Factors associated with risky sexual behavior among HIV negative partners in HIV discordant relationships in Nairobi, Kenya

Introduction: Whereas risky sexual behavior influences HIV acquisition, little information is available on risk taking practices among negative partners in HIV discordant relationships in our settings. This study sought to determine the associated factors among this population in Nairobi.Methods: This study was a cross-sectional descriptive study and 133 HIV negative partners participated in the study.Results: Out of the 133 participants, 66.9% were male and 33.1% were female. Overall, 44.4% of the study participants reported inconsistent condom use, 14.3% reported having another sexual partner and 30% reported ever engaging in sexual activities under the influence of alcohol. Monthly earnings (p- 0.02), alcohol use (p- 0.03) and the index partner being on anti-retroviral medication (p-0.02) were significantly associated with having another sexual partner. Focus group discussion findings showed that male gender, alcohol use and the duration of the relationship influenced the decision to use condoms while male gender influenced having another sexual partner.Conclusion: Risky sexual behavior practices still occur among the HIV negative partners in discordant relationships. More education and sensitization should be made on the risks associated with this behavior so as to reduce the risk of HIV infection from their infected partners.Afr J Health Sci. 2013; 26:324-33

Experiences in effective communication on transgenic technology in Africa – the case of the insect resistant maize for Africa (IRMA) project

The Insect Resistant Maize for Africa (IRMA) Project, aimed to improve food security through developing and deploying locally adapted stem borer resistant maize varieties using both conventional and biotechnology mediated methods, especially Bt technology. This technology uses a gene from the soil bacterium Bacillus thuringiensis (Bt) to create transgenic maize varieties. Transgenic technologies have been a controversial and emotive topic in recent years, and the IRMA project was launched against this backdrop. To ensure widespread acceptance of the IRMA project and its Bt technology, the project carefully planned and implemented its communication and public awareness strategy. Following its public launch in March 2000, the project promoted an open communication environment and continuously engaged with stakeholders to update them on progress. The project achieved this through targeted and diverse communications products such as media articles and broadcast news pieces, newsletters, websites, videos and reports. To complement these, the project conducted annual stakeholders’ meetings, and specialized training for frontline project staff and collaborators, especially extension agents. This paper reviews the IRMA Project’s public awareness and communication strategy and analyzes its effectiveness.Key words: Transgenic technology, Bacillus thuringiensis (Bt) maize technology, communication, public awareness, insect resistant maize for Africa (IRMA) project

Associations between exclusive breastfeeding duration and children's developmental outcomes: evidence from Siaya county, Kenya

BACKGROUND: Exclusive breastfeeding (EBF) during the first 6 months of life is widely promoted as a key strategy to enhance child health, growth, and development. Even though a high proportion of children in Kenya are currently breastfed exclusively, there is little evidence regarding the developmental benefits during the first year of life. This paper aims to fill this gap by establishing an association between EBF and early childhood developmental outcomes among children below the age of 6 months in Kenya. METHODS: We used data collected as part of a cluster-randomized controlled trial conducted in Bondo sub-county in the western part of Kenya to assess the associations between EBF and development in the first year of life. The primary exposure variable was EBF, and the outcome variable was child development as measured by the Ages and Stages Questionnaire-Third Edition (ASQ-3). RESULTS: We analyzed data from 570 children aged below 6 months at the time of the interview. Breastfeeding children exclusively between 3 and 6 months was associated with 0.61 standard deviation (SD) higher ASQ-3 scores in the adjusted model. When specific domains were considered, in the adjusted models, EBF in the 3-6 months period was associated with 0.44 SD, 0.34 SD and 0.36 SD higher ASQ-3 scores in communication, gross motor, and problem solving domains, respectively. There were weak associations in the fine motor and social-emotional domains. CONCLUSION: EBF in the 3- to 6-month age range has significant positive associations with child development, especially for communication, gross motor, and problem-solving. Programs encouraging mothers to continue EBF in this period may have substantial benefits for children

Subtype-Specific Differences in Gag- Protease-Driven Replication Capacity Are Consistent with Intersubtype Differences in HIV-1 Disease Progression

