“Facing Our Fears”: Using facilitated film viewings to engage communities in HIV research involving MSM in Kenya

Kenya is a generally homophobic country where homosexuality is criminalised and people who engage in same sex sexuality face stigma and discrimination. In 2013, we developed a 16 min documentary entitled "Facing Our Fears" that aimed at sharing information on how and why men who have sex with men (MSM) are involved in on-going KEMRI HIV prevention research, and associated community engagement. To consider the film's usefulness as a communication tool, and its perceived security risks in case the film was publicly released, we conducted nine facilitated viewings with 122 individuals representing seven different stakeholder groups. The documentary was seen as a strong visual communication tool with potential to reduce stigma related to homosexuality, and facilitated film viewings were identified as platforms with potential to support open dialogue about HIV research involving MSM. Despite the potential, there were concerns over possible risks to LGBT communities and those working with them following public release. We opted-giving emphasis to the "do no harm" principle-to use the film only in facilitated settings where audience knowledge and attitudes can be carefully considered and discussed. The results highlight the importance of carefully assessing the range of possible impacts when using visuals in community engagement.</p

Effect of an opt-out point-of-care HIV-1 nucleic acid testing intervention to detect acute and prevalent HIV infection in symptomatic adult outpatients and reduce HIV transmission in Kenya: a randomized controlled trial

Background: In sub-Saharan Africa, adult outpatients with symptoms of acute infectious illness are not routinely tested for prevalent or acute HIV infection (AHI) when seeking healthcare. Methods: Adult symptomatic outpatients aged 18–39 years were evaluated by a consensus AHI risk score. Patients with a risk score ≥ 2 and no previous HIV diagnosis were enrolled in a stepped-wedge trial of opt-out delivery of point-of-care (POC) HIV-1 nucleic acid testing (NAAT), compared with standard provider-initiated HIV testing using rapid tests in the observation period. The primary outcome was the number of new diagnoses in each study period. Generalized estimating equations with a log-binomial link and robust variance estimates were used to account for clustering by health facility. The trial is registered with ClinicalTrials.gov NCT03508908. Results: Between 2017 and 2020, 13 (0.9%) out of 1374 participants in the observation period and 37 (2.5%) out of 1500 participants in the intervention period were diagnosed with HIV infection. Of the 37 newly diagnosed cases in the intervention period, two (5.4%) had AHI. Participants in the opt-out intervention had a two-fold greater odds of being diagnosed with HIV (odds ratio = 2.2, 95% confidence interval: 1.39–3.51) after adjustment for factors imbalanced across study periods. Conclusions: Among symptomatic adults aged 18–39 years targeted by our POC NAAT intervention, we identified one chronic HIV infection for every 40 patients and one AHI patient for every 750 patients tested. Although AHI yield was low in this population, routinely offered opt-out testing could diagnose twice as many patients as an approach relying on provider discretion

Biophysical interactions in tropical agroforestry systems

sequential systems, simultaneous systems Abstract. The rate and extent to which biophysical resources are captured and utilized by the components of an agroforestry system are determined by the nature and intensity of interac-tions between the components. The net effect of these interactions is often determined by the influence of the tree component on the other component(s) and/or on the overall system, and is expressed in terms of such quantifiable responses as soil fertility changes, microclimate modification, resource (water, nutrients, and light) availability and utilization, pest and disease incidence, and allelopathy. The paper reviews such manifestations of biophysical interactions in major simultaneous (e.g., hedgerow intercropping and trees on croplands) and sequential (e.g., planted tree fallows) agroforestry systems. In hedgerow intercropping (HI), the hedge/crop interactions are dominated by soil fertility improvement and competition for growth resources. Higher crop yields in HI than in sole cropping are noted mostly in inherently fertile soils in humid and subhumid tropics, and are caused by large fertility improvement relative to the effects of competition. But, yield increases are rare in semiarid tropics and infertile acid soils because fertility improvement does not offse

Factors Associated with Revision Surgery after Internal Fixation of Hip Fractures

Background: Femoral neck fractures are associated with high rates of revision surgery after management with internal fixation. Using data from the Fixation using Alternative Implants for the Treatment of Hip fractures (FAITH) trial evaluating methods of internal fixation in patients with femoral neck fractures, we investigated associations between baseline and surgical factors and the need for revision surgery to promote healing, relieve pain, treat infection or improve function over 24 months postsurgery. Additionally, we investigated factors associated with (1) hardware removal and (2) implant exchange from cancellous screws (CS) or sliding hip screw (SHS) to total hip arthroplasty, hemiarthroplasty, or another internal fixation device. Methods: We identified 15 potential factors a priori that may be associated with revision surgery, 7 with hardware removal, and 14 with implant exchange. We used multivariable Cox proportional hazards analyses in our investigation. Results: Factors associated with increased risk of revision surgery included: female sex, [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.25-2.50; P = 0.001], higher body mass index (fo

Laboratory screening of some saprophytic coffee surface microflora antagonistic to Colletotrichum kahawae

