A Model for HIV Disclosure of a Parent\u27s And/Or a Child\u27s Illness

HIV prevalence in Kenya remains steady at 5.6% for adults 15 years and older, and 0.9% among children aged below 14 years. Parents and children are known to practice unprotected sex, which has implications for continued HIV spread within the country. Additionally, due to increased accessibility of antiretroviral therapy, more HIV-positive persons are living longer. Therefore, the need for HIV disclosure of a parent\u27s and/or a child\u27s HIV status within the country will continue for years to come. We conducted a qualitative phenomenological study to understand the entire process of disclosure from the time of initial HIV diagnosis of an index person within an HIV-affected family, to the time of full disclosure of a parent\u27s and/or a child\u27s HIV status to one or more HIV-positive, negative, or untested children within these households. Participants were purposively selected and included 16 HIV-positive parents, seven HIV-positive children, six healthcare professionals (physician, clinical officer, psychologist, registered nurse, social worker, and a peer educator), and five HIV-negative children. All participants underwent an in-depth individualized semistructured interview that was digitally recorded. Interviews were transcribed and analyzed in NVivo 8 using the modified Van Kaam method. Six themes emerged from the data indicating that factors such as HIV testing, living with HIV, evolution of disclosure, questions, emotions, benefits, and consequences of disclosure interact with each other and either impede or facilitate the HIV disclosure process. Kenya currently does not have guidelines for HIV disclosure of a parent\u27s and/or a child\u27s HIV status. HIV disclosure is a process that may result in poor outcomes in both parents and children. Therefore, understanding how these factors affect the disclosure process is key to achieving optimal disclosure outcomes in both parents and children. To this end, we propose an HIV disclosure model incorporating these six themes that is geared at helping healthcare professionals provide routine, clinic-based, targeted, disclosure-related counseling/advice and services to HIV- positive parents and their HIV-positive, HIV-negative, and untested children during the HIV disclosure process. The model should help improve HIV disclosure levels within HIV-affected households. Future researchers should test the utilit

A Model for HIV Disclosure of a Parent\u27s And/Or a Child\u27s Illness

HIV prevalence in Kenya remains steady at 5.6% for adults 15 years and older, and 0.9% among children aged below 14 years. Parents and children are known to practice unprotected sex, which has implications for continued HIV spread within the country. Additionally, due to increased accessibility of antiretroviral therapy, more HIV-positive persons are living longer. Therefore, the need for HIV disclosure of a parent\u27s and/or a child\u27s HIV status within the country will continue for years to come. We conducted a qualitative phenomenological study to understand the entire process of disclosure from the time of initial HIV diagnosis of an index person within an HIV-affected family, to the time of full disclosure of a parent\u27s and/or a child\u27s HIV status to one or more HIV-positive, negative, or untested children within these households. Participants were purposively selected and included 16 HIV-positive parents, seven HIV-positive children, six healthcare professionals (physician, clinical officer, psychologist, registered nurse, social worker, and a peer educator), and five HIV-negative children. All participants underwent an in-depth individualized semistructured interview that was digitally recorded. Interviews were transcribed and analyzed in NVivo 8 using the modified Van Kaam method. Six themes emerged from the data indicating that factors such as HIV testing, living with HIV, evolution of disclosure, questions, emotions, benefits, and consequences of disclosure interact with each other and either impede or facilitate the HIV disclosure process. Kenya currently does not have guidelines for HIV disclosure of a parent\u27s and/or a child\u27s HIV status. HIV disclosure is a process that may result in poor outcomes in both parents and children. Therefore, understanding how these factors affect the disclosure process is key to achieving optimal disclosure outcomes in both parents and children. To this end, we propose an HIV disclosure model incorporating these six themes that is geared at helping healthcare professionals provide routine, clinic-based, targeted, disclosure-related counseling/advice and services to HIV- positive parents and their HIV-positive, HIV-negative, and untested children during the HIV disclosure process. The model should help improve HIV disclosure levels within HIV-affected households. Future researchers should test the utilit

Parents\u27 and children\u27s emotions spanning the HIV disclosure process in Kenya

