Implementation of repeat HIV testing during pregnancy in Kenya: a qualitative study.

BackgroundRepeat HIV testing in late pregnancy has the potential to decrease rates of mother-to-child transmission of HIV by identifying mothers who seroconvert after having tested negative for HIV in early pregnancy. Despite being national policy in Kenya, the available data suggest that implementation rates are low.MethodsWe conducted 20 in-depth semi-structured interviews with healthcare providers and managers to explore barriers and enablers to implementation of repeat HIV testing guidelines for pregnant women. Participants were from the Nyanza region of Kenya and were purposively selected to provide variation in socio-demographics and job characteristics. Interview transcripts were coded and analyzed in Dedoose software using a thematic analysis approach. Four themes were identified a priori using Ferlie and Shortell's Framework for Change and additional themes were allowed to emerge from the data.ResultsParticipants identified barriers and enablers at the client, provider, facility, and health system levels. Key barriers at the client level from the perspective of providers included late initial presentation to antenatal care and low proportions of women completing the recommended four antenatal visits. Barriers to offering repeat HIV testing for providers included heavy workloads, time limitations, and failing to remember to check for retest eligibility. At the facility level, inconsistent volume of clients and lack of space required for confidential HIV retesting were cited as barriers. Finally, at the health system level, there were challenges relating to the HIV test kit supply chain and the design of nationally standardized antenatal patient registers. Enablers to improving the implementation of repeat HIV testing included client dissemination of the benefits of antenatal care through word-of-mouth, provider cooperation and task shifting, and it was suggested that use of an electronic health record system could provide automatic reminders for retest eligibility.ConclusionsThis study highlights some important barriers to improving HIV retesting rates among pregnant women who attend antenatal clinics in the Nyanza region of Kenya at the client, provider, facility, and health system levels. To successfully implement Kenya's national repeat HIV testing guidelines during pregnancy, it is essential that these barriers be addressed and enablers capitalized on through a multi-faceted intervention program

Determinants of acceptability of cricket consumption and adoption for improved food security among riparian communities of the Victoria Basin, Kenya

overburdened environment; malnutrition is likely to be on the rise with human population growth projected at 9.7 billion by 2050. This has seen cricket consumption for household food security increasing in the past decade. Cricket (acheta domesticus) farming can contribute positively to solving malnutrition problems being experienced among the riparian communities in the Kenyan Lake Victoria Basin. Cricket farming presents a livelihood diversification strategy that can help buffer rural households against food insecurity and provide an alternative source of income. However, its adoption as an alternative source of protein for improved household food security has remained low among smallholder farmers. The study investigated determinants of acceptability of cricket consumption and its influence on adoption for farming as an alternative source of food. The study employed a mixed methods research approach to collect quantitative and qualitative data from 120 trained cricket farmers from selected riparian counties including Siaya, Kisumu and Homa Bay in Kenyan Victoria basin. Descriptive statistics and logistic regression model were used to summarize quantitative data while content analysis was used to analyze qualitative data by thematic arrangements and similarities across different investigation areas. Based on data analyzed, the results indicated that cultural beliefs, perception and attitude such as cultural value attached to cricket consumption (p = 0.021), crickets are sweet and tender than poultry (p = 0.037) as well as age with a p<0.028, had statistical significance on acceptability to cricket consumption. On the other hand, regression β coefficient of awareness, access and availability were found to have no association with the adoption of cricket farming. The study recommended that: first, the government formulates a policy on farming edible insects as mini-livestock and improved food security. Secondly, further study is needed to determine possible strategies for changing attitude towards cricket consumption for increased adoption by smallholder farmers

Emergence of Clinical Clostridioides Difficile Isolates With Decreased Susceptibility to Vancomycin

BACKGROUND: Clostridioides difficile infection (CDI) is a leading cause of hospital-associated antibiotic-related diarrhea and deaths worldwide. Vancomycin is one of the few antibiotics recommended for both nonsevere and severe CDI cases. We sought to determine whether vancomycin nonsusceptible C. difficile strains are circulating in the patient population. METHODS: Stool samples from patients with CDI were collected from 438 and 98 patients at a large university hospital in Houston, Texas, and Nairobi, Kenya, respectively. The stools were examined for the presence of vancomycin and metronidazole nonsusceptible C. difficile using broth dilution culture, Etest (BioMérieux, France), polymerase chain reaction (PCR), whole-genome sequencing, and in vivo testing in a CDI mouse model. RESULTS: Of the Houston stool samples, 114/438 (26%) had vancomycin nonsusceptible C. difficile isolates and 128/438 (29%) were metronidazole nonsusceptible. Similarly, 66 out of 98 (67%) and 83/98 (85%) of the Nairobi patients harbored vancomycin and metronidazole nonsusceptible isolates, respectively. Vancomycin treatment of a CDI mouse model infected with a vancomycin nonsusceptible isolate failed to eradicate the infection. Whole-genome sequencing analyses did not identify vanA genes, suggesting a different mechanism of resistance. CONCLUSIONS: C. difficile strains exhibiting reduced susceptibility to vancomycin are currently circulating in patient populations. The spread of strains resistance to vancomycin, a first-line antibiotic for CDI, poses a serious therapeutic challenge. Routine susceptibility testing may be necessary

