Updated on Dec 8, 2023 | AIGH
Peer navigators play an integral role in the care provided to adolescents at the AMPATH Rafiki Clinic. The peer navigators at the MTRH-Rafiki Centre for Excellence in Adolescent Health serve more than 800 adolescents who have shared lived experiences, such as living with HIV, experiencing pregnancy during adolescence, and/or being street-connected.
Peer navigators create a sense of community in the clinic, a space without judgment where adolescents can interact and receive care without the burden of stigma. They connect adolescents to appropriate care services, improving engagement in care and subsequent care outcomes.
When the Rafiki Center Peer Navigator program first began in 2016, it consisted of only two peer navigators, one female and one male. Whitney was the first female peer navigator at Rafiki, and Ashley Chory, Senior Program Manager for Global Adolescent Health at the Arnhold Institute. Whitney served as a peer mentor at the Rafiki Center for three years, then transitioned to the role of study peer/peer researcher, working to help engage adolescents in research, especially those who may be harder to reach.
Ashley Chory
In this interview, Whitney discusses the impact that being a peer navigator has had on her life, HIV-related stigma and how it affects the peer navigator role, and the opportunities that working at the Rafiki Center has brought her. Whitney suggests possible improvements for the peer navigator program, such as integrating the program into the clinic more seamlessly, reducing provider stigma, and how to better support peer navigators employed at Rafiki.
What is a Peer Navigator?
A peer navigator is a young woman or man who helps a young person in care navigate the care system. Every time they have challenges, we are there for them and basically support them through the experience, because we speak the same language. Peer navigators are the bridge between adolescents and the clinic system and school, and with their parents.
Tell me about what a peer navigator does and your role at Rafiki and AMPATH as a young person.
Peer navigators worked at module 4 [the pediatric unit at Moi University Hospital] before the adolescent clinic was open. Module 4 is now a clinic for children from birth to 15 years old, before they are disclosed [made aware of their HIV status]. They transition to Module 4 after testing positive [for HIV] at the mother-child clinic. When I worked at module 4, it served those up to 24 years old (before the Rafiki center). I was one of the first peer mentors for adolescents at AMPATH.
My responsibilities as a peer navigator include giving group health talks to adolescents related to HIV management, facilitating group pre-test HIV education and psychosocial support, co-facilitating support groups, and providing one-on-one peer education to adolescent clients and their partners. I conduct tracing of priority adolescent clients who have not shown up to an appointment, refer adolescent clients to other services within the health facility, and encourage partner involvement in maternal child health and family planning services.
[At the Rafiki Center] the first person an adolescent meets is the peer. We talk about school, home. In the beginning of the program, counseling was not a choice, it was a part of engagement in the clinic. Now, you must have an issue before you join counseling, which is a barrier to receiving mental health care due to stigma and logistical barriers. We must create a safe space and guide the adolescents to counseling, referring them to care while maintaining confidentiality.
How long have you been a peer navigator at Rafiki/AMPATH?
I was a peer mentor for three year, and then transitioned to a study peer. Study peers help reach adolescents who may be interested or eligible to participate in research but may be harder to reach. Study peers follow the participant from care through to enrollment and participation in the study, and they help adolescents feel safe in sharing information.
How has being a peer navigator changed your life?
Being a peer navigator helped me accept myself, and gave me confidence to do things I didn’t think I could do. It also provided me with a platform where I can meet and interact with other peers. I learned a lot about peer mentoring, beyond the program for adolescents. The program helped me transition from peer mentor, to study peer, to the current day where I am going back to school to get a diploma in counseling. Peer mentoring is not the end goal, it is a stepping stone on my career path.
I don’t think I would have had the same opportunities if I wasn’t a peer—I have attended conferences, symposiums, have talked and presented for the county Ministry of Health, and have learned from many leaders in adolescent health. Every day I am motivated that there is more coming, and I will have new ideas and come back and share them.
What motivates you as a peer navigator?
How I am able to talk to an adolescent—I admit them, they look bad, they have no [medication] adherence, and I go through the whole process with them until I see that they are well and healthy and they are talking a lot. I oversee their care from day one of their hospital admission to their discharge, to their care at the clinic and good medication adherence. And then I can rest at night knowing I just changed my patient’s perspective on life. There are so many adolescents who come in and are doing so badly—I work with them and then they are better. I am also motivated by how my fellow peers treat me like their role model. They look up to me for advice, and I am always available for them to reach, unlike some nurses and doctors
How did being a peer mentor help you accept yourself?
