HIV/ AIDS

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An analysis of enteric pathogens among HIV infected individuals with and without diarrhea at Queen Elizabeth Central Hospital
(Kamuzu University of Health Sciences, 2022-08-17) Nyirenda, James
Eastern and Southern Africa bears the blunt of the Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Virus Syndrome (AIDS) pandemic having about 54% of world’s HIV/AIDS infected individuals coming from this region. Diarrhea is one of the most common complications of HIV with 80% of all HIV/AIDS infected individuals developing this condition. There is an association between CD4+ T cell count and presence of opportunistic infections. Management of diarrhea in developing countries including Malawi depends on empirical administration of drugs, mostly antibiotics. This is often times due to lack of proper diagnostic capability to determine full profile of enteric pathogens that are likely to contribute to diarrhea for particular patients. Objective: To identify and determine entero-pathogens which are likely contributors of diarrhea among HIV infected individuals in Malawi. Specific Objectives:  Determine the profile of enteric pathogens across HIV infected individual with and without diarrhea.  To identify pathogens detected in diarrheagenic amounts among HIV infected individuals with and without diarrhea. To determine if the antibiotic prescribing pattern among clinicians covers enteropathogens detected using TaqMan array card.  To determine if there is an association between CD4 T cell count and type of pathogens detected in HIV positive individuals with and without diarrhea. Methods: This study will be nested in a phase 2A clinical Trial investigating the safety and efficacy of Clofazimine for treatment of Cryptosporidiosis among HIV+ adults. Two arms of study participants will be used to answer our questions; 22 HIV infected individuals with diarrhea and 10 infected individuals without diarrhea. TaqMan array based polymerase chain reaction (PCR) was used to detect multiple enteric pathogens from stool samples in the main study. In this study threshold cycle (Ct) values and pathogens detected from each group will be analyzed and used to determine the mostly likely pathogen contributing or causing diarrhea. In addition CD4 T cell values and profile of identified entero-pathogens will be analyzed to determine if level of an individual’s immunity plays a role in profile of enteric pathogens among HIV infected individuals. Furthermore, antibiotics that were administered to manage diarrhea will be analyzed to determine whether it necessary for treating the type of pathogens detected. Study Place: Data analysis and investigations will be conducted at the College of Medicine Department of Pathology and college of medicine Library. Expected outcome: We expect to identify enteric pathogens that are more likely than others to contribute to diarrhea among HIV infected individuals. We will identify pathogens and make profile of pathogens in relation to CD4 T cell values. This data will be essential for policy formulation for management of diarrhea in HIV infected adults since treatment is mostly empirical in developing countries such as Malawi due to poor diagnostic capacity.
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Assessing determinants of access to HIV and STI preventive services among female sex workers in Mwanza district, Malawi
(Kamuzu University of Health Sciences, 2021-05-21) Kasom, Steven
Type of the study The study is a cross-sectional, it will employ quantitative methods. Problem In Malawi studies on factors influencing the access to HIV/STI preventive services using provider and facility-based approaches have been done. In response to these studies Hybrid approaches on service provision have been employed and yet only around 30% of FSWs are currently accessing the preventive services in Malawi including Mwanza district. This study will use the Client centered conceptual framework to identify the gap in determinants from the client‘s perspective. Objectives The broad objective; To assess the determinants of access to STIs and HIV prevention services among female sex workers in Mwanza district. The specific objectives include; To determine approachability of HIV and STI prevention services among female sex workers in Mwanza district. To measure acceptability of HIV and STI prevention services among female sex workers in Mwanza district. To determine availability of HIV and STI prevention services among female sex workers in Mwanza district. To assess affordability of HIV and STI prevention services among female sex workers in Mwanza district. To assess appropriateness of HIV and STI prevention services among female sex workers in Mwanza district. Methodology This study is a cross-sectional study. Time-location sampling will be done and 309 female sex workers who have lived in Mwanza district for at least 3 months will be included. Face to face interviews using structured questionnaire will be employed. Logistic regression analysis will be done using SPSS. And results will be presented in graphs and tables. Expected findings and dissemination The study is expected to reveal the factors that influence the access to HIV/STIs preventive services among FSWs in this district. With the involvement of COMREC the results will be disseminated through College of Medicine research conference, publication in a journal, the report will also be presented and handed over to Mwanza district assembly.
