HIV/ AIDS

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Cultural adaptation of an evidence-based psychosocial screening tool for adolescents living with HIV/AIDS in adolescents’ antiretroviral therapy program in Zomba, Malawi
(Kamuzu University of Health Sciencies, 7-07-21) Kip, Esther C.
Executive Summary D. Title of the study: Cultural adaptation of an evidence-based psychosocial screening tool for adolescents living with HIV/AIDS in adolescents’ antiretroviral therapy program in Malawi Problem Statement: In Malawi, a study on depression among adolescents living with HIV (ALHIV) revealed a prevalence rate of 18.9%3. Despite the high prevalence and impact of depression on ALHIV health outcomes, lack of awareness and stigma around mental health services leave ALHIV with depression undetected and there are few culturally, sensitive, standardized, and validated instruments available for depression screening in the African region1,6. The Home, Education, Activities, Drugs, Sexuality, Suicide/Depression (HEADSS) psychosocial screening tool, is an efficacious evidence-based intervention (EBI)8-10 to improve identification of psychosocial issues, such as depression screening and risky behavior. This tool was recommended for use in the adolescent antiretroviral therapy (ART) program called Teen Club (TC) in Malawi in an attempt to identify the above-mentioned challenges. However, its introduction has had poor uptake. Our previous formative study on “Implementation barriers of the HEADSS screening tool in Teen Club Program in two districts in Malawi” found that HEADSS was too long, time consuming and not culturally appropriate to the Malawi setting and some of the suggestions included modification of this tool in order to be culturally acceptable for use in Malawi. Therefore, this current study builds upon our previous findings. Main objective of the study: The long-term goal of this study is to culturally adapt the HEADSS psychosocial screening tool based on our formative work, identify the barriers and facilitators to implementing the modified HEADSS, and identify implementation strategies to address identified barriers to improve the mental health outcomes among ALHIV in Malawi. Specific Objectives are to: 1) Review prior formative study findings and conduct systematic modifications process of the existing HEADSS psychosocial screening tool. 2) Identify the barriers and facilitators to the implementation of the adapted HEADSS among the HCPs in Teen Club program and ALHIV in order to understand the usability and acceptability of the adapted HEADSS screening tool. 3) Based on the findings in objective 2, identify implementation strategies to address the identified barriers to improve the mental health outcomes among ALHIV in Malawi. Methodology: This will be a cross-sectional descriptive qualitative study design and it will take place in Zomba district (Zomba Central Hospital and 1 health center). A purposive sampling approach will be used to select the participants. In-depth interviews (IDIs) using a semi-structured questionnaire will be conducted with key informants (KIs) and health care providers (HCPs) then FGDs with adolescents living with HIV (ALHIV) between 12 and 18 years old. The sample will comprise of 1 clinical psychologist, 1 psychosocial counsellor, 1 Adolescent Coordinators from the NGOs, 1 District Nursing Officer as key informants and 4 HCPs from the Health center and 2 from Zomba Central Hospital Teen Club Program (Lighthouse). A similar proportion of male and female ALHIV will be included in the FGDs from each site, totalling to 20 ALHIV in the 2 sites. An estimated total of 30 research participants will be included in this study. Potential constraints: Not many ALHIV might feel comfortable to speak up, however, our formative study showed that the ALHIV were open and expressed themselves without any problem. The training will be provided to the Research Assistant prior to commencement of data collection, and this will deliver specialized communication skills to enable ALHIV to feel free and speak out on their experiences. Support will be provided to those ALHIV who need to be referred to specialized mental health services and the research team will be trained to ensure that a correct support and referral system is in place before the start of data collection. Some participants may also experience discomfort to respond to the questions, however, they will be informed during the consenting process that they have the right to refuse to answer any question that makes them uncomfortable and to stop the interview at any time. In addition, while the research is aiming to reach an equal number of females and males, it may not be possible be get a gender balanced participation. However, we will communicate these limitations clearly during feedback, recommendation and dissemination activities. Additionally, due to the Covid pandemic, it might be a challenge to get the number of ALHIV on the appointed date as there is limited number of staff and ALHIV assigned for each day. We might even have to do face-to face interviews instead of FGDs depending on how the situation will be during
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“Factors associated with antiretroviral therapy defaulting among HIV positive youth in Mzimba south, Malawi”. by Isaac Paul Kasalu
(Kamuzu University of Health Sciences, 8-10-21) Kasalu, Isaac Paul
Thetype of research study:The researcher proposes to conduct a case control studyto identify factors associated withAnti-retroviraltherapy(ART)defaulting among the Human ImmunodeficiencyVirus (HIV)positiveyouthsaccessing HIV carein MzimbaSouth Districtof Malawi. The problem:There is evidence thatART defaulting is highest amongHIV positiveyouth in Malawi. Studies conducted in someparts ofMalawiindicatethatbetween 11 and 30 per 100HIV positiveyouthsdefault ART. ART defaulting has been associated with development ofdrug resistance in individuals enrolled onART. This could lead to increased morbidity and mortality of HIV positive clients due toresurgence ofopportunistic infections. In addition,an ARTresistant strain of HIVcan be transmitted from one patient taking ARVs to anotherthrough unprotected sexual intercourse.Evidencesuggeststhat physical, psychological,socialeconomic,demographic and health facilityfactors can contribute to ART defaulting.Nevertheless,there is scarcity of reportedevidence regarding specific factorsthat contribute to ART defaulting among the youth in Mzimba.Thisstudy therefore,aims atassessingfactorsinfluencingARTdefaulting in HIV positive youth enrolled onARTinMzimba. Objectives:The main objective of this study is to determine factors contributing to defaulting amongHIV positive youth enrolled on antiretroviral therapy in Mzimba South District.Specific objectives are:to determine prevalence of ART defaulting among the youth living with HIV in Mzimba South district;to assess patient (physical, psychological) related factors influencing ART defaulting among the youth in Mzimba South;to assess availability of communitysocial support initiativesfor youth on ART program;to identify healthfacilityinitiativesfor youths accessing HIV care in Mzimba Southand to identify risk factors for ART defaulting among the youth accessing HIV carein Mzimba South District. Methodology:Thisstudy will utilizeaquantitative,case control design.A sample population of 411HIV positive youth(137cases and274controls) attendingan HIV careclinic will be recruited. BothART defaulters and non-defaulterswill beenrolledinthis studyusing stratified random sampling technique.Data will be collected using astructured questionnaire.Datawill be analyzed using the Statistical Package for Social Scientists (SPSS)version 20.0.Chi-squareandbinary logistic regression will be carried out to establish relationship between ART defaulting and the independent variables. Expected findings anddissemination:It is expected thatthis study will identify specific factors that contribute to defaulting of treatment among the youth livingwith HIVandAIDSin Mzimba South.Findingsfrom this studywill be disseminated to the health facility management and care providers in respective facilities where the study will be conducted.Furthermore, resultswill be shared to the District ExecutiveCommittee (DEC)for M’mbelwa council, Kamuzu College of Nursing,College of medicine research and ethics committee (COMREC)and other research seminars. The manuscripts shall also be prepared for publication.
