Detection and typing of Human Papillomavirus in urine from patients attending a sexually transmitted infections clinic in Nairobi County, Kenya

Human papillomavirus (HPV) is a common sexually transmitted infection (STI) that has been etiologically linked to cervical cancer. Different types of samples can be used for cervical screening, including Pap test or biopsy and Liquid Based Cytology, visual inspection using acetic acid or Lugol’s iodine, and HPV testing. These methods are invasive. The use of urine as an alternative specimen may be more widely accepted since it is non-invasive and the sample is readily available. The study aimed at detecting and genotyping HPV in urine from patients attending a sexually transmitted infections clinic in Nairobi County. It also aimed at assessing the factors associated with HPV infection. In this cross-sectional study, a structured ‘risk factor’ questionnaire was administered and HPV from urine specimen was genotyped using the L1 gene. Phylogenetic and molecular evolutionary analyses were conducted. Bivariate analysis and Pearson’s chi square (χ2) tests were used to determine the association between HPV infection and factors associated with HPV. A total of 222 adults (45 males and 177 females) aged 18-49 years were recruited. The prevalence of HPV among males and females was 22.2% (10/45) and 32.8% (58/177) respectively. The prevalence of high-risk types among males and females was 25% (1/4) and 27.5% (11/40) respectively. The high risk HPV genotypes detected among females were: HPV-16 (10%), -66 (7.5%), and -70 (7.5%) while low risk types were HPV 6 (27.5%), followed by -81 (25%), -83 (10%), -11 (7.5%), and -54 (2.5%) respectively. The prevalence of low risk types among males and females was 75% (3/4) and 72.5% (29/40) respectively. The prevalent low-risk HPV type detected in males was HPV type 6 (75%) while HPV-58 (25%) was the only high risk type in males. History of sexually transmitted infections was significantly associated with HPV infection among females (P=0.002). There was also significant association between marital status among males (p=0.046), how often one had used the contraceptives among females (p=0.038) and HPV genotypes at bivariate level. The results indicate high HPV prevalence, high risk and low risk HPVs could be detected in urine from the two populations. Therefore; molecular testing of HPV on urine samples is a method that utilizes a non-invasive technique that may increase screening coverage as it is easy to obtain. Key words: urine, Human papillomavirus, HPV genotypes, PCR, cervical cancer

HIV-1 subtype and viral tropism determination for evaluating antiretroviral therapy options: an analysis of archived Kenyan blood samples

<p>Abstract</p> <p>Background</p> <p>Infection with HIV-1 is characterized by genetic diversity such that specific viral subtypes are predominant in specific geographical areas. The genetic variation in HIV-1 <it>pol </it>and <it>env </it>genes is responsible for rapid development of resistance to current drugs. This variation has influenced disease progression among the infected and necessitated the search for alternative drugs with novel targets. Though successfully used in developed countries, these novel drugs are still limited in resource-poor countries. The aim of this study was to determine HIV-1 subtypes, recombination, dual infections and viral tropism of HIV-1 among Kenyan patients prior to widespread use of antiretroviral drugs.</p> <p>Methods</p> <p>Remnant blood samples from consenting sexually transmitted infection (STI) patients in Nairobi were collected between February and May 2001 and stored. Polymerase chain reaction and cloning of portions of HIV-1 <it>gag</it>, <it>pol </it>and <it>env </it>genes was carried out followed by automated DNA sequencing.</p> <p>Results</p> <p>Twenty HIV-1 positive samples (from 11 females and 9 males) were analyzed. The average age of males (32.5 years) and females (26.5 years) was significantly different (p value < 0.0001). Phylogenetic analysis revealed that 90% (18/20) were concordant HIV-1 subtypes: 12 were subtype A1; 2, A2; 3, D and 1, C. Two samples (10%) were discordant showing different subtypes in the three regions. Of 19 samples checked for co-receptor usage, 14 (73.7%) were chemokine co-receptor 5 (CCR5) variants while three (15.8%) were CXCR4 variants. Two had dual/mixed co-receptor use with X4 variants being minor population.</p> <p>Conclusion</p> <p>HIV-1 subtype A accounted for majority of the infections. Though perceived to be a high risk population, the prevalence of recombination in this sample was low with no dual infections detected. Genotypic co-receptor analysis showed that most patients harbored viruses that are predicted to use CCR5.</p