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Assessing factors associated with attrition among older adults on antiretroviral therapy in Malawi
(Kamuzu University of Health Sciences, 2021-10-18) Londo, Mathias
Type of research study: This quantitative study will employ a retrospective observational cohort design. The problem: Access to HIV services among adults aged ≥50 is compromised due to the stereotypes surrounding their perceived low susceptibility to HIV. This leads to minimal interventions targeting them as well as low follow-up for them after ART initiation. In SSA, attrition after ART initiation ranges from 23.4% to 57% and is mainly due to either death or loss to follow-up. Polypharmacy, drug toxicities, and co-infections increase the risk of attrition among older adults. However, most HIV interventions primarily focus on populations aged 15-49 and children neglecting those aged ≥50. There is still inadequate information on levels of attrition and associated factors among these adults, hence the need for this study. Broad objective: To assess attrition after antiretroviral therapy initiation among adults at Nkhatabay district hospital. Specific objectives • To compare levels of attrition between older and younger adults 24 months after ART initiation • To determine the predictors of mortality and loss to follow up among older adults 24 months after ART initiation. Methodology: The study will be a quantitative retrospective observational cohort design. The study will analyze outcomes of adults aged 15-49 and those aged ≥50 initiated on ART between 2015 and 2019 at Nkhatabay District Hospital. The sample size will be 208 and participants will be selected using a simple random method. Data will be collected using patients' master cards and ART registers. Data analysis will be done using STATA 14.0. Attrition post ART initiation will be determined by the Kaplan-mier survival function. Cox proportional hazard model will be used to measure factors associated with attrition. Expected findings and their dissemination: It is expected that there will be variations in attrition levels post ART initiation between older and younger adults. Predictors of attrition among older adults will be ascertained. The study findings will be shared with the College of Medicine Research. Committee (COMREC), Nkhatabay District Office, the library of COM, and the Department of HIV/AIDS at the Ministry of Health. The results will also be published and presented at research conferences.
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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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Assessing prevalence and determinants of routine viral load monitoring among pregnant and breastfeeding women on first line antiretroviral therapy at Dedza District Hospital.
(Kamuzu University of Health Sciences, 2021-07-15) Chinthola, Wellings
Study type: This will be a descriptive quantitative cross-sectional study. Background Increased maternal viral load poses a serious health risk of mother to child transmission of HIV and increased morbidity and mortality to both pregnant and breastfeeding women. As part of prevention of mother to child transmission of HIV, both WHO and UNAIDS recommend vial load monitoring to all eligible client on ART at six months, 12 months and then every 12 months thereafter if the patient is stable on ART. Viral load monitoring plays a pivotal role in assessing treatment outcome, early detection of treatment failure and determining treatment failure. Currently, Malawi is using 4th edition of clinical management of HIV in adults and children of 2018. This is being used hand in hand with 2019 policy updates addendum to the 4th edition which came into force from April, 2019. The updated guidelines on routine monitoring of viral load recommends viral load testing at six months after starting ART, at 12 months and then every 12 months from the last test if the patient is stable on ART. This is different from the previous edition that was recommending routine monitoring of viral load at 6 months, 2years, 4yrs and then every 2years from the previous test. Problem Dedza District Hospital is one of the facilities that offers a wide range of ART and PMTCT services. It is estimated that more than 800 women are enrolled in PMTCT programme annually. Despite the reported positive progress on the increased number of pregnant and breastfeeding women enrolled in PMTCT programme at the facility, there is insufficient evidence suggesting the extent of routine viral load monitoring implementation and factors influencing it following introduction of 2019 new guidelines. This therefore calls for urgent need for a research to establish the magnitude of routine viral load monitoring among PMTCT women. Objectives The main objective of the study is to assess prevalence and determinants of Viral Load Monitoring among HIV Positive Pregnant Women on First Line Antiretroviral Therapy in Dedza District. The specific objectives include;  To establish social demographic characteristics of HIV positive pregnant and breastfeeding women receiving PMTCT services at Dedza district hospital  To ascertain the proportion of pregnant and breastfeeding women receiving routine viral load monitoring.  