Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya : a modelling study

Background: Multiple prevention interventions, including early antiretroviral therapy initiation, may reduce HIV incidence in hyperendemic settings. Our aim was to predict the short-term impact of various single and combined interventions on HIV spreading in the adult population of Ndhiwa subcounty (Nyanza Province, Kenya). Methods: A mathematical model was used with data on adults (15-59 years) from the Ndhiwa HIV Impact in Population Survey to compare the impacts on HIV prevalence, HIV incidence rate, and population viral load suppression of various interventions. These interventions included: improving the cascade of care (use of three guidelines), increasing voluntary medical male circumcision (VMMC), and implementing pre-exposure prophylaxis (PrEP) use among HIV-uninfected women. Results: After four years, improving separately the cascade of care under the WHO 2013 guidelines and under the treat-all strategy would reduce the overall HIV incidence rate by 46 and 58 %, respectively, vs. the baseline rate, and by 35 and 49 %, respectively, vs. the implementation of the current Kenyan guidelines. With conservative and optimistic scenarios, VMMC and PrEP would reduce the HIV incidence rate by 15-25 % and 22-28 % vs. the baseline, respectively. Combining the WHO 2013 guidelines with VMMC would reduce the HIV incidence rate by 35-56 % and combining the treat-all strategy with VMMC would reduce it by 49-65 %. Combining the WHO 2013 guidelines, VMMC, and PrEP would reduce the HIV incidence rate by 46-67 %. Conclusions: The impacts of the WHO 2013 guidelines and the treat-all strategy were relatively close; their implementation is desirable to reduce HIV spread. Combining several strategies is promising in adult populations of hyperendemic areas but requires regular, reliable, and costly monitoring

Optimisation of a somatic embryogenesis and transformation protocol for farmer-preferred cassava cultivars in Kenya

Cassava ( Manihot esculenta Crantz ) is a major food crop in developing countries, and holds potential for industrial use. It is, however, affected by various biotic and abiotic stresses that greatly affect its production. The existing regeneration and transformation protocols are not compatible with all cassava cultivars, thus efficient and robust transformation and regeneration protocols for farmer-preferred cultivars need to be optimised for ease of transfer of novel genes. The objective of this study was to develop an efficient transformation and regeneration protocol for a farmer-preferred Kenyan cassava cultivar. We cultured immature leaf lobe and stem explants on Murashige and Skoog (MS) medium, supplemented with varying concentrations of 2,4-dichlorophenoxyacetic acid (2,4-D), Picloram and \ue1-naphthalene acetic acid (NAA). Plants were recovered on media with 6-Benzylaminopurine (BAP) and GA3 under a 16 hour light/8 hour darkness photoperiod regime. Results showed high regeneration and transformation frequencies for both cultivars. High frequencies of callus induction (>98%) for both cultivars, were obtained when 2,4-D and Picloram were used. Similarly, both auxins initiated somatic embryogenesis, with Picloram producing the highest frequency of somatic embryos (>92%) in TMS 60444, using stem explants. Gus assays revealed high frequencies of transformation of >77% (TMS 60444) and 60% (Kibanda meno mkubwa). This protocol offers promising perspectives for rapid improvement of these cultivars and, therefore, provides a platform for cleaning planting materials, as well as cassava genetic improvement programmes such as control of viral diseases.Le manioc ( Manihot esculenta Crantz ) est une culture vivri\ue8re de grande importance pour les pays en d\ue9veloppement, avec un potentiel pour l\u2019usage industriel. N\ue9anmoins, le manioc est sujet \ue0 des stress d\u2019origines biotique et abiotique, affectant sa production. Les protocoles de r\ue9g\ue9n\ue9ration et de transformation existante ne sont pas compatibles avec toutes les accessions de manioc. Ainsi, il est n\ue9cessaire de d\ue9velopper des protocoles de r\ue9g\ue9n\ue9ration et de transformation efficaces pour les accessions adopt\ue9es par les paysans, afin de faciliter les transferts de g\ue8nes d\u2019int\ue9r\ueat. L\u2019objectif de cet etude \ue9tait de d\ue9velopper un protocole de r\ue9g\ue9n\ue9ration et de transformation adapte a la vari\ue9t\ue9 de manioc. Des feuilles et tiges immatures ont \ue9t\ue9 cultiv\ue9es sur des media Murashige et Skoog (MS), auxquels diff\ue9rentes concentrations de 2,4-dichlorophenoxyacetic acide (2,4-D), Picloram et \ue1-naphtal\ue8ne ac\ue9tique acide (NAA). Les plantes ont \ue9t\ue9 recouvertes de 6-Benzylaminopurine (BAP) et GA3 sous une photop\ue9riode de 16h jour/8h nuit. Les r\ue9sultats ont montr\ue9 des fr\ue9quences \ue9lev\ue9es de r\ue9g\ue9n\ue9ration et de transformation pour les deux cultivars Kibanda meno mkubwa et TMS 60444. Des fr\ue9quences \ue9lev\ue9es d\u2019induction de callosit\ue9s (>98%) ont \ue9t\ue9 obtenues pour les deux cultivars, lorsque 2,4-D et Picloram ont \ue9t\ue9 utilis\ue9s. De la m\ueame fa\ue7on, les deux embryogen\ue8ses somatiques initi\ue9es a l\u2019auxine, avec des explants de tiges et du Picloram ont exhibe la fr\ue9quence la plus \ue9lev\ue9e d\u2019embryon somatique (>92%) en TMS 60444. Des essais de Gus ont r\ue9v\ue9l\ue9s des fr\ue9quences \ue9lev\ue9es de transformation >77% (TMS 60444) et 60% (Kibanda meno mkubwa). Ce protocole offre des perspectives pour l\u2019am\ue9lioration rapide de ces cultivars, et par cons\ue9quent, fournit une plateforme pour la production de mat\ue9riels de culture propres, mais aussi servira d\u2019outil dans les programmes d\u2019am\ue9lioration g\ue9n\ue9tique visant la lutte contre les maladies virales

