School of Medicine

A pilot randomized controlled trial to explore the feasibility of a peer-delivered single-session brief intervention for youth with moderate risk substance use

Mon, 16 Mar 2026 00:00:00 GMT

A pilot randomized controlled trial to explore the feasibility of a peer-delivered single-session brief intervention for youth with moderate risk substance use Jaguga, Florence; Turissini, Matthew; Kamaru Kwobah, Edith; Apondi, Edith; A. Enane, Leslie; Barasa, Julius; Kosgei, Gilliane; Olando, Yvonne; A. Ott, Mary; Kimaina, Allan; C. Aalsma, Matthew Background Youth in sub-Saharan Africa are at high risk of substance use yet lack access to appropriate interventions. The goal of this project was to evaluate the feasibility of a definitive trial to explore efficacy of a peer-delivered single-session brief intervention (SSBI) for youth with substance use in Kenya. Methods Seventy youth aged 15−24 years with moderate risk substance use were randomized to SSBI or to psychoeducation. Data was collected at baseline and month three. Pri- mary outcomes: Feasibility criteria, e.g., study participation rate, proportion of partici- pants willing to be randomized, and study completion rate. Strategies for recruitment in a future trial were collected using focus group discussions with the youth at month three. Secondary outcomes: (i) Change in substance use (Alcohol, Smoking & Sub- stance Use Involvement Screening Test for Youth [ASSIST-Y] questionnaire), depres- sion (Patient Health Questionnaire [PHQ-9]), anxiety (Generalized Anxiety Disorder [GAD-7 scale]), and quality of life (World Health Organization-Quality of Life BriefVersion [WHO-QOL BREF]) scores between baseline and month 3; (ii) Fidelity to the intervention assessed using fidelity checklists. Results This pilot met most of the predefined minimum requirements for feasibility. For instance, 96.9% of those meeting eligibility criteria consented to participate (bench- mark was 80%), and 100% of those who consented were willing to be randomized to either study arm. Youth reported that young people who use substances can be most effectively recruited from community settings. The SSBI showed a small effect on reducing total ASSIST-Y (Standardized Mean Difference [SMD] −0.33 95% Con- fidence Interval [CI] −0.83,0.16) scores in the intervention group compared to the control. There was a moderate improvement in the quality of life for the intervention group compared to the control (SMD −0.41 CI −0.91,0.09). The intervention had no effect on depression (SMD 0.23 CI −0.27,0.72) and anxiety symptoms (SMD 0.70 CI 0.19,1.2) at month 3. Conclusion It is feasible to conduct a randomized controlled trial of a peer-delivered SSBI for youth with moderate risk substance use in Kenya.

Pregnancy outcomes among women with and without HIV infections who underwent excisional treatment for high-grade cervical intraepithelial neoplasia: a retrospective cohort study in low-resource settings

Mon, 26 Jan 2026 00:00:00 GMT

Pregnancy outcomes among women with and without HIV infections who underwent excisional treatment for high-grade cervical intraepithelial neoplasia: a retrospective cohort study in low-resource settings Amubuomombe, Poli Philippe; Itsura, Peter; K Tonui, Philiph; Omenge Orang’o, Elkanah; Elly Odongo, Benjamin; Joseph Loehrer, Patrick; Cu-Uvin, Susan Objective The standard treatment for high-grade squamous intraepithelial lesions is excisional involving the uterine cervix, while surveillance is an acceptable approach for low-grade squamous intraepithelial lesions. There is controversy about excisional treatment on pregnancy outcomes. The objective of this study was to determine pregnancy outcomes in women living with and without HIV who underwent excisional treatment for high- grade cervical intraepithelial lesions. Design This retrospective cohort study compared the pregnancy outcomes of women with and without HIV who were or were not treated for cervical intraepithelial lesions. A cohort of 488 women with and without HIV infection who did or did not receive excisional treatment for cervical intraepithelial lesions between 2009 and 2022 was enrolled. Adverse pregnancy outcomes (preterm delivery and pregnancy loss) in women with and without HIV, untreated or treated for cervical dysplasia, were recorded and analysed. The significance of the obtained results was judged at the 5% level. Study settings The study was conducted at all Academic Model Providing Access to Healthcare-Kenya satellite sites, which offer cervical cancer screening and treatment for cervical dysplasia in western Kenya. The Moi Teaching and Referral Hospital was also included. Participants A cohort of 488 women aged between 20 years and 49 years, with and without HIV, diagnosed and treated for high-grade cervical intraepithelial neoplasia, and those followed up for low-grade cervical intraepithelial neoplasia between 2009 and 2022, were included. Outcomes measured The study was interested in adverse pregnancy outcomes, particularly pregnancy loss and preterm delivery following cervical excision treatment for high-grade cervical intraepithelial lesions. Results After adjustment for confounding factors, excisional treatment involving the uterine cervix— particularly cold knife conisation—was associated with higher odds of adverse pregnancy outcomes (OR 13.1; 95% CI 1.1 to 137.1; p=0.032). A prior history of adverse pregnancy outcomes was also strongly associated with subsequent adverse outcomes after treatment (OR 37.7; 95% CI 13.8 to 102.7; p<0.001). In contrast, maternal HIV infection was not independently associated with adverse pregnancy outcomes after adjustment (p=0.125). Conclusion Adverse pregnancy outcomes after excisional treatment of the uterine cervix for high-grade squamous intraepithelial lesions are multifactorial and were associated with cold knife conisation and prior adverse pregnancy outcomes, while maternal HIV infection was not independently associated with adverse outcomes.