Co-production as an approach to developing stakeholder partnerships to reduce mental health inequalities: an evaluation of a pilot service

Aim This study aimed to evaluate a pilot cross-sector initiative - bringing together public health, a community group, primary mental health teams and patients - in using co-production approaches to deliver a mental health service to meet the needs of the black and minority ethnic communities. Background Black and minority ethnic communities continue to face inequalities in mental health service access and provision. They are under-represented in low-level interventions as they are less likely to be referred, and more likely to disengage from mainstream mental health services. Effective models that lead to improved access and better outcomes are yet to be established. It has long been recognised that to be effective, services need to be more culturally competent, which may be achieved through a co-production approach. Methods This study aimed to evaluate the role of co-production in the development of a novel community mental health service for black and minority ethnic service users. Qualitative research methods, including semi-structured interviews and focus groups, were used to collect data to examine the use of co-production methods in designing and delivering an improved mental health service. Findings Twenty five patients enrolled into the study; of these, ten were signposted for more intensive psychological support. A 75% retention rate was recorded (higher than is generally the case for black and minority ethnic service users). Early indications are that the project has helped overcome barriers to accessing mental health services. Although small scale, this study highlights an alternative model that, if explored and developed further, could lead to delivery of patient-centred services to improve access and patient experience within mental health services, particularly for black and minority ethnic communities

Infant HIV testing at birth using point-of-care and conventional HIV DNA PCR: an implementation feasibility pilot study in Kenya

Abstract Background Infant HIV diagnosis by HIV DNA polymerase chain reaction (PCR) testing at the standard 6 weeks of age is often late to mitigate the mortality peak that occurs in HIV positive infants’ first 2–3 months of life. Kenya recently revised their early infant diagnosis (EID) guidelines to include HIV DNA PCR testing at birth (pilot only), 6 weeks, 6 months, and 12 months postnatal and a final 18-month antibody test. The World Health Organization (WHO) approved point-of-care (POC) diagnostic platforms for infant HIV testing in resource-limited countries that could simplify logistics and expedite infant diagnosis. Sustainable scale-up and optimal utility in Kenya and other high-prevalence countries depend on robust implementation studies in diverse clinical settings. Methods We will pilot the implementation of birth testing by HIV DNA PCR, as well as two POC testing systems (Xpert HIV-1 Qual [Xpert] and Alere q HIV-1/2 Detect [Alere q]), on specimens collected from Kenyan infants at birth (0 to 2 weeks) and 6 weeks (4 to < 24 weeks) postnatal. The formative phase will inform optimal implementation of birth testing and two POC testing technologies. Qualitative interviews with stakeholders (providers, parents of HIV-exposed infants, and community members) will assess attitudes, barriers, and recommendations to optimize implementation at their respective sites. A non-blinded pilot study at four Kenyan hospitals (n = 2 Xpert, n = 2 Alere q platforms) will evaluate infant HIV POC testing compared with standard of care HIV DNA PCR testing in both the birth and 6-week windows. Objectives of the pilot are to assess uptake, efficiency, quality, implementation variables, user experiences of birth testing with both POC testing systems or with HIV DNA PCR, and costs. Discussion This study will generate data on the clinical impact and feasibility of adding HIV testing at birth utilizing POC and traditional PCR HIV testing strategies in resource-limited settings. Data from this pilot will inform the optimal implementation of Kenya’s birth testing guidelines and of POC testing systems for the improvement of EID outcomes. Trial registration ClinicalTrials.gov, NCT03435887. Registered 26 February 2018

Co-Infection Burden of Hepatitis C Virus and Human Immunodeficiency Virus among Injecting Heroin Users at the Kenyan Coast.