ABSTRACT There are marked differences in the spread and prevalence of HIV-1 subtypes worldwide, and differences in clinical progression have been reported. However, the biological reasons underlying these differences are unknown. Gag-protease is essential for HIV-1 replication, and Gag-protease-driven replication capacity has previously been correlated with disease progression. We show that Gag-protease replication capacity correlates significantly with that of whole isolates ( r = 0.51; P = 0.04), indicating that Gag-protease is a significant contributor to viral replication capacity. Furthermore, we investigated subtype-specific differences in Gag-protease-driven replication capacity using large well-characterized cohorts in Africa and the Americas. Patient-derived Gag-protease sequences were inserted into an HIV-1 NL4-3 backbone, and the replication capacities of the resulting recombinant viruses were measured in an HIV-1-inducible reporter T cell line by flow cytometry. Recombinant viruses expressing subtype C Gag-proteases exhibited substantially lower replication capacities than those expressing subtype B Gag-proteases ( P &lt; 0.0001); this observation remained consistent when representative Gag-protease sequences were engineered into an HIV-1 subtype C backbone. We identified Gag residues 483 and 484, located within the Alix-binding motif involved in virus budding, as major contributors to subtype-specific replicative differences. In East African cohorts, we observed a hierarchy of Gag-protease-driven replication capacities, i.e., subtypes A/C &lt; D &lt; intersubtype recombinants ( P &lt; 0.0029), which is consistent with reported intersubtype differences in disease progression. We thus hypothesize that the lower Gag-protease-driven replication capacity of subtypes A and C slows disease progression in individuals infected with these subtypes, which in turn leads to greater opportunity for transmission and thus increased prevalence of these subtypes. IMPORTANCE HIV-1 subtypes are unevenly distributed globally, and there are reported differences in their rates of disease progression and epidemic spread. The biological determinants underlying these differences have not been fully elucidated. Here, we show that HIV-1 Gag-protease-driven replication capacity correlates with the replication capacity of whole virus isolates. We further show that subtype B displays a significantly higher Gag-protease-mediated replication capacity than does subtype C, and we identify a major genetic determinant of these differences. Moreover, in two independent East African cohorts we demonstrate a reproducible hierarchy of Gag-protease-driven replicative capacity, whereby recombinants exhibit the greatest replication, followed by subtype D, followed by subtypes A and C. Our data identify Gag-protease as a major determinant of subtype differences in disease progression among HIV-1 subtypes; furthermore, we propose that the poorer viral replicative capacity of subtypes A and C may paradoxically contribute to their more efficient spread in sub-Saharan Africa. </jats:p

Schistosoma haematobium and soil-transmitted Helminths in Tana Delta District of Kenya:infection and morbidity patterns in primary schoolchildren from two isolated villages

BACKGROUND: Schistosomes and soil-transmitted helminths (STH) (hookworm, Trichuris trichiura and Ascaris lumbricoides) are widely distributed in developing countries where they infect over 230 million and 1.5 billion people, respectively. The parasites are frequently co-endemic and many individuals are co-infected with two or more of the species, but information on how the parasites interact in co-infected individuals is scarce. The present study assessed Schistosoma haematobium and STH infection and morbidity patterns among school children in a hyper-endemic focus in the Tana River delta of coastal Kenya. METHODS: Two hundred and sixty-two children aged 5–12 years from two primary schools were enrolled in the study. For each child, urine was examined for S. haematobium eggs and haematuria, stool was examined for STH eggs, peripheral blood was examined for eosinophilia and haemoglobin level, the urinary tract was ultrasound-examined for S. haematobium-related pathology, and the height and weight was measured and used to calculate the body mass index (BMI). RESULTS: Prevalences of S. haematobium, hookworm, T. trichiura and A. lumbricoides infection were 94, 81, 88 and 46 %, respectively. There was no significant association between S. haematobium and STH infection but intensity of hookworm infection significantly increased with that of T. trichiura. Lower BMI scores were associated with high intensity of S. haematobium (difference =−0.48, p > 0.05) and A. lumbricoides (difference =−0.67, p < 0.05). Haematuria (both macro and micro) was common and associated with S. haematobium infection, while anaemia was associated with high intensity of S. haematobium (OR = 2.08, p < 0.05) and high hookworm infections OR = 4.75; p < 0.001). The majority of children had eosinophilia, which was significantly associated with high intensity of hookworm infection (OR = 5.34, p < 0.05). Overall 38 % of the children had ultrasound-detectable urinary tract morbidity, which was associated with high intensity of S. haematobium infection (OR = 3.13, p < 0.05). CONCLUSION: Prevalences of S. haematobium and STH infections among the primary school children were high and the parasites were responsible for significant morbidity. A clear synergistic interaction was observed between hookworm and T. trichiura infections. Increased coverage in administration of praziquantel and albendazole in the area is recommended to control morbidity due to these infections

