Research Articles

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A research article reports the results of original research, assesses its contribution to the body of knowledge in a given area, and is published in a peer-reviewed scholarly journal. The faculty publications through published and on-going articles/researches are captured in this community

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Now showing 1 - 10 of 44
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    Hypertension Among Cohort of Persons With Human Immunodeficiency Virus Initiated on a Dolutegravir-Based Antiretroviral Regimen in Ghana
    (Open Forum Infectious Diseases, 2024) Lartey, M.; Torpey, K.; Ganu, V.; et al.
    Background. Dolutegravir (DTG), a new antiretroviral drug, is being integrated into antiretroviral regimens for people with human immunodeficiency virus (PWH) in Ghana. There is little evidence of the effect of DTG on blood pressure (BP) levels in sub-Saharan Africa, especially West Africa. Our aim was to assess the incidence and predictors of hypertension (HTN) among PWH initiated on a DTG-based antiretroviral regimen in Ghana. Methods. An observational multicenter longitudinal study was conducted among PWH in Ghana from 2020 to 2022. BPs of nonhypertensive patients with BP ≤120/80 mm Hg at baseline were measured at 3, 6, 12, and 18 months post–DTG initiation. The primary outcome of the study was incidence of HTN, defined as BP ≥140/90 mm Hg. Kaplan-Meier estimator was used to estimate risk of developing HTN. Cox proportional hazards model with robust standard errors was used to estimate hazard ratios (HRs). Results. HTN prevalence among PWH screened was 37.3% (1366/3664). The incidence of de novo HTN among nonhypertensive PWH at 72 weeks was 598.4 per 1000 person-years (PY) (95% confidence interval [CI], 559.2–640.3) with incidence proportion of 59.90 (95% CI, 57.30–62.44). A quarter of those with de novo HTN developed it by month 6. Obesity (adjusted HR [aHR], 1.27 [95% CI, 1.05–1.54]), abnormal serum urea (aHR, 1.53 [95% CI, 1.27–1.85]), and low high-density lipoprotein (aHR, 1.45 [95% CI, 1.22–1.72]) were risk factors for HTN. Conclusions. Incidence of HTN was high among PWH on DTG. There is a need to monitor BP for HTN in adult PWH as well as traditional risk factors to reduce the burden of HTN and its complications.
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    Hypertension Among Cohort of Persons With Human Immunodeficiency Virus Initiated on a Dolutegravir-Based Antiretroviral Regimen in Ghana
    (Open Forum Infectious Diseases, 2024) Lartey, M.; Torpey, K.; Ganu, V.; et al.
    Background. Dolutegravir (DTG), a new antiretroviral drug, is being integrated into antiretroviral regimens for people with human immunodeficiency virus (PWH) in Ghana. There is little evidence of the effect of DTG on blood pressure (BP) levels in sub-Saharan Africa, especially West Africa. Our aim was to assess the incidence and predictors of hypertension (HTN) among PWH initiated on a DTG-based antiretroviral regimen in Ghana. Methods. An observational multicenter longitudinal study was conducted among PWH in Ghana from 2020 to 2022. BPs of nonhypertensive patients with BP ≤120/80 mm Hg at baseline were measured at 3, 6, 12, and 18 months post–DTG initiation. The primary outcome of the study was incidence of HTN, defined as BP ≥140/90 mm Hg. Kaplan-Meier estimator was used to estimate risk of developing HTN. Cox proportional hazards model with robust standard errors was used to estimate hazard ratios (HRs). Results. HTN prevalence among PWH screened was 37.3% (1366/3664). The incidence of de novo HTN among nonhypertensive PWH at 72 weeks was 598.4 per 1000 person-years (PY) (95% confidence interval [CI], 559.2–640.3) with incidence proportion of 59.90 (95% CI, 57.30–62.44). A quarter of those with de novo HTN developed it by month 6. Obesity (adjusted HR [aHR], 1.27 [95% CI, 1.05–1.54]), abnormal serum urea (aHR, 1.53 [95% CI, 1.27–1.85]), and low high-density lipoprotein (aHR, 1.45 [95% CI, 1.22–1.72]) were risk factors for HTN. Conclusions. Incidence of HTN was high among PWH on DTG. There is a need to monitor BP for HTN in adult PWH as well as traditional risk factors to reduce the burden of HTN and its complications.
