School of Medicine

Delays in Tuberculosis Treatment smong people with pulmonary tuberculosis in East Africa: findings from a prospective cohort study

2026-08-11T05:47:32Z

Delays in Tuberculosis Treatment smong people with pulmonary tuberculosis in East Africa: findings from a prospective cohort study Prabhudas-Strycker, Kirsten; Diero, Lameck; Muyindike, Winnie; Byakwaga, Helen; Kitur, Sylvia; Mining’wo, Joseph; Ssekyanzi, Bob; Byaruhanga, Alexis; Kooreman, Harold; Pabon-Rodriguez, Felix; Truong, Hong-Ha M.; Lewis Kulzer, Jayne; Ochomo, Edwin; Odhiambo, Francesca; Goodrich, Suzanne; Semeere, Aggrey; Navuluri, Neelima; Wools-Kaloustian, Kara; Enane, Leslie A. Background. Although timely tuberculosis (TB) diagnosis and treatment are essential to TB elimination, care delays remain a challenge. Understanding factors associated with delayed TB diagnosis and treatment may inform interventions. Methods. The TB Sentinel Research Network of the International epidemiology Databases to Evaluate AIDS (IeDEA) is a prospective study of people aged ≥15 years with pulmonary TB. At sites in Eldoret, Kenya, and Mbarara, Uganda, questionnaires ascertained timing of recalled TB symptom onset, number/setting of healthcare visits prior to TB diagnosis, symptoms, demographics, food insecurity, and TB- and HIV-related stigma. Robust negative binomial regression was used to examine factors associated with longer overall duration from TB symptom onset to documented treatment initiation. Results. Among 264 participants—median age 33 years (IQR, 25–43 years), 67% male, 31% people with HIV, 51% urban residents—median duration from TB symptom onset to treatment initiation was 65.5 days (IQR, 33–131 days). Longer time to TB treatment was associated with female sex (adjusted incidence rate ratio [aIRR], 1.27 [95% CI, 1.00–1.61]); previous careseeking at a pharmacy (aIRR, 1.53 [95% CI, 1.22–1.92]), and presence of dyspnea (aIRR, 1.43 [95% CI, 1.09–1.86]) or fatigue (aIRR, 1.63 [95% CI, 1.11–2.37]) at initiation. Shorter duration to TB treatment was associated with HIV-positive status (aIRR, 0.50 [95% CI, .39–.64]). Among people with HIV, shorter duration to TB treatment was associated with CD4 count <200 cells/μL (aIRR, 0.63 [95% CI, .43–.93]). Conclusions. Interventions are needed to increase community-level TB diagnostic access, including at pharmacies and lower levels of care. Decentralized TB testing strategies and tailored interventions for groups with lower care access should be pursued.

Contextual challenges of implementing adolescent and youth-friendly health services in Uasin Gishu county Kenya: a qualitative analysis

2026-08-10T06:51:12Z

Contextual challenges of implementing adolescent and youth-friendly health services in Uasin Gishu county Kenya: a qualitative analysis Embleton, Lonnie; Ashimosi, Celestine; Kirwa, Sheila; Boal, Ava; Chory, Ashley; Kodituwakku, Thiyasha; Johanek, Camila; Ott, Mary A.; Vreeman, Rachel C.; Marete, Irene Objectives: Substantial gaps in the implementation of adolescent and youth-friendly health services (AYFHS) have been identified in Uasin Gishu (UG) county, Kenya, across all eight domains of the WHO global standards, particularly with respect to adolescent health literacy, community support, provider competencies, and equity and non-discrimination. To respond, we undertook a qualitative analysis to explore contextual challenges of implementing AYFHS from the perspectives of adolescents and young adults (AYA) aged 10-24 years, policymakers, caregivers of AYA, healthcare providers, peer mentors, and community leaders. Methods: We used a hybrid inductive/deductive thematic analysis to explore contextual and systems-level determinants of implementing AYFHS in UG county, Kenya. Results: Our analysis generated four major themes: 1) priorities of political leadership and health systems management; 2) financial challenges; 3) human resources and facility infrastructure; and 4) social-cultural barriers. Participants perceived political will, leadership, and health systems management to be obstacles to implementing AYFHS. Further, participants stated that financial challenges were a leading barrier to the implementation of AYFHS in the county, and that dispersion of funds from the county government to facilities was inadequate. Intersecting with the political-economic context, participants discussed limited human resources, poor facility infrastructure, and supply issues as determinants of implementation. Lastly, social-cultural norms in association with sexual and reproductive health discussed as a substantial issue. Conclusions: Addressing implementation determinants of AYFHS, including political, economic, and social-cultural barriers, can enable adoption and facilitate implementation and scale of AYFHS that are a fundamental component of living healthy and productive lives for AYA in Kenya

Social relationships, mental health, and stigma: A qualitative study of social networks and HIV disclosure in Western Kenya

2026-08-06T07:01:31Z

Social relationships, mental health, and stigma: A qualitative study of social networks and HIV disclosure in Western Kenya Obatsa, Sarah; Mburia-Mwalili, Adel; JaureguiIII, Salvador; D. Wagner, Karla; Atwoli, Lukoye; Odhiambo, Francesca; Lewis-Kulzer, Jayne; Goodrich, Suzanne; Wools-Kaloustian, Kara; L. Syvertsen, Jennifer

Reduced efficacy of piperonyl butoxide based long-lastingiInsecticide-treated nets against malaria vectors in western Kenya

2026-08-06T06:50:01Z

Reduced efficacy of piperonyl butoxide based long-lastingiInsecticide-treated nets against malaria vectors in western Kenya Kahindi, Samuel; Abel, Lucy; Kirwa, Erastus; Amunga, Mark; Kimachas, Emma; Omondi, Evans; Cherono, Millicent; Mangeni, Judith; Obala, Andrew; Markwalter, Christine; Prudhomme O’Meara, Wendy Abstract. In response to rising insecticide resistance among malaria vector species, countries are implementing long-lasting insecticide treated nets (LLINs) coformulated with piperonyl butoxide (PBO), which can restore susceptibility to pyrethroid-based nets. In mid-2021, Kenya National Malaria Program rolled out PBO-LLINs in Bungoma County. We evaluated the susceptibility of wild-collected vectors to new versus used PBO-LLINs using the WHO cone bioassays. Results were confirmed with the WHO susceptibility assay. A total of 2,020 female Anopheles were tested, of which 1,480 were wild-collected and 540 were a Kilifi-susceptible strain. Mortality after exposure to new PBO-LLINs was only 68% in the wild-collected mosquitoes and as low as 34% when mosquitoes were exposed to used, 24-month old PBO- LLINs. Anopheles arabiensis was the main vector species that survived exposure. Susceptibility tests confirmed very low mortality after exposure to permethrin with or without PBO. Reduced sensitivity can be attributed partly to the aging of the net but also to very high levels of resistance in the local vector population.