Good immune restitution but unsatisfactory viral suppression in children on ART in a remote Western Kenya area

Mexico AIDS Conference 200

Family model of HIV care and treatment: a retrospective study in Kenya

<p>Abstract</p> <p>Background</p> <p>Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal.</p> <p>Methods</p> <p>A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach.</p> <p>Results</p> <p>Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively.</p> <p>Conclusions</p> <p>The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement.</p

Prevalence and Risk Factors of Hypertension Stratified by HIV Status in Western Kenya

Thesis (Master's)--University of Washington, 2020Introduction The burden of cardiovascular disease (CVD) is increasing in sub-Saharan Africa (SSA) and untreated hypertension is a major contributing factor. The prevalence and risk factors associated with hypertension among PLWHV who are on long-term ART are not well studied and we determined these in a cohort of PLWHV and HIV negative individuals in Kisumu, Kenya. Methods In this cross-sectional study, we enrolled 300 PLWHV on long-term ART (≥6 months) and 298 HIV-negative adults seeking routine services at the Kisumu County hospital between 2017-2018. We diagnosed participants with hypertension (defined as blood pressure of ≥140/90mmHg) and used multivariate regression to evaluate the association between hypertension, HIV, other sociodemographic, and CVD risk factors. Results The overall prevalence of hypertension was 25% and PLWHV had a lower prevalence of hypertension than HIV- negative persons (18% vs 33% respectively; p51 years had a 4.66-fold higher hypertension risk (95% CI 2.62-8.29) compared to individuals 30 kg/m2 had a 2.65 fold-greater risk of hypertension (95% CI 1.55-4.50) compared to those with BMI in the normal range (18-25 kg/m2). Conclusion We found a high prevalence of hypertension overall, and this was associated with advancing age and higher BMI. PLWHV on stable ART had a lower prevalence compared to HIV-negative individuals

Viral load testing cascade for HIV infected children on non-nucleoside reverse transcriptase inhibitor-based first line regimen at selected health facilities in western Kenya

Background: Viral load (VL) testing is critical in monitoring response to HIV treatment for children.Objectives: To describe access to VL testing and testing outcomes for children on Nevirapine or Efavirenz based first line antiretroviral treatment&nbsp; (ART).Design: Retrospective cohort studySetting: HIV clinics. Participants: Children aged 6 weeks to 14 years.Main outcome measures: VL test results, viral suppression, Methods: We reviewed records of children initiated on ART between 2010 and 2014. Clinic attendance within 90 days was considered active. Virological failure was defined as VL&gt;1000copies/ml while repeat VL&gt;1000c/ml qualified for regimen switch. Analysis used Stata Version 13.1 and Cox proportional hazard ratio was used to explore the association between outcome measures and sociodemographic at p≤0.05 level of significanceResults: Of 3,432 eligible children, 69.1% had VL results and 69.5% achieved viral suppression. Of 3,118 active on ART, 73.1% had VL results and 70.1% achieved viral suppression compared to 314 attritions from care with 29.5% and 55.4% respectively (P&lt;0.001). Fewer children on ART &lt; 24 months had VL results compared to those on ART for longer, 52.1% vs 76.1% (p&lt;0.001). Probability of virological failure was higher for males and duration on ART of &gt; 24 months but lower for age 2 – 10 years and CD4 &gt;500 cells/mm3 compared to age &lt; 2 years and CD4 &lt;350 cells/mm3 respectively. Of 809 (30%) children with virological failure, 81.1% had repeat VL results of whom 72.0% had VL &gt;1000 copies/ml and 58.9% had regimen switch. Of the 809, 308 (38.1%) switched regimen without repeat VL results and 79.9% had follow up VL &gt;1000 copies/ml.Conclusion: Although most children achieved viral suppression, gaps in access to timely VL testing remain a challenge. Children aged &gt;24 months and those switched without repeat VL results need additional support to achieve viral suppression

Modelling local and global effects on the risk of contracting Tuberculosis using stochastic Markov-chain models

