John Kinuthia

John Kinuthia
University of Washington | UW · Department of Obstetrics and Gynecology

About

300
Publications
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4,514
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Publications

Publications (300)
Article
Background Tuberculosis disease (TB) caused 214,000 pediatric deaths in 2022. A growing body of evidence suggests that HIV exposed uninfected infants (iHEU) are at increased risk for Mycobacterium tuberculosis (Mtb) infection. Harnessing the power of the maternal immune system to protect infants has shown promise in other infections. Yet no well po...
Article
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Background Historically, children who are HIV-exposed, uninfected (CHEU) have been found to have greater morbidity and mortality than children who are HIV-unexposed, uninfected (CHUU). To assess whether this difference persists in the era of universal antiretroviral therapy (ART), we conducted a cohort study to compare the risk of acute diarrhoea,...
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Background Preterm birth (PTB) is a leading cause of neonatal mortality, particularly in sub-Saharan Africa where 40% of global neonatal deaths occur. We identified and combined demographic, clinical, and psychosocial correlates of PTB among Kenyan women to develop a risk score. Methods We used data from a prospective study enrolling HIV-negative...
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The evidence of COVID-19 vaccine efficacy for reducing the severe effects of COVID-19 infection, including hospitalization and death has been well established. Understanding health providers' COVID-19 vaccine concerns can provide critical insights to optimize the success of the vaccine rollout program as they are a trusted and important source of h...
Article
Introduction Adolescent girls and young women (AGYW) in Kenya have low pre-exposure prophylaxis (PrEP) initiation rates in part due to stigmatizing interactions with health care providers. Our recent randomized clinical trial of a standardized patient actor (SP) training intervention for providers found higher quality PrEP delivery at intervention...
Article
In Kenya, persons insufficiently engaged in HIV Testing Services (HTS) are often treated in emergency departments (ED). There are limited data from healthcare workers on ED-HTS. A qualitative study was completed to understand challenges and facilitators for ED-HTS and HIV self-testing (HIVST). Data were collected via six focus groups of healthcare...
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Background Provision of essential newborn care at home, rapid identification of illness, and care-seeking by caregivers can prevent neonatal mortality. Mobile technology can connect caregivers with information and healthcare worker advice more rapidly and frequently than healthcare visits. Community health workers (CHWs) are well-suited to deliver...
Article
Background: Persons seeking emergency injury care are often from higher-risk and underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods:...
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Pre-exposure prophylaxis (PrEP) is being scaled up to prevent HIV acquisition among adolescent girls and young women (AGYW) in Eastern and Southern Africa. In a prior study more than one-third of AGYW ‘mystery shoppers’ stated they would not return to care based on interactions with health providers. We examined the experiences of AGYW in this stud...
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Background Isoniazid preventive therapy (IPT) decreases risk of tuberculosis (TB) disease; impact on long-term infant growth is unknown. In a recent randomized trial (RCT), we assessed IPT effects on infant growth without known TB exposure. Methods The infant TB Infection Prevention Study (iTIPS) trial was a non-blinded RCT among HIV-exposed uninf...
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Objective To compare preferences, uptake, and cofactors for unassisted home-based oral self-testing (HB-HIVST) versus clinic-based rapid diagnostic blood tests (CB-RDT) for maternal HIV retesting. Design Prospective cohort. Methods Between November 2017 and June 2019, HIV-negative pregnant Kenyan women receiving antenatal care were enrolled and g...
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Background Clinical risk score tools require validation in diverse settings and populations before they are widely implemented. We aimed to externally validate an HIV risk assessment tool for predicting HIV acquisition among pregnant and postpartum women. In the context of prevention of mother-to-child transmission programs, risk score tools could...
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Introduction Pharmacy‐delivered HIV prevention services might create more options for pregnant women to use HIV prevention tools earlier and more consistently during pregnancy. We quantified preferences for attributes of potential HIV prevention services among women of childbearing age in Western Kenya. Methods From June to November 2023, we admin...
Article
Background Studies evaluating the association between the vaginal microbiota and miscarriage have produced variable results. Objective This study evaluated the association between periconceptual and first‐trimester vaginal microbiota and women's risk for miscarriage. Methods At monthly preconception visits and at 9–12 weeks gestation, women colle...
