Kenya

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Focus: HIV - Continuum of Care and Implementation Science

Affiliation: Kenyatta National Hospital (KNH)

Contacts:

Site and Background: The Kenyatta National Hospital (KNH) was established in 1901 as a national teaching and referral hospital and to act as a site of medical research. It serves as the most senior referral hospital in the Kenya health system. The KNH campus area also hosts the oldest medical school in Kenya – the College of Health Sciences at the University of Nairobi -  as well as several other training and medical research institutions including the Kenya Medical Training College, the  Kenya Medical Research Institute and National Laboratory Service (Ministry of Health)1. Additionally, KNH offers Specialized Nursing Training in the in-house nursing school which was established in 1996. The nursing school now provides specialized training for nurses from East and Central Africa and graduates approximately 100 nurses each year. KNH will provide an inter-professional training opportunity related to the continuum of HIV care, among other conditions, within an implementation science framework. The site will offer a wealth of experience, not limited to research related to HIV prevention, treatment and care, but also in other areas of infectious and non-communicable diseases as well. As a national/regional referral and teaching hospital with a mandate to support the national government in health care, research and policy formulation, Fogarty Global Health Equity Scholars will have access to all the government health facilities across the country, and a multidisciplinary team of biobehavioral, research, and clinical scientists, epidemiologists and design, evaluation and implementation science specialists.

KNH has a dedicated Research and Programs Department which is responsible for coordinating research within the hospital. The Research and Programs office provides research support for personnel within the hospital as well as students within the University of Nairobi College of Health Sciences who wish to conduct research within the hospital. Support provided includes technical assistance crafting research studies, including biostatistical or epidemiological consultation. The department also organizes or provides support for several training opportunities within the institution on conduct of clinical research studies, as well as convening or supporting symposia on other topics of interest to relevant departments within the hospital, for example radiation safety, diabetes, mental health and alcoholism among others. The department also provides small grants to students and health personnel who wish to conduct research studies within the hospital. Additionally, the Kenyatta National Hospital/University of Nairobi Ethics and Research Committee (KNH/UoN ERC) is responsible for ensuring that the basic ethic principles as well as the regulations from the National Council of Science and Technology, Government of Kenya laws and University of Nairobi/KNH policies governing protection of research participants are applied to research activities. The Office for Human Research Protection, a branch of the US Department of Health and Human Services has granted KNH/UoN ERC the authority to perform these activities under KNH’s Federal Wide Assurance (FWA#00002173).

KNH has had a longstanding and robust relationship with the University of Washington, New York University and Yale University through various projects and programs over the last 25 years, including time during which Dr. Ann Kurth was faculty and a collaborator in these institutions. This collaboration has resulted in innumerable projects being implemented at KNH and Kenya at large involving investigators from the institutions resulting in many publications in the field of HIV2-10, STIs11sup> and malaria12,13sup> among others. In 1988, the University of Nairobi (affiliated with KNH) and the University of Washington through the Fogarty-funded International AIDS Research and Training Program (IARTP) initiated collaboration for a reciprocal training program for Kenyan and US-based health professionals. The IARTP has facilitated the training of Kenyan-based researchers, including those from KNH, Dr. James Kiarie, Dr. Nelly Mugo, Dr. Irene Inwani, and Dr. John Kinuthia at the University of Washington for research training courses. Other examples of global health professionals who were supported by Fogarty training grants are Dr. Peter Cherutich (physician, national HIV policy leader, and implementation science PhD) and Dr. Kenneth Ngure (a nurse and public health researcher).  

In the last two years, KNH has partnered with the IARTP to facilitate the training of health professionals from KNH in implementation science, focusing on improving the HIV Care Cascade. The HIV Care Cascade training programs has two tracks: the 4 year MPH/PhD track and the 1 year non-matriculated training track. Scholars in the 4 year program travel to Seattle for didactic courses focusing on implementation science culminating in an MPH from the University of Washington. The rest of the program is carried out in Kenya where scholars return to formulate their PhD proposal and conduct their studies resulting in the award of a PhD from the University of Nairobi. The 1 year track involves 3 months of coursework at the University of Washington followed by 9 months of a mentored research project in Kenya.  Selection of scholars in these programs is through a competitive selection process and there are currently 9 scholars in total, 6 of whom are based at KNH.

