Landcare Bylaws Increase Adoption of Soil Erosion Control Technologies: Evidence from Mt. Elgon Highlands in Eastern Uganda

Uganda faces severe environmental problems such as soil erosion, yet adoption of technologies that can sustainably reduce or stop soil erosion remains low. This is partly due to lack of locally enacted landcare bylaws and limited involvement of local communities in bylaws formulation. Using a case study of Kween district we assessed the effect of landcare bylaws and local community involvement in bylaws formulation on adoption of soil erosion control technologies. The study used primary data collected from a survey of 120 randomly selected farmers and secondary information synthesized from Kapchorwa District Landcare Chapter reports, consultative workshops attendance lists, lists of members on the Bylaw Implementation Committee, and the printed poster of the ‘‘Benet landcare bylaws”. The data was analysed through generation of descriptive statistics. Findings indicate that there was minimal involvement of local communities in bylaws formulation. Although penalties for breaking the enacted landcare bylaws exist, they were yet to be enforced. Further, we note a sharp increase in adoption levels of all technologies stipulated in the bylaws during the year (2009) when the bylaws were passed and popularized. Adoption of soil erosion control technologies is highest among people who participated in the formulation of the bylaws. Thus, we conclude that other factors remaining constant, both the landcare bylaws, and involvement of local communities in bylaws formulation are associated with increase in technology adoption. Keywords: Landcare bylaws; Community involvement; Uganda

Profitability of soil erosion control technologies in Eastern Uganda Highlands

The lack of farmer awareness of costs and benefits associated with the use of sustainable land management (SLM) technologies is one of the major constraints to technology adoption in sub-Saharan Africa. The objective of this study was to estimate the profitability of application of SLM in the form of soil erosion control technologies by communities in the highlands of eastern Uganda; a hot spot for this land degradation agent. A survey was conducted using 240 farmers in the highlands of eastern Uganda. The findings from Partial Budget Analysis indicate that the net returns associated with the use of soil erosion control technologies, are sufficiently high to offset the costs involved. For example, for every US$invested per hectare in terracing and tree planting, there is a return of over US$ 15. However, these returns are likely to be much less if inflation is not regulated. For example, the profits expected from the use of terraces and trees would reduce by about 3 percent if inflation rose to 30 percent. Thus, for the benefits to be sustainable, farmers have to regularly maintain the structures (terraces, contours, and trenches) and the vegetation (trees and grasses). Also, use of soil erosion control technologies would remain profitable only if the Central Bank fulfils its mandate of keeping inflation low and stable.Le manque de connaissance sur les co\ufbts et les b\ue9n\ue9fices li\ue9s \ue0 l\u2019utilisation des technologies de la gestion durable de terres (SLM) est l\u2019une des contraintes majeurs \ue0 l\u2019adoption des technologies en Afrique Sub-Saharienne. L\u2019objectif de cette \ue9tude \ue9tait d\u2019estimer la profitabilit\ue9 de l\u2019application les technologies SLM de lutte contre l\u2019\ue9rosion par les communaut\ue9s des hautes terres de l\u2019Est de l\u2019Uganda, un lieu de pr\ue9dilection de cet agent de d\ue9gradation de sol. Une enqu\ueate \ue9tait conduite utilisant 240 fermiers dans les terre de l\u2019Est de l\u2019Uganda. Les r\ue9sultats de l\u2019analyse du budget partiel indiquent que les b\ue9n\ue9fices provenant de l\u2019utilisation des technologies anti-\ue9rosives sont suffisamment \ue9lev\ue9s pour compenser les co\ufbts impliqu\ue9s. Par exemple, pour chaque US investi par hectare dans les travux de terracement et plantation d\u2019arbre, il ya un b\ue9n\ue9fice de plus de US 15. Par ailleurs, ces b\ue9n\ue9fices sont vraissemblablement r\ue9duits si l\u2019inflation n\u2019est pas r\ue9gul\ue9e. Par exemple, les profits attendus de l\u2019utilisation des terraces et arbres plant\ue9s se trouveraient r\ue9duits de trois pourcent si l\u2019inflation augmente de trente pourcent. Ainsi, pour que les b\ue9n\ue9fices soient durables, les fermiers doivent r\ue9guli\ue8rement maintenir les structures (terraces, contours et trench\ue9es) et la vegetation (arbres et herbes). Aussi, l\u2019utilisation des technologies de contr\uf4le de l\u2019\ue9rosion du sol pourraient demeurer b\ue9n\ue9fiques seulement si la Banque Centrale remplit correctement son mandat de garder l\u2019inflation basse et stable

Adherence to Antiretroviral Therapy among HIV Infected Children Measured by Caretaker Report, Medication Return, and Drug Level in Dar Es Salaam, Tanzania.

