Correlates of prior HIV testing and schistosomiasis treatment: Baseline survey findings from the “creating demand for fishermen’s schistosomiasis HIV services” (FISH) cluster-randomized trial in Mangochi, Malawi

Background: Fishing exposes fishermen to schistosomiasis-infested fresh water and concurrently through precarious livelihoods to risky sexual behaviour, rendering these two infections occupational hazards for fishermen. This study aimed to characterize the knowledge of the two conditions to obtain necessary data for a subsequent cluster randomized trial designed to investigate demand creation strategies for joint HIV-schistosomiasis service provision in fishing villages on the shores of southern Lake Malawi. Methods: Enumeration of all resident fishermen in 45 clusters (fishing communities) was carried out between November 2019 and February 2020. In a baseline survey, fishermen reported their knowledge, attitudes and practices in the uptake of HIV and schistosomiasis services. Knowledge of HIV status and previous receipt of praziquantel were modelled using random effects binomial regression, accounting for clustering. Prevalence of willingness to attend a beach clinic was computed. Results: A total of 6,297 fishermen were surveyed from the 45 clusters with harmonic mean number of fishermen per cluster of 112 (95% CI: 97; 134). The mean age was 31.7y (SD: 11.9) and nearly 40% (2,474/6,297) could not read or write. Overall, 1,334/6,293 (21.2%) had never tested for HIV, with 64.4% (3,191/4,956) having tested in the last 12 months, and 5.9% (373/6290) taking antiretroviral therapy (ART). In adjusted analyses, being able to read and write (adjusted risk ratio [aRR: 1.91, 95% CI: 1.59–2.29, p<0.001); previous use of praziquantel (aRR: 2.00,95% CI: 1.73–2.30, p<0.001); knowing a relative or friend who died of HIV (aRR: 1.54,95% CI: 1.33–1.79, p<0.001); and being on ART (aRR: 12.93, 95% CI: 6.25–32.93, p<0.001) were associated with increased likelihood of ever testing for HIV. Only 40% (1,733/4,465) had received praziquantel in the last 12 months. Every additional year of age was associated with 1% decreased likelihood of having taken praziquantel in the last 12 months (aRR: 0.99, 95% CI: 0.98–0.99, p<0.001). However, recent HIV testing increased the likelihood of taking praziquantel by over 2-fold (aRR 2.24, 95% CI: 1.93–2.62, p<0.001). Willingness to attend a mobile beach clinic offering integrated HIV and schistosomiasis services was extremely high at 99.0% (6,224/6,284). Conclusion: In a setting with an underlying high prevalence of both HIV and schistosomiasis, we found low knowledge of HIV status and low utilization of free schistosomiasis treatment. Among fishermen who accessed HIV services, there was a very high likelihood of taking praziquantel suggesting that integrated service delivery may lead to good coverage. Trial registration: This trial is registered in the ISRCTN registry: ISRCTN14354324; date of registration: 05 October 2020

Shifting climate zones and expanding tropical and arid climate regions across Kenya (1980–2020)

Abstract Human-induced climate change significantly alters the spatiotemporal characteristics of climate zones, which drives agricultural land use and ecosystem change. However, the detectability of shifting climate zones and the rate and time of the changes has yet to be adequately addressed at the regional-to-local scale. We mapped and analyzed changes to temperature and precipitation across Kenya during the past four decades, and linked those changes to shifts in the geographic distribution and arrangement of climate zones at regional scales. We observed an approximate 1 °C increase in average annual temperature over the 40-year period. A total of 76,346 km2 shifted from cooler to hotter zones, while 1298 km2 shifted from hotter to cooler zones. Tropical climate regions expanded from 91 to 93%, with over 13,000 km2 shifting from alpine and temperate to tropical regions. Average annual precipitation demonstrated little or no trend, but substantial spatial changes were observed. A total of 136,129 km2 shifted from wetter to drier zones, while 23,317 km2 shifted from drier to wetter zones. Arid climate regions expanded from 72 to 81%, a roughly 50,000 km2 shift from humid and semi-humid-to-semi-arid to arid regions. Overall, there was a 207,557 km2 shift in temperature and precipitation zones. As the climate zones predominately shift toward hotter and drier conditions, climatic diversity will decline, and in turn, ecosystem diversity and the ecosystem goods and services to society will decline. The changes also have broader global implications in terms of their contribution to global drylands as well as influencing earth system cycles. Overall, such information can better inform the Kenyan National Climate Change Response Strategy and be used to reach the UN Sustainable Development Goals.</jats:p

Spatial changes to climatic suitability and availability of agropastoral farming systems across Kenya (1980–2020)

Productive global agriculture is under a convergence of pressures, and particularly climate change and population growth. The impact is especially stark in East Africa where crop production is mostly rain-fed and population growth rates are among the highest in the world. Our objective for this study was to understand how climate change and population growth have impacted the size of agropastoral areas across Kenya over 40 years. Climate-suitable areas for all primary crops decreased 28% over the study period. Climate-suitable areas for primary crops increased 3% in highly productive counties, decreased 25% in moderately productive counties, and decreased 62% in low productive counties. Climate-suitable areas over the study period decreased 13% for ranching areas, 21% for dairying areas, 24% for mixed crop and ranching areas, and 28% for mixed crop and dairying areas, while climate-suitable areas for pastoralism increased 12%. Population across Kenya more than tripled over the study period, while population relative to climate-suitable areas for crops increased nearly fourfold, and population relative to climate-suitable areas for pastoralism nearly tripled. Population relative to available climate-suitable areas for crops more than doubled in highly productive counties, increased more than four-fold in moderately productive counties, and was nearly 15 times higher in low productive counties. Examining the cumulative effects of climate change and population growth on agricultural sectors across Kenya can help to develop policies and strategies to reach the UN Sustainable Development Goals. </jats:p