Scholars in the HIV Care Cascade program are trained in biostatistics, epidemiology and HIV research principles among other core research courses to enhance their skills. Each scholar is matched to a faculty mentor at the University of Washington based on shared interests and potential for continued future collaboration. The faculty mentor guides the scholar through their individualized training program and advises them on their research study. The scholars are also co-mentored by a local Kenyan researcher who serves as an advisor during the MPH component of their study and continues to guide them through their research studies during the PhD section of the training program.  

The joint training program offered by KNH and the IARTP program demonstrates the kind of innovative and timely collaboration that supports capacity building of health professionals based at KNH and ultimately improves the quality of research conducted at that institution. Through IARTP, KNH and University of Washington has facilitated training of 10 Kenyans and 21 US fellows within a duration of one to two years depending on the program.  Fifteen 4th year students from Kenya have also been supported during their three (3) months elective term where four (4) of those went to University of Washington for orientation and the rest were attached to various projects within the institution.

We believe that as a result of this collaborative history, KNH has the capacity and necessary infrastructure to engage with Yale University to mentor additional professionals (both US fellows and in-country LMIC scholars) in their global health research training and education.

References
1.   KNH. Kenyatta National Hospital. 2015; knh.or.ke. Accessed 29Dec2015.
2.   Kinuthia J, Kiarie JN, Farquhar C, et al. Cofactors for HIV-1 Incidence during Pregnancy and Postpartum Period. Current HIV Research. 2010;8(7):510-514.
3.   John-Stewart G, Wariua G, Beima-Sofie K, et al. Prevalence, Perceptions and Correlates of Pediatric HIV Disclosure in an HIV Treatment Program in Kenya. AIDS care. 2013;25(9):1067-1076.
4.   Kinuthia J, Kiarie JN, Farquhar C, et al. Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma. Journal of the International AIDS Society. 2011;14:61-61.
5.   Obimbo EM, Wamalwa D, Richardson B, et al. Pediatric HIV-1 in Kenya: Pattern and Correlates of Viral Load and Association With Mortality. Journal of acquired immune deficiency syndromes (1999). 2009;51(2):209-215.
6.   Mugo NR, Hong T, Celum C, et al. Pregnancy Incidence and Outcomes among Women Receiving Pre-Exposure Prophylaxis for HIV Prevention: A Randomized Clinical Trial. JAMA. 2014;312(4):362-371.
7.   Wamalwa DC, Obimbo EM, Farquhar C, et al. Predictors of mortality in HIV-1 infected children on antiretroviral therapy in Kenya: a prospective cohort. BMC Pediatrics. 2010;10:33-33.
8.   Wamalwa DC, Farquhar C, Obimbo EM, et al. Early response to highly active antiretroviral therapy in HIV-1-infected Kenyan children. J Acquir Immune Defic Syndr. 2007;45(3):311-317.
9.   Osoti AO, John-Stewart G, Kiarie J, et al. Home Visits during Pregnancy Enhance Male Partner HIV Counseling and Testing in Kenya: A Randomized Clinical Trial. AIDS (London, England). 2014;28(1):95-103.
10.  Rositch AF, Cherutich P, Brentlinger P, Kiarie JNM, Nduati R, Farquhar C. HIV infection and sexual partnerships and behaviour among adolescent girls in Nairobi, Kenya. International journal of STD & AIDS. 2012;23(7):468-474.
11.  Muiru AN, Guthrie BL, Bosire R, et al. Incident HSV-2 Infections Are Common Among HIV-1-discordant Couples. The Journal of Infectious Diseases. 2013;208(7):1093-1101.
12.  Onchiri FM, Pavlinac PB, Singa BO, et al. Frequency and correlates of malaria over-treatment in areas of differing malaria transmission: a cross-sectional study in rural Western Kenya. Malaria Journal. 2015;14:97.
13.  Onchiri FM, Pavlinac PB, Singa BO, et al. Low Bacteremia Prevalence Among Febrile Children in Areas of Differing Malaria Transmission in Rural Kenya: A Cross-Sectional Study. J Pediatric Infect Dis Soc. 2015.