Before, I didn’t see a role model for young people living with HIV. Peers can help. When I was younger, I did not have anyone who was living with HIV (and was not ashamed of it) for me to look up to. Previously I was too shy to talk about anything, about my story, and peers help normalize this life experience. I am no longer sad or crying, but laughing. It helped me with my self-worth. Now when I look in the mirror, there is nobody that can tell me anything about myself. I get sentimental watching other adolescents go through this.
What opportunities do you see for expansion of the clinic’s services?
The clinic needs more activities beyond clinical care. The way the country is going, adolescents are suffering to get jobs and to fit in. There are youth who have support from their parents, and others who do not. The clinic is a good setting to provide training that helps.
Adolescents sometimes forget what their purpose is in life. Peers can intervene to help adolescents figure out their goals, and use the clinic to push toward their goals. Peers need help transitioning into other things—skill building, and finding other opportunities. They need to be told to go back to school, so that they can be a model for younger adolescents. We should add other classes (they have planting now), to build skills. Adolescents don’t always know what classes are available to them. The classes should be tailored to ensure each and every adolescent belongs to a group and visits the Rafiki center during school breaks so they can learn when they have time.
Peer navigators should be more integrated into the clinic. Providers can be dismissive of peer navigators, which makes it hard to work together, despite the fact that they are all there for the same reason: adolescents. The Rafiki center has providers who are cool—they sometimes wear jeans—you think you are just at home.
There are many peer navigators now, maybe we can have a training where we get all of the peers from the different counties together in Eldoret, once a year. To network, learn from others, dance, etc. People can then go and actualize the ideas in their clinics. “Aging as a peer navigator” is a possible topic for exploration.
What is one thing that you wish people knew about the role of youth peer navigators?
Being a peer navigator does not exclude you from stigma—I am glad I can be a peer navigator because I can correct things that happen in the health care setting that are stigmatizing. We can air out some of the differences and problems that we see, and make it better for the younger kids. As one of the first peer navigators, I did not have an example or mentor for me to look up to. It took a lot of guts and self-talk to do it. Something you need to carry yourself, and do wholeheartedly—it is a calling, it is not a job.
Regarding stigma—We work with nurses, doctors, and outreach workers and sometimes they can be stigmatizing. If you ask a question, they may respond dismissively because of one’s HIV status. They are supposed to help you. They are the same people who tell clients that some employees are living with HIV—outing people, creating confidentiality issues between patients and providers. Peer navigators still feel the stigma, but you have to talk yourself out of it, because you are someone’s role model.
When peer navigators first began working at the Rafiki center, there was a question about whether they should be paid, or not, stipend or not. Getting a small stipend motivated me to be able to study, support my family. I still think they should provide more financial support. They are not just adolescents here to do this and that.
What is your favorite thing about working as a peer navigator?
Seeing a smile on a parent’s face. There were times when parents came to me to see what was happening with their child. That smile, after you’ve sorted out the adolescents—like checking in on a pregnancy scare, etc.—it is fine, they are all fine. Making the caregiver happy, it gives me happiness.
Looking back at how the peer navigator program has expanded makes me so happy. It used to be much smaller, there were just two of us, but now there are many, for all of the different kinds of needs. It has grown so much and that makes me so happy. I’m happy that the peer navigator program is a success. And all that we’ve been able to do in such a short time—getting adolescents [virally] suppressed, getting adolescents who were lost to follow up to come back to clinic, and adolescents joining the many psychosocial groups. My favorite thing is handing over the job and mentoring younger up-and-coming peer navigators at the clinic.
Outside of being a peer navigator what are you doing (such as school/education, working, parenting, looking for work)?
I transitioned to the research department working as a peer researcher. [Whitney has worked as a peer mentor on several studies, focused on addressing HIV stigma in the classroom, developing educational strategies to combat HIV stigma, assessing the impacts of the pandemic on Youth Living with HIV (YLWH), and examining stakeholder perspectives on reducing stigma in Kenya.] I’ve just received a diploma in psychological counseling. My goal in life is to start a clinic for mental health counseling for young people. I am also a commercial model, and a content creator. And I am an excellent makeup artist.
What are some words that best describe you?
Down to earth, outgoing, bubbly, jolly.