For some diseases, the transmission of infection can cause spatial clustering of disease cases. This clustering has an impact on how one estimates the rate of the spread of the disease and on the design of control strategies. It is, however, difficult to assess such clustering, (local effects on transmission), using traditional statistical methods. A stochastic Markov-chain model that takes into account possible local or more dispersed global effects on the risk of contracting disease is introduced in the context of the transmission dynamics of tuberculosis. The model is used to analyse TB notifications collected in the Asembo and Gem Divisions of Nyanza Province in western Kenya by the Kenya Ministry of Health/National Leprosy and Tuberculosis Program and the Centers for Disease Control and Prevention. The model shows evidence of a pronounced local effect that is significantly greater than the global effect. We discuss a number of variations of the model which identify how this local effect depends on factors such as age and gender. Zoning/clustering of villages is used to identify the influence that zone size has on the model's ability to distinguish local and global effects. An important possible use of the model is in the design of a community randomised trial where geographical clusters of people are divided into two groups and the effectiveness of an intervention policy is assessed by applying it to one group but not the other. Here the model can be used to take the effect of case clustering into consideration in calculating the minimum difference in an outcome variable (e.g. disease prevalence) that can be detected with statistical significance. It thereby gauges the potential effectiveness of such a trial. Such a possible application is illustrated with the given time/spatial TB data set. (C) 2009 Elsevier Inc. All rights reserved

Uptake and continuation of HIV pre‐exposure prophylaxis among women of reproductive age in two health facilities in Kisumu County, Kenya

Abstract Introduction In 2020, Kenya had 19,000 new HIV infections among women aged 15+ years. Studies have shown sub‐optimal oral pre‐exposure prophylaxis (PrEP) use among sub‐populations of women. We assessed the uptake and continuation of oral PrEP among women 15–49 years in two health facilities in Kisumu County, Kenya. Methods A retrospective cohort of 262 women aged 15–49 years, initiated into oral PrEP between 12 November 2019 and 31 March 2021, was identified from two health facilities in the urban setting of Kisumu County, Kenya. Data on baseline characteristics and oral PrEP continuation at months 1, 3 and 6 were abstracted from patient records and summarized using descriptive statistics. Missing data in the predictor variables were imputed within the joint modelling multiple imputation framework. Using logistic regression, we evaluated factors associated with the discontinuation of oral PrEP at month 1. Results Of the 66,054 women screened, 320 (0.5%) were eligible and 262 (82%) were initiated on oral PrEP. Uptake was higher among women 25–29 years as compared to those 15–24 years (77% vs. 33%). Oral PrEP continuation declined significantly with increasing duration of follow‐up; 37% at month 1, 21% at month 3 and 12% at month 6 (p<0.05). In the adjusted analysis, women 15–24 years had lower adjusted odds of continuing at month 1 than women ≥25 years (adjusted odds ratio [aOR]: 0.41, 95% CI: 0.21–0.82). There was no association between being sero‐discordant and continuation of oral PrEP at month 1 (aOR; 1.21, 95% CI 0.59–2.50). Women from the sub‐county hospital were more likely to continue at month 1 of follow‐up compared to women enrolled in the county referral hospital (aOR 5.11; 95% CI 2.24–11.70). Conclusions The low eligibility for oral PrEP observed among women 15–49 years in an urban setting with high HIV prevalence calls for a review of the screening process to validate the sensitivity of the screening tool and its proper application. The low uptake and continuation among adolescent girls and young women underscores the need to identify and address specific patient‐ and facility‐level barriers affecting different sub‐populations at risk for HIV acquisition

From Import Substitution to Integration into Global Production Networks: The Case of the Indian Automobile Industry

This paper examines the growth trajectory and the current state of the Indian automobile industry, paying attention to factors that underpinned its transition from import substitution to integration into global production networks. Market-conforming policies implemented by the government of India over the past 2 decades, which marked a clear departure from protectionist policies in the past, have been instrumental in transforming the Indian automobile industry in line with ongoing structural changes in the world automobile industry. India has emerged as a significant producer of compact cars within global automobile production networks. Compact cars exported from India have become competitive in the international market because of the economies of scale of producing for a large domestic market and product adaptation to suit domestic market conditions. Interestingly, there are no significant differences in prices of compact cars sold in domestic and foreign markets. This suggests that the hypothesis of “import protection as export promotion” does not hold for Indian automobile exports