Comparative durability of nevirapine versus efavirenz in first-line regimens during the first year of initiating antiretroviral therapy among Swaziland HIV-infected adults

Nevirapine (NVP) and Efavirenz (EFV) have generally comparable clinical and virologic efficacy. However, data comparing NVP durability to EFV are imprecise. We analyzed cohort data to compare durability of NVP to EFV among patients initiating ART in Mbabane, Swaziland. The primary outcome was poor regimen durability defined as any modification of NVP or EFV to the ART regimen. Multivariate Cox proportional hazards models were employed to estimate the risk of poor regimen durability (all-cause) for the two regimens and also separately to estimate risk of drug-related toxicity. We analyzed records for 769 patients initiating ART in Mbabane, Swaziland from March 2006 to December 2007. 30 patients (3.9%) changed their NVP or EFV-based regimen during follow up. Cumulative incidence for poor regimen durability was 5.3 % and 2.7 % for NVP and EFV, respectively. Cumulative incidence for drug-related toxicity was 1.9 % and 2.7 % for NVP and EFV, respectively. Burden of TB was high and 14 (46.7%) modifications were due to patients substituting NVP due to beginning TB treatment. Though the estimates were imprecise, use of NVP - based regimens seemed to be associated with higher risk of modifications compared to use of EFV - based regimens (HR 2.03 95%CI 0.58 - 7.05) and NVP - based regimens had a small advantage over EFV - based regimens with regard to toxicity - related modifications (HR 0.87 95%CI 0.26 - 2.90). Due to the high burden of TB and a significant proportion of patients changing their ART regimen after starting TB treatment, use of EFV as the preferred NNRTI over NVP in high TB endemic settings may result in improved first-line regimen tolerance. Further studies comparing the cost-effectiveness of delivering these two NNRTIs in light of their different limitations are required.Key words: Tolerability, Toxicity, Efavirenz, Nevirapine, Antiretroviral therapy, Resource limited setting, Swazilan

Strategic assessment of research priorities for sweetpotato.

The following report presents an ex‐ante evaluation of priority research options for sweetpotato carried out in the scope of the strategic assessment of research priorities for the CGIAR Research Program on Roots, Tubers, and Bananas (RTB). It contains the results from the economic surplus model used for the assessment, which are extended to include estimations of the number of beneficiaries and poverty reduction effects. The report identifies and describes the sweetpotato research options taken into consideration for and included into the assessment. The socioeconomic and technological parameters used as input data for the analysis are described and information on the elicitation process and data sources is provided. Results are presented so as to explain the outputs obtained and interpreted with respect to the relevant differences between research option

Consumers’ salient beliefs regarding foods from edible insects in Kenya: a qualitative study using concepts from the theory of planned behaviour

Population growth, urbanization and climate change, are among the factors that have created uncertainties and pressures on current global food and economic systems. Agricultural intensification can no longer support the increasing demand for food, especially of protein origin. Consequently, pressure is mounting on the supply side (private sector) to develop viable alternative sources of protein’ foods. Insects as food and consumption of foods from edible insects (FEI) are being promoted as one potential solution to the declining access to protein foods. However, one of the challenges facing the private sector is to demonstrate the efficacy of FEI programmes in the face of limited information regarding consumer - psychographic characteristics including their attitudes, values, interests and beliefs. The aim of the study was to explore the salient beliefs underlying consumer attitudes towards FEI consumption in Kenya. To achieve this objective, six focus group discussions (FGDs) were conducted (n= 43), three with only female participants and the other three with a mixed gender. The FGD script was coded using the Theory of Planned Behaviour theoretical framework. The results show that, salient beliefs related to taste, availability, convenience, affordability and other benefits beyond nutrition, are the main determinants of the participants’ intentions to consume FEI. Intentions are also influenced by the perceived feelings regarding the social referents, including family members, peers, religious leaders and health officials; and perceived behavioural control factors such as perceived risks on their food choices, perceived convenience and availability. While designing local programmes to promote FEI consumption, participants support the idea of small groups, but expresses concern about the time of day (evening preferred), length and location of the group session. However, many participants are not receptive to receiving telephone messages, although they are open to the idea of receiving phone calls. The study findings provide unique insights, among them, cultural beliefs that underlies consumer attitudes towards consuming FEI. Additionally, the results suggest possible approaches and practical interventions that can be used to promote FEI consumption in specific regions of Kenya.Key words: Foods from edible insects, theory of planned behaviour, Salient belief

