48 results on '"van der Elst E"'
Search Results
2. Dealing with chemotherapy-related symptoms at home: a qualitative study in adult patients with cancer
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COOLBRANDT, A., DIERCKX DE CASTERLÉ, B., WILDIERS, H., AERTGEERTS, B., VAN DER ELST, E., VAN ACHTERBERG, T., and MILISEN, K.
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- 2016
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3. Risk factors for HIV-1 infection and high HIV-1 incidence of men who have sex with men, in and around Mombasa, Kenya
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Sanders, EJ, Graham, S, Okuku, HS, van der Elst, E, Muhaari, A, Davies, A, Peshu, N, Fast, P, McClelland, RS, and Smith, A
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- 2016
4. A nursing intervention to support cancer patients in dealing with chemotherapy-related symptoms at home (CHEMO-SUPPORT): a qualitative study of the patient experience
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Coolbrandt, A., primary, Wildiers, H., additional, Aertgeerts, B., additional, Dierckx de Casterlé, B., additional, Van Achterberg, T., additional, Van der Elst, E., additional, and Milisen, K., additional
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- 2017
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5. Aan de redactie van de economist
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Van Der Elst, E.
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- 1860
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6. Dealing with chemotherapy-related symptoms at home: a qualitative study in adult patients with cancer
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Coolbrandt, A., primary, Dierckx de Casterlé, B., additional, Wildiers, H., additional, Aertgeerts, B., additional, Van der Elst, E., additional, van Achterberg, T., additional, and Milisen, K., additional
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- 2015
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7. Challenges in addressing counselling needs of MSM in highly stigmatized contexts: results of a qualitative study from Kenya
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Taegtmeyer, M, Muhaari, A, Davies, A, Mwangome, M, van der Elst, E, Graham, S, and Sanders, E
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virus diseases - Abstract
The role of men who have sex with men (MSM) in the African HIV epidemic is gaining recognition yet capacity to address the HIV prevention needs of this group is limited. HIV testing and counselling is not only a critical entry point for biomedical HIV prevention interventions, such as pre-exposure prophylaxis, rectal microbicides and early treatment initiation, but is also an opportunity for focused risk reduction counselling that can support individuals living in difficult circumstances. For prevention efforts to succeed, however, MSM need to access services and they will only do so if these are non-judgmental, informative, focused on their needs, and of clear benefit. This study aimed to understand Kenyan providers' attitudes towards and experiences with counselling MSM in a research clinic targeting this group for HIV prevention. We used in-depth interviews to explore values, attitudes and cognitive and social constructs of 13 counsellors and 3 clinicians providing services to MSM at this clinic. Service providers felt that despite their growing experience, more targeted training would have been helpful to improve their effectiveness in MSM-specific risk reduction counselling. They wanted greater familiarity with MSM in Kenya to better understand the root causes of MSM risk-taking (e.g., poverty, sex work, substance abuse, misconceptions about transmission, stigma, and sexual desire) and felt frustrated at the perceived intractability of some of their clients' issues. In addition, they identified training needs on how to question men about specific risk behaviours, improved strategies for negotiating risk reduction with counselling clients, and improved support supervision from senior counsellors. This paper describes the themes arising from these interviews and makes practical recommendations on training and support supervision systems for nascent MSM HIV prevention programmes in Africa. © 2013 Taegtmeyer et al.
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- 2009
8. 1811 - A nursing intervention to support cancer patients in dealing with chemotherapy-related symptoms at home (CHEMO-SUPPORT): a qualitative study of the patient experience
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Coolbrandt, A., Wildiers, H., Aertgeerts, B., Dierckx de Casterlé, B., Van Achterberg, T., Van der Elst, E., and Milisen, K.
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- 2017
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9. Flanders’ falls awareness week: An example of promoting fall prevention strategies within the community and residential care settings
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Leysens, G., primary, Van der Elst, E., additional, Vlaeyen, E., additional, Dejaeger, E., additional, and Milisen, K., additional
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- 2013
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10. Characteristics and effectiveness of fall prevention programs in nursing homes: A systematic review and meta-analysis of randomized controlled trials
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Vlaeyen, E., primary, Coussement, J., additional, Leysens, G., additional, Van der Elst, E., additional, Delbaere, K., additional, Cambier, D., additional, Denhaerynck, K., additional, Dejaeger, E., additional, Boonen, S., additional, and Milisen, K., additional
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- 2013
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11. Center of expertise for fall & fracture prevention Flanders: Strategies to implement fall prevention in clinical practice
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Vlaeyen, E., primary, Leysens, G., additional, Van Der Elst, E., additional, Dejaeger, E., additional, Boonen, S., additional, and Milisen, K., additional
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- 2012
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12. Elderly patients' and residents' perceptions of 'the good nurse': a literature review.
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Van der Elst E, Dierckx de Casterlé B, and Gastmans C
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This article describes the findings of a mixed method literature review that examined the perceptions of elderly patients and residents of a good nurse in nursing homes, hospitals and home care. According to elderly patients and residents, good nurses are individuals who have the necessary technical and psychosocial skills to care for patients. They are at their disposal, promptly recognising the patients' needs. Good nurses like their job and are sincere and affectionate. They are understanding and caring. They do not hesitate to enter into a trust-based relationship with their patients. Knowing and understanding how elderly patients and nursing home residents perceive 'the good nurse' is crucial for providing quality care and for promoting better patient outcomes in geriatric care. [ABSTRACT FROM AUTHOR]
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- 2012
13. Pharmacodynamics of intravenous and subcutaneous tinzaparin and heparin in healthy volunteers.
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Fossler, M J, Barrett, J S, Hainer, J W, Riddle, J G, Ostergaard, P, van der Elst, E, and Sprogel, P
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The pharmacodynamics of i.v. and subcutaneous (s.c.) tinzaparin sodium compared with heparin in healthy volunteers were studied. A randomized, open-label, five-treatment, five-period-crossover study with a Latin square design was performed in 30 healthy men to estimate tinzaparin pharmacodynamics (anti-Xa and anti-IIa activities) after single-dose i.v. and s.c. administration, to evaluate absolute bioavailability, to determine the effect of a preservative (benzyl alcohol), to evaluate the dose-activity relationship, and to compare tinzaparin with unfractionated heparin. Treatments were (1) heparin 5,000 units s.c., (2) tinzaparin 4,500 anti-Xa IU without preservative s.c., (3) tinzaparin 4,500 anti-Xa IU without preservative i.v., (4) tinzaparin 12,250 anti-Xa IU with preservative s.c., and (5) tinzaparin 4,500 anti-Xa IU with preservative s.c. Blood samples for the measurement of anti-Xa and anti-IIa activities were drawn over 24 hours. Anti-Xa and anti-IIa activities were determined by chromogenic methods; data were analyzed by using a noncompartmental approach. The clearance of tinzaparin based on anti-Xa activity ranged from 1.14 to 2.04 L/hr. The volume of distribution was 3.1-5.0 L, suggesting that the molecular entities responsible for anti-Xa and anti-IIa activities are confined to the intravascular space. Mean peak anti-Xa activity occurred three to four hours after s.c. injection, independent of the dose. The mean half-life of anti-Xa activity after s.c. injection ranged from 3.41 to 4.13 hours and was independent of the dose. The mean absolute bioavailability of s.c. tinzaparin was 86.7%. Intersubject pharmacodynamic variability was low for tinzaparin compared with heparin. Benzyl alcohol did not affect tinzaparin pharmacodynamics. A clear dose-activity relationship was seen for the two fixed doses of tinzaparin (12,250 and 4,500 IU). Single doses of tinzaparin were safe and well tolerated after administration by either route. The anti-Xa profile of tinzaparin supports the pharmacodynamic superiority of low-molecular-weight heparins over standard i.v. heparin administration. This pharmacodynamic study in healthy volunteers indicates that s.c. tinzaparin sodium was well absorbed; the presence of a preservative, benzyl alcohol, did not affect the activity of tinzaparin; and tinzaparin activity is dose-related.
