Impact of antiretroviral therapy on household economics: Findings from Mombasa, Kenya

While the clinical impact of receiving antiretroviral therapy (ART) on individuals living with HIV is well documented, less is known about how the receipt of ART affects household economics. This analysis examined the direct and indirect effects of receiving ART on household economics. A direct effect is reduced spending on health services as a result of the improved health status of the household member on ART. The potential indirect effects include increased labor-force participation by the household member on ART, a change in how other household members spend their time (working or in school), and a shift in composition of household expenditures. This brief describes the experiences of a cohort of people living with HIV who were receiving ART through a program coordinated by the Coast Provincial General Hospital in Mombasa, Kenya. A longitudinal study of clients on ART found that perceived health improved, reported incidence of illness and use of health services declined, and labor-force participation increased within 12 months of initiating therapy

Perceived stigma among patients receiving antiretroviral treatment: a prospective randomised trial comparing an m-DOT strategy with standard-of-care in Kenya

HIV and AIDS remain highly stigmatised. Modified directly observed therapy (m-DOT) supports antiretroviral treatment (ART) adherence but little is known about its association with perceived stigma in resource-constrained settings. In 2003, 234 HIV-infected adults enrolled in a two-arm randomised trial comparing a health centre-based m-DOT strategy with standard self-administration of ART. Data on perceived stigma were collected using Berger\u27s HIV stigma scale prior to starting ART and after 12 months. This was a secondary analysis to examine whether perceived stigma was related to treatment delivery. Perceived stigma scores declined after 12 months of treatment from a mean of 44.9 (sd=7.6) to a mean of 41.4 (sd=7.7), (t=6.14,

An annotated checklist of vascular plants of Cherangani hills, Western Kenya

Cherangani hills, located in Western Kenya, comprises of 12 forest blocks, maintaining great plant diversity. However, little attention to plant diversity studies has been paid to it in the past years. Here, we present a checklist of the vascular plants of this region obtained through intensive field investigations and matching of herbarium specimens. In total, 1296 species, including 17 endemic species are documented, belonging to 130 families and 608 genera. This flora represents 18.50%, 43.83% and 54.17% of the Kenyan species, genera and families, respectively. The habit, habitat and voucher specimens, as well as brief notes on the distribution of each taxon recorded are presented in this checklist. It is the first exhaustive inventory of the terrestrial vascular plants in Cherangani hills which is a significant regional centre for plant diversity

Changes in stigma among a cohort of people on antiretroviral therapy: Findings from Mombasa, Kenya

Stigma has been a reality in the lives of people living with HIV (PLHIV) since the inception of the AIDS epidemic, and it can have profound implications for health, psychosocial well-being, and utilization of health services. In the industrialized world, the availability of antiretroviral therapy (ART) and a subsequent change in perception of AIDS as a chronic manageable disease has coincided with a decrease in stigma and discrimination directed toward PLHIV. However, little is known in developing countries about whether perceptions and experiences of stigma among PLHIV have changed following increased access to ART. The Horizons Program and the International Centre for Reproductive Health undertook an observational study in Mombasa, Kenya, to document changes in internalized and experienced stigma in a cohort of HIV-infected individuals over a 12-month period after initiating ART. As detailed in this brief, the study found that levels of internalized stigma decreased after 12 months on treatment. Participants also disclosed to a greater number of family members. Despite these positive changes, internalized stigma remains a problem for many respondents and warrants increased stigma-reduction activities in the community

Sexual risk behaviors of HIV-positive persons receiving ART in Mombasa, Kenya: Longitudinal study findings

As a result of the success of antiretroviral therapy (ART) in dramatically decreasing morbidity and mortality due to HIV, many HIV-infected individuals are now living longer, healthier, and more sexually active lives. However, unprotected sex by people living with HIV is an area of concern because of the risk of transmission to sero-discordant partners and reinfection with new, drug-resistant viral strains. There is evidence to suggest that some sero-positive individuals continue to engage in unprotected sex that places others at risk for infection and places themselves at risk for contracting secondary infections. To learn more about the impact of ART on sexual risk behavior in a developing country setting, researchers from the Horizons Program and the International Center for Reproductive Health followed a cohort of HIV-positive individuals receiving ART for 12 months in Mombasa, Kenya. The study revealed no increase in unsafe sex. However, there remained a risk of HIV transmission as a result of unprotected sex with an HIV-negative or unknown status partner. As indicated in this brief, safer-sex counseling needs special emphasis in ART programs

Promoting adherence through a directly administered antiretroviral therapy strategy in Mombasa, Kenya