EFFECT OF AGRIBUSINESS SUPPORT SERVICES ON CHOICE OF DAIRY COOPERATIVE MARKET CHANNELS IN KENYA

Kenya is witnessing an immense increase in number of smallholder dairy agripreneurs sourcing income from the dairy sub-sector. Smallholder dairy agripreneurs who dominate the production sector are forced to sell milk to informal buyers such as middlemen/women, who exploit them by paying less than the market price. As a result of this, the Kenyan Government has made significant efforts to upgrade dairy cooperatives to link the dairy agripreneurs with consumers. In spite of this, milk marketing is still dominated by traditional informal outlets. This study sought to determine the effect of provision of agribusiness support services on choice of dairy cooperative market channel. Data were collected from a cross-sectional survey of 682 respondents from Muranga County in Kenya, using a semi-structured questionnaire. Results revealed that provision of business plan training, group marketing, pregnancy diagnosis and deworming support services had significant and positive effects on the choice of cooperative market channel. In contrast, access to vaccination services and supply of feeds had negative effectson the choice of cooperative market channel. This study recommends strong coordination among the agribusiness support service providers and the dairy cooperatives in order to increase adoption of the cooperative marketing channel. In addition, dairy cooperatives need to redesign their business models to ensure that their members not only receive agribusiness support services, but also get better prices and prompt payments to increase supply of milk to cooperatives by dairy agripreneurs.En ces deux derni\ue8res d\ue9cennies, le secteur laitier au Kenya a attir\ue9 l\u2019attention d\u2019un grand nombre des petits entrepreneurs, qui en outre consid\ue8rent l\u2019activit\ue9 entrepreneuriale dans le secteur laitier comme leur source principale de revenu. Mais au vu de leur taille d\u2019activit\ue9s, ils sont contraints d\u2019op\ue9rer dans le circuit informel de commercialisation de leurs produits laitiers, et par cons\ue9quent per\ue7oivent le prix de revient inferieur, que celui du march\ue9 formel. Par contre le Gouvernement Kenyan avait mis en place une s\ue9rie des politiques de soutien aux coop\ue9ratives laiti\ue8res du pays afin de formaliser le circuit de commercialisation des produits laitiers, pour une connectivit\ue9 efficace entre les petits entrepreneurs du secteur laitier \ue0 leurs consommateurs potentiels. Malgr\ue9 ces efforts, il est \ue0 signaler que le march\ue9 laitier kenyan est toujours domin\ue9 par un circuit de commercialisation informelle. Cette \ue9tude cherchait \ue0 d\ue9terminer les effets des subventions de soutien aux entreprises laiti\ue8res sur les choix du circuit de commercialisation. Les donn\ue9es \ue9taient collect\ue9es sur un \ue9chantillon de 682 r\ue9pondants dans la collectivit\ue9 de Muranga au Kenya, sur base d\u2019une enqu\ueate transversale, utilisant un questionnaire semi-structur\ue9. Les r\ue9sultats ont r\ue9v\ue9l\ue9 que la formation \ue0 la gestion d\u2019affaires, le groupement des vendeurs, le diagnostic de grossesse et l\u2019acc\ue8s aux services de d\ue9parasitage ont eu des effets significatifs et positifs sur le choix du circuit de commercialisation par coop\ue9rative. En revanche, l\u2019acc\ue8s aux services de vaccination et la fourniture d\u2019aliments ont n\ue9gativement influenc\ue9 le choix du circuit de commercialisation par coop\ue9rative. Ainsi, la pr\ue9sente \ue9tude recommande une effective coordination entre les prestataires de services de soutien \ue0 l\u2019agro-industrie laiti\ue8re et les coop\ue9ratives afin d\u2019accro\ueetre l\u2019adoption du circuit de commercialisation formel par coop\ue9rative. En outre, les coop\ue9ratives laiti\ue8res doivent r\ue9viser leurs mod\ue8les d\u2019op\ue9ration d\u2019achat et de vente pour garantir \ue0 leurs membres non seulement des services de soutien, mais \ue9galement les meilleur conditions de paiement, \ue0 des prix r\ue9mun\ue9rateur, \ue0 temps pour enfin financer les approvisionnements en lait et accroitre ainsi l\u2019offre de lait de la part des Agripreneurs

