Nutritional status of adult male on art at Kericho District Hospital, Kericho County, Kenya

Background: Nutrition and HIV are strongly related and any immune impairment as a result of HIV leads to malnutrition while malnutrition leads to immune impairment and thus worsens the effect of HIV. Individuals living with HIV have special nutritional needs irrespective of whether they are on anti-retroviral treatment or receiving care services.Objective: To establish nutritional status of adult male on ART at Kericho District Hospital, Kenya.Design: Cross sectional analytical study.Setting: HIV clinic at Kericho District Hospital, Kenya.Subjects: HIV positive adult male patientsResults: Body Mass Index ≥18.5 and ≤ 24.5 (70.92), >16 & < 18.5 (11.94), >25.5 and < 30 (11.94), ≤ 16 (2.58) and ≥30.Conclusion: There is a high burden of malnutrition among PLHIV on ART (29.1%). Nutritional assessment, Counseling and support (NACS) should be the key intervention during the course of chronic HIV care and follow up

Plant Morphoecological Traits, Grass-Weed Interactions and Water Use Efficiencies of Grasses Used for Restoration of African Rangelands

Degradation characterized by depleted vegetation cover is a serious environmental problem in African rangelands. It poses a serious threat to millions of pastoralists and agropastoralists who depend on livestock as a source of livelihood. Consequently, there has been a growing global interest to consolidate efforts to restore degraded ecosystems. For example, the UN decade of Ecosystem Restoration initiative aims at uniting the world behind a common goal of preventing, halting and reversing the degradation of ecosystems. Grass reseeding using native perennial species has been identified as one of the practical ecological strategies for restoring degraded African rangelands, enhancing vegetation cover and forage production. Knowledge of the multifaceted performance of African rangeland grasses in terms of morphoecological traits, interaction with weeds and water use efficiencies is however largely limited and often elusive. Perennial grasses indigenous to African rangelands Cenchrus ciliaris L. (African foxtail grass), Enteropogon macrostachyus (Hochst. Ex A. Rich.) Monro ex Benth. (Bush rye grass) and Eragrostis superba Peyr. (Maasai love grass), were established in an African semi-arid rangeland under natural conditions to fill this knowledge gap. Morphoecological plant traits: aboveground biomass (shoot, leaf and stem) production, plant densities, basal cover, tiller densities and plant height were measured 9 months after establishment. Interaction between the target grass species and weeds and water use efficiencies (WUE) were also determined. Enteropogon macrostachyus displayed significantly higher values for plant densities, tiller densities and basal cover, indices commonly used to estimate the potential of grasses for ecological restoration. Eragrostis superba produced the highest shoot biomass and water use efficiencies. This is attributed to its higher leafy biomass fraction. Higher aboveground biomass production of E. superba demonstrate its suitability for enhancing rangeland productivity. Cenchrus ciliaris suppressed the weeds. This is linked to its aggressive and allelopathic nature. In conclusion, the three perennial grasses displayed distinct morphoecological traits. In order to achieve successful seed-based restoration of degraded African rangelands using native perennial grasses, careful selection species to maximize on their unique traits is recommended. Ultimately, this selection process should match the desired restoration outcomes and subsequent use of the rangeland.Peer reviewe

Combining Rainwater Harvesting and Grass Reseeding to Revegetate Denuded African Semi-arid Landscapes

In African drylands, perennial grasses preferred by grazing livestock are disappearing at an alarming rate. This has led to recurrent livestock feed shortages threatening pastoralist’s livelihoods. Combining native grass reseeding and rainwater harvesting offers a viable and innovative solution to reverse this trend. However, studies to determine how biomass yields are affected by soil moisture availability attributed to in situ rainwater harvesting in African drylands are limited. We investigated how biomass yields of three grasses native to Africa, i.e., Enteropogon macrostachyus (Bush rye grass), Cenchrus ciliaris (African foxtail grass), and Eragrostis superba (Maasai love grass), are affected by soil moisture content in a typical semi-arid landscape. Rainwater harvesting structures included trenches, micro-catchments and furrows. Additionally, rain runoff was diverted from an adjacent road used as a catchment area. Soil moisture was measured between November 2018 and August 2019 using PlantCare Mini-Logger sensors installed at 40 and 50 cm depths and 0, 1, 5 and 15 m away from the trench. Quadrat method was used to determine biomass yields in August 2019. Peaks in soil moisture were observed after rainfall events. Soil moisture content gradually decreased after the rainy season, but was higher closer to the trench. This is attributed to the prolonged rainwater retention in the trenches. Biomass yields were in the order Eragrostis superba > Cenchrus ciliaris > Enteropogon macrostachyus. Biomass production was higher near the trenches for all the studied species. Sensitivity to soil moisture demonstrated by the magnitude to yield reduction during the growing season was in the order Eragrostis superba > Cenchrus ciliaris > Enteropogon macrostachyus. These results suggest that Eragrostis superba is more sensitive to drought stress than Enteropogon macrostachyus that is adapted to a wide range of soil moisture conditions. We demonstrated that in situ rainwater harvesting structures enhanced soil moisture availability and displayed great potential for revegetating denuded natural rangelands in semi-arid African landscapes. Thus, combining rainwater harvesting and reseeding techniques can produce measurable improvements in pastoral livelihoods and should be incorporated in dryland development policies in the region. Ultimately, incorporating such innovative strategies can strengthen the effectiveness of ecological restoration in African drylands to meet the objectives of the UN Decade on Ecosystem Restoration and achieving the UN Sustainable Development Goals.Peer reviewe

