HIV Prevalence and the HIV Treatment Cascade Among Female Sex Workers in Cross-Border Areas in East Africa

In cross-border areas of East Africa, sexual networks include partnerships across resident, migrant, and mobile populations, and risky behaviors can coincide with fragmented health services given the challenges of cross-border coordination. Among those most at risk are female sex workers (FSWs). We map HIV prevalence among FSWs in 14 cross-border areas, estimate associations between FSW characteristics and HIV and undiagnosed HIV, and estimate progress towards the UNAIDS 90–90–90 targets. The 2016–2017 East Africa Cross-Border Integrated Health Study recruited 4040 women; 786 were classified as FSWs. Overall HIV prevalence among FSWs was 10.8% (95% CI 8.2%, 13.3%), though area-specific estimates varied considerably. Among FSWs living with HIV, 46.1% (95% CI 33.2%, 59.0%) knew their status, 80.6% (95% CI 66.3%, 94.9%) of FSWs who knew their status were on ART, and 84.8% (95% CI 66.1%, 100.0%) of FSWs on ART were virally suppressed. Results indicate a need for expanded HIV testing

Improving HIV outreach testing yield at cross-border venues in East Africa

Objective: The aim of this study was to evaluate HIV testing yield under several candidate strategies for outreach testing at venues (i.e. places where people socialize and meet new sex partners) in East Africa cross-border areas. Design: Population-based cross-sectional biobehavioural survey of people who had not been previously diagnosed with HIV found in venues. Methods: We identified participants who would have been tested for HIV under each of 10 hypothetical outreach testing strategies and calculated the proportion who would have newly tested positive for HIV under each strategy. On the basis of this proportion, we calculated the 'number needed to test' (NNT) to identify one new case of HIV under each strategy. All estimates were obtained by applying survey sampling weights to account for the complex sampling design. Results: If testing was performed at a random sample of venues, 35 people would need to be tested to identify one new case of HIV, but higher yield could be found by limiting testing to venues with specific characteristics. Strategies focusing on women had higher testing yield. Testing women employed by venues would result in highest yield of all strategies examined (NNT=15), while testing men under age 24 would result in the lowest yield (NNT=99). Conclusion: Quantitatively evaluating HIV testing strategies prior to implementation using survey data presents a new opportunity to refine and prioritize outreach testing strategies for the people and places most likely to result in high HIV testing yiel

The HIV care continuum among resident and non-resident populations found in venues in East Africa cross-border areas

Introduction: HIV care and treatment in cross-border areas in East Africa face challenges perhaps not seen to the same extent in other geographic areas, particularly for mobile and migrant populations. Here, we estimate the proportion of people with HIV found in these cross-border areas in each stage of the HIV care and treatment cascade, including the proportion who knows their status, the proportion on treatment and the proportion virally suppressed. Methods: Participants (n = 11,410) working or socializing in public places in selected East Africa cross border areas were recruited between June 2016 and February 2017 using the Priorities for Local AIDS Control Efforts method and administered a behavioural survey and rapid HIV test. This approach was designed to recruit a stratified random sample of people found in public spaces or venues in each cross border area. For participants testing positive for HIV, viral load was measured from dried blood spots. The proportion in each step of the cascade was estimated using inverse probability weights to account for the sampling design and informative HIV test refusals. Estimates are reported separately for residents of the cross border areas and non-residents found in those areas. Results: Overall, 43% of participants with HIV found in cross-border areas knew their status, 87% of those participants were on antiretroviral therapy (ART), and 80% of participants on ART were virally suppressed. About 20% of people with HIV found in cross border areas were sampled outside their subdistrict or subcounty of residence. While both resident and non-resident individuals who knew their status were likely to be on ART (85% and 96% respectively), people on ART recruited outside their area of residence were less likely to be suppressed (64% suppressed; 95% CI: 43, 81) compared to residents (84% suppressed; 95% CI: 75, 93). Conclusions: People living in or travelling through cross-border areas may face barriers in learning their HIV status. Moreover, while non-residents were more likely to be on treatment than residents, they were less likely to be suppressed, suggesting gaps in continuity of care for people in East Africa travelling outside their area of residence despite timely initiation of treatment

