Alcohol and illicit drug use among young people living with HIV compared to their uninfected peers from the Kenyan coast: prevalence and risk indicators

Background: In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people. Methods: Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). Alcohol and drug use disorders identification tests (AUDIT and DUDIT) were administered via audio computer-assisted self-interview alongside other measures. Logistic regression was used to determine substance use risk indicators. Results: The point prevalence of current substance use was significantly lower among YLWH than HIV-uninfected youths: current alcohol use, 13% vs. 24%, p \u3c 0.01; current illicit drug use, 7% vs. 15%, p \u3c 0.01; current alcohol and illicit drug use comorbidity, 4 vs. 11%, p \u3c 0.01. Past-year prevalence estimates for hazardous substance use were generally low among young people in this setting (\u3c 10%) with no significant group differences observed. Being HIV-positive independently predicted lower odds of current substance use, but not hazardous substance use. There was overlap of some risk indicators for current substance use between young people with and without HIV including male sex, khat use and an experience of multiple negative life events, but risk indicators unique to either group were also identified. Among YLWH, none of the HIV-related factors was significantly associated with current substance use. Conclusions: At the Kenyan coast, substance use is a reality among young people. The frequency of use generally appears to be low among YLWH compared to the HIV-uninfected peers. Substance use prevention initiatives targeting young people, regardless of HIV infection status, are warranted in this setting to avert their potential risk for developing substance use disorders, including dependence. The multifaceted intrapersonal and interpersonal factors that place young people at risk of substance use need to be addressed as part of the substance use awareness and prevention initiatives

Opportunities and Challenges to Emergency Department-Based HIV Testing Services and Self-Testing Programs: A Qualitative Study of Healthcare Providers and Patients in Kenya

BACKGROUND: Young people in Sub-Saharan Africa, especially males, have been insufficiently engaged through HIV Testing Services (HTS). In Kenya, younger persons are often treated in emergency departments (EDs) for injuries, an interaction where HTS and HIV self-testing (HIVST) can be leveraged. Data from stakeholders on ED-HTS and HIVST is lacking and needed to understand opportunities and barriers for HIV testing and care, and inform program implementation. METHODS: Between December 2021 and March 2022, 32 in-depth interviews (IDIs) were conducted with 16 male and 16 female patients who had been treated in the Kenyatta National Hospital (KNH) ED, half of whom had been HIV-tested. Six focus-group discussions (FGDs) were also conducted with 50 nurses, doctors, HIV testing counselors, and administrators working in the ED. All transcripts were double-coded and thematically analyzed using Dedoose software and a parallel inductive and deductive coding approach which allowed for capture of both a priori and emergent themes. RESULTS: Patients and providers agreed that ED-HTS are facilitated by friendly staff, patient education, high perceived HIV risk, and confidentiality. However, ED-HTS is limited by burdens on staff, resources, time, and space, as well as severity of patient injuries limiting ability to consent to or prioritize HIV testing. These limitations provide opportunities for ED-HIVST: particularly the ability to test at a comfortable time and place, especially when provided alongside sufficient HIV and testing education, contact with healthcare providers, and psychosocial support. Barriers for ED-HIVST where identified and as patients’ concerns about HIVST accuracy and mental health impacts of a positive test, as well providers’ identified barriers on their concerns for loss to follow up and inability to complete confirmatory testing. COM-B Model [Figure: see text] Application of the COM-B Model of Behavior Change to ED-HIVST Acceptability in Kenya CONCLUSION: ED stakeholders are receptive to HTS and HIVST, and patients desire the opportunity to use HIVST. Potential challenges—such as psychological effects of testing positive, worries about access to follow-up care, and confusion about how to self-administer testing, may be addressed through programming designed to promote education, access and ensure follow-up mechanisms. DISCLOSURES: All Authors: No reported disclosures

Rural livelihood diversity and its influence on the ecological intensification potential of smallholder farms in Kenya