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Background Exclusive breastfeeding (EBF) in the first six months remains low globally, despite known benefits of lower morbidity and mortality among breastfed infants. It is important to understand factors associated with breastfeeding to support optimal breastfeeding practices, particularly in settings with a high burden of HIV. Methods We analyz...
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We examined the association between serum aflatoxin B1‐lysine adduct (AFB1‐lys) levels in pregnant women and adverse pregnancy outcomes (low birthweight, miscarriage and stillbirth) through a nested matched case–control study of pregnant women enroled at ≤28 weeks' gestation in Mombasa, Kenya, from 2017 to 2019. Cases comprised women with an advers...
Article
Objective To evaluate effectiveness of a standardized patient actor (SP) training intervention to improve quality of PrEP services for adolescent girls and young women (AGYW) in Kenya. Design Cluster randomized trial and mystery shopper evaluation. Methods Twelve of 24 maternal child health and family planning facilities were randomized to SP tra...
Article
We evaluated hair tenofovir (TFV) concentrations as an adherence metric for HIV preexposure prophylaxis during pregnancy and postpartum and compared hair levels with TFV-diphosphate levels in dried blood spots (DBSs). Overall 152 hair samples from 102 women and 36 hair-DBS paired samples from 29 women were collected from a subset of women in a clus...
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Background In 2020, 14% of diagnosed persons living with HIV (PLWH) in Kenya were not taking antiretroviral therapy (ART), and 19% of those on ART had unsuppressed viral loads. Long-acting antiretroviral therapy (LA-ART) may increase viral suppression by promoting ART uptake and adherence. We conducted key informant (KI) interviews with HIV experts...
Preprint
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The nasopharynx and its microbiota are implicated in respiratory health and disease. The interplay between viral infection and the nasopharyngeal microbiome is an area of increased interest and of clinical relevance. The impact of SARS-CoV-2, the etiological agent of the Coronavirus Disease 2019 (COVID-19) pandemic, on the nasopharyngeal microbiome...
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Microbiome perturbations can have long-term effects on health. The dynamics of the gut microbiome and virome in women living with HIV (WLHIV) and their newborn infants is poorly understood. Here, we performed metagenomic sequencing analyses on longitudinal stool samples including 23 mothers (13 WLHIV, 10 HIV-negative) and 12 infants that experience...
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Background: Persons seeking emergency injury care are often from underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods: This quasi-experime...
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Background Women living with HIV (WLWH) face unique reproductive health (RH) barriers which increase their risks of unmet need for contraception, contraceptive failure, unintended pregnancy, and pregnancy-related morbidity and mortality and may prevent them from achieving their reproductive goals. Patient-centered counseling interventions that supp...
Preprint
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ABSTRACT (word count 250/250) Objective: To compare preferences, uptake, and cofactors for unassisted home-based oral self-testing (HB-HIVST) versus clinic-based rapid diagnostic blood tests (CB-RDT) for maternal HIV retesting. Design: Prospective cohort Methods: Between November 2017 and June 2019, HIV-negative pregnant Kenyan women receiving ante...
Article
Background: COVID-19 has disrupted health-care services delivery globally. Limited data exists about personal protective equipment (PPE) availability for health-care workers (HCW) and perceptions of COVID-19 service disruption in low-resource settings. Methods: We used the Healthcare Worker Exposure Response and Outcomes (HERO) Registry Protective...
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Introduction Adverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya....
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Background: Few data on maternal-infant hair cortisol are available from HIV high-burden settings. We evaluated maternal hair cortisol and its relationship with infant hair cortisol, perinatal stressors, and pregnancy outcomes in Kenya. Materials and Methods: We analyzed data from an HIV prevention trial (NCT03070600). Pregnant women without HIV we...
Preprint
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Background: In 2020, health providers were expected to provide care to individuals with coronavirus disease 2019 (COVID-19) putting them at risk of acquiring COVID-19. The possibility of acquiring poorly understood infectious diseases while providing care may have an impact on the mental health of providers. We conducted a study to explore the effe...
