Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-8 (of 8 Records) |
Query Trace: Makanga M[original query] |
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Non-adherence among women enrolled in a contraceptive vaginal ring use study in Kisumu, Kenya, 2014-2015
McLellan-Lemal E , Gvetadze R , Desai MA , Makanga EM , Pan Y , Haaland RE , Holder AN , Mudhune V , Williams T , Samandari T . J Glob Health Rep 2018 2 BACKGROUND: Given future potential use of vaginal rings to prevent HIV infection, we examined the association of contraceptive vaginal ring (CVR) non-adherence with user dissatisfaction, tolerability, demographic, and behavioral factors. METHODS: In an open-label single-group study, sexually active women aged 18-34 years using oral or injectable hormonal contraception, conveniently sampled from general population, were assigned to 6-month use of a commercial CVR currently not licensed for use in Kenya. Non-adherence in any CVR cycle completed was assessed from: (1) self-report (not used for at least 1 day), and (2) pharmacy record (failure to timely receive a new CVR or return a used one). Additionally, non-adherence was assessed in a subset of participants by residual progestin and estrogen levels measured in returned CVRs. RESULTS: Of 202 participants who underwent CVR insertion by a study clinician, 142 completed all 6 visits, 172 responded to questions about ring use, and 43 provided used CVRs from months 1, 3, and 6 for residual hormone analysis. Non-adherence was 14.0% (24/172) by self-report and 54.5% (110/202) by pharmacy record. Non-adherence by pharmacy record was significantly reduced among women with a salary-based income (prevalence ratio (PR) 0.71, 95% confidence interval (CI) (0.55-0.91)] compared to women with income not salary-based or no income. Participants dissatisfied with CVR on ≥4 aspects (ambiguity of instructions, inconvenience of use, sensation, sexual discomfort, etc.) were more likely to report non-adherence (PR 2.69, 95% CI=(1.31-5.52)] compared to those dissatisfied with ≤3 aspects. Non-adherence by residual hormone levels was identified in 46.5% (20/43) participants. Over time, this subset of participants showed increasing non-adherence (P=0.004). We found lack of agreement among the various measures of non-adherence. CONCLUSIONS: Economic empowerment interventions, especially those emphasizing partner-independent income options, and expanded education on CVR features may alleviate non-adherence. Addressing CVR dissatisfaction preemptively may also help mitigate non-adherence. |
Building national health security through a rapid self-assessment and annual operational plan in Uganda, May to September 2021
Nabatanzi M , Bakiika H , Nabukenya I , Lamorde M , Bukirwa J , Achan MI , Babigumira PA , Nakiire L , Lubanga T , Mbabazi E , Taremwa RB , Mayinja H , Nakinsige A , Makanga DK , Muruta A , Okware S , Komakech I , Makumbi I , Wetaka MM , Kayiwa J , Ocom F , Ario AR , Nabatanzi S , Ojwang J , Boore A , Yemanaberhan R , Lee CT , Obuku E , Stowell D . Health Secur 2023 21 (2) 130-140 Uganda established a National Action Plan for Health Security in 2019, following a Joint External Evaluation (JEE) of International Health Regulations (2005) capacities in 2017. The action plan enhanced national health security awareness, but implementation efforts were affected by limited funding, excess of activities, and challenges related to monitoring and evaluation. To improve implementation, Uganda conducted a multisectoral health security self-assessment in 2021 using the second edition of the JEE tool and developed a 1-year operational plan. From 2017 to 2021, Uganda's composite ReadyScore improved by 20%, with improvement in 13 of the 19 technical areas. Indicator scores showing limited capacity declined from 30% to 20%, and indicators with no capacity declined from 10% to 2%. More indicators had developed (47% vs 40%), demonstrated (29% vs 20%), and sustained (2% vs 0%) capacities in 2021 compared with 2017. Using the self-assessment JEE scores, 72 specific activities from the International Health Regulations (2005) benchmarks tool were selected for inclusion in a 1-year operational plan (2021-2022). In contrast to the 264 broad activities in the 5-year national action plan, the operational plan prioritized a small number of activities to enable sectors to focus limited resources on implementation. While certain capacities improved before and during implementation of the action plan, countries may benefit from using short-term operational planning to develop realistic and actionable health security plans to improve health security capacities. |