Autism outcomes and neurobehavioural markers in young children born to mothers with HIV in Kenya: a protocol for the alama project

Thu, 05 Mar 2026 00:00:00 GMT

Autism outcomes and neurobehavioural markers in young children born to mothers with HIV in Kenya: a protocol for the alama project Oyungu, Eren; Keehn, Brandon; S McHenry, Megan; O Monahan, Patrick; M Joseph, Robert; Yoon, Seung-Yeol; G Carlucci, James; Saina, Chelagat; Khaitan, Alka; Baliddawa, Joice; McNally Keehn, Rebecca Introduction The over 14 million African children who are HIV-exposed but uninfected (CHEU) are at risk for poor health outcomes, including neurodevelopmental conditions such as autism; however, no study to date has examined autism in CHEU in Africa, where the vast majority of these children live. Scalable diagnostic and neurobehavioural tools, including powerful, low-cost approaches such as eye-tracking, for detection and study of mechanistic neural processes are necessary to advance autism research in these settings. The objective of this study is to examine autism diagnostic outcomes and eye-tracking biomarkers in relation to CHEU while at the same time building capacity for neuro-health research in Kenya. Methods and analysis This study will leverage a longitudinally assessed cohort of CHEU and children who are HIV-unexposed and uninfected (CHUU) with well characterised HIV-related and contextual exposures. We will first determine and compare autism diagnostic outcomes between young CHEU and CHUU across a large cohort (n=850) of Kenyan children using research-grade autism assessment tools, and, second, determine whether neurobehavioural eye-tracking markers predict autism outcomes across this cohort. Ethics and dissemination Human subjects approvals have been obtained from Moi University Institutional Review and Ethics Committee (IREC; IREC/909/2024; Approval #0004835), Kenya’s National Commission for Science, Technology and Innovation (NACOSTI; Reference #NACOSTI/P/25/415028), the Institutional Review Board of the Indiana University School of Medicine (Protocol #23171), with reliance agreements executed with Purdue University and Boston University. Dissemination of findings will occur through multiple channels within the research and clinical community, including peer-reviewed journal publications and conference abstracts and presentations. As part of capacity building efforts, the research team will also communicate study results to policy makers, the lay public and other health systems involved in the care of young children with disabilities via study-hosted workshops and conferences.

Identifying community-sourced implementation strategies for delivering a task-shared mental health intervention for fathers in Kenya

Thu, 01 Jan 2026 00:00:00 GMT

Identifying community-sourced implementation strategies for delivering a task-shared mental health intervention for fathers in Kenya Giusto, Ali; Jaguga, Florence; Greenlee, Michaela; Triplett, Noah; Rono, Wilter; Rukh-E-Qamar, Hani; Korir, Mercy; Aburi, Dan; Wainberg, Milton Background: To design accessible interventions, understanding how best to implement them in context is essential. Strategies that reflect community perspectives may be most relevant and impactful. This study aimed to identify and spe- cify community-sourced implementation strategies for delivering a mental health and alcohol use intervention for fathers in Kenya and to map them to the Expert Recommendations for Implementing Change (ERIC) taxonomy. Method: In Eldoret, Kenya, focus groups (seven groups; 31 participants) and key informant interviews (n = 18) were con- ducted with hospital leaders, policymakers, mental health providers, community leaders, fathers, lay providers, patients, and men currently experiencing mental health and alcohol use challenges. Data were analyzed using the framework method to generate high-level codes, followed by a second phase to extract, specify, and review implementation strategies. Results: Community members identified lay providers recruited from the community as a promising delivery approach, with professional providers contributing to linkage to care and support for more acute needs. Engagement of community leaders and leveraging existing infrastructure were seen as key to enhancing implementation and reach, particularly among men. Multiple delivery settings (e.g., church, hospital, school) were considered acceptable depending on patient preference. A total of 25 unique community-sourced strategies were identified: three directly matched ERIC strategies, 19 were adapted, and two were unique to the community context. Conclusions: This study identified locally grounded implementation strategies to guide early-stage intervention delivery for fathers in Kenya. Findings contribute to the growing body of implementation science in non-Western contexts and highlight a participatory approach for identifying and specifying strategies relevant to local systems and populations.