Article
Background Oral PrEP and male partner HIV self-testing (HIVST) is being scaled up within antenatal clinics (ANC). Few data are available on how co-distribution influences acceptance of both interventions. Methods We utilized data from the PrIMA (NCT03070600) trial in Kenya. Women included in this analysis were determined to be at high risk of HIV...
Article
Background The effect of maternal HIV on infant Mycobacterium tuberculosis (Mtb) infection risk is not well-characterized. Methods Pregnant women with/without HIV and their infants were enrolled in a longitudinal cohort in Kenya. Mothers had interferon gamma-release assays (QFT-Plus) and tuberculin skin tests (TST) at enrollment in pregnancy; chil...
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Background Pre-exposure prophylaxis (PrEP) is recommended by the World Health Organization and the Kenyan Ministry of Health for HIV prevention in pregnancy and postpartum for women at risk for HIV. Integration of PrEP into antenatal care is promising, but delivery gaps exist in the face of healthcare provider shortages in resource-limited settings...
Article
Background Differentiated service delivery (DSD) approaches decrease frequency of clinic visits for individuals who are stable on antiretroviral therapy (ART). It is unclear how to optimize DSD models for postpartum women living with HIV (PWLH). We evaluated longitudinal HIV viral load (VL) and cofactors, and modelled DSD eligibility with virologic...
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Background Exposure to HIV and antiretroviral therapy (ART) in utero may influence infant growth and development. Most available evidence predates adoption of universal ART (Option B+ ART regimens). In a recent cohort, we compared growth and development in HIV-exposed uninfected (HEU) to HIV-unexposed (HUU) infants. Design Prospective cohort study...
Article
Background Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in pregnancy contribute to adverse perinatal outcomes. We identified predictors of CT and/or NG infection among pregnant Kenyan women. Methods Women without HIV were enrolled at two antenatal clinics in Western Kenya. CT and NG were assessed using endocervical samples...
Preprint
Full-text available
Background: Isoniazid preventive therapy (IPT) decreases risk of tuberculosis (TB) disease; impact on long-term infant growth is unknown. In a recent randomized trial (RCT), we assessed IPT effects on infant growth without known TB exposure. Methods: The infant TB Infection Prevention Study (iTIPS) trial was a non-blinded RCT among HIV-exposed unin...
Article
Objectives To assess the level and correlates of biomarker-confirmed adherence to isoniazid (INH) preventive therapy (IPT) among children living with HIV (CLHIV). Design This prospective cohort study assessed adherence among CLHIV on IPT in public sector HIV clinics from 2019 through 2020. Methods Adherence was assessed by pill counts or caregive...
Article
Background Pregnancy and human immunodeficiency virus (HIV) may influence tuberculosis infection detection using interferon (IFN)-γ release assay (QFT-Plus; Qiagen) and tuberculin skin test (TST). Methods Participants in Western Kenya underwent QFT-Plus and TST in pregnancy, 6 weeks postpartum (6wkPP) and 12 months postpartum (12moPP). Results 40...
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Background: Preterm birth complications are the leading cause of newborn and under-5 mortality. Over 85% of all preterm births occur in the late preterm period i.e., between 34 and <37 weeks of gestation. Antenatal corticosteroids (ACS) prevent mortality and respiratory morbidity when administered to women at high risk of an early preterm birth i.e...
Article
Study question: Is Mycoplasma genitalium-infection associated with reduced fecundability? Summary answer: Preconception M. genitalium-infection was associated with 27% lower fecundability though confidence intervals were wide, and the association between M. genitalium and fecundability may be dependent on concurrent bacterial vaginosis (BV). Wh...
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Background There is a higher risk for HIV acquisition during pregnancy and postpartum. Pre-exposure prophylaxis (PrEP) is recommended during this period for those at high risk of infection; integrated delivery in maternal and child health (MCH) clinics is feasible and acceptable but requires implementation optimization. Methods The PrEP in Pregnan...
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Infant antibody responses to viral infection can differ from those in adults. However, data on the specificity and function of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in infants, and direct comparisons between infants and adults are limited. Here, we characterize antibody binding and functionality against Wuhan-Hu-1...