HIV acquisition prior to entry into formal sex work: inference from next-generation viral sequencing.

OBJECTIVE: To infer the timing of HIV acquisition in relation to self-reported events in the sexual life course of adolescent girls and young women (AGYW) who self-identify as female sex workers (FSW) in Mombasa, Kenya. DESIGN: Next-generation viral sequencing of samples of AGYW living with HIV in the Transitions study, a cross-sectional bio-behavioural survey of AGYW aged 14-24 years in Mombasa, Kenya. METHOD: Dried blood spot specimens were collected from study participants ( n  = 37, all FSW). A portion of the HIV pol gene was sequenced using an in-house next-generation sequencing assay for HIV drug resistance mutation genotyping. Estimated time since infection (ETI) was inferred using the HIV EVO web-based tool ( https://hiv.biozentrum.unibas.ch/ETI/ ), and data on self-reported events were obtained from the survey. RESULTS: The median ETI among FSW was 3.4 (interquartile range = 1.7, 6.3) years, with a median ETI of 1.5 years prior to entry into formal sex work. We estimated that 74.1% (95% confidence interval = 53.7-88.9%) of participants living with HIV and who self-identified as FSW likely acquired HIV prior to self-identification as a sex worker. CONCLUSIONS: Findings suggest a large fraction of prevalent HIV infection among AGYW engaged in sex work stems from acquisition prior to entry into formal sex work. Current HIV prevention programs tailored for sex workers may miss key opportunities for HIV prevention as they are designed to reach women after entry into formal sex work, signaling a need for tailored programs to reach high-risk AGYW earlier on in their sexual life course

Informing HIV prevention programs for adolescent girls and young women: a modified approach to programmatic mapping and key population size estimation

Background: Standard programmatic mapping involves identifying locations where key populations meet, profiling of these locations (hotspots), and estimating the key population size. Information gained from this method has been used for HIV programming—resource allocation, program planning, service delivery, and monitoring and evaluation—for people who inject drugs, men who have sex with men, and female sex workers (FSWs). With an increasing focus on adolescent girls and young women (AGYW) as a priority population for HIV prevention, programs need to know the location of and how to effectively reach individuals who are at increased risk for HIV but were conventionally considered part of the general population. We hypothesize that AGYW who engage in transactional and casual sex also congregate at sex work hotspots to meet sex partners. Therefore, we adapted the standard programmatic mapping approach to understand the geographic distribution and population size of AGYW at increased HIV risk in Mombasa County, Kenya. Objectives: The objectives are several-fold: (1) detail and compare the modified programmatic mapping approach used in this study to the standard approach, (2) estimate the number of young FSWs, (3) estimate the number of AGYW who congregate in sex work hotspots to meet sex partners other than clients, (4) estimate the overlap in sexual network in hotspots, (5) describe the distribution of sex work hotspots across Mombasa and its four subcounties, and (6) compare the distribution of hotspots that were known to the local HIV prevention program prior to this study and those newly identified. Methods: The standard programmatic mapping approach was modified to estimate the population of young women aged 14 to 24 years who visit sex work hotspots in Mombasa to meet partners for commercial, transactional, and casual sex. Results: We estimated that there were 11,777 FSWs (range 9265 to 14,290) in Mombasa in 2014 among whom 6127 (52.02%) were 14 to 24 years old. The population estimates for women aged 14 to 24 years who engaged in transactional and casual sex and congregated at the hotspots were 5348 (range 4185 to 6510) and 4160 (range 3194 to 5125), respectively. Of the 1025 validated sex work hotspots, 870 (84.88%) were locations also visited by women engaged in transactional and casual sex. Only 47 (4.58%) hotspots were exclusive sex work locations. The geographic and typological distribution of hotspots were significantly different between the four subcounties (P<.001). Of the 1025 hotspots, 419 (40.88%) were already known to the local HIV prevention program and 606 (59.12%) were newly identified. Conclusions: Using the adapted programmatic mapping approach detailed in this study, our results show that HIV prevention programs tailored to AGYW can focus delivery of their interventions to sex work hotspots to reach subgroups that may be at increased risk for HIV