Smallholder farmers represent the majority of food producers around the world, yet they are often the most at risk of suffering yield gaps and not achieving their production potential. Ecological Intensification (EI) is a knowledge intensive approach to sustainable agricultural intensification which utilises biodiversity-based ecosystem services to support greater yield and reduce reliance on agrochemical inputs. Despite the potential benefit of EI based practices, uptake by smallholders is not as widespread as it could be. Here we test the hypothesis that application of EI on smallholder farms in Kenya is a viable approach that could be taken in order to enhance food security. Focusing on natural pest control and crop pollination, we used farmer surveys to explore the potential for EI in central Kenya. We identified to what extent farm typology and access to knowledge determine the incentives and barriers facing smallholder producers and how this influences optimal pathways for sharing knowledge and providing extension services. We found considerable potential for EI of smallholder farms in this region; most farmers grew insect pollinated crops and some farmers already employed EI practices, while others relied heavily on chemical pesticides. Based on physical, social and economic factors, three farm typologies emerged including ‘semi-commercial’, ‘market orientated’ and ‘subsistence’. These typologies influenced the appropriate EI practices available to farmers, as well as routes through which knowledge was shared and the extent to which extension services were utilised. We propose that to support effective uptake of EI practices, smallholder farm heterogeneity should be acknowledged and characterised in order to target the needs and capabilities of farmers and identify appropriate knowledge sharing and support pathways. The approach we take here has the potential to be employed in other regions globally

Non-Invasive Sampling of Schistosomes from Humans Requires Correcting for Family Structure

For ethical and logistical reasons, population-genetic studies of parasites often rely on the non-invasive sampling of offspring shed from their definitive hosts. However, if the sampled offspring are naturally derived from a small number of parents, then the strong family structure can result in biased population-level estimates of genetic parameters, particularly if reproductive output is skewed. Here, we document and correct for the strong family structure present within schistosome offspring (miracidia) that were collected non-invasively from humans in western Kenya. By genotyping 2,424 miracidia from 12 patients at 12 microsatellite loci and using a sibship clustering program, we found that the samples contained large numbers of siblings. Furthermore, reproductive success of the breeding schistosomes was skewed, creating differential representation of each family in the offspring pool. After removing the family structure with an iterative jacknifing procedure, we demonstrated that the presence of relatives led to inflated estimates of genetic differentiation and linkage disequilibrium, and downwardly-biased estimates of inbreeding coefficients (F[subscript IS]). For example, correcting for family structure yielded estimates of F[[subscript ST] among patients that were 27 times lower than estimates from the uncorrected samples. These biased estimates would cause one to draw false conclusions regarding these parameters in the adult population. We also found from our analyses that estimates of the number of full sibling families and other genetic parameters of samples of miracidia were highly intercorrelated but are not correlated with estimates of worm burden obtained via egg counting (Kato-Katz). Whether genetic methods or the traditional Kato-Katz estimator provide a better estimate of actual number of adult worms remains to be seen. This study illustrates that family structure must be explicitly accounted for when using offspring samples to estimate the genetic parameters of adult parasite populations

Incidence and Correlates of HIV-1 RNA Detection in the Breast Milk of Women Receiving HAART for the Prevention of HIV-1 Transmission

The incidence and correlates of breast milk HIV-1 RNA detection were determined in intensively sampled women receiving highly active antiretroviral therapy (HAART) for the prevention of mother-to-child HIV-1 transmission.Women initiated HAART at 34 weeks of pregnancy. Breast milk was collected every 2-5 days during 1 month postpartum for measurements of cell-associated HIV DNA and cell-free HIV RNA. Plasma and breast milk were also collected at 2 weeks, 1, 3 and 6 months for concurrent HIV-1 RNA and DNA measurements. Regression was used to identify cofactors for breast milk HIV-1 RNA detection.Of 259 breast milk specimens from 25 women receiving HAART, 34 had detectable HIV-1 RNA (13%, incidence 1.4 episodes/100 person-days 95% CI = 0.97-1.9). Fourteen of 25 (56%) women had detectable breast milk HIV-1 RNA [mean 2.5 log(10) copies/ml (range 2.0-3.9)] at least once. HIV-1 DNA was consistently detected in breast milk cells despite HAART, and increased slowly over time, at a rate of approximately 1 copy/10(6) cells per day (p = 0.02). Baseline CD4, plasma viral load, HAART duration, and frequency of breast problems were similar in women with and without detectable breast milk HIV-1 RNA. Women with detectable breast milk HIV-1 RNA were more likely to be primiparous than women without (36% vs 0%, p = 0.05). Plasma HIV-1 RNA detection (OR = 9.0, 95%CI = 1.8-44) and plasma HIV-1 RNA levels (OR = 12, 95% CI = 2.5-56) were strongly associated with concurrent detection of breast milk HIV-1 RNA. However, no association was found between breast milk HIV-1 DNA level and concurrent breast milk HIV-1 RNA detection (OR = 0.96, 95%CI = 0.54-1.7).The majority of women on HAART had episodic detection of breast milk HIV-1 RNA. Breast milk HIV-1 RNA detection was associated with systemic viral burden rather than breast milk HIV-1 DNA

