Jennifer Kibicho

Marriage as a risk factor for HIV: Learning from the experiences of HIV-infected women in Malawi

Abstract The gender inequalities that characterise intimate partner relationships in Malawi, a country with one of the highest HIV prevalence rates in the world, arguably place marriage as an important risk factor for HIV infection among women, yet few studies detail the complex interactions of marriage and risk. In order to develop HIV-prevention interventions that have lasting impacts in such communities, we need a deeper understanding of the intricacies of womens lives, how and why they are involved in marital relationships, and the implications of these relationships for HIV transmission or prevention. This article describes how women understand marriages effects on their lives and their HIV risks. Drawing from focus group discussions with 72 women attending antiretroviral clinics in Malawi, we explore why women enter marriage, what womens experiences are within marriage and how they leave spouses for other relationships. Based on their narratives, we describe womens lives after separation, abandonment or widowhood, and report their reflections on marriage after being married two or three times. We then review womens narratives in light of published work on HIV, and provide recommendations that would minimise the risks of HIV attendant on marriage.

Is the US AIDS Drug Assistance Program Cost-effective?

Each year, the US AIDS drug assistance program (ADAP) provides access to prescription drugs—including antiretrovirals—to more than 110,000 persons living with HIV (PLWH) who lack adequate medical insurance. PLWH on effective antiretroviral therapy live longer lives, with enhanced quality of life, and are less likely to transmit HIV to others. There are thus significant benefits associated with the ADAP program. But there also are substantial costs. A mathematical model was used to assess the cost-effectiveness of the US ADAP program. Findings indicate that by providing antiretrovirals to underinsured persons, the ADAP program prevented 3,191 secondary infections and saved 24,922 quality-adjusted life years in 2008. The net cost per quality-adjusted life year saved was

Community-Based Pharmacists’ Needs for HIV-Related Training and Experience:

11,955, which suggests that the ADAP program is cost-effective by conventional standards.

Methods and protocol of a mixed method quasi-experiment to evaluate the effects of a structural economic and food security intervention on HIV vulnerability in rural Malawi: The SAGE4Health Study

Objective: To examine pharmacists’ self-reported competence in providing care to persons living with HIV (PLWH) and their HIV-related training and experience needs. Methods: We interviewed 28 community-based pharmacists providing care to PLWH in 4 Midwestern cities. Results: Less than half (46%) of the pharmacists considered themselves competent to provide PLWH care, and less than a third (29%) worked with PLWH during their pharmacy residency. Specialty pharmacists need training on opportunistic infections and HIV-related comorbidities, nonspecialty pharmacists need general training in HIV treatment and patient communications skills, and all pharmacists require a mechanism to keep updated in the latest HIV treatment recommendations. Conclusion: In the current era of patient-centered care, a pharmacist that is well rounded—not just in dispensing antiretroviral medications but highly knowledgeable in different aspects of ART and HIV-specific patient care—can make a valuable contribution to the health care team. Pharmacy school curricula and continuing professional education need to be aligned to meet the knowledge and competency needs of community pharmacists who are strategically positioned to provide care to PLWH.

The innovative and collective capacity of low-income East African women in the era of HIV/AIDS: contesting western notions of African Women.