What do you want the world to know about young people and young people in Kenya?
Young people are special. They need to be understood, and given opportunities, as many as they want. They are in the midst of dealing with puberty, relationships, mental health struggles, and discovering themselves. They need nurturing, support and love from the people around them in order to make them better people. School, home, and clinic should all come together to support adolescents and support their goals. At the clinic, we are trying our best to support them—the school and their parents should do the same.
If you had three wishes, what would they be?
I wish there were no sicknesses in this world. I wish for many more wishes, so that I can cure the world.
Ashley Chory, MPH, is Senior Program Manager, Global Adolescent Health for the Kenya partnership at the Arnhold Institute for Global Health and for the Department of Global Health and Health System Design.
Ava Boal is an Associate Researcher.
Oct 23, 2023 | AIGH
I arrived in Eldoret, “The City of Champions,” at the beginning of September 2023 to embark on a three-month research elective within the Academic Model Providing Access to Healthcare (AMPATH). As a fourth-year MD/MPH dual-degree student at the Icahn School of Medicine at Mount Sinai, I hoped this project would serve as a culmination of my previous coursework in global health, research methods, and preventive medicine, as well as a preview into what my future career could look like, which I hoped would include a strong research component to inform my clinical and public health responsibilities.
Kevin Griffee (he/him) is a Class of 2024 MD/MPH candidate at the Icahn School of Medicine at Mount Sinai
I first became interested in research and global health in college, where I worked on a wide range of projects, including those aimed at improving perinatal health among underserved patients in Washington, D.C.; preventing the spread of Lassa fever in Benin and Togo; and understanding the central auditory deficits associated with HIV infection in Dar es Salaam, Tanzania. I ultimately received a Certificate in Global Health upon graduating, along with a major in neuroscience and minors in biology and Chinese.
Following my medical school matriculation, I became increasingly interested in HIV. The COVID-19 pandemic served as a striking reminder that a parallel viral epidemic, more than four decades old, was continuing to infect more than one million people annually, including almost 500,000 young people. I wanted to understand exactly why this virus has persisted, despite the availability of antiretroviral therapy (ART) to prevent transmission and pre-exposure prophylaxis (PrEP) to prevent acquisition. The optimist in me even hoped we could make HIV obsolete in a generation, provided we maximize every tool in our HIV care and prevention toolbox.
One way to do this is through improving ART adherence. Adherence among youth populations tends to be lower than among other age demographics, which increases the risk for viral failure, drug resistance, and secondary HIV transmission. Our team was therefore interested in assessing novel approaches for improving ART adherence in this population, specifically digital health interventions, like mHealth and eHealth. We found mixed but promising evidence supporting the use of these interventions, especially text message-based ones. We hoped our findings would help guide future research and clinical decisions in this relatively nascent area of digitally supported HIV care.
Another HIV tool we have yet to fully maximize is PrEP. When used as prescribed, PrEP can reduce the risk of acquiring HIV by up to 99 percent. Unfortunately, PrEP use is plagued by disparities in access. In Kenya, for example, preliminary studies have suggested youth experience lower rates of PrEP uptake and adherence compared to older adults. The goal of our current study is to understand why this is the case, a particularly critical question given the large burden of HIV among youth in Kenya. By better understanding barriers to PrEP access, we hope to expand PrEP delivery programs in a way that best meets youth needs.
Key to this PrEP project, and other HIV-related projects that preceded it, is the participation of youth. Youth have generously shared their experiences, insights, and in some cases, their blood samples, for the benefit of research and future advances in HIV care. Another project I am working on is critically examining what youth, along with caregivers and subject matter experts, think about this research, and specifically the practice of biobanking for longitudinal clinical studies. We want to ensure that this research is done ethically, and part of this is confirming that the perspectives of youth and other stakeholders are reflected in current biobanking-related policies and procedures.
Together, these research projects address part three of AMPATH’s tripartite mission of care, training, and research. I also hope that the findings from our PrEP study will be used to improve PrEP service delivery at AMPATH-affiliated clinics and will therefore address part one of this mission as well. For part two, the training piece, I have enjoyed working with the incredible peer navigators at the Moi Teaching and Referral Hospital (MTRH) Rafiki Center of Excellence in Adolescent Health.
Members of the adolescent health research team. From left: Kevin Griffee, Ashley Chory, Josephine Aluoch, Eslyne Jepkemboi, Dennis Munyoro, and Tabitha Njoroge.