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- 2001
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14. Die godsdiensgegewe in twee romans van Berta Smit
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Van der Elst, E. A., primary
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- 1983
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15. Die Godsdiensgegewe in Enkele Hoogtepunte in die prosa van J. van Melle
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Van der Elst, E. A., primary
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- 1984
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16. Van eensame mense.
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van der Elst, E. A.
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- 2006
17. Marié Heese: Die uurwerk kantel.
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Van Der Elst, E. A. (Betsie)
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- 2007
18. Strengthening HIV preventive services for transgender women and men who have sex with men in coastal Kenya
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Kimani, Makobu, Rinke de Wit, T.F., Sanders, E.J., van der Elst, E., Operario, D., Faculteit der Geneeskunde, Rinke de Wit, Tobias F., Sanders, Eduard, van der Elst, Elise, and Graduate School
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virus diseases - Abstract
Men who have sex with men (MSM) and transgender women (TW), are at the highest risk for infection with the Human Immunodeficiency Virus (HIV). Globally, MSM and TW have higher prevalence of common mental disorders (CMD) including depression, anxiety and substance abuse. Finally, most of sub-Saharan Africa countries are rights constrained settings for both MSM and TW. The lack of legal recognition and protection for MSM and TW results in both internal and enacted stigma. Mental health challenges, stigma, lack of social protection and reduced access to healthcare services create a vicious cycle of increased risk for HIV infection. Pre-exposure prophylaxis (PrEP), could help prevent incident HIV infections in MSM and TW. In the empirical chapters of this thesis the author present studies in this thesis address the challenges MSM and TW face in accessing PrEP. The studies demonstrate the PrEP provision cascade including PrEP knowledge, desire to take it up, adherence and retention in follow-up. Additionally, the author explores the prevalence of CMD in MSM and any association with HIV status. In the discussion chapter, the author synthesises the findings from the studies against current literature. Finally, there are recommendations to improve HIV prevention for MSM and TW specifically in coastal Kenya. There are also recommendations addressing diagnosis and management of CMD in MSM. The author also gives suggestions for areas of further research especially in TW who are still underserved and underreached in sub-Saharan Africa.
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- 2021
19. Impact of coronavirus disease 2019-related clinic closures on HIV incidence in young adult MSM and transgender women in Kenya.
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Wahome E, Otieno FO, Kimani J, Boyd A, Okall D, Nzioka J, Gichuru E, van der Elst E, Mehta SD, Bailey RC, Graham SM, and Sanders EJ
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- Male, Humans, Female, Young Adult, Homosexuality, Male, Incidence, Cohort Studies, Prospective Studies, Kenya epidemiology, Bayes Theorem, Pandemics, Sexual Behavior, HIV Infections epidemiology, Transgender Persons, Sexual and Gender Minorities, COVID-19 epidemiology
- Abstract
Introduction: Little is known about the impact that the COVID-19 pandemic had on risk of HIV acquisition in sub-Saharan Africa. We assessed the impact of COVID-19-related clinic closures on HIV incidence in a cohort of gay, bisexual, and other men who have sex with men (MSM) and transgender women in Kenya., Methods: MSM and transgender women enrolled in a prospective, multicentre cohort study were followed quarterly for HIV testing, behaviour assessments, and risk. We estimated the HIV incidence rate and its 95% credible intervals (CrI) among participants who were HIV-negative before COVID-19-related clinic closure, comparing incidence rate and risk factors associated with HIV acquisition before vs. after clinic reopening, using a Bayesian Poisson model with weakly informative priors., Results: A total of 690 (87%) participants returned for follow-up after clinic reopening (total person-years 664.3 during clinic closure and 1013.3 after clinic reopening). HIV incidence rate declined from 2.05/100 person-years (95% CrI = 1.22-3.26, n = 14) during clinic closures to 0.96/100 person-years (95% CrI = 0.41-2.07, n = 10) after clinic reopening (IRR = 0.47, 95% CrI = 0.20-1.01). The proportion of participants reporting hazardous alcohol use and several sexual risk behaviours was higher during clinic closures than after clinic reopening. In multivariable analysis adjusting for study site and participant characteristics, HIV incidence was lower after clinic reopening (IRR 0.57, 95% CrI = 0.23-1.33). Independent risk factors for HIV acquisition included receptive anal intercourse (IRR 1.94, 95% CrI = 0.88-4.80) and perceived risk of HIV (IRR 3.03, 95% CRI = 1.40-6.24)., Conclusion: HIV incidence during COVID-19-related clinic closures was moderately increased and reduced after COVID-19 restrictions were eased. Ensuring access to services for key populations is important during public health emergencies., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2024
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20. The Effect of the Shikamana Peer-and-Provider Intervention on Depressive Symptoms, Alcohol Use, and Other Drug Use Among Gay, Bisexual, and Other Men Who Have Sex with Men in Kenya.
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Graff NR, Hong C, Guthrie B, Micheni M, Chirro O, Wahome E, van der Elst E, Sanders EJ, Simoni JM, and Graham SM
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- Humans, Male, Anti-Retroviral Agents therapeutic use, Depression drug therapy, Depression epidemiology, Depression psychology, Homosexuality, Male psychology, Kenya epidemiology, Randomized Controlled Trials as Topic, HIV Infections drug therapy, HIV Infections epidemiology, HIV Infections psychology, Sexual and Gender Minorities, Substance-Related Disorders epidemiology, Substance-Related Disorders psychology
- Abstract
Kenyan gay, bisexual, and other men who have sex with men (GBMSM) face stigma and discrimination, which may adversely impact mental health and limit antiretroviral therapy (ART) adherence among GBMSM living with HIV. We evaluated whether the Shikamana peer-and-provider intervention, which improved ART adherence among participants in a small randomized trial, was associated with changes in mental health or substance use. The intervention was associated with a significant decrease in PHQ-9 score between baseline and month 6 (estimated change - 2.7, 95% CI - 5.2 to - 0.2, p = 0.037) compared to standard care. In an exploratory analysis, each one-point increment in baseline HIV stigma score was associated with a - 0.7 point (95% CI - 1.3 to - 0.04, p = 0.037) greater decrease in PHQ-9 score over the study period in the intervention group. Additional research is required to understand factors that influence this intervention's effects on mental health outcomes., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
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- 2023
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21. Transgender women in Kenya experience greater stigma, depressive symptoms, alcohol and drug use and risky sexual practices than cis-gendered men who have sex with men.
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Mehta SD, Otieno FO, Kimani J, Wahome E, Okal D, Roy A, van der Elst E, Graham SM, Sanders EJ, and Bailey RC
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- Infant, Newborn, Male, Humans, Female, Homosexuality, Male, Gender Identity, Prospective Studies, Kenya epidemiology, Depression epidemiology, Sexual Behavior, Transgender Persons psychology, HIV Infections epidemiology, Sexual and Gender Minorities, Substance-Related Disorders epidemiology
- Abstract
Background: Worldwide, sexual and gender minority individuals have disproportionate burden of HIV. There are limited quantitative data from sub-Saharan Africa on the intersection of risks experienced by transgender women (TGW) in comparison to cis-men who have sex with men (MSM). This analysis addresses this gap by comparing reported stigma, psychosocial measures of health, and sexual risk practices between TGW and cis-MSM in Kenya., Methods: We analyzed data from the baseline visit of an ongoing prospective cohort study taking place in three diverse metropolitan areas. Eligible participants were HIV-negative, assigned male at birth, ages 18-29 years, and reported anal intercourse in the past 3 months with a man or TGW. Data collected by audio computer assisted self-interview included sociodemographic measures, and sexual practices occurring in the past 3 months. Multivariable regressions assessed differences between TGW and cis-MSM in selected sexual practices, depressive symptoms, alcohol and drug use, and stigma., Results: From September, 2019, through May, 2021, 838 participants were enrolled: 108 (12.9%) TGW and 730 (87.1%) cis-MSM. Adjusting for sociodemographic variables, TGW were more likely than cis-MSM to report: receptive anal intercourse (RAI; adjusted prevalence ratio [aPR] = 1.59, 95% CI: 1.32 - 1.92), engaging in group sex (aPR = 1.15, 95% CI: 1.04 - 1.27), 4 or more male sex partners (aPR = 3.31, 95% CI: 2.52 - 4.35), and 3 or more paying male sex partners (aPR = 1.58, 95% CI: 1.04 - 2.39). TGW were also more likely to report moderate to severe depressive symptoms (aPR = 1.42, 95% CI: 1.01 - 1.55), and had similar alcohol and drug abuse scores as cis-MSM. In sensitivity analysis, similar to TGW, male-identifying individuals taking feminizing gender affirming therapy had an increased likelihood of reporting RAI and group sex, and greater numbers of male sex partners and paying male sex partners relative to cis-MSM., Conclusions: Across three metropolitan areas in Kenya, TGW were more likely to report depressive symptoms and increased sexual risk taking. We identified a need for research that better characterizes the range of gender identities. Our analysis affirms the need for programmatic gender-affirming interventions specific to transgender populations in Kenya and elsewhere in Africa., (© 2023. BioMed Central Ltd., part of Springer Nature.)