Local Connectivity in Qt Markup Language

The objective of this thesis was to study Qt/QML, NFC and Bluetooth technology, with the aim of investigating how data is transferred from low level NFC to QML application level. The knowledge gained was to be used to develop a QML-based application to demonstrate the local connectivity of Bluetooth and NFC. The target device was the Symbian phone for which Nokia 603 was selected in this project for demonstration purposes. The project was carried out in two parts first, the theoretical part and the practical part. The theoretical part entailed studying of Qt platform, QML language, NFC and Bluetooth tech-nologies. Qt and QML were used as the development environment and development lan-guage respectively. NFC was used to trigger the local connectivity and Bluetooth aided in the transfer of user input from one phone to the other and vice versa. The basic idea, which was the practical part, was demonstrated by developing a sample game that could be played by two players, data was transferred over Bluetooth and the connection was initiated by NFC. In the game data transfer was initiated by NFC that started the Bluetooth pairing and connection. The Bluetooth connection was then used to pass the data from one phone to another phone. The result of this thesis showed a successful local connection of NFC and Bluetooth using QML technology. This clarified Qt, QML, NFC and Bluetooth technologies in the different aspects and the development of a QML mobile application. The result showed that even a developer with the basic programming skills can easily study, develop and deploy applica-tions in QML. It also shows that different technologies can be combined to come up with one working application. The game which was developed in this project gave a clear indi-cation that more intuitive applications and games could be developed using QML with NFC and Bluetooth technologies

Talent management system for financial institutions in Kenya

Submitted in partial fulfillment of the requirements for the Degree of Master of Science in Information TechnologyThis research aims to provide a solution to the question of talent management for financial institutions in Kenya. The absence of talent management systems has led to financial institutions experiencing retention problems as well as difficulties in succession planning. Applied research was adopted and data was collected through secondary sources such as literature and an interview with managers in the financial sector. Considering the presence of the millennial generation in today's workplace, the solution was based on how to reach them in the environment they are usually found in and applying best practice techniques on rewarding and retaining them. In conclusion, there is a need for the financial institutions to strategize and look into new ways of how to efficiently tap into the talent amongst the millennial generation and establish a sustainable talent pipeline in order to remain competitive in the long run

Enhancing legume crop pollination and natural pest regulation for improved food security in changing African landscapes

Legumes are important crops for food security, consumed by millions of people especially in Africa where they are an essential protein source and provide key vitamins and minerals. Most legumes depend on insect pollination and natural pest regulation for sufficient yields, however, there is emerging evidence that yield gaps caused by lack of pollination and/or pest pressure may be common. Here we review the literature reporting on pollinators and natural enemies contributing to legume crop yields, and the impact of land-use change on the services provided by these beneficial organisms. We identify strategies for enhancing the benefits of pollination and natural pest control in legumes and propose policy and practice interventions for better utilization of pollinators and natural enemies in legume cropping systems in Africa

Improving and Sustaining ICT Skills of Health Researchers in Kenya Through a Three-Tiered Approach of Online Learning, Hands-On Workshops, and Personalized Mentoring

Despite the recent growth in health informatics, the use of information, communication and technology (ICT) by health researchers in resource-limited settings has been slow and inequitable. Further, many local institutions that have excellent ICT capacity do not routinely provide such services to the health researchers. innovative delivery of ICT skills to health researchers may improve the quality and impact of research outcomes