High prevalence of sexually transmitted infections among women screened for a contraceptive intravaginal ring study, Kisumu, Kenya, 2014
Oliver VO , Otieno G , Gvetadze R , Desai MA , Makanga M , Akelo V , Gust DA , Nyagol B , McLellan-Lemal E . Int J STD AIDS 2018 29 (14) 956462418782810 We assessed prevalence and correlates of bacterial vaginosis (BV) and sexually transmitted infections (STIs) including herpes simplex virus type 2 (HSV-2), gonorrhoea (GC), syphilis (SYP), Chlamydia (CT) and HIV among Kenyan women aged 18-34 years who were screened for a contraceptive intravaginal ring study. Women provided demographic, behavioural and medical information, and underwent medical evaluation, including a pelvic exam. We computed crude and adjusted prevalence ratio (aPR) and 95% confidence interval (CI) using log-binomial regression. Of 463 women screened, 457 provided laboratory specimens and were included in the analysis. The median age was 25 years, interquartile range (21-28), and 68.5% had completed primary or lower education. Overall, 72.2% tested positive for any STI or BV. Point prevalence was 55.6, 38.5, 3.9, 2.0, 4.6, and 14.7% for HSV-2, BV, GC, SYP, CT, and HIV, respectively. Co-infection with HSV-2, BV, and HIV occurred in 28 (6.1%) participants. Having >/=1 STI/BV was associated with younger age at first sex (</=13 versus 17-19 years, aPR=1.27, 95% CI 1.07-1.51), history of exchange sex (aPR = 2.05, 95% CI 1.07-3.92), sexual intercourse in the past seven days (aPR = 1.17, 95% CI 1.01-1.36), and older age (30-34 versus 18-24 years, aPR = 1.26, 95% CI 1.06-1.48). STI/BV diagnosis was less likely for women reporting one lifetime sexual partner compared to women with >/=4 lifetime sexual partners (aPR = 0.70, 95% CI 0.54-0.92). Combination prevention approaches (biomedical, behavioural, social, and structural) tailored to women with diverse risk profiles may help mitigate STI/BV prevalence in this setting. |
Contraceptive vaginal ring experiences among women and men in Kisumu, Kenya: A qualitative study
McLellan-Lemal E , Ondeng'e K , Gust DA , Desai M , Otieno FO , Madiega PA , Nyagol B , Makanga EM . Front Womens Health 2017 2 (1) BACKGROUND: Future HIV prevention options for women will likely include Antiretroviral (ARV)-based intravaginal rings. Valuable insights may be gained by examining user experiences with a similar licensed technology, a contraceptive ring, especially in settings where this technology may not be currently available. METHODS: In-depth interviews with 24 females enrolled in a trial assessing acceptability and use of a contraceptive ring, and 20 male sexual partners were conducted September 2014-April 2015. Elements of ethnography and phenomenological anthropology were used to collect, analyze, interpret, and describe ring users' experiences. Thematic analysis was completed in MaxQDA-10. RESULTS: Experiences with the contraceptive ring reflected a broader Family Planning (FP) paradigm that centered around three themes: latitudes and drawbacks of FP (being free); an FP method needs to be compatible with a woman's body (feeling normal); and dealing with fertility control uncertainties (how well does it really work). FP intentions and disclosure practices were influenced by partner support, socioeconomic factors, religion, cultural beliefs, and societal norms, including female sexuality. A user-friendly FP design was emphasized. Non-suppression of menstruation was favored by most. Unease with vaginal insertion as well as ring placement issues (slippage, expulsion) created initial challenges requiring clinician assistance and practice for some participants. While minor side-effects were described, concerns centered on ring efficacy, negative effect on a woman's sexual desire, and future fertility issues. CONCLUSIONS: Awareness of the multiple contexts in ring users' experience may inform the development, education, and promotion approaches for future ARV rings. |
Factors associated with psychological distress among young women in Kisumu, Kenya