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- 2023
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22. Testing strategies to detect acute and prevalent HIV infection in adult outpatients seeking healthcare for symptoms compatible with acute HIV infection in Kenya: a cost-effectiveness analysis.
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Babigumira JB, Agutu CA, Hamilton DT, van der Elst E, Hassan A, Gichuru E, Mugo PM, Farquhar C, Ndung'u T, Sirengo M, Chege W, Goodreau SM, Sanders EJ, and M Graham S
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- Adult, Cost-Benefit Analysis, Delivery of Health Care, Humans, Kenya epidemiology, Outpatients, Acquired Immunodeficiency Syndrome, HIV Infections diagnosis, Nucleic Acids
- Abstract
Background: Detection of acute and prevalent HIV infection using point-of-care nucleic acid amplification testing (POC-NAAT) among outpatients with symptoms compatible with acute HIV is critical to HIV prevention, but it is not clear if it is cost-effective compared with existing HIV testing strategies., Methods: We developed and parametrised a decision tree to compare the cost-effectiveness of (1) provider-initiated testing and counselling (PITC) using rapid tests, the standard of care; (2) scaled-up provider-initiated testing and counselling (SU-PITC) in which all patients were tested with rapid tests unless they opted out; and (3) opt-out testing and counselling using POC-NAAT, which detects both acute and prevalent infection. The model-based analysis used data from the Tambua Mapema Plus randomised controlled trial of a POC-NAAT intervention in Kenya, supplemented with results from a stochastic, agent-based network model of HIV-1 transmission and data from published literature. The analysis was conducted from the perspective of the Kenyan government using a primary outcome of cost per disability-adjusted life-year (DALY) averted over a 10-year time horizon., Results: After analysing the decision-analytical model, the average per patient cost of POC-NAAT was $214.9 compared with $173.6 for SU-PITC and $47.3 for PITC. The mean DALYs accumulated per patient for POC-NAAT were 0.160 compared with 0.176 for SU-PITC and 0.214 for PITC. In the incremental analysis, SU-PITC was eliminated due to extended dominance, and the incremental cost-effectiveness ratio (ICER) comparing POC-NAAT to PITC was $3098 per DALY averted. The ICER was sensitive to disability weights for HIV/AIDS and the costs of antiretroviral therapy., Conclusion: POC-NAAT offered to adult outpatients in Kenya who present for care with symptoms compatible with AHI is cost-effective and should be considered for inclusion as the standard of HIV testing in this population., Trial Registration Number: Tambua Mapema ("Discover Early") Plus study (NCT03508908) conducted in Kenya (2017-2020) i.e., Post-results., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
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- 2022
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23. Modeling the Impact of HIV-1 Nucleic Acid Testing Among Symptomatic Adult Outpatients in Kenya.
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Hamilton DT, Agutu C, Babigumira JB, van der Elst E, Hassan A, Gichuru E, Mugo P, Farquhar C, Ndung'u T, Sirengo M, Chege W, Goodreau SM, Elder A, Sanders EJ, and Graham SM
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- Adult, Counseling methods, Humans, Kenya epidemiology, Mass Screening methods, Outpatients, HIV Infections diagnosis, HIV Infections drug therapy, HIV Infections epidemiology, HIV Seropositivity, HIV-1 genetics, Nucleic Acids
- Abstract
Background: Up to 69% of adults who acquire HIV in Kenya seek care before seroconversion, providing an important opportunity for early diagnosis and treatment. The Tambua Mapema Plus (TMP) trial tested a combined HIV-1 nucleic acid testing, linkage, treatment, and partner notification intervention for adults aged 18-39 years with symptoms of acute HIV infection presenting to health facilities in coastal Kenya. We estimated the potential impact of TMP on the Kenyan HIV epidemic., Methods: We developed an agent-based network model of HIV-1 transmission using TMP data and Kenyan statistics to estimate potential population-level impact of targeted facility-based testing over 10 years. Three scenarios were modeled: standard care [current use of provider-initiated testing and counseling (PITC)], standard HIV rapid testing scaled to higher coverage obtained in TMP (scaled-up PITC), and the TMP intervention., Results: Standard care resulted in 90.7% of persons living with HIV (PLWH) knowing their status, with 67.5% of those diagnosed on treatment. Scaled-up PITC resulted in 94.4% of PLWH knowing their status and 70.4% of those diagnosed on treatment. The TMP intervention achieved 97.5% of PLWH knowing their status and 80.6% of those diagnosed on treatment. The percentage of infections averted was 1.0% (95% simulation intervals: -19.2% to 19.9%) for scaled-up PITC and 9.4% (95% simulation intervals: -8.1% to 24.5%) for TMP., Conclusion: Our study suggests that leveraging new technologies to identify acute HIV infection among symptomatic outpatients is superior to scaled-up PITC in this population, resulting in >95% knowledge of HIV status, and would reduce new HIV infections in Kenya., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2022 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2022
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24. Stopping and restarting PrEP and loss to follow-up among PrEP-taking men who have sex with men and transgender women at risk of HIV-1 participating in a prospective cohort study in Kenya.
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Wahome E, Boyd A, Thiong'o AN, Mohamed K, Oduor T, Gichuru E, Mwambi J, van der Elst E, Graham SM, Prins M, and Sanders EJ
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- Female, Follow-Up Studies, Homosexuality, Male, Humans, Kenya epidemiology, Male, Prospective Studies, HIV Infections prevention & control, HIV Seropositivity, HIV-1, Pre-Exposure Prophylaxis, Sexual and Gender Minorities, Transgender Persons
- Abstract
Objective: To assess frequency and predictors of switching between being on and off PrEP and being lost to follow-up (LTFU) among men who have sex with men (MSM) and transgender women (TGW) with access to PrEP services in Sub-Saharan Africa., Methods: This was a prospective cohort study of MSM and TGW from coastal Kenya who initiated daily oral PrEP from June 2017 to June 2019. Participants were followed monthly for HIV-1 testing, PrEP refill, risk assessment and risk reduction counselling. Follow-up was censored at the last visit before 30 June 2019, or the last HIV-1-negative visit (for those with HIV-1 seroconversion), whichever occurred first. We estimated transition intensities (TI) and predictors of switching: (i) between being off and on PrEP; and (ii) from either PrEP state and being LTFU (i.e. not returning to the clinic for > 90 days) using a multi-state Markov model., Results: In all, 134 participants starting PrEP were followed for a median of 20.3 months [interquartile range (IQR): 7.7-22.1]. A total of 49 (36.6%) people stopped PrEP 73 times [TI = 0.6/person-year (PY), 95% confidence interval (CI): 0.5-0.7] and, of these, 25 (51.0%) restarted PrEP 38 times (TI = 1.2/PY, 95% CI: 0.9-1.7). In multivariable analysis, stopping PrEP was related to anal sex ≤ 3 months, substance-use disorder and travelling. Restarting PrEP was related to non-Christian or non-Muslim religion and travelling. A total of 54 participants were LTFU: on PrEP (n = 47, TI = 0.3/PY, 95% CI: 0.3-0.5) and off PrEP (n = 7, TI = 0.2/PY, 95% CI: 0.1-0.4). In multivariable analysis, becoming LTFU while on PrEP was associated with secondary education or higher, living in the area for ≤ 1 year, residence outside the immediate clinic area and alcohol-use disorder., Conclusions: Switching between being on and off PrEP or becoming LTFU while on PrEP was frequent among individuals at risk of HIV-1 acquisition. Alternative PrEP options (e.g. event-driven PrEP) may need to be considered for MSM and TGW with PrEP-taking challenges, while improved engagement with care is needed for all MSM and TGW regardless of PrEP regimen., (© 2022 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)
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- 2022
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25. Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men.