HIV prevalence, testing and treatment among men who have sex with men through engagement in virtual sexual networks in Kenya: a cross-sectional bio-behavioural study

INTRODUCTION: In Kenya, men who have sex with men (MSM) are increasingly using virtual sites, including web-based apps, to meet sex partners. We examined HIV testing, HIV prevalence, awareness of HIV-positive status and linkage to antiretroviral therapy (ART), for HIV-positive MSM who solely met partners via physical sites (PMSM), compared with those who did so in virtual sites (either solely via virtual sites (VMSM), or via both virtual and physical sites (DMSM)). METHODS: We conducted a cross-sectional bio-behavioural survey of 1200 MSM, 15 years and above, in three counties in Kenya between May and July 2019, using random sampling of physical and virtual sites. We classified participants as PMSM, DMSM and VMSM, based on where they met sex partners, and compared the following between groups using chi-square tests: (i) proportion tested; (ii) HIV prevalence and (iii) HIV care continuum among MSM living with HIV. We then performed multivariable logistic regression to measure independent associations between network engagement and HIV status. RESULTS: 177 (14.7%), 768 (64.0%) and 255 (21.2%), of participants were classified as PMSM, DMSM and VMSM respectively. 68.4%, 70.4% and 78.5% of PMSM, DMSM and VMSM, respectively, reported an HIV test in the previous six months. HIV prevalence was 8.5% (PMSM), 15.4% (DMSM) and 26.7% (VMSM), p < 0.001. Among those living with HIV, 46.7% (PMSM), 41.5% (DMSM) and 29.4% (VMSM) were diagnosed and aware of their status; and 40.0%, 35.6% and 26.5% were on antiretroviral treatment. After adjustment for other predictors, MSM engaged in virtual networks remained at a two to threefold higher risk of prevalent HIV: VMSM versus PMSM (adjusted odds ratio 3.88 (95% confidence interval (CI) 1.84 to 8.17) p < 0.001); DMSM versus PMSM (2.00 (95% CI 1.03 to 3.87), p = 0.040). CONCLUSIONS: Engagement in virtual networks is associated with elevated HIV risk, irrespective of individual-level risk factors. Understanding the difference in characteristics among MSM-seeking partners in different sites will help HIV programmes to develop subpopulation-specific interventions

Micro-planning at scale with key populations in Kenya: Optimising peer educator ratios for programme outreach and HIV/STI service utilisation

Peer education with micro-planning has been integral to scaling up key population (KP) HIV/STI programmes in Kenya since 2013. Micro-planning reinforces community cohesion within peer networks and standardizes programme inputs, processes and targets for outreach, including peer educator (PE) workloads. We assessed programme performance for outreach-in relation to the mean number of KPs for which one PE is responsible (KP:PE ratio)-and effects on HIV/STI service utilisation. Quarterly programmatic monitoring data were analysed from October 2013 to September 2016 from implementing partners working with female sex workers (FSWs) and men who have sex with men (MSM) across the country. All implementing partners are expected to follow national guidelines and receive micro-planning training for PEs with support from a Technical Support Unit for KP programmes. We examined correlations between KP:PE ratios and regular outreach contacts, condom distribution, risk reduction counselling, STI screening, HIV testing and violence reporting by KPs. Kenya conducted population size estimates (PSEs) of KPs in 2012. From 2013 to 2016, KP programmes were scaled up to reach 85% of FSWs (PSE 133,675) and 90% of MSM (PSE 18,460). Overall, mean KP:PE ratios decreased from 147 to 91 for FSWs, and from 79 to 58 for MSM. Lower KP:PE ratios, up to 90:1 for FSW and 60:1 for MSM, were significantly associated with more regular outreach contacts (p<0.001), as well as more frequent risk reduction counselling (p<0.001), STI screening (p<0.001) and HIV testing (p<0.001). Condom distribution and reporting of violence by KPs did not differ significantly between the two groups over all time periods. Micro-planning with adequate KP:PE ratios is an effective approach to scaling up HIV prevention programmes among KPs, resulting in high levels of programme uptake and service utilisation

Multi‐stakeholder participation for successful implementation of applied research projects in Africa