Assessing access barriers to tuberculosis care with the tool to Estimate Patients' Costs: pilot results from two districts in Kenya

<p>Abstract</p> <p>Background</p> <p>The poor face geographical, socio-cultural and health system barriers in accessing tuberculosis care. These may cause delays to timely diagnosis and treatment resulting in more advanced disease and continued transmission of TB. By addressing barriers and reasons for delay, costs incurred by TB patients can be effectively reduced. A Tool to Estimate Patients' Costs has been developed. It can assist TB control programs in assessing such barriers. This study presents the Tool and results of its pilot in Kenya.</p> <p>Methods</p> <p>The Tool was adapted to the local setting, translated into Kiswahili and pretested. Nine public health facilities in two districts in Eastern Province were purposively sampled. Responses gathered from TB patients above 15 years of age with at least one month of treatment completed and signed informed consent were double entered and analyzed. Follow-up interviews with key informants on district and national level were conducted to assess the impact of the pilot and to explore potential interventions.</p> <p>Results</p> <p>A total of 208 patients were interviewed in September 2008. TB patients in both districts have a substantial burden of direct (out of pocket; USD 55.8) and indirect (opportunity; USD 294.2) costs due to TB. Inability to work is a major cause of increased poverty. Results confirm a 'medical poverty trap' situation in the two districts: expenditures increased while incomes decreased. Subsequently, TB treatment services were decentralized to fifteen more facilities and other health programs were approached for nutritional support of TB patients and sputum sample transport. On the national level, a TB and poverty sub-committee was convened to develop a comprehensive pro-poor approach.</p> <p>Conclusions</p> <p>The Tool to Estimate Patients' Costs proved to be a valuable instrument to assess the costs incurred by TB patients, socioeconomic situations, health-seeking behavior patterns, concurrent illnesses such as HIV, and social and gender-related impacts. The Tool helps to identify and tackle bottlenecks in access to TB care, especially for the poor. Reducing delays in diagnosis, decentralization of services, fully integrated TB/HIV care and expansion of health insurance coverage would alleviate patients' economic constraints due to TB.</p

Effects of biofertilizer containing N-fixer, P and K solubilizers and AM fungi on maize growth: A greenhouse trial.

An in vitro study was undertaken to evaluate the compatibility of indigenous plant growth promoting rhizobacteria (PGPR) with commonly used inorganic and organic sources of fertilizers in tea plantations. The nitrogenous, phosphatic and potash fertilizers used for this study were urea, rock phosphate and muriate of potash, respectively. The organic sources of fertilizers neem cake, composted coir pith and vermicompost were also used. PGPRs such as nitrogen fixer; Azospirillum lipoferum, Phosphate Solubilizing Bacteria (PSB); Pseudomonas putida, Potassium Solubilizing Bacteria (KSB); Burkholderia cepacia and Pseudomonas putida were used for compatibility study. Results were indicated that PGPRs preferred the coir pith and they proved their higher colony establishment in the formulation except Azospirillum spp. that preferred vermicompost for their establishment. The optimum dose of neem cake powder

Cascade of HIV care and population viral suppression in a high-burden region of Kenya

Introduction: Direct measurement of antiretroviral treatment (ART) program indicators essential for evidence-based planning and evaluation - especially HIV incidence, population viral load, and ART eligibility - is rare in sub-Saharan Africa. Design/methods: To measure key indicators in rural western Kenya, an area with high HIV burden, we conducted a population survey in September to November 2012 via multistage cluster sampling, recruiting everyone aged 15-59 years living in 3330 randomly selected households. Consenting individuals were interviewed and tested for HIV at home. Participants testing positive were assessed for CD4(+) cell count and viral load, and their infections classified as either recent or long term based on Limiting Antigen Avidity assays. HIV-negative participants were tested by nucleic acid amplification to detect acute infections. Results: Of 6833 household members eligible for the study, 6076 (94.7% of all women and 81.0% of men) agreed to participate. HIV prevalence and incidence were 24.1% [95% confidence interval [CI] 23.0-25.2] and 1.9 new cases/100person-years (95% CI 1.1-2.7), respectively. Among HIV-positive participants, 59.4% (95% CI 56.8-61.9) were previously diagnosed, 53.1% (95% CI 50.5-55.7) were receiving care, and 39.7% (95% CI 37.1-42.4) had viral load less than 1000copies/ml. Applying 2013 WHO recommendations for ART initiation increased the proportion of ART-eligible people from 60.0% (based on national guidelines in place during the survey; 95% CI 57.3-62.7) to 82.0% (95% CI 79.5-84.5). Among HIV-positive people not receiving ART, viral load increased with decreasing CD4(+) cell count (500-749 vs. 750cells/l, adjusted mean difference, 0.40log(10)copies/ml, 95% CI 0.20-0.60, P<0.01). Conclusion: This study demonstrates how population-level data can help optimize HIV programs. Based on these results, new regional programs are prioritizing diagnosis and expanding ART eligibility, key steps to reach undetectable viral load