Cyrus Mugo

I am a Physician-Epidemiologist with 11-years experience in Pediatric and Adolescent HIV research and programming. My background training is in Medicine (MBChB), Global Health (MPH), Epidemiology (PhD) and Implementation Science (Postdoctoral fellowship). My affiliations are with Kenyatta National Hospital and University of Washington. I am a member of the National Adolescent Technical Working Group at Kenya's National AIDS/STI Control Program, and the US National Institutes of Health's Adolescent HIV Implementation Science Alliance (AHISA).

PROFESSIONAL COMPETENCIES

• Setting research priorities for Kenyatta National Hospital
• Designing clinical, epidemiological, implementation science and operational research projects and implementation of the studies in low and middle income countries
• Evaluation of health programs in low and middle income countries
• Stakeholder management and analysis to ensure equity in contribution, ownership of projects and adoption of sustainable products
• Health system strengthening and quality improvement of service delivery including application of continuous quality improvement, process mapping, and failure mode and effect analysis
• Analysis of complex data – including longitudinal program data from low resource settings (using R and STATA programs).

RESEARCH EXPERIENCE

A: 2010-present: Kenyatta National Hospital/University of Nairobi/University of Washington pediatric and adolescent HIV research collaborative group

1. Strengthening HIV testing, linkage to care and treatment for children, adolescents and adults

Effectiveness trials

2010-2016       Optimizing Pediatric HAART (OPH), University of Nairobi and University of Washington (NIH R01 HD023412). Randomized clinical trial to assess the impact of interrupting HIV treatment for children with stable clinical, immunologic and virologic parameters.

                        Role: Study physician – participant enrollment and follow up, in-patient and outpatient care 

2014-2016       Pediatric Urgent Start of HAART (PUSH), University of Nairobi and University of Washington (NIH R01 HD023412). Randomized clinical trial conducted in Kenya assessing impact of early HIV treatment for children (<48 hours versus 1-2 weeks after diagnosis) on mortality and clinical outcomes.

                        Role: Study physician – participant enrollment and follow up, in-patient and outpatient care, and quantitative data analysis. 

Operational/ Implementation Science and hybrid projects

2021-2022       Adolescent HIV viral load monitoring optimization study, Kenyatta National Hospital (IAPAC). Implementation Science study of the pediatric and adolescent HIV viral load monitoring cascade to determine the bottlenecks in the cascade and relevant solutions using the failure mode and effect analysis framework in Nairobi County, Kenya. 

                        Role: Principal Investigator – study design, execution and dissemination, and both quantitative and qualitative data analysis.

2013-2016       HIV-1 Counseling and Testing for Children at Home (CATCH), University of Nairobi and University of Washington (UW Royalty Research Fund A83526 and NIH R21 HD079637). Implementation of index case testing, targeting HIV positive adults in care to reach their children of unknown HIV status. 

                        Role: Study coordinator – involved in the study design, oversaw study execution, data collection and patient care, stakeholder engagement and dissemination, and both quantitative and qualitative data analysis.

2015-2016       Developing Adolescent Strategies for HIV Testing (DASH), Kenyatta National Hospital and University of Washington (NIH supplement to P30, AI027757). Utilizing a continuous quality improvement (CQI) framework to improve HIV testing services at Kenyatta National Hospital HIV prevention unit. 

Role: Study coordinator – involved in the study design, oversaw study execution, data collection and patient care, stakeholder engagement and dissemination, and both quantitative and qualitative data analysis.

2015-2018       Financial Incentives to Increase Prompt Pediatric HIV Testing (FIT) (IAS CIPHER 323-NJU and UW CFAR P30AI027757). Randomized controlled trial assessing impact of financial incentives on completion of pediatric HIV testing by HIV positive caregivers.

Role: Co-investigator – involved in the study design and execution and dissemination, and both quantitative and qualitative data analysis.

2. Treatment support for adolescents and youth living with HIV

Longitudinal epidemiological study

2021-2023       Self-disclosure of HIV status for adolescents and young adults living with HIV in Kenya (ELEZA study), Kenyatta National Hospital (UW/ Fred Hutch Center for AIDS Research Mentored International Investigator Award P30AI027757). Longitudinal study to determine the impact of communication of HIV status to others by adolescents living with HIV in Kenya.

