Kristjana Asbjornsdottir

• MPH, PhD
• Researcher at University of Washington

Background Following the conclusion of a stepped-wedge cluster randomized trial of the Systems Analysis and Improvement Approach (SAIA) to optimize the Prevention of Mother-to-Child HIV Transmission (PMTCT) cascade in Manica Province, Mozambique, we conducted a natural experiment to test the sustainability of the delivery model with limited financi...

Background Healthcare systems in low-resource settings need simple, low-cost interventions to improve services and address gaps in care. Though routine data provide opportunities to guide these efforts, frontline providers are rarely engaged in analyzing them for facility-level decision making. The Systems Analysis and Improvement Approach (SAIA) i...

We used geospatial methods to track soil-transmitted helminths prevalence where soil samples were collected and species identified using meta-genomics

Background: Healthcare systems in low-resource settings need simple, low-cost interventions to improve services and address gaps in care. Though routine data provide opportunities to guide these efforts, frontline healthcare workers (HCW) are rarely engaged in analyzing them for facility-level decision making. The Systems Analysis and Improvement A...

Introduction Understanding community women's relational and financial empowerment in social entrepreneurship could be the key to scaling up community-based human papillomavirus (HPV) self-sampling programs in low- and middle-income countries. The Hope Project, social entrepreneurship in Peru, trains women (Hope Ladies) to promote HPV self-sampling...

BACKGROUND Optimal delivery of prevention of mother to child transmission of HIV (PMTCT) programs is challenging, including in Mozambique. The Systems Analysis and Improvement Approach (SAIA) is a multi-component, systems engineering strategy that has demonstrated PMTCT cascade improvement in a previous cluster randomized trial. To facilitate scale...

Background: The Systems Analysis and Improvement Approach (SAIA) is an evidence-based, multi-component implementation strategy that engages service providers in the use of routinely-available service data to optimize service delivery cascades and promote systems-level thinking. SAIA was originally developed to address bottlenecks in HIV care in low...

Background: Understanding the community women’s sense of relational and financial empowerment in the social entrepreneurship context could be the key to developing a sustainable pathway to scale-up community-based human papillomavirus (HPV) self-sampling programs in low-resource settings. The Hope Project, social entrepreneurship from Peru, trains...

Malawi has successfully leveraged multiple delivery platforms to scale-up and sustain the implementation of preventive chemotherapy (PCT) for the control of morbidity caused by soil-transmitted helminths (STH). Sentinel monitoring demonstrates this strategy has been successful in reducing STH infection in school-age children, although our understan...

Since 2015, India has coordinated the largest school-based deworming program globally, targeting soil-transmitted helminths (STH) in ~250 million children aged 1 to 19 years twice yearly. Despite substantial progress in reduction of morbidity associated with STH, reinfection rates in endemic communities remain high. We conducted a community based p...

An amendment to this paper has been published and can be accessed via the original article.

Global efforts to control morbidity associated with soil-transmitted helminth infections (STH) have focused largely on the targeted treatment of high-risk groups, including children and pregnant women. However, it is not clear when such programs can be discontinued and there are concerns about the sustainability of current STH control programs. The...

Malawi has successfully leveraged multiple delivery platforms to scale-up and sustain the implementation of preventive chemotherapy (PCT) for the control of morbidity caused by soil-transmitted helminths (STH). Sentinel monitoring demonstrates this strategy has been successful in reducing STH infection in school-age children, although our understan...

We developed an electronic treatment register for the DeWorm3 Project, a cluster-randomised, controlled trial in Benin, India, and Malawi testing the feasibility of interrupting transmission of soil-transmitted helminths through community-wide mass drug administration. The electronic treatment register was designed in xlsform, deployed via the Surv...

Following publication of the original article [1], the authors reported a typo in the title of the article.

Background: Across sub-Saharan Africa, evidence-based clinical guidelines to screen and manage hypertension exist; however, country level application is low due to lack of service readiness, uneven health worker motivation, weak accountability of health worker performance, and poor integration of hypertension screening and management with chronic...

Purpose This study describes patterns of community-level stigmatizing attitudes towards mental illness (MI) in central Mozambique. Methods Data for this study come from a representative community household survey of 2933 respondents ≥ 18 years old in Manica and Sofala Provinces, Mozambique. Six MI stigma questions represented primary research outc...