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    What Is the Cost of Providing Outpatient HIV Counseling and Testing and Antiretroviral Therapy Services in Selected Public Health Facilities in Nigeria?
    (J Acquir Immune Defic Syndr, 2012) Aliyu, H.B.; Chuku, N.N.; Torpey, K.; et al.
    Background: Limited data on actual cost of providing HIV/AIDS services in Nigeria makes planning difficult. A study was conducted in 9 public health facilities supported by the Global HIV/AIDS Initiative Nigeria. The objective was to determine the cost of outpatient HIV Testing and Counseling (HTC) and antiretroviral therapy (ART) services per patient. Methods: Two tertiary and 7 secondary facilities were purposively selected across the six geopolitical regions. Facilities were distrib uted in urban and rural settings. Utilization and cost data for a 12-month period (January to December 2010) were analyzed. Cost elements included consumables, human resources, infrastructure, trainings, facility management, and Global HIV/AIDS Initiative Nigeria technical support. Total costs were apportioned based on percentage utilization by services, and unit costs were derived by dividing resource inputs by service outputs. Data were analyzed using Microsoft Excel 2003. A sensitivity analysis was also conducted for key assumptions. Results: Mean costs for HTC and ART were US $7.4 and US $209.0, respectively. Costs were higher in Northern facilities (US $6.9, US $250.8), compared with Southern ones (US $6.7, US $194.7); and in tertiary facilities ($18.5, $338.4), compared with secondary ones ($6.3, $204.9). Major cost drivers for HTC and ART were human resources—ranging from 62% to 50%, and ARV drugs —ranging from 54% to 31%, respectively.
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    Lower Levels of Antiretroviral Therapy Enrollment Among Men with HIV Compared with Women — 12 Countries, 2002–2013
    (Centers for Disease Control & Prevention (CDC), 2015) Auld, A.F.; Mbofana, F.; Torpey, K.; et al.
    World AIDS Day, observed on December 1, draws atten tion to the current status of the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) epidemic worldwide. This year’s theme is World AIDS 2015: The Time to Act is Now. The first cases of AIDS were reported more than 30 years ago, in the June 5, 1981 issue of MMWR. At the end of 2014, approximately 36.9 million persons worldwide were living with HIV infection (1). Although AIDS-related deaths have decreased by 42% since 2004, an estimated 1.2 million persons died from AIDS in 2014 (1). Global efforts, including the U.S. President’s Emergency Plan for AIDS Relief (in which CDC is a principal agency), have resulted in approximately 13.5 million persons in low- and middle-income countries receiving antiretroviral therapy (ART) for HIV infection in 2014 (2). Globally, approximately 15 million persons are on ART (1). An estimated 1.2 million persons in the United States and Puerto Rico are living with HIV infection (3) and approximately 50,000 persons become infected with HIV each year (4).
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    Trends in Prevalence of Advanced HIV Disease at Antiretroviral Therapy Enrollment — 10 Countries, 2004–2015
    (Morbidity and Mortality Weekly Report, 2017) Auld, A.F.; Shiraishi, R.W.; Torpey, K.; et al.
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    Laboratory Quality Audit in 25 Anti-Retroviral Therapy Facilities in North West of Nigeria
    (Open Journal of Clinical Diagnostics, 2014) Jegede, F.E.; Mbah, H.A.; Torpey, K.; et al.