Hepatosplenomegaly associated with chronic malaria exposure: evidence for a pro-inflammatory mechanism exacerbated by schistosomiasis

In sub-Saharan Africa, chronic hepatosplenomegaly, with palpable firm/hard organ consistency, is common, particularly among school-aged children. This morbidity can be caused by long-term exposure to malaria, or by Schistosoma mansoni, and it is exacerbated when these two occur together. Although immunological mechanisms probably underlie the pathogenic process, these mechanisms have not been identified, nor is it known whether the two parasites augment the same mechanisms or induce unrelated processes that nonetheless have additive or synergistic effects. Kenyan primary schoolchildren, living in a malaria/schistosomiasis co-transmission area, participated in cross-sectional parasitological and clinical studies in which circulating immune modulator levels were also measured. Plasma IL-12p70, sTNF-RII, IL-10 and IL-13 levels correlated with relative exposure to malaria, and with hepatosplenomegaly. Soluble-TNF-RII and IL-10 were higher in children infected withS. mansoniHepatosplenomegaly caused by chronic exposure to malaria was clearly associated with increased circulating levels of pro-inflammatory mediators, with higher levels of regulatory modulators, and with tissue repair cytokines, perhaps being required to control the inflammatory response. The higher levels of regulatory modulators amongstS. mansoniinfected children, compared to those without detectableS. mansoni and malarial infections, but exposed to malaria, suggest thatS. mansoniinfection may augment the underlying inflammatory reaction

Urinary cytokines in <i>Schistosoma haematobium</i>-infected schoolchildren from Tana Delta District of Kenya

BACKGROUND: Pathological changes due to infection with Schistosoma haematobium include cytokine-mediated urinary tract inflammation. The involved cytokines may be excreted in urine and their presence in urine may therefore reflect S. haematobium-related urinary tract pathology. The present study, for the first time, reports on the relationship between selected cytokines in urine and infection with S. haematobium in children from an area highly affected by this parasite. METHODS: Children aged 5–12 years from two primary schools in Tana Delta District of Kenya were examined for S. haematobium eggs using urine filtration technique, for haematuria using dipstix and for eosinophil cationic protein (ECP), IL-6, IFN- γ, TNF-α and IL-10 levels using ELISA, and for S. haematobium-related urinary tract pathology using ultrasonography. In addition, venous blood was examined for serum IL-6, IFN- γ, TNF-α and IL-10 levels using ELISA. RESULTS: There was no significant correlation between urinary and serum levels of IL-6, IFN- γ, TNF-α or IL-10. There was no significant difference in geometric mean intensity (GMI) in any of the serum cytokines, or in urinary TNF-α or IFN-γ, between children with light and heavy S. haematobium infections. However, children with heavy S. haematobium infections had significantly higher GMI of urinary IL-6 (p < 0.001) and lower GMI of urinary IL-10 (p = 0.002) than children with light infections. There was also a significant positive correlation between urinary IL-6 and urinary ECP (p < 0.001) and a significant negative correlation between urinary IL-10 and urinary ECP (p = 0.012). CONCLUSION: Urinary IL-6 was positively correlated to and IL-10 was negatively correlated to infection intensity and urinary tract inflammation in S. haematobium-infected children. Urinary IL-6 and IL-10 ELISA may be a useful non-invasive tool to complement the already available tools for studying S. haematobium-related urinary tract pathology in children. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/1471-2334-14-501) contains supplementary material, which is available to authorized users