2014 APHA Annual Conference Tuesday, November 18, 2014 New Orleans, LA HIV disclosure from parent to child is challenging. While disclosure is expected to be emotion for parents and children, the total disclosure experience has not been described. The purpose of this study was to understand the lived experiences of HIV - positive parents and their children in Kenya during the disclosure process

HIV-Positive Parents, HIV-Positive Children, and HIV-Negative Children’s Perspectives on Disclosure of a Parent’s and Child’s Illness in Kenya

HIV disclosure from parent to child is complex and challenging to HIV-positive parents and healthcare professionals. The purpose of the study was to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. Sixteen HIV-positive parents, seven HIV-positive children, and five HIV-negative children completed semistructured, in-depth interviews. Data were analyzed using the Van Kaam method; NVivo 8 software was used to assist data analysis. We present data on the process of disclosure based on how participants recommended full disclosure be approached to HIV-positive and negative children. Participants recommended disclosure as a process starting at five years with full disclosure delivered at 10 years when the child was capable of understanding the illness, or by 14 years when the child was mature enough to receive the news if full disclosure had not been conducted earlier. Important considerations at the time of full disclosure included the parent’s and/or child’s health statuses, number of infected family members’ illnesses to be disclosed to the child, child’s maturity and understanding level, and the person best suited to deliver full disclosure to the child. The results also revealed it was important to address important life events such as taking a national school examination during disclosure planning and delivery. Recommendations are made for inclusion into HIV disclosure guidelines, manuals, and programs in resource-poor nations with high HIV prevalence

Parents\u27 and children\u27s emotions spanning the HIV disclosure process in Kenya

2014 APHA Annual Conference Tuesday, November 18, 2014 New Orleans, LA HIV disclosure from parent to child is challenging. While disclosure is expected to be emotion for parents and children, the total disclosure experience has not been described. The purpose of this study was to understand the lived experiences of HIV - positive parents and their children in Kenya during the disclosure process

HIV-Positive Parents, HIV-Positive Children, and HIV-Negative Children’s Perspectives on Disclosure of a Parent’s and Child’s Illness in Kenya

HIV disclosure from parent to child is complex and challenging to HIV-positive parents and healthcare professionals. The purpose of the study was to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. Sixteen HIV-positive parents, seven HIV-positive children, and five HIV-negative children completed semistructured, in-depth interviews. Data were analyzed using the Van Kaam method; NVivo 8 software was used to assist data analysis. We present data on the process of disclosure based on how participants recommended full disclosure be approached to HIV-positive and negative children. Participants recommended disclosure as a process starting at five years with full disclosure delivered at 10 years when the child was capable of understanding the illness, or by 14 years when the child was mature enough to receive the news if full disclosure had not been conducted earlier. Important considerations at the time of full disclosure included the parent’s and/or child’s health statuses, number of infected family members’ illnesses to be disclosed to the child, child’s maturity and understanding level, and the person best suited to deliver full disclosure to the child. The results also revealed it was important to address important life events such as taking a national school examination during disclosure planning and delivery. Recommendations are made for inclusion into HIV disclosure guidelines, manuals, and programs in resource-poor nations with high HIV prevalence

Demonstrating PM2.5 and road-side dust pollution by heavy metals along Thika superhighway in Kenya, sub-Saharan Africa

This study assessed the level of heavy metal in roadside dust and PM2.5 mass concentrations along Thika superhighway in Kenya. Thika superhighway is one of the busiest roads in Kenya, linking Thika town with Nairobi. Triplicate road dust samples collected from 12 locations were analysed for lead (Pb), chromium (Cr), cadmium (Cd), nickel (Ni), zinc (Zn), and copper (Cu) using atomic absorption spectrophotometry (AAS). PM2.5 samples were collected on pre-weighed Teflon filters using a BGI personal sampler and the filters were then reweighed. The ranges of metal concentrations were 39–101 μg/g for Cu, 95–262 μg/g for Zn, 9–28 μg/g for Cd, 14–24 μg/g for Ni, 13–30 μg/g for Cr, and 20–80 μg/g for Pb. The concentrations of heavy metals were generally highly correlated, indicating a common anthropogenic source of the pollutants. The results showed that the majority of the measured heavy metals were above the background concentration, and in particular, Cd, Pb, and Zn levels indicated moderate to high contamination. Though not directly comparable due to different sampling timeframes (8 h in this study and 24 h for guideline values), PM2.5 for all sites exceeds the daily WHO PM2.5 guidelines of 25 μg/m3. This poses a health risk to people using and working close to Thika superhighway, for example, local residents, traffic police, street vendors, and people operating small businesses. PM2.5 levels were higher for sites closer to Nairobi which could be attributed to increased vehicular traffic towards Nairobi from Thika. This study provides some evidence of the air pollution problem arising from vehicular traffic in developing parts of the world and gives an indication of the potential health impacts. It also highlights the need for source apportionment studies to determine contributions of anthropogenic emissions to air pollution, as well as long-term sampling studies that can be used to fully understand spatiotemporal patterns in air pollution within developing regions

