Chronic kidney disease (CKD) is a leading cause of morbidity and mortality globally. The risk of CKD is increased in people of African ancestry and with Human Immunodeficiency Virus (HIV) infection.
...We conducted a cross-sectional study investigating the relationship between region of ancestry (East, Central, South or West Africa) and kidney disease in people of sub-Saharan African ancestry with HIV in the UK between May 2018 and February 2020. The primary outcome was renal impairment (estimated glomerular filtration rate eGFR of <60 mL/min/1.73 m2). Secondary outcomes were stage 5 CKD (eGFR <15 ml/min/1.73 m2, on dialysis for over 3 months or who had received a kidney transplant), proteinuria (urine protein/creatinine ratio >50 mg/mmol), and biopsy-confirmed HIV-associated nephropathy (HIVAN), focal segmental glomerulosclerosis (FSGS) or arterionephrosclerosis. Multivariable robust Poisson regression estimated the effect of region of African ancestry on kidney disease outcomes.
Of the 2468 participants (mean age 48.1 SD 9.8 years, 62% female), 193 had renal impairment, 87 stage 5 CKD, 126 proteinuria, and 43 HIVAN/FSGS or arterionephrosclerosis. After adjusting for demographic characteristics, HIV and several CKD risk factors and with East African ancestry as referent, West African ancestry was associated with renal impairment (prevalence ratio PR 2.06 95% CI 1.40–3.04) and stage 5 CKD (PR 2.23 1.23–4.04), but not with proteinuria (PR 1.27 0.78–2.05). West African ancestry (as compared to East/South African ancestry) was also strongly associated with a diagnosis of HIVAN/FSGS or arterionephrosclerosis on kidney biopsy (PR 6.44 2.42–17.14).
Our results indicate that people of West African ancestry with HIV are at increased risk of kidney disease. Although we cannot rule out the possibility of residual confounding, geographical region of origin appears to be a strong independent risk factor for CKD as the association did not appear to be explained by several demographic, HIV or renal risk factors.
This study was supported by the Medical Research Council (UK) Confidence in Concept scheme (MC_PC_17164). The project has been supported in part the National Institutes of Health and the National Cancer Institute Intramural Research Program (CAW) and under contract HHSN26120080001E.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Introduction: Many marginalised, vulnerable people in Europe who are most in need of healthcare, such as migrants, sex workers, the homeless, people who inject drugs (PWID), prisoners, or LGTBI ...people, are amongst the least likely to receive it. This is owing to a complex mix of administrative and structural barriers, and often a lack of understanding or unintentional discriminatory practices by service providers. Innovative policy responses and a rethink of health service design, informed by the groups affected, are needed to address these inherent inequities. Policy context and objective: Sustainable Development Goal target 3.8 emphasises universal access to quality health services. Despite being at elevated risk of poor health, marginalised groups are underserved by health systems. Their exclusion from health service planning results in a misalignment between the service design and the users’ fundamental needs, which limits their uptake and effectiveness. The Nobody Left Behind (NLO) Platform provides a forum for community organisations to collaborate at European level to identify common challenges and solutions to improve access to integrated health and social services. The NLO Platform has developed a Service re-Design Checklist intended for use by health service providers and policymakers to design and deliver targeted services that are accessible to all, particularly underserved, vulnerable people, and for advocacy use by community representatives. Targeted groups: Migrant, homeless, PWID, sex worker, prisoner and LGTBI communities Highlights: The NLO Checklist resulted from project meetings, research and a policy incubation workshop at the European Health Forum, Gastein (2017). It provides a structured series of questions which service providers and policymakers should consider to ensure that health services are accessibie to target groups and to foster engagement with community representatives. Following the World Health Organization Health Systems Framework, the NLO Checklist comprises six sections. A). Service delivery (aiming to design and deliver an easily accessible service that meets the needs of target communities, considering design-stage issues, the range of integrated or linked services provided, accessibility and adaptation measures, and peer support. B) Health workforce (to prevent and address discrimination and ensure the workforce is enabled to deliver the service through education and training). C. Health information systems (to ensure the service is used and meets users’ needs). D. Medical products and technologies (to ensure that all service users have equitable access to care. E). Financing (to ensure the service is adequately sustainably resourced) and F). Leadership and governance (to ensure that community representatives are involved in the governance of a well-organised service). The Checklist is supplmented by an Implementation Guide. NLO Platform members are using the Checklist in ongoing projects. Conclusion: Marginalised groups are often described as ‘hard to reach’ whereas, from the perspective of users, it is frequently the services that are hard to reach. The NLO Platform is a unique collaboration between underserved communities facing common and inter-related healthcare access challenges. The NLO Checklist is a practical tool useful at the policy and local implementation levels to improve access to integrated services, in alignment with the SDGs and universal health equity principles.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Background
People living with human immunodeficiency virus (HIV) are disproportionately impacted by socioeconomic deprivation and are at increased risk of developing other long‐term conditions ...(LTCs). These illnesses require transformative action to tackle the adverse effects on their health. Data on lived experiences of LTCs among people living with HIV of Black African and Black Caribbean ethnicities are sparse, and how people with LTCs are impacted by social determinants of health (SDoH).