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Strategies for linking HIV exposed infants to HIV care services at South Lunzu health centre by Rhoda Salome Kunje
(Kamuzu University of Health Sciences, 12-05-21) Kunje, Rhoda Salome
Background: HIV exposed infant care in Malawi is integrated with maternal ART follow-up to improve retention. Malawi National HIV Testing and Counselling (HTC) guide lines for HIV –exposed infants recommend a DNA PCR test done at 6 weeks, followed by 2 confirmatory rapid tests at 12 and 24 months to determine the HIV status of HIV exposed infants. Infants also receive 6 weeks of Nevirapine(NVP) starting at birth and early infant HIV DNA polymerase chain Reaction(PCR) diagnosis using dried blood spots after 6 weeks of age are done, Infants are clinically followed up until determination of final HIV infection status(1). Despite efforts to improve retention, lost to follow-up remains a challenge in the care of HIV exposed infants. Astudy done by Wingston F. Ng’ambi and others in Lilongwe Malawi showed that overall 48% of HIV-exposed infants were declared lost to follow-up due to a number of reasons (2). Available data at South Lunzu health facility in Blantyre Malawi, demonstrates that from 2018 to 2020, there has been increased numbers of children who have defaulted from HIV care services especially at 12 months and 24 months after being initiated in care.In 2018, out of the 213 HIV exposed infants that were enrolled at 2 months,96.6% were retained in care and 2.4% was the default rate.At 12 months 190 infants were enrolled in care and 70.4% was the retaintion rate and 9.6% was the default rate.At 24 months 176 infants were enrolled and there was 57.4% retaintion rate and 42.6% default rate.In 2019, 175 HIV exposed infants were enrolled and retention rate was at 97.6% and default rate was at 2.4%. At 12 months 162 HIV exposed infants were enrolled, 81.8% was the retention rate and 18.2% was the default rate. At 24 months, 146 infants were enrolled and retention rate was 61.1% and 38.4% was the default rate. This trend of defaulting from HIV care continued for the year 2020 especially as the children grew older. For this study, the researcher expects to find that there are no strategies or interventions at the health facility that are put in place to link back the HIV exposed infants who are lost to follow up for HIV health care services despite the increased default rates. PROBLEM STATEMENT Early Infant Diagnosis (EID) of HIV infection at the primary care level in Malawi is challenging. Many children are indeed tested for HIV and some are found to be HIV infected while others are HIV uninfected in the HIV diagnosis and treatment program and they are lost to follow-up at various stages. In Malawi’s option B+, loss to follow-up remains a great challenge in the care of HIV exposed infants, and although the Malawi government recommends HIV exposed infants receive Early Infant Diagnosis(EID) at under-five Paediatric clinics, most of these children are never enrolled. In 2014, less than 20% of HIV-exposed infants received early infant diagnosis test in the first 2 months of life, and only 30% of the HIV infected children were on antiretroviral therapy (13). Those children who are lost to follow are at higher risk of infection and opportunities to enter them into care are rare, consequently these children do not come back, if they come at all, its until they develop serious AIDS- defining illnesses, leading to death. OBJECTIVES: The aim of the study is to explore strategies for linking HIV- exposed infants who are lost to follow-up back into HIV care services at South Lunzu Health Centre in Blantyre,Malawi.Specifically, the study seeks to determine the proportion of HIV-exposed babies who tested positive to HIV and were lost to follow-up in relation to HIV care services,to describe the views of Health Care workers on effectiveness of the interventions currently in place for linking HIV exposed infants to HIV care services and to establish the remedies suggested by postpartum/breastfeeding mothers who are infected with HIV on minimizing lost to follow up cases amongst HIV positive infants at South Lunzu Health Centre. METHODOLOGY The research is a cross-sectional study using mixed methods (quantitative and qualitative) where data will be collected at the same time or approximately the same time period. Questionnaires and Focus Group Discussions will be used to collect the data at the same time period. The population of interest for this study will include ;HIV positive mothers who have exposed their infants to HIV but are lost to follow-up to HIV services and care, HIV exposed infants, and the health Care Workers at South Lunzu health facility (Nurse midwives, Health Surveillance Assistants, Clinicians, Expert clients).The sample size for the quantintative method will be 384 and participants will be randomly sampled from health records at the facility.The sample size for the qualitative method will be approximately 30, and participants will be purposefully selected.Data collection for the qualitative method will be done right at the health facility in quiet and private rooms through focus group discussions(FGDs).Abstrction sheet will be used to abstract data from health records. Data collected from participants will be securely stored in a computer data base that has a password and limited access will be provided to the study team. Data analysis will be done using deductive thematic content analysis. Informed consent will be obtained from each participant before being enrolled in the study. Confidentiality throughout study participation and therafter will be ensured. Ethical approval will be sought from College of Medicine and Ethics Committee(COMREC). DISSEMINATION OF EXPECTED FINDINGS The results of this study shall be disseminated in writing and presentations as feedback will be made to the: College of Medicine Research Ethics Committee(COMREC), investigators and study team, College of Medicine library, The University Research and Publication Committee(URPC)through the COMREC secretariat, All health workers at South Lunzu Health Centre, District Health Management Team (DHMT)for Blantyre including the Blantyre District PMTCT/EID Technical Working Group and to the wider scientific community through the COM Research and Dissemination Conference and preparation of a manuscript for submission to a peer-review journal.
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Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol
(Kamuzu University Of Health Sciencies, 16-06-21) Phiri, Wyness
This is an analytical cross-sectional study that aims to determine prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital. Problem to be studied Several factors are known to be associated with neonatal sepsis. Despite this, studies that have been conducted in Malawi have focused mainly on causative organisms. Understanding specific factors that are associated with neonatal sepsis is crucial in the prevention and management of neonatal sepsis. Therefore, this study aims at determining neonatal and maternal factors that are associated with neonatal sepsis at KCH in Lilongwe, Malawi. Objectives The study aims to determine factors associated with neonatal sepsis at KCH, Lilongwe Malawi. specifically, to determine the prevalence of neonatal sepsis to determine maternal factors associated with neonatal sepsis, and to determine neonatal factors associated with neonatal sepsis. Methodology We will use secondary data which will be extracted from the case notes. Neonates who were admitted from 1st January to 31st March 2021 will be included in the study. Neonates whose admission and discharge outcome data was captured by Neo-Tree bed-side tablet will be eligible for this study. Simple random sampling will be used to select participants of this study. The study will require a sample size of 380 participants to achieve a power of 80% at a 95% confidence interval. Collected data will be entered and cleaned in Microsoft excel then analyzed in Stata 16.0 to come up with odds ratios. Univariate and multivariate analysis will be done to identify statistically significant factors associated with neonatal sepsis. Expected findings and their dissemination It is expected that neonatal sepsis is associated with preventable risk factors. This study will add knowledge on the risk factors associated with neonatal sepsis which will help in coming up with evidence-based institutional interventions which will aim at reducing neonatal morbidity and mortality. The findings will be disseminated with Kamuzu Central Hospital, Reproductive Health Unit, College of Medicine library, and College of Medicine Research Ethics Committee (COMREC). 3.0 Background information and introduction The neonatal period is defined as the first 28 days of the life of a child. It is the most critical stage of life. Recent reports in 2019 show that 2.4 million children died in the first month of life globally. Sub-Saharan Africa and South Asia contributed to the highest neonatal mortality of 27 and 25 deaths per 1000 live births respectively [1] Recent reports of 2019 show that neonatal mortality for Malawi was at 19.8 deaths per 1000 live births [2]. Neonatal mortality is attributed to three major conditions which are preventable and treatable; Prematurity, intrapartum-related complications like birth asphyxia, and neonatal infections. These three major conditions account for 80% of neonatal deaths. [3] Neonatal sepsis is defined as a clinical syndrome characterized by signs and symptoms of infection in neonates from day 1 of life to 28 days [4]. Neonatal sepsis is divided into two; early- onset which occurs in the first 72 hours of life and late-onset which occurs after 3 to 7 days of life. The most critical one which contributes more to neonatal mortality is the early onset [5]. For a systematic review and a meta-analysis which was conducted, a pooled neonatal sepsis incidence from 26 studies of 2824 neonatal sepsis cases per 100 000 live births was estimated [6]. Neonatal sepsis attributes to 17% of neonatal deaths in Sub-Saharan Africa (SSA) [7]. Despite neonatal sepsis deaths surpassing that of HIV in neonates, neonatal sepsis does not receive much funding as a public health priority worldwide. Neonatal sepsis accounts for an annual economic burden ranging from 10 billion to 469 billion US dollars in SSA [8]. Several pathogens cause neonatal sepsis. Studies that have been conducted in developed countries have reported that group B streptococcus (GBS) is the commonest cause of neonatal sepsis. In developing countries, Gram-negative bacteria is the commonest cause contrary to developed countries. [13] Clinical signs are used to come up with the diagnosis of neonatal sepsis using the Integrated management of childhood illnesses (IMCI) guideline by WHO in developing countries including Malawi [14]. The presence of two or more of the following signs are signals neonatal sepsis; a core temperature of greater than 38.5 degrees Celsius or less than 36 degrees’ Celsius convulsions, bradycardia or tachycardia, lethargy, respiratory distress, apnoea, poor reflexes, abdominal distension, and bleeding [15] [16]. Several studies have been conducted in India [18], Ghana [19] [20], Nigeria [21], Ethiopia [22] [23], and Tanzania [24] [25] to identify maternal and neonatal risk factors associated with neonatal sepsis. Key maternal risk factors associated with neonatal sepsis were premature rupture of membranes (PROM) [18] [23] [25], maternal age [18] [7] [25], and place of delivery [21] [18] [25] while neonatal risk factors were neonatal age [18] [19] [20] [22] [4] [24], use of oxygen via 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021 13 Mask [22] [18] [24], birth weight 20] [23], APGAR score [19] [24], and resuscitation at birth [19] [24]. Curiously, neonatal sepsis was not associated with gestation age [20] [22] [23] [25], antenatal care services [4] [19] [22] [23], and urinary tract infection [14] [19] [22]. A study in Nigeria investigated association of neonatal sepsis with change in antibiotics, and number of switches in antibiotics which were statistically significant factors [21]. These factor has not been investigated in most of studies conducted in Africa. Neonatal sepsis is managed by the administration of broad-spectrum antibiotics, fluids, vasoactive, and/or inotropic support [16]. In developing