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Acquired Immunodeficiency Syndrome: HELP
Articles from Kenya
Based on 55 articles published since 2008

These are the 55 published articles about Acquired Immunodeficiency Syndrome that originated from Kenya during 2008-2019.
+ Citations + Abstracts
Pages: 1 · 2 · 3
1 Review Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya. 2017

Njoroge, Martin / Zurovac, Dejan / Ogara, Esther A A / Chuma, Jane / Kirigia, Doris. ·Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya. wnjoroge@kemri-wellcome.org. · Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya. · Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK. · Center for Global Health and Development, Boston University School of Public Health, 85 East Concord Street, Boston, MA, 02118, USA. · Ministry of Health, Division of eHealth, Nairobi, Kenya. ·BMC Res Notes · Pubmed #28183341.

ABSTRACT: BACKGROUND: The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. RESULTS: A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. CONCLUSION: This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.

2 Review Defeating AIDS--advancing global health. 2015

Piot, Peter / Abdool Karim, Salim S / Hecht, Robert / Legido-Quigley, Helena / Buse, Kent / Stover, John / Resch, Stephen / Ryckman, Theresa / Møgedal, Sigrun / Dybul, Mark / Goosby, Eric / Watts, Charlotte / Kilonzo, Nduku / McManus, Joanne / Sidibé, Michel / Anonymous4930834. ·London School of Hygiene & Tropical Medicine, London, UK. Electronic address: director@lshtm.ac.uk. · Centre for the AIDS Programme of Research in South Africa, Durban, South Africa. · Results for Development Institute, Washington, DC, USA. · London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. · UNAIDS, Geneva, Switzerland. · Avenir Health, Glastonbury, CT, USA. · Harvard T H Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA. · Norwegian Knowledge Centre for the Health Services, Oslo, Norway. · Global Fund to Fight Aids, Tuberculosis and Malaria, Geneva, Switzerland. · Global Health Sciences, University of California, San Francisco, CA, USA. · London School of Hygiene & Tropical Medicine, London, UK. · National AIDS Control Council, Nairobi, Kenya. · independent, Oxford, UK. ·Lancet · Pubmed #26117719.

ABSTRACT: -- No abstract --

3 Review HIV/AIDS: the first 25 years--a view from Nairobi. 2008

Rees, P H. ·Nairobi Hospital, P.O. Box 30026-00100, Nairobi, Kenya. ·East Afr Med J · Pubmed #18817026.

ABSTRACT: HIV infections are zoonoses occurring in communities that hunt chimpanzees (HIV 1) and sooty mangabeys (HIV 2) in the forests of equatorial and West Africa respectively. Most cross species transmission to man probably fizzles out, but the transmission of HIV 1 type M around 1930 eventually resulted in a pandemic that has spread around the world. HIV 2 types A and B have caused epidemics in West Africa. HIV infections are characterised by three phases (i) an initial, primary infective phase with rising viraemia, asymptomatic and silent, lasting for some 10 weeks, (ii) a long quiescent phase with the viraemia and illness mostly held in check by the immune response and lasting some 10 years in HIV 1 and 20 years or so in HIV 2 and (iii) a terminal third phase lasting some 10 months with rising viraemia, falling CD4 levels and multiple opportunistic infections recognised in a community by the onset of a florid AIDS epidemic. The silent primary epidemic reached Nairobi around 1980, with the florid secondary AIDS epidemic peaking here around 1992 and overwhelming the hospitals and other health services. The introduction of highly active antiretroviral therapy (HAART) has dramatically improved the prognosis for individual patients with AIDS, but it has been education and a changing attitude to condoms that has led to a progressive fall in incidence, so that the worst of the epidemic may now be over. Modifying the immunological response during the quiescent phase with the hope of prolonging this phase indefinitely may be the way forward for those who are already infected. Steroids have been shown to have a possible role here rather than anti-retroviral drugs (ARVs) which are not curative and prone to the development of drug resistance. Limited personal experience suggests that steroids may also have a role in salvaging critically ill AIDS patients, who need to be treated as emergencies. With an educated public and attention to alternative routes of infection such as blood transfusion, the epidemic should be increasingly contained during the next 25 years, and may even fizzle out.

4 Clinical Trial Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. 2014

Grinsztejn, Beatriz / Hosseinipour, Mina C / Ribaudo, Heather J / Swindells, Susan / Eron, Joseph / Chen, Ying Q / Wang, Lei / Ou, San-San / Anderson, Maija / McCauley, Marybeth / Gamble, Theresa / Kumarasamy, Nagalingeshwaran / Hakim, James G / Kumwenda, Johnstone / Pilotto, Jose H S / Godbole, Sheela V / Chariyalertsak, Suwat / de Melo, Marineide Gonçalves / Mayer, Kenneth H / Eshleman, Susan H / Piwowar-Manning, Estelle / Makhema, Joseph / Mills, Lisa A / Panchia, Ravindre / Sanne, Ian / Gallant, Joel / Hoffman, Irving / Taha, Taha E / Nielsen-Saines, Karin / Celentano, David / Essex, Max / Havlir, Diane / Cohen, Myron S / Anonymous2560787. ·Instituto de Pesquisa Clinica Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil. · University of North Carolina School of Medicine, Chapel Hill, NC, USA; UNC Project-Malawi, Lilongwe, Malawi. · Harvard School of Public Health, Boston, MA, USA. · University of Nebraska Medical Center, Omaha, NE, USA. · University of North Carolina School of Medicine, Chapel Hill, NC, USA. · Fred Hutchinson Cancer Research Center, Seattle, WA, USA. · FHI 360, Washington, DC, USA. · FHI 360, Durham, NC, USA. · Y R Gaitonade Center for AIDS Research and Education, Chennai, India. · University of Zimbabwe, Harare, Zimbabwe. · College of Medicine-Johns Hopkins Project, Lilongwe, Malawi. · Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz, Rio de Janeiro, Brazil. · National AIDS Research Institute (ICMR), Pune, India. · Research Institute for Health Sciences, Chiang Mai University, Chaing Mai, Thailand. · Hospital Nossa Senhora da Conceição, Porto Alegre RS, Brazil. · Fenway Institute, Boston, MA, USA. · Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Botswana Harvard AIDS Institute, Gabarone, Botswana. · KEMRI-CDC, Kisumu, Kenya. · Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. · Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · David Geffen UCLA School of Medicine, Los Angeles, CA, USA. · University of California, San Francisco, CA, USA. · University of North Carolina School of Medicine, Chapel Hill, NC, USA. Electronic address: mscohen@med.unc.edu. ·Lancet Infect Dis · Pubmed #24602844.