Purpose of Review This review offers an operational definition of systems engineering (SE) as applied to public health, reviews applications of SE in the field of HIV, and identifies opportunities and challenges of broader application of SE in global health. Recent Findings SE involves the deliberate sequencing of three steps: diagnosing a problem...

Background The introduction of option B+—rapid initiation of lifelong antiretroviral therapy regardless of disease status for HIV-infected pregnant and breastfeeding women—can dramatically reduce HIV transmission during pregnancy, birth, and breastfeeding. Despite significant investments to scale-up Option B+, results have been mixed, with high rat...

Background Lack of accurate data on the distribution of sub-national populations in low- and middle-income countries impairs planning, monitoring, and evaluation of interventions. Novel, low-cost methods to develop unbiased survey sampling frames at sub-national, sub-provincial, and even sub-district levels are urgently needed. This article details...

The current World Health Organization strategy to address soil-transmitted helminth (STH) infections in children is based on morbidity control through routine deworming of school and pre-school aged children. However, given that transmission continues to occur as a result of persistent reservoirs of infection in untreated individuals (including adu...

Background: The under-5 mortality rate (U5MR) is an important metric of child health and survival. Country-level estimates of U5MR are readily available, but efforts to estimate U5MR subnationally have been limited, in part, due to spatial misalignment of available data sources (e.g., use of different administrative levels, or as a result of histo...

Background Community-based public health campaigns, such as those used in mass deworming, vitamin A supplementation and child immunization programs, provide key healthcare interventions to targeted populations at scale. However, these programs often fall short of established coverage targets. The purpose of this systematic review was to evaluate th...

Background Proper collection and storage of fecal samples is necessary to guarantee the subsequent reliability of DNA-based soil-transmitted helminth diagnostic procedures. Previous research has examined various methods to preserve fecal samples for subsequent microscopic analysis or for subsequent determination of overall DNA yields obtained follo...

In recent years, an increased focus has been placed upon the possibility of the elimination of soil-transmitted helminth (STH) transmission using various interventions including mass drug administration. The primary diagnostic tool recommended by the WHO is the detection of STH eggs in stool using the Kato-Katz (KK) method. However, detecting infec...

Current control strategies for soil-transmitted helminths (STH) emphasize morbidity control through mass drug administration (MDA) targeting preschool- and school-age children, women of childbearing age and adults in certain high-risk occupations such as agricultural laborers or miners. This strategy is effective at reducing morbidity in those trea...

Analysis of deviance table for GLM at -20°C. This table shows that there was no significant effect on the integrity of the samples over time (F = 0.079, p = 0.780) for those samples stored at -20°C. (XLSX)

Coefficients from the GLM along with their standard errors (SE) at 32°C. The first column shows the method of preservation employed (indexed by j). In the second column, the value in the first row is exp(α0) and the values in all subsequent rows are exp(α1j). These are exponentiated coefficients associated with each treatment upon initial applicati...

Bayesian fitting to mean worm burden (mu) and aggregation parameter k for Ascaris. (TIF)

Model parameters of the simulation model for Ascaris and hookworm. Please note, the major differences between the diseases are reflected by the female worm fecundity and reservoir decay rate. (DOCX)

Average Cq values from quantitative real-time PCR testing for IAC and N. americanus. Note that only a small subset of the samples underwent preliminary testing before determining that an additional purification step was required. For potassium dichromate, Cq values were significantly improved after the purification step, whereas for other preservat...

Mean Cq values from the quantitative real-time PCR testing of all N. americanus biological replicates (n = 9) for each preservative, temperature and time point (total n = 628). (XLSX)

Fiiting a negative binomial distribution to worm count data (with MCMC) to estimate the aggregation parameter k. (DOCX)

Analysis of deviance table for GLM at 4°C. At 4°C we fit the full model specified in Eq 1. The marginal significance of the interaction term (F = 1.825; p = 0.083) suggests that there is only weak evidence that these methods differ in their preservation ability over time. That is, at 4°C, the differences in Cq are attributable to the application of...