To determine factors associated with viral load monitoring among pregnant and breastfeeding women on first line antiretroviral therapy Methodology A quantitative cross sectional design will be used on randomly selected master cards of clients enrolled in PMTCT from April 2019 to April 2020. Data will be collected using a structured data collection sheet and will be organized on a spread sheet for cleaning before actual analysis using Statistical Package for the Social Sciences (SPSS) version 20. Strength of association will be measured using odds ratio and 95% confidence intervals and the p-value <0.05 will be set for statistical significance. Expected findings This study is expected to reveal the prevalence of routine viral load monitoring among pregnant and breastfeeding women at Dedza district hospital and factors that determine it. Dissemination of results The results of this study will be disseminated at Kamuzu College of Nursing Research Conference. Copies will be sent to Dedza District Hospital where study will be conducted, Kamuzu College of Nursing Library where the researcher is pursuing his studies, College of Medicine Research Ethics Committee (COMREC) where ethical clearance will be obtained and all research supervisors who are providing academic support. Relevant findings of this study will also be sent for possible publication in peer-review journals through KCN.
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Assessing the effectiveness of HIV and AIDS service delivery models for key populations in Malawi
(Kamuzu University of Health Sciences, 2021-07) Ngulube, Maria Chinoko
This is a mixed methods study that will use both quantitative and qualitative data. The quantitative part will use secondary data collected as part of the Centre for the Development of People’s (CEDEP) routine monitoring process for the periods – 2018/19 and 2019/20 focusing on five key variables (Key population prevention messages - KP_PREV, HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity distribution, STI screening and diagnosed). The data will be collected using an excel template presented in Annex 5. Qualitative data will be collected directly from men who have sex with men (MSM) and health service providers (HSPs) that work with CEDEP in the delivery of HIV and AIDS services for MSM ). The HSPs include CEDEP staff. The problem: Globally, Men who have sex with men (MSM) are at high risk of contracting and transmitting HIV but have the least access to HIV prevention, care, and treatment services because their behaviours are often stigmatized, and criminalized. In sub-Saharan Africa, same-sex behaviours have been largely neglected by HIV research up to now. In Malawi, 7 % of MSM live with HIV and yet are also arrested if their sexual orientation is exposed when seeking healthcare, causing many to shun HIV and other sexual health services(1). Different models have been used to reach out to MSM with HIV and AIDS services. However, the effectiveness of these models have not been fully investigated to guide KP programing. This study therefore, will examine the different service delivery models currently being used to provide HIV and AIDS services to MSM. The objectives: The broad objective of the study is to assess the effectiveness of the service delivery models employed by CEDEP in reaching out to MSM with HIV and AIDS services (outreach, hybrid-public and private facilities and drop-in centres). Specifically, the study will focus on the following objectives: 1. To identify Service delivery models that are high yielding. 2. To explore factors that contribute to high yielding in the identified service delivery models 3. To identify bottlenecks associated with the use of the different models employed by CEDEP; 4. To explore potential solutions for improving uptake of HIV and AIDS services by MSM. Methodology The study will use a mixed method approach. The quantitative part will use secondary data collected as part of CEDEP’s routine monitoring process for periods - 2018/19 and 2019/20. CEDEP’s routine monitoring data will be filtered to extract five key variables (Key population prevention messages - KP_PREV, HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity distribution, STI screening and diagnosed). Quantitative data will be requested from CEDEP using the excel template present in Annex 5. Only routine monitoring data for Lilongwe district will be used for this study. On the other hand, the qualitative partNgulube_P.04/21/3307_Version 2.0_20210610_Expedited 11 will rely on primary data to be collected directly from MSM using MSM interview guide (See Annex 1) and health service providers (HSPs) including CEDEP staff that support MSM service delivery using the HSP interview guide (See Annex 2). The study will be done in Lilongwe targeting MSM accessing services at CEDEP service delivery points, health service providers including CEDEP staff. Qualitative data will be collected from 49 MSM using MSM interview guide (See Annex 1) and eight health service providers and five CEDEP staff using the health service provider interview guide (See Annex 2). A combination of purposive and snowball sampling techniques will be used to select 49 MSM who will respond to the MSM interview guide while purposive sampling will be used to select 13 key informants to participate in the study (8 health service providers, and 5 CEDEP staff). Qualitative data will be collected once the protocol receives approval from COMREC. Two data collectors will be hired to collect qualitative data from MSM using the MSM interview guide while the principal researcher will collect qualitative data from key informants using interview guides. Quantitative data will be analyzed using the Statistical Package for Social Sciences (SPSS). A Chi-Square test will be used to test if there is any relationship between service delivery model and service uptake by MSM. The test