The University of Washington/Fred Hutch Center for AIDS Research (CFAR) present the New Investigator Awards each year. These awards fund and support HIV and AIDS research by new, promising investigators early in their careers. The 2019 awards will allow Department of Global Health researchers, Kristin-Beima Sofie, Katrina Ortblad, and Arianna Means to study ways to empower caregivers of adolescents living with HIV, PrEP delivery by community pharmacies, and nutritional services for HIV-exposed children in Kenya.
Kristin Beima-Sofie - Associate Professor, Department of Global Health
Q: Tell us about your research project.
A: Globally, adolescents living with HIV (ALHIV) have poor health outcomes when compared to adults and younger children with HIV. Primary caregivers and parents of adolescents are an untapped support resource that could be harnessed to improve health outcomes for ALHIV. I think the challenge is empowering caregivers, so they have knowledge and skills to better support adolescents.
The study, called “Developing a data-informed caregiver intervention to improve adolescent HIV outcomes in Kenya” will identify caregiver attributes associated with poor outcomes among ALHIV, prioritize preferred attributes for caregiver support, and develop a data-informed caregiver support intervention.
To do this, the study includes plans to survey 300 caregivers of ALHIV at six HIV treatment facilities in Kenya. We will also conduct 30 focus-group discussions with ALHIV, caregivers and healthcare workers, and support 50 caregivers, adolescents, healthcare workers, and policymakers to apply user-centered design strategies. This will help us develop a locally tailored caregiver intervention.
Q: What do you hope this project will accomplish?
A: We aim to gather data both from the patients and the caregivers about caregiver characteristics. The data can help create interventions that can ultimately help improve health outcomes for adolescents stricken with HIV.
This project is timely given the growing population of HIV-infected adolescents, poor clinical outcomes among adolescents, and the untapped, yet impactful, resource of caregiver support.
Q: What do you think will be the most rewarding part of this project?
A: Overall, the goal is to find a way to provide better care. Previous qualitative work I’ve done with caregivers of ALHIV have identified that caregivers really struggle with how best to support their adolescents, and adolescents have told us that they really want their caregivers to continue to be involved in their care. I hope the project will inform development of an intervention that can be later applied on a global scale.
Katrina Ortblad - Senior Fellow, Department of Global Health
Q: Tell us about your research project.
A: The project entails developing and testing a pharmacy-based PrEP refill program in Kenya, where PrEP users initiate PrEP at public HIV clinics, then have the option to refill their PrEP medications at nearby community pharmacies. Data from other studies supports that the delivery of PrEP at community pharmacies is highly desirable to young people at HIV risk in Kenya.
The title of my project is “Pharmacy-based PrEP refills in Kenya: feasibility, acceptability, and continuation.” This refill model might help users overcome barriers to PrEP continuation at public HIV clinics, such as stigma associated with frequenting these clinics and inconvenient clinic hours and locations. With this project, we hope to contribute to the improvement of PrEP delivery in Kenya through a novel delivery model that is acceptable for users and providers while reducing the burden on HIV clinics.
Q: What research led up to this project, and what sort of challenges did you run into?
A: When I was in Kenya this past winter (February 2019), I visited a number of community pharmacies in the greater Nairobi area to understand pharmacists’ willingness to provide PrEP and to assess the feasibility that pharmacies could deliver the anticipated core components of PrEP refills: HIV testing, adherence and risk reduction counseling, assessment of side effects, and drug dispensing.
The pharmacists I met with were enthusiastic about the idea of delivering PrEP to customers. One of the challenges we anticipate is the price at which we will charge for pharmacy-based PrEP refills. Since community pharmacies are private entities, the services they provide need to be profitable for their continued provision over time.
Q: What do you hope this project will accomplish in terms of impact/results?
A: I hope that through this project, we will increase PrEP continuation among PrEP users. Additionally, I hope that this project can help expand the locations where individuals at risk of HIV infection can access PrEP in Kenya, potentially increasing access among those who may have difficulty or feel uncomfortable accessing PrEP at public HIV clinics.
Q: What do you think will be the most rewarding part of this project?
A: The most rewarding part of this project to date has been developing the concept of a pharmacy-based PrEP refill program with my Kenyan colleagues, who are all excited about this research and look forward to expanding the options for PrEP delivery in Kenya.
Arianna Means – Acting Assistant Professor, Global Health
Q: Tell us about your research project.
A: There is a lot of work being done to make sure that children born to mothers who have HIV don’t become infected. These children, who are HIV-exposed uninfected, are predisposed to poor health outcomes like malnutrition. There tends to be a disconnect, though, between the different types of services that these babies need.
One goal of this project is to try to understand if children who are HIV-exposed, both infected and uninfected, are receiving the nutritional services that they need. If not, what can we do to improve the systems and make sure that they’re comprehensively cared for?
Q: What do you hope this project will accomplish in terms of impact/results?
A: The idea is to develop implementation strategies that can be used to improve nutritional care for kids who are already engaged in HIV programs in Kenya. The purpose of this project is essentially to understand what’s working well and what’s not working well, both at an individual provider level and also at the health systems level. Understanding what we can do better to address this, and achieve tangible results, is the main focus.
Q: What do you think will be the most rewarding part of this project?
A: What we’re really interested in as implementation scientists is how to get evidence-based interventions to people who need them. HIV care for HIV-exposed infants is incredibly evidence-based, as are malnutrition services. The fact that so few children are receiving this comprehensive package of care that they need is a huge implementation gap, so working to rectify that should be extremely rewarding.
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