11 results on '"Thorp, Marguerite"'
Search Results
2. Geographic mobility and HIV care engagement among people living with HIV in rural Kenya and Uganda
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Ayieko, James, Thorp, Marguerite, Getahun, Monica, Gandhi, Monica, Maeri, Irene, Gutin, Sarah A, Okiring, Jaffer, Kamya, Moses R, Bukusi, Elizabeth A, Charlebois, Edwin D, Petersen, Maya, Havlir, Diane V, Camlin, Carol S, and Murnane, Pamela M
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- 2023
3. Understanding the Unique Barriers and Facilitators that Affect Men’s Initiation and Retention in HIV Care: A Qualitative Study to Inform Interventions for Men Across the Treatment Cascade in Malawi
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Coursey, Kate, Phiri, Khumbo, Choko, Augustine T., Kalande, Pericles, Chamberlin, Stephanie, Hubbard, Julie, Thorp, Marguerite, Hoffman, Risa, Coates, Thomas J., and Dovel, Kathryn
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- 2023
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4. Factors associated with men’s health facility attendance as clients and caregivers in Malawi: a community-representative survey
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Thorp, Marguerite, Balakasi, Kelvin T., Mphande, Misheck, Robson, Isabella, Khan, Shaukat, Stillson, Christian, Doi, Naoko, Nichols, Brooke E., and Dovel, Kathryn
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- 2022
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5. Improving care engagement for mobile people living with HIV in rural western Kenya.
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Ayieko, James, Charlebois, Edwin D., Maeri, Irene, Owino, Lawrence, Thorp, Marguerite, Bukusi, Elizabeth A., Petersen, Maya L., Kamya, Moses R., Havlir, Diane V., and Camlin, Carol S.
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HIV ,HIV-positive persons ,MEDICAL personnel ,HEALTH services accessibility ,DRUG packaging ,PATIENT-centered care - Abstract
Background: Antiretroviral therapy (ART) assures major gains in health outcomes among people living with HIV, however, this benefit may not be realized by all due to care interruptions. Mobile populations comprise a subgroup that is likely to have sub-optimal care engagement, resulting in discontinuation of ART. We sought to evaluate the barriers to care engagement among highly mobile individuals living with HIV and explore options aimed at improving engagement in care for this group. Methods: Qualitative in-depth interviews were conducted in 2020 among a purposive sample of twelve persons living with HIV and eight health care providers in western Kenya, within a mixed methods study of mobility in communities participating in the SEARCH trial (NCT01864603). We explored the barriers to care engagement among mobile individuals living with HIV and explored different options aimed at enhancing care engagement. These included options such as a coded card containing treatment details, alternative drug packaging to conceal drug identity, longer refills to cover travel period, wrist bands with data storage capability to enable data transfer and "warm handoff" by providers to new clinics upon transfer. Data were inductively analyzed to understand the barriers and acceptability of potential interventions to address them. Results: Stigma and lack of disclosure, rigid work schedules, and unpredictability of travel were major barriers to care engagement for highly mobile individuals living with HIV. Additionally, lack of flexibility in clinic schedules and poor provider attitude were identified as health-system-associated barriers to care engagement. Options that enhance flexibility, convenience and access to care were viewed as the most effective means of addressing the barriers to care by both patients and providers. The most preferred option was a coded card with treatment details followed by alternative drug packaging to conceal drug identity due to stigma and longer refills to cover travel periods. Conclusion: Highly mobile individuals living with HIV desire responsive, flexible, convenient and patient-centered care delivery models to enhance care engagement. They embraced simple health delivery improvements such as coded cards, alternative drug packaging and longer refills to address challenges of mobility. [ABSTRACT FROM AUTHOR]
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- 2023
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6. Mobility and ART retention among men in Malawi: a mixed‐methods study.
