Evolution of HIV Training for Enhanced Care Provision in Kenya: Challenges and Opportunities

Background: Healthcare worker capacity building efforts over the past decade have resulted in decentralisation of HIV prevention, care and treatment servicesObjective: To provide an overview of the evolution of HIV training in Kenya, from 2003 to dateData sources: Various Government of Kenya publications, policy documents and websites on training for HIV service delivery. Publications and websites of stakeholders, donors and partners as well. Journal articles, published peer reviewed literature, abstracts, websites and programme reports related to training for HIV treatment in Kenya and the region. Personal experiences of the authors who are trainers by mandate.Data selection: Data related to training for HIV treatment in Kenya and the region on websites and publications were scrutinised.Data extraction: All selected articles were read.Data synthesis: All the collected data together with the authors’  experiences were used for this publication.Conclusion: Accelerated in-service capacity building efforts have contributed to the success of decentralisation of HIV services. Pre-service HIV training provides an opportunity for sustaining the gains made so far, in the face of declining donor funds. Implementation of the proposed harmonized HIV curriculum in the setting of devolved healthcare provides an opportunity for partnerships between stakeholders involved in pre-service and in-service HIV training to ensure sustainability

Health related quality of life of patients on maintenance haemodialysis at Kenyatta National Hospital

Background: Health related quality of life is increasingly being recognised as a primary outcome measure in treatment of end-stage renal disease. The health related quality of life of patients on maintenance haemodialysis is reduced. Several interventions directed at modifiable risk factors have been shown to improve quality of life of patients on haemodialysis.Objective: To assess the health-related quality of life of patients on maintenance haemodialysis at the Kenyatta National Hospital.Design: Cross sectional descriptive study.Setting: Kenyatta National Hospital, Renal Unit.Subjects: The study was conducted on 96 patients with end-stage renal disease on maintenance haemodialysis. Socio-demographic and clinical factors were recorded for all patients. Health-related quality of life was assessed using the Kidney Disease Quality of Life-36 questionnaire. Two summary scores and three subscale scores were calculated.Results: The mean physical composite summary and mental composite summary scores were 39.09±9.49 and 41.87±10.56 respectively. The burden of kidney disease subscale, symptom and problems subscale and effect of kidney disease on daily life subscale scores were 16.15±21.83, 73.46±18.061 and 67.63±23.45 respectively.Conclusion: Health-related quality of life of patients on maintenance haemodialysis is reduced. The physical quality of life is more affected than the mental quality of life. The burden of kidney disease subscale is the most affected subscale score

Crosstalk between reactive oxygen species and pro-inflammatory markers in developing various chronic diseases: a review

The inflammation process in the human body plays a central role in the pathogenesis of many chronic diseases. In addition, reactive oxygen species (ROS) exert potentially a decisive role in human body, particularly in physiological and pathological process. The chronic inflammation state could generate several types of diseases such as cancer, atherosclerosis, diabetes mellitus and arthritis, especially if it is concomitant with high levels of pro-inflammatory markers and ROS. The respiratory burst of inflammatory cells during inflammation increases the production and accumulation of ROS. However, ROS regulate various types of kinases and transcription factors such nuclear factor-kappa B which is related to the activation of pro-inflammatory genes. The exact crosstalk between pro-inflammatory markers and ROS in terms of pathogenesis and development of serious diseases is still ambitious. Many studies have been attempting to determine the mechanistic mutual relationship between ROS and pro-inflammatory markers. Therefore hereby, we review the hypothetical relationship between ROS and pro-inflammatory markers in which they have been proposed to initiate cancer, atherosclerosis, diabetes mellitus and arthritis

Pseudoxanthoma elasticum in a patient with sickle cell disease: case report

No Abstract. East African Medical Journal Vol. 85 (2) 2008 pp. 98-10

Osteopaenia and Osteonecrosis in HIV Infection: Report of Two Cases

The introduction in the mid 1990’s of highly active anti-retroviral drugs therapy (HAART) in the treatment of human immunodeficiency virus (HIV) infection has significantly changed the course, manifestation of HIV disease and improved the life expectancy of HIV infected patients.The consequence of longer survival has manifested increasing rates of co-morbid diseases and aroused interest in the interaction of HIV and aging The pathogenesis of the resultant conditions though not fully understood is likely multifactorial and may be related to direct effect of the HIV virus and associated immunodeficiency, underlying opportunistic events, immunoactivation ,related vasculopathies and inflammatory processes and toxic effects of anti-retroviral agents Bone disorders as such osteopaenia, osteoporosis and bone fractures, osteonecrosis and accompanying metabolic changes, has been reported with increasing frequency. We report two cases of patients known to be HIV positive and on HAART who presented with hip pain. The first patient had radiological evidence of osteonecrosis (avascular necrosis) of the head of femur, and second patient who presented with acute sudden onset pain had fracture of the neck of femur. Literature is reviewed to elucidate possible mechanism of disease and a brief consideration of possible therapy is discussed