countries, neonatal sepsis is managed in line with IMCI guidelines as follows; hospitalization of the neonate with rapid administration of antibiotics either intravenously or intramuscularly, a combination of gentamicin and benzylpenicillin or ampicillin for 7-10 days [17]. Efforts have been put in place to achieve the Sustainable Development Goal (SDG) number 3 which aims at ending preventable deaths in neonates and under-fives. Thermal protection by skin to skin contact between a mother and the neonate, hygienic umbilical cord and skin care, early and exclusive breastfeeding, assessment of danger signs, and preventive treatment like immunization with BCG and vitamin K prophylaxis are some of the essential newborn care strategies to improve child survival and wellbeing [9]. However, with the current trends, it is reported that more than 60 countries will not be able to achieve the neonatal mortality target of at least less than 12 deaths per 1000 live births by 2030[10]. The government of Malawi in collaboration with USAID works to prevent neonatal and maternal deaths by integrating evidence-based activities in activities that address vital maternal, neonatal, and child health at households, community, and facility levels. At the facility level, they have provided Basic Emergency Obstetric and Newborn Care (BEMONC) life-saving signal interventions in some districts, the orientation of health workers on Kangaroo Mother Care (KMC), provision of Bubble Continuous Positive Airway Pressure mentorship to health workers through MOH Acute Respiratory Infections Programs and distribution of Maternal Newborn Child Health (MNCH) equipment and supplies [11] In 2015, Every Newborn Action Plan was launched in Malawi to guide the efforts of the Ministry of Health, district officers, and all stakeholders to design specific plans for accelerating progress toward ending preventable deaths among mothers and newborns and avoidable stillbirth. The plan calls for the provision of a skilled attendant at every birth, community involvement in maternal and neonatal care, and strengthening facilities that provide basic emergency obstetric and neonatal care and comprehensive emergency obstetric and neonatal care. [12] 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021 14 4.0 Rationale/ justification for the research project To achieve the sustainable development goal number 3 by 2030 which aims to end preventable deaths of new-born and children under five years of age, there is a need to come up with strategies to reduce these neonatal deaths. Since neonatal sepsis is one of the major causes of neonatal morbidity and mortality, determining factors that are associated with neonatal sepsis at KCH will help in the early identification of neonates at risk of neonatal sepsis and coming up with an evidence-based institutional intervention that may help in reducing neonatal morbidity and mortality. The studies that have been conducted in Malawi have focused on the causative organisms [13] [26]. There is limited scientific knowledge on the factors that are associated with neonatal sepsis in Malawi. Although studies have been conducted in other African countries, findings cannot be applied in Malawi settings due to differences in health systems building blocks that exist among countries; leadership and governance, health care financing, health workforce, medical products and technologies, information and research, and service delivery. Therefore, this study will determine factors that are associated with neonatal sepsis in Malawi. The study will determine associations between maternal age, PROM, place of delivery, neonatal age, use of oxygen via face masks, birth weight, APGAR score, and resuscitation at birth which are statistically associated with neonatal sepsis in studies that have been conducted. The study will also determine associations between intravenous cannulation [24], immediate and exclusive breastfeeding [4], mode of feeding, and neonatal sepsis because few studies have assessed their associations with neonatal sepsis. 4.0 Objectives of the study 5.1 Broad objective To determine prevalence and factors associated with neonatal sepsis at KCH from 1st January 2021 to 31st March 2021 5.1.1 specific objectives  To determine the proportion of neonates with neonatal sepsis  To assessdetermine maternal factors associated with neonatal sepsis  To identifydetermine neonatal factors associated with neonatal sepsis 1 1Maternal age, premature rupture of membranes(PROM), place of delivery, mode of delivery, age 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021 16 of a neonate on admission, birth weight, resuscitation at birth, oxygen administration via face mask, time of initiation of breastfeeding, mode of feeding, APGAR score at one minute and five minutes, intravenous cannulation, and duration of staying in the hospital. 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021 17 6.0 Methodology 6.1 Type of the study This is an analytical cross-sectional study that aims to determine factors associated with neonatal sepsis. 6.2 Study place The study will be conducted at KCH; Ethel Mutharika Nursery in Lilongwe, Malawi. It is located in the central region of Malawi. KCH has been chosen as a study site because it is a tertiary hospital with good diagnostic equipment to diagnosis neonatal sepsis. It also has specialist and consultants who are experts in giving definite diagnosis neonatal sepsis. Since all the facilities in Lilongwe and surrounding districts do not have the capacity to diagnose and manage neonatal sepsis, cases are referred to KCH. Lilongwe has a population of 1,170,870. Ethel Mutharika nursery is a referral facility that admits sick babies from the northern and central regions of Malawi. The facility admits 250 babies per month on average. The facility admits neonates with prematurity, birth asphyxia, neonatal sepsis, pneumonia, prematurity with respiratory distress syndrome, low birth weight, jaundice, congenital abnormalities, gastroschisis, meconium aspiration, and others which are categorized as other conditions. Consultants and specialists help in the management of patients at this facility. It has a bed capacity of about 100. The hospital uses Neo-Tree electronic system data capture to document admissions and outcome data. The Neo-Tree is a bedside digital tablet with an electronic admission form that was developed based on the facility guidelines. In between admission and discharge, care given to patients is documented manually in the case files. All the printouts from the Neo-Tree are attached to the patient's file. 6.3 Study population All neonates who were admitted from 1st January 2021 to 31st March 2021 at the Ethel Mutharika nursery unit will be the study population for this study. This period is when Neo-Tree came into effect at KCH. The system minimizes human errors during data collection. The following is the inclusion criteria; 1. Neonates admitted between 1st January 2021 to 31st March 2021 2. Case notes which data was captured by Neo-Tree on admission The following is the exclusion criteria; 1. Neonates admitted out of the study period 2. Case notes which data was not captured by Neo-Tree on admission 16-Jun-2021 Prevalence and factors associated with neonatal sepsis at Kamuzu Central Hospital, Lilongwe, Malawi. Study protocol, v 1.0. 13/04/2021 version 2.0 P. 04/21/3310 - 26/05/2021
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Assessing the perception and knowledge of voluntary medical male circumcision among middle aged men in peri-urban, Blantyre
(Kamuzu University of Health Sciencies, 18-10-21) Khuliwa, Innocent; Singano,Nomsa; Chivunga, Constance
Adequate sleep contributes to a student’s overall health and wellbeing. Getting proper amount of sleep helps one to stay focused, improve concentration and academic performance. Studies have shown that most youths who do not get enough sleep have a high risk of having many health problems including, obesity, DM type 2, poor mental health and injuries. They are more likely to have attention and behavioral problems which can contribute to poor academic performance. College students are among the most susceptible group of people to poor sleeping habits due to the increased academic pressure. Recent studies have shown that students with medical related majors are more likely to have poor quality of sleep in comparison to those with a humanities major. Despite the established evidence on how important sleep is, no studies have been conducted here in Malawi to assess quality of sleep among college students. This study seeks to bridge this gap by assessing quality of sleep and its associated factors among undergraduate medical students at Kamuzu University of Health sciences, Blantyre campus, Malawi. This research will be a cross sectional study design. Our problem objectives will be to establish the association between quality of sleep and other factors such as gender and mental health. A sample size of 428 will be used and participants will be systematically selected from the classes. Questionnaires will be used to collect data on both sleep quality and mental health. A Pittsburgh sleep quality index (PSQI) and patient health questionnaire (PHQ 9) will be used respectively. Data will be entered into excel and analyzed using epi info software. By the end of the study we expect get data on quality of sleep among medical students as well as its associated factors. This assessment will help us evaluate the extent of the burden of poor sleep among college students and how much this burden is affecting their life more especially academic performance. In the end we will be able to develop proper interventions such as proper sensitization on good sleep health. This will ensure that students get good quality sleep and in turn reduce the complications associated with poor sleep. The results of this study will be presented in a full report to COMREC. We will also present our study findings at an annual College research dissemination conference. The results will also be made available on medical research journal websites
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Effect of Covid – 19 on Antiretroviral Treatment Therapy Outcomes in HIV/AIDS Clients at Partners in Hope, Lilongwe
(Kamuzu University of Health Sciences, 19-01-22) Lifumba, Marlone
Type: A retrospective cohort study to study impact of covid-19 on antiretroviral treatment therapy outcomes in HIV/AIDS clients. Problem: HIV/AIDS remains a big challenge worldwide especially in Southern Africa estimated at 37.9 million while in Malawi it’s at 1.1 million persons. Essentially, Anti-Retroviral Therapy (ART) have improved the livelihoods of people living with the disease as there is no cure to date but uptake is meeting challenges, at present Covid 19 being the main culprit. As such ART adherence is estimated at 65% thus for Partners in Hope though Malawi as a whole; it’s estimated at 75%. Treatment failure has resulted due to these adherence issues. This adherence level to ART is suspected that it may have dropped from 65% during the covid era as different clients have been switched on treatment regimens, more hospital admissions and, more deaths from those suffering from both HI/AIDS (and on treatment) and covid 19. Therefore, the study aims to effect of covid– 19 on antiretroviral treatment therapy outcomes in HIV/AIDS clients. Main Objective: To investigate the impact of covid-19 on antiretroviral treatment therapy outcomes in HIV/AIDS clients. Specific objectives: i). To evaluate risk factors of primary study outcomes including sociodemographic factors with ART outcomes during covid-19 pandemic. ii) To compare the incidence of primary study outcomes before and during covid 19 pandemic. Methodology: A retrospective cohort study design will be utilized to conduct this study. 82 participants will be recruited in the study through their patient files by data collectors: nurses and midwife technicians. Viral load results for the 2 years prior and during Covid-19 will be utilized to compare their health outcomes between the two time periods. Data will be collected from viral load registers and patient files through a question checklist formulated by the investigator. Data will be entered in Microsoft Excel and exported into Stata v14.0 for analysis. Permission to conduct the study will be sought from COMREC, Partners in Hope and Lilongwe District Council.