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Thorp, Marguerite, Bellos, MacDaphton, Temelkovska, Tijana, Mphande, Misheck, Cornell, Morna, Hubbard, Julie, Choko, Augustine, Coates, Thomas J., Hoffman, Risa, and Dovel, Kathryn
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PEER counseling , *HUMAN beings in art , *ANTIRETROVIRAL agents , *MEN in art , *COMPARATIVE method , *RESIDENTIAL mobility - Abstract
Introduction: Mobility is associated with worse outcomes across the HIV treatment cascade, especially among men. However, little is known about the mechanisms that link mobility and poor HIV outcomes and what types of mobility most increase the risk of treatment interruption among men in southern Africa. Methods: From August 2021 to January 2022, we conducted a mixed‐methods study with men living with HIV (MLHIV) but not currently receiving antiretroviral therapy (ART) in Malawi. Data collection was embedded within two larger trials (ENGAGE and IDEaL trials). We analysed baseline survey data of 223 men enrolled in the trials who reported being mobile (defined as spending ≥14 nights away from home in the past 12 months) using descriptive statistics and negative binomial regressions. We then recruited 32 men for in‐depth interviews regarding their travel experiences and ART utilization. We analysed qualitative data using constant comparative methods. Results: Survey data showed that 34% of men with treatment interruptions were mobile, with a median of 60 nights away from home in the past 12 months; 69% of trips were for income generation. More nights away from home in the past 12 months and having fewer household assets were associated with longer periods out of care. In interviews, men reported that travel was often unplanned, and men were highly vulnerable to exploitive employer demands, which led to missed appointments and ART interruption. Men made major efforts to stay in care but were often unable to access care on short notice, were denied ART refills at non‐home facilities and/or were treated poorly by providers, creating substantial barriers to remaining in and returning to care. Men desired additional multi‐month dispensing (MMD), the ability to refill treatment at any facility in Malawi, and streamlined pre‐travel refills at home facilities. Conclusions: Men prioritize ART and struggle with the trade‐offs between their own health and providing for their families. Mobility is an essential livelihood strategy for MLHIV in Malawi, but it creates conflict with ART retention, largely due to inflexible health systems. Targeted counselling and peer support, access to ART services anywhere in the country, and MMD may improve outcomes for mobile men. [ABSTRACT FROM AUTHOR]
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- 2023
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7. Mobility and HIV care engagement: a research agenda.
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Thorp, Marguerite, Ayieko, James, Hoffman, Risa M., Balakasi, Kelvin, Camlin, Carol S., and Dovel, Kathryn
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HIV , *HIV-positive persons , *RESIDENTIAL mobility , *EMIGRATION & immigration , *TREATMENT effectiveness - Abstract
Introduction: Mobility is common and an essential livelihood strategy in sub‐Saharan Africa (SSA). Mobile people suffer worse outcomes at every stage of the HIV care cascade compared to non‐mobile populations. Definitions of mobility vary widely, and research on the role of temporary mobility (as opposed to permanent migration) in HIV treatment outcomes is often lacking. In this article, we review the current landscape of mobility and HIV care research to identify what is already known, gaps in the literature, and recommendations for future research. Discussion: Mobility in SSA is closely linked to income generation, though caregiving, climate change and violence also contribute to the need to move. Mobility is likely to increase in the coming decades, both due to permanent migration and increased temporary mobility, which is likely much more common. We outline three central questions regarding mobility and HIV treatment outcomes in SSA. First, it is unclear what aspects of mobility matter most for HIV care outcomes and if high‐risk mobility can be identified or predicted, which is necessary to facilitate targeted interventions for mobile populations. Second, it is unclear what groups are most vulnerable to mobility‐associated treatment interruption and other adverse outcomes. And third, it is unclear what interventions can improve HIV treatment outcomes for mobile populations. Conclusions: Mobility is essential for people living with HIV in SSA. HIV treatment programmes and broader health systems must understand and adapt to human mobility, both to promote the rights and welfare of mobile people and to end the HIV pandemic. [ABSTRACT FROM AUTHOR]
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- 2023
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8. Transitioning youth living with HIV to adult HIV care
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Ayieko, James and Thorp, Marguerite
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- 2022
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9. WhatsApp Linking Lilongwe, Malawi to Los Angeles: Impacting Medical Education and Clinical Management.