Peer navigators are members of the community who serve as links between patients and providers, and who offer counseling and other support services for youth living with HIV. Among their many responsibilities, peer navigators work to strengthen care engagement, improve medication adherence, and reduce HIV-related stigma. I have really enjoyed getting to know the peer navigators and helping them refine their project ideas for the Young Leaders Pilot Program, a joint initiative by Mount Sinai, Moi University, and MTRH to accelerate the development of adolescent health programs at Rafiki and AMPATH more generally. I have also enjoyed helping lead a workshop series with the peer navigators covering topics in research and professional development.
Outside of these activities, I have spent my free time in Eldoret engaging in AMPATH-sponsored lectures and discussions, exploring downtown and surrounding areas, sampling the delicious local cuisine, participating in pick-up soccer games, and taking regular Swahili and sewing lessons.
Overall, I feel so privileged to stay in this beautiful place, honored to work with such wonderful mentors and collaborators, and grateful to be so kindly welcomed into this community. I am very much looking forward to the remainder of my time here, strengthening the relationships I forged so far, and continuing to work together to make progress towards equitable, patient-centered access to effective HIV treatment and prevention methods worldwide. I would like to thank AMPATH, Moi University, MTRH, and Mount Sinai’s Arnhold Institute for Global Health for making this experience possible.
Kevin Griffee (he/him) is a Class of 2024 MD/MPH candidate at the Icahn School of Medicine at Mount Sinai
Updated on Sep 26, 2023 | AIGH
Jeb Weisman, PhD
Jeb Weisman, PhD, is Director of Global Health Informatics. He leads the Arnhold Institute for Global Health’s design and informatics initiatives, applying unique methods, tools, technologies, and multidisciplinary and interdisciplinary perspectives to complex global health challenges. His work centers on and supports novel applications of available technologies to address health information challenges and disparities on a global scale.
In this Q&A, he discusses his career journey and what inspired him to work in global health.
Can you tell us a little bit about yourself and your background?
I was born in the Canary Islands but grew up in the New York area. I’m happy to say I’ve lived and worked quite a few places around the world. I hold a doctorate in anthropology and have more than 35 years in health information systems. Though both anthropology and computer systems have been part of my life since the late 1960s, I’ve been an archaeologist, software developer, member of disaster response teams, textbook editor, and university faculty and CIO. I also worked once as a bouncer in Hawaii.
What inspired you to get into your career?
I’ve been inspired by the lives and philosophies of friends, colleagues, and human action through history. I prefer to do things that help people, through which I learn new things, and get to make a tangible difference. And I like to repurpose existing things—objects, ideas, approaches—to address existing needs. Still, I can’t say I’ve followed a career path in the traditional sense or even had a specific career in mind.
I decided at a very young age that I wanted to be an anthropologist, but less as a profession and more as an approach to understanding the world in which I was growing up. At the same time, I had a fascination for technologies that were maturing in the 1960s and 1970s, including computer programming. I learned to apply the ideas and practices embedded in my studies and interests to the occupations that presented themselves. Today I combine all the things I’ve studied and worked at into a useful and flexible skill set that serves the work I do every day.
What do you like most about working at the Institute?
The list is extensive, but here are a few. I like that my work and the work of my colleagues can have a direct and lasting impact on the quality of life of the people with whom we work, as well as the challenge of scaling this work. I like that I work with smart people who truly lead with a desire to make an enduring difference. And I like that working at the Institute forces me constantly to evaluate assumptions, and to adapt theory, knowledge, and skills to the work.
What led you to work in global health and what do you like about it?
I had done international work in disaster preparedness and response technology, archaeology, and cultural and forensic anthropology for a number of years before joining the Institute. So, the transition was fairly organic. All the pieces were in place waiting for the opportunity to present itself. As for why I like it, for the same reasons I like working at the Institute: enduring impact, smart people, scale, and constant challenges to my world view.
Can you tell us more about your research and how it has affected your work?
My work tends toward the applied, though sometimes it is in support of the academic research of others. One of the paths that led me here was translating social science to action. What we now call Translational Social Science (TSS). One of the best examples of TSS, for which I can take no credit, is Social Determinants of Health—which is now pervasive.