ABSTRACT: BACKGROUND: Use of antiretroviral treatment for HIV-1 infection has decreased AIDS-related morbidity and mortality and prevents sexual transmission of HIV-1. However, the best time to initiate antiretroviral treatment to reduce progression of HIV-1 infection or non-AIDS clinical events is unknown. We reported previously that early antiretroviral treatment reduced HIV-1 transmission by 96%. We aimed to compare the effects of early and delayed initiation of antiretroviral treatment on clinical outcomes. METHODS: The HPTN 052 trial is a randomised controlled trial done at 13 sites in nine countries. We enrolled HIV-1-serodiscordant couples to the study and randomly allocated them to either early or delayed antiretroviral treatment by use of permuted block randomisation, stratified by site. Random assignment was unblinded. The HIV-1-infected member of every couple initiated antiretroviral treatment either on entry into the study (early treatment group) or after a decline in CD4 count or with onset of an AIDS-related illness (delayed treatment group). Primary events were AIDS clinical events (WHO stage 4 HIV-1 disease, tuberculosis, and severe bacterial infections) and the following serious medical conditions unrelated to AIDS: serious cardiovascular or vascular disease, serious liver disease, end-stage renal disease, new-onset diabetes mellitus, and non-AIDS malignant disease. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00074581. FINDINGS: 1763 people with HIV-1 infection and a serodiscordant partner were enrolled in the study; 886 were assigned early antiretroviral treatment and 877 to the delayed treatment group (two individuals were excluded from this group after randomisation). Median CD4 counts at randomisation were 442 (IQR 373-522) cells per μL in patients assigned to the early treatment group and 428 (357-522) cells per μL in those allocated delayed antiretroviral treatment. In the delayed group, antiretroviral treatment was initiated at a median CD4 count of 230 (IQR 197-249) cells per μL. Primary clinical events were reported in 57 individuals assigned to early treatment initiation versus 77 people allocated to delayed antiretroviral treatment (hazard ratio 0·73, 95% CI 0·52-1·03; p=0·074). New-onset AIDS events were recorded in 40 participants assigned to early antiretroviral treatment versus 61 allocated delayed initiation (0·64, 0·43-0·96; p=0·031), tuberculosis developed in 17 versus 34 patients, respectively (0·49, 0·28-0·89, p=0·018), and primary non-AIDS events were rare (12 in the early group vs nine with delayed treatment). In total, 498 primary and secondary outcomes occurred in the early treatment group (incidence 24·9 per 100 person-years, 95% CI 22·5-27·5) versus 585 in the delayed treatment group (29·2 per 100 person-years, 26·5-32·1; p=0·025). 26 people died, 11 who were allocated to early antiretroviral treatment and 15 who were assigned to the delayed treatment group. INTERPRETATION: Early initiation of antiretroviral treatment delayed the time to AIDS events and decreased the incidence of primary and secondary outcomes. The clinical benefits recorded, combined with the striking reduction in HIV-1 transmission risk previously reported, provides strong support for earlier initiation of antiretroviral treatment. FUNDING: US National Institute of Allergy and Infectious Diseases.

5 Article Esophagectomy in Patients with Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome: A Viable Option. 2018

Mwachiro, Michael / Mitchell, Eric / Topazian, Hillary M / White, Russell. ·Department of General Surgery, Tenwek Hospital, Bomet, Kenya. Electronic address: deche2002@yahoo.com. · Department of General Surgery, Tenwek Hospital, Bomet, Kenya. ·Semin Thorac Cardiovasc Surg · Pubmed #29747950.

ABSTRACT: The objective of this study was to assess the outcomes for patients with human immunodeficiency virus (HIV) and acquired immune deficiency virus (AIDS) who had esophagectomy done for both benign and malignant conditions. A retrospective chart review of patients with HIV and AIDS undergoing esophagectomy at a rural referral hospital was done for the period of 2009-2014. Patient postoperative complications, outcomes, and follow-up data were charted. All procedures were done by a single lead surgeon. Nine patients met the study criteria, 7 of whom had esophageal cancer, and 2 with strictures. Four patients had received nutritional self-expanding metal stent preoperatively. The mean stent duration was 61 days. Three patients had been on antiretroviral therapy before surgery. Preoperative CD4 counts were available in 7 patients. Eight patients underwent a 3-field esophagectomy and 1 was unresectable. Seven of these patients had successful outcomes, with varying follow-up times. One patient died post procedure while in the hospital. Complications included stricture and anastomotic leak. Although HIV-positive patients face increased risk during surgical procedures, this status should not be a firm contraindication to surgery. Quality nutritional status, antiretroviral use, and overall CD4 count levels remain important parameters in considering surgical treatment for these patients. With careful patient evaluation and planning, esophagectomy in an HIV and AIDS setting is feasible with successful outcomes.

6 Article Late entry to HIV and AIDS care and treatment, Juba Teaching Hospital, Juba, South Sudan, 2013-2016. 2018

Johnson, Muki / Lemi, Benjamin L / Tonny, Hillary L / David, Adelina D / Boru, Waqo / Ransom, James. ·a Immunization and Field Epidemiology Training Project , Juba , South Sudan. · b Field Epidemiology and Laboratory Training Program , Nairobi , Kenya. · c Juba Teaching Hospital , Juba , South Sudan. · d Piret Partners Consulting , Washington, DC , USA. ·Afr J AIDS Res · Pubmed #29745288.

ABSTRACT: Late diagnosis of HIV and enrolment to care are global public health challenges. This study aimed to characterise late HIV diagnoses and initiation of treatment among patients at Juba Teaching Hospital (JTH) in South Sudan. We conducted a retrospective review of lab-confirmed HIV patients at JTH, 2013-2016. Demographic, clinical, and laboratory data were entered into and descriptive statistics were calculated using Microsoft Excel. We identified 401 patients, with mean age 33.71±4.54 years, 235 (59%) were female, 307 (77%) were late entry, 64 (16%) were lost to follow-up, and 57 (14%) died within 12 months of diagnosis. Among patients who presented late, 122 (57%) were female, and 112 (53%) were <34 years old. Among patients who died, 33 (58%) were male, and 52 (91%) had CD4 counts <350 cells/mm3 and World Health Organization (WHO) stage >2 at diagnosis. Late diagnosis of HIV infection is a significant public health problem in South Sudan, particularly for younger and female patients.

7 Article Key Programme Science lessons from an HIV prevention 'Learning Site' for sex workers in Mombasa, Kenya. 2018

McClarty, Leigh M / Bhattacharjee, Parinita / Isac, Shajy / Emmanuel, Faran / Kioko, Japheth / Njiraini, Margaret / Gichangi, Peter / Okoth, Clifford Duncan / Musimbi-Mbole, Janet / Blanchard, James F / Moses, Stephen / Muysyoki, Helgar / Becker, Marissa L. ·Department of Community Health Sciences, Centre for Global Public Health, University of Manitoba, Winnipeg, Manitoba, Canada. · National AIDS and STI Control Programme, Ministry of Health, Government of Kenya, Nairobi, Kenya. · Partners for Health and Development in Africa, Nairobi, Kenya. · International Centre for Reproductive Health Kenya, Mombasa, Kenya. · Community Advisory Board, Learning Site, Mombasa, Kenya. ·Sex Transm Infect · Pubmed #29242195.