Prevalence of fibromyalgia in ambulatory HIV positive patients with musculoskeletal pain at Comprehensive Care Clinic, Kenyatta National Hospital

Background: Fibromyalgia is a rheumatic condition that is characterized by chronic widespread musculoskeletal pain with painful pressure points. There are other symptoms that are associated with this condition and they include fatigue, sleep disturbance and depression. The cause of this condition is unknown however chronic viral infections eg HIV have been associated with bromyalgia. Objective: This study aimed to determine the prevalence of fibromyalgia in HIV positive patients. Design: This was a cross-sectional descriptive study. Setting: The study was carried out at the Comprehensive Care Centre, Kenyatta National Hospital. Methods: The patients attending the clinic between the month of February 2013 and April 2013 were assessed for chronic musculoskeletal pain and subsequently fibromyalgia using the American College of Rheumatology criteria. Those found to have fibromyalgia were given the FIQR and those without were given the SIQR for comparison purposes. Clinical details eg WHO clinical stage, CD4 counts and HAART regimen for those on HAART were also documented. Results: A total of 380 patients were evaluated. The prevalence of fibromyalgia in HIV positive patients at the Comprehensive Care Centre, Kenyatta National Hospital was 68 (17.9%). The mean age of these patients was 42.2 years with a median of 40.5 years.There was a female preponderance of 60 (88.2%). Fibromyalgia was independently associated with female gender, OR=2.75, unemployment status, OR=5.68 and retired status, OR=3.01. A majority of the patients were in WHO clinical stage 3 and the mean CD4 count was 276.2. There was however no association between fibromyalgia and WHO clinical stage, CD4 count and use of HAART or the specific HAART regimens. The mean FIQR was 50.1 which was significantly higher than the mean SIQR score of 12.4 in those without fibromyalgia. Conclusion: Fibromyalgia is a prevalent rheumatologic condition among HIV positive patients with chronic musculoskeletal pain. It is also associated with a high FIQR score

Bone mineral density abnormalities in HIV infected patients and HIV negative respondents at Mbagathi Hospital using calcaneal quantitative ultrasound

Background: Osteoporosis is a systemic skeletal disorder characterized by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and fracture. Use of Highly Active Anti-Retroviral Therapy (HAART) has been associated with prolonged survival and consequently with an increase in the prevalence of decreased bone mineral density. Quantitative Ultrasound (QUS) is gaining popularity as an appropriate tool for determination of bone mineral density profiles in resource- poor settings.Objectives: To determine and compare the difference in the prevalence of Bone Mineral Density (BMD) abnormalities using quantitative calcaneal ultrasound between HIV infected patients on a TDF based first-line regime for at least one year, HAART-naive HIV positive patients in Mbagathi Comprehensive Care Clinic (CCC) and a HIV negative control group seen at the Mbagathi Voluntary Counselling and Testing Centre (VCT). To describe the occurrence of traditional risk factors associated with decreased BMD in the above populations (oral corticosteroid use, smoking, alcohol, previous bone fracture, body mass index and physical inactivity).Methods: This was a cross-sectional comparative group descriptive study of HIV positive adult patients on TDF based first-line regime (exposed), HIV positive HAART- naive adult patients (unexposed) and HIV negative adult group (control) at Mbagathi Hospital. Random sampling was used to recruit 315 participants (105 in each arm). An interviewer administered questionnaire was used to document risk factors for low BMD. Quantitative ultrasound bone mineral density was done using a heel ultrasonic gel- coupled QUS system, the Sunlight Mini Omni (Beam Med Ltd, Israel).Results: The prevalence of osteoporosis among HIV positive respondents on HAART was significantly higher (58.1%) compared to HIV positive respondents not on HAART (32.6%) (Z-test p-value = 0.001) and HIV negative respondents (9.3%) (Z-test p-value = 0.001). Older patients had lower levels of BMD (i.e. more negative BMD. p-value = 0.032). HIV positive respondents on HAART had lower BMI than HAART naïve and HIV negative individuals (23.6%, 24.8% and 26.1% respectively). There was a significant positive correlation between T-score and BMI (p-value 0.043). There was no significant correlation between Tscore and the other traditional risk factors (oral corticosteroid use, smoking, alcohol use, history of bone fractures and physical activity).Conclusions: Use of TDF based HAART regimes is associated with higher rates of osteoporosis compared to HAART naïve and HIV negative populations which may be partly mediated by lower Body Mass Index (BMI)