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Operario D, Sun S, Bermudez AN, Masa R, Shangani S, van der Elst E, and Sanders E
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- Homosexuality, Male psychology, Humans, Male, Mental Health, Syndemic, HIV Infections epidemiology, HIV Infections prevention & control, HIV Infections psychology, Sexual and Gender Minorities
- Abstract
In this Series paper, we review evidence on the co-occurring and synergistic epidemics (syndemic) of HIV and mental health problems worldwide among men who have sex with men (MSM). The multilevel determinants of this global syndemic include structural factors that enable stigma, systematic bias, and violence towards MSM across geographical and cultural contexts. Cumulative exposure to these factors over time results in population-level inequities in the burden of HIV infections and mental health problems among MSM. Evidence for this syndemic among MSM is strongest in the USA, Canada, western Europe, and parts of Asia and Latin America, with emerging evidence from sub-Saharan Africa. Integrated interventions are needed to address syndemics of HIV and mental health problems that challenge the wellbeing of MSM populations worldwide, and such interventions should consider various mental health conditions (eg, depression, anxiety, trauma, and suicidality) and their unique expressions and relationships with HIV outcomes depending on cultural contexts. In addition, interventions should identify and intervene with locally relevant structural factors that result in HIV and mental health vulnerabilities among MSM., Competing Interests: Declaration of interests We declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)
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- 2022
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26. Effect of an opt-out point-of-care HIV-1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial.
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Sanders EJ, Agutu C, van der Elst E, Hassan A, Gichuru E, Mugo P, Farquhar C, Babigumira JB, Goodreau SM, Hamilton DT, Ndung'u T, Sirengo M, Chege W, and Graham SM
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- Adolescent, Adult, Humans, Kenya epidemiology, Outpatients, Point-of-Care Systems, Young Adult, HIV Infections diagnosis, HIV Infections epidemiology, HIV-1 genetics, Nucleic Acids
- Abstract
Background: In sub-Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare., Methods: Adult symptomatic outpatients aged 18-39 years were evaluated by a consensus AHI risk score. Patients with a risk score ≥ 2 and no previous HIV diagnosis were enrolled in a stepped-wedge trial of opt-out delivery of point-of-care (POC) HIV-1 nucleic acid testing (NAAT), compared with standard provider-initiated HIV testing using rapid tests in the observation period. The primary outcome was the number of new diagnoses in each study period. Generalized estimating equations with a log-binomial link and robust variance estimates were used to account for clustering by health facility. The trial is registered with ClinicalTrials.gov NCT03508908., Results: Between 2017 and 2020, 13 (0.9%) out of 1374 participants in the observation period and 37 (2.5%) out of 1500 participants in the intervention period were diagnosed with HIV infection. Of the 37 newly diagnosed cases in the intervention period, two (5.4%) had AHI. Participants in the opt-out intervention had a two-fold greater odds of being diagnosed with HIV (odds ratio = 2.2, 95% confidence interval: 1.39-3.51) after adjustment for factors imbalanced across study periods., Conclusions: Among symptomatic adults aged 18-39 years targeted by our POC NAAT intervention, we identified one chronic HIV infection for every 40 patients and one AHI patient for every 750 patients tested. Although AHI yield was low in this population, routinely offered opt-out testing could diagnose twice as many patients as an approach relying on provider discretion., (© 2021 The Authors. HIV Medicine published by John Wiley & Sons Ltd on behalf of British HIV Association.)
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- 2022
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27. PrEP uptake and adherence in relation to HIV-1 incidence among Kenyan men who have sex with men.
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Wahome EW, Graham SM, Thiong'o AN, Mohamed K, Oduor T, Gichuru E, Mwambi J, Prins PM, van der Elst E, and Sanders PEJ
- Abstract
Background: Data on HIV-1 incidence following programmatic pre-exposure prophylaxis (PrEP) uptake by men who have sex with men (MSM) are limited in sub-Saharan Africa., Methods: Since June 2017, MSM participating in an ongoing cohort study in Kenya were offered daily PrEP, assessed for PrEP uptake and adherence, and evaluated for HIV-1 acquisition monthly. We determined tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots 6-12 months after PrEP initiation, and tenofovir (TFV) concentrations and genotypic drug resistance in plasma samples when HIV-1 infection occurred. We assessed HIV-1 incidence by reported PrEP use., Findings: Of 172 MSM, 170 (98·8%) were eligible for PrEP, 140 (82·4%) started it, and 64 (57·7%) reported PrEP use at end of study. Of nine MSM who acquired HIV-1 [incidence rate: 3·9 (95% confidence interval (CI), 2·0-7·4) per 100 person-years (PY)], five reported PrEP use at the time of HIV-1 acquisition [incidence rate: 3·6 (95% CI, 1·5-8·6) per 100 PY)] and four had stopped or had never started PrEP [incidence rate: 4·3 (95% CI, 1·6-11·3) per 100 PY]. Among 76 MSM who reported PrEP use, 11 (14·5%) had protective TFV-DP concentrations of ≥700 fmol/punch (≥4 tablets a week). Among the five MSM who acquired HIV-1 while reporting PrEP use, only one had detectable but low TFV concentrations in plasma and none had genotypic HIV-1 resistance., Interpretation: HIV-1 incidence among MSM with access to programmatic PrEP was high and did not differ by reported PrEP use. Only one in seven MSM taking PrEP had protective tenofovir concentrations and four out of five MSM who acquired HIV-1 while reporting PrEP use had not taken it. Strengthened PrEP adherence support is required among MSM in Kenya., Funding: This work was supported by the International AIDS Vaccine Initiative (IAVI)., Competing Interests: Dr Prins reports grants from Gilead sciences, Roche, AbbVie, and MSD during the conduct of the study. All other authors have nothing to report., (© 2020 The Authors.)
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- 2020
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28. A Novel HIV-1 RNA Testing Intervention to Detect Acute and Prevalent HIV Infection in Young Adults and Reduce HIV Transmission in Kenya: Protocol for a Randomized Controlled Trial.