ABSTRACT: OBJECTIVES: In 2013, Kenya's National AIDS and STI Control Programme established a Learning Site (LS) in Mombasa County to support and strengthen capacity for HIV prevention programming within organisations working with sex workers. A defining feature of LS was the use of a Programme Science approach throughout its development and implementation. We provide an overview of the key components of LS, present findings from 23 months of programme monitoring data, and highlight key Programme Science lessons from its implementation and monitoring. METHODS: Routine monitoring data collected from September 2013 through July 2015 are presented. Individual-level service utilisation data were collected monthly and indicators of interest were analysed over time to illustrate trends in enrolment, programme coverage and service utilisation among sex workers in Mombasa County. RESULTS: Over the monitoring period, outreach programme enrolment occurred rapidly; condom distribution targets were met consistently; rates of STI screening remained high and diagnoses declined; and reporting of and response to violent incidents increased. At the same time, enrolment in LS clinics was relatively low among female sex workers, and HIV testing at LS was low among both female and male sex workers. CONCLUSION: Lessons learnt from operationalising the Programme Science framework through the Mombasa LS can inform the development and implementation of similar LS in different geographical and epidemiological contexts. Importantly, meaningful involvement of sex workers in the design, implementation and monitoring processes ensures that overall programme performance is optimised in the context of local, 'on-the-ground' realities. Additionally, learnings from LS highlight the importance of introducing enhanced monitoring and evaluations systems into complex programmes to better understand and explain programme dynamics over time.

8 Article Bewitching sex workers, blaming wives: HIV/AIDS, stigma, and the gender politics of panic in western Kenya. 2018

Pfeiffer, Elizabeth J / Maithya, Harrison M K. ·a Department of History and Anthropology , Butler University , Indianapolis , IN , USA. · b Department of Microbiology and Immunology , Indiana University School of Medicine , Indianapolis , IN , USA. · c Department of Sociology and Anthropology , South Eastern Kenya University , Kitui , Kenya. ·Glob Public Health · Pubmed #27590587.

ABSTRACT: Since access to HIV testing, counselling, and drug therapy has improved so dramatically, scholars have investigated ways this 'scale-up' has interacted with HIV/AIDS-related stigma in sub-Saharan Africa. Drawing on data collected during ethnographic research in a trading centre in western Kenya, this paper critically analyses two violent and localised case studies of panic over the ill health of particular community residents as a nuanced lens through which to explore the dynamic interplay of gender politics and processes of HIV/AIDS-related stigma in the aftershocks of the AIDS crisis. Gaining theoretical momentum from literatures focusing on stigma, gender, witchcraft, gossip, and accusation, we argue that the cases highlight collective anxieties, as well as local critiques of shifting gender roles and the strain of globalisation and legacies of uneven development on myriad forms of relationships. We further contend that these heightened moments of panic and accusation were deployments of power that ultimately sharpened local gender politics and conflicts on the ground in ways that complicated the social solidarity necessary to tackle social and health inequalities. The paper highlights one community's challenge to eradicate the stigma associated with HIV/AIDS during a period of increased access to HIV services.

9 Article The validity of the SF-12 and SF-6D instruments in people living with HIV/AIDS in Kenya. 2017

Patel, Anik R / Lester, Richard T / Marra, Carlo A / van der Kop, Mia L / Ritvo, Paul / Engel, Lidia / Karanja, Sarah / Lynd, Larry D. ·Department of Medicine, University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. anikpa@mail.ubc.ca. · Faculty of Pharmaceutical Science, University of British Columbia, 2405 Westbrook Mall, Vancouver, Canada. anikpa@mail.ubc.ca. · Department of Medicine, University of British Columbia, 828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. · School of Pharmacy, University of Otago, Dunedin, New Zealand. · Department of Public Health Sciences/Global Health (IHCAR), Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171-77, Stockholm, Sweden. · School of Kinesiology & Health Sciences, York University, 160 Campus Walk, North York, ON, M3J 1P3, Canada. · Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada. · Deakin University, Geelong Australia, Faculty of Health, School of Health and Social Development, 221 Burwood Highway, Burwood, Victoria, 3125, Australia. · Monitoring, Evaluation and Research Unit, Amref Health Africa in Kenya, P.O. Box 30125-00100, Nairobi, Kenya. · Faculty of Pharmaceutical Science, University of British Columbia, 2405 Westbrook Mall, Vancouver, Canada. · Center for Health Evaluation and Outcomes Science, St. Paul's Hospital, 588 - 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. ·Health Qual Life Outcomes · Pubmed #28716065.

ABSTRACT: BACKGROUND: Health-related quality of life (HRQoL) and health state utility value (HSUV) measurements are vital components of healthcare clinical and economic evaluations. Accurate measurement of HSUV and HRQoL require validated instruments. The 12-item Short-Form Health Survey (SF-12) is one of few instruments that can evaluate both HRQoL and HSUV, but its validity has not been assessed in people living with HIV/AIDS (PLWHA) in east Africa, where the burden of HIV is high. METHODS: This cross-sectional study used baseline data from a randomized trial involving PLWHA in Kenya. Data included responses from a translated and adapted SF-12 survey as well as key demographic and clinical data. Construct validity of the survey was examined by testing the SF-12's ability to distinguish between groups known in advance to have differences in their health based on their disease severity. We classified disease severity based on established definitions from the US Center for Disease Control (CDC) and WHO, as well as a previously studied viral load threshold. T-tests and ANOVA were used to test for differences in HRQoL and HSUV scores. Area under the receive operator curve (AUC) was used to test the discriminative ability of the HRQoL and HSUV instruments. RESULTS: Differences in physical component scores met the minimum clinically important difference among participants with more advanced HIV when defined by CD4 count (4.3 units) and WHO criteria (compared to stage 1, stages 2, 3 and 4 were 2.0, 7.2 and 9.8 units lower respectively). Mental score differences met the minimum clinically important difference between WHO stage 1 and stage 4 patients (4.4). Differences in the HSUV were statistically lower in more advanced HIV by all three definitions of severity. The AUC showed poor to weak discriminatory ability in most analyses, but had fair discriminatory ability between WHO clinical stage 1 and clinical stage 4 individuals (AUC = 0.71). CONCLUSION: Our findings suggest that the Kiswahili translated and adapted version of the SF-12 could be used as an assessment tool for physical health, mental health and HSUV for Kiswahili-speaking PLHWA. TRIAL REGISTRATION: Clinical trials.gov identifier: NCT00830622 . Registered 26 January 2009.

10 Article 'Leaving no one behind': reflections on the design of community-based HIV prevention for migrants in Johannesburg's inner-city hostels and informal settlements. 2017

Scorgie, Fiona / Vearey, Jo / Oliff, Monique / Stadler, Jonathan / Venables, Emilie / Chersich, Matthew F / Delany-Moretlwe, Sinead. ·Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. · African Centre for Migration & Society, University of the Witwatersrand, Johannesburg, South Africa. · Wellsense International, Kilifi, Kenya. · Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa. · Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. sdelany@wrhi.ac.za. ·BMC Public Health · Pubmed #28527472.