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Assessing the utilization of cervical cancer screening services and its associated factors among HIV positive women in settings of integrated HIV/cervical cancer screening in Rural Malawi, a case of Thyolo District
(Kamuzu University of Health Sciences, 21-10-18) Ngwalangwa, Victor Goldon
1.1 TYPE OF STUDY This will be a descriptive facility based cross-sectional study aimed at determining the proportion of HIV positive women who have ever been screened for cervical cancer and establishing its associated factors in settings of integrated HIV/Cervical cancer screening services in Thyolo District, Rural Malawi. 1.2 THE PROBLEM High HIV prevalence rate in Malawi, (10.6% of adults aged 15-64 years)(1) has been linked withto increased cases of cervical dysplasia and neoplasia in Malawi.Consequently Likewise, there is a high incidence, of cervical cancer with (75.9.age standardised per 100,000)(2) and more than 80% of Malawian women diagnosed at an inoperable cancer stage,leading toe(3) leading to high mortality rates among cervical cancer patientspatients. All these that havesve also largely been attributed to low cervical cancer screening uptake (27% and 15% for the general women population and women living with HIV respectively).(4) The Malawi cervical cancer screening guidelines recommend that HIV-positive women should have annual cervical screening at their baseline evaluation, thereafter, annually for those with normal results. But utilization of these services remains low in Malawi even in this population despitewho are most of them having access to health workers through routinely attendance ating Anti-retroRviral Therapy(ART)T clinics(5). The uptake of cervical cancer screening among HIV positive women in MalawiThe above stated figures raises a concern as they still fall short of the Malawi national target of 80 percent despite being a high risk group for cervical cancer. District level efforts to improve uptake of cervical cancer needs to be implemented to improve the overall uptake for the country. However, there is a need to understand the current uptake of the screening and the factors associated with screening among the HIV positive patients in Thyolo. This study therefore will look at the prevalence of cervical cancer screening and factors associated with its uptake in clinics where HIV and cervical cancer screening services are integrated in Rural areas.
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Assessing the utilization of cervical cancer screening services and its associated factors among HIV positive women in settings of integrated HIV/cervical cancer screening in Rural Malawi
(Kamuzu University of Health Sciences, 21-10-18) Ngwalangwa, Victor
1.1 TYPE OF STUDY This will be a descriptive facility based cross-sectional study aimed at determining the proportion of HIV positive women who have ever been screened for cervical cancer and establishing its associated factors in settings of integrated HIV/Cervical cancer screening services in Thyolo District, Rural Malawi. 1.2 THE PROBLEM High HIV prevalence rate in Malawi, (10.6% of adults aged 15-64 years)(1) has been linked withto increased cases of cervical dysplasia and neoplasia in Malawi.Consequently Likewise, there is a high incidence, of cervical cancer with (75.9.age standardised per 100,000)(2) and more than 80% of Malawian women diagnosed at an inoperable cancer stage,leading toe(3) leading to high mortality rates among cervical cancer patientspatients. All these that havesve also largely been attributed to low cervical cancer screening uptake (27% and 15% for the general women population and women living with HIV respectively).(4) The Malawi cervical cancer screening guidelines recommend that HIV-positive women should have annual cervical screening at their baseline evaluation, thereafter, annually for those with normal results. But utilization of these services remains low in Malawi even in this population despitewho are most of them having access to health workers through routinely attendance ating Anti-retroRviral Therapy(ART)T clinics(5). The uptake of cervical cancer screening among HIV positive women in MalawiThe above stated figures raises a concern as they still fall short of the Malawi national target of 80 percent despite being a high risk group for cervical cancer. District level efforts to improve uptake of cervical cancer needs to be implemented to improve the overall uptake for the country. However, there is a need to understand the current uptake of the screening and the factors associated with screening among the HIV positive patients in Thyolo. This study therefore will look at the prevalence of cervical cancer screening and factors associated with its uptake in clinics where HIV and cervical cancer screening services are integrated in Rural areas
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Factors associated with conducting repeat HIV testing among pregnant women during the third trimester in Blantyre by Martha Kaula
(Kamuzu University of Health Sciencies, 28-10-21) Kaula, Martha
Type of Study: A convergent parallel mixed-methods study design will be used to collect, analyse and interpret quantitative and qualitative data. Problem statement Mother to child transmission of HIV during pregnancy remains high in Malawi currently at 13% (15). A repeat HIV testing has been adopted in antenatal guidelines as one of the strategies in eliminating paeditric HIV infection in Malawi since 2019 (2). However, there is scanty information on repeat HIV testing among pregnant women and associated factors to its implementation, hence the need for this study. Objectives of the study The overall objective of the study is to investigate the factors associated with conducting a repeat HIV test among pregnant women in the third trimester specifically to; 1. determine the proportion of pregnant women who received a repeat HTC in the third trimester in 2020. 2. assess clients’ characteristics that influence uptake of repeat HIV test among pregnant women in the third trimester. 3. assess clinic organisational factors that influence uptake of repeat HIV test among pregnant women in the third trimester. 4. explore intervention characteristics that influence uptake of repeat HIV test among pregnant women in the third trimester. 5. identify strategies at service delivery level and health workforce that can increase uptake of repeat HIV test in the third trimester. Methodology The study which will use case review for quantitative and exploratory cross-sectional design for qualitative data. Study setting The study will be conducted in Blantyre district at Ndirande and Lirangwe primary health facilities. Study population Antenatal clients assisted from July 2019 to June 2020 will constitute population for the quantitative approach. All the pregnant women, postnatal women, PMTCT providers and HCT will comprise the population for the qualitative data. Study period The study will be conducted over a period of ten (10) months from June 2021 to March 2022. Sample size A total of 1024 records of antenatal women will be reviewed to collect quantitative data while 62 participants will be selected purposively and recruited for the qualitative data. Data collection The researchers will conduct all the survey and the interviews. A checklist will be used for clients’ case note reviews. Semi structured question guides will be used for in-depth interviews, key informant interviews and focus group discussion to obtain qualitative data Data management and analysis Stata 14 will be used to analyse quantitative data and the results will be presented as descriptive statistics. Qualitative data will be managed with NVivo 10.0 and analysed using thematic analysis and results presented as themes. Expected findings and dissemination of results. It is expected that the study will identify the prevalence of repeat HIV testing among pregnant women and its associated factors. The results of this study will be shared with the department of HIV and AIDS (DHA) in the Ministry of Health, other stakeholders include Blantyre District Health Office, College of Medicine Research and Ethics Committee (COMREC) and M-HIRST coordinating team. Furthermore, the findings will be disseminated through meetings, reports, international and local conferences and through publication in peer reviewed journals. Ethical Considerations Permission to conduct the study will be sought from College of Medicine Research and Ethics Committee (COMREC) while institutional permission will be sought from Blantyre District Health Office. Written informed consent for participation and digital recording of the discussions will be obtained from each participant. Each participant will be informed that participation is voluntary and can with draw their participation at any point without reprimands. Possible constraints The participants will be from Ndirande and Lirangwe health facilities and their catchment areas, therefore the results cannot be generalized. However, the findings will contribute towards improving uptake of repeat HIV testing among pregnant women in Blantyre.