BIOSORPTION OF SELECTED HEAVY METALS BY THE BIOMASS OF THE GREEN ALGA SPIROGYRA SP.

In this paper, the influence of contact time, initial pH and metal ion concentrations on the adsorption properties of a freshwater green alga (Spirogyra sp.) biomass was studied. Several model solutions of selected heavy metals (Cd, Cu, Cr, Pb) were put into contact with the green algae-based sorbent for different time periods. After the treatment, the concentrations of heavy metals in model solutions were determined using flame atomic absorption spectrometry (FAAS) and inductively-coupled plasma-optical emission spectrometry (ICP-OES). Fourier transform infrared spectroscopy (FTIR) was used to reveal which functional groups were responsible for the green algae biosorption properties. Adsorption capacities were found to be 22.52, 38.19, 35.59 and 94.34 mg/g for Cd, Cr, Cu and Pb, respectively, at contact times of 15-50 minutes and initial metal ion concentrations of 500-700 µg/g. The optimum pH for biosorption of Cd, Cr, Cu and Pb were 5.5, 5.8, 5.9 and 5.0, respectively. The biosorption process followed second order kinetics and fittedthe Langmuir isotherm model. Biomonitoring studies suggested the possible use of this freshwater green algaas a bioindicator, with mean concentration factors for the selected elements in the range of 367-7154. BIOSORPCIJA ODABRANIH TEŠKIH METALA POMOĆU BIOMASE ZELENE ALGE SPIROGYRA sp.   U ovom radu je proučavan uticaj kontaktnog vremena, početnog pH i početne koncentracije metalnih jona na sorpcione karakteristike slatkovodne zelene alge Spirogyra sp. Nekoliko model-rastvora odabranih teških metala (Cd, Cu, Cr, Pb) je tretirano, u različitim vremenskim intervalima, sorbentom pripremljenim od zelenihalgi. Plamena atomska apsorpciona spektrometrija (FAAS) i induktivno kuplovana plazma sa optičkom emisionom spektrometrijom(ICP-OES) su korišćene za određivanje sadržaja teških metala u model-rastvorima Nakon tretmana. Furijeova transformacion ainfracrvena spektroskopija (FTIR) je pokazala koje funkcionalne grupe su nosioci biosorpcionih osobina zelenih algi. Pri kontaktnim vremenima u opsegu 15-50 minuta i polaznoj koncentraciji metala 500-700 µg/ml, sorpcioni kapacitet je iznosio 22,52, 38,19, 35,59 i 94,34 mg/g za Cd, Cr, Cu i Pb. Optimalni pH za biosorpciju Cd, Cr, Cu i Pb je bio 5,5, 5,8, 5,9 i 5,0. Proces biosorpcije prati kinetiku drugog reda i zakonitosti Lengmirovog izotermalnog modela. Rezultati biomonitoringa ukazuju da zelene alge imaju veliki potencijal kao bioindikatori; srednji koncentracioni fakori za proučavane metale su bili u opsegu 367-7154.

Larval habitats of Anopheles gambiae s.s. (Diptera: Culicidae) influences vector competence to Plasmodium falciparum parasites