ABSTRACT: BACKGROUND: Unmanaged urban growth in southern and eastern Africa has led to a growth of informal housing in cities, which are home to poor, marginalised populations, and associated with the highest HIV prevalence in urban areas. This article describes and reflects on the authors' experiences in designing and implementing an HIV intervention originally intended for migrant men living in single-sex hostels of inner-city Johannesburg. It shows how formative research findings were incorporated into project design, substantially shifting the scope of the original project. METHODS: Formative research activities were undertaken to better understand the demand- and supply-side barriers to delivering HIV prevention activities within this community. These included community mapping, a baseline survey (n = 1458) and client-simulation exercise in local public sector clinics. The intervention was designed and implemented in the study setting over a period of 18 months. Implementation was assessed by way of a process evaluation of selected project components. RESULTS: The project scope expanded to include women living in adjacent informal settlements. Concurrent sexual partnerships between these women and male hostel residents were common, and HIV prevalence was higher among women (56%) than men (24%). Overwhelmingly, hostel residents were internal migrants from another province, and most felt 'alienated' from the rest of the city. While men prioritised the need for jobs, women were more concerned about water, sanitation, housing and poverty alleviation. Most women (70%) regarded their community as unsafe (cf. 47% of men). In the final intervention, project objectives were modified and HIV prevention activities were embedded within a broader health and development focus. 'Community health clubs' were established to build residents' capacity to promote health and longer term well-being, and to initiate and sustain change within their communities. CONCLUSIONS: To improve efforts to address HIV in urban informal settings, intervention designers must acknowledge and engage with the priorities set by the marginalised communities that live here, which may well encompass more pressing issues associated with daily survival.

11 Article Low implementation of Xpert MTB/RIF among HIV/TB co-infected adults in the International epidemiologic Databases to Evaluate AIDS (IeDEA) program. 2017

Clouse, Kate / Blevins, Meridith / Lindegren, Mary Lou / Yotebieng, Marcel / Nguyen, Dung Thi / Omondi, Alfred / Michael, Denna / Zannou, Djimon Marcel / Carriquiry, Gabriela / Pettit, April / Anonymous211119. ·Vanderbilt Institute for Global Health, Nashville, Tennessee, United States of America. · Vanderbilt University Medical Center, Nashville, Tennessee, United States of America. · Vanderbilt Tuberculosis Center, Nashville, Tennessee, United States of American. · Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, United States of America. · College of Public Health, The Ohio State University, Columbus, Ohio, United States of America. · National Hospital of Tropical Diseases, Hanoi, Vietnam. · Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya. · National Institute for Medical Research (NIMR), Mwanza, Tanzania. · Faculté des Sciences de la Santé, Université d'Abomey-Calavi, Cotonou, Bénin. · Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru. ·PLoS One · Pubmed #28182705.

ABSTRACT: OBJECTIVE: Xpert MTB/RIF is recommended by the World Health Organization (WHO) as the initial tuberculosis (TB) diagnostic test in individuals suspected of HIV-associated TB. We sought to evaluate field implementation of Xpert among a cohort of HIV/TB co-infected individuals, including availability, utilization and outcomes. DESIGN: Observational cohort study (patient-level data) and cross-sectional study (site-level Xpert availability data). METHODS: Data were collected at 30 participating International epidemiologic Databases to Evaluate AIDS (IeDEA) sites in 18 countries from January 2012-January 2016. All patients were HIV-infected and diagnosed with TB, either bacteriologically or clinically, and followed until a determination of TB treatment outcome. We used multivariable modified Poisson regression to estimate adjusted relative risk (RR) and 95% confidence intervals for unfavorable TB treatment outcomes. RESULTS: Most sites (63%) had access to Xpert, either in the clinic (13%), in the same facility (20%) or offsite (30%). Among 2722 HIV/TB patients included, median age was 35.4 years and 41% were female; BMI and CD4 count were low. Overall, most patients (76%) received at least one TB test; 45% were positive. Only 4% of all patients were tested using Xpert: 64% were Xpert-positive, 13% showed rifampicin (RIF) resistance and 30% were extrapulmonary (EPTB) or both pulmonary-EPTB. Treatment outcomes were mostly favorable (77%) and we found little association between Xpert use and an unfavorable TB treatment outcome (RR 1.25, 95%CI: 0.83, 1.90). CONCLUSIONS: In this cohort, Xpert utilization was low even though the majority of sites had access to the test. Our findings show the need for expanded implementation and further research exploring barriers to use in low-resource settings.

12 Article People-centred health systems, a bottom-up approach: where theory meets empery. 2017

Sturmberg, Joachim P / Njoroge, Alice. ·Department of General Practice, The University of Newcastle, Wamberal, Australia. · Eastern Deanery AIDS Program, Nairobi, Kenya. ·J Eval Clin Pract · Pubmed #27062608.

ABSTRACT: BACKGROUND AND METHODS: Health systems are complex and constantly adapt to changing demands. These complex-adaptive characteristics are rarely considered in the current bureaucratic top-down approaches to health system reforms aimed to constrain demand and expenditure growth. The economic focus fails to address the needs of patients, providers and communities, and ultimately results in declining effectiveness and efficiency of the health care system as well as the health of the wider community. A needs-focused complex-adaptive health system can be represented by the 'healthcare vortex' model; how to build a needs-focused complex-adaptive health system is illustrated by Eastern Deanery AIDS Relief Program approaches in the poor neighbourhoods of Nairobi, Kenya. FINDINGS AND CONCLUSIONS: A small group of nurses and community health workers focused on the care of terminally ill HIV/AIDS patients. This work identified additional problems: tuberculosis (TB) was underdiagnosed and undertreated, a local TB-technician was trained to run a local lab, a courier services helped to reach all at need, collaboration with the Ministry of Health established local TB and HIV treatment programmes and philanthropists helped to supplement treatment with nutrition support. Maternal-to-child HIV-prevention and adolescent counselling services addressed additional needs. The 'theory of the healthcare vortex' indeed matches the 'empery of the real world experiences'. Locally developed and delivered adaptive, people-centred health systems, a bottom-up community and provider initiated approach, deliver highly effective and sustainable health care despite significant resource constraints.

13 Article A Qualitative Study on the Interconnected Nature of HIV, Water, and Family. 2017

Ramirez-Ortiz, Daisy / Zolnikov, Tara Rava. ·Department of Public Health Sciences, University of Miami, Miami, FL, USA. · Kenya Red Cross, Red Cross Road, Bellevue, "South C", Nairobi, Kenya. · Department of Community Health, National University, San Diego, CA, USA. tarazolnikov@gmail.com. · Kenya Red Cross, Red Cross Road, Bellevue, "South C", Nairobi, Kenya. tarazolnikov@gmail.com. ·AIDS Behav · Pubmed #26874847.

