Acceptability of HIV Testing and Counseling Services among Persons Visiting a Funeral Home in a Regional Referral Hospital in Western Kenya, 2014-2015

Funeral homes in health facilities are accessed by persons who may not visit other parts of the hospital to access HTC services. Between November 2014 and February 2015, all persons visiting the Jaramogi Oginga Odinga Teaching and Referral Hospital funeral home were offered HTC and grief counseling services and interviewed to determine the acceptability of HTC services at this location. This was done as they waited for various services. ‘Acceptability’ was defined as the proportion of those who felt people should receive HTC services at the funeral home. Qualitative data was manually coded and thematically analyzed. Of 609 persons interviewed, majority were aged 25-34 years (33%), female (54%), married (68%), of primary level education (39%), self-employed (49%) and were not related to the deceased (53%). Majority had come to collect/bring the body of the deceased (63%) and had undergone prior testing (91%). A minority (2%) who found HTC services unacceptable were aged 18-24 years (42%), single (50%), of tertiary level education (58%), came to collect/bring the bodies of their deceased (83%), had ever been tested (92%) and were self-employed (33%) or unemployed (33%). Respondents stated that this was because, “….the bereaved not in the right frame of mind” (76%) and “…the HTC service-providers were very conspicuous” (26%). Acceptability did not differ by age-group, gender or relationship to the deceased. Of the 569 (93%) who were tested, 42 (7%) were first-time testers; HIV prevalence was 3% and 5% respectively. Funeral homes provide acceptable avenues for increasing access to knowledge of HIV status which could have a substantial impact on the HIV epidemic

Victims and Perpetrators of Intimate Partner Violence Among Sexually Active Youth in a Community With a High HIV Prevalence in Western Kenya

Background: Physical intimate partner violence (IPV) is an important risk factor for sexually transmitted infections, including HIV. We set out to determine the prevalence and correlates of IPV among youth aged 15 to 24 years – in a community with a high HIV prevalence – with a view to recommending strategies to address IPV.   Methods: We analysed data from an HIV seroprevalence survey, which included participants aged 13 years and above and was conducted between November 2012 and December 2014 in Gem Subcounty, Siaya County, Western Kenya. Participants between 15 and 24 years old (youth) were described as “perpetrators of IPV” if they had done anything to physically hurt their sexual partners in the previous year and as “victims of IPV” if they had been physically hurt by a sexual partner in the same timeframe. Logistic regression was used to determine factors associated with being either a victim or perpetrator of IPV.   Results: Of 1,957 participants included in the analysis, 142 (7%) were victims of IPV, and 77 (4%) were perpetrators of IPV. Victims were likely to be women (adjusted odds ratio [AOR] 7.9; 95% CI, 3.6 to 17.5), in a relationship or married (AOR 3.1; 95% CI, 1.8 to 5.4), and to have had multiple lifetime sexual partners. Victims of IPV were also more likely than not to have been subjected to sexual violence in the past (AOR 1.9; 95% CI, 1.0 to 3.4) or recently (AOR 3.9; 95% CI, 2.2 to 6.8). Perpetrators were likely to be men (AOR 2.1; 95% CI, 1.2 to 3.7), with 5 or more lifetime sexual partners (AOR 2.8; 95% CI, 1.3 to 6.3), and to have committed sexual violence recently (AOR 2.9; 95% CI, 1.1 to 7.7).   Conclusion: There was a high prevalence of IPV among sexually active youth in this rural community. Study participants were recurrent victims or perpetrators and reported behaviours that put them at risk of HIV acquisition. Health programmes should screen for IPV victims and perpetrators using identified characteristics. Existing policies regarding gender-based violence should be enforced, and future research should focus on the impact of IPV prevention programmes

Carbapenem resistance expressed by Gram-negative bacilli isolated from a cohort of Libyan patients