Impacts of dietary forage and crude protein levels on the shedding of Escherichia coli O157:H7 and Listeria in dairy cattle feces

Shedding of Escherichia coli O157:H7 and Listeria monocytogenes in ruminant manure is well reported. However, the influence of dietary manipulation on the shedding of the pathogens is not well understood. This study was conducted to improve the understanding of the relationship between dietary feed composition and pathogen shedding in dairy feces, particularly E. coli O157:H7 and L. monocytogenes. Twelve cows were randomly assigned to a 2 × 2 factorial arrangement of 2 dietary forage levels: low forage (37.4% of dry matter [DM]) vs. high forage (HF, 53.3% of DM) and two dietary crude protein (CP) levels: low protein (LP, 15.2% of DM) vs. high protein (HP, 18.5% of DM) in a 4 × 4 replicated Latin square design with four periods each including 15 d adaptation and 3 d sample collection. In CP treatments, significantly low concentrations of L. monocytogenes were observed from cows fed the HP (0.9-1.6 log10 cfu/g) compared to the LP diet (1.3–2.1 log10 cfu/g). Significant interaction effect was observed between dietary forage and crude protein on the presence of E. coli O157:H7 (P < 0.05) but not on L. monocytogenes. On average, the highest E. coli O157:H7 concentration (6.5 log10 cfu/g of feces) was observed from the HF and HP diet and the lowest concentration was 6.2 log10cfu/g from the HF and LP diet. The average L. monocytogenes shedding was within the range of 1.8 to 2.4 log 10cfu/g among the treatments. The study showed that diet has an influence on the shedding of pathogenic bacteria in dairy excreta

Influence of amyloglucosidase in bread crust properties

Enzymes are used in baking as a useful tool for improving the processing behavior or properties of baked products. A number of enzymes have been proposed for improving specific volume, imparting softness, or extend the shelf life of breads, but scarce studies have been focused on bread crust. The aim of this study was to determine the use of amyloglucosidase for modulating the properties of the bread crust and increase its crispness. Increasing levels of enzyme were applied onto the surface of two different partially bake breads (thin and thick crust bread). Amyloglucosidase treatment affected significantly (P<0.05) the color of the crust and decreased the moisture content and water activity of the crusts. Mechanical properties were modified by amyloglucosidase, namely increasing levels of enzyme promoted a decrease in the force (Fm) required for crust rupture and an increase in the number of fracture events (Nwr) related to crispy products. Crust microstructure analysis confirmed that enzymatic treatment caused changes in the bread crust structure, leading to a disruption of the structure, by removing the starchy layer that covered the granules and increasing the number of voids, which agree with the texture fragility.Authors acknowledge the financial support of Spanish Ministry of Economy and Sustainability (Project AGL2011-23802), the European Regional Development Fund (FEDER), Generalitat Valenciana (Project Prometeo 2012/064) and the Consejo Superior de Investigaciones Cientificas (CSIC). R. Altamirano-Fortoul would like to thank her grant to CSIC. The authors also thank Forns Valencians S. A. (Spain) for supplying commercial frozen partially baked breads.Altamirano Fortoul, RDC.; Hernando Hernando, MI.; Molina Rosell, MC. (2014). Influence of amyloglucosidase in bread crust properties. 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FACTORS CONTRIBUTING TO LOW M-KESHO ADOPTION AMONG SUBSCRIBERS

ABSTRACT Millions of people across the developing world do not have access to banking services. Kenya has undergone a remarkable information and communications technology (ICT) revolution. A unique facet of the ICT phenomenon in Kenya has been the widespread proliferation of mobile money such as Mkesho. However, in Kenya evidence shows that there is a low uptake of Mkesho services among the subscribers. The scope of the study was undertaken in Nairobi region. The descriptive survey research design was adopted and analysis tools used to analyze the factors that contribute to the performance of the Mkesho. Data was collected using structured and unstructured questionnaire and then analyzed using descriptive statistics and content analysis. Quantitative data was presented using tables and percentages. The level of bureaucracy had influenced the rate of Mkesho adoption. The registration procedures were viewed by subscribers as been unnecessaril