    Introduction: A laboratory’s ability to consistently produce high-quality and reliable results hinges on adopting laboratory standards that guide daily practices to ensure steady quality improvement. Although assessment is an extremely rewarding exercise in health care quality improvement processes, it is always considered very time consuming and expensive in developing world set tings. A quarterly internal audit was conducted in 25 FHI360 supported Antiretroviral Treatment laboratories in the North West of Nigeria which can surely provide reference for other countries. Methodology: A checklist adapted from the World Health Organization/African Regional Office la boratory accreditation checklist was used to quantitatively evaluate 7 quality essentials (QEs). A team composed of technical staff from FHI360, State Ministry of Health and facility laboratory heads, conducted the audits, developed and monitored intervention plans. Information obtained with the checklist was captured in excel, validated and imported into Grappa Prism software ver sion 5.0 for analysis. Results: Most (92%) facilities were at secondary level with (8%) at tertiary level. The mean total score on all QEs across the facilities was 63.34 ± 9.77 in quarter (Q) 1, 68.8 ± 10.91 in Q2, 72.59 ± 8.02 in Q3 and 72.72 ± 9.16 in Q4 (p ≤ 0.0001). The most improved QE through Q1-Q4 was organization and personnel (32.2%), while signage/bench top reference had an 18.6% point decline. In ranking facilities based on differences of total scores between Q4 and Q1, Kachia General Hospital was the highest with 27 point increase. Considering the mean percentage score for all quarters per facility, 4 had ≥ 80%, 19 had between 60% - 80% and 2 had ˂60%. The total non-conformities cited for QI-Q4 were 185, 100, 78 and 64 respectively with highest recorded in internal and external quality control and the least in facility and safety. Conclusion: We recorded some improvement in most QEs confirming the benefits of internal audits, reviews and follow-up. However, much more is needed in terms of technical assistance, capacity building, mentorship, and commitment at facility and state level to meet minimum acceptable laboratory quality standards.
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    Piloting Laboratory Quality System Management in Six Health Facilities in Nigeria
    (PLOS ONE, 2014) Mbah, H.; Ojo, E.; Torpey, K.; et al.
    Background: Achieving accreditation in laboratories is a challenge in Nigeria like in most African countries. Nigeria adopted the World Health Organization Regional Office for Africa Stepwise Laboratory (Quality) Improvement Process Towards Accreditation (WHO/AFRO– SLIPTA) in 2010. We report on FHI360 effort and progress in piloting WHO-AFRO recognition and accreditation preparedness in six health facility laboratories in five different states of Nigeria. Method: Laboratory assessments were conducted at baseline, follow up and exit using the WHO/AFRO– SLIPTA checklist. From the total percentage score obtained, the quality status of laboratories were classified using a zero to five star rating, based on the WHO/AFRO quality improvement stepwise approach. Major interventions include advocacy, capacity building, mentorship and quality improvement projects. Results: At baseline audit, two of the laboratories attained 1- star while the remaining four were at 0- star. At follow up audit one lab was at 1- star, two at 3-star and three at 4-star. At exit audit, four labs were at 4- star, one at 3-star and one at 2- star rating. One laboratory dropped a ‘star’ at exit audit, while others consistently improved. The two weakest elements at baseline; internal audit (4%) and occurrence/incidence management (15%) improved significantly, with an exit score of 76% and 81% respectively. The elements facility and safety was the major strength across board throughout the audit exercise. Conclusion: This effort resulted in measurable and positive impact on the laboratories. We recommend further improvement towards a formal international accreditation status and scale up of WHO/AFRO– SLIPTA implementation in Nigeria.
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    Implementation and evaluation of a culturally grounded group-based HIV prevention programme for men who have sex with men in Ghana
    (Global Public Health, 2020) Abubakari, G.M.; Nelson, L.E.; Torpey, K.; et al.