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Graham SM, Agutu C, van der Elst E, Hassan AS, Gichuru E, Mugo PM, Farquhar C, Babigumira JB, Goodreau SM, Hamilton DT, Ndung'u T, Sirengo M, Chege W, and Sanders EJ
- Abstract
Background: Detection and management of acute HIV infection (AHI) is a clinical and public health priority, and HIV infections diagnosed among young adults aged 18 to 39 years are usually recent. Young adults with recent HIV acquisition frequently seek care for symptoms and could potentially be diagnosed through the health care system. Early recognition of HIV infection provides considerable individual and public health benefits, including linkage to treatment as prevention, access to risk reduction counseling and treatment, and notification of partners in need of HIV testing., Objective: The Tambua Mapema Plus study aims to (1) test 1500 young adults (aged 18-39 years) identified by an AHI screening algorithm for acute and prevalent (ie, seropositive) HIV, linking all newly diagnosed HIV-infected patients to care and offering immediate treatment; (2) offer assisted HIV partner notification services to all patients with HIV, testing partners for acute and prevalent HIV infection and identifying local sexual networks; and (3) model the potential impact of these two interventions on the Kenyan HIV epidemic, estimating incremental costs per HIV infection averted, death averted, and disability-adjusted life year averted using data on study outcomes., Methods: A modified stepped-wedge design is evaluating the yield of this HIV testing intervention at 4 public and 2 private health facilities in coastal Kenya before and after intervention delivery. The intervention uses point-of-care HIV-1 RNA testing combined with standard rapid antibody tests to diagnose AHI and prevalent HIV among young adults presenting for care, employs HIV partner notification services to identify linked acute and prevalent infections, and follows all newly diagnosed patients and their partners for 12 months to ascertain clinical outcomes, including linkage to care, antiretroviral therapy (ART) initiation and virologic suppression in HIV-infected patients, and pre-exposure prophylaxis uptake in uninfected individuals in discordant partnerships., Results: Enrollment started in December 2017. As of April 2020, 1374 participants have been enrolled in the observation period and 1500 participants have been enrolled in the intervention period, with 13 new diagnoses (0.95%) in the observation period and 37 new diagnoses (2.47%), including 2 AHI diagnoses, in the intervention period. Analysis is ongoing and will include adjusted comparisons of the odds of the following outcomes in the observation and intervention periods: being tested for HIV infection, newly diagnosed with prevalent or acute HIV infection, linked to care, and starting ART by week 6 following HIV diagnosis. Participants newly diagnosed with acute or prevalent HIV infection in the intervention period are being followed for outcomes, including viral suppression by month 6 and month 12 following ART initiation and partner testing outcomes., Conclusions: The Tambua Mapema Plus study will provide foundational data on the potential of this novel combination HIV prevention intervention to reduce ongoing HIV transmission in Kenya and other high-prevalence African settings., Trial Registration: ClinicalTrials.gov NCT03508908; https://clinicaltrials.gov/ct2/show/NCT03508908., International Registered Report Identifier (irrid): DERR1-10.2196/16198., (©Susan M Graham, Clara Agutu, Elise van der Elst, Amin S Hassan, Evanson Gichuru, Peter M Mugo, Carey Farquhar, Joseph B Babigumira, Steven M Goodreau, Deven T Hamilton, Thumbi Ndung'u, Martin Sirengo, Wairimu Chege, Eduard J Sanders. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 07.08.2020.)
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- 2020
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29. Adjustment to acute or early HIV-1 infection diagnosis to prompt linkage to care and ART initiation: qualitative insights from coastal Kenya.
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Van Der Elst EM, Kombo B, Mugo P, Thiong'o A, Kanungi J, Wahome E, Chirro O, Graham SM, Operario D, and Sanders EJ
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- Adult, Anti-Retroviral Agents therapeutic use, Cohort Studies, Contact Tracing, Disclosure, Early Diagnosis, Female, Grounded Theory, HIV Infections diagnosis, HIV Infections drug therapy, HIV-1, Humans, Kenya, Male, Qualitative Research, Sex Workers, Emotional Adjustment, HIV Infections psychology
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Diagnosing and treating patients with acute or early HIV-1 infection (AEHI) is an important strategy to prevent HIV-1 transmission. We used qualitative methods to understand factors that facilitate adjustment to AEHI diagnosis, prompt linkage to care and initiation of antiretroviral treatment (ART). Twenty-three AEHI patients (12 women, 11 men) included 18 participants identified at health facilities, and 5 participants identified in a sex worker cohort. Of these, 17 participants (9 women, 8 men) participated in qualitative interviews about their AEHI status 2 weeks after diagnosis. Thirteen participants (7 women, 6 men) returned for a second interview 12 weeks after diagnosis. Interviews explored participants' experiences at the time of and following their diagnosis, and examined perceptions about ART initiation and behavior change recommendations, including disclosure and partner notification. A grounded theory framework was used for analysis, eliciting three important needs that should be addressed for AEHI patients: 1) the need to better understand AEHI and accept one's status; 2) the need to develop healthy strategies and adjust to the reality of AEHI status; and 3) the need to protect self and others through ART initiation, adherence, safer sex, and disclosure. A preliminary conceptual framework to guide further intervention and research with AEHI populations is proposed.
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- 2019
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30. Pilot testing of an online training module about screening for acute HIV infection in adult patients seeking urgent healthcare.
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Rafferty H, Chirro O, Oduor C, Wahome E, Ngoi C, van der Elst E, Berger R, Rowland-Jones S, Graham SM, and Sanders EJ
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- Acute Disease, Adolescent, Adult, Algorithms, Ambulatory Care statistics & numerical data, Clinical Competence statistics & numerical data, Female, Humans, Kenya, Male, Patient Acceptance of Health Care, Physicians, Primary Care statistics & numerical data, Pilot Projects, Young Adult, Education, Distance, HIV Infections diagnosis, Mass Screening, Physicians, Primary Care education
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Background: Acute HIV infection (AHI) is the phase of HIV infection immediately after acquisition, during which many patients develop symptoms and often seek healthcare. However, clinicians in sub-Saharan Africa are not currently taught about AHI., Methods: This study pilot-tested a self-directed AHI training module among clinical officers (COs) in coastal Kenya and assessed knowledge gained and challenges to instituting screening. The training module included four domains: AHI definition and importance of AHI recognition; symptoms and screening algorithms; diagnostic strategies; and management. AHI knowledge was assessed before and immediately after training. Participants' ability to utilize an AHI screening algorithm was evaluated with a case-based exercise., Results: Self-directed training was completed by 45 COs. Pre-test scores were low (median score 35% IQR 30-45%), but improved significantly after training (median post-test score 75%, IQR 70-85%, Wilcoxon signed-rank test p<0.0001). Participants had challenges in understanding the utility and application of a screening algorithm to identify patients for whom AHI testing would be indicated. Knowledge of AHI was poor at baseline, but improved with self-directed learning. Based on these findings, we revised and improved the AHI training module and pre- and post-assessments, which are now freely available online at www.marps-africa.org., Conclusions: Guidelines on AHI screening and diagnosis are urgently needed in high HIV transmission areas., (© The Author(s) 2018. Published by Oxford University Press Royal Society of Tropical Medicine and Hygiene.)
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- 2019
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31. A nursing intervention aimed at reducing symptom burden during chemotherapy (CHEMO-SUPPORT): A mixed-methods study of the patient experience.
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Coolbrandt A, Milisen K, Wildiers H, Aertgeerts B, van Achterberg T, Van der Elst E, and Dierckx de Casterlé B
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- Adaptation, Psychological, Adult, Aged, Drug-Related Side Effects and Adverse Reactions psychology, Female, Humans, Male, Middle Aged, Patient Satisfaction, Socioeconomic Factors, Surveys and Questionnaires, Antineoplastic Agents adverse effects, Antineoplastic Agents therapeutic use, Drug-Related Side Effects and Adverse Reactions etiology, Drug-Related Side Effects and Adverse Reactions nursing, Neoplasms drug therapy, Neoplasms nursing, Palliative Care methods
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Purpose: CHEMO-SUPPORT is a nursing intervention that supports cancer patients in dealing with chemotherapy-related symptoms at home. The aims of the current study were (1) to determine how patients had experienced the intervention, and (2) to identify and better understand the mechanisms underlying CHEMO-SUPPORT's effects, its essential elements and possible pitfalls., Methods: All 71 patients who had received the CHEMO-SUPPORT intervention completed a questionnaire, asking their opinion on the helpfulness, strengths, and weaknesses of the individual components of the intervention. Semi-structured interviews were also conducted with a purposeful selection of 9 of the 71 patients to get a deeper understanding of the patient experience., Results: Nurses' caring support, combined with competent care, gave patients a sense of reassurance and made them feel (better) able to deal with their symptoms. The importance patients ascribed to the intervention varied according to the individual symptom experience and coping mechanisms of the patients, and by their experience with regular care. Patients rated the informational brochure component of the intervention most helpful. It served as their 'companion', offering support and expert advice at home. Patients felt that a strength of the brochure was the support they received from the quotes of fellow patients., Conclusions: The CHEMO-SUPPORT intervention made patients feel more reassured and empowered in dealing with symptoms at home. That the CHEMO-SUPPORT experience was influenced by personal and contextual factors highlights the importance of tailoring the intervention to each patient, as well as improving supportive and competent symptom-management support in daily oncology care., (Copyright © 2018. Published by Elsevier Ltd.)
