Kenya is home to more than 1.4 million people living with HIV with adolescent girls and young women (AGYW) being disproportionately affected by HIV when compared to their male counterparts. Having a partner of unknown HIV status is associated with HIV acquisition among AGYW in HIV high-burden settings and increasing knowledge of male partner HIV status is an HIV effective prevention strategy. Therefore, increasing access to HIV testing for AGYW and their partners is crucial. Recent studies demonstrate the acceptability and feasibility of a secondary distribution strategy to promote male partner HIV testing through provision of multiple HIV self-test to women seeking health services. We piloted provision of HIV self-test kits for secondary distribution to male partners among AGYW seeking contraception at 4 commercial pharmacies in Kisumu, Kenya. We recruited 40 AGYW who were purposively sampled based on whether or not they offered their male partner(s) the HIV self-test kits. Participants will return for a 1-month follow-up visit where we will conduct qualitative in-depth interviews (IDIs) among the subset to elicit each participant’s experience with the kits. A thematic approach will guide an iterative process of transcript coding and data analysis using Atlas.ti software. Qualitative methods will be used to explore factors influencing why or why not the kit was offered to male partner(s), in addition to any barriers or facilitators related to offering the kit. We anticipate barriers to offering HIV self-tests to male partners will include relationship climate and fear of negative partner reactions. By understanding the barriers and facilitators experienced by AGYW when offering the kits to their male partners, we can gain insight about how to successfully increase access to HIV testing among this population.

Respiratory viruses are a major cause of death worldwide, with an estimated 2.7 million deaths in 2015. There are currently no vaccines available for many infections responsible for common respiratory diseases including respiratory syncytial virus (RSV), human metapneumovirus (HMPV), and human parainfluenza virus types one (HPIV1) and three (HPIV3). The aim of this project is to evaluate in vitro and in vivo whether administration of a bi-specific antibody (bsAb) could help prevent and treat infections caused by the previously mentioned viruses. Binding and neutralization by bsAbs are evaluated using bio-layer interferometry and plaque reduction assays, respectively. We have designed and produced multiple formats of bispecific antibodies. We have tested one of them and found so far that this bsAb binds RSV, HMPV and HPIV3 well and neutralizes RSV, HPIV1 and HPIV3. Testing of the other bsAb formats in vitro and in vivo are in progress. The findings of this study will lead to the development of novel strategies for protecting vulnerable patients from respiratory viral infections. 

The utilization of crowdfunding websites has grown in popularity, particularly in the arena of medical crowdfunding to cover costs due to inadequate health insurance coverage and lack of social safety-net systems in place. Research on medical crowdfunding in global health contexts is not robust, and knowledge about its impacts on health outcomes is limited. What is known is that unmet health disparities are driving the need for medical crowdfunding, and crowdfunders face numerous disparities that impact campaign outcomes, such as racial or gendered biases among campaign donors. Using descriptive statistics and content analysis of viral medical campaign data from the GoFundMe site, this research helps create an archetype for the most successful campaigns and examine social ideas of deservingness related to race, gender, and severity of the disease. The results show stark disparities in medical crowdfunding outcomes based on race and gender and a lack of diverse representation among highly successful crowdfunding campaigns, particularly in the case of Black women. This mixed methods research analysis looks to create further discussion on how technology may aid in creating health inequities for already marginalized and traditionally disenfranchised populations.

 Decreases in the bone density of the metacarpals due to age and disease can make orthopedic procedures such as fracture fixation challenging. There is limited information in the literature regarding the effect of age and sex on the patterns of these density changes across the bone. Characterizing these changes could assist the surgeon in planning optimal instrumentation placement. For this study, we used opportunistic QCT to perform a detailed assessment of bone density in the metacarpals. We hypothesized that changes in the cortical and trabecular density on a local level would be significantly associated with age and sex, and we aimed to identify these regions as well as overall patterns of change. In addition, we aimed to provide detailed visualizations of the results to demonstrate these regional changes and determine which regions had the highest variability. Fifty 3-dimensional models of the metacarpals were segmented from routine clinical computed tomography (CT) scans, and detailed calibrated bone density measurements obtained for each bone model. The effects of age and sex on bone density were assessed for the all the metacarpals. Specific regions where these factors had a significant effect were identified. Three dimensional models were generated to allow clear visualization of the changes in density patterns. Initial results from this study show that changes in the bone density distribution of the metacarpals are associated with factors including sex and age. This information could help with future implant design and with further development could provide patient-specific data to assist with surgical planning.

Depression is world’s leading cause of disability, yet only 1 in 23 people in low-and-middle income countries (LMICs) receive minimally adequate depression treatment. A common antidepressant is amitriptyline, which is classified as an essential medication by the World Health Organization. However, there is only limited evidence of the availability of essential psychiatric medicines in LMIC health facilities. The Demographic and Health Surveys Program conducts the Service Provision Assessment (SPA) to understand availability of services and essential medicines in LMIC health facilities. We analyzed available SPA data for Afghanistan, Bangladesh, Democratic Republic of Congo, Malawi, Nepal, Senegal and Tanzania to understand the distribution and determinants of amitriptyline availability in each country. We analyzed data from 9470 health facilities. Overall, only 12% of sampled facilities had amitriptyline on the day of assessment, suggesting that the majority do not carry amitriptyline. Multivariable regression models indicated that faith-based and private-for-profit facilities were more likely than public facilities to have amitriptyline, and that hospitals were more likely than primary care facilities to have amitriptyline. The gap between hospitals and primary facilities were wider in the same country than between them. Our results indicate a severe shortage of amitriptyline in health facilities in these eight LMICs. Efforts to narrow the mental health treatment gap by integrating mental health services into primary care will be limited without the availability of essential medicines like amitriptyline. Expanded purchasing and distribution of amitriptyline, especially to LMIC primary care facilities, is warranted.

Kenya has the fourth-largest HIV epidemic globally, with adolescent girls and young women (AGYW), ages 15-24, holding the highest number of HIV infections. Antiretroviral-based daily oral pre-exposure prophylaxis (PrEP) for HIV prevention reduces HIV acquisition risk by over 95%. Kenya is a leader for PrEP delivery in Africa and efforts are ongoing to increase PrEP accessibility; however, most approaches include expanding access within health facility-based settings. Many AGYW at-risk for HIV in Kenya access contraception at commercial pharmacies without interfacing with public sector health facilities. Commercial pharmacies could increase options for reaching AGYW at-risk of HIV with PrEP services. We piloted nurse-facilitated PrEP provision at 3 commercial pharmacies in Kisumu, Kenya. PrEP-prescribing nurses counseled on and offered PrEP to all AGYW purchasing contraception per national guidelines. AGYW who accepted PrEP were provided with a free one-month supply of PrEP pills. We evaluated acceptance among all AGYW offered PrEP; at 30 days after acceptance, we evaluated PrEP use initiation, and plans for continuation among those who accepted PrEP. We enrolled AGYW until 200 AGYW had accepted PrEP . We will use a concurrent triangulation mixed methods study design. Among a subset of 40 AGYW who initially accepted PrEP pills, we will conduct qualitative in-depth interviews (IDIs) to examine user experience of pharmacy-delivered PrEP. We anticipate that AGYW will report positive user experiences with pharmacy-based PrEP and that offering PrEP in this setting will increase accessibility to HIV prevention treatment options for AGYW. Quantitative data analysis will compare socio-demographic and behavioral characteristics between AGYW who do and do not accept PrEP. Data from this study will help determine if pharmacy-based PrEP convenience is feasible as it could increase PrEP availability and work as a model for future implementation.