Adam R. Aluisio

Background: Emergency departments (EDs) provide care to higher-risk and underserved populations for HIV services. This study evaluated eligibility and acceptability of same-day HIV pre-exposure prophylaxis (PrEP) initiation among persons seeking emergency care in Nairobi, Kenya. Design: Cross-sectional study. Methods: ED patients were continuously screened at Kenyatta National Hospital (5 July to 18 August 2024). Non-pregnant and non-incarcerated persons aged >18 years were enrolled. Data were collected on socio-demographics, health characteristics and PrEP aspects. PrEP eligibility was based on national guidelines. Acceptability was defined as participants reporting willingness to initiate same-day PrEP, if indicated. Multivariable regression assessed factors associated with acceptability of ED-PrEP initiation, reported as adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results: Among 325 enrolled participants (median age: 31 years), 56.3% were male and 15.3% were from key populations (KPs). PrEP-eligibility was 16.0%, and 74.6% of participants reported willingness to initiate same-day PrEP. For persons from KPs, PrEP eligibility was 28.6%, and acceptability was 73.5%. Correlates of same-day PrEP initiation included having a primary/regular sex partner (aOR=2.26, 95% CI: 1.20–4.24, p=0.01) and multiple sex partners in the past three months (aOR=2.36, 95% CI: 1.29–4.33, p=0.01). Injection was the preferred PrEP formulation (62.5%), with 70.0% preferring a six-month dispensing interval. Conclusion: High PrEP eligibility and acceptability suggest that emergency care settings in Kenya are strategic PrEP programming venues, with potential to expand access to underserved populations. Further research is warranted to inform strategies to implement PrEP in ED settings in Kenya and other similar settings.

Background: Same-day HIV pre-exposure prophylaxis (PrEP) implementation remains challenging, especially in high-volume settings like emergency departments (EDs). To guide program design and implementation efforts, we qualitatively explored anticipated implementation determinants and accompanying strategies facilitating same-day PrEP implementation in an urban Kenyan ED. Methods: In 2024-2025, we conducted a cross-sectional qualitative study involving key informant interviews ( N =20) with physicians, nurses, pharmacists, HIV counselors, and administrators at Kenyatta National Hospital (KNH) in Nairobi, Kenya. Using the Consolidated Framework for Implementation Research (CFIR), we explored theorized determinants of ED-based PrEP implementation and subsequently mapped identified determinants to requisite implementation strategies, articulated in the Expert Recommendations for Implementing Change (ERIC) taxonomy, using a CFIR-ERIC matching approach. Results: The most salient barriers to same-day, ED-based PrEP implementation emerged within the Inner Setting domain, including space limitations, staffing shortages, as well as suboptimal capacity and provider competency to deliver PrEP in emergency care settings. Some providers perceived HIV services and emergency care as incongruous, impeding integration of PrEP into ED-based clinical workflows. Anticipated patient stigma, perceived incompatibility of PrEP services with status-neutral care environments, and opaque clinical/practice guidelines also constrained ED-based PrEP implementation. Identified facilitators included existing leadership involvement in clinical decision-making, existing interdepartmental collaborations, and provider enthusiasm to reach younger persons and key populations with PrEP in the ED. ERIC strategies mapping to all five CFIR domains included: conducting ongoing training , promoting network weaving , and tailoring strategies . Conclusion: Findings indicate strategies like longitudinal training, standardizing screening with integrated systems, and configuration of setting-specific guidelines/protocols may enhance same-day, ED-based PrEP programming.

In Kenya, incident and undiagnosed HIV infections are concentrated among populations who are inadequately reached by existing HIV services. These difficult