will focus on the three service delivery models (outreach, hybrid and DIC) on one side and five service uptake indicators on the other side which include; Key population prevention messages - KP_PREV, HIV testing services - HTS_TST, HIV positive-HTS_POS, commodity distribution, STI screening and diagnosed. The reach data for the different services accessed at each service delivery point (outreach, hybrid-public and private facilities and drop-in centres) will be plotted to show the trends over time (2018/19 and 2019/20). Qualitative data will be summarized in word to extract the key themes and issues coming out of the discussions which will then be analyzed to inform the findings and report writing. Expected findings and their dissemination. In recent years, the government has acknowledged the existence of MSM and the need to make health services available to them. This study therefore is expected to identify the key service delivery models that are high yielding and effective in reaching out to MSM with different HIV and AIDS services. This will significantly contribute to the limited body of knowledge on MSM and provoke the debate on which approaches could be cost-effective in reaching the MSM with the much need health services in an environment where they are stigmatized and criminalized. The findings of the study will be shared with key stakeholders (such as CEDEP, NAC, COM, MoH) who are actively involved in HIV service delivery for MSM. The findings will also be submitted for consideration to be presented at local and international HIV and AIDS dissemination 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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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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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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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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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 Viral Load suppression in clients receiving 6 Multi Month Refill at Dedza District Hospital
(Kamuzu University of Health Sciences, 2022-01-19) Chibwana, Chikaiko
Type of Study This will be retrospective cohort study design. Problem Human Immunodeficiency Virus (HIV) positive clients taking Anti-Retroviral Therapy (ART) put on newly introduced Service Delivery Model (DSD) of 6 Multi Months Refill (6MMR) take about 6 months before they are seen at a clinic for clinical assessment including adherence counselling by a professional health worker. Studies done in some countries have associated this long period to have negative effect on Viral Load (VL) suppression. High viral load is associated with increased risk of opportunistic infections, treatment failure and death. Broad Objective To assess viral load suppression among clients on 6 MMR enrolled at ART clinic at Dedza District Hospital. Specific Objectives 1. To establish viral load suppression rate in clients on 6 MMR enrolled at Dedza District Hospital ART clinic. 2. To compare viral load suppression rates among clients on 3 Multi Months Refill (3 MMR) to those on 6 MMR enrolled at Dedza District Hospital ART clinic 3. To identify factors associated with viral load suppression in clients receiving 6 MMR enrolled at Dedza District ART clinic Methodology Study Place The study will take place in Dedza district at Dedza District Hospital. Data will be collected at Dedza District Hospital ART clinic. Study Population Participants to the study will be HIV positive clients enrolled at Dedza ART clinic, 18 years old and who were given 3 or 6 MMR from September 2019 to July 2021. Study Period The study period will be 12 months (from April 2021 to May 2022) including time for developing protocol, data extraction tools, obtaining all appropriate approvals, training of study assistants, data collection, data analysis, writing dissertation and dissemination. Data collection Procedures The study will utilize secondary data that will be extracted from ART, HIV Testing Services (HTS), appointment registers, client master cards and Electronic Master Record (EMR) using a designed data collection tools. The following variables will be collected: Demographic data, type of employment, distance from the hospital, place of residence (rural, urban or semi urban), type of relation with guardian, months on ART regimen, pill count, comorbidity with Tuberculosis (TB), viral load result after receiving either 3 MMR or 6 MMR. Data analysis Multivariate binary logistic regression will be used to test if each of explanatory variables is associated with Viral Load Suppression among clients on 6 MMR. Constraints Being a retrospective study that will use secondary data, some data valuables like employment status, pill count and viral load results might be missing. However, the researcher plans to be looking for the missing data in Electronic Master Record (EMR), in paper based master cards and Laboratory registers for viral load loads results. Expected Findings The study will establish rates of viral suppression and identify factors associated with viral load suppression in clients receiving 6 MMR. The findings will inform policy makers in deciding the right clients to be put on 6 MMR basing on the factors that will be associated with viral load suppression. Dissemination Research finding will submitted to College of Medicine Research and Ethics Committee (COMREC), College of Medicine Library and Dedza District Hospital. Manuscript will be prepared for peer Journal publication.