Background and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) and other Gram-negative bacteria are among the most common pathogens responsible for both community and hospital acquired infection. The global spread of cephalosporinases in Enterobacteriaceae has led to the increased use of carbapenems resulting in the emergence and rapid spread of CRE. This has become an alarming public health concern, yet the condition in Libya remains unclear. The aim of this study was to obtain a better understanding of CRE strains prevalent in Libyan patients by investigating their phenotypic characteristics and antibiograms. Methods: Gram-negative bacterial species were collected from Misrata Central Hospital, Misrata Cancer Centre and Privet Pathology Laboratories. Clinical samples and swabs were obtained from hospitalised and non-hospitalised patients and from mechanical ventilation and suction machines. Patients who had received antibiotic therapy for at least three days prior to the study were excluded. The identification and characterization of the isolated species were achieved using the growth characteristics on MacConkey and blood agar, spot tests and API 20E or API 20NE biochemical testing systems. Screening for carbapenem resistance was performed using the disk diffusion method with carbapenem 10 μg and cephalosporin 30 μg disks and minimum inhibitory concentrations (MIC) determined using the Sensititre Gram-negative Xtra plate format (GNX2F). All strains demonstrating resistance or reduced susceptibility to one of the four carbapenems were subjected to carbapenememase activity detection using the RAPIDEC CARBA NP test, Modified Hodge test and carbapenem inactivation methods. Results: A total of one hundred and forty isolates representing fourteen bacterial species were isolated from 140 non-duplicated specimens. Clinical specimens included urine samples (96/140, 68.57%), sputum (15/140, 10.71%), surgical wound swabs (18/140, 12.85%), foot swabs from diabetes mellitus (DM) patients (6/140, 4.29%), ear swabs (3/140, 2.14%) and wound swabs (2/140, 1.43%). Thirty-four (24.29%) isolates demonstrated resistance to at least one of the four carbapenems with Klebsiella pneumoniae representing 73.53% (25 isolates) of all carbapenem resistant species, followed by 8.82% for Pseudomonas aeruginosa (3 isolates), 5.88% for both Proteus mirabilis (2 isolates) and Escherichia coli (2 isolates) and 2.94% for both Citrobacter koseri (1 isolate) and Rahnella aquatilis (1 isolate). The other isolates were either susceptible or cephalosporinase producers. Conclusion: This study has revealed the high rate of carbapenem resistance amongst Libyan patients and emphasizes the crucial need for accurate screening, identification and susceptibility testing to prevent further spread of nosocomial and community acquired resistance. This may be achieved through the establishment of antibiotic stewardship programmes along with firm infection control practices.National Research Foundation of South Africa; Libyan GovernmentWeb of Scienc

The use of laypersons to support tuberculosis screening at a Kenyan Referral Hospital

Background: The former Nyanza Province of Kenya bore the brunt of HIV-driven tuberculosis (TB); 62% of the 19,152 cases in 2010 were HIV co-infected. The use of laypersons to improve TB case finding in community settings has shown rewarding results in other countries. We have no documented Kenyan experience in health facility settings. We evaluated the benefit of using laypersons to support TB screening and referrals at the former Nyanza Province of kenya province's largest regional referral facility. Methods: In 2010, five high school graduates were trained on symptomatic recognition of TB suspects and assisted sputum production by the region's District's TB and Leprosy Coordinator. They then identified and referred TB suspects (from hospital patients and visitors) at waiting-areas and wards to clinicians and documented their TB screening and referral outcomes. We describe results from one waiting-area with complete documentation between January and December 2011. Results: Of the 217 TB suspects identified, majority were male (55%); their median age was 36 (range 1–70) years. 11% (23) were aged <15 years; 65% (15) were diagnosed with TB by, a combination of sputum microscopy and chest X-rays (5) followed by chest X-ray alone (50), then sputum microscopy alone (1), and TB score chart (4). Of those aged 15+ years, 72% (140) were diagnosed with TB by a combination of sputum microscopy and chest X-rays (75) followed by sputum microscopy alone (38), and chest X-ray alone (27). Excluding cases that transferred out, this process contributed to 33% of Jaramogi Oginga Odinga Teaching and Referral Hospital's annual TB case burden. Conclusions: TB case detection in high TB burden regions can be supported the use of laypersons in hospital settings

Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya.

OBJECTIVE:To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya. DESIGN:Prospective cohort study. METHODS:PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and "Improving Diagnosis of TB in HIV-infected persons" (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey. RESULTS:Overall, 738 (85.6%) of 862 PLHIV enrolled were included in the analysis. Estimated TB prevalence was 11.2% (95% CI, 9.9-12.7). Sensitivity of the three screening algorithms was similar [WHO, 74.1% (95% CI, 64.1-82.2); MOH, 77.5% (95% CI, 68.6-84.5); and ID-TB/HIV, 72.5% (95% CI, 60.9-81.7)]. Sensitivity of the WHO algorithm was significantly lower among HIV-infected pregnant women [28.2% (95% CI, 14.9-46.7)] compared to non-pregnant women [78.3% (95% CI, 67.3-86.4)] and men [77.2% (95% CI, 68.3-84.2)]. Chest radiography increased WHO algorithm sensitivity and negative predictive value to 90.9% (95% CI, 86.4-93.9) and 96.1% (95% CI, 94.4-97.3), respectively, among asymptomatic men and non-pregnant women. CONCLUSIONS:Clinical screening missed approximately 25% of laboratory-confirmed TB cases among all PLHIV and more than 70% among HIV-infected pregnant women. National HIV programs should evaluate the feasibility of laboratory-based screening for TB, such as a single Xpert MTB/RIF test for all PLHIV, especially pregnant women, at enrollment in HIV services

Sensitivity of Xpert MTB/RIF and liquid culture of sputum specimens provided by TB cases (as compared to a composite gold standard), stratified by CD4 cell count of participant and specimen collection type (spot vs. morning).

<p>Sensitivity of Xpert MTB/RIF and liquid culture of sputum specimens provided by TB cases (as compared to a composite gold standard), stratified by CD4 cell count of participant and specimen collection type (spot vs. morning).</p