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Nagata J.M.,University of Oxford | Nagata J.M.,University of California at San Francisco | Magerenge R.O.,Organic Response | Young S.L.,Cornell University | And 3 more authors.
AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV | Year: 2012

Food insecurity is a considerable challenge in sub-Saharan Africa, disproportionately affecting persons living with HIV/AIDS. This study investigates the lived experience, determinants, and consequences of food insecurity and hunger among individuals living with HIV/AIDS on the shore of Lake Victoria in Suba District, Kenya. Parallel mixed methods included semi-structured interviews and administration of the Household Food Insecurity Access Scale among a systematic sample of 67 persons living with HIV/AIDS (49 of whom were receiving antiretroviral therapy [ART]). All respondents were either severely (79.1%) or moderately (20.9%) food insecure; no respondents were mildly food insecure or food secure. Qualitative data and simple and multiple linear regression models indicated that significant determinants of food insecurity include increased age, a greater number of children, and not being married. A number of themes related to food insecurity and ART emerged, including: (1) an increase in hunger or appetite since initiating ART; (2) exacerbation of ART-related side effects; and (3) non-adherence to ART due to hunger, food insecurity, or agricultural work responsibilities. HIV interventions should address food insecurity and hunger, particularly among at-risk populations, to promote ART adherence and better health outcomes. © 2012 Copyright Taylor and Francis Group, LLC.


Hickey M.D.,University of California at San Francisco | Hickey M.D.,Organic Response | Salmen C.R.,University of California at San Francisco | Salmen C.R.,Organic Response | And 16 more authors.
Journal of Acquired Immune Deficiency Syndromes | Year: 2014

Antiretroviral hair levels objectively quantify drug exposure over time and predict virologic responses. We assessed the acceptability and feasibility of collecting small hair samples in a rural Kenyan cohort. Ninety-five percentage of participants (354/373) donated hair. Although median self-reported adherence was 100% (interquartile range, 96%-100%), a wide range of hair concentrations likely indicates overestimation of self-reported adherence and the advantages of a pharmacologic adherence measure. Higher nevirapine hair concentrations observed in women and older adults require further study to unravel behavioral versus pharmacokinetic contributors. In resource-limited settings, hair antiretroviral levels may serve as a low-cost quantitative biomarker of adherence. Copyright © 2014 by Lippincott Williams & Wilkins.


PubMed | University of Minnesota, Microclinic International MCI, Organic Response, Kenya Medical Research Institute and 4 more.
Type: | Journal: Social science & medicine (1982) | Year: 2015

In sub-Saharan Africa, failure to initiate and sustain HIV treatment contributes to significant health, psychosocial, and economic impacts that burden not only infected individuals but diverse members of their social networks. Yet, due to intense stigma, the responsibility for managing lifelong HIV treatment rests solely, and often secretly, with infected individuals. We introduce the concept of HIV risk induction to suggest that social networks of infected individuals share a vested interest in improving long-term engagement with HIV care, and may represent an underutilized resource for improving HIV/AIDS outcomes within high prevalence populations.In 2012, we implemented a microclinic intervention to promote social network engagement in HIV/AIDS care and treatment. A microclinic is a therapy management collective comprised of a small group of neighbors, relatives, and friends who are trained as a team to provide psychosocial and adherence support for HIV-infected members. Our study population included 369 patients on ART and members of their social networks on Mfangano Island, Kenya, where HIV prevalence approaches 30%. Here we report qualitative data from 18 focus group discussions conducted with microclinic participants (n = 82), community health workers (n = 40), and local program staff (n = 39).Participants reported widespread acceptability and enthusiasm for the microclinic intervention. Responses highlight four overlapping community transformations regarding HIV care and treatment, namely (1) enhanced HIV treatment literacy (2) reduction in HIV stigma, (3) improved atmosphere for HIV status disclosure and (4) improved material and psychosocial support for HIV-infected patients. Despite challenges, participants describe an emerging sense of collective responsibility for treatment among HIV-infected and HIV-uninfected members of social networks.The lived experiences and community transformations highlighted by participants enrolled in this social network intervention in Western Kenya suggest opportunities to reframe the continuum of HIV care from a secretive individual journey into a network-oriented cycle of engagement.


