Acceptability, barriers and facilitators to integrating menopausal syndrome screening at Kenyatta National Hospital

Kenyatta National Hospital, Nairobi

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Abstract

Kenya has a high burden of generalized HIV with women disproportionately affected. The use of highly active antiretroviral therapy (HAART) has improved survival of people living with HIV, with more women living with HIV (WLHIV) transitioning into menopause. Menopause, diagnosed retrospectively following cessation of menstrual period for twelve consecutive months, is associated with mild to debilitating symptoms; reduced adherence to HAART and high risk of cardiovascular diseases, obesity and diabetes. It results in reduced health related quality of life, productivity, physical activity, and higher cost of healthcare. Kenya has no program to screen and provide menopause care to WLHIV transitioning into menopause. The proposed study aims to determine acceptability, barriers and facilitators of the integration of menopausal syndrome screening among women receiving HIV care, and complement the training and capacity building activities currently underway as part of the NIH D43 (INTEGRATE (NIH TW009580) at Kenyatta National Hospital. Specifically, the proposed study will provide an opportunity for research training and mentorship for Dr. James Amenge, a Gynecologist at Kenyatta National Hospital (KNH), and provide preliminary data for his K43 application. In aim 1, we will use the six-item Menopause Question (MQ6) and the Menopause Rating Scale (MRS) to screen and score the severity of menopausal symptoms among WLHIV ages >35 years. In am 2, we will use mixed methods to identify barriers and facilitators to integration of menopause screening; and through a stakeholder led process develop a primary health menopausal care package that includes screening and management of non-severe menopausal symptoms in aim 3. This is one of the first studies aimed at integrating menopause screening and management in HIV care in Kenya. An integrated screening and management will enable prompt identification, and management of menopausal syndrome with resultant improved quality of life, enhanced productivity and a dignified healthy transition.