<p>Abstract</p> <p>Background</p> <p>The origin of highly competent malaria vectors has been linked to productive larval habitats in the field, but there isn't solid quantitative or qualitative data to support it. To test this, the effect of larval habitat soil substrates on larval development time, pupation rates and vector competence of <it>Anopheles gambiae </it>to <it>Plasmodium falciparum </it>were examined.</p> <p>Methods</p> <p>Soils were collected from active larval habitats with sandy and clay substrates from field sites and their total organic matter estimated. <it>An. gambiae </it>larvae were reared on these soil substrates and the larval development time and pupation rates monitored. The emerging adult mosquitoes were then artificially fed blood with infectious <it>P. falciparum </it>gametocytes from human volunteers and their midguts examined for oocyst infection after seven days. The wing sizes of the mosquitoes were also measured. The effect of autoclaving the soil substrates was also evaluated.</p> <p>Results</p> <p>The total organic matter was significantly different between clay and sandy soils after autoclaving (P = 0.022). A generalized liner model (GLM) analysis identified habitat type (clay soil, sandy soil, or lake water) and autoclaving (that reduces presence of microbes) as significant factors affecting larval development time and oocyst infection intensities in adults. Autoclaving the soils resulted in the production of significantly smaller sized mosquitoes (P = 0.008). Autoclaving clay soils resulted in a significant reduction in <it>Plasmodium falciparum </it>oocyst intensities (P = 0.041) in clay soils (unautoclaved clay soils (4.28 ± 0.18 oocysts/midgut; autoclaved clay soils = 1.17 ± 0.55 oocysts/midgut) although no difference (P = 0.480) in infection rates was observed between clay soils (10.4%), sandy soils (5.3%) or lake water (7.9%).</p> <p>Conclusion</p> <p>This study suggests an important nutritional role for organic matter and microbial fauna on mosquito fitness and vector competence. It shows that the quality of natural aquatic habitats of mosquito larvae may influence malaria parasite transmission potential by <it>An. gambiae</it>. This information can be important in targeting larval habitats for malaria control.</p

Lessons Learned Developing a Diagnostic Tool for HIV-Associated Dementia Feasible to Implement in Resource-Limited Settings: Pilot Testing in Kenya

Objective: To conduct a preliminary evaluation of the utility and reliability of a diagnostic tool for HIV-associated dementia (HAD) for use by primary health care workers (HCW) which would be feasible to implement in resource-limited settings. Background: In resource-limited settings, HAD is an indication for anti-retroviral therapy regardless of CD4 T-cell count. Anti-retroviral therapy, the treatment for HAD, is now increasingly available in resource-limited settings. Nonetheless, HAD remains under-diagnosed likely because of limited clinical expertise and availability of diagnostic tests. Thus, a simple diagnostic tool which is practical to implement in resource-limited settings is an urgent need. Methods: A convenience sample of 30 HIV-infected outpatients was enrolled in Western Kenya. We assessed the sensitivity and specificity of a diagnostic tool for HAD as administered by a primary HCW. This was compared to an expert clinical assessment which included examination by a physician, neuropsychological testing, and in selected cases, brain imaging. Agreement between HCW and an expert examiner on certain tool components was measured using Kappa statistic. Results: The sample was 57 % male, mean age was 38.6 years, mean CD4 T-cell count was 323 cells/mL, and 54 % had less than a secondary school education. Six (20%) of the subjects were diagnosed with HAD by expert clinical assessment. The diagnostic tool was 63 % sensitive and 67 % specific for HAD. Agreement between HCW and expert examiners was poor for many individual items of the diagnostic tool (K =.03–.65). This diagnostic tool had moderate sensitivity and specificity fo

Population-Based Biochemistry, Immunologic and Hematological Reference Values for Adolescents and Young Adults in a Rural Population in Western Kenya

BACKGROUND: There is need for locally-derived age-specific clinical laboratory reference ranges of healthy Africans in sub-Saharan Africa. Reference values from North American and European populations are being used for African subjects despite previous studies showing significant differences. Our aim was to establish clinical laboratory reference values for African adolescents and young adults that can be used in clinical trials and for patient management. METHODS AND FINDINGS: A panel of 298, HIV-seronegative individuals aged 13-34 years was randomly selected from participants in two population-based cross-sectional surveys assessing HIV prevalence and other sexually transmitted infections in western Kenya. The adolescent (/=18 years) ratio and the male-to-female ratio was 1ratio1. Median and 95% reference ranges were calculated for immunohematological and biochemistry values. Compared with U.S-derived reference ranges, we detected lower hemoglobin (HB), hematocrit (HCT), red blood cells (RBC), mean corpuscular volume (MCV), neutrophil, glucose, and blood urea nitrogen values but elevated eosinophil and total bilirubin values. Significant gender variation was observed in hematological parameters in addition to T-bilirubin and creatinine indices in all age groups, AST in the younger and neutrophil, platelet and CD4 indices among the older age group. Age variation was also observed, mainly in hematological parameters among males. Applying U.S. NIH Division of AIDS (DAIDS) toxicity grading to our results, 40% of otherwise healthy study participants were classified as having an abnormal laboratory parameter (grade 1-4) which would exclude them from participating in clinical trials. CONCLUSION: Hematological and biochemistry reference values from African population differ from those derived from a North American population, showing the need to develop region-specific reference values. Our data also show variations in hematological indices between adolescent and adult males which should be considered when developing reference ranges. This study provides the first locally-derived clinical laboratory reference ranges for adolescents and young adults in western Kenya

Molecular characterization of HIV type 1 among respondents in a cohort being prepared for HIV-1 phase III clinical trials, Western Kenya.

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