A collaboration between the Duke Global Health Institute and the Kilimanjaro Clinical Research Institute. Funded by the Fogarty International Center and the National Institute of Allergy and Infectious Diseases.
Dr. Preeti Manavalan has been a member of the Option B+ study team since 2017, when she joined the team during the research year of her Infectious Diseases fellowship at Duke to help with data collection, analysis, and dissemination of findings. As a Fogarty Global Health Fellow, Dr. Manavalan is completing a year of research at Kilimanjaro Christian Medical Center in Moshi. During this time, she has had the opportunity to pursue her own research interests related to development of high-quality care models for people living with HIV and non-communicable diseases.
For her research, Dr. Manavalan aims to develop a task-shifting intervention to address hypertension among HIV-infected adults in Moshi. Hypertension is a leading risk factor for cardiovascular mortality and is an emerging threat among people living with HIV, but efforts at control have been largely neglected in resource-limited settings. Dr. Manavalan is collecting qualitative data to better understand the standard of care for hypertension management and to identify barriers and facilitators for improved care. She has screened patients for hypertension to determine the prevalence among HIV-infected adults engaged in care, and is assessing their risk factors, knowledge, attitudes, and practices of hypertension. Using this qualitative and quantitative data she will develop an integrative task-shifting intervention to improve blood pressure control among adults engaged in HIV care, and will evaluate its feasibility, fidelity and acceptability with a pilot feasibility study.
Dr. Manavalan hopes that results from her study will be used as formative data to inform future research for the development, integration and scale-up of task-shifting strategies to improve cardiovascular outcomes among people living with HIV.
From December 3-5, researchers, policy makers, government officials, and stakeholders involved in HIV work met in Arusha, Tanzania to share and discuss strategies, guidelines, innovations, and research findings on HIV and AIDS. The goal of the meeting was to disseminate the health sector HIV and AIDS guidelines and strategies, to share innovations and research findings to inform the HIV and AIDS response, and to prepare regional action plans to address identified challenges. Over the course of the meeting, the Option B+ team had three presentations and participated in discussions to inform the National AIDS Control Program (NACP)s action plan for the Northern Zone of Tanzania.
On the first day of the meeting, Linda Minja and James Ngocho presented data on retention in HIV care under Option B+ across 39 clinics in the Kilimanjaro region. The analysis used medical record data obtained from the Tanzania National AIDS Control Database. Findings highlighted the high loss to follow-up during initiation of PMTCT care and during the postpartum period, with higher loss of newly diagnosed clients. Results pointed to the need for targeted interventions that recognize the vulnerability of newly diagnosed patients, and address both early and postpartum retention.
On the third day of the meeting, Dr. Melissa Watt, who was visiting from the U.S., presented results from the Option B+ cohort to continue the conversation about care retention among pregnant and postpartum women. After sharing findings about facility-level implementation of Option B+ guidelines, care engagement at six months, depression, HIV disclosure, and barriers to care, the presentation concluded with a discussion of next steps, leading into an introduction of the stigma-based counseling intervention. Dr. Jane Rogathi then presented an overview of the new R21 activities and goals. The presentations stimulated great conversation, ideas, and support from attendees.