Access to HIV prevention services in East African cross‐border areas: a 2016‐2017 cross‐sectional bio‐behavioural study

Introduction: East African cross-border areas are visited by mobile and vulnerable populations, such as men, female sex workers, men who have sex with men, truck drivers, fisher folks and young women. These groups may not benefit from traditional HIV prevention interventions available at the health facilities where they live, but may benefit from services offered at public venues identified as places where people meet new sexual partners (e.g. bars, nightclubs, transportation hubs and guest houses). The goal of this analysis was to estimate availability, access and uptake of prevention services by populations who visit these venues. Methods: We collected cross-sectional data using the Priorities for Local AIDS Control Efforts sampling method at cross-border locations near or along the land and lake borders of Kenya, Rwanda, Tanzania and Uganda from June 2016–February 2017. This bio-behavioural survey captured information from a probability sample of 11,428 individuals at 833 venues across all areas. Data were weighted using survey sampling weights and analysed using methods to account for the complex sampling design. Results: Among the 85.6% of persons who had access to condoms, 60.5% did not use a condom at their last anal or vaginal sexual encounter. Venues visited by high percentages of persons living with HIV were not more likely than other venues to offer condoms. In 12 of the 22 cross-border areas, male or female condoms were available at less than 33% of the venues visited by persons having difficulty accessing condoms. In 17 of the 22 cross-border areas, education outreach visits in the preceding six months occurred at less than 50% of the venues where participants had low effective use of condoms. Conclusions: Individuals visiting venues in cross-border areas report poor access to and low effective use of condoms and other prevention services. Availability of HIV prevention services differed by venue and population type and cross-border area, suggesting opportunities for more granular targeting of HIV prevention interventions and transnational coordination of HIV programming

Validation of 24-hour dietary recall in Ugandan children by simultaneous weighed food assessment

Background: Undernutrition remains highly prevalent in African children, highlighting the need for accurately assessing dietary intake. In order to do so, the assessment method must be validated in the target population. A triple pass 24 hour dietary recall with volumetric portion size estimation has been described but not previously validated in African children. This study aimed to establish the relative validity of 24-hour dietary recalls of daily food consumption in healthy African children living in Mbale and Soroti, eastern Uganda compared to simultaneous weighed food records. Methods: Quantitative assessment of daily food consumption by weighed food records followed by two independent assessments using triple pass 24-hour dietary recall on the following day. In conjunction with household measures and standard food sizes, volumes of liquid, dry rice, or play dough were used to aid portion size estimation. Inter-assessor agreement, and agreement with weighed food records was conducted primarily by Bland-Altman analysis and secondly by intraclass correlation coefficients and quartile cross-classification. Results: 19 healthy children aged 6 months to 12 years were included in the study. Bland-Altman analysis showed 24-hour recall only marginally under-estimated energy (mean difference of 149kJ or 2.8%; limits of agreement -1618 to 1321kJ), protein (2.9g or 9.4%; -12.6 to 6.7g), and iron (0.43mg or 8.3%; -3.1 to 2.3mg). Quartile cross-classification was correct in 79% of cases for energy intake, and 89% for both protein and iron. The intraclass correlation coefficient between the separate dietary recalls for energy was 0.801 (95% CI, 0.429-0.933), indicating acceptable inter-observer agreement. Conclusions: Dietary assessment using 24-hour dietary recall with volumetric portion size estimation resulted in similar and acceptable estimates of dietary intake compared with weighed food records and thus is considered a valid method for daily dietary intake assessment of children in communities with similar diets. The method will be utilised in a sub-study of a large randomised controlled trial addressing treatment in severe childhood anaemia