Combining TSS with informatics, I’ve developed and taught TSS courses, particularly in the context of digital health interventions. These interventions cover everything from EHRs and telehealth to all the devices we use to monitor our health and well-being. How do they shape us? What aren’t we seeing or misunderstanding when we use them? What are the unintended consequences and how do we think about and anticipate what we don’t yet understand? Social science, information systems and technology, and global health have come together in a way that lets me contribute to the global work that the Institute and Mount Sinai are doing in places such as Guyana and our other global partners, from Nepal to New York City.
What is some advice you would give someone looking to go into informatics?
Informatics is an enormous field with many, many sub-specialties, some very technical, others organizational, and still others process oriented. As you find the facet of informatics that most interests you and matches your skills, connect those skills with your unique life experience. Through this approach you can extend the value of your informatics work to the social, lived world. Hopefully, one result is that you create the basis for change and inspire new ideas and ways of doing things. And don’t worry if your path is not a straight line.
Sep 26, 2023 | AIGH
We are currently in the midst of a global crisis in child and adolescent mental health. The COVID-19 pandemic put a spotlight on the significant barriers youth and their families experience to accessing quality, evidence-based mental health care in all settings, including those that are otherwise considered to be resource-rich. In Kenya, the 2021 National Adolescent Mental Health Survey found that 12.2 percent of Kenyan adolescents (10-17 years) met criteria for a psychiatric disorder. However, of those, only 11.1 percent had accessed any form of support for their mental health concerns in the prior year, in part because of a lack of available services.
Mental health plays a critical role in the development and overall well-being of young people, which is why efforts are being undertaken at the MTRH-Rafiki Center for Excellence in Adolescent Health to improve the availability of mental health services for youth in western Kenya.
Florence Jaguga, MBChB, MMed, and Brittany McCoy, MD, are working together to lead progress towards the mental health-related care, research, and education priorities set out by the AMPATH Adolescent Working Group at the AMPATH Adolescent Summit earlier this year.
Brittany McCoy, MD
Dr. McCoy is the new Adolescent Mental Health Team Lead for AMPATH, a T32 Postdoctoral Research Fellow in Psychiatry, and an Instructor in the Departments of Psychiatry, and Global Health and Health System Design at the Icahn School of Medicine at Mount Sinai. She is a recent graduate of the Mount Sinai Triple Board Residency Program, where she trained in general pediatrics, general psychiatry, and child and adolescent psychiatry, and completed the requirements of both the pediatrics global health and global mental health residency tracks.
Dr. McCoy has a long history of engagement with AMPATH Kenya, starting in 2016 when she served for a year as the Indiana University School of Medicine Pediatric Global Health Research Scholar working with Rachel Vreeman, MD, MS. She has completed AMPATH clinical rotations at MTRH and continued to work with Dr. Vreeman and her team on research projects related to the mental health of youth living with HIV throughout her subsequent medical education and residency training.
More recently, she completed a study funded by an Pediatric Research Scholars Award at Icahn Mount Sinai to adapt a battery of mental health measures culturally and developmentally for Kenyan youth living with HIV. In her new position at AMPATH, Dr. McCoy hopes to use the unique skillset she has gained as a “Triple Boarder” to inform research, care, and education initiatives aimed at increasing adolescents’ access to evidence-based, culturally and developmentally appropriate mental health services in western Kenya.
Dr. Jaguga is a psychiatrist at MTRH and Head of the Alcohol and Drug Abuse Rehabilitation Services. She is co-chair of the AMPATH Adolescent Health Working Group. Dr. Jaguga has conducted research projects to evaluate the feasibility of a peer-led substance use screening and brief intervention program for youth at Rafiki. Her research findings support the feasibility of this program.
Florence Jaguga, MBChB, MMed
Dr. Jaguga has worked to integrate mental health and substance use screening for youth into the AMPATH electronic medical records system. The tools included in the screening are the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) scale, and the Substance Use Screening to Brief Intervention (S2BI) tool.
Next steps include training peer counselors to conduct screening for mental health using the tools. Youth screening positive will be referred to the psychologist that is currently stationed at Rafiki Clinic. Rafiki now also runs a weekly mental health clinic led by an MTRH psychiatrist, and youths who screen positive for a mental health concern will also be referred to this weekly clinic.
Over the coming months, Dr. Jaguga and Dr. McCoy will work together with others in the adolescent health and mental health initiatives at AMPATH to continue to grow the mental health services offered by the Rafiki Center and support adolescents’ mental health.