Gust DA , Gvetadze R , Furtado M , Makanga M , Akelo V , Ondenge K , Nyagol B , McLellan-Lemal E . Int J Womens Health 2017 9 255-264 BACKGROUND: Attention to mental health issues is growing globally. In many countries, including Kenya, however, assessment of psychological distress, especially in rural areas, is limited. METHODS: We analyzed data from young women screened for a longitudinal contraceptive ring study in Kisumu, Kenya. Multivariable regression analysis was used to assess factors associated with recent moderate and high psychological distress, as measured by the Kessler (K-6) psychological distress scale. RESULTS: Among the 461 women screened, most (58.4%) were categorized as having moderate psychological distress, 20.8% were categorized as having low or no psychological distress, and 20.8% were categorized as having high psychological distress. Moderate psychological distress (vs low/no) was significantly more likely among women who reported a history of forced sex and were concerned about recent food insecurity. High (vs low/no) psychological distress was significantly more likely among women who reported a history of forced sex, who were concerned about recent food insecurity, and who self-reported a sexually transmitted infection. CONCLUSION: To reduce psychological distress, a focus on prevention as well as care methods is needed. Girls need a path toward a healthy and productive adulthood with a focus on education, which would help them gain skills to avoid forced sex. Women would benefit from easy access to social services and supports that would help them with basic needs like food security among other things. A holistic or ecological approach to services that would address mental, educational, social, health, and economic issues may have the highest chance of having a long-term positive impact on public health. |
Residual hormone levels in used contraceptive rings as a measurement of adherence to vaginal ring use
Haaland RE , Holder A , Evans-Strickfaden T , Nyagol B , Makanga M , Oyaro B , Humwa F , Williams T , McLellan-Lemal E , Desai M , Huey MJ . Contraception 2017 95 (6) 602-604 OBJECTIVE: This study sought to measure residual contraceptive hormone levels in vaginal rings as an adherence marker for monitoring product use in clinical trials. STUDY DESIGN: Residual etonogestrel and ethinyl estradiol levels from used NuvaRings(R) of 26 self-reported adherent women enrolled in a clinical trial of vaginal ring acceptability were compared to those from 16 women who used NuvaRing(R) as their contraceptive choice. RESULTS: Twenty-one (81%) clinical trial rings had contraceptive hormone levels within the range of those used as a contraceptive choice. Five returned rings had unused or discordant levels of residual contraceptive hormones. CONCLUSION: Residual vaginal ring drug levels could help assess adherence in clinical trials. |
Characteristics of women screened for a contraceptive intravaginal ring study in Kisumu, Kenya, 2014
McLellan-Lemal E , Gust DA , Gvetadze R , Furtado M , Otieno FO , Desai M , Zeh C , Samandari T , Nyagol B , Makanga EM . Res J Womens Health 2016 3 (1) BACKGROUND: HIV antiretroviral-based intravaginal rings with and without co-formulated contraception hold promise for increasing HIV prevention options for women. Acceptance of and ability to correctly and consistently use this technology may create challenges for future ring-based microbicide trials in settings where this technology has not been introduced. We examined baseline factors associated with enrolling in a contraceptive intravaginal ring study in Kisumu, Kenya and describe notional acceptability (willingness to switch to a contraceptive ring based solely on information received about it). METHODS: Demographic, psychosocial, and behavioral eligibility screening of women 18-34 years was undertaken. Testing for pregnancy, HIV, and other sexually transmitted infections (STIs) was also conducted. We compared enrollment status across groups of categorical predictors using prevalence ratios (PR) and 95% confidence interval (CI) estimates obtained from a log-binomial regression model. RESULTS: Out of 692 women pre-screened April to November 2014, 463 completed screening, and 302 women were enrolled. Approximately 97% of pre-screened women were willing to switch from their current contraceptive method to use the intravaginal ring exclusively for the 6-month intervention period. Pregnancy, HIV, and STI prevalence were 1.7%, 14.5%, and 70.4% respectively for the 463 women screened. Women 18-24 (PR=1.47, CI 1.15-1.88) were more likely to be enrolled than those 30-34 years of age, as were married/cohabitating women (PR=1.62, CI 1.22-2.16) compared to those separated, divorced, or widowed. In adjusted analyses, sexual debut at less than 17 years of age, one lifetime sexual partner, abnormal vaginal bleeding in the past 12 months, condomless vaginal or anal sex in the past 3 months, and not having a sexual partner of unknown HIV status in the past 3 months were predictive of enrollment. CONCLUSION: High notional acceptability suggests feasibility for contraceptive intravaginal ring use. Factors associated with ring use initiation and 6-month use will need to be assessed. |