Methods
Through a phenomenological study design this qualitative study, conducted in 2022, comprised four focus group discussions (FGDs) with 20 people of Black ethnicities living with HIV were purposively invited from a community organisation (CO) in London, including four semistructured interviews with CO staff. Following transcription, qualitative data were analysed thematically and measures to validate the findings were implemented.
Results
The findings are presented in terms of the following four levels of SDoH: (1) individual determinants (such as the impact of SDoH on lifestyle modification and self‐management); (2) interpersonal determinants (such as positive experiences of accessing healthcare for LTCs); (3) clinical determinants (such as care pathway barriers) and (4) systemic determinants (such as systemic barriers related to race/ethnicity).
Conclusions
It is necessary to provide ongoing and interactive education to community members who live with HIV, focusing on risks and management of LTCs. Additionally, individuals would benefit from support to navigate increasingly complex and fragmented health services. Health Service staff require cultural competence when caring for patients of Black African and Black Caribbean ethnicities with complex health and psychosocial needs.
Patient or Public Contribution
The research team collaborated with an HIV CO in South London from the very start of the project to agree the study design and learn about the realities of their daily lived experiences. Community collaborators helped to develop the semistructured interview and FGD topic guides, and were directly involved in the data gathering, analysis and validation.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK, VSZLJ
BackgroundMarginalised communities such as homeless people, people who use drugs (PWUD), lesbian, gay, bisexual, transgender and intersex people (LGBTI), prisoners, sex workers and undocumented ...migrants are at high risk of poor health and yet face substantial barriers in accessing health and support services. The Nobody Left Outside (NLO) Service Design Checklist aims to promote a collaborative, evidence-based approach to service design and monitoring based on equity, non-discrimination and community engagement.MethodsThe Checklist was a collaborative project involving nine community advocacy organisations, with a focus on homeless people, PWUD, LGBTI people, prisoners, sex workers, and undocumented migrants. The Checklist was devised via a literature review; two NLO platform meetings; a multistakeholder policy workshop and an associated published concept paper; two conference presentations; and stakeholder consultation via a European Commission-led Thematic Network (including webinar).ResultsThe NLO Checklist has six sections in line with the WHO Health Systems Framework. These are: (1) service delivery, comprising design stage (6 items), services provided (2 items), accessibility and adaptation (16 items), peer support (2 items); (2) health workforce (12 items); (3) health information systems (7 items); (4) medical products and technologies (1 item); (5) financing (3 items); and (6) leadership and governance (7 items). It promotes the implementation of integrated (colocated or linked) healthcare services that are community based and people centred. These should provide a continuum of needs-based health promotion, disease prevention, diagnosis, treatment and management, together with housing, legal and social support services, in alignment with the goals of universal health coverage and the WHO frameworks on integrated, people-centred healthcare.ConclusionsThe Checklist is offered as a practical tool to help overcome inequalities in access to health and support services. Policymakers, public health bodies, healthcare authorities, practitioner bodies, peer support workers and non-governmental organisations can use it when developing, updating or monitoring services for target groups. It may also assist civil society in wider advocacy efforts to improve access for underserved communities.
A degree of calm had returned to Kenya but tensions were still high in the countryside and the country's productive heartland, the Rift Valley. By mid-February, it appeared that through ...Secretary-General of the United Nations Kofi Annan's diplomatic skills, a political solution had been found. Following discussions between Annan and teams from the government as well as the opposition, the two sides, Raila Odinga's ODM and Mwai Kibaki's PNU had agreed to a "comprehensive review" of all aspects of the 2007 presidential elections. The 10-point deal will also include rewriting the constitution within one year and reforms of the electoral law. Now that a measure of stability has returned to Kenya, the business community is counting the cost of the 'period of madness' and wonders how long it will take to return Kenya to economic equilibrium. Early in February, while the country's political leadership dithered and stood impotently on the side lines, Kenya's business leaders went into action.
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CEKLJ, IZUM, KILJ, NUK, PILJ, SAZU, UL, UM, UPUK
Background and Aims: There is a high prevalence of noncommunicable diseases (NCDs), low knowledge of the risk factors, a weak surveillance system, and no known tool for patient self-risk assessment ...in resource-limited settings. The study assessed the contribution of a novel tool for the improvement of the knowledge level of NCD risk factors. Methodology: This intervention study in a primary health-care facility in Kenya involved 1595 people living with HIV (PLHIV) aged 18–69 years. The study developed a tool based on NCD risk factors and used it as educational material. Baseline data were collected using the World Health Organization step-wise approach to surveillance. Results: The median age in years (interquartile range) was 41 (25–50), and females were 65.9%. The ability to conduct self-risk assessment rose from 2.1% to 57.1% after education. Knowledge of risk factors had a mean score of 0.9 and 0.3 for hypertension and diabetes, respectively, before education. Scores increased to 4.4 and 4.3, respectively, after the intervention. There was a significant difference in the means with a P = 0.00 after education. Conclusion: PLHIV in Kenya lacks knowledge of self-risk assessment and risk factors. The tool can improve knowledge of NCD risk factors. The integration of this tool into the routine HIV standard package of care is crucial as part of surveillance in preventing and controlling NCDs.
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