BackgroundPoverty and lack of a predictable, stable source of food are two fundamental determinants of ill health, including HIV/AIDS. Conversely, episodes of poor health and death from HIV can disrupt the ability to maintain economic stability in affected households, especially those that rely on subsistence farming. However, little empirical research has examined if, and how, improvements in people’s economic status and food security translate into changes in HIV vulnerability.MethodsIn this paper, we describe in detail the methods and protocol of an academic-NGO collaboration on a quasi-experimental, longitudinal study of the mechanisms and magnitude of the impact of a multilevel economic and food security program (Support to Able-Bodied Vulnerable Groups to Achieve Food Security; SAFE), as implemented by CARE. Primary outcomes include HIV vulnerability (i.e., HIV risk behaviors, HIV infection), economic status (i.e., income, household assets) and food security (including anthropometric measures). We recruited participants from two types of areas of rural central Malawi: traditional authorities (TA) selected by CARE to receive the SAFE program (intervention group) and TAs receiving other unrelated CARE programming (controls). In the intervention TAs, we recruited 598 program participants (398 women, 200 men) and interviewed them at baseline and 18- and 36-month follow-ups; we interviewed 301 control households. In addition, we conducted random surveys (n = 1002) in the intervention and control areas with a 36-month assessment interval, prior to and after implementation of SAFE. Thus, we are examining intervention outcomes both in direct SAFE program participants and their larger communities. We are using multilevel modeling to examine mediators and moderators of the effects of SAFE on HIV outcomes at the individual and community levels and determine the ways in which changes in HIV outcomes feed back into economic outcomes and food security at later interviews. Finally, we are conducting a qualitative end-of-program evaluation consisting of in-depth interviews with 90 SAFE participants.DiscussionIn addition to examining pathways linking structural factors to HIV vulnerability, this research will yield important information for understanding the impact of a multilevel environmental/structural intervention on HIV, with the potential for other sustainable long-term public health benefits.

Antibiotic Use After Removal of Penicillin Allergy Label

Historically, African women have been viewed through a colonizing and Eurocentric lens emphasizing poverty, oppression, and suffering. A postcolonial, feminist approach to our two qualitative studies with human immunodeficiency virus (HIV)-infected women in Malawi and Kenya led us to depart from this discourse, highlighting womens capacity. Through this article, not only is a forum created for African womens voices to be heard as subaltern knowledge leading to transformational change, but also health care providers are made aware, through womens words, of how they might capitalize on grassroots womens movements, particularly in resource-poor communities, to implement effective HIV prevention and treatment strategies.

Missed opportunities for early HIV diagnosis: critical insights from the stories of Kenyan women living with HIV

Children with penicillin allergy were tested, found to receive negative test results, and, subsequently, tolerated penicillin without serious adverse or allergic reactions. BACKGROUND: Penicillin allergy is commonly reported in the pediatric emergency department. We previously performed 3-tier penicillin allergy testing on children with low-risk symptoms, and 100% tolerated a penicillin challenge without an allergic reaction. We hypothesized that no serious allergic reactions would occur after re-exposure to penicillin and that prescription practices would change after testing. METHODS: We performed a follow-up case series of 100 children whose test results were negative for penicillin allergy. Research staff administered a brief follow-up phone survey to the parent and primary care provider of each patient tested. We combined the survey data and summarized baseline patient characteristics and questionnaire responses. We then completed a 3-tier economic analysis from the prescription information gathered from surveys in which cost savings, cost avoidance, and potential cost savings were calculated. RESULTS: A total of 46 prescriptions in 36 patients were reported by the primary care provider and/or parents within the year after patients were tested for penicillin allergy. Twenty-six (58%) of the prescriptions filled were penicillin derivatives. One (4%) child developed a rash 24 hours after starting the medication; no child developed a serious adverse reaction after being given a penicillin challenge. We found that the cost savings of delabeling patients as penicillin allergic was

Advocating for HIV Prevention and Care: A Critical Role for Older Women Living With HIV in Rural Kenya

1368.13, the cost avoidance was

Pharmacists' strategies for promoting medication adherence among patients with HIV

1812.00, and the total potential cost savings for the pediatric emergency department population was

A Patient-Centered Pharmacy Services Model of HIV Patient Care in Community Pharmacy Settings: A Theoretical and Empirical Framework

192 223.00. CONCLUSIONS: Children with low-risk penicillin allergy symptoms whose test results were negative for penicillin allergy tolerated a penicillin challenge without a severe allergic reaction developing. Delabeling children changed prescription behavior and led to actual health care savings.