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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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Assessment of Knowledge, Attitude and Practice (KAP) of HIV Post Exposure Prophylaxis (PEP) Medicines among individuals who drink alcohol compared to non-alcohol consuming individuals in Lilongwe city of Malawi
(Kamuzu University of Health Sciences, 2022-02-09) Foster, Enock Kupita
4.1.The type of research study The study will be quantitative cross-sectional study 4.2.The problem [to be studied] There is increase in unprotected sexual behavior among alcohol consuming individuals compared to non-alcohol consumers. Such behaviors lead to increased risks of HIV infections. The HIV/AIDS risks can be minimized by the use of ART in form of Post Exposure Prophylaxis Medicine (PEP). However, uncontrolled use of PEP can increase the risks of HIV medicine resistance. This is compounded by insufficient data on knowledge, attitude and practice (use) of PEP among individuals who drink alcohol compared to non-alcohol consumers to inform on whether strategies should be drawn to stop miss use of PEP thereby avoiding HIV medicine resistance. 4.3.The objectives The main The objective is to assess Knowledge, Attitude and Practice (KAP) of Human Immunodeficiency Virus HIV Post Exposure Prophylaxis (PEP) Medicines usage among individuals who drink alcohol in Lilongwe city of Malawi compared to nonalcohol consuming individuals. Specific objectives are to assess Knowledge of Human Immunodeficiency Virus Post Exposure Prophylaxis medicines in those drinking alcohol in Lilongwe city of Malawi compared to non-alcohol consuming individuals; to determine the attitude towards Human Immunodeficiency Virus Post Exposure Prophylaxis medicines among those drinking alcohol in Lilongwe city of Malawi compared to non-alcohol consuming individuals; to investigate the practice of Human Immunodeficiency Virus Post Exposure Prophylaxis medicines among those drinking alcohol in Lilongwe city of Malawi compared to non-alcohol consuming individuals. 4.4.Methodology Methodologically, the data will be collected through face-to-face interviews using structured questionnaires (Appendix 3) to all consenting participants. Participants’ confidentiality will be ensured by not taking their names. This will be further provided by assigning specific codes before proceeding with face-to-face interviews. The principal investigator will sample 266 alcohol consuming individuals as the interest group and another 266 non-alcohol consuming individuals as the control group. The collected and analyzed data (by SPSS v.2 22) will be secured in laptop and google drive for ease of access should the laptop gets stolen. Data such as gender, marital status, age, sexual orientation, sexual behavior, level of alcohol consumptions, knowledge of PEP, its attitude and practices will be obtained and analyzed by SPSS version 22. 4.5.Expected findings and their dissemination It is expected that there will be adequate knowledge, positive attitude but poor practice of PEP among individuals drinking alcohol in the city of Lilongwe (Null hypothesis). The findings are expected to be shared with COMREC, fellow students as well as publishing in various Journals.