ABSTRACT: Human immunodeficiency virus infection/acquired immunodeficiency syndrome (HIV/AIDS) and poor access to water are two primary global health issues. Poor access to water may significantly affect families infected with HIV and result in adverse social and health consequences. A qualitative study used semi-structured interviews to understand health and social outcomes of families after the implementation of water interventions in rural Kenya. One major sub-theme emerged during this research, which included the effects of water on an HIV-affected family. Prior to the water interventions, common adverse health effects from lack of nutrition, water, and poor hygiene were experienced. After receiving access to water, nutrition and hygiene were improved and additional time was gained and used to reinforce relationships and spread awareness about HIV/AIDS. This study provides need-based evidence for access to safe drinking water in order to decrease adverse health outcomes and improve the quality of life for HIV-affected individuals.

14 Article Risk factors for Kaposi's sarcoma in human immunodeficiency virus patients after initiation of antiretroviral therapy: A nested case-control study in Kenya. 2017

Lupia, Rodgers / Wabuyia, Peter B / Otiato, Peter / Fang, Chi-Tai / Tsai, Feng-Jen. ·Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. · Comprehensive Care Clinic Department, ACK Maseno Hospital, Maseno, Kenya. · Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. · Master Program in Global Health and Development, College of Public Health and Nutrition, Taipei Medical University, Taipei, Taiwan. Electronic address: jeanfjtsai@tmu.edu.tw. ·J Microbiol Immunol Infect · Pubmed #26712092.

ABSTRACT: BACKGROUND/PURPOSE: This study aimed to evaluate the association between highly active antiretroviral therapy (HAART) adherence and development of Kaposi's sarcoma (KS) in human immunodeficiency virus (HIV)/AIDS patients. METHODS: We conducted a retrospective nested case-control study of 165 participants (33 cases and 132 controls) receiving HAART care at Maseno Hospital, Kenya, from January 2005 to October 2013. Cases were HIV-positive adults with KS, who were matched with controls in a ratio of 1:4 based on age (±5 years of each case), sex, and KS diagnosis date. Perfect adherence to HAART was assessed on every clinic visit by patients' self-reporting and pill counts. Chi-square tests were performed to compare socioeconomic and clinical statuses between cases and controls. A conditional logistic regression was used to assess the effects of perfect adherence to HAART, the latest CD4 count, education level, distance to health-care facility, initial World Health Organization stage, and number of regular sexual partners on the development of KS. RESULTS: Only 63.6% participants reported perfect adherence, and the control group had a significantly higher percentage of perfect adherence (75.0%) than did cases (18.2%). After adjustment for potential imbalances in the baseline and clinical characteristics, patients with imperfect HAART adherence had 20-times greater risk of developing KS than patients with perfect HAART adherence [hazard ratios: 21.0, 95% confidence interval: 4.2-105.1]. Patients with low latest CD4 count (≤350 cells/mm CONCLUSION: Imperfect HAART adherence and low latest CD4 count are significantly associated with KS development.

15 Article Evaluating strategies to improve HIV care outcomes in Kenya: a modelling study. 2016

Olney, Jack J / Braitstein, Paula / Eaton, Jeffrey W / Sang, Edwin / Nyambura, Monicah / Kimaiyo, Sylvester / McRobie, Ellen / Hogan, Joseph W / Hallett, Timothy B. ·Department of Infectious Disease Epidemiology, Imperial College London, London, UK. Electronic address: jack.olney11@imperial.ac.uk. · Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Moi University, College of Health Sciences, School of Medicine, Department of Medicine, Eldoret, Kenya. · Department of Infectious Disease Epidemiology, Imperial College London, London, UK. · Academic Model Providing Access to Healthcare, Eldoret, Kenya. · Department of Biostatistics and Center for Statistical Sciences, Brown University School of Public Health, Providence, RI, USA. ·Lancet HIV · Pubmed #27771231.

ABSTRACT: BACKGROUND: With expanded access to antiretroviral therapy (ART) in sub-Saharan Africa, HIV mortality has decreased, yet life-years are still lost to AIDS. Strengthening of treatment programmes is a priority. We examined the state of an HIV care programme in Kenya and assessed interventions to improve the impact of ART programmes on population health. METHODS: We created an individual-based mathematical model to describe the HIV epidemic and the experiences of care among adults infected with HIV in Kenya. We calibrated the model to a longitudinal dataset from the Academic Model Providing Access To Healthcare (known as AMPATH) programme describing the routes into care, losses from care, and clinical outcomes. We simulated the cost and effect of interventions at different stages of HIV care, including improvements to diagnosis, linkage to care, retention and adherence of ART, immediate ART eligibility, and a universal test-and-treat strategy. FINDINGS: We estimate that, of people dying from AIDS between 2010 and 2030, most will have initiated treatment (61%), but many will never have been diagnosed (25%) or will have been diagnosed but never started ART (14%). Many interventions targeting a single stage of the health-care cascade were likely to be cost-effective, but any individual intervention averted only a small percentage of deaths because the effect is attenuated by other weaknesses in care. However, a combination of five interventions (including improved linkage, point-of-care CD4 testing, voluntary counselling and testing with point-of-care CD4, and outreach to improve retention in pre-ART care and on-ART) would have a much larger impact, averting 1·10 million disability-adjusted life-years (DALYs) and 25% of expected new infections and would probably be cost-effective (US$571 per DALY averted). This strategy would improve health more efficiently than a universal test-and-treat intervention if there were no accompanying improvements to care ($1760 per DALY averted). INTERPRETATION: When resources are limited, combinations of interventions to improve care should be prioritised over high-cost strategies such as universal test-and-treat strategy, especially if this is not accompanied by improvements to the care cascade. International guidance on ART should reflect alternative routes to programme strengthening and encourage country programmes to evaluate the costs and population-health impact in addition to the clinical benefits of immediate initiation. FUNDING: Bill & Melinda Gates Foundation, United States Agency for International Development, National Institutes of Health.

16 Article Food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County, Kenya. 2016

Chege, Peter M / Ndungu, Zipporah W / Gitonga, Betty M. ·Department of Food, Nutrition and Dietetics, Kenyatta University, P.O Box 43844-00100, Nairobi, Kenya. chegepeterm@gmail.com. · Department of Nutrition and Dietetics, Jomo Kenyatta University of Agriculture and Technology, P.O Box 62000-01000, Thika, Kenya. · Department of Nutrition and Dietetics, Mount Kenya University, P.O Box 342-01000, Thika, Kenya. ·J Health Popul Nutr · Pubmed #27443524.

