Comparison of indirect fluorescent antibody test and enzyme linked immunosorbent assay in the detection of exposure of cattle to Theileria parva in Kenya

Appraisal of the indirect fluorescent antibody test (IFAT) and antigen enzyme linked immunosorbent assay (ELISA) serological tests as carried out to detect cattle exposed to Theileria parva at the National Veterinary Research Centre, Muguga (NVRC), Kenya is reported. Using sera from T parva naive cattle and cattle experimentally exposed to T parva, the two tests were appraised in terms of their sensitivity and specificity.IFAT and ELISA had the same sensitivity of 90% while ELISA had a higher specificity (90 %) than IFAT (80 %). A comparison was also made of the capability of the two tests to detect exposure of dairy cattle to T parva prior to immunization against East Coast fever (ECF). The positive outcome from the IFAT was significantly higher (X2 = 30,36; P < 0,001) than that from the ELISA. The agreement between the two tests was low (Kappa= 0,21 ). The two tests indicated a higher risk of ECF in the study area than was expected. Indications are that the ELISA has been effectively adopted at NVRC.The articles have been scanned in colour with a HP Scanjet 5590; 600dpi. Adobe Acrobat v.9 was used to OCR the text and also for the merging and conversion to the final presentation PDF-format.Department for International Development, UK. Government of Kenya

Evaluation of Kenya’s readiness to transition from sentinel surveillance to routine HIV testing for antenatal clinic-based HIV surveillance

BACKGROUND: Sentinel surveillance for HIV among women attending antenatal clinics using unlinked anonymous testing is a cornerstone of HIV surveillance in sub-Saharan Africa. Increased use of routine antenatal HIV testing allows consideration of using these programmatic data rather than sentinel surveillance data for HIV surveillance. METHODS: To gauge Kenya’s readiness to discontinue sentinel surveillance, we evaluated whether recommended World Health Organization standards were fulfilled by conducting data and administrative reviews of antenatal clinics that offered both routine testing and sentinel surveillance in 2010. RESULTS: The proportion of tests that were HIV-positive among women aged 15–49 years was 6.2 % (95 % confidence interval [CI] 4.6–7.7 %] in sentinel surveillance and 6.5 % (95 % CI 5.1–8.0 %) in routine testing. The agreement of HIV test results between sentinel surveillance and routine testing was 98.0 %, but 24.1 % of specimens that tested positive in sentinel surveillance were recorded as negative in routine testing. Data completeness was moderate, with HIV test results recorded for 87.8 % of women who received routine testing. CONCLUSIONS: Additional preparation is required before routine antenatal HIV testing data can supplant sentinel surveillance in Kenya. As the quality of program data has markedly improved since 2010 a repeat evaluation of the use of routine antenatal HIV testing data in lieu of ANC sentinel surveillance is recommended

Integrated HIV Testing, Malaria, and Diarrhea Prevention Campaign in Kenya: Modeled Health Impact and Cost-Effectiveness

Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign.We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease.Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of$37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of$32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83$20.A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive

Estimation of milk production from smallholder dairy cattle in the coastal lowlands of Kenya

A study was carried out on 92 smallholder farms in Kwale district in Coast Province of Kenya to estimate the milk yield. The effect of concentrate feed supplementation on milk yield was also evaluated. Data were collected during a one-year observational longitudinal study. Analysis was done for 371 observations following 63 calving events. The mean annual milk offtake was estimated at 2021 kg/cow. Forty-nine (77.8%) of the lactating cows were supplemented with concentrate feeds at varying rates of 0.5-3.0 kg/cow per day. Supplementary feeding of lactating cows led to a significantly higher mean daily milk yield compared to non-supplemented cows throughout the year (p<0.05). The mean annual milk offtake from supplemented cows (2195 kg/cow) was 18.6% more than offtake from non-supplemented cows, a difference that was statistically significant (p<0.05). Therefore, supplementary feeding of commercial feed concentrates was a rational management practice. It was also concluded that milk production from smallholder dairy cows in the coastal lowlands of Kenya was comparable to that from similar production systems but lower than national targets

The incidence of calf morbidity and mortality due to vector-borne infections in smallholder dairy farms in Kwale District, Kenya

An observational longitudinal study was carried out on 92 randomly selected smallholder farms in two coastal lowland zones of Kwale District in Kenya between December 1997 and November 1999. The objective was to estimate the incidence of the main vector-transmitted diseases in pre-weaned calves. From an initial 41 pure or cross-bred Bos taurus calves which were less than 2 months and whose birth and disease histories were known, study calves were recruited progressively and monitored until they were weaned at around 146 days. Overall, 130 calves in 67 farms were monitored and these contributed a total risk period of 30,062 days. Disease parameters were analysed and compared as true annual and age-specific incidence rates. The incidences of East Coast fever (ECF) (23.1%) and trypanosomosis (29.1%) were the highest among the vector-borne diseases. The corresponding mortality incidence rates of ECF and trypanosomosis were 10.9 and 3.6%, respectively. The annual incidence rates of anaplasmosis and babesiosis were 10.9 and 1.2%, respectively. There was no mortality arising specifically from anaplasmosis or babesiosis. Analysis of survival times to natural infection indicated that the field challenge resulting to cases of trypanosomosis was much higher compared to the risk of either ECF or anaplasmosis. It was concluded that these vector-borne diseases constrain production of replacement stock in this coastal lowlands region of Kenya

Kenyan MSM: no longer a hidden population.

