI was a $130 million competitively awarded grant by President's Emergency Plan for AIDS Relief (PEPFAR) and National Institutes of Health (NIH) to 13 Medical Schools in 12 Sub-Saharan African countries and a Coordinating Centre (CC). Implementation was led by Principal investigators (PIs) from the grantee institutions supported by Health Resources and Services Administration (HRSA), NIH and the CC from September, 2010 to August, 2015. The goals were to increase the capacity of the awardees to produce more and better doctors, strengthen locally relevant research, promote retention of the graduates within their countries and ensure sustainability. MEPI ignited excitement and stimulated a broad range of improvements in the grantee schools and countries. Through in-country consortium arrangements African PIs expanded the programme from the 13 grantees to over 60 medical schools in Africa, creating vibrant South–South and South–North partnerships in medical education, and research. Grantees revised curricular to competency based models, created medical education units to upgrade the quality of education and established research support centres to promote institutional and collaborative research. MEPI stimulated the establishment of ten new schools, doubling of the students’ intake, in some schools, a three-fold increase in post graduate student numbers, and faculty expansion and retention. Sustainability of the MEPI innovations was assured by enlisting the support of universities and ministries of education and health in the countries thus enabling integration of the new programs into the regular national budgets. The vibrant MEPI annual symposia are now the largest medical education events in Africa attracting global participation. These symposia and innovations will be carried forward by the successor of MEPI, the African Forum for Research and Education in Health (AFREhealth). AFREhealth promises to be more inclusive and transformative bringing together other health professionals including nurses, pharmacists, and dentists.<p