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THORP, MARGUERITE, POOL, KARA-LEE, TYMCHUK, CHRISTOPHER, and SAAB, FAYSAL
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MEDICAL education ,RADIOLOGY ,PULMONOLOGY ,DERMATOLOGY - Abstract
Background: Subspecialty expertise is often lacking in clinical environments in lowresource settings. As a result, medically complicated patients can receive suboptimal care, local clinicians can feel inadequately supported, and global health engagements can be difficult for medical trainees accustomed to more expert supervision at their home institutions. Objective: We created WhatsApp Messenger discussion groups to connect subspecialists at the University of California, Los Angeles (UCLA) David Geffen School of Medicine with clinicians and rotating global health residents at Partners in Hope (PIH) Medical Center in Lilongwe, Malawi. Methods: Case submitters and subspecialist respondents were surveyed about their experience in the discussion groups. Findings: Over a three-year period, 95 cases were discussed in ten subspecialty groups, with dermatology and radiology/pulmonology receiving the most submissions. Participants were surveyed and reported excellent educational outcomes; large majorities of both case submitters (89%) and experts (71%) agreed or strongly agreed that the case discussions improved their medical education. The surveys also suggested positive impact on medical management decisions and patient outcomes. The major challenge to our intervention was low utilization of this resource by Malawian clinicians in comparison to medical residents. We hope to further address the barriers to participation and adapt the intervention to better support our Malawian colleagues. Conclusion: Because the discussion groups are free to create and require very little maintenance, this intervention can be easily replicated at other institutions looking to augment their global health educational engagements and support their clinical partners abroad. [ABSTRACT FROM AUTHOR]
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- 2021
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10. Negative Rapid Serological Tests in an HIV-Infected Infant: A Call for Improved Inpatient Provider-Initiated Testing and Counseling Beginning With Breastfeeding Mothers.
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Lisboa, Anselmo, Thorp, Marguerite, Lambo, Luisa, Chaúque, Sílvia, Elias, Beatriz, Domingos, Celina, Macassa, Eugénia, and Buck, W Chris
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HIV infections , *HIV-positive persons , *GANCICLOVIR , *HEMOGLOBINS , *SERODIAGNOSIS , *SEROCONVERSION , *OXYGEN saturation , *ALANINE aminotransferase - Abstract
Rapid serological tests are unreliable for the diagnosis of HIV exposure and infection in infants. This case reports an HIV-infected infant with a delayed diagnosis due to multiple negative serological tests, highlighting the importance of maternal testing for provider-initiated testing and counseling in hospitalized infants. [ABSTRACT FROM AUTHOR]
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- 2021
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11. Stakeholder Priorities for ART Initiation and Early Retention Interventions in Malawi: A Qualitative Study Comparing International and National Perspectives.
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Hariprasad S, Phiri K, Thorp M, Holland K, Nyirenda R, Gupta S, Phiri S, Sabin L, and Dovel K
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Background: New or returning ART clients are often ineligible for differentiated service delivery (DSD) models, though they are at increased risk of treatment interruption and may benefit greatly from flexible care models. Stakeholder support may limit progress on development and scale-up of interventions for this population. We qualitatively explored stakeholder perceptions of and decision-making criteria regarding DSD models for new or returning ART clients in Malawi., Methods: We conducted in-depth interviews with internationally based stakeholders (from foundations, multilateral organizations, and NGOs) and Malawi-based stakeholders (from the Malawi Ministry of Health and PEPFAR implementing partners). The interviews included two think-aloud scenarios in which participants rated and described their perceptions of 1) the relative importance of five criteria (cost, effectiveness, acceptability, feasibility, and equity) in determining which interventions to implement for new or returning ART clients and 2) their relative interest in seven potential interventions (monetary incentives, nonmonetary incentives, community-based care, ongoing peer/mentor support and counseling, eHealth, facility-based interventions, and multimonth dispensing) for the same population. The interviews were completed in English via video conference and were audio-recorded. Transcriptions were coded using ATLAS.ti version 9. We examined the data using thematic content analysis and explored differences between international and national stakeholders., Results: We interviewed twenty-two stakeholders between October 2021 and March 2022. Thirteen were based internationally, and nine were based in Malawi. Both groups prioritized client acceptability but diverged on other criteria: international stakeholders prioritized effectiveness, and Malawi-based stakeholders prioritized cost, feasibility, and sustainability. Both stakeholder groups were most interested in facility-based DSD models, such as multimonth dispensing and extended facility hours. Nearly all the stakeholders described person-centered care as a critical focus for any DSD model implemented., Conclusions: National and international stakeholders support DSD models for new or returning ART clients. Client acceptability and long-term sustainability should be prioritized to address the concerns of nationally based stakeholders. Future studies should explore the reasons for differences in national and international stakeholders' priorities and how to ensure that local perspectives are incorporated into funding and programmatic decisions., Competing Interests: Competing interests The authors declare that they have no competing interests. Additional Declarations: No competing interests reported.
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- 2023
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