ABSTRACT: BACKGROUND: HIV and AIDS affect most the productive people, leading to reduced capacity to either produce food or generate income. Children under-fives are the most vulnerable group in the affected households. There exists minimal information on food security status and its effect on nutritional status of children under-fives in households affected by HIV and AIDS. The aim of this study was to assess food security and nutritional status of children under-five in households affected by HIV and AIDS in Kiandutu informal settlement, Kiambu County. METHODS: A cross-sectional analytical design was used. A formula by Fisher was used to calculate the desired sample size of 286. Systematic random sampling was used to select the children from a list of identified households affected by HIV. A questionnaire was used to collect data. Focus group discussion (FGD) guides were used to collect qualitative data. Nutri-survey software was used for analysis of nutrient intake while ENA for SMART software for nutritional status. Data were analyzed using SPSS computer software for frequency and means. Qualitative data was coded and summarized to capture the emerging themes RESULTS AND DISCUSSION: Results show that HIV affected the occupation of people with majority being casual laborers (37.3 %), thus affecting the engagement in high income generating activities. Pearson correlation coefficient showed a significant relationship between dietary diversity score and energy intake (r = 0.54 p = 0.044) and intake of vitamin A, iron, and zinc (p < 0.05). A significant relationship was also noted on energy intake and nutritional status (r = 0.78 p = 0.038). Results from FGD noted that HIV status affected the occupation due to stigma and frequent episodes of illness. The main source of food was purchasing (52.7 %). With majority (54.1 %) of the households earning a monthly income less than US$ 65, and most of the income (25.7 %) being used for medication, there was food insecurity as indicated by a mean household dietary diversity score of 3.4 ± 0.2. This together with less number of meals per day (3.26 ± 0.07 SD) led to consumption of inadequate nutrients by 11.4, 73.9, 67.7, and 49.2 % for energy, vitamin A, iron, and zinc, respectively. This resulted to poor nutritional status noted by a prevalence of 9.9 % in wasting. Stunting and underweight was 17.5 and 5.5 %, respectively. Qualitative data shows that the stigma due to HIV affected the occupation and ability to earn income. CONCLUSIONS: The research recommends a food-based intervention program among the already malnourished children.

17 Article Population health and individualized care in the global AIDS response: synergy or conflict? 2016

El-Sadr, Wafaa M / Rabkin, Miriam / DeCock, Kevin M. ·aICAP at Columbia University, Mailman School of Public Health, New York, New York, USA bUS Centers for Disease Control and Prevention, Nairobi, Kenya. ·AIDS · Pubmed #27367489.

ABSTRACT: -- No abstract --

18 Article Spatial modeling of HIV and HSV-2 among women in Kenya with spatially varying coefficients. 2016

Okango, Elphas / Mwambi, Henry / Ngesa, Oscar. ·School of Mathematics, Statistics and Computer Science, University of KwaZulu -Natal, Private Bag X01, 3201, Pietermaritzburg, South Africa. kangphas@gmail.com. · School of Mathematics, Statistics and Computer Science, University of KwaZulu -Natal, Private Bag X01, 3201, Pietermaritzburg, South Africa. · Mathematics and Informatics Department, Taita Taveta University College, P.O Box 635-80300, Voi, Kenya. ·BMC Public Health · Pubmed #27103038.

ABSTRACT: BACKGROUND: Disease mapping has become popular in the field of statistics as a method to explain the spatial distribution of disease outcomes and as a tool to help design targeted intervention strategies. Most of these models however have been implemented with assumptions that may be limiting or altogether lead to less meaningful results and hence interpretations. Some of these assumptions include the linearity, stationarity and normality assumptions. Studies have shown that the linearity assumption is not necessarily true for all covariates. Age for example has been found to have a non-linear relationship with HIV and HSV-2 prevalence. Other studies have made stationarity assumption in that one stimulus e.g. education, provokes the same response in all the regions under study and this is also quite restrictive. Responses to stimuli may vary from region to region due to aspects like culture, preferences and attitudes. METHODS: We perform a spatial modeling of HIV and HSV-2 among women in Kenya, while relaxing these assumptions i.e. the linearity assumption by allowing the covariate age to have a non-linear effect on HIV and HSV-2 prevalence using the random walk model of order 2 and the stationarity assumption by allowing the rest of the covariates to vary spatially using the conditional autoregressive model. The women data used in this study were derived from the 2007 Kenya AIDS indicator survey where women aged 15-49 years were surveyed. A full Bayesian approach was used and the models were implemented in R-INLA software. RESULTS: Age was found to have a non-linear relationship with both HIV and HSV-2 prevalence, and the spatially varying coefficient model provided a significantly better fit for HSV-2. Age-at first sex also had a greater effect on HSV-2 prevalence in the Coastal and some parts of North Eastern regions suggesting either early marriages or child prostitution. The effect of education on HIV prevalence among women was more in the North Eastern, Coastal, Southern and parts of Central region. CONCLUSIONS: The models introduced in this study enable relaxation of two limiting assumptions in disease mapping. The effects of the covariates on HIV and HSV-2 were found to vary spatially. The effect of education on HSV-2 status for example was lower in North Eastern and parts of the Rift region than most of the other parts of the country. Age was found to have a non-linear effect on HIV and HSV-2 prevalence, a linearity assumption would have led to wrong results and hence interpretations. The findings are relevant in that they can be used in informing tailor made strategies for tackling HIV and HSV-2 in different counties. The methodology used here may also be replicated in other studies with similar data.

19 Article Data Resource Profile: Network for Analysing Longitudinal Population-based HIV/AIDS data on Africa (ALPHA Network). 2016

Reniers, Georges / Wamukoya, Marylene / Urassa, Mark / Nyaguara, Amek / Nakiyingi-Miiro, Jessica / Lutalo, Tom / Hosegood, Vicky / Gregson, Simon / Gómez-Olivé, Xavier / Geubbels, Eveline / Crampin, Amelia C / Wringe, Alison / Waswa, Laban / Tollman, Stephen / Todd, Jim / Slaymaker, Emma / Serwadda, David / Price, Alison / Oti, Samuel / Nyirenda, Moffat J / Nabukalu, Dorean / Nyamukapa, Constance / Nalugoda, Fred / Mugurungi, Owen / Mtenga, Baltazar / Mills, Lisa / Michael, Denna / McLean, Estelle / McGrath, Nuala / Martin, Emmanuel / Marston, Milly / Maquins, Sewe / Levira, Francis / Kyobutungi, Catherine / Kwaro, Daniel / Kasamba, Ivan / Kanjala, Chifundo / Kahn, Kathleen / Kabudula, Chodziwadziwa / Herbst, Kobus / Gareta, Dickman / Eaton, Jeffrey W / Clark, Samuel J / Church, Kathryn / Chihana, Menard / Calvert, Clara / Beguy, Donatien / Asiki, Gershim / Amri, Shamte / Abdul, Ramadhani / Zaba, Basia. ·Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, georges.reniers@lshtm.ac.uk. · African Population and Health Research Center, Nairobi, Kenya. · Tazama Project, Tanzania National Institute for Medical Research, Mwanza, Tanzania. · Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya. · MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda. · Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda. · Africa Centre for Population Health, Mtubatuba, South Africa, Department of Social Statistics and Demography, Southampton University, Southampton, UK. · Manicaland Centre for Public Health Research, Harare, Zimbabwe, Department of Infectious Disease Epidemiology, Imperial College, London, UK. · School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. · Ifakara Health Institute, Dar-Es-Salaam, Tanzania. · Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK. · Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK. · School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Centre for Global Health Research, Umea° University, Umea°, Sweden. · Rakai Health Sciences Program, Uganda Virus Research Institute, Rakai, Uganda, School of Public Health, Makerere University, Kampala, Uganda. · Manicaland Centre for Public Health Research, Harare, Zimbabwe, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe. · Kenya Medical Research Institute and the Centers for Disease Control, Kisumu, Kenya, Division of HIV/AIDS Prevention, CDC, Atlanta GA, USA and. · Malawi Epidemiology and Intervention Research Unit, Lilongwe, UK. · Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa. · Africa Centre for Population Health, Mtubatuba, South Africa. · Department of Infectious Disease Epidemiology, Imperial College, London, UK. · School of Public Health, University of the Witwatersrand, Johannesburg, South Africa, Department of Sociology, University of Washington, Seattle WA, USA. ·Int J Epidemiol · Pubmed #26968480.