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Assessment of knowledge, attitude and practice of HIV post exposure prophylaxis treatment amongst adolescent girls and young women in Blantyre urban
(Kamuzu University of Health Sciences, 2021-09-15) Sosola, Macdonald
Background: Human immunodeficiency virus (HIV) is the main cause of morbidity and mortality in Africa. HIV infection is disproportionately higher in adolescent girls and young women in Malawi with approximately 24% of new HIV infections in 2019 occurring in this age group, despite composing 10% of the population. Non-occupational HIV post exposure prophylaxis (PEP) treatment is over 80% effective in preventing HIV infection when initiated within 72 hours of exposure and taken with full adherence. The study aims to assess the knowledge, attitude and practice of non-occupational HIV PEP amongst adolescent girls and young women (AGYW) in Blantyre urban and provide evidence based information for developing messaging of HIV PEP and maximize HIV PEP uptake with a goal of attaining zero new infections in Malawi by 2030. Objectives: The broad objective of the study is to assess knowledge, attitude and practice of non-occupational HIV PEP treatment amongst adolescent girls and young women in Blantyre urban. Specific objectives are; i) to estimate the proportion of adolescent girls and young women in Blantyre urban region who are aware of and have knowledge of non-occupational HIV PEP treatment; ii) to estimate the proportion of adolescent girls and young women in Blantyre urban who have used non occupational HIV PEP effectively on at least one occasion; iii) to determine attitudes of non-occupational HIV PEP use amongst adolescent girls and young women in Blantyre urban; iv) To determine factors that influence awareness, knowledge and uptake of HIV PEP by adolescent girls and young women. Methods: A descriptive cross sectional study design, will be used to address the research objectives. The study will be conducted in Blantyre urban, with the target population being Blantyre urban female citizens aged 15 years to 24 years. Sample size (n) of 153 for females aged between 15 years and 24 years will be sufficient to address specific objectives 1, 2, 3 and 4. Data will be summarized and analyzed using chi square test and logistic regression. Statistical software STATA MP 16 will be used for data analysis Expected findings and dissemination: Extrapolating from a similar study done in USA New York, our expected findings are that less than 10% of the target population have knowledge of non-occupational HIV PEP treatment. The findings will be part of the requirements for award of an MPH to the investigator. Furthermore the findings will be disseminated to various stakeholders involved in HIV intervention measures in order to advocate increased messaging of non-occupational HIV PEP treatment in the population as one of the methods to fulfill one of the targets of the HIV national strategic plan 2020-2025 of zero new infections by 2030.
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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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Barriers and facilitators to implementing advanced HIV disease diagnostic package at a district hospital; An exploratory study
(Kamuzu University of Health Sciences, 2022-02-09) Mithi, Brany
Sequential exploratory mixed methods study design. Problem: One third of the people beginning treatment for HIV present with advanced disease with severe immune suppression (CD4<200), putting them at very high risk of opportunistic infections (OIs) as well as death. Unfortunately, a good number of People Living with HIV (PLHIV) meeting the WHO eligibility criteria are not screened for Advanced HIV Disease (AHD). Currently, data on implementation bottlenecks are scarce. To derive an effective implementation strategy for scaling up AHD screening coverage, there is need to identify barriers and facilitators to implementation of AHD diagnostic services. Aims and Objectives: To explore factors influencing effective implementation of WHO recommended AHD Diagnostic package at Rumphi District Hospital. Specific objectives: • To determine the baseline uptake of AHD screening at Rumphi District Hospital between June and December 2021. • To explore the health facility barriers and facilitators to implementation of AHD diagnostic tests at Rumphi District Hospital using the CFIR conceptual framework. To explore implementation strategies for optimizing AHD diagnostic test package. Methodology: This is a sequential exploratory study that will employ both quatintative and qualitative methods. A Consolidated Framework for Implementation Research (CFIR) will be used to develop an interview guide that will be used for collecting qualitative data from health care workers (HCWs) pertaining to barriers and facilitators to AHD diagnostic package at Rumphi District Hospital. A NVivo software package will be used to organize interview transcripts in preparation for thematic analysis. Quantitative baseline data will be extracted from quarterly reports on AHD for the period of July, 2021 to December,2021 retrospectively. The data will be analysed using STATA 15.0 statistical software and the results will be presented in tables, histograms, and frequency distribution tables.Expected findings and dissemination of results: We expect to establish barriers and facilitators from which implementation strategies would be derived. We hope that the identified strategies can be used to scale up utilization of AHD diagnostic services at Rumphi District Hospital and in other settings in Malawi and beyond. Findings of the study will be shared with Ministry of Health, College of Medicine Research and Ethics Committee (CoMREC), College of Medicine Research Dissemination Forum and the Medicine Library. Findings will also be shared with funders of the study. A manuscript will be prepared for publication.