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Abstract Background There is a lack of consensus about how to prioritize potential implementation strategies for HIV pre-exposure prophylaxis (PrEP) delivery. We compared several prioritization methods for their agreement and pragmatism in practice in a resource-limited setting. Methods We engaged diverse stakeholders with clinical PrEP delivery an...
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Background Risk of HIV acquisition is high during pregnancy and postpartum, and pre-exposure prophylaxis (PrEP) is recommended for peripartum populations. Integrating PrEP into maternal and child health (MCH) clinics is feasible and acceptable. Understanding clinics' service availability and readiness is essential for effective scale up. Methods T...
Article
Introduction: Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged in HIV Testing Services (HTS). In Kenya, these persons are often treated in emergency departments (EDs) for injuries, a healthcare interaction where HTS including HIV self-testing (HIVST) could be leveraged. There is, however, limited data from stak...
Article
Objective: We evaluated PrEP initiation, persistence, and adherence measured via tenofovir-diphosphate (TFV-DP) concentrations in dried blood spots (DBS) among women offered PrEP during pregnancy. Methods: We prospectively analyzed data from participants in the PrIMA Study (NCT03070600) who were offered PrEP during the 2nd trimester and followed...
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Introduction: Long-acting pre-exposure prophylaxis (PrEP) options could overcome barriers to oral PrEP persistence during pregnancy and postpartum. We evaluated long-acting PrEP preferences among oral PrEP-experienced pregnant and postpartum women in South Africa and Kenya, countries with high PrEP coverage with pending regulatory approvals for lo...
Preprint
Full-text available
Background: Preterm birth (PTB) is a leading cause of neonatal mortality, particularly in sub-Saharan Africa where 40% of global neonatal deaths occur. We identified and combined correlates of PTB among Kenyan women to develop a risk score. Methods: We used data from a prospective study enrolling HIV-negative women from 20 antenatal clinics in West...
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Full-text available
Background Mobile Health (“mHealth”) interventions have shown promise in improving HIV treatment outcomes for stigmatized populations. This paper presents the findings from a randomized controlled trial to assess the efficacy, participant-level feasibility and acceptability of a theory-informed mHealth intervention, Motivation Matters!, designed to...
Article
Background: Evidence gaps remain regarding the influence of prenatal psychosocial factors on adverse pregnancy outcomes. Objective: The objective of this study is to evaluate relationships between psychosocial factors and adverse perinatal outcomes among Kenyan women. Methods: We analysed data from a prospective cohort study enrolling HIV-nega...
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Objective The authors evaluated factors contributing to coronavirus disease 2019 (COVID‐19) vaccine hesitancy among pregnant and postpartum women to inform vaccine scale‐up strategies. Methods This observational study utilized data from pregnant and postpartum women attending four public maternal child health (MCH) clinics in Western Kenya. From O...
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Background: There are limited data on home pregnancy test use among women in low-and-middle-income countries. A prior survey found that only 20% of women in western Kenya used a home pregnancy test to confirm their pregnancies before going to antenatal care. This qualitative study aims to understand why women do not use home pregnancy tests in ear...
Article
Background: Availability of laboratory confirmation of sexually transmitted infections (STIs) is increasing in low- and middle-income countries, but costs continue to limit their access. Chlamydia trachomatis (CT) is an STI of significant clinical importance, particularly among women. This study aimed to develop a risk score to identify women with...
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Introduction: Integrating pre-exposure prophylaxis (PrEP) delivery for pregnant and postpartum women within maternal and child health (MCH) clinics is feasible and acceptable. It is unknown whether a risk-guided model would facilitate appropriate PrEP use among MCH attendees better than universally offering PrEP. Methods: The PrEP Implementation...
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For women living with HIV (WLH) in serodiscordant partnerships, decisions about childbearing can challenge condom use and antiretroviral adherence. In a prospective cohort of 148 WLH in serodiscordant partnerships, 58 (39%) wanted more children in the future but were not currently trying to conceive (fertility desire), and 32 (22%) were currently t...
Preprint
Full-text available
Infant antibody responses to viral infection can differ from those in adults. However, data on the specificity and function of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in infants, and direct comparisons between infants and adults are limited. We characterized antibody binding and functionality in convalescent plasma f...