Role: Principal Investigator – study design and execution (ongoing)

Hybrid trials with effectiveness and implementation science components

2015-2020       Simulated Patient Encounters Promote Early Detection and Engagement in HIV Care for Adolescents (SPEED), University of Nairobi and University of Washington (NIH R01HD085807). A hybrid implementation study that developed and is evaluating a training package for frontline health providers on delivery of adolescent friendly services, using standardized patient actors (SPs).

Role: Study coordinator – involved in the study design, oversaw study execution, data collection and patient care, stakeholder engagement and dissemination; I was also the lead trainer on components of the adolescent package of care and motivational interviewing. I was involved in both quantitative and qualitative data analysis.

2017-2020       Adolescent Transition to Adult Care for HIV-infected adolescents in Kenya (ATTACH), University of Nairobi and University of Washington (NIH 1R01HD089850-01). A hybrid implementation study that studied disclosure and transition practices in 102 sites in Kenya, developed tools for pediatric HIV status disclosure and transition to adult care and assessing their effectiveness in a cluster randomized trial in 20 facilities.

Role: Study coordinator – involved in the study design, oversaw study execution, data collection and patient care, stakeholder engagement and dissemination; I was also the lead investigator on execution and data collection for implementation science components including the continuous quality improvement, and documenting changes to intervention delivery. I was involved in both quantitative and qualitative data analysis.

Qualitative studies

2019-2021      HIV-related causes of death among adolescents living with HIV (ELEWA study). University of Nairobi and University of Washington (UW CFAR MIIA). The study seeks to understand the risk factors for death among young people living with HIV in Kenya.

Role: Co-investigator – involved in the study design and execution and dissemination. I was involved in quantitative data analysis.

2022-2024      Optimizing HIV care for non-adherent adolescents enrolled in care (ZINGATIA). Kenyatta National Hospital and University of Washington (UW CFAR NIA AI027757). The study seeks to engage youth and health care workers to better understand non-adherence, existing interventions and implementation and identify gaps in health systems to support YLH adherence.

Role: Co-investigator – involved in the study design and execution and dissemination. I was involved in quantitative data analysis.

Implementation Science study

2022-2023       Sustainability and Scale-Up of an Evidence Based Intervention to Support Adolescent Transition to Independent Care, Kenyatta National Hospital and University of Washington (NIH Fogarty Center, Adolescent HIV Implementation Science Alliance Small Award). An implementation Science study assessing sustainment and fidelity of the adolescent transition package (ATP) and develop plans for ATP intervention scale-up with local, county, and national policy makers.

Role: Co-investigator – involved in the study design and execution and dissemination. I was involved in quantitative data analysis.

3. Community-based HIV testing

Implementation Science project

2018-2019       Youth Engaged Self-Testing (YES) study, Kenyatta National Hospital and University of Washington (UW CFAR NIA AI027757). An implementation study looking at acceptability and feasibility of community approaches for delivering HIV self-testing kits to adolescents and young adults

Role: Co-investigator – involved in the study design and execution and dissemination, and both quantitative and qualitative data analysis.

4. mHealth solutions for delivery of health services and research opportunities to adolescents

Effectiveness trial 

2017-2019       Social Media for Adolescent Retention and Treatment (Vijana SMART), Kenyatta National Hospital and University of Washington (UW CFAR NIA AI027757). Study the utilization of WhatsApp by HIV-infected adolescents and young adults (AYA) for peer-to-peer social and treatment support and develop a structured, facilitated WhatsApp support group with content that can be adapted for diverse populations. 

Role: Study coordinator – involved in the study design, oversaw study execution, data collection, stakeholder engagement and dissemination, and both quantitative and qualitative data analysis.

Observational studies with qualitative data components

2018-2021       M-health Strategies for the Pediatric to Adult HIV Care Transition (MPACT study), Kenyatta National Hospital and University of Washington (NIH R34 MH114834.). Develop an mHealth peer intervention for the preparation of adolescents’ transition to adult HIV care. 

Role: Co-investigator – involved in the study design and execution and dissemination, and qualitative data analysis.

2019-2021       Sauti ya Vijana study: WhatsApp Focus Groups and Respondent-Driven Sampling, Kenyatta National Hospital and University of Washington (UW CFAR NIA AI027757). Evaluate the use of respondent driven sampling to engage hard-to-reach adolescents who may not regularly engage with the health system. 