PubMed | Organic Response, Kenya Medical Research Institute and University of California at San Francisco
Type: Journal Article | Journal: AIDS care | Year: 2016

HIV treatment is life-long, yet many patients travel or migrate for their livelihoods, risking treatment interruption. We examine timely reengagement in care among patients who transferred-out or were lost-to-follow-up (LTFU) from a rural HIV facility. We conducted a cohort study among 369 adult patients on antiretroviral therapy between November 2011 and November 2013 on Mfangano Island, Kenya. Patients who transferred or were LTFU (i.e., missed a scheduled appointment by 90 days) were traced to determine if they reengaged or accessed care at another clinic. We report cumulative incidence and time to reengagement using Cox proportional hazards models adjusted for patient demographic and clinical characteristics. Among 369 patients at the clinic, 23(6%) requested an official transfer and 78(21%) were LTFU. Among official transfers, cumulative incidence of linkage to their destination facility was 91% at three months (95%CI (confidence intervals) 69-98%). Among LTFU, cumulative incidence of reengagement in care at the original or a new clinic was 14% at three months (95%CI 7-23%) and 60% at six months (95%CI 48-69%). In the adjusted Cox model, patients who left with an official transfer reengaged in care six times faster than those who did not (adjusted hazard ratio 6.2, 95%CI 3.4-11.0). Patients who left an island-based HIV clinic in Kenya with an official transfer letter reengaged in care faster than those who were LTFU, although many in both groups had treatment gaps long enough to risk viral rebound. Better coordination of transfers between clinics, such as assisting patients with navigating the process or improving inter-clinic communication surrounding transfers, may reduce delays in treatment during transfer and improve overall clinical outcomes.


Patent
Organic Response | Date: 2011-04-21

The present invention provides apparatus and methods for controlling the illumination throughout an area where even and constant lighting is not required. The invention includes one or more light sources, such as luminaires, the status of which is controlled by a controller responsive to a sensor for detecting a parameter of interest. Preferably the sensor detects motion of a subject moving through the area of controlled illumination. Each independent controller may receive and transmit signals indicative of the status of one or more nearby light source for determining and controlling the lighting status of the light source with which it is in controlling communication. The determining by the controller is preferably carried out by a programmed microprocessor. The communication between controllers may be wireless. The signals communicated among controllers may be hierarchical for determining whether a response is required and what the response might be.


Patent
Organic Response | Date: 2013-08-13

A lighting control apparatus for controlling one or more light sources, the lighting control apparatus including: at least one sensor for detecting or sensing a parameter of interest; a transmitter for transmitting one or more wireless signals to one or more other lighting control apparatuses; a receiver for receiving one or more wireless signals from one or more other lighting control apparatuses; and a controller having at least one processor and a memory in communication with the processor to store configuration data representing one or more processes to be executed by the processor; wherein the stored configuration data represents one or more processes that, when executed by the processor, causes the processor to: receive, via the receiver, configuration update data representing one or more further processes to be executed by the processor; and modify the stored configuration data to represent the one or more further processes to be executed by the processor.


Patent
Organic Response | Date: 2013-10-24

A device or system, including: a control component and a controlled non-lighting component, wherein the control component is operatively coupled to the controlled component to control the operation thereof; wherein the control component includes: (i) a wireless receiver for receiving wireless signals representing occupancy data indicative of real-time occupancies of locations and respective distances to said locations; (ii) a control interface to output at least one control signal or power to the controlled component; and (iii) a controller configured to process said occupancy data to selectively output the control signal or to control the supply of power to the controlled component in order to control the controlled component on the basis of said occupancy data.

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