Including PrEP for key populations in combination HIV prevention: a mathematical modelling analysis of Nairobi as a case-study

Background: The role of PrEP in combination HIV prevention remains uncertain. We aimed to identify an optimal portfolio of interventions to reduce HIV incidence for a given budget, and to identify the circumstances in which PrEP could be used in Nairobi, Kenya. Methods: A mathematical model was developed to represent HIV transmission among specific key populations (female sex workers (FSW), male sex workers (MSW), and men who have sex with men (MSM)) and among the wider population of Nairobi. The scale-up of existing interventions (condom promotion, anti-retroviral therapy (ART) and male circumcision) for key populations and the wider population as have occurred in Nairobi is represented. The model includes a detailed representation of a Pre-Exposure Prophylaxis (PrEP) intervention and is calibrated to prevalence and incidence estimates specific to key populations and the wider population. Findings: In the context of a declining epidemic overall but with a large sub-epidemic among MSM and MSW, an optimal prevention portfolio for Nairobi should focus on condom promotion for MSW and MSM in particular, followed by improved ART retention, earlier ART, and male circumcision as the budget allows. PrEP for MSW could enter an optimal portfolio at similar levels of spending to when earlier ART is included, however PrEP for MSM and FSW would be included only at much higher budgets. If PrEP for MSW cost as much $500, average annual spending on the interventions modelled would need to be less than$3·27 million for PrEP for MSW to be excluded from an optimal portfolio. Estimated costs per infection averted when providing PrEP to all FSW regardless of their risk of infection, and to high risk FSW only, are $65,160 (95$43,520 - $90,250) and$10,920 (95% credible interval: $4,700 -$51,560) respectively. Interpretation: PrEP could be a useful contribution to combination prevention, especially for underserved key populations in Nairobi. An ongoing demonstration project will provide important information regarding practical aspects of implementing PrEP for key populations in this setting

Experience and Lessons Learnt on Health Care Personnel Participating In the Implementation of TB Operational Research at (EAPHLNP -OR) Malindi, Kenya

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Comparison of demographic and clinical characteristics between pulmonary and extra-pulmonary tuberculosis patients in Kiambu County, 2012-2015

Background: Tuberculosis (TB) continues to be a public health challenge globally. The most common organ to be involved is the lung although it can affect any organ in the body. The diagnosis of extra-pulmonary TB (EPTB) has faced many challenges mainly due to inadequate expertise to diagnose or lack of equipment for diagnosis.Objective: To compare the demographic and clinical characteristics between pulmonary and extrapulmonary tuberculosis in Kiambu CountyDesign: Retrospective cross-sectional studySetting: Kiambu County, KenyaSubjects: Tuberculosis patients notified in TIBU surveillance systemResults: Of the 15, 833 patients analyzed, 2,704 (17%) had extra-pulmonary tuberculosis. Male to female ratio was 1:1.7 in PTB and 1:1.3 in EPTB patients. There was declining trend of TB cases notified over the years for both PTB and EPTB. Pleural TB accounted for 38% with TB lymphadenitis accounting for 14% of the EPTB subtypes. TB-HIV co-infection was higher among EPTB (36%) compared to PTB (30%). The treatment success rate was 85% and 86% among PTB and EPTB cases respectively. The mortality was 10% among EPTB and 5% in PTB cases. The 5-14 age category were more likely to developing EPTB compared to PTB (AOR 4.67 95% CI (1.5-13.99). Kabete zone was most affected with EPTB (AOR 2.11(1.19-2.74) while a protective factor was observed among the HIV positive clients (AOR 0.58 (0.43 - 0.78)Conclusion: There was a general decline in cases for both EPTB and PTB. However, the age category most affected was 5-14 years. The co-infectivity rate was higher among the EPTB patients compared to the PTB patients. High index of suspicion and appropriate diagnostic tools are needed in evaluation particularly in EPTB which will assist in early management of the patients. ART uptake could play a big role in protecting HIV positive clients from getting EPTB