Prevalence of Hepatitis C Virus and its genotypes among a cohort of drug users in Kenya

Background: Prevalence of hepatitis C virus and that of its main genotypes varies between the worlds geographic regions. The risk factors for infection with HCV include blood transfusion, tattoing and injecting drug use. Objectives: To examine the prevalence of HCV and determine its main genotypes among a cohort of drug users in Kenya. Design: A laboratory based study. Setting: Hepatitis research laboratory in the Centre for Virus Research at the Kenya Medical Research Institute, Nairobi. Subjects: Three hundred and fourteen male and 19 female intravenous and non-intravenous drug users aged between 15-55 years. Results: Seventy four (22.2%) out of 333 samples tested positive for anti-HCV. Sixty nine out of the 74 serum samples were assayed for HCV RNA and 38 (55.5%) were positive. The RNA positive samples were further subjected to sequencing and 19 (73%) of the samples were classified as genotype la, while seven (27%) samples were classified as genotype 4. Genotypes 2, 3, 5 and 6 were not identified in this study. Conclusions: These results demonstrate a high HCV infection prevalence among this cohort of drug users (22.2 %) as compared to that of the general population, which is estimated to be 0.2- 0.9%. The study also confirms the presence of at least two major genotypes among Kenyan drug users (genotypes 1 and 4). East African Medical Journal Vol. 85 (7) 2008: pp. 318-32

Ethnic disparity in 21-hydroxylase gene mutations identified in Pakistani congenital adrenal hyperplasia patients

Background: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders caused by defects in the steroid 21 hydroxylase gene (CYP21A2). We studied the spectrum of mutations in CYP21A2 gene in a multi-ethnic population in Pakistan to explore the genetics of CAH. Methods: A cross sectional study was conducted for the identification of mutations CYP21A2 and their phenotypic associations in CAH using ARMS-PCR assay. Results: Overall, 29 patients were analyzed for nine different mutations. The group consisted of two major forms of CAH including 17 salt wasters and 12 simple virilizers. There were 14 phenotypic males and 15 females representing all the major ethnic groups of Pakistan. Parental consanguinity was reported in 65% cases and was equally distributed in the major ethnic groups. Among 58 chromosomes analyzed, mutations were identified in 45 (78.6%) chromosomes. The most frequent mutation was I2 splice (27%) followed by Ile173Asn (26%), Arg 357 Trp (19%), Gln319stop, 16% and Leu308InsT (12%), whereas Val282Leu was not observed in this study. Homozygosity was seen in 44% and heterozygosity in 34% cases. I2 splice mutation was found to be associated with SW in the homozygous. The Ile173Asn mutation was identified in both SW and SV forms. Moreover, Arg357Trp manifested SW in compound heterozygous state. Conclusion: Our study showed that CAH exists in our population with ethnic difference in the prevalence of mutations examined

Outcomes of community-based differentiated models of multi-month dispensing of antiretroviral medication among stable HIV-infected patients in Lesotho : a cluster randomised non-inferiority trial protocol

CITATION: Faturiyele, I. O., et al. 2018. Outcomes of community-based differentiated models of multi-month dispensing of antiretroviral medication among stable HIV-infected patients in Lesotho : a cluster randomised non-inferiority trial protocol. BMC Public Health, 18:1069, doi:10.1186/s12889-018-5961-0.The original publication is available at https://bmcpublichealth.biomedcentral.comBackground: Current World Health Organization (WHO) guidelines recommend early initiation of HIV positive patients on antiretroviral therapy (ART) irrespective of their clinical or immunological status known as the test and start approach. Lesotho, like many other countries introduced this approach in 2016 as a strategy to reach epidemic control. There will be rapidly growing number of HIV-infected individuals initiating treatment leading to practical challenges on health systems such as congestion, long waiting time for patients and limited time to provide quality services to patients. Differentiated models of ART delivery is an innovative solution that helps to increase access to care, while reducing the burden on existing health systems. Ultimately this model will help to achieve retention and viral suppression. We describe a demonstration study designed to evaluate a community-based differentiated model of multi-month dispensing (MMD) approaches of ART among stable HIV patients in Lesotho. Methods: This study will be a three-arm cluster randomised trial, which will enrol approximately 5760 HIV-infected individuals who are stable on ART in 30 selected clusters. The clusters, which are health facilities, will be randomly assigned into the following differentiated model of care arms: (i) 3 monthly ART supply at facilities (Control), (ii) 3 monthly ART supply through community ART groups (CAGs) and (iii) 6 monthly ART supply through community ART distribution points (CAD). Primary outcomes are retention in care and virologic suppression, and secondary outcomes include feasibility and cost effectiveness. Discussion: Important lessons will be learnt to allow for improved implementation of such demonstration projects, including various needs for reliable supply of medication, access to quality clinical data including access to viral loads (VLs) results, frameworks to support lay worker cadre, involvement of community stakeholders, and reliable data systems including records of key indicators. MMD will have positive implications including improved retention, virologic suppression, convenience and access to medication.https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5961-0Publisher's versio

Prevalence of hepatitis c virus and its genotypes among a cohort of drug users in Kenya

Background: Prevalence of hepatitis C virus and that of its main genotypes varies between the worlds geographic regions. The risk factors for infection with HCV include blood transfusion, tattoing and injecting drug use.Objectives: To examine the prevalence of HCV and determine its main genotypes among a cohort of drug users in Kenya.Design: A laboratory based study.Setting: Hepatitis research laboratory in the Centre for Virus Research at the Kenya Medical Research Institute, Nairobi.Subjects: Three hundred and fourteen male and 19 female intravenous and non-intravenous drug users aged between 15-55 years.Results: Seventy four (22.2%) out of 333 samples tested positive for anti-HCV. Sixty nine out of the 74 serum samples were assayed for HCV RNA and 38 (55.5%) were positive. The RNA positive samples were further subjected to sequencing and 19 (73%) of the samples were classified asgenotype la, while seven (27%) samples were classified as genotype 4. Genotypes 2, 3, 5 and 6 were not identified in this study.Conclusions: These results demonstrate a high HCV infection prevalence among this cohort of drug users (22.2 %) as compared to that of the general population, which is estimated to be 0.2- 0.9%. The study also confirms the presence of at least two major genotypes among Kenyan drugusers (genotypes 1 and 4)