Adoption of Improved Groundnut Varieties in Uganda

This paper evaluates the level of adoption of improved groundnut varieties and the role of information, seed supply and credit constraints for variety adoption in rural Uganda. We use large-scale primary survey data collected in seven groundnut growing districts to understand the adoption behavior of farm households and the key determinants of variety uptake. The study finds that the level of adoption of improved varieties in Uganda is very high; about 59% of the households grow improved varieties. About 62% of the groundnut area is planted to improved varieties, indicating a high intensity of adoption. On average, the income per ha from improved varieties is about 80% higher than local cultivars. Owing to the interdependence of variety choice decisions, we use a multivariate probit specification to identify variety-specific drivers of adoption. About 10% of farmers lack information on new varieties, while 18% and 6% cannot adopt mainly due to seed supply and capital constraints, respectively. This indicates that a tobittype specification, which considers all non-adopters as disinterested in the technology would lead to inconsistent parameter estimates and misguided conclusions. We therefore estimate a modified multi-hurdle specification, which takes into account the information, seed supply and capital constraints in determining the desired demand and intensity of adoption of new groundnut varieties. These findings provide new insights as to why adoption of new agricultural technologies in Africa has lagged behind – not so much due to lack of economic incentives, but due to the persistent failure to provide vital information along with seeds and required credit to translate the desired positive demand into effective and actual adoption of new varieties. These are important lessons that need to be considered as Africa searches for alternative pathways to launch an effective and sustainable green revolution that will transform smallholder agriculture. Shiferaw B, Muricho G, Okello J, Kebede T A and Okecho G

Knowledge, attitudes and practices of prevention of mother to child transmision of HIV among women in Laroo Division Gulu Municipality, Uganda

This study is exploring the knowledge, attitudes and practices of Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) among child bearing women aged between 15- 45 years old in Laroo division in Gulu municipality. The goal of the study was to determine the level of attitude as well as of knowledge and belief about PMTCT and proportion of women practicing it among the child bearing women of Laroo Division. The Cross-sectional and Descriptive study design was applied in multistage sampling method with random selection of a parish followed by random selection of a village within the parish from which a sample of homesteads was randomly selected. From each homesteads, a single respondent was randomly selected and registered in the study. Questionnaires were given to respondents that had consented to take part in the study. A total of 208 respondents were registered and interviewed in a period of February to march 2011. There were 165 (79.3%) of the mothers who had knowledge about various PMTCT methods. Of these 86(52%) heard about PMTCT first from hospital. 50 (30%) knew about exclusive breast feeding, while another 50(30%) use of ART, 45(27%) knew about replacement feedings and only 21(13%) knew of elective caesarean section as method of PMTCT. However the majority of the mothers 159(96.5%) thought that PMTCT was beneficial. Nevertheless some mothers thought that PMTCT causes various counter indications including infertility 17 (10.5%) and abnormalities in children at birth 27 (16.7). Their HIV serostatus also varied. Of the 135(81.7%) screened for HIV 42(31.2%) tested HIV positive and only 27 (64.2%) used contraceptives to prevent pregnancy while they were HIV positive. However of the correspondents who tested positive in their last HIV tests, the majority (83%) had had at least a pregnancy after testing HIV positive of which 6.8% did not practice PMTCT. Our study suggests evidence that Knowledge, attitude and practice of PMTCT among women of reproductive age in Laroo Division in Gulu municipality in Northern Uganda is adequate.Nevertheless with the infection rate of 31.2% among them points out that there is a substantial burden of HIV in the women community

Patient-provider experiences with chronic non-communicable disease care during COVID-19 lockdowns in rural Uganda: A qualitative analysis

Non-communicable diseases (NCDs) are a growing health burden in Sub-Saharan Africa and especially Uganda, where they account for over one third of all deaths. During the COVID-19 pandemic, public health control measures such as societal "lockdowns"had a significant impact on longitudinal NCD care though no studies have looked at the lived experience around NCD care during the pandemic. Our objective was to understand the experience of NCD care for both patients and providers in southwestern Uganda during the COVID-19 pandemic. We conducted in-depth, in-person qualitative interviews with 20 patients living with hypertension, diabetes, and/or cardiac disease purposefully selected from the outpatient clinics at Mbarara Regional Referral Hospital and 11 healthcare providers from public health facilities in Mbarara, southwestern Uganda. We analyzed transcripts according to conventional content analysis. We identified four major themes that emerged from the interviews; (1) difficulty accessing medication; (2) food insecurity; (3) barriers to the delivery of NCD clinical care and (4) alternative forms of care. Pre-existing challenges with NCD care were exacerbated during COVID-19 lockdown periods and care was severely disrupted, leading to worsened patient health and even death. The barriers to care were exacerbations of underlying systemic problems with NCD care delivery that require targeted interventions. Future work should leverage digital health interventions, de-centralizing NCD care, improving follow-up, providing social supports to NCD patients, and rectifying supply chain issues