1068-Kenya-Leveraging routinely collected data to focus the HIV response among female sex workers in Kenya

Kenya has made significant strides in testing, treatment, and viral suppression, but these improvements have not been equitably realized across all groups. Many individuals labeled as "lost to care" include not only those who have genuinely discontinued treatment but also those who have unofficially transferred to other facilities without proper documentation. These "silent transfers," where patients move between facilities without formal notification, can compromise clinical care. Existing data systems, especially in resource-limited settings, often struggle to track patients over time or across facilities, but integrated electronic medical systems may offer a solution for better monitoring patient retention and transfers. In response, our goals are to use existing program data collated from the Kenya Electronic Medical Record (KenyaEMR) system and strategic qualitative data collection understand the scale and impact of silent transfers on treatment outcomes, document implementation gaps in the treatment initiation process, and co-create an intervention to reduce silent transfers among female sex workers in Nairobi, Kenya. These goals will be achieved via the following study objectives: 1) Estimate the frequency of antiretroviral therapy facility switching, proportion of switches that are silent transfers, and the relationship between silent transfers and 12-month viral suppression among female sex workers living with HIV in Nairobi, Kenya between 2022-2024. 2) Map the implementation context of the antiretroviral therapy transfer process for female sex workers living with HIV in Nairobi, Kenya using mixed methods -2a: Use qualitative methods to document the current facility switching process across ten clinics providing services to female sex workers -2b: Investigate sociodemographic, behavioral, and program-level characteristics associated with silent transfers 3)– Use human-centered design to develop an enhanced antiretroviral therapy initiation process to reduce the proportion of total transfers that are silent

The student will work with Partners for Health and Development in Africa (PHDA) Kenya and collaboratively engage with the Sex Workers Outreach Project (SWOP) on this exciting project funded by the National Institute of Allergy and Infectious Diseases (NIAID). One student is requested to support 1) technical support and implementation of the project activities, including data collation, harmonization, , and analysis; and 2) liaising and collaborating with PHDA personnel, program partners, USAID personnel, government partners, and other key populations data stakeholders. This placement will be located at the PHDA Kenya office in Nairobi, Kenya. PHDA is an international non-profit organization registered in Kenya and provides technical support to the Government of Kenya National AIDS & STI Control Programme (NASCOP) in Kenya, and is a partnership between the NASCOP and University of Manitoba, Canada. For over 20 years, PHDA has been working with communities living with and affected by HIV/AIDS in Kenya, and in particular key populations. PHDA provides leadership and support for programme science initiatives and in partnership with community based organizations. As part of the NASCOP-Technical Support Unit, PHDA focuses on fostering local capacity in data management and data coordination, and support the implementation of bio-behavioral and polling booth surveys, and analyses of key indicator programmatic data, as part of NASCOP’s surveillance and monitoring and evaluation strategies across the country. Technical activities of the project include: 1) Building on the existing synthesis of all available Key Population data for Kenya to include an expanded range of data source types, with a focus on routinely collected program data by PHDA/SWOP for the KenyaEMR system and [eCHIS], as well as including recent evaluations, peer-reviewed and grey literature sources. This includes, but is not limited to, data characterizing HIV prevalence and incidence, ART access and retention, PrEP coverage; 2) Supporting quantitative analyses of routinely collected data, with a focus on assessing the association between silent transfers and viral load suppression, as well as other analyses specific to HIV testing, prevention, and treatment as indicated by the PHDA/SWOP team; 3) Supporting data synthesis and harmonization for innovative repository development, which may include but is not limited to: collating existing .csv files with aggregate indicators, developing structured .csv file templates, utilizing R. Shiny/Python, developing an API, etc.; 4) Developing and presenting data dissemination products including presentations, brief reports, data visualizations, and/or abstracts via in-person and virtual platforms; and 5) Developing capacity building training workshops—engaging in both formative planning activities and in facilitation—as identified by the PHDA/SWOP team. This project offers an opportunity both professional and academic to gain critical skills in the intersection of health systems strengthening and epidemiological approaches through data capacity-building, community and stakeholder engagement and relationship building, as well as experience working on HIV-related implementation science and research activities aiming to impact public health practice in a low-to-middle-income country. Working in the field with local counterparts gives the applicant the opportunity to develop skills in project management and stakeholder engagement that will help them critically analyze how they would design future projects.

The professional work environment at the site is extremely positive and fosters mentorship and productivity across team members, partners and program staff. The workplace operates in a mature, respectful matter and collaboration and team work are hallmarks of the project. We as a team are always available for support and ongoing communication throughout this collaboration.

This placement would be a good fit for someone who is motivated and can take the lead on projects. Regular mentoring and supervision will be provided by investigators and staff in the US and Kenya; however it will be the responsibility of the student to use the ideas and advice provided by the investigative team to move aspects of the project along, requesting additional support along the way when needed. Students with an interest in Key Populations, data analytics, big data science, and capacity building are encouraged to apply.

Epidemiology and Biostatistics (620 series or above preferred); courses in health communications, health equity, and implementation science are a plus, but not required

Name: Amrita Rao, arao24@jhu.edu 

I would describe my communication and mentorship styles as... 

I am supportive, available to provide thoughtful feedback and guidance at any point either in-person, by phone or via email. I work closely with the research and study team to ensure goals are met and individuals are supported to engage at the highest level. We work as a unified team and provide support and mentorship across multiple levels.

A complementary student would have a working style and mentorship expectations that are..

A complementary student will be interested in the work, hardworking, and able to work independently and collaboratively. We are looking for students that are excited about the work, willing to learn, and interested in integrating within the PHDA team. Students who are able to take initiative and ownership of their responsibilities within the project will be a good fit for this placement.

Estimated Costs:

$0 The monthly stipend is sufficient to cover housing, food and use of public transport. Students wishing to further travel for personal reasons may incur out of pocket expenses.

Additional support from PI:

We will work with the student to develop a budget to cover monthly expenses including housing, transportation, groceries, and other basic living expenses. Any living expenses not covered by the GHEFP grant will be covered by the project. The project will cover the student’s airfare to and from Kenya, if appropriate, and all required vaccinations and health visits separately from the GHEFP stipend.