Comparison of stochastic individual-based model runs (grey lines) and the deterministic model (red line). Prevalence is the measured prevalence as described by Coffeng et al., (2017) and Truscott et al., (2017) [9,35]. (TIF)

Sample size calculations depending on test sensitivity. (TIF)

Purpose of review: Soil-transmitted helminths (STH) are endemic in 120 countries and are associated with substantial morbidity and loss of economic productivity. Although current WHO guidelines focus on morbidity control through mass drug administration (MDA), there is global interest in whether a strategy targeting disease elimination might be fe...

Background There is an increased focus on whether mass drug administration (MDA) programmes alone can interrupt the transmission of soil-transmitted helminths (STH). Mathematical models can be used to model these interventions and are increasingly being implemented to inform investigators about expected trial outcome and the choice of optimum study...

Background: Assisted partner services for index patients with HIV infections involves elicitation of information about sex partners and contacting them to ensure that they test for HIV and link to care. Assisted partner services are not widely available in Africa. We aimed to establish whether or not assisted partner services increase HIV testing,...

Objective: To evaluate the impact of highly-active antiretroviral therapy (HAART) on CMV transmission and breast milk level in the context of maternal HIV. Design: Specimens from a randomized trial conducted in Nairobi, Kenya between 2003-2005 were used to compare CMV transmission and breast milk levels between mother-infant pairs randomized to...

Background: Virologic and immunologic responses to antiretroviral treatment (ART) in infants may differ from older children due to immunologic, clinical or epidemiologic characteristics. Methods: Longitudinal ART responses were modeled and compared in HIV-infected infants and children enrolled in cohorts in Nairobi, Kenya. Participants were enro...

In light of the unprecedented momentum to control or eliminate ten neglected tropical diseases (NTDs) by 2020, the NTD community is at a crossroads of opportunity. Efforts to eliminate lymphatic filariasis (LF) using mass drug administration (MDA) platforms have dramatically and simultaneously increased the number of individuals treated for soil-tr...

Background: Cytomegalovirus (CMV) is associated with morbidity and mortality in HIV-exposed infants. We assessed the effect and relative contribution of breastfeeding on infant CMV acquisition in the setting of maternal HIV infection. Methods: Between 1993-1998 pregnant, HIV-infected women in Nairobi, Kenya were randomized to breastfeeding or fo...

Background: Human immunodeficiency virus (HIV)-exposed uninfected (HEU) infants are a growing population in sub-Saharan Africa, with higher morbidity and mortality than HIV-unexposed infants. HEU infants may experience increased morbidity due to breastfeeding avoidance. Objectives: We sought to describe the burden and identify predictors of hosp...

Background: Depot medroxyprogesterone acetate (DMPA) is associated with HIV acquisition. We studied changes in vaginal microbiota and inflammatory milieu after DMPA initiation. Methods: In a cohort of HIV-negative Kenyan women, we collected monthly vaginal swabs over 1 year before and after DMPA. Using quantitative polymerase chain reaction, we...

Studies in HIV-1-infected infants and HIV-1-exposed, uninfected infants link early cytomegalovirus (CMV) acquisition with growth delay and cognitive impairment. We investigated maternal valacyclovir to delay infant acquisition of CMV. Pregnant women with HIV-1, HSV-2 and CD4 count >250 cells/µl were randomized at 34 weeks gestation to 500 mg twice-...

Background. Cytomegalovirus (CMV) infection is associated with adverse outcomes in human immunodeficiency virus (HIV)-exposed infants. Determinants of vertical CMV transmission in the setting of maternal HIV-1 infection are not well-defined.Methods. CMV and HIV-1 levels were measured in plasma, cervical secretions, and breast milk of 147 HIV-1-infe...

HIV-exposed uninfected (HEU) infants have higher infectious disease morbidity and mortality than unexposed infants. We determined the incidence and risk factors for pneumonia, a leading cause of infant mortality worldwide, in a cohort of HEU infants. Identifying predictors of pneumonia among HEU infants may enable early identification of those at h...

The Plasmodium proteasome has been suggested to be a potential antimalarial drug target; however, toxicity of inhibitors has prevented validation of this enzyme in vivo. We report a screen of a library of 670 analogs of the recent US Food and Drug Administration-approved inhibitor, carfilzomib, to identify compounds that selectively kill parasites....