    This study examined the feasibility and acceptability of an evidence-based HIV prevention programme for men who have sex with men (MSM) in Ghana through a participatory approach. The programme involved 57 self-identified adult cisgender MSM and led by a community-based organisation in collaboration with local nurses. We used an explanatory mixed-method design to evaluate the programme. We computed descriptive statistics, relative frequency, and paired proportionate analysis for the survey data and subjected the focus groups data to summative content analysis. Five key themes from the qualitative data indicated strong evidence of the acceptability and efficacy of the programme among MSM. The programme contributed to building social support networks, a sense of social justice among MSM, and facilitated the development of personalised HIV prevention menus by the participants. We observed increases in HIV testing (from 4% to 17%) and increases in the relative frequency of condom use for anal, oral, and vaginal sex. The programme served as an example of a successfully implemented culturally grounded intervention that has the potential to increase HIV and STI awareness and prevention among MSM in Ghana and other highly stigmatised environments.
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    TRIPS, the Doha Declaration and increasing access to medicines: policy options for Ghana
    (Globalization and Health, 2005) Cohen, J.C.; Gyansa-Lutterodt, M.; Torpey, K.; et al.
    There are acute disparities in pharmaceutical access between developing and industrialized countries. Developing countries make up approximately 80% of the world's population but only represent approximately 20% of global pharmaceutical consumption. Among the many barriers to drug access are the potential consequences of the Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Many developing countries have recently modified their patent laws to conform to the TRIPS standards, given the 2005 deadline for developing countries. Safeguards to protect public health have been incorporated into the TRIPS Agreement; however, in practice governments may be reluctant to exercise such rights given concern about the international trade and political ramifications. The Doha Declaration and the recent Decision on the Implementation of Paragraph 6 of the Doha Declaration on the TRIPS Agreement and Public Health may provide more freedom for developing countries in using these safeguards. This paper focuses on Ghana, a developing country that recently changed its patent laws to conform to TRIPS standards. We examine Ghana's patent law changes in the context of the Doha Declaration and assess their meaning for access to drugs of its population. We discuss new and existing barriers, as well as possible solutions, to provide policy-makers with lessons learned from the Ghanaian experience.
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    National and subnational size estimation of female sex workers in Ghana 2020: Comparing 3-source capture-recapture with other approaches
    (PLOS ONE, 2021) Guure, C.; Dery, S.; Torpey, K.; et al.
    Background Key Population size estimation (PSE) is instrumental for HIV/STI preventive, treatment and care services planning, implementation and delivery. The objective was to estimate the overall population of female sex workers (FSW) in all the 16 regions of Ghana using different PSE methods. Method Mapping of venues and complete enumeration of seaters was conducted at the formative stage prior to the bio-behavioral survey (BBS). Three PSE methods were used to derive the size estimates of FSW in the 16 regions. These include: Capture-recapture (CRC), service multiplier and three-source capture recapture (3SCRC) methods. The final choice of the estimation method used to estimate the roamer population was 3SCRC. This method was chosen because of its perfect record-linkage–hierarchic combination of three names that minimizes overmatching as well as the addition of an interaction term in the model which corrects for the dependencies in CRC. Results The total population size estimate of the female sex workers in the country obtained for roamers using capture re-capture was 41,746 (95% CI: 41,488–41,932). Using the service multiplier, the total population for both the roamers and seaters was 41,153 (95% CI: 37,242–45,984). The 3-source capture re-capture yielded 55,686 roamers FSW (95% CI: 47,686–63,686). The seater population was 4,363 FSW based on census/complete enu meration. The total population size estimate of FSW (seaters and roamers) in Ghana was 60,049 when 3SCRC and census were added. This represents about 0.76% of all estimated adult females aged 15-49yrs in Ghana. Conclusion We report population size estimates (PSE) for FSW in Ghana. These estimates are the results of 3SCRC. These findings provide a valid and reliable source of information that should be referenced by government officials and policymakers to plan, implement and pro vide HIV/STI preventive, treatment, and care services for FSW in Ghana.