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Barriers and facilitators to screening for dyslipidaemia, hypertension and diabetes among people living with HIV aged 40 years and above at ART clinics in district hospitals in Southern Malawi
(Kamuzu University of Health Sciences, 2021-11-18) Katundu, Kondwani
Study Type: The study will utilise a mixed-methods (convergent) approach. Background: Malawi is ranked among the countries in the world with the highest burden of atherosclerotic cardiovascular diseases (ASCD) among people living with HIV (PLWH). Dyslipidaemia, Hypertension, and diabetes mellitus (DM) are major risk factors for ASCD and lead to debilitating consequences such as stroke. There is a gap in the effectiveness in identifying and managing hypertension dyslipidaemia and DM among PLWH in many public health facilities across Malawi. Investigating the local barriers and facilitators in the Malawian setting is critical to creating better implementation strategies for the effective screening and management of these cardiovascular risk factors in district hospitals of the country. Study Objectives: The objectives of this study are: (a) to determine the proportion of PLWH aged 40 years and older who are evaluated for dyslipidaemia, hypertension and DM in routine care at district hospital ART clinics in Southern Malawi (b) to identify the barriers and facilitators to screening for dyslipidaemia, hypertension and DM among PLWH) aged 40 years and older at ART clinics in district hospitals in Southern Malawi. Methods: A mixed-methods (convergence) approach will be used to collect the study data. Firstly, we will quantitatively collect retrospective data on the performance of five randomly selected district hospital ART clinics in Southern Malawi to screen for hypertension, dyslipidaemia and DM in routine care. From these clinics, we will purposefully select three clinics rated as highest, intermediate and low on the screening performance for hypertension, which is the expected standard routine assessment in these clinics, according to Malawi standard clinical guidelines for the management of PLWH. In the three clinics we will collect qualitative data guided by the Consolidated Framework for Implementation Research (CFIR), and we will assess for three major domains namely the intervention, the inner setting and the characteristics of individuals. Expected findings and dissemination: We expect to find a relatively high prevalence of screening for hypertension since it is in the national management guidelines. However, we hypothesize that the prevalence for screening for DM and dyslipidaemia will be lower due to the lack of inclusion in the national guidelines and screening resources in district hospitals. We expect to identify the barriers and facilitators to the integration of screening of hypertension, DM and dyslipidaemia in the ART clinics. The results once analysed will be published in an international scientific journal and will be presented both at local and regional or international conferences. Published results will also be submitted to the district hospitals engaged, the HIV and non-communicable diseases units of the Malawi Ministry of Health, the College of Medicine Research and Ethics Committee (COMREC) and the Kamuzu University of Health Sciences Library.
