Supporting early career health investigators in Kenya: A qualitative study of HIV/AIDS research capacity building

Introduction: strategies to transfer international health research training programs to sub-Saharan African institutions focus on developing cadresof local investigators who will lead such programs. Using a critical  leadership theory framework, we conducted a qualitative study of one program to understand how collaborative training and research can support early career investigators in Kenya toward the program transfer goal.Methods: We used purposive sampling methods and a semi-structured protocol to conduct in-depth interviews with US (N=5) and Kenyan (N=5)independent investigators. Transcripts were coded using a two-step  process, and then compared with each other to identify major themes.Results: A limited local research environment, funding needs and research career mentorship were identified as major influences on early career researchers. Institutional demands on Kenyan faculty to teach rather than complete research restricted investigators' ability to develop research careers. This was coupled with lack of local funding to support research. Sustainable collaborations between Kenyan, US and other international investigators were perceived to mitigate these challenges and support early career investigators who would help build a robust local research environment for training. Conclusion: mutually beneficial collaborations between Kenyan and US investigators developed during training mitigate these challenges and build a supportive research environment for training. In these collaborations, early career investigators learn how to navigate the complex international research environment to build local HIV research capacity.Shared and mutually beneficial resources within international research collaborations are required to support early career investigators and plans to transfer health research training to African institutions

Adherence to national guidelines in prevention of mother to child transmission of HIV

Background: Mother-to-child transmission (MTCT) of Human Immunodeficiency Virus (HIV) contributes to over 90% of the paediatric HIV infections. The national PMTCT guidelines make recommendations for specific interventions to reduce perinatal transmission. Data on adherence to the guidelines by caregivers and quality of PMTCT care is however limited.objective: To evaluate the extent to which PMTCT care offered to HIV positive women admitted for delivery at Kenyatta National Hospital (KNH) and Pumwani Maternity Hospital (PMH) adheres to National Guidelines in order to reduce vertical transmission of HIV during labour and delivery.Design: A cross-sectional study.Setting: Kenyatta National Hospital and Pumwani Maternity Hospitalfrom January to April 2009.Subjects: All consenting HIV positive women admitted to the labour wards at the two facilities and planned for delivery.Results: A total of 370 women were enrolled, 266 at Pumwani Maternity Hospital and 104 at Kenyatta National Hospital. Among the enrolled women 357 (96.4%) had been counselled on vertical transmission and 205(55.4%) had HIV disease staging by CD4 cell count. There were no significant differences between the two study sites in the proportion of women counselled on MTCT (p=0.398) and receiving HIV disease staging by CD4 testing (p=0.28). Three hundred and forty nine (94.3%) women were offered varied ARV regimens for PMTCT. 101(27.3%) received HAART, 94(26.9%) were given single dose nevirapine and 130(37%) received AZT+NVP combination prophylaxis. Twenty one women received no ARV prophylaxis. Overall, 268 women (72.5%) had spontaneous vertex delivery. An episiotomy rate of 7% was observed and no vacuum delivery was recorded. A Caesarean section rate of 27.5% was recorded with PMTCT as aan indication in almost half of the cases. Women delivered at KNH were more likely to receive HAART (p<0.001) and to be delivered by elective caesarean (p<0.001).Conclusion: A great majority of HIV positive women admitted for delivery received counseling on vertical transmission and were offered ARVs for PMTCT. Many women did not get CD4 measurement and clinical staging as recommended in the National guidelines

Prevalence and risk factors of previous or active Hepatitis B infection among HIV-1 discordant heterosexual couples

Background: Hepatitis B Virus (HBV) and HIV spread in the same manner, but HBV is more infectious  than HIV-1. Active HBV requires modification of HIV-1 therapy and is associated with increased risk for sexual transmission of HBV.Objective: To determine the prevalence and knowledge of HBV among HIV-1 discordant couples.Design: A cross-sectional study.Setting: Couple Counselling Centres in Nairobi and Thika clinics in Kenya.Subjects: HIV discordant couples attending Couples Counselling Centres in Nairobi and Thika clinics in Kenya.Results: One hundred and sixty one couples with a mean age of 33 years (Standard Deviation 8.4) were enrolled into the study. HBV prevalence was higher among HIV positive women than among HIV negative women (10.2% vs. 5.9%, OR=0.5, 95% CI 0.2-1.0; p=0.05). However, among men, prevalence of HBV was higher among the HIV negative than the HIV positive participants (8.4 vs. 6.2%, OR=3.0, CI  1.3-6.5; p=0.04). There was no association between HBV and HIV (p=0.4) or gender (p=0.5). HIV  positive participants were more likely to have adequate knowledge compared to HIV negative participants (13% vs. 3.7%, OR=2.7, 95% CI 1.95-7.9; p=0.05)Conclusions: Female index participants had the highest HBV prevalence. Knowledge on HBV was lacking, particularly among the HIV negative; a target group for health education regarding risk factors and prevention of HBV infection

What advances may the future bring to the diagnosis, treatment, and care of male sexual and reproductive health?