Clinical determinants of early parasitological response to ACTs in African patients with uncomplicated falciparum malaria: a literature review and meta-analysis of individual patient data
Abdulla S , Adam I , Adjei GO , Adjuik MA , Alemayehu B , Allan R , Arinaitwe E , Ashley EA , Ba MS , Barennes H , Barnes KI , Bassat Q , Baudin E , Berens-Riha N , Bjorkman A , Bompart F , Bonnet M , Borrmann S , Bousema T , Brasseur P , Bukirwa H , Checchi F , Dahal P , D'Alessandro U , Desai M , Dicko A , Djimde AA , Dorsey G , Doumbo OK , Drakeley CJ , Duparc S , Eshetu T , Espie E , Etard JF , Faiz AM , Falade CO , Fanello CI , Faucher JF , Faye B , Faye O , Filler S , Flegg JA , Fofana B , Fogg C , Gadalla NB , Gaye O , Genton B , Gething PW , Gil JP , Gonzalez R , Grandesso F , Greenhouse B , Greenwood B , Grivoyannis A , Guerin PJ , Guthmann JP , Hamed K , Hamour S , Hay SI , Hode EM , Humphreys GS , Hwang J , Ibrahim ML , Jima D , Jones JJ , Jullien V , Juma E , Kachur PS , Kager PA , Kamugisha E , Kamya MR , Karema C , Kayentao K , Kieche JR , Kironde F , Kofoed PE , Kremsner PG , Krishna S , Lameyre V , Lell B , Lima A , Makanga M , Malik EM , Marsh K , Martensson A , Massougbodji A , Menan H , Menard D , Menendez C , Mens PF , Meremikwu M , Moreira C , Nabasumba C , Nambozi M , Ndiaye JL , Ngasala BE , Nikiema F , Nsanzabana C , Ntoumi F , Oguike M , Ogutu BR , Olliaro P , Omar SA , Ouedraogo JB , Owusu-Agyei S , Penali LK , Pene M , Peshu J , Piola P , Plowe CV , Premji Z , Price RN , Randrianarivelojosia M , Rombo L , Roper C , Rosenthal PJ , Sagara I , Same-Ekobo A , Sawa P , Schallig HDFH , Schramm B , Seck A , Shekalaghe SA , Sibley CH , Sinou V , Sirima SB , Some FA , Sow D , Staedke SG , Stepniewska K , Sutherland CJ , Swarthout TD , Sylla K , Talisuna AO , Taylor WRJ , Temu EA , Thwing JI , Tine RCK , Tinto H , Tommasini S , Toure OA , Ursing J , Vaillant MT , Valentini G , Van den Broek I , Vugt MV , Ward SA , Winstanley PA , Yavo W , Yeka A , Zolia YM , Zongo I , WWARN Artemisinin based Combination Therapy (ACT) Africa Baseline Study Group . BMC Med 2015 13 212 BACKGROUND: Artemisinin-resistant Plasmodium falciparum has emerged in the Greater Mekong sub-region and poses a major global public health threat. Slow parasite clearance is a key clinical manifestation of reduced susceptibility to artemisinin. This study was designed to establish the baseline values for clearance in patients from Sub-Saharan African countries with uncomplicated malaria treated with artemisinin-based combination therapies (ACTs). METHODS: A literature review in PubMed was conducted in March 2013 to identify all prospective clinical trials (uncontrolled trials, controlled trials and randomized controlled trials), including ACTs conducted in Sub-Saharan Africa, between 1960 and 2012. Individual patient data from these studies were shared with the WorldWide Antimalarial Resistance Network (WWARN) and pooled using an a priori statistical analytical plan. Factors affecting early parasitological response were investigated using logistic regression with study sites fitted as a random effect. The risk of bias in included studies was evaluated based on study design, methodology and missing data. RESULTS: In total, 29,493 patients from 84 clinical trials were included in the analysis, treated with artemether-lumefantrine (n = 13,664), artesunate-amodiaquine (n = 11,337) and dihydroartemisinin-piperaquine (n = 4,492). The overall parasite clearance rate was rapid. The parasite positivity rate (PPR) decreased from 59.7 % (95 % CI: 54.5-64.9) on day 1 to 6.7 % (95 % CI: 4.8-8.7) on day 2 and 0.9 % (95 % CI: 0.5-1.2) on day 3. The 95th percentile of observed day 3 PPR was 5.3 %. Independent risk factors predictive of day 3 positivity were: high baseline parasitaemia (adjusted odds ratio (AOR) = 1.16 (95 % CI: 1.08-1.25); per 2-fold increase in parasite density, P <0.001); fever (>37.5 degreeC) (AOR = 1.50 (95 % CI: 1.06-2.13), P = 0.022); severe anaemia (AOR = 2.04 (95 % CI: 1.21-3.44), P = 0.008); areas of low/moderate transmission setting (AOR = 2.71 (95 % CI: 1.38-5.36), P = 0.004); and treatment with the loose formulation of artesunate-amodiaquine (AOR = 2.27 (95 % CI: 1.14-4.51), P = 0.020, compared to dihydroartemisinin-piperaquine). CONCLUSIONS: The three ACTs assessed in this analysis continue to achieve rapid early parasitological clearance across the sites assessed in Sub-Saharan Africa. A threshold of 5 % day 3 parasite positivity from a minimum sample size of 50 patients provides a more sensitive benchmark in Sub-Saharan Africa compared to the current recommended threshold of 10 % to trigger further investigation of artemisinin susceptibility. |
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