ABSTRACT: -- No abstract --

20 Article Living with AIDS in Uganda: a qualitative study of patients' and families' experiences following referral to hospice. 2015

Too, Wesley / Watson, Michael / Harding, Richard / Seymour, Jane. ·Kabarak University, School of Medicine and Health Sciences, P O Private Bag-20157 Kabarak, Nakuru, Kenya. wtoo@kabarak.ac.ke. · School of Health Sciences, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK. michael.watson@nottingham.ac.uk. · The Cicely Saunders Institute, Bessemer Road, Kings College, London, SE5 9PJ, UK. richard.harding@kcl.ac.uk. · School of Health Sciences, University of Nottingham, Queen's Medical Centre, Derby Road, Nottingham, NG7 2UH, UK. jane.seymour@nottingham.ac.uk. ·BMC Palliat Care · Pubmed #26615391.

ABSTRACT: BACKGROUND: Globally, the majority of people with HIV/AIDS live in sub-Saharan Africa. While the increasing availability of antiretroviral therapy is improving the outlook for many, its effects are yet to reach all of those in need and patients still present with advanced disease. This paper reports findings from qualitative interviews with patients living with AIDS and their caregivers who were receiving palliative care from Hospice Africa Uganda (HAU). We aimed to understand what motivated patients and their families to seek formal healthcare, whether there were any barriers to help- seeking and how the help and support provided to them by HAU was perceived. METHODS: We invited patients with AIDS and their relatives who were newly referred to HAU to participate in qualitative interviews. Patients and carers were interviewed in their homes approximately four weeks after the patient's enrolment at HAU. Interviews were translated, transcribed and analysed using narrative and thematic approaches. RESULTS: Interviews were completed with 22 patients (10 women and 12 men) and 20 family caregivers, nominated by patients. Interviews revealed the extent of suffering patients endured and the strain that family caregivers experienced before help was sought or accessed. Patients reported a wide range of severe physical symptoms. Patients and their relatives reported worries about the disclosure of the AIDS diagnosis and fear of stigma. Profound poverty framed all accounts. Poverty and stigma were, depending on the patient and family situation, both motivators and barriers to help seeking behaviour. Hospice services were perceived to provide essential relief of pain and symptoms, as well as providing rehabilitative support and a sense of caring. The hospice was perceived relieve utter destitution, although it was unable to meet all the expectations that patients had. CONCLUSION: Hospice care was highly valued and perceived to effectively manage problems such as pain and other symptoms and to provide rehabilitation. Participants noted a strong sense of being "cared for". However, poverty and a sense of stigma were widespread. Further research is needed to understand how poverty and stigma can be effectively managed in hospice care for patients for advanced AIDS and their families.

21 Article HLA B51 is associated with faster AIDS progression among newly diagnosed HIV-infected individuals in Manitoba, Canada. 2015

Keynan, Y / Rueda, Z V / Bresler, K / Becker, M / Kasper, K. ·Manitoba HIV Program, Winnipeg, MB, Canada. · Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada. · Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada. · Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya. · Universidad Pontificia Bolivariana, Medellin, Colombia. · Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada. ·Int J Immunogenet · Pubmed #26263514.

ABSTRACT: Human leucocyte antigen (HLA) alleles influence the rate of CD4 decline among HIV-infected individuals. We investigated the association between HLA B35 and HLA B51 and the rate of CD4 decline and/or opportunistic infections, among 294 HIV-positive individuals from Manitoba, Canada. All individuals presenting with a CD4 count >200 cells μL(-1) , who had at least two CD4 counts, and no evidence of co-infection were included. Individuals bearing HLA B35 or HLA B51 were compared to controls. A multivariate model demonstrated that HLA B35 allele was associated with a hazard ratio of 2.05 (95% CI 1.31-3.18) for reaching AIDS and HLA B51 allele with HR of 2.03 (95% CI 1.18-3.49) for reaching the same end-point. High prevalence of HLA B35 was seen in the patient population receiving care in Manitoba. Our observations confirm the association of HLA B35 with rapid disease progression. We report, for the first time, faster CD4 decline among individuals with HLA B51 allele.

22 Article Pretreatment HIV drug resistance increases regimen switches in sub-Saharan Africa. 2015

Boender, T Sonia / Hoenderboom, Bernice M / Sigaloff, Kim C E / Hamers, Raph L / Wellington, Maureen / Shamu, Tinei / Siwale, Margaret / Labib Maksimos, Eman E F / Nankya, Immaculate / Kityo, Cissy M / Adeyemo, Titilope A / Akanmu, Alani Sulaimon / Mandaliya, Kishor / Botes, Mariette E / Ondoa, Pascale / Rinke de Wit, Tobias F. ·Amsterdam Institute for Global Health and Development and Department of Global Health. · Amsterdam Institute for Global Health and Development and Department of Global Health Department of Internal Medicine, Division of Infectious Diseases, Academic Medical Center of the University of Amsterdam, The Netherlands. · Newlands Clinic, Harare, Zimbabwe. · Lusaka Trust Hospital. · Coptic Hospital, Lusaka, Zambia. · Joint Clinical Research Centre, Kampala, Uganda. · Department of Haematology and Blood Transfusion, University of Lagos, Nigeria University Teaching Hospital, Nigeria. · Coast Province General Hospital, Mombasa, Kenya. · Muelmed Hospital, Pretoria, South Africa. ·Clin Infect Dis · Pubmed #26240203.

ABSTRACT: BACKGROUND: After the scale-up of antiretroviral therapy (ART) for human immunodeficiency virus (HIV) infection in Africa, increasing numbers of patients have pretreatment drug resistance. METHODS: In a large multicountry cohort of patients starting standard first-line ART in six African countries, pol genotyping was retrospectively performed if viral load (VL) ≥1000 cps/mL. Pretreatment drug resistance was defined as a decreased susceptibility to ≥1 prescribed drug. We assessed the effect of pretreatment drug resistance on all-cause mortality, new AIDS events and switch to second-line ART due to presumed treatment failure, using Cox models. RESULTS: Among 2579 participants for whom a pretreatment genotype was available, 5.5% had pretreatment drug resistance. Pretreatment drug resistance was associated with an increased risk of regimen switch (adjusted hazard ratio [aHR] 3.80; 95% confidence interval [CI], 1.49-9.68; P = .005) but was not associated with mortality (aHR 0.75, 95% CI, .24-2.35; P = .617) or new AIDS events (aHR 1.06, 95% CI, .68-1.64; P = .807). During three years of follow up, 106 (4.1%) participants switched to second-line, of whom 18 (17.0%) switched with VL < 1000 cps/mL, 7 (6.6%) with VL ≥ 1000 cps/mL and no drug resistance mutations (DRMs), 46 (43.4%) with VL ≥ 1000 cps/mL and ≥1 DRMs; no HIV RNA data was available for 32 (30.2%) participants. CONCLUSIONS: Given rising pretreatment HIV drug resistance levels in sub-Saharan Africa, these findings underscore the need for expanded access to second-line ART. VL monitoring can improve the accuracy of failure detection and efficiency of switching practices.