Over the past 40 years, since the publication of the original WHO Laboratory Manual for the Examination and Processing of Human Semen, the laboratory methods used to evaluate semen markedly changed and benefited from improved precision and accuracy, as well as the development of new tests and improved, standardized methodologies. Herein, we present the impact of the changes put forth in the sixth edition together with our views of evolving technologies that may change the methods used for the routine semen analysis, up-and-coming areas for the development of new procedures, and diagnostic approaches that will help to extend the often-descriptive interpretations of several commonly performed semen tests that promise to provide etiologies for the abnormal semen parameters observed. As we look toward the publication of the seventh edition of the manual in approximately 10 years, we describe potential advances that could markedly impact the field of andrology in the future

Clinical Outcomes of Colorectal Cancer in Kenya

Background The incidence of colorectal cancer in Africa is increasing. True data on clinical outcomes of the disease is hampered by follow up challenges. Method Follow up data of 233 patients treated for colorectal cancer between 2005 and 2010 at various Nairobi hospitals were evaluated. The primary outcome was mortality while secondary outcomes included recurrence rates, time to recurrence and the patient, disease and treatment factors associated with mortality and recurrence. Kaplan Meir charts were charted for survival trends. Results Half of the lesions were located in the rectum. There was no relationship between the sub-site location and recurrence and mortality. The mean follow-up period was 15.9 months. Overall recurrency and mortality rates were 37.5% and 29.4% respectively. Most recurrences occurred within one year of surgery. Recurrence was not influenced by age, gender, sub-site, chemotherapy receipt or presence of comorbidity. Factors significantly associated with mortality included the male gender ( p 0.04), presence of co-morbidity (p 0.029), recurrence (p 0.001), curative intent (p 0.01), disease stage (p 0.036) and receipt of chemotherapy ( p< 0.01). Conclusion Follow up of colorectal cancer patients is still challenging. The mortality and recurrence rates are high for the short follow up periods. Further studies are needed to explore the determinants of both survival and recurrences, especially with longer follow ups

Postpartum family-planning barriers and catalysts in Burkina Faso and the Democratic Republic of Congo: a multiperspective study.

PURPOSE: To address the high unmet need for postpartum family planning (PPFP) in resource-limited settings, particularly in sub-Saharan Africa, this study aimed to identify PPFP-related barriers and catalysts to inform policies and programs to increase access to postpartum contraception. METHODS: Using qualitative methodology, we explored the perspectives of women, adolescent girls, men, religious and community leaders, service providers, and decision makers from three rural communities in Burkina Faso and three rural-urban communities in the Democratic Republic of Congo. Both countries have high unmet need for PPFP and are priority countries of the French Muskoka Fund for Maternal and Child Health. RESULTS: Perceived catalysts included negative traditional views on the consequences borne by closely spaced children and their mothers; a 6-week postpartum visit dedicated to PPFP (albeit poorly attended); political will and enabling policies for FP; and support from certain religious leaders and men. Main reported barriers were the lack of male engagement; out-of-pocket copayment for contraceptives; reliance on amenorrhea for pregnancy prevention without knowing its limits; misconceptions about modern contraceptives, including prerequisites for the lactational amenorrhea method; sexual abstinence supported by religious and traditional norms for up to 3-6 months, although women reported earlier resumption of sexual activity; low prioritization of scheduled postpartum visits by women; and limited availability of readily accessible methods, PPFP counseling materials, and clinic days and scheduled visits dedicated to contraceptive services. CONCLUSION: Based on results found to be most actionable, the following interventions have the potential to optimize access to PPFP services: counseling women on postpartum-pregnancy risks and options at different points in time before and after childbirth through the use of appropriate information, education, and counseling materials; integrating PPFP services into existing maternal and child health visits; making contraceptives readily available and affordable; and meaningfully engaging male partners

Do clinicians adhere to practice guidelines? A descriptive study at a referral hospital in Kenya