Saprophytic microflora were isolated from coffee berry surfaces. Eight isolates were selected for antagonistic tests against Colletotrichum kahawae. Six isolates (Bacillus macerans [two isolates], Epicoccum nigrum, Aspergillus niger, Penicillium citrinum and Pestalotiopsis sp) were selected for having inhibition zones against fungi on isolation plates and two isolates (Cladosporium sp. and Phoma sp.) were selected as being most common and populous. All the antagonists reduced germination of Colletotrichum kahawae on detached green coffee berries and with exception of Pestalotiopsis sp. they reduced appresoria formation. They all reduced infection of the berries and sporulation of Colletotrichum sp. on detached maturing coffee twigs. Four of the antagonists (Bacillus macerans, Epicoccum nigrum, Aspergillus niger and Cladosporium sp.) were found to reduce infection when used in mixtures and when grown on whole maize meal broth. It was concluded that there is potential of using saprophytic coffee surface microflora in biological control of coffee berry disease. It would also be possible to develop farm-based technology to use the microflora. Future research needs in this area are presented.La microflore saprophyte de surface a été isolée des baies de café. Huit isolats ont été sélectionnés pour les tests d\'antagonisme contre Colletotrichum kahawae. Six isolats (Bacillus macerans [deux isolats], Epicoccum nigrum, Aspergillus niger, Penicillium citrinum et Pestalotiopsis sp) ont été sélectionnés pour avoir présenté des zones d\'inhibition contre le champignon en milieu artificiel et les deux autres (Cladosporium sp. et Phoma sp.) en raison de leur présence habituelle en conditions naturelles. Tous les antagonistes ont réduit la germination de Colletotrichum kahawae sur les baies vertes détachées de café et ils ont, à l\'exception de Pestalotiopsis sp., permis de réduire la formation appressoriale. Ils ont tous permis de réduire l\'infection des baies et la sporulation de Colletotrichum sp. sur les jeunes rameaux détachés. Quatre des ces antagonistes (Bacillus macerans, Epicoccum nigrum, Aspergillus niger et Cladosporium sp.) ont réduit l\'infection lorsqu\'ils sont utilisés en mélange et cultivés dans un milieu de culture à base de farine de maïs. Il a été conclut qu\'il existe un potentiel pour le contrôle biologique de l\'anthracnose des baies de café par l\'usage de la microflore saprophyte de surface. Il serait ainsi possible de développer des techniques paysannes pour la production de la microflore saprophyte. Les besoins de recherche dans ce domaine seront ci-dessus discutés. Keywords:Colletotrichum kahawae, microflora, antagonists, coffee berry diseaseAgronomie Africaine Vol. 17 (2) 2005: pp. 73-8

A Comparative analysis associated to virulence of Pseudomonas syringae pv. garcae, the causative agent of Bacterial Blight of coffee in Kenya

The Pseudomonas syringae pathogen is genetically diverse, presumably due to the adaptation of individual pathovars to suit the environments of their respective host plants. Given the immense damage and yield loss due to BBC disease that is caused by Psg, this study sought to determine the diversity associated to virulence of the PSG isolates on coffee in Kenya. Twelve strains of Psg pathogen were collected from different coffee growing regions in Kenya and characterized using both phenotypic and molecular tools using inoculation via host-pathogen interaction and genomic sequencing. The sequencing was done using 16S ribosomal RNA primers 8 F and 1492 R and sequences were then retrieved for alignment and phylogenetic analysis using MEGA 6 via clustalW. The results correlating the 16S rRNA diversity found in the strains with their virulence by inoculation in 4 different coffee genotypes revealed possible existence of different races of Psg. The study provides new knowledge on the nature of virulence of BBC pathogen and a platform towards breeding for durable resistance in Kenya

Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya

In Kenyan communities, religious leaders are important gatekeepers in matters of health and public morality. In a context that is generally homophobic, religious leaders may aggravate or reduce stigmatization of sexual minorities such as gay and bisexual men, and other men who have sex with men (GBMSM). Literature indicates mixed results in efforts to encourage religious leaders to work effectively and sensitively with issues regarding HIV and sexuality. This paper describes the implementation of an engagement intervention with religious leaders from different denominations, which took place following a homophobic hate attack that was led by local religious leaders, at an HIV research clinic for GBMSM on the Kenyan coast. After the homophobic attack, tailored engagement activities, including a comprehensive four-day online sensitivity training course took place between June 2015 and October 2016 in the Kenyan coast. HIV researchers, together with trained GBMSM activists, organized the series of engagement activities for religious leaders which unfolded iteratively, with each subsequent activity informed by the results of the previous one. Facilitated conversations were used to explore differences and disagreements in relation to questions of scripture, mission, HIV, and human sexuality. As a result, researchers noted that many religious leaders, who initially expressed exceedingly negative attitudes towards GBMSM, started to express far more accepting and supportive views of sexuality, sexual identities, and same-sex relations. This paper describes the changes in religious leaders' discourses relating to GBMSM, and highlights the possibility of using engagement interventions to build trust between research institutes, religious leaders, and GBMSM

Engaging religious leaders to support HIV prevention and care for gays, bisexual men, and other men who have sex with men in coastal Kenya

In Kenyan communities, religious leaders are important gatekeepers in matters of health and public morality. In a context that is generally homophobic, religious leaders may aggravate or reduce stigmatization of sexual minorities such as gay and bisexual men, and other men who have sex with men (GBMSM). Literature indicates mixed results in efforts to encourage religious leaders to work effectively and sensitively with issues regarding HIV and sexuality. This paper describes the implementation of an engagement intervention with religious leaders from different denominations, which took place following a homophobic hate attack that was led by local religious leaders, at an HIV research clinic for GBMSM on the Kenyan coast. After the homophobic attack, tailored engagement activities, including a comprehensive four-day online sensitivity training course took place between June 2015 and October 2016 in the Kenyan coast. HIV researchers, together with trained GBMSM activists, organized the series of engagement activities for religious leaders which unfolded iteratively, with each subsequent activity informed by the results of the previous one. Facilitated conversations were used to explore differences and disagreements in relation to questions of scripture, mission, HIV, and human sexuality. As a result, researchers noted that many religious leaders, who initially expressed exceedingly negative attitudes towards GBMSM, started to express far more accepting and supportive views of sexuality, sexual identities, and same-sex relations. This paper describes the changes in religious leaders' discourses relating to GBMSM, and highlights the possibility of using engagement interventions to build trust between research institutes, religious leaders, and GBMSM