Role: Co-investigator – involved in the study design and execution and dissemination. I am involved in the ongoing quantitative data analysis of respondent driven sampling data

5. Pediatric neurodevelopment following HIV exposure or HIV infection

Observational study 

2013-2017       Impact of HIV on Neurodevelopment in Kenya (INK), University of Nairobi, Kenya and University of Washington (NIH K01NS080637). An observational study looking at differences in neurodevelopmental outcomes of HIV-infected children, HIV-exposed uninfected and HIV-uninfected children in Kenya.

                        Role: Study physician – participant enrollment and follow up, in-patient and outpatient care

Effectiveness trial

2014-2016       Mediational Intervention for Sensitizing Caregivers in Kenya (MISCK), University of Nairobi, Kenya and Seattle Children’s Hospital, WA, (Seattle children’s hospital). We compared the efficacy of the MISC intervention delivered individually at home versus as a clinic-based group intervention among caregivers of HIV-infected children. Neurodevelopmental outcomes were assessed using the Malawi development assessment tool (MDAT) and Bayley scales of infant development. In this study, I participated in quantitative and qualitative data collection and analysis

Role: Study physician – participant enrollment and follow up, in-patient and outpatient care

6. Mental health research

Implementation Science study

2022-2023       Implementation Strategies For Depression Management For Youth With HIV In Kenya (M-HIS study), University of Washington IMPACT Center. An Implementation Science study to identify implementation strategies for depression assessment in HIV clinics in Kenya.

Role: Principal Investigator – study design and execution (ongoing)

Effectiveness-Implementation study

2023-2028       Psychoeducation, Relaxation, PrOblem solving, Activation, Cognitive coping Therapy’ (PRO-ACT) for Adolescents and Youth in HIV Care, Kenyatta National Hospital and University of Washington (NIH 1R01MH133261). A hybrid 1 cluster randomized trial to assess the effectiveness of a brief psychological intervention among youth with mild-moderate psychological distress in HIV clinics.

Role: Study Director – study design and execution (ongoing)

B: Consultancies 

1. 2017-2019: Washington State University Global Health Program, Kenya and the University of Nairobi

Observational study/Surveillance: Disease surveillance and establishing critical population health impact 

Incidence and Outcomes of Zika virus infection in pregnant women and their newborns in Mombasa County (KenZIK study, U01GH002143-01.), Kenyatta National Hospital, Washington State University, and Centers for Disease Control and Prevention (US-CDC). A large cohort study to investigate numerous exposures in pregnancy, including Zika, Dengue and Chikungunya viruses, HIV, aflatoxin, Toxoplasmosis, Rubella, Cytomegallovirus, Syphilis, and Hepatitis B, and pregnancy and neonatal outcomes in Mombasa

Role: Study coordinator – involved in the study design, led protocol development, oversaw study execution, data collection, stakeholder engagement and dissemination, and both quantitative and qualitative data analysis.

2. 2021-2022: Chemonics International, USA

Observational study: Program evaluation for Differentiated Service Delivery of HIV services (Funding: USAID)

Differentiated Service Delivery Models for People Living With HIV in Nigeria, Chemonics International (Funded by USAID). Analysis of routine patient data, cross-sectional surveys with key persons and prospective studies to determine a) the impact and cost effectiveness of differentiated service delivery models including different antiretroviral therapy dispensing models for people living with HIV and b) the modifiable causes for poor viral suppression among children in Nigeria.

Role: Lead Epidemiology consultant – Led the study design, study protocol and tools development, oversaw study execution, and data collection, and dissemination. I led both quantitative and qualitative data analysis.

3. 2022: University of Washington/ Kenya Medical Research Institute

Implementation Science project: Optimizing nutritional care for HIV exposed children in Kenya (Funding: University of Washington/Fred Hutch Center for AIDS Research New Investigator Award)

Process mapping of services at the Maternal and Child Health clinics to guide quality improvement of nutrition services in Western Kenya

Role: Train investigators and study leads from the study sites in Western Kenya and guide the process mapping in the clinics involved in the project.

4. 2023: University of Washington/ Fred Hutch Center, USA

Addressing the burden of untreated HIV in cancer patients in sub-Saharan Africa: feasibility and planning for a pragmatic clinical trial. (Funder: NIAID- R21 AI155055)

Process mapping of HIV services in cancer centers and cancer diagnosis and referral services in HIV clinics in Uganda, Zimbabwe, South Africa and Malawi

Role: Train investigators and study leads in the 4 countries and guide the process mapping in the clinics involved in the project.