Background: Clinical guidelines when implemented correctly have shown to improve disease outcomes. This study describes utilization of Kenya National guidelines in managing ante partum haemorrhage (APH) in 3rd trimester.Objective: To describe adherence to clinical guideline in management of antepartum haemorrhage at Garissa Provincial General Hospital Design: Crossectional mixed methods studySetting: Garissa Provincial General HospitalSubjects: Medical records of patients managed for APH between 2002 and 2012 and Key Informant Interviews (KIIs) of Health workers.Results: 36.1% of the cases assessed were managed with strict adherence to guidelines. 90% of health care workers had high levels of awareness of the existence of guidelines and sited utilization challenges attributed to resource inadequacies.Conclusion: Clinicians are skilled on APH guidelines, but adherence levels are still low. Therefore, continuous appraisal of clinical practices, availing equipment, facilities and supplies to reinforce adherence is recommended

Spodoptera frugiperda population structure and influence of farmers’ practices on gut biodiversity for sustainable management of the pest in Kenya

Fall armyworm (FAW), Spodoptera frugiperda, is a highly polyphagous pest that recently invaded Kenya, among other African countries. Information on the pest’s genetic diversity and mechanisms conferring insecticide resistance, in addition to farmers’ knowledge and perceptions on the applicable mitigation measures, inform the development of sustainable management strategies. Therefore, this study collected cross-sectional data from 800 farmers in Kenya and documented their knowledge and perceptions on FAW and factors influencing their choice of FAW control methods. Additionally, we identified the strains present in 8 counties in Kenya using the mitochondrial Cytochrome Oxidase sub-unit I (mt COI) gene, and correlated pesticide use to gut microbiome diversity via 16S rRNA metagenomics to investigate the probable contribution of gut bacteria towards insecticide resistance evolution. All farmers reported FAW infestations, and 24% reported limited and total non-response of FAW to insecticides. Fall armyworm rice-strain and corn-strain were detected ravaging corn fields. However, the corn-strain revealed higher microbial diversity than the rice-strain. Furthermore, pathogenic bacterial genera were elevated in the insect gut in both corn and rice strains after chemical-treatments. Insecticide–endosymbiont interactions should be further explored, and farmers’ training on effective alternative pest control methods is recommended

An updated systematic review of epidemiological evidence on hormonal contraceptive methods and HIV acquisition in women

We are grateful to Sharon Achilles for her thoughtful input related to describing potential biological mechanisms, and to all study investigators who provided additional information about their analyses. WHO provided support for the writing of this systmatic review and for the writing group to attend a working meeting in Geneva, Switzerland in October 2015. D.J.W. was partially funded by NIH DP2-HD-08-4070. The review was conducted independently of the WHO guidance development process; and conclusions represent the independent opinions of the authors. The findings and conclusions in this article do not necessarily reflect the positions and policies of the donor. Role of authors: The World Health Organization (J.N.K. and P.S.S.) initiated the idea to conduct this systematic review update. C.B.P. led the conduct of the systematic review, including conducting the systematic literature search and drafting the manuscript. C.B.P., K.M.C., and P.C.H. screened titles, abstracts, and full-text manuscripts to determine study inclusion. S.J.P. conducted the statistical meta-analysis. All coauthors (C.B.P., K.M.C., P.C.H., S.J.P., T.C., J.N.K., D.J.W., and P.S.S.) participated in framing the study question, developing the quality criteria, abstracting study information and assessing study quality, interpreting the data, and contributing to the writing and editing of the manuscript. Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official positions of the Guttmacher Institute, the Centers for Disease Control and Prevention, the World Health Organization, the National Institutes of Health, or other institutions with which the authors are affiliated.Peer reviewedPublisher PD

The Gender Context of HIV Risk and Pregnancy Goals in Western Kenya

Background: Intentional childbearing may place heterosexual couples at risk of HIV infection in resource-limited settings with high HIV prevalence areas where society places great value on having children.Objective: To explore cognitive, cultural, and spatial mapping of sexual and reproductive health domains and services in western Kenya among men and women.Design: Community-based formative qualitative study design.Setting: Five administrative/geographical divisions of Nyando District, western Kenya.Subjects: Adult male 18 years and older and female who were of reproductive-potential ages (15 to 49 years for females)(n=90).Results:Men and women have disparate goals for number of children and engage in gendered patterns of protective method use (contraceptives used by women often in secret, condoms by men but rarely).Conclusion: HIV infection was still seen as stigmatising. These study results are relevant to design of effective integrated delivery for reproductive and HIV services in high-burden sub-Saharan African countries