A principal concern of antiretroviral therapy (ART) programs is the ability of clients to maintain a high level of adherence to medication. Based on formative research conducted with HIV-infected clients and health workers in Mombasa, Kenya, and lessons learned from directly observed therapy strategies to encourage adherence to treatment for tuberculosis, a directly administered antiretroviral therapy (DAART) strategy to promote adherence to ART was developed. This study examines whether the intervention was more effective in fostering adherence to ART than standard follow-up among people living with HIV in Mombasa. Researchers from the Horizons Program and the International Centre for Reproductive Health conducted a randomized controlled two-arm study to determine the short- and longer-term effects of DAART compared to standard care. DAART was found to be more effective in promoting adherence during the 24-week intervention period than standard care, but the effect was not sustained postintervention. As noted in this brief, results suggest that DAART is effective for improving adherence in this setting, but the optimal length of the intervention for sustaining adherence and its transition to standard care may warrant further research

Agronomic Factors Influencing Fall Armyworm (Spodoptera frugiperda) Infestation and Damage and Its Co-Occurrence with Stemborers in Maize Cropping Systems in Kenya

Infestation and Damage and Its Co-Occurrence with Stemborers in Maize Cropping Systems in Kenya

CONTEXT OF PROFESSIONAL DEVELOPMENT POLICIES AND TEACHER OF BUSINESS STUDIES COMPETENCY IN PUBLIC SECONDARY SCHOOLS IN KAJIADO COUNTY, KENYA

Potent policies directing professional development for teachers of Business studies focus on skills and competencies which address specific needs of learners for high achievement. Professional development for teachers of Business studies has been a trending phenomenon in the education sector in Kenya for enhancing effective teaching and learning. Contemporary training prepares teachers of Business studies with appropriate competencies for equipping learners with skills and capabilities to thrive in a dynamic and interconnected world that joins and engages the sense of curiosity. In addition, teachers of Business studies receive updates on modern pedagogical skills through pre-service training and capacity building and job motivation through teacher promotion for raising productivity. Professional development for teachers is guided by feasible policies which act as control mechanism for enhancing discipline, order and accountability in the teaching profession. Thus, this study determined the influence of policies guiding professional development on teacher of Business studies competency in Kajiado county, Kenya. The study was premised on the Context evaluation, Input evaluation, Process evaluation and Product evaluation model. Anchored on a descriptive survey design, the study targeted a population of 42 respondents from eleven public secondary schools and education offices in Isinya sub-county; Kajiado county. Data was gathered from teachers of Business studies using questionnaires and from school principals and sub-county education officials using interview schedules. Data collected was coded and fed into SPSS software version 25.0 and statistical analysis using inferential and descriptive statistics was done on cross-tabulations. The study found that policies guiding the professional development of teachers of Business studies were significantly related to teacher competency. The study recommends the Teachers Service Commission (TSC) to formulate more feasible policies that guide professional development of teachers of Business studies through capacity building training, targeting contemporary issues surrounding Business studies and equipping teachers with practical skills critical for enhancing socio-economic development. Further, the study recommends the TSC to formulate attainable policies that guide and create morale of teachers of Business studies through continuous job promotion for high learner achievement.  Article visualizations

Implementation of clinic-based modified-directly observed therapy (m-DOT) for ART; experiences in Mombasa, Kenya

The effectiveness of modified-directly observed therapy (m-DOT), an adherence support intervention adapted from TB DOTS programmes, has been documented. Describing the implementation process and acceptability of this intervention is important for scaling up, replication in other settings and future research. In a randomised trial in Mombasa, Kenya, patients were assigned to m-DOT or standard of care for 24 weeks. m-DOT entailed twice weekly visits to a health centre for medication collection, ongoing adherence counselling and nurse-observed pill ingestion. Community health workers (CHWs) traced non-attendees, observing pill taking at participant's home. Using process indicators and a semi-structured questionnaire, implementation of m-DOT was evaluated among 94 participants who completed 24 weeks m-DOT (81%; 94/116). Two-thirds of m-DOT recipients were female (64%; 74/116) and a mean 37 years (SD = 7.8). Selection of the m-DOT observation site was determined by proximity to home for 73% (69/94), with the remainder choosing sites near their workplace, or due to perceived high-quality services. A median 42 of 48 scheduled m-DOT visits (IQR = 28-45) were attended. Most found m-DOT is very useful (87%; 82/94) and had positive attitudes to the services. A high proportion received CHWs home visits (96%; 90/94) and looked forward to these. Use of CHWs and several satellite observation sites facilitated provision of services closer to patient's homes. A substantial number, however, thought 24 weeks of m-DOT was too long (43%; 42/94). Our experience suggests that m-DOT services could be implemented widely and are acceptable if delivered with adequate attention to coordination, provision of a broad set of interventions, shifting tasks to less-specialised workers and integration within the health system. m-DOT programmes should utilise existing resources while simultaneously expanding capacity within communities and the public sector. These findings could be used to inform replication of such services and to improve the design of m-DOT in future studies