Rainwater harvesting from Roads For Indigenous Pasture production and improved rural livelihoods in Kitui, Kenya (ROFIP) is an applied research project. It assessed the potential of combining multiple sustainable land management practices, for example native grass reseeding, rainwater harvesting from roads and in situ microcatchments to enhance vegetation cover in a semi-arid dryland in Kenya. Rural earth roads were used as a catchment. Runoff generated from rainfall events was diverted into reseeded pastures with trenches established at intervals, across a slope. The ROFIP project also integrated microcatchments created using ox-driven ploughs, a traditional practice for seedbed preparation and harnessing in situ rainwater harvesting in African drylands. Combining the diversion of runoff from roads and harvesting rainwater in situ improves and prolongs soil moisture availability in reseeded pastures. Consequently, this translated to higher biomass yields (i.e. forage for livestock) and vegetation cover (land degradation mitigation and enhanced soil health). This project clearly showed that combining rainwater harvesting and native pasture reseeding improves water retention and soil health, thus improving sustainable pasture production. However, for this to be achieved, it is prudent to involve practitioners to co-design practical solutions that are socially, economically and environmentally sustainable. Multi-stakeholder engagement, effective knowledge sharing, and community involvement can be major enablers in the pursuit of environmental and socioeconomic relevant benefits in applied research projects in Africa. This approach enhances a sense of shared purpose among practitioners and empowers them to become points of reference to their peers

Transitions: novel study methods to understand early HIV risk among adolescent girls and young women in Mombasa, Kenya, and Dnipro, Ukraine

Transitions aims to understand the human immunodeficiency virus (HIV) risk at critical transition points in the sexual life course of adolescent girls and young women (AGYW) who engage in casual sex, transactional sex, and sex work. In this article, we present the Transitions study methods. The Transitions study has the following objectives: (1) to describe how the characteristics and length of the transition period and access gap vary across two epidemiological contexts (Mombasa, Kenya, and Dnipro, Ukraine); (2) to understand how the risk of HIV varies by length and characteristics of the transition period and access gap across epidemiologic contexts; and (3) to assess the extent to which HIV infections acquired during the transition period and access gap could mitigate the population-level impact of focused interventions for female sex workers and explore the potential marginal benefit of expanding programs to reach AGYW during the transition period and access gap. Cross-sectional biobehavioral data were collected from young women aged 14 to 24 years who were recruited from locations in Mombasa County, Kenya, and Dnipro, Ukraine, where sex work took place. Data are available for 1,299 Kenyan and 1,818 Ukrainian participants. The survey addressed the following areas: timing of transition events (first sex, first exchange of sex for money or other resources, self-identification as sex workers, entry into formal sex work, access to prevention program services); sexual behaviors (condom use, anal sex, sex under the influence of drugs or alcohol); partnerships (regular and first-time clients, regular and first-time transactional sex partners, and husbands and boyfriends); alcohol use; injection and non-injection illicit drug use; experience of violence; access to HIV prevention and treatment program; testing for sexually transmitted and blood-borne infections and HIV; and reproductive health (pregnancies, abortions, contraceptives). HIV and hepatitis C virus prevalence data were based on rapid test results. Mathematical modeling will be used to generate projections of onward HIV transmission at specific transition points in the sexual life course of AGYW. Taken together, these data form a novel data resource providing comprehensive behavioral, structural, and biological data on a high-risk group of AGYW in two distinct sociocultural and epidemiologic contexts

Controlled Human Malaria Infection in Semi-Immune Kenyan Adults (CHMI-SIKA): a study protocol to investigate in vivo Plasmodium falciparum malaria parasite growth in the context of pre-existing immunity [version 2; peer review: 2 approved]

Malaria remains a major public health burden despite approval for implementation of a partially effective pre-erythrocytic malaria vaccine. There is an urgent need to accelerate development of a more effective multi-stage vaccine. Adults in malaria endemic areas may have substantial immunity provided by responses to the blood stages of malaria parasites, but field trials conducted on several blood-stage vaccines have not shown high levels of efficacy. We will use the controlled human malaria infection (CHMI) models with malaria-exposed volunteers to identify correlations between immune responses and parasite growth rates in vivo. Immune responses more strongly associated with control of parasite growth should be prioritized to accelerate malaria vaccine development. We aim to recruit up to 200 healthy adult volunteers from areas of differing malaria transmission in Kenya, and after confirming their health status through clinical examination and routine haematology and biochemistry, we will comprehensively characterize immunity to malaria using >100 blood-stage antigens. We will administer 3,200 aseptic, purified, cryopreserved Plasmodium falciparum sporozoites (PfSPZ Challenge) by direct venous inoculation. Serial quantitative polymerase chain reaction to measure parasite growth rate in vivo will be undertaken. Clinical and laboratory monitoring will be undertaken to ensure volunteer safety. In addition, we will also explore the perceptions and experiences of volunteers and other stakeholders in participating in a malaria volunteer infection study. Serum, plasma, peripheral blood mononuclear cells and whole blood will be stored to allow a comprehensive assessment of adaptive and innate host immunity. We will use CHMI in semi-immune adult volunteers to relate parasite growth outcomes with antibody responses and other markers of host immunity. / Registration: ClinicalTrials.gov identifier NCT02739763