Injection drug use is steadily rising in Kenya. We assessed the prevalence of both human immunodeficiency virus type 1 (HIV-1) and hepatitis C virus (HCV) infections among injecting heroin users (IHUs) at the Kenyan Coast.A total of 186 IHUs (mean age, 33 years) from the Omari rehabilitation center program in Malindi were consented and screened for HIV-1 and HCV by serology and PCR and their CD4 T-cells enumerated by FACS.Prevalence of HIV-1 was 87.5%, that of HCV was 16.4%, co-infection was 17.9% and 18/152 (11.8%) were uninfected. Only 5.26% of the HIV-1 negative injectors were HCV positive. Co-infection was higher among injectors aged 30 to 40 years (20.7%) and among males (22.1%) than comparable groups. About 35% of the injectors were receiving antiretroviral treatment (ART). Co-infection was highest among injectors receiving D4T (75%) compared to those receiving AZT (21.6%) or TDF (10.5%) or those not on ART (10.5%). Mean CD4 T-cells were 404 (95% CI, 365 - 443) cells/mm3 overall, significantly lower for co-infected (mean, 146; 95% CI 114 - 179 cells/mm3) than HIV mono infected (mean, 437, 95% CI 386 - 487 cells/mm3, p<0.001) or uninfected (mean, 618, 95% CI 549 - 687 cells/mm3, p<0.001) injectors and lower for HIV mono-infected than uninfected injectors (p=0.002). By treatment arm, CD4 T-cells were lower for injectors receiving D4T (mean, 78; 95% CI, 0.4 - 156 cells/mm3) than TDF (mean 607, 95% CI, 196 - 1018 cells/mm3, p=0.005) or AZT (mean 474, 95% CI -377 - 571 cells/mm3, p=0.004).Mono and dual infections with HIV-1 and HCV is high among IHUs in Malindi, but ART coverage is low. The co-infected IHUs have elevated risk of immunodeficiency due to significantly depressed CD4 T-cell numbers. Coinfection screening, treatment-as-prevention for both HIV and HCV and harm reduction should be scaled up to alleviate infection burden

CD4 Counts across various categories of heroin injectors.

<p>CD4 T-cells are compared between treatment arms of injectors (A). ¶ Counts are significantly lower for the D4T- arm than for the AZT arm (p = 0.004), TDF (p = 0.005) or the ART- (p<0.001) arm and lower for the sub-optimal ART than ART- (p = 0.023) arm. All subjects in the ‘ART-’ arm were not infected (NI) by either virus. Mean CD4 counts are compared between infection statuses (B). These are significantly lower for co-infected than HIV-1 mono infected injectors as shown. §Shows significantly lower CD4 counts for HIV mono-infected than NI injectors (p = 0.002). CD4 data is compared between age groups of the different infection statuses (C). No significant (NS) difference was observed. *Co-infected injectors had much lower CD4 levels compared to other infection categories in any age group. Only one injector was HCV mono-infected (horizontal bar in the >30–40 years category). CD4 Counts were not significantly different between genders of injectors (D). ART, antiretroviral treatment; CTX, cotrimoxazole (septrin); ART-, No ART; Uk, unknown ART status; Sub, sub optimal ART.</p

CD4 T-cell counts compared by various categories of heroin injectors who were screened for both HIV and HCV.

<p>Legend of table:</p><p>^† P-value is significant at level shown comparing mean CD4 between infection statuses or between treatment arms.</p><p>^a No qualifying subjects.</p><p>^b Confidence Interval (CI) is not applicable. ART, antiretroviral treatment. Only one subject (aged 31-40yrs, CD4 T-cells of 287 counts/mm³) was HCV mono-infected, and is excluded from this table. Sub-optimal ART cases are IHUs with unexplained use of single-drug ART regimen.</p><p>CD4 T-cell counts compared by various categories of heroin injectors who were screened for both HIV and HCV.</p