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- 2018
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32. " Facing Our Fears ": Using facilitated film viewings to engage communities in HIV research involving MSM in Kenya.
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Kombo B, Sariola S, Gichuru E, Molyneux S, Sanders EJ, and van der Elst E
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Kenya is a generally homophobic country where homosexuality is criminalised and people who engage in same sex sexuality face stigma and discrimination. In 2013, we developed a 16 min documentary entitled " Facing Our Fears " that aimed at sharing information on how and why men who have sex with men (MSM) are involved in on-going KEMRI HIV prevention research, and associated community engagement. To consider the film's usefulness as a communication tool, and its perceived security risks in case the film was publicly released, we conducted nine facilitated viewings with 122 individuals representing seven different stakeholder groups. The documentary was seen as a strong visual communication tool with potential to reduce stigma related to homosexuality, and facilitated film viewings were identified as platforms with potential to support open dialogue about HIV research involving MSM. Despite the potential, there were concerns over possible risks to LGBT communities and those working with them following public release. We opted-giving emphasis to the "do no harm" principle-to use the film only in facilitated settings where audience knowledge and attitudes can be carefully considered and discussed. The results highlight the importance of carefully assessing the range of possible impacts when using visuals in community engagement.
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- 2017
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33. Implementation of fall prevention in residential care facilities: A systematic review of barriers and facilitators.
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Vlaeyen E, Stas J, Leysens G, Van der Elst E, Janssens E, Dejaeger E, Dobbels F, and Milisen K
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- Humans, Accidental Falls prevention & control, Nursing Homes organization & administration
- Abstract
Objectives: To identify the barriers and facilitators for fall prevention implementation in residential care facilities., Design: Systematic review. Review registration number on PROSPERO: CRD42013004655., Data Sources: Two independent reviewers systematically searched five databases (i.e. MEDLINE, EMBASE, CINAHL, PsycINFO, and Web of Science) and the reference lists of relevant articles., Review Methods: This systematic review was conducted in line with the Center for Reviews and Dissemination Handbook and reported according to the PRISMA guideline. Only original research focusing on determinants of fall prevention implementation in residential care facilities was included. We used the Mixed Method Appraisal Tool for quality appraisal. Thematic analysis was performed for qualitative data; quantitative data were analyzed descriptively. To synthesize the results, we used the framework of Grol and colleagues that describes six healthcare levels wherein implementation barriers and facilitators can be identified., Results: We found eight relevant studies, identifying 44 determinants that influence implementation. Of these, 17 were facilitators and 27 were barriers. Results indicated that the social and organizational levels have the greatest number of influencing factors (9 and 14, respectively), whereas resident and economical/political levels have the least (3 and 4, respectively). The most cited facilitators were good communication and facility equipment availability, while staff feeling overwhelmed, helpless, frustrated and concerned about their ability to control fall management, staffing issues, limited knowledge and skills (i.e., general clinical skill deficiencies, poor fall management skills or lack of computer skills); and poor communication were the most cited barriers., Conclusion: Successful implementation of fall prevention depends on many factors across different healthcare levels. The focus of implementation interventions, however, should be on modifiable barriers and facilitators such as communication, knowledge, and skills. Effective fall prevention must consist of multifactorial interventions that target each resident's fall risk profile, and should be tailored to overcome context-specific barriers and put into action the identified facilitators., (Copyright © 2017 Elsevier Ltd. All rights reserved.)
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- 2017
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34. Public/community engagement in health research with men who have sex with men in sub-Saharan Africa: challenges and opportunities.
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Molyneux S, Sariola S, Allman D, Dijkstra M, Gichuru E, Graham S, Kamuya D, Gakii G, Kayemba B, Kombo B, Maleche A, Mbwambo J, Marsh V, Micheni M, Mumba N, Parker M, Shio J, Yah C, van der Elst E, and Sanders E
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- Africa South of the Sahara, Developing Countries, Homophobia, Human Rights, Humans, Male, Research Design, Research Personnel, Social Discrimination, Social Responsibility, Social Stigma, Community Participation, Delivery of Health Care, Ethics, Research, Health Services, Health Services Research ethics, Homosexuality, Male, Public Health
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Background: Community engagement, incorporating elements of the broader concepts of public and stakeholder engagement, is increasingly promoted globally, including for health research conducted in developing countries. In sub-Saharan Africa, community engagement needs and challenges are arguably intensified for studies involving gay, bisexual and other men who have sex with men, where male same-sex sexual interactions are often highly stigmatised and even illegal. This paper contextualises, describes and interprets the discussions and outcomes of an international meeting held at the Kenya Medical Research Institute-Wellcome Trust in Kilifi, Kenya, in November 2013, to critically examine the experiences with community engagement for studies involving men who have sex with men., Discussion: We discuss the ethically charged nature of the language used for men who have sex with men, and of working with 'representatives' of these communities, as well as the complementarity and tensions between a broadly public health approach to community engagement, and a more rights based approach. We highlight the importance of researchers carefully considering which communities to engage with, and the goals, activities, and indicators of success and potential challenges for each. We suggest that, given the unintended harms that can emerge from community engagement (including through labelling, breaches in confidentiality, increased visibility and stigma, and threats to safety), representatives of same-sex populations should be consulted from the earliest possible stage, and that engagement activities should be continuously revised in response to unfolding realities. Engagement should also include less vocal and visible men who have sex with men, and members of other communities with influence on the research, and on research participants and their families and friends. Broader ethics support, advice and research into studies involving men who have sex with men is needed to ensure that ethical challenges - including but not limited to those related to community engagement - are identified and addressed. Underlying challenges and dilemmas linked to stigma and discrimination of men who have sex with men in Africa raise special responsibilities for researchers. Community engagement is an important way of identifying responses to these challenges and responsibilities but itself presents important ethical challenges.
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- 2016
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35. Heterosexual behaviours among men who sell sex to men in coastal Kenya.
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Smith AD, Muhaari AD, Agwanda C, Kowuor D, van der Elst E, Davies A, Graham SM, Jaffe HW, and Sanders EJ
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- Adult, Female, Humans, Kenya epidemiology, Male, Prevalence, Risk-Taking, Self Report, Sexual Partners, Young Adult, Bisexuality statistics & numerical data, HIV Infections epidemiology, HIV Infections transmission, Heterosexuality psychology, Homosexuality, Male statistics & numerical data, Sex Workers statistics & numerical data
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Objective: African men who have sex with men often sell sex to men, and MSM who sell sex (MSM-SW) often also have female partners. We compared sexual risk behaviour of MSM-SW who were sexually active with female partners (bisexual MSW) to MSM-SW with only male partners (exclusive MSW)., Design: Descriptive behavioural study, Methods: : A novel, validated daily event and partner diary self-completed by 82 MSM who sold sex over a follow-up period of 42 days with weekly review. Cumulative individual counts of sex and condomless sex were compiled by partner characteristics. The incidence of specific partnerships and sex acts were compared within and between bisexual and exclusive MSW., Results: Most (59%) MSM-SW reported female partners during follow-up. The majority of both male and female partners were cash-paying clients originating locally. Bisexual MSW reported a similar rate of condomless sex with male and female partners, but significantly fewer male partners than exclusive MSW. Bisexual MSW had lower HIV prevalence, were more likely to only report insertive anal sex roles, and reported lower frequencies of condomless receptive anal sex than exclusive MSW., Conclusion: Bisexually active male sex workers in coastal Kenya create HIV and other sexually transmitted infection transmission pathways to partners and clients in both MSM and heterosexual networks, but differed from exclusive MSW in having lower HIV acquisition and transmission risks. Epidemiological projection methods are liable to overestimate bridging potential of MSM-SW and MSM populations without account for systematic differences in risk within these populations.