Characterization of the Nairobi River catchment impact zone and occurrence of pharmaceuticals: implications for an impact zone inclusive environmental risk assessment

The largely uncontrolled release of active pharmaceuticals ingredients (APIs) within untreated wastewater discharged to waterbodies, associated with many rapidly urbanising centres is of growing concern owing to potential antimicrobial resistance, endocrine disruption and potential toxicity. A sampling campaign has been undertaken to assess the source, occurrence, magnitude and risk associated with APIs and other chemicals within the Nairobi/Athi river basin, in Kenya, East Africa. The catchment showed an extensive downstream impact zone estimated to extend 75 km, mostly, but not exclusively, derived from the direct discharge of untreated wastewater from the urban centre of Nairobi city. The exact extent of the downstream boundary of the Nairobi city impact zone was unclear owing to the inputs of untreated wastewater sources from the continuous urbanized areas along the river, which counteracted the natural attenuation caused by dilution and degradation. The most frequently detected APIs and chemicals were caffeine, carbamazepine, trimethoprim, nicotine, and sulfamethoxazole. Paracetamol, caffeine, sulfamethoxazole, and trimethoprim alone contributed 86% of the total amount of APIs determined along the Nairobi/Athi catchment. In addition to direct discharge of untreated domestic wastewater attributed to the informal settlements within the conurbation, other sources were linked to the industrial area in Nairobi City where drug formulation is known to occur, the Dandora landfill and veterinary medicines from upstream agriculture. It was shown that there was a possible environmental risk of API ecotoxicological effects beyond the end of the traditional impact zone defined by elevated biochemical oxygen demand concentrations; with metronidazole and sulfamethoxazole exhibiting the highest risk

Capacity building for conservation: problems and potential solutions for sub-Saharan Africa

To successfully achieve their stated conservation goals individuals, communities and organisations need to acquire a diversity of skills, knowledge and information (capacity). Despite current efforts to build and maintain appropriate levels of conservation capacity, it has been recognised that there will need to be a significant scaling-up of these activities in sub-Saharan Africa. This is because of the rapidly growing number and extent of environmental problems in the region. This paper presents a range of socio-economic contexts relevant to four key areas of African conservation capacity building: protected area management, community engagement, effective leadership, and professional e-Learning. Under these core themes, 39 specific recommendations are presented. These were derived from multi-stakeholder workshop discussions at an international conference held in Nairobi (Kenya) in 2015. At the meeting, 185 delegates (practitioners, scientists, community groups and government agencies) represented 105 organisations from 24 African nations and 8 non-African nations. The 39 recommendations constitute five broad types of suggested action: those that recommend (i) the development of new methods, (ii) the provision of capacity building resources e.g. information or data, (iii) the communication of ideas or examples of successful initiatives, (iv) the implementation of new research or gap analyses, (v) the establishment of new structures within and between organisations, and (vi) the development of new partnerships. A number of cross-cutting issues also emerged from the discussions. For example, all four workshops highlighted the need for a greater sense of urgency in developing capacity building activities in response to ongoing and rapid socio-environmental change in the region. Delegates also felt that conservation organisations, responsible agencies and donors need to recognise capacity building as one of the most urgent conservation issues we face. The need to develop novel and cost-efficient capacity building methodologies (and associated evaluation metrics), was also identified as a key issue. However, it was stressed that future of capacity building efforts will be best served by integrating new methods with more established activities. Importantly, given the broad suite of social, cultural and economic contexts found across sub-Saharan Africa, the need to move away from ‘one-size-fits-all’ approaches was strongly recommended in all thematic areas. Lastly, it was recognised that closing the gap between capacity need and capacity provision in the region will only be achieved through multi-partner capacity initiatives and networks.Additional co-authors: Vivian Kosgei, Anthony Kuria, Chris Magero, Maaike Manten, Paul Mugo, Eduard Müller, Julie Mulonga, Leo Niskanen, Josephine Nzilani, Mary Otieno, Nisha Owen, Juliet Owuor, Stuart Paterson, Sébastien Regnaut, Richard Rono, Joseph Ruhiu, Jesse Theuri Njoka, Lucy Waruingi, Brian Waswala Olewe and Emily Wilso