Adherence to antiretroviral drugs in the treatment of paediatric HIV infection is complicated because of many factors including stigma and drug intake logistics. It is therefore important to identify children with non-adherence in order to intervene before they become at risk of developing treatment failure or drug resistance. The aim of this study was to determine the level of adherence to antiretroviral therapy (ART), measured by caretaker report, medication return and nevirapine plasma concentration. In addition, the association between level of adherence and patient's immune status was compared across the three methods of measuring adherence. This was a descriptive cross-sectional study involving HIV infected children aged 2-14 years, on nevirapine- based antiretroviral treatment for at least six months, attending care and treatment clinic in three municipal hospitals in Dar- Es- Salaam City. Eligible patients and their accompanying caretakers were consecutively enrolled after obtaining written informed consent. Structured questionnaires were administered to caretakers to assess patient's adherence by caretaker report and medication return whereas a single blood sample for CD4 cell count/percent and determination of nevirapine plasma concentration was taken from patients on the day of assessment. A total of 300 patients and accompanying caretakers were enrolled and the mean patient age (SD) was 8 (3) years. Caretakers' report and medication return showed good adherence (98% and 97%) respectively. However, the level of adherence assessed by nevirapine plasma concentration (85%) was significantly lower than caretaker report and medication return (p < 0.001). The agreement between nevirapine plasma concentration and medication return and between nevirapine plasma concentration and caretaker report was weak (k = 0. 131) (k = 0. 09) respectively. Nevirapine plasma concentration below 3 μg/ml was associated with immunosuppression (p = 0. 021) whereas medication return (>5% of prescribed doses) and caretaker reported missing more than one dose within 72 hours prior to interview were not associated with immunosuppression (p = 0. 474), (p = 0. 569) respectively. Lower adherence level observed using nevirapine plasma concentration and its association with immunological response supports the validity of the method and indicates that adherence data obtained from caretaker report and medication return may overestimate the true adherence in paediatric antiretroviral therapy

Reproducibility matters: intra- and inter-sample variation of the point-of-care circulating cathodic antigen test (POC-CCA) in two Schistosoma mansoni endemic areas in Uganda

Over 240 million people are infected with schistosomiasis. Detecting Schistosoma mansoni eggs in stool using Kato–Katz thick smears (Kato-Katzs) is highly specific but lacks sensitivity. The urine-based point-of-care circulating cathodic antigen test (POC-CCA) has higher sensitivity, but issues include specificity, discrepancy between batches and interpretation of trace results. A semi-quantitative G-score and latent class analyses making no assumptions about trace readings have helped address some of these issues. However, intra-sample and inter-sample variation remains unknown for POC-CCAs. We collected 3 days of stool and urine from 349 and 621 participants, from high- and moderate-endemicity areas, respectively. We performed duplicate Kato-Katzs and one POC-CCA per sample. In the high-endemicity community, we also performed three POC-CCA technical replicates on one urine sample per participant. Latent class analysis was performed to estimate the relative contribution of intra- (test technical reproducibility) and inter-sample (day-to-day) variation on sensitivity and specificity. Within-sample variation for Kato-Katzs was higher than between-sample, with the opposite true for POC-CCAs. A POC-CCA G3 threshold most accurately assesses individual infections. However, to reach the WHO target product profile of the required 95% specificity for prevalence and monitoring and evaluation, a threshold of G4 is needed, but at the cost of reducing sensitivity. This article is part of the theme issue ‘Challenges and opportunities in the fight against neglected tropical diseases: a decade from the London Declaration on NTDs’

Excellent Adherence to Antiretrovirals in HIV+ Zambian Children Is Compromised by Disrupted Routine, HIV Nondisclosure, and Paradoxical Income Effects

INTRODUCTION: A better understanding of pediatric antiretroviral therapy (ART) adherence in sub-Saharan Africa is necessary to develop interventions to sustain high levels of adherence. METHODOLOGY/PRINCIPAL FINDINGS: Adherence among 96 HIV-infected Zambian children (median age 6, interquartile range [IQR] 2,9) initiating fixed-dose combination ART was measured prospectively (median 23 months; IQR 20,26) with caregiver report, clinic and unannounced home-based pill counts, and medication event monitoring systems (MEMS). HIV-1 RNA was determined at 48 weeks. Child and caregiver characteristics, socio-demographic status, and treatment-related factors were assessed as predictors of adherence. Median adherence was 97.4% (IQR 96.1,98.4%) by visual analog scale, 94.8% (IQR 86,100%) by caregiver-reported last missed dose, 96.9% (IQR 94.5,98.2%) by clinic pill count, 93.4% (IQR 90.2,96.7%) by unannounced home-based pill count, and 94.8% (IQR 87.8,97.7%) by MEMS. At 48 weeks, 72.6% of children had HIV-1 RNA <50 copies/ml. Agreement among adherence measures was poor; only MEMS was significantly associated with viral suppression (p = 0.013). Predictors of poor adherence included changing residence, school attendance, lack of HIV disclosure to children aged nine to 15 years, and increasing household income. CONCLUSIONS/SIGNIFICANCE: Adherence among children taking fixed-dose combination ART in sub-Saharan Africa is high and sustained over two years. However, certain groups are at risk for treatment failure, including children with disrupted routines, no knowledge of their HIV diagnosis among older children, and relatively high household income, possibly reflecting greater social support in the setting of greater poverty