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- 2015
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36. Risk of sexual, physical and verbal assaults on men who have sex with men and female sex workers in coastal Kenya.
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Micheni M, Rogers S, Wahome E, Darwinkel M, van der Elst E, Gichuru E, Graham SM, Sanders EJ, and Smith AD
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- Adolescent, Adult, Africa South of the Sahara epidemiology, Female, HIV Infections prevention & control, Humans, Incidence, Kenya epidemiology, Male, Odds Ratio, Retrospective Studies, Risk, Risk-Taking, Sexual Partners, Young Adult, HIV Infections epidemiology, Homosexuality, Male statistics & numerical data, Sex Offenses statistics & numerical data, Sex Workers statistics & numerical data, Violence statistics & numerical data
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Background: Violence toward MSM and female sex workers (FSW) is associated with HIV risk, and its prevention is prioritized in international HIV/AIDS policy., Methods: Sociodemographic and behavioural data derived from HIV risk and follow-up cohorts including MSM and FSW in coastal Kenya between 2005 and 2014 was used to estimate the risk of rape, physical assault and verbal abuse, and to assess associations between first occurrence of assault with individual and recent behavioural factors., Results: Incidence of first reported rape was similar for MSM [3.9, confidence interval (CI) 3.1-5.0 per 100 person-years (pyrs)] and FSW (4.8 CI 3.5-6.4 per 100 pyrs), P = 0.22. Incidence of first reported physical and verbal assault was higher for FSW than MSM (21.1 versus 12.9 per 100 pyrs, P = 0.14 and 51.3 versus 30.9 per 100 pyrs, P = 0.03 respectively). Recent alcohol use was associated with reporting of all forms of assault by MSM [adjusted odds ratio (AOR) 1.8, CI 0.9-3.5] and FSW (AOR 4.4, CI 1.41-14.0), as was recent sale of sex for MSM (AOR 2.0, CI 1.1-3.8). Exclusive sex with men, active sex work, and group sex were also specifically associated with reporting rape for MSM. Perpetrators of sexual and verbal assault were usually unknown, whilst perpetrators of physical violence toward FSW were usually regular sexual partners., Conclusion: MSM and FSW experienced a similarly high incidence of sexual assault in coastal Kenya, in addition to physical and verbal assault. Current national policies focus heavily on gender-based violence against women and young girls, but need to be inclusive of MSM and FSW.
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- 2015
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37. Understanding Adherence to Daily and Intermittent Regimens of Oral HIV Pre-exposure Prophylaxis Among Men Who Have Sex with Men in Kenya.
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Mugo PM, Sanders EJ, Mutua G, van der Elst E, Anzala O, Barin B, Bangsberg DR, Priddy FH, and Haberer JE
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- Administration, Oral, Anti-HIV Agents therapeutic use, Dose-Response Relationship, Drug, Drug Administration Schedule, Emtricitabine therapeutic use, Female, HIV Infections drug therapy, Humans, Kenya, Male, Middle Aged, Outcome Assessment, Health Care, Socioeconomic Factors, Tenofovir therapeutic use, Anti-HIV Agents administration & dosage, Emtricitabine administration & dosage, HIV Infections prevention & control, Homosexuality, Male, Medication Adherence statistics & numerical data, Pre-Exposure Prophylaxis methods, Tenofovir administration & dosage
- Abstract
A qualitative assessment of Kenyan men who have sex with men taking daily and intermittent oral HIV pre-exposure prophylaxis (PrEP) found stigma, sex work, mobility, and alcohol impacted adherence. We analyzed quantitative data from the same cohort to explore different definitions of intermittent adherence. Volunteers were randomized to daily emtricitabine/tenofovir or placebo, or intermittent (prescription: Mondays/Fridays/after sex, maximum 1 dose/day) emtricitabine/tenofovir or placebo (2:1:2:1), and followed for 4 months. By electronic monitoring, median adherence for daily dosing was 80 %. Median adherence for intermittent dosing was 71 % per a "relaxed" definition (accounting for off-prescription dosing) and 40 % per a "strict" definition (limited to the prescription). Factors associated with lower adherence included travel, transactional sex, and longer follow-up; higher adherence was associated with daily dosing and an income. The definition of intermittent dosing strongly affects interpretation of adherence. These findings suggest interventions should address challenges of mobility, sex work, and long-term PrEP.
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- 2015
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38. Characteristics and effectiveness of fall prevention programs in nursing homes: a systematic review and meta-analysis of randomized controlled trials.
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Vlaeyen E, Coussement J, Leysens G, Van der Elst E, Delbaere K, Cambier D, Denhaerynck K, Goemaere S, Wertelaers A, Dobbels F, Dejaeger E, and Milisen K
- Subjects
- Aged, Humans, Randomized Controlled Trials as Topic, Accident Prevention, Accidental Falls prevention & control, Nursing Homes
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Objectives: To determine characteristics and effectiveness of prevention programs on fall-related outcomes in a defined setting., Design: Systematic review and meta-analysis., Setting: A clearly described subgroup of nursing homes defined as residential facilities that provide 24-hour-a-day surveillance, personal care, and limited clinical care for persons who are typically elderly and infirm., Participants: Nursing home residents (N = 22,915)., Measurements: The primary outcomes were number of falls, fallers, and recurrent fallers., Results: Thirteen studies met the inclusion criteria. Six fall prevention programs were single (one intervention component provided to the residents), one was multiple (two or more intervention components not customized to individual fall risk), and six were multifactorial (two or more intervention components customized to each resident's fall risk). Meta-analysis found significantly fewer recurrent fallers in the intervention groups (4 studies, relative risk (RR) = 0.79, 95% confidence interval (CI) = 0.65-0.97) but no significant effect of the intervention on fallers (6 studies, RR = 0.97, 95% CI = 0.84-1.11) or falls (10 studies, RR = 0.93, 95% CI = 0.76-1.13). Multifactorial interventions significantly reduced falls (4 studies, RR = 0.67, 95% CI = 0.55-0.82) and the number of recurrent fallers (4 studies, RR = 0.79, CI = 0.65-0.97), whereas single or multiple interventions did not. Training and education showed a significant harmful effect in the intervention groups on the number of falls (2 studies, RR = 1.29, 95% CI = 1.23-1.36)., Conclusion: This meta-analysis failed to reveal a significant effect of fall prevention interventions on falls or fallers but, for the first time, showed that fall prevention interventions significantly reduced the number of recurrent fallers by 21%., (© 2015, Copyright the Authors Journal compilation © 2015, The American Geriatrics Society.)
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- 2015
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39. Internal consistency and construct validity assessment of a revised Facts on Aging Quiz for Flemish nursing students: an exploratory study.