C: 2022-2023 Post-doctoral research

1. University of Washington/ Kenyatta National Hospital: PrEP Adherence Among Adolescent Girls and Young Women: A Multidimensional Evaluation (Funder: NIH 1R01 HD094630-01)

Role: Lead analyses and manuscript writing using AGYW data on post-partum family planning uptake, PrEP adherence measurement using self-report and biomarkers, and contribute to an overview reviewing lifecycle approaches to HIV care.

2. University of Washington/ Kenya Medical Research Institute: Women and HIV (WHIV) and International AIDS Research and Training Program (Funder: NIH FIC D43) 

Role: Develop and submit a career development proposal looking at optimizing the HIV care cascade and integration of HIV and non-communicable diseases; mentor PhD students at the University of Nairobi funded by the NIH Fogarty International Center; develop manuscripts from my PhD dissertation and other post-doctoral research.

CLINICAL PRACTICE

2022-               Medical Specialist II, Kenyatta National Hospital

2014-2018       Senior medical officer, The Nairobi Hospital, Nairobi, Kenya. Emergency and outpatient departments and HIV care clinic

2014-2015       Medical officer, Aga Khan University Hospital, Nairobi, Kenya 

2013-2014       Medical officer, Eldama Ravine Sub-district hospital, Baringo, Kenya. 

2012-2013       Medical officer intern, Rift Valley Provincial General Hospital, Nakuru, Kenya

MENTORSHIP AND TEACHING

2020-present   Tutor at the NIH Fogarty-funded Northern Pacific Global Health Research Fellows Training Consortium (NPGH) Fellowship Quantitative Methods training

2017-present   Ongoing training and mentoring staff from Kenyatta National Hospital and students from University of Nairobi schools of medicine and nursing on research methods and manuscript writing

2023                Mentor for Kenyan Master of Public Health students at the University of Washington and PhD students in Public Health at the University of Nairobi on scholarship from the Fogarty-funded Women and HIV (WHIV), International AIDS Research and Training Program (IARTP) and HIV Care Cascade Program.

2021                Speaker at the NIH Adolescent HIV Implementation Science Alliance event at the International AIDS Society 2021

2021                Speaker at the Implementation Science Fund event at the Fast-track Cities 2021 in Lisbon, Portugal          

2020-2021       Tutor for Master of Public Health students and other scholars (10) at the University of Washington, sponsored by the International AIDS Research and Training Program

2020                Co-chair, University of Nairobi/ University of Washington Center for AIDS Research workshop on ‘Ethics in Adolescent Research’ at the University of Nairobi

2020                Guest lecture on epidemiological methods in the University of Nairobi’s Health-Professional Education Partnership Initiative (HEPI) Kenya manuscript writing workshop.

2020                Panelist on the Responsible Conduct for Research course at the University of Washington discussing my journey and roles in Global Health research

2020                Guest speaker at the Bioethics Society of Kenya Conference to discuss autonomy of adolescents in seeking health care and participating in research

2019                Guest speaker in Global health undergraduate class at the University of Washington to discuss my role in transitioning research products into practice. This was an opportunity to describe how collaborations with front-line providers, communities and policy makers influence success and impact of research. This invitation was extended due to my work in the designing and implementing the CATCH study

2019                Guest panelist at University of Washington's Center for AIDS research (CFAR) adolescent working group. My role in this meeting was to share my experience reaching and working with HIV-infected adolescents, and consenting challenges for adolescents in research

2019                Guest panelist at the Coast region PrEP/ HIV self-testing learning forum. My role was to share my experience and research regarding delivery of HIV self-testing to adolescents and youth

2020-2022       University of Washington, Seattle, United States of America

PhD in Public Health (Epidemiology)

2021-2023       Washington University in St. Louis, United States of America 

Fellow, HIV, Infectious Disease and Global Health Implementation Research Institute (HIGH-IRI) – Implementation Science

2021-2022       NIH Fogarty Global Health Fellowship 

Fellow, Northern Pacific Global Health Research Fellows Training Consortium (NPGH)

2018-2019       University of Washington, Seattle, United States of America

                        Master in Public Health (Global health) 

2018-2022      NIH Fogarty International AIDS Research and Training Program (IARTP)

Scholar, HIV Care Cascade

2006-2011       University of Nairobi, Nairobi, Kenya

Bachelor of Medicine and Surgery (MBChB) 

2005-2006       Starehe Technical Training Institute, Nairobi, Kenya

                        Diploma in Information and Technology