Adherence to highly active antiretroviral therapy and its correlates among HIV infected pediatric patients in Ethiopia

BACKGROUND: The introduction of combination antiretroviral therapy (ART) has resulted in striking reductions in HIV-related mortality. Despite increased availability of ART, children remain a neglected population. This may be due to concerns that failure to adhere appears to be related to continued viral replication, treatment failure and the emergence of drug-resistant strains of HIV. This study determines the rates and factors associated with adherence to Antiretroviral (ARV) Drug therapy in HIV-infected children who were receiving Highly Active Antiretroviral Therapy (HAART) in Addis Ababa, Ethiopia in 2008. METHODS: A cross-sectional study was conducted in five hospitals in Addis Ababa from February 18 - April 28, 2008. The study population entailed parents/caretaker and index children who were following ART in the health facilities. A structured questionnaire was used for data collection. RESULTS: A total of 390 children respondents were included in the study with a response rate of 91%. The majority, equaling 205 (52.6%) of the children, were greater than 9 years of age. Fifty five percent of the children were girls. A total of 339 children (86.9%) as reported by caregivers were adherent to antiretroviral drugs for the past 7 days before the interview. Numerous variables were found to be significantly associated with adherence: children whose parents did not pay a fee for treatment [OR = 0.39 (95%CI: 0.16, 0.92)], children who had ever received any nutritional support from the clinic [OR = 0.34 (95%CI: 0.14, 0.79)] were less likely to adhere. Whereas children who took co-trimoxazole medication/syrup besides ARVs [OR = 3.65 (95%CI: 1.24, 10.74)], children who did not know their sero-status [OR = 2.53 (95%CI: 1.24, 5.19)] and children who were not aware of their caregiver's health problem [OR = 2.45 (95%CI: 1.25, 4.81)] were more likely to adhere than their counterparts. CONCLUSION: Adherence to HAART in children in Addis Ababa was higher than other similar set-ups. However, there are still significant numbers of children who are non-adherent to HAART

Multiple Measures Reveal Antiretroviral Adherence Successes and Challenges in HIV-Infected Ugandan Children

Background: Adherence to HIV antiretroviral therapy (ART) among children in developing settings is poorly understood. Methodology/Principal Findings: To understand the level, distribution, and correlates of ART adherence behavior, we prospectively determined monthly ART adherence through multiple measures and six-monthly HIV RNA levels among 121 Ugandan children aged 2–10 years for one year. Median adherence levels were 100% by three-day recall, 97.4% by 30-day visual analog scale, 97.3% by unannounced pill count/liquid formulation weights, and 96.3% by medication event monitors (MEMS). Interruptions in MEMS adherence of $\geq$48 hours were seen in 57.0% of children; 36.3% had detectable HIV RNA at one year. Only MEMS correlated significantly with HIV RNA levels (r = −0.25, p = 0.04). Multivariable regression found the following to be associated with <90% MEMS adherence: hospitalization of child (adjusted odds ratio [AOR] 3.0, 95% confidence interval [CI] 1.6–5.5; p = 0.001), liquid formulation use (AOR 1.4, 95%CI 1.0–2.0; p = 0.04), and caregiver’s alcohol use (AOR 3.1, 95%CI 1.8–5.2; p<0.0001). Child’s use of co-trimoxazole (AOR 0.5, 95%CI 0.4–0.9; p = 0.009), caregiver’s use of ART (AOR 0.6, 95%CI 0.4–0.9; p = 0.03), possible caregiver depression (AOR 0.6, 95%CI 0.4–0.8; p = 0.001), and caregiver feeling ashamed of child’s HIV status (AOR 0.5, 95%CI 0.3–0.6; p<0.0001) were protective against <90% MEMS adherence. Change in drug manufacturer (AOR 4.1, 95%CI 1.5–11.5; p = 0.009) and caregiver’s alcohol use (AOR 5.5, 95%CI 2.8–10.7; p<0.0001) were associated with $\geq$48-hour interruptions by MEMS, while second-line ART (AOR 0.3, 95%CI 0.1–0.99; p = 0.049) and increasing assets (AOR 0.7, 95%CI 0.6–0.9; p = 0.0007) were protective against these interruptions. Conclusions/Significance: Adherence success depends on a well-established medication taking routine, including caregiver support and adequate education on medication changes. Caregiver-reported depression and shame may reflect fear of poor outcomes, functioning as motivation for the child to adhere. Further research is needed to better understand and build on these key influential factors for adherence intervention development