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Van der Elst E, Deschodt M, Welsch M, Milisen K, and Dierckx de Casterlé B
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- Aged, Belgium, Cross-Sectional Studies, Educational Measurement, Humans, Reproducibility of Results, Surveys and Questionnaires, Aging psychology, Attitude of Health Personnel, Education, Nursing, Baccalaureate standards, Geriatric Nursing education, Health Knowledge, Attitudes, Practice, Psychometrics education, Students, Nursing psychology
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Background: Since more people are reaching older and older ages, healthcare systems are becoming in need of more and more knowledgeable nurses to meet the specific health care needs of older persons. Several instruments exist to measure and evaluate students' knowledge of older persons, ageing, and gerontological care; however, unequivocal evidence on their use and psychometric properties is scarce. The aim of the study was to validate a revised version of Palmore's Facts on Aging Quiz (FAQ)., Methods: A cross-sectional, exploratory study was conducted. Palmore's FAQ version 1 and Facts on Aging Mental Health Quiz were used as bases for the development of a revised FAQ instrument. Three researchers translated these instruments into Dutch. A panel of nine experts in geriatric research and gerontological care evaluated the translation and the face and content validity of the instrument. We used a cross-sectional, exploratory design to assess its internal consistency and construct validity. Cronbach's alpha coefficients, exploratory factor analysis, and the known-groups technique were used for these analyses., Results: Based on the experts' consensus, a revised version of the FAQ, consisting of 36 items, was produced. Exploratory factor analysis did not reveal underlying constructs suggesting that the revised version encloses a more general concept of knowledge (e.g. about older persons, aging, gerontological care). Using the known-groups technique, we validated the instrument, showing that it discriminates between the knowledge of first- and third-year nursing students. The overall Cronbach's coefficient of 0.723 was acceptable and changed minimally (from 0.708 to 0.724) when items were removed., Conclusion: We conclude that the revised version of the FAQ can be used to properly evaluate nursing students' knowledge about older persons and gerontological care, as reasonable reliability and validity were established for this revised version of the FAQ.
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- 2014
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40. Characteristics and effectiveness of complex nursing interventions aimed at reducing symptom burden in adult patients treated with chemotherapy: a systematic review of randomized controlled trials.
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Coolbrandt A, Wildiers H, Aertgeerts B, Van der Elst E, Laenen A, Dierckx de Casterlé B, van Achterberg T, and Milisen K
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- Adult, Humans, Antineoplastic Agents therapeutic use, Neoplasms drug therapy, Nursing Process, Randomized Controlled Trials as Topic
- Abstract
Objectives: The multiplicity and complexity of symptoms in patients treated with chemotherapy requires multifaceted symptom management interventions. The aim of this systematic review was to describe the characteristics and evaluate the effectiveness of complex nursing interventions that target multiple symptoms in patients receiving chemotherapy., Design: We searched Medline, Embase, Cinahl and the Cochrane Central Register of Controlled Trials for randomized controlled trials that compared complex nursing interventions to usual care and that provided data on symptom prevalence, severity, distress or limitations. Characteristics of the interventions were described in a narrative way. Regarding the effectiveness of the interventions, ratios of means were calculated in order to present data in a comparable and clinically interpretable way., Results: We included 11 studies, some with considerable risk of bias. Despite being heterogeneous, the interventions have patient education, symptom assessment and coaching in common. Although some interventions fail to show significant effects, others significantly reduce aspects of symptom burden by 10-88%., Conclusion: Although some complex nursing interventions in this systematic review produce clinically meaningful and statistically relevant reductions in symptom burden, based on the available data it is not possible to make definitive conclusions about the vital parts, circumstances or preferred target population of the interventions. Quality of the studies and modeling and piloting of the interventions are important challenges for future research., (Copyright © 2013 Elsevier Ltd. All rights reserved.)
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- 2014
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41. Oncology patients' perceptions of "the good nurse": a descriptive study in Flanders, Belgium.
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Van der Elst E, Dierckx de Casterlé B, Biets R, Rchaidia L, and Gastmans C
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- Adolescent, Adult, Aged, Aged, 80 and over, Attitude to Health, Belgium, Cross-Sectional Studies, Humans, Male, Middle Aged, Neoplasms psychology, Nurse-Patient Relations, Psychometrics, Surveys and Questionnaires, Young Adult, Neoplasms nursing, Oncology Nursing standards
- Abstract
The image of "the good nurse" is mainly studied from the perspective of nurses, which often does not match the image held by patients. Therefore, a descriptive study was conducted to examine oncology patients' perceptions of "the good nurse" and the influence of patient- and context-related variables. A cross-sectional, comparative, descriptive design was used. The sample comprised 557 oncology patients at one of six Flemish hospitals, where they were treated in an oncology day-care unit, oncology hospital ward, or palliative care unit. Data were collected using the Flemish Care-Q instrument. Factor analysis summarised the most important characteristics of "the good nurse". We reassessed the reliability and construct validity of the Flemish Care-Q and examined the influence of patient- and context-related variables on patient perceptions. Using factor analysis, we grouped the different items of the Flemish Care-Q according to three characteristics: "the good nurse" (I) has a supportive and communicative attitude towards patient and family, (II) is competent and employs a professional attitude, and (III) demonstrates personal involvement towards patient and family. Median factor scores of Factors I, II, and III, respectively, were 8.00, 9.00, and 8.00 (varying from 1, not important, to 10, very important). In order of importance, Factors II, I, and III were identified as valuable characteristics of "the good nurse". Gender, care setting, and province were influential variables. As perceived by oncology patients, "the good nurse" has a broad range of qualities, of which competence and professionalism are the most valuable.
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- 2013
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42. Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in coastal Kenya.
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Graham SM, Mugo P, Gichuru E, Thiong'o A, Macharia M, Okuku HS, van der Elst E, Price MA, Muraguri N, and Sanders EJ
- Subjects
- Adolescent, Adult, Black People psychology, Black People statistics & numerical data, CD4 Lymphocyte Count, Follow-Up Studies, HIV Infections prevention & control, HIV Infections psychology, HIV-1, Heterosexuality ethnology, Homosexuality, Male statistics & numerical data, Humans, Kenya, Lost to Follow-Up, Male, Middle Aged, Prospective Studies, Risk Factors, Sex Workers psychology, Sex Workers statistics & numerical data, Social Stigma, Socioeconomic Factors, Surveys and Questionnaires, Treatment Outcome, Young Adult, Anti-Retroviral Agents therapeutic use, HIV Infections drug therapy, Heterosexuality psychology, Homosexuality, Male psychology, Medication Adherence psychology, Risk-Taking
- Abstract
African men who have sex with men (MSM) face significant stigma and barriers to care. We investigated antiretroviral therapy (ART) adherence among high-risk adults, including MSM, participating in a clinic-based cohort. Survival analysis was used to compare attrition across patient groups. Differences in adherence, weight gain, and CD4 counts after ART initiation were assessed. Among 250 HIV-1-seropositive adults, including 108 MSM, 15 heterosexual men, and 127 women, patient group was not associated with attrition. Among 58 participants who were followed on ART, 40 % of MSM had less than 95 % adherence, versus 28.6 % of heterosexual men and 11.5 % of women. Although MSM gained less weight after ART initiation than women (adjusted difference -3.5 kg/year), CD4 counts did not differ. More data are needed on barriers to adherence and clinical outcomes among African MSM, to ensure that MSM can access care and derive treatment and prevention benefits from ART.
- Published
- 2013
- Full Text
- View/download PDF
43. [Not Available].
- Author
-
Van der Elst E
- Subjects
- France, History, Modern 1601-, Education, Medical history, Urology history
- Published
- 1978
44. [Diaphysial fractures of both bones of the leg; therapy and importance of sequels].
- Author
-
DE DONCKER E and VAN DER ELST E
- Subjects
- Humans, Bone and Bones, Diaphyses, Fractures, Bone, Leg, Leg Injuries
- Published
- 1953
45. Contribution to the study of the treatment of traumatic affections of the upper limb in particular infections by the use of stellar infiltration.
- Author
-
BELENGER M, LEFEVRE MJ, and VAN DER ELST E
- Subjects
- Humans
- Published
- 1948
46. [Old total dislocations of the elbow; remote physiologic results].
- Author
-
BELENGER M and VAN DER ELST E
- Subjects
- Humans, Elbow Joint, Joint Dislocations, Elbow Injuries
- Published
- 1955
47. [Not Available].
- Author
-
Van der Elst E
- Subjects
- France, History, Modern 1601-, Literature history
- Published
- 1972
48. [Dorsal edema of the hand, so-called Secretan's edema].
- Author
-
VAN DER ELST E
- Subjects
- Humans, Edema etiology, Hand, Hand Injuries
- Published
- 1960
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