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Full-text available
Background Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnan...
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Background HIV may increase SARS-CoV-2 infection risk and COVID-19 severity generally, but data are limited about its impact on postpartum women and their infants. As such, we characterized SARS-CoV-2 infection among mother-infant pairs in Nairobi, Kenya. Methods We conducted a nested study of 62 HIV-uninfected and 64 healthy women living with HIV...
Article
Background Emergency department-based HIV self-testing (ED-HIVST) could increase HIV-testing services to high-risk, under-reached populations. Objectives This study sought to understand the injury patient acceptability of ED-HIVST. Methods Injury patients presenting to the Kenyatta National Hospital Accident and Emergency Department were enrolled...
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Full-text available
Background Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged through HIV Testing Services (HTS). In Kenya, younger persons are often treated in emergency departments (EDs) for injuries, an interaction where HTS and HIV self-testing (HIVST) can be leveraged. Data from stakeholders on ED-HTS and HIVST is lacking a...
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Full-text available
Background Although HIV testing in family planning (FP) clinics is a promising approach for engaging women in HIV treatment and prevention services, HIV testing rates are low in FP clinics in Kenya. In 2018, a cluster randomized trial was implemented in Mombasa, Kenya applying the Systems Analysis and Improvement Approach (SAIA) to integrate HIV te...
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Background: Identifying optimal depression screening tools for use in maternal health clinics could improve maternal and infant health. We compared four tools for diagnostic performance and epidemiologic associations. Methods: This study was nested in a cluster-randomized trial in Kenya. Women in 20 maternal health clinics were evaluated at 6 we...
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The carotid intimal media thickness (CIMT) is a validated measure of subclinical atherosclerosis. Human immunodeficiency virus (HIV) is a risk factor for cardiovascular disease (CVD) and has been associated with CIMT in North America and Europe; however, there are limited data from Sub-Saharan Africa (SSA). In this cross-sectional study, we measure...
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Background The WHO ACTION-I trial demonstrated that dexamethasone significantly reduced neonatal mortality when administered to women at risk of early preterm birth in low-resource countries. We conducted a secondary analysis to determine how these benefits can be optimised, by evaluating the effect of dexamethasone compared to placebo on newborn m...
Preprint
Full-text available
Introduction Long-acting pre-exposure prophylaxis (PrEP) options could overcome some barriers to oral PrEP persistence during pregnancy and postpartum. We evaluated long-acting PrEP preferences among oral PrEP-experienced pregnant and postpartum women in South Africa and Kenya, two countries with high coverage of oral PrEP and with pending regulato...
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A multitude of enzyme-linked immunosorbent assays (ELISAs) have been developed to detect SARS-CoV-2 antibodies since the COVID-19 pandemic started in late 2019. Assessing the reliability of these assays in diverse global populations is critical. This study compares use of the commercially available Platelia Total Ab Assay (Bio-Rad) nucleocapsid ELI...
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Emergency departments (EDs) in Africa are contact points for key groups for HIV testing services (HTS) but understanding of ED-testing delivery is limited which may impeded program impacts. This study evaluated the offering and uptake of standard HTS among injured persons seeking ED care at Kenyatta National Hospital (KNH) in Nairobi, Kenya. An ED...
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Background: PMTCT programs serve women continuing and initiating ART in pregnancy, and follow-up schedules align to delivery rather than ART initiation, making conventional HIV retention measures (assessed from ART initiation) challenging to apply. We evaluated three measures of peripartum non-retention in Kenyan women living with HIV from pregnan...
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Background After considerable debate, there is now unequivocal evidence that use of antenatal corticosteroids improves outcomes in preterm neonates when used in women at risk of early preterm birth in reasonably equipped hospitals in low-resource countries. We aimed to evaluate the cost-effectiveness of dexamethasone administration in the managemen...
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Background Perinatal depression is broadly defined as depressive symptoms during pregnancy or within the 12 months following delivery, affecting approximately 20–25% of pregnant and postpartum women in low- and middle-income countries. The wide accessibility of mobile phones allows mobile health (mHealth) interventions to be considered a solution t...