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Blood culture sample management at Kamuzu Central Hospital
(Kamuzu University of Health Sciences, 2021-08-11) Bakali, Benson; Chinguwo, Peter
Sample management is a part of process control, one of the essentials of a quality management system. The laboratory must be proactive in ensuring that the samples it receives meet all the requirements needed to produce accurate test results. Blood culture bottle contains nutrients used by bacteria to grow and this is used to identify organisms in both children and adults. Blood culture is a gold standard methods for identifying organisms in the blood stream. This research broadly aims at assessing health workers’ level of knowledge on blood culture sample management. The Malawian picture on management of blood culture involving nurses, clinicians and laboratory technologists may not vary much with many developing countries, however there is no data available to establish this claim. It is not known how well are the health workers, if at all, equipped with knowledge on management of blood culture. This research has the following objectives; to determine health worker’s knowledge on blood culture sample management, to assess health workers’ attitude towards blood culture sample management and to explore the health worker’s experience with blood culture sample management. Cross sectional research design will be used during the research. The sample size will be 63, and participants will be selected using convenience sampling techniques. We will only allow health workers who participate in blood culture sample management; at clinical or laboratory level. Data is to be collected using a questionnaire and presented in proportions, percentage, graphs, tables and charts. We will seek permission from College of Medicine Research and Ethics Committee (COMREC) and Kamuzu Central Hospital Administrator before conducting the study. This study is expected to help fill the existing gap on data of health workers’ knowledge on blood culture sample management. A full written report of our findings will be presented to COMREC, COM library, KCH and MLS department. Upon approval by the COMREC the findings will be published in Malawi medical journal.
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Characteristics and outcomes of HIV Patients starting ART in the era of routine screening for advanced HIV Disease at Lighthouse Trust, Lilongwe
(Kamuzu University of Health Sciences, 2023-01-11) Buleya, Shameem
Type of Research Study This is a retrospective cohort study that will focus on exploring the characteristics and outcomes of HIV patients starting ART in the era of routine screening for advanced HIV diseases at Lighthouse Trust, Malawi. Problem statement The department of HIV/AIDS in Malawi implemented the Advanced HIV Disease (AHD) package of care in 2018 to reduce deaths in People living with HIV (PLHIV). AHD laboratory screening for tuberculosis and cryptococcal infection using CD4 count of ≤200 cells/ul as a cut-off point was since enforced on every newly HIV diagnosed client before starting ART. However, it has been observed that despite the implementation of the AHD package, there is limited data in Malawi on the proportion of people initiated on ART with AHD and their specification on age segregation. Subsequently, the effect of CD4 screening and testing for opportunistic infections on antiretroviral Treatment (ART) outcomes has not been well described in Malawi. This study will address the knowledge gap on distribution of AHD in people newly diagnosed with HIV will help program implementors introduce approaches to reduce the prevalence of AHD in the general HIV population of PLHIV. Objectives The broad objective of the study is to describe the epidemiology of clients diagnosed with AHD in the Era of Routine advanced HIV disease screening at Lighthouse Clinic- Lilongwe. The specific objectives are: i. To estimate the proportion of people with CD4 count of ≤200 cells/ul. ii. To determine the demographic characteristics of people starting ART with CD4 count of ≤200 cells/ul. iii. To assess the ART outcomes of clients diagnosed with AHD conditions at ART initiation. Methodology This is a quantitative study of retrospective cohort design which will be conducted at Lighthouse Trust, Lilongwe. The study population will include all HIV newly diagnosed patients started ART at Lighthouse Trust from October 2020 to September 2021, with a CD4 count result before initiation. A suitable anonymized purposive sample of one-year initiations will be selected from the Electronic Medical Records System (EMRS) and all study records meeting the inclusion criteria. Secondary data will be collected from laboratory equipment, registers and the lighthouse electronic medical record keeping system, which will be entered in a tailored data collection tool (appendix A). Data will be analyzed through regression analysis. Expected Findings The study expects to find the proportion of people starting ART with AHD using CD4 count as a marker as well as WHO HIV clinical staging. It will assess the characteristics of individuals presenting with AHD at initiation and their clinical outcomes over a year. For instance, it is anticipated that males of older age groups (above 50 years) have higher risk of developing AHD due to their poor health seeking behaviors. Patients who started ART with existing AHD are expected to have poorer clinical outcomes; weight loss, elevated HIV Viral Load copies at 6 months, and higher mortality rates than their counterparts with higher CD4 count. Dissemination of results Presentation of the outcomes shall be in tables, charts, and graphs, the research findings will be presented to College of Medicine Research ethics Committee (COMREC) as well as Lighthouse Trust clinic.