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HIV/AIDS workplace policy development and implementation in public hospitals in Lilongwe, Malawi
(Kamuzu University of Health Sciences, 2020-04-21) Kapangama, Patricia
Introduction and background HIV/AIDS is a global burden which has affected 77.3 million people worldwide and more than half (34.4 million) of infected people have died since the start of the epidemic[1]. HIV/AIDS has negatively affected Malawi in such a way that 10.6 % of population aged between 15 -49 are infected [2].This is the age group which is economically productive and greatly contribute to countries economy. However, HIV related infections affect their productivity and leads to early retirement and untimely deaths. These effects increase organization‘s training and costs due to replacement of the HIV/AIDS infected employees who have died or retired on medical grounds. In order to reduce negative impact of HIV/AIDS, work place policy was introduced in organizations. However, Malawi‘s adoption of the policy is low as evidenced by results from a study conducted in 2011, which revealed that 38% of sampled private sector companies in Malawi had adopted HIV/AIDS policies whilst 62% had not yet adopted the policy [3]. Therefore, this study sets out to explore factors affecting development and implementation of HIV/AIDS work place and policy. Objectives The main objective of the study is to explore factors that affect development and implementation of HIV/AIDS work place policy in public health facilities in Lilongwe. The specific objectives of the study are to examine personal and facility factors that affect development and implementation of HIV/AIDS workplace policy. The study will also examine challenges in the development and implementation of HIV work place policy.
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Assessing viral load testing adherence and coverage and the related client outcomes in the 90:90:90 era
(Kamuzu University of Health Sciences, 2020-06-05) Kholomana, Thokozani
The type of research study This will be a retrospective quantitative cohort study. The problem to be studied: Viral load (VL) testing is one of the essential measure of HIV client progress in regards to ART where suppression shows treatment success. So this study intends to find out the level of VL coverage and adherence to protocol and describe the relationship between those clinical factors and the development of Tuberculosis (TB), infantile deaths and miscarriages. Main objectives: To assess the viral load testing adherence and coverage and the related client outcomes Specific objectives 1. To assess the level of clinical adherence and coverage in regards to viral load time frames 2. To measure the prevalence of Tuberculosis in HIV care enrolled clients and the related VL adherence and coverage before diagnosis 3. To estimate the rate of miscarriages in HIV clients and the related VL adherence and coverage prior to incident 4. To determine the prevalence of infantile deaths and the related VL adherence and coverage prior to the incident Methodology Study design: The study will employ a retrospective quantitative cohort design. Study place: This will be conducted in Ntchisi district. Respondents will be recruited from Ntchisi district hospital ART clinic. Study population: HIV reactive clients attending Ntchisi district hospital ART clinic will be eligible for this study. Study Period: The study will run from April 2019 to July 2020. This is a 16-month period which conceptualization of the proposal to thesis submission will be done. Data collection procedures: This study will utilize a checklist to extract data following the subjects consent. The checklist will look at such variables as age, sex, marital status of HIV positive patients, TB status, infantile deaths status, miscarriages, the number of VL tests and the times when their viral load testing was done. Mainly the clients master cards, and the prevention of mother to child transmission (PMTCT) registers utilized will be used to extract such data. Data management and analysis: All data will be kept in Microsoft excel with a passcode for safety. So, these data will be exported to Stata wherein cleaning and analysis will occur. Moreover, respondents’ identities will not be identifiable since they will be represented by codes. Data analysis will involve both descriptive and inferential statistics. Constraints: The researcher supposes there might be missing VL results in other study participants. In regards to this, the researcher plans to rectify this by following up with the central laboratory. Implications of the study: Results from this study are expected to contribute knowledge to the body of research in HIV medicine. For that cause, this information will be important when developing interventions for HIV clients’ care, providers protocol, including mentorship and supervision schedules. Expected findings and their dissemination: This study will find the period prevalence of Tuberculosis, miscarriages, and infantile deaths in people living with HIV (PLHIV). Moreover, this will show coverage and adherence frequencies in regards to VL testing in PLHIV and the relationship and association between the dependent and independent variables. Moreover, the results be contained in the author’s Master of Global Health thesis that will be submitted to COMREC and college library.
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Association between pregnancy progression and HIV acquisition among the reproductive age group at Machinga District Hospital
(Kamuzu University of Health Sciences, 2020-06-05) Kang'oma, Melina; Kaonga, Clevereen; Chitanje, Olivetta
Pregnancy is a crucial period in planning for interventions against HIV [1], since it is associated with many behavioral and physiological changes. These changes are associated with an increased risk of HIV acquisition [2]. One of the interventions put in place is the PMTCT programme, which has 4 pronged strategies that targets both HIV negative and positive women. The prongs include; primary prevention of HIV in women of child bearing age, prevention of unintended pregnancies among HIV positive women, prevention of HIV transmission from mother to child and provision of continuous care and treatment for infected mothers, partners and their children. This study aims at measuring the association between progression of pregnancy and HIV acquisition among women of the reproductive age group in Machinga. The first specific objective is to measure the incidence of HIV among pregnant women during their second Ante natal care clinic visit. This is in accordance with one of the prongs that targets primary prevention of HIV among women of reproductive age and the prevention of HIV transmission from HIV positive mothers to their unborn child. Analyzing the trend in HIV incidence among pregnant women according to their characteristics is the second specific objective. These characteristics will include marital status, age, occupation or their spouse occupation and trimester period. This will help in finding the characteristics associated with an increased rate of seroconversion. The last specific objective will involve finding out the risk factors for HIV acquisition as pregnancy progresses from both male and female perspective. This will both help to know if the community thinks pregnancy can really increase the chances of seroconverting and to know the exact area to be targeted for interventions in reducing the HIV incidence. The research will involve a mixed study design. The incidence of HIV will be measured among women who attended at least two ANC visits and were HIV negative on their first ANC visit. This will use a retrospective cohort study which will involve secondary data analysis for the past 5 years (from 2015-2020). The study will describe people’s knowledge on the risk factors of acquisition of HIV during pregnancy using in-depth interviews with a minimum of 10 and a maximum of 30 participants depending on the saturation point. The expected outcome is, there is an increased chance of acquiring HIV as the pregnancy progresses. A copy of the research results will be presented to the board of supervisors from the University of Malawi-College of Medicine and the District health office of Machinga.
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Assessing the relationship between Adverse Childhood Experiences (ACE) and high HIV risk behaviours among male and female adolescents: A cross sectional study in Balaka district.