Tissue proteomic analysis identifies mechanisms and stages of immunopathology in fatal COVID-19

Funding: This work was funded by UK Research and Innovation (UKRI) (Coronavirus Disease [COVID-19] Rapid Response Initiative; MR/V028790/1 to C.D.L., D.A.D., and J.A.H.), LifeArc (through the University of Edinburgh STOPCOVID funding award, to K.D, D.A.D., C.D.L), The Chief Scientist Office (RARC-19 Funding Call, ‘Inflammation in Covid-19: Exploration of Critical Aspects of Pathogenesis; COV/EDI/20/10’ to D.A.D, C.D.L, C.D.R, J.K.B and D.J.H), and Medical Research Scotland (CVG-1722- 2020 to DAD, CDL, CDR, JKB, and DJH). C.D.L is funded by a Wellcome Trust Clinical Career Development Fellowship (206566/Z/17/Z). J.K.B. and C.D.R. are supported by the Medical Research Council (grant MC_PC_19059) as part of the ISARIC Coronavirus Clinical Characterisation Consortium (ISARIC-4C). C.D.R. is supported by an Edinburgh Clinical Academic Track (ECAT)/Wellcome Trust PhD Training Fellowship for Clinicians award (214178/Z/18/Z). J.A.H. is supported by the U.S. Food and Drug Administration (contract 75F40120C00085, Characterization of severe coronavirus infection in humans and model systems for medical countermeasure development and evaluation’). G.C.O is funded by an NRS Clinician award. N.N.G. is funded by a Pathological Society Award. A.R.A. is supported by a Cancer Research UK Clinician Scientist Fellowship award (A24867).Immunopathology occurs in the lung and spleen in fatal COVID-19, involving monocytes/macrophages and plasma cells. Anti-inflammatory therapy reduces mortality but additional therapeutic targets are required. We aimed to gain mechanistic insight into COVID-19 immunopathology by targeted proteomic analysis of pulmonary and splenic tissues. Lung parenchymal and splenic tissue was obtained from 13 post-mortem examinations of patients with fatal COVID-19. Control tissue was obtained from cancer resection samples (lung) and deceased organ donors (spleen). Protein was extracted from tissue by phenol extraction. Olink® multiplex immunoassay panels were used for protein detection and quantification. Proteins with increased abundance in the lung included MCP-3, antiviral TRIM21 and pro-thrombotic TYMP. OSM and EN-RAGE/S100A12 abundance was correlated, and associated with inflammation severity. Unsupervised clustering identified ‘early viral’ and ‘late inflammatory’ clusters with distinct protein abundance profiles, and differences in illness duration prior to death and presence of viral RNA. In the spleen, lymphocyte chemotactic factors and CD8A were decreased in abundance, and pro-apoptotic factors were increased. B-cell receptor signalling pathway components and macrophage colony stimulating factor (CSF-1) were also increased. Additional evidence for a sub-set of host factors (including DDX58, OSM, TYMP, IL-18, MCP-3 and CSF-1) was provided by overlap between (i) differential abundance in spleen and lung tissue, (ii) meta-analysis of existing datasets, and (iii) plasma proteomic data. This proteomic analysis of lung parenchymal and splenic tissue from fatal COVID-19 provides mechanistic insight into tissue anti-viral responses, inflammation and disease stages, macrophage involvement, pulmonary thrombosis, splenic B-cell activation and lymphocyte depletion.Publisher PDFPeer reviewe