In 2005, almost 25 years after the emergence of the HIV pandemic among MSM in the United States, the first substantial report of HIV and sexually transmitted infections (STIs) among a large group of MSM from Senegal was published in AIDS[1]. Although MSM received late recognition in the African HIV epidemic [2,3][2,3], Kenya was at the forefront in recognizing the vulnerabilities of this highly stigmatized population that feared legal authorities and had virtually no access to health services [4]. Numerous studies have since documented the elevated HIV/STI infection risks of African MSM, and donor responses have begun to focus on inclusion of MSM and their emerging organizations in HIV prevention and care programming in Africa [5]. Despite legal challenges and largely negative public debates [6], the Kenyan Ministry of Health and National AIDS and STI Control Programme has recognized that MSM are one of the key populations in need of urgent attention and have demonstrated their willingness to work with them [7]

Strengthening healthcare providers' skills to improve HIV services for MSM in Kenya.

Research on HIV burden and determinants of HIV risks among MSM in sub-Saharan Africa is now considerable [1]. A meta-analysis of 51 surveys conducted between 2005 and 2013 estimated 18.7% HIV prevalence among MSM, a disproportionately large contribution to the HIV epidemic in sub-Saharan Africa [2,3]. Targeted interventions for MSM could significantly decrease HIV transmission, not only among MSM but also on a population level [4,5]. However, anal intercourse in African societies remains highly stigmatized and HIV public health messaging is still unfocused [6]. Compilation of data on testing behaviour among African MSM derives mostly from studies centred among urban and sex worker MSM [7,8] and indicates that legal policy, social inequality, and inadequate training of healthcare providers (HCPs) discourage MSM from seeking HIV prevention and treatment [9–13]. Addressing HIV and other health needs among MSM in this region cannot be met through the healthcare sector alone. Rigorous structural efforts promoting a skilled healthcare labour force, and community sensitization to protect against unfair treatment will improve the provision of effective and ethical health services for African MS

Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in coastal Kenya.

African men who have sex with men (MSM) face significant stigma and barriers to care. We investigated antiretroviral therapy (ART) adherence among high-risk adults, including MSM, participating in a clinic-based cohort. Survival analysis was used to compare attrition across patient groups. Differences in adherence, weight gain, and CD4 counts after ART initiation were assessed. Among 250 HIV-1-seropositive adults, including 108 MSM, 15 heterosexual men, and 127 women, patient group was not associated with attrition. Among 58 participants who were followed on ART, 40 % of MSM had less than 95 % adherence, versus 28.6 % of heterosexual men and 11.5 % of women. Although MSM gained less weight after ART initiation than women (adjusted difference-3.5 kg/year), CD4 counts did not differ. More data are needed on barriers to adherence and clinical outcomes among African MSM, to ensure that MSM can access care and derive treatment and prevention benefits from ART

Emergence of fluoroquinolone resistance in Neisseria gonorrhoeae isolates from four clinics in three regions of Kenya.

We have recently reported high levels of fluoroquinolone resistance in a single region of Kenya. In this article, we report high prevalence of fluoroquinolone resistance (53.2%) in Neisseria gonorrhoeae isolates from 4 clinics in 3 additional regions of Kenya. These findings highlight the need to change first-line treatment in these settings and the need to evaluate empirical management guidelines for treatment of gonococcal infection in Kenya

Evaluation of Kenya's readiness to transition from sentinel surveillance to routine HIV testing for antenatal clinic-based HIV surveillance

BACKGROUND: Sentinel surveillance for HIV among women attending antenatal clinics using unlinked anonymous testing is a cornerstone of HIV surveillance in sub-Saharan Africa. Increased use of routine antenatal HIV testing allows consideration of using these programmatic data rather than sentinel surveillance data for HIV surveillance. METHODS: To gauge Kenya’s readiness to discontinue sentinel surveillance, we evaluated whether recommended World Health Organization standards were fulfilled by conducting data and administrative reviews of antenatal clinics that offered both routine testing and sentinel surveillance in 2010. RESULTS: The proportion of tests that were HIV-positive among women aged 15–49 years was 6.2 % (95 % confidence interval [CI] 4.6–7.7 %] in sentinel surveillance and 6.5 % (95 % CI 5.1–8.0 %) in routine testing. The agreement of HIV test results between sentinel surveillance and routine testing was 98.0 %, but 24.1 % of specimens that tested positive in sentinel surveillance were recorded as negative in routine testing. Data completeness was moderate, with HIV test results recorded for 87.8 % of women who received routine testing. CONCLUSIONS: Additional preparation is required before routine antenatal HIV testing data can supplant sentinel surveillance in Kenya. As the quality of program data has markedly improved since 2010 a repeat evaluation of the use of routine antenatal HIV testing data in lieu of ANC sentinel surveillance is recommended