23 Article A structured approach to recording AIDS-defining illnesses in Kenya: A SNOMED CT based solution. 2015

Oluoch, Tom / de Keizer, Nicolette / Langat, Patrick / Alaska, Irene / Ochieng, Kenneth / Okeyo, Nicky / Kwaro, Daniel / Cornet, Ronald. ·U.S. Centers for Disease Control and Prevention, Division of Global HIV/AIDS, Nairobi, Kenya. Electronic address: toluoch@cdc.gov. · Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. · Kenya Medical Research Institute - CDC Collaborative Program, Kisumu, Kenya. · Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Biomedical Engineering, Linköping University, Linköping, Sweden. ·J Biomed Inform · Pubmed #26184057.

ABSTRACT: INTRODUCTION: Several studies conducted in sub-Saharan Africa (SSA) have shown that routine clinical data in HIV clinics often have errors. Lack of structured and coded documentation of diagnosis of AIDS defining illnesses (ADIs) can compromise data quality and decisions made on clinical care. METHODS: We used a structured framework to derive a reference set of concepts and terms used to describe ADIs. The four sources used were: (i) CDC/Accenture list of opportunistic infections, (ii) SNOMED Clinical Terms (SNOMED CT), (iii) Focus Group Discussion (FGD) among clinicians and nurses attending to patients at a referral provincial hospital in western Kenya, and (iv) chart abstraction from the Maternal Child Health (MCH) and HIV clinics at the same hospital. Using the January 2014 release of SNOMED CT, concepts were retrieved that matched terms abstracted from approach iii & iv, and the content coverage assessed. Post-coordination matching was applied when needed. RESULTS: The final reference set had 1054 unique ADI concepts which were described by 1860 unique terms. Content coverage of SNOMED CT was high (99.9% with pre-coordinated concepts; 100% with post-coordination). The resulting reference set for ADIs was implemented as the interface terminology on OpenMRS data entry forms. CONCLUSION: Different sources demonstrate complementarity in the collection of concepts and terms for an interface terminology. SNOMED CT provides a high coverage in the domain of ADIs. Further work is needed to evaluate the effect of the interface terminology on data quality and quality of care.

24 Article Supporting early career health investigators in Kenya: A qualitative study of HIV/AIDS research capacity building. 2015

Daniels, Joseph / Nduati, Ruth / Kiarie, James / Farquhar, Carey. ·Department of Global Health, University of Washington, USA. · Department of Global Health, University of Washington, USA ; Department of Pediatrics and Child, Health University of Nairobi, Kenya. · Department of Global Health, University of Washington, USA ; Department of Obstetrics and Gynaecology, University of Nairobi, Kenya. · Department of Global Health, University of Washington, USA ; Department of Medicine, University of Washington, USA ; Department of Epidemiology, University of Washington, USA. ·Pan Afr Med J · Pubmed #26113923.

ABSTRACT: INTRODUCTION: Strategies to transfer international health research training programs to sub-Saharan African institutions focus on developing cadres of local investigators who will lead such programs. Using a critical leadership theory framework, we conducted a qualitative study of one program to understand how collaborative training and research can support early career investigators in Kenya toward the program transfer goal. METHODS: We used purposive sampling methods and a semi-structured protocol to conduct in-depth interviews with US (N = 5) and Kenyan (N = 5) independent investigators. Transcripts were coded using a two-step process, and then compared with each other to identify major themes. RESULTS: A limited local research environment, funding needs and research career mentorship were identified as major influences on early career researchers. Institutional demands on Kenyan faculty to teach rather than complete research restricted investigators' ability to develop research careers. This was coupled with lack of local funding to support research. Sustainable collaborations between Kenyan, US and other international investigators were perceived to mitigate these challenges and support early career investigators who would help build a robust local research environment for training. CONCLUSION: Mutually beneficial collaborations between Kenyan and US investigators developed during training mitigate these challenges and build a supportive research environment for training. In these collaborations, early career investigators learn how to navigate the complex international research environment to build local HIV research capacity. Shared and mutually beneficial resources within international research collaborations are required to support early career investigators and plans to transfer health research training to African institutions.

25 Article Diagnostic challenges of oral and cutaneous Kaposi's sarcoma in resource-constrained settings. 2015

Speicher, David J / Wanzala, Peter / D'Lima, Melvin / Njiru, Anthony / Chindia, Mark / Dimba, Elisabeth / Johnson, Newell W. ·School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia. · Molecular Basis of Disease Research Program, Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia. · Population & Social Health Research Program (Population Oral Health), Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia. · Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya. · Kenyatta National Hospital, Nairobi, Kenya. · School of Dental Sciences, University of Nairobi, Nairobi, Kenya. ·J Oral Pathol Med · Pubmed #25782476.

ABSTRACT: OBJECTIVES: Kaposi's sarcoma (KS), caused by HHV-8, is the most frequent HIV-associated malignancy worldwide and remains a major scourge in Sub-Saharan Africa. KS is also endemic in much of Africa. There is a risk of misdiagnosis based solely on clinical appearance and haematoxylin and eosin (H&E) staining, especially with other reactive and neoplastic vascular proliferations which occur in the mouth. This study examined oral and cutaneous biopsies from clinically diagnosed lesions of KS in Kenya, using histopathology supplemented with immunohistochemistry (IHC) and polymerase chain reaction (PCR) for HHV-8 as confirmation of diagnosis. METHODS: Biopsies of 49 lesions (28 oral, 21 cutaneous) previously diagnosed as 'KS' were re-examined by H&E staining and IHC targeting HHV-8 LANA-1. Positive controls were sections from embedded BCBL-1 cell lines. Negative controls were from three different HHV-8-negative biopsies. Confirmation of HHV-8 immunohistochemistry was sought by PCR and by determining the HHV-8 ORFK1 subtype. RESULTS: Whilst most cases were confirmed, 12 oral and 4 cutaneous lesions displayed clinical and histological features of KS but were negative to HHV-8 IHC. These oral lesions were re-diagnosed as pyogenic granulomata (n = 6), deep mycosis (n = 1), inflamed mucosa (n = 2) or 'uncertain but not KS' (n = 3). Whilst PCR is usually helpful in differentiating HHV-8 disease, all samples were HHV-8 PCR positive, with identical sequences, suggesting cross-contamination of samples in the original pathology laboratories. CONCLUSION: HHV-8 IHC is essential for the correct diagnosis of KS, but due to the high level of contamination in resource-poor settings, PCR is inadvisable.