(2020-06-15) Kaponda, Alice
Executive Summary Type of research study This will be a Cross Sectional Study to done in Balaka district. The problem Human Immunodeficiency Virus (HIV) remains a burden in Malawi with high incidences among adolescents (0.23% per year). Adverse childhood experiences (ACEs) refers to a range of events (such as physical, emotional and sexual abuse, bullying, etc) that children can experience early in their life that leads to stress and can result in trauma and unhealthy behaviours such as sexual immorality, indulging in substance abuse. There are a number of behaviours that exposes one to high HIV risks. Some of the high HIV risk behaviours include having multiple sexual partners and infrequent condom use. This study seeks to assess the relationship between adverse childhood experiences and high HIV risk behaviours specifically having multiple sexual partners and infrequent condom use among adolescents that may lead to increased HIV incidences in Balaka district. Objectives This study will assess the relationship between adverse childhood experiences and high HIV risk behaviours specifically having multiple sexual partners and infrequent condom use among female and male adolescents’ in Balaka district. Methodology This will be a cross sectional study involving a total of 314 adolescents aged between 10-18 years who were interviewed in the Malawi Longitudinal Study of Families and Health (MLSFH) study during the 2017/2018 data collection wave. The parent MLSFH study, collected data for a number of variables among which some will be used in this study. These variables include: Age, gender, tribe, religion, caregiver, caregiver change over time, school attendance, household size, family income status, sexual activities, infrequent condom use and exposure to different types of ACEs. This study will analyse secondary data from Balaka district under the parent MLSFH study which was collected in 2017/2018 data collection wave for adolescents’ cohort. Logistic regression analysis will be performed using STATA v14 to assess the association between adverse childhood experiences (ACEs) and HIV risk behaviours (multiple sexual partners and infrequent condom use) among male and female adolescents.
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A comparative analysis of Antiretroviral Therapy treatment outcomes in the public, private and Christian Health Association of Malawi by service delivery system in Blantyre city of Malawi
(Kamuzu University of Health Sciences, 2020-11-11) Chuka, Stuart
The Antiretroviral Therapy (ART) Program for Malawi started in 2004 and the key providers in provision of ART services in Malawi include; the public sector, the private sector for-profit and nonprofit and Christian Health Association of Malawi (CHAM. Since then, no known studies have been conducted to compare primary ART treatment outcomes across private, public and CHAM health facilities by service provider type. In addition, information on variation of primary ART treatment outcomes by service provider type thus; private, public and CHAM is not known and probably has not been published. This is a cross-sectional study and will utilize both quantitative and qualitative methods. The quantitative method will use facility level secondary data from the Malawi National ART Program in the Department of HIV in the Ministry of Health. The qualitative method will use in-depth interviews using an interview guide to key informants. Data will be analyzed using STATA statistical software package version 15. T-test and Analysis of Variance (ANOVA) will be used to compare the variations of primary ART outcomes among in public, private and CHAM ART sites. To compare proportions, will use Chi-Square Test and Fisher Exact Test. Logistic regression will be used to describe data and to explain the relationship between the variables. The results of this study will assist to improve the health care service delivery across private sector, CHAM and Public ART Clinics in Malawi through policy decisions which will also have a major impact in the National ART Program and the global world as a whole. The results of the study will be submitted to College of Medicine Ethics Review Committee (COMREC), COM library and presented at the COM Research Dissemination conference.
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Assessing factors that influence the uptake of youth friendly HIV testing and counselling services in Blantyre district
(Kamuzu University of Health Sciences, 2021-03-04) Phiri, Kate Chimwemwe
Type of study This is a cross-sectional study Study Problem Youth Friendly Health services have existed in Malawi since 2007, yet uptake of the HIV Testing and counselling services among young people in Blantyre district remains suboptimal. For uptake of these services to improve, a rich understanding is needed of the factors impacting their uptake from the perspective of young people, youth friendly health personnel, parents and community leaders. Broad objective To assess factors that influence uptake of Youth Friendly-HIV Testing and Counselling services in Blantyre urban Specific objectives i. To identify individual specific factors that influence uptake of HTC services in Blantyre urban ii. To determine health service factors that influence the uptake of HTC services among young people aged 18-24 in Blantyre urban. iii. To identify community factors that influence uptake of HTC services among young people aged 18-24 in Blantyre urban Methodology Qualitative research methods will be used. It will invove having six focus group discussions with young people aged 18-24, parents and community leaders, 20 in-depth interviews and 4 key individual interviews from Ndirande and Chilomoni health facilities in Blantyre urban. The study findings will be analyzed using thematic framework method whereby codes and themes will be identified in line with study objectives as well as inductively from the data. Study constraints The possible constraints of the study include the refusal of individuals to participate in the study and inability to meet the required sample size of study participants at study areas. Expected findings and their dissemination The study anticipates to discover- Individual, community and health system factors influencing HIV testing and counselling uptake among young people in Blantyre urban. The study findings will be disseminated to COMREC and College of Medicine. Copies of research will also be submitted to Ndirande and Chilomoni health facilities as study sites. The research findings will be published and shared with different HIV and AIDS stakeholders for policy, strategy review and plans reprogramming.
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Pilot of an intervention for Malawian pregnant women with HIV to improve depression, viral suppression and engagement of partners in HIV self-testing
(Kamuzu University of Health Sciences, 2021-03-17) Abas, Melanie;
Type of research study: This will be a mixed-methods pilot study employing both qualitative and quantitative data collection approaches. Qualitative methods will be used during formative work to adapt an intervention to treat depression and optimise adherence to HIV medication for the Malawian antenatal context. Quantitative methods will be used within a Phase 2 exploratory pilot trial aimed at testing the feasibility and acceptability of the integrated intervention, and feasibility of collecting clinical outcome measures at baseline and post randomisation follow up to inform a future fully powered cluster randomised trial. The problem to be studied Globally, 38 million people are living with HIV, with nearly 70% of these in sub-Saharan Africa. Policies to improve access to antiretroviral therapy (ART) for the treatment of HIV have dramatically reduced the rate of HIV related mortality in sub-Saharan Africa. This is because ART supresses the level of virus in the blood which halts the virus’s ability to attack the immune system. The result is that people living with HIV have a significantly reduced risk of transmitting the virus to sexual partners and from mother to child. HIV infection remains one of the biggest killers globally. However, the benefits of ART are reliant on daily adherence to the regimen. Malawi has a successful programme for prevention of mother to child transmission of HIV based on routine antenatal testing and provision of ART. However, 23% of women attending HIV antenatal care are lost to care at one year. Depression is an important cause of poor adherence to medication for the treatment of HIV and disengagement from HIV care. Depression is two to three times higher in people living with HIV than in the general population, and common in pregnant and post-natal women in Southern Africa. Symptoms of depression such as reduced concentration, memory, problem-solving ability and motivation, adversely affect engagement with health care and adherence to medication. Malawi's successful programme of antenatal testing presents an opportunity to engage their male partners in HIV testing. Men are less likely than women to test for HIV and know their status. In Malawi over 45% of HIV-positive women in stable relationships have an HIV-negative partner. Without intervention, HIV-negative partners acquire HIV at up to 12% per year. Supporting women to adhere optimally to their HIV medication to ensure their virus is well controlled reduces the risk of transmission to zero. HIV self-testing, whereby an individual collects their own sample, conducts the test and interprets their result increases coverage and frequency of testing. Partner-delivered self-test kits, where woman distribute a test to their male partner, is becoming routine antenatal policy and practice in high HIV prevalence settings including Malawi. Study objectives The aim of the proposed research is to finalise and test the feasibility and acceptability of an intervention for pregnant women living with HIV and depression, to reduce depression and optimise engagement in HIV care, and to increase uptake of HIV testing, prevention and care for their male partners.Specific aims are: The overall aim of the study is to test the feasibility and acceptability of an intervention for depression in people living with HIV called TENDAI-Together among pregnant women living with HIV and depression in Blantyre. Specific objectives in the Formative Phase of our research are: 1. To translate and back-translate the existing draft TENDAI-Together intervention from English to Chichewa, a main language used in Blantyre2. To use qualitative methods (in-depth interviews and focus groups discussions) and Theory of Change in Malawi to learn from women, partners, and health staff about terminology for distress and views about an intervention, to learn how to adapt the intervention and how to implement it in antenatal clinics in Bangwe Health Centre 3. To review emerging evidence on ingredients of efficacious brief psychological interventions for couples, so we can strengthen the content of the intervention, and add 1-2 sessions for the partner or significant other Aim 1: To finalise “Task-shifting to improve Depression and Adherence to HIV medication” (TENDAI-Together), a task-shifted intervention to treat depression and optimize adherence to ART for antenatal women living with HIV in Malawi. 