BackgroundTraumatic injuries are a leading cause of morbidity and mortality globally and have a disproportionate prevalence in low- and middle-income countries. In Nepal, trauma-related deaths and disability remain high, yet data from rural settings are limited, ultimately limiting local innovation and community centered solutions. Bayalpata Hospital, a provincial facility in rural far-west Nepal, serves a catchment area of approximately 1.7 million people. This study characterizes trauma epidemiology, injury patterns, and predictors of hospital admission among patients presenting with traumatic injury to its emergency department over five years.MethodsWe conducted a retrospective cross-sectional analysis of all emergency department encounters for traumatic injuries at Bayalpata Hospital between July 2018 to July 2023. Patient information was extracted from the hospital electronic health data systems. Descriptive statistics summarized injury patterns, and age-adjusted logistic regression analyses assessed associations between injury mechanisms and admission outcomes.ResultsAmong 26,594 emergency room visits, 10,455 (39.3%) were trauma-related. Falls were the most common mechanism (reported in 73.1% of injuries), followed by cut injuries (11.4%), and animal bites (9.8%). Children (≤18 years) comprised a large proportion of trauma presentations, and male patients predominated across nearly all injury mechanisms. Fractures were documented in 56.1% of fall injuries and 14.7% of cut injuries. Compared with patients presenting with falls, those presenting with cut injuries (adjusted odds ratio [aOR] 0.33; 95% CI 0.19–0.57) and animal bites (aOR 0.39; 95% CI 0.26–0.59) were significantly less likely to require hospital admission.ConclusionThis study demonstrates that traumatic injuries account for a substantial proportion of emergency department visits in rural Nepal, with falls and pediatric trauma particularly prevalent. The patterns identified underscore the need for locally tailored injury prevention efforts and mechanism-specific strategies to improve trauma care and outcomes in similar low-resource rural settings. Facility-level evidence such as this is essential for informing national trauma planning and reducing injury-related morbidity in underserved rural populations.

Original Article Approaches and impacts of digital health in HIV self-testing uptake & use among populations from low- and middle-income countries: a descriptive systematic review and meta-analysis Preston Nicely, Lucille Xiang, Joshua Smith-Sreen, Stephanie C. Garbern, Adam R. Aluisio

In Kenya, persons insufficiently engaged in HIV Testing Services (HTS) are often treated in emergency departments (ED). There are limited data from healthcare workers on ED-HTS. A qualitative study was completed to understand challenges and facilitators for ED-HTS and HIV self-testing (HIVST). Data were collected via six focus groups of healthcare workers. Data were inductively analyzed and mapped to the Capability-Opportunity-Motivation Behavioral Model. Focus groups were completed with 49 healthcare workers: 18 nurses, 15 HIV counselors, 10 physicians and 6 administrators. HTS challenges included staff burdens, resources access, deficiencies in systems integration and illness severity. HTS facilitators included education of healthcare workers and patients, services coordination, and specific follow-up processes. HIVST challenges included accuracy concerns, follow-up barriers and psychosocial risks. HIVST facilitators were patient autonomy and confidentiality, resource utilization and ability to reach higher-risk persons. Mapping to the Capability-Opportunity-Motivation Behavioral Model interventions within the domains of knowledge, decision processes, environmental aspects, social influences and professional identities could support enhanced ED-HTS with integrated HIVST delivery. This study provided insights into challenges and facilitators on ED-HTS and identifies pragmatic approaches to improve healthcare workers' behaviors and abilities to provide services to persons already in contact with healthcare.

Background Persons seeking emergency injury care are often from underserved key populations (KPs) and priority populations (PPs) for HIV programming. While facility-based HIV Testing Services (HTS) in Kenya are effective, emergency department (ED) delivery is limited, despite the potential to reach underserved persons. Methods This quasi-experimental prospective study evaluated implementation of the HIV Enhanced Access Testing in Emergency Departments (HEATED) at Kenyatta National Hospital ED in Nairobi, Kenya. The HEATED program was designed using setting specific data and utilizes resource reorganization, services integration and HIV sensitization to promote ED-HTS. KPs included sex workers, gay men, men who have sex with men, transgender persons and persons who inject drugs. PPs included young persons (18-24 years), victims of interpersonal violence, persons with hazardous alcohol use and those never previously HIV tested. Data were obtained from systems-level records, enrolled injured patient participants and healthcare providers. Systems and patient-level data were collected during a pre-implementation period (6 March - 16 April 2023) and post-implementation (period 1, 1 May - 26 June 2023). Additional, systems-level data were collected during a second post-implementation (period 2, 27 June – 20 August 2023). Evaluation analyses were completed across reach, effectiveness, adoption, implementation and maintenance framework domains. Results All 151 clinical staff were reached through trainings and sensitizations on the HEATED program. Systems-level ED-HTS increased from 16.7% pre-implementation to 23.0% post-implementation periods 1 and 2 (RR=1.31, 95% CI:1.21-1.43; pConclusions The HEATED program increased ED-HTS and augmented delivery to KPs/PPs, suggesting that broader implementation could improve HIV services for underserved persons, already in contact with health systems.