4. Aim 2: To develop finalise an Short-Message Service (SMS) -based intervention for providing to information on the correct use of HIV self-test kits and provide "U = U" "Undetectable = Untransmutable" HIV messages education for targeting male partners of antenatal women living with HIV. 5. To integrate knowledge gathered through 1-3 to inform adaption and a draft intervention protocol for TENDAI-Together with the SMS-based HIV-self testing intervention. 6. Pilot test the intervention through a small case series to learn about training of interventionists and to iteratively finalise the intervention. Specific objectives in the Feasibility Phase of our research are: 7. To test the feasibility of clinic-based recruitment, through running an individually randomised pilot trial, with 20 women in the Tendai-Together arm and 20 women receiving enhanced usual care 8. To test the fidelity of Tendai Together intervention delivery within the health centre context in Malawi Through these objectives, we will be ready to apply for a future RCT to test the effectiveness and costeffectiveness of TT, and we will be in a position to justify whether the future trial will be in Malawi alone or multi-country. Aim 3a: To integrate TENDAI-Together with the SMS-based HIV-self testing intervention Aim 3b: To test feasibility and acceptability of the integrated intervention, and feasibility of collecting clinical outcome measures at baseline and post randomisation follow up through a Phase 2 exploratory trial to inform a future fully powered RCT. Methodology Formative work will involve finalising the TENDAI Together intervention to be suitable for the Malawian antenatal context will include formative work, comprising focus group discussions(FGD) and in-depth interviews (IDI) with 30 key informants (pregnant women, male partners, families, and health workers). This work will ensure that our final checklist of barriers to ART adherence includes those of most relevance for the ANC context, and to gather views and approaches about bringing the woman’s partner, or an alternative significant other, into two of the sessions, to provide education about depression and to inform about the U=U message (using self-testing SMS platform) and the benefits of both partners knowing their HIV status. The Pilot Trial will recruit 40 women in the 2nd trimester and randomise them, 3:1 to the active intervention or enhanced usual care. We will test the feasibility and acceptability of providing the TENDAI Together intervention with the self-testing SMS platform to allow the woman access to simple care for depression, optimise her engagement in HIV care, and engage her partner with HIVST and subsequent HIV care and prevention steps. We will also asses the feasibility of collecting clinical outcome measures at baseline and at 6 months post randomisation follow up and 6 weeks postdelivery for the infant, to inform a future fully powered RCT. Expected findings and dissemination. The expected findings for this study will include 1) Acceptability of the TENDAI Together intervention to participants, intervention providers and clinic staff; Feasibility of methods for conducting a future randomised controlled trial powered to determine the effectiveness of the stepped care Tendai Together intervention for depressed pregnant women living with HIV on viral suppression, depression, infant outcomes and serostatus of male partner at 12 months follow up; and 3) Feasibility of collecting clinical outcome measures for depression, viral load, infant clinical outcomes and uptake of HIV self-testing by male partner. Our aim to share our findings with scientists in the field, COMREC, College of Medicine Library, research participants and Malawians who can influence local policy. We plan to publish the findings of this study in peer-reviewed journals. Participants will be given written feedback on the results of the trial. We plan to present findings from this study at scientific conferences.
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Assessing the effectiveness of Multi Month Scripting of Anti Retroviral Therapy amongst stable patients: A comparative case of Bwaila Martin Preuss Center and Kapiri In Malawi
(Kamuzu University of Health Sciences, 2021-03-17) Longwe Matupa, Elinat
Type of research: A quantitative multiple retrospective study aimed at evaluating the effectiveness of multi-month scripting (MMS) on ART amongst stable adult patients living with HIV under care using a comparative case of Bwaila Martin Preuss Clinic in Lilongwe and Kapiri Mission Hospital in Mchinji, Malawi. Secondary data will be used. The problem: The United Nations Programme on HIV/AIDS (UNAIDS) and WHO promote adoption of the Differentiated Service Delivery (DSD) approach with its 95-95-95 targets by 2030. Malawi adopted the multi-month scripting (MMS) among other models to relieve the burden of frequent 28 September 2016. National Health Sciences Research Committee (NHSRC) number 15/11/1513”. The study population will include stable adult patients living with HIV on Regimen 5A TDF/3TC/EFV (300/300/600mg) at Bwaila Martin Pruess Clinic and Kapiri Health Centre. A total of 3,565 patient records receiving three months (90days) dispensing intervals in these two health facilities will be used for the study. Data used will be secondary quantitative data collected routinely as part of clinic Electronic Medical Records (EMR) at the two health facilities. Collected data will be stored securely in computer data base that have a password and only limited access to key study team will be provided. Stata version 15 will be used for analysis with summary statistics including percentages, medians and ranges calculated and presented for quantitative variables. Ethical approval will be sought from the College of Medicine Research and Ethics Committee (COMREC). Expected findings and their Dissemination: It is anticipated that the study will generate findings that are well enriched with adequate information that provides a deep understanding of the subject and contribute meaningfully to the body of knowledge on Differentiated Service Delivery. We expect to determine the effectiveness of MMS on ART among stable patients and if patient characteristics are associated with retention. Research results will be disseminated in writing and presentations. The report will be submitted to College of Medicine, University of Malawi being the institution to award the degree. Research findings will be presented to health care workers and senior management teams the participating health facilities. The researcher will be available to share the results from the study through local dissemination conferences, seminars and workshops organized by the College of Medicine’s Research Support Centre (RSC) and Research and Ethics Committee (COMREC). An abstract will be developed for submission to conferences and publication in journals. appointments of patients and providers, freeing up resources to provide more intensive care to complex patients where HIV mortality is high. Since 2016 all government health facilities in Malawi have implemented 3 months multi- month scripting for stable patients on ART. However, there is no evidence on the comparative effect of MMS on improved patient outcomes in terms of adherence to ART and the influence of the captured patient characteristics on the adherence to ART. Objectives: The aim of the study is to evaluate the effectiveness of multi-month scripting (MMS) on ART amongst stable adult patients living with HIV under care using a comparative case of Bwaila Martin Preuss Clinic in Lilongwe and Kapiri Mission Hospital in Mchinji, Malawi. The study specifically seeks to determine the effect of MMS on patient retention; assess the patient characteristics that are associated with the degree of compliance to ART treatment and assess the influence of patient characteristics on retention in care for patients on MMS. Methodology: A quantitative multiple retrospective study will be used to evaluate the effectiveness of multi month scripting (MMS) on ART amongst stable adult patients living with HIV under care at Bwaila Martin Preuss Clinic in Lilongwe and Kapiri Mission Hospital in Mchinji. Secondary data analysis will be done on data collected from the study titled “Assessing Implementation of Models of Differentiated Care for HIV Service Delivery in Malawi: A Process Evaluation dated
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Strategies for linking HIV exposed infants to HIV care services at South Lunzu health centre
(Kamuzu University of Health Sciences, 2021-05-12) Kunje, Rhoda Salome
Background: HIV exposed infant care in Malawi is integrated with maternal ART follow-up to improve retention. Malawi National HIV Testing and Counselling (HTC) guide lines for HIV –exposed infants recommend a DNA PCR test done at 6 weeks, followed by 2 confirmatory rapid tests at 12 and 24 months to determine the HIV status of HIV exposed infants. Infants also receive 6 weeks of Nevirapine(NVP) starting at birth and early infant HIV DNA polymerase chain Reaction(PCR) diagnosis using dried blood spots after 6 weeks of age are done, Infants are clinically followed up until determination of final HIV infection status(1). Despite efforts to improve retention, lost to follow-up remains a challenge in the care of HIV exposed infants. Astudy done by Wingston F. Ng’ambi and others in Lilongwe Malawi showed that overall 48% of HIV-exposed infants were declared lost to follow-up due to a number of reasons (2). Available data at South Lunzu health facility in Blantyre Malawi, demonstrates that from 2018 to 2020, there has been increased numbers of children who have defaulted from HIV care services especially at 12 months and 24 months after being initiated in care. In 2018, out of the 213 HIV exposed infants that were enrolled at 2 months,96.6% were retained in care and 2.4% was the default rate. At 12 months 190 infants were enrolled in care and 70.4% was the retention rate and 9.6% was the default rate. At 24 months 176 infants were enrolled and there was 57.4% retention rate and 42.6% default rate. In 2019, 175 HIV exposed infants were enrolled and retention rate was at 97.6% and default rate was at 2.4%. At 12 months 162 HIV exposed infants were enrolled, 81.8% was the retention rate and 18.2% was the default rate. At 24 months, 146 infants were enrolled and retention rate was 61.1% and 38.4% was the default rate. This trend of defaulting from HIV care continued for the year 2020 especially as the children grew older. For this study, the researcher expects to find that there are no strategies or interventions at the health facility that are put in place to link back the HIV exposed infants who are lost to follow up for HIV health care services despite the increased default rates. Problem statement: Early Infant Diagnosis (EID) of HIV infection at the primary care level in Malawi is challenging. Many children are indeed tested for HIV and some are found to be HIV infected while others are HIV uninfected in the HIV diagnosis and treatment program and they are lost to follow-up at various stages. In Malawi’s option B+, loss to follow-up remains a great challenge in the care of HIV exposed infants, and although the Malawi government recommends HIV exposed infants receive Early Infant Diagnosis(EID) at under-five Paediatric clinics, most of these children are never enrolled. In 2014, less than 20% of HIV-exposed infants received early infant diagnosis test in the first 2 months of life, and only 30% of the HIV infected children were on antiretroviral therapy (13). Those children who are lost to follow are at higher risk of infection and opportunities to enter them into care are rare, consequently these children do not come back, if they come at all, its until they develop serious AIDS- defining illnesses, leading to death. OBJECTIVES: The aim of the study is to explore strategies for linking HIV- exposed infants who are lost to follow-up back into HIV care services at South Lunzu Health Centre in Blantyre,Malawi.Specifically, the study seeks to determine the proportion of HIV-exposed babies who tested positive to HIV and were lost to follow-up in relation to HIV care services,to describe the views of Health Care workers on effectiveness of the interventions currently in place for linking HIV exposed infants to HIV care services and to establish the remedies suggested by postpartum/breastfeeding mothers who are infected with HIV on minimizing lost to follow up cases amongst HIV positive infants at South Lunzu Health Centre. Methodology: The research is a cross-sectional study using mixed methods (quantitative and qualitative) where data will be collected at the same time or approximately the same time period. Questionnaires and Focus Group Discussions will be used to collect the data at the same time period. The population of interest for this study will include ;HIV positive mothers who have exposed their infants to HIV but are lost to follow-up to HIV services and care, HIV exposed infants, and the health Care Workers at South Lunzu health facility (Nurse midwives, Health Surveillance Assistants, Clinicians, Expert clients).The sample size for the quantitative method will be 384 and participants will be randomly sampled from health records at the facility. The sample size for the qualitative method will be approximately 30, and participants will be purposefully selected. Data collection for the qualitative method will be done right at the health facility in quiet and private rooms through focus group discussions(FGDs). Abstraction sheet will be used to abstract data from health records. Data collected from participants will be securely stored in a computer data base that has a password and limited access will be provided to the study team. Data analysis will be done using deductive thematic content analysis. Informed consent will be obtained from each participant before being enrolled in the study. Confidentiality throughout study participation and thereafter will be ensured. Ethical approval will be sought from College of Medicine and Ethics Committee(COMREC). Dissemination of expected findings: The results of this study shall be disseminated in writing and presentations as feedback will be made to the: College of Medicine Research Ethics Committee(COMREC), investigators and study team, College of Medicine library, The University Research and Publication Committee(URPC)through the COMREC secretariat, All health workers at South Lunzu Health Centre, District Health Management Team (DHMT)for Blantyre including the Blantyre District PMTCT/EID Technical Working Group and to the wider scientific community through the COM Research and Dissemination Conference and preparation of a manuscript for submission to a peer-review journal.
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A comparison of antiretroviral therapy outcomes among adolescents in teen clubs and standard care clinics: Blantyre, Malawi
(Kamuzu University of Health Sciences, 2021-05-12) Alibi, Michael
Introduction This is a retrospective cohort study designed to investigate the impact of the teen club model among adolescents living with HIV on antiretroviral therapy (ART) outcomes in Blantyre. Teen clubs are among the Differentiated Service Delivery (DSD) models being implemented in Malawi to improve antiretroviral treatment outcomes. Currently, more studies have been conducted in Malawi focusing on the impact of teen clubs in adherence to ART and reducing loss to follow up, but very little has been done to investigate the impact of the model in improving long-term outcomes of ART such as viral load suppression, reduced virological failure, and prolonged life. Some African countries such as South Africa and Namibia have recently conducted similar studies. Objectives The primary objective of the study is to compare antiretroviral therapy outcomes among adolescents living with the human immune-deficiency virus (HIV) in teen clubs compared to those in standard care clinics. The primary outcome is differences in virological suppression among the two groups, the exposed (adolescents in teen clubs) and the unexposed (adolescents in the standard of care). Virological failure and 24 months survival analysis for adolescents in teen clubs and those receiving standard of care will as be assessed. Methodology The retrospective cohort study will be from the 1st of January, 2018 to the 31st of December, 202019. A sample of 182 adolescents living with HIV on ART from the 6 public health care clinics in Blantyre will be identified (3 with teen clubs and 3 using the standard of care model). The health care clinics were identified through stratified random sampling. Stratification was based on the type of adolescent ART service being provided by the health facility (teen club model or standard of care). The study sample is all-inclusive of the study population. A case report form will be used to extract demographic and clinical data from the ART registers, client master cards, and Electronic Medical Records database. Virological data will be obtained from the master cards and demographic and ART outcome data will be obtained from the ART registers. STATA 16.0 will be used to analyze the data and chi-squared and poison regression will be used to analyze the differences in the two groups and Kaplan Meier curves and Cox proportional hazard method will be used for survival analysis. The study will be conducted from February to December 2021. Expected findings and their dissemination. Based on studies conducted in other countries with a similar setting as Malawi, it is expected that the teen club model is most likely to improve the long-term ART outcomes as compared to the standard of care. The outcomes include viral load suppression and virological failure. The results will be disseminated to the College of Medicine Research and Ethics Committee (CoMREC), College of Medicine Library, and the University Research and Publication Committee, to College of Medicine as partial fulfillment of the Master of Epidemiology (MSc in Epidemiology) program, the District and city health offices, Blantyre city and District AIDS coordination committees and the Blantyre HIV treatment and care, technical working group.
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Factors Associated with retention in care among people living with HIV/AIDS in Ubungo Municipality, Tanzania
(Kamuzu University of Health Sciences, 2021-05-12) Moshi, Sylvia D.
Study type: This study will be cross sectional study utilizing a mixed method approach such that both quantitative and qualitative method will be used. The problem (to be studied): In Tanzania, 1.6 million people were living with HIV in 2018. This equates to an estimated HIV prevalence among adults of 4.6%(1) with more women infected than men. (2). In the same year, 72,000 people were newly infected with HIV, and 24,000 people died from an AIDS-related illness(3). Dar es Salaam has the highest burden of HIV/AIDS with a prevalence of 11%(2). For both sexes, urban residents have a significantly higher risk of HIV infection 11% than rural residents 5%. Prevalence among urban women is 12%, compared with 6 %t for rural women while prevalence among urban men is 10 %, compared with 5%for rural men(2). Objectives: To assess the factors associated with retention in care among people living with HIV/AIDS in Ubungo municipality, Tanzania. Specifically, the study is aiming to determine the proportion of people retained in care among HIV positive clients attending Ubungo Municipality, to determine factors contributing to poor retention in care among people living with HIV/AIDS in Ubungo Municipality and to identify factors leading to the uptake of care among people living with HIV/AIDS in Ubungo Municipality. Methodology: A cross-sectional study utilizing a mixed methods approach and a convergence model will be used to determine factors associated with retention in care among people living with HIV/AIDS in Ubungo municipality, Tanzania. Data will be collected, using self-administered questionnaires for quantitative data and In-depth Interviews with patients and Key informant Interviews (KII) with health facilities staff will be used to collect qualitative data. We will draw a systematic sampling for the quantitative approach and a purposive sample for the qualitative aspect respectively. Descriptive statistics will be used to summarize findings in tables, graphs and charts, Chi square test and logistic regression analysis will be used to determine the factors associated with retention in HIV care using SPSS software. Recorded audios from in-depth interviews and KIIs will be transcribed, translated, coded, analyzed thematically and presented in verbatim. Dissemination of Expected findings: Research results will be disseminated in writing and presentations to all health care facilities in Ubungo Municipality. Recommendations will be made to all decision-makers and policymakers at Ubungo municipality health facilities, Medical Officers office, and local implementing partner Management and Development for Health (MDH) on improvements that need to be made to improve retention in care among people living with HIV/AIDS. Also, dissemination of results will be made to the University of Malawi College of Medicine senate, to College of Medicine Research Ethics Committee (COMREC), and the National Institute of Medical Research in Tanzania (NIMR). Copies will be made available at the COM library. At some point, the results from this study will be published in a peer-reviewed open-access journal.