Gender differences in retention and survival on antiretroviral therapy of HIV-1 infected adults in Malawi

BackgroundThere is currently a dearth of knowledge on gender differences in mortality among patients on ART in Africa. MethodsUsing data from the national ART monitoring and evaluation system, a survival analysis of all healthcare workers, teachers, and police/army personnel who accessed ART in Malawi by June, September and December 2006 respectively, was undertaken. Gender differences in survival were analysed using Kaplan-Meier estimates and rate ratios were derived from Poisson regression adjusting for confounding.Results4670 ART patients (49.8% female) were followed up for a median of 8.7 months after starting ART. Probability of death was significantly higher for men than women (

Incidence of lactic acidosis toxicity among patients on stavudine or zidovudine containing antiretroviral therapy at Lighthouse clinics

Although stavudine and zidovudine remain frequently used in low-income countries in Africa, they are associated with long-term toxicities. Lactic acidosis is one of the most serious toxicities in antiretroviral treatment (ART) and occurs predominantly in regimens containing stavudine (D4T) or zidovudine (AZT). We conducted this study to determine the incidence and risk factors for lactic acidosis among HIV-positive patients that have been on ART for at least 6 months. This study will bridge the gap that exists due to scarcity of data on the extent of toxicities due to long-term use of D4T and AZT. We conducted a retrospective cohort study using routine clinic data from the Lighthouse and Martin Preuss Centre electronic data systems. We used the clinic data collected between 1st January 2004 and 31st December 2011. We included into the analysis all patients that have been on D4T- or AZT-containing ARV drugs for at least 6 months. We analysed the data using Poisson regression of the number of cases of lactic acidosis (LA) on gender, age at ART initiation, baseline BMI, and lipodystrophy in order to determine the incidence and risk factors for lactic acidosis. All statistical analyses were done at 5% significance level. We identified 14,854 patients that have ever been on D4T- or AZT-containing ARV drugs for longer than 5 months. Of these, 43% were male and median age was 34 years. The total number of cases of confirmed LA was 342 with observed mortality rate 40% more than the patients without confirmed LA. There were 23.02 cases of LA for every 1000 patient-years on D4T- or AZT-containing ART regimens. The strongest risk factor identified for developing LA was having a baseline BMI >25 with incidence rate ratio (IRR) 3.11 (95% CI: 2.49, 3.88). The IRR for patients with a diagnosis of lipodystrophy was 1.77 (95% CI: 1.35, 2.32). Patients aged <30 years at ART initiation had 31% reduced risk of developing LA as compared to patients aged>39 years at ART initiation. We were unable to detect any increased risk associated with gender. Clinicians should always have significantly higher index of suspicion of LA in patients with established lipodystrophy, aged more than 30 years at ART initiation and patients with higher baseline BMIs. The number of cases of fatal lactic acidosis that did not present to the clinic is unknown but is likely to be significant

Assessment of non-standard HIV antiretroviral therapy regimens at Lighthouse Trust in Lilongwe, Malawi

Aim: Lighthouse Trust in Lilongwe, Malawi serves approximately 25,000 patients with HIV antiretroviral therapy (ART) regimens standardized according to national treatment guidelines. However, as a referral centre for complex cases, Lighthouse Trust occasionally treats patients with non-standard ART regimens (NS-ART) that deviate from the treatment guidelines. We evaluated factors contributing to the use of NS-ART and whether patients could transition to standard regimens.Methods: This was a cross-sectional study of all adult patients at Lighthouse Trust being treated with NS-ART as of February 2012. Patients were identified using the electronic data system. Medical charts were reviewed and descriptive statistics were obtained.Results: One hundred six patients were initially found being treated with NS-ART, and 92 adult patients were confirmed to be on NS-ART after review. Mean patient age was 42.4 ± 10.3 years, and 52 (57%) were female. Mean duration of treatment with the NS-ART being used at the time of data collection was 2.1 ± 1.5 years. Eight patients (9%) were on modified first-line NS-ART and 84 (91%) were on modified second-line NS-ART, with 90 patients (98%) having multiple factors contributing to NS-ART use. Severe toxicity from one medication contributed in 28 cases (30%) and toxicity from multiple medications contributed in 46 cases (50%), while 22 patients (24%) were transitioned to NS-ART following a stockout of their original medication. Following clinical review, 84 patients (91%) were transitioned to standard regimens, and eight (9%) were maintained on NS-ART because of incompatibility of their clinical features with the latest national guidelines.Conclusions: Primary factors contributing to NS-ART use were medication toxicities and medication stockouts. Most patients were transitioned to standard regimens, although the need for NS-ART remains

Assessment of community led total sanitation uptake in rural Kenya

Background: Community Led Total Sanitation (CLTS) is an innovative community led drive to set up pit latrines in rural Kenya with an aim of promoting sustainable sanitation through behaviour change. It’s a behaviour change approach based on social capital that triggers households to build pit latrines without subsidy. The Ministry of Health introduced the CLTS campaign in 2007 and the first road map to ODF ended in 2013. Since the commencement of the CLTS Programme in, there is little documentation on assessment of its uptake from triggering to the certification of open defecation free villages.Objective: To assess the magnitude of Community Led Total Sanitation (CLTS) triggering to certification of Open Defecation free (ODF) villages in rural Kenya.Design: A retrospective descriptive study.Setting: The 47 counties in Kenya. Kenya is projected to have a population of 46 million people with the majority as rural populace. The study unit were Villages across the 47 counties from the data generated in the CLTS monitoring and evaluation dataset.Results: The number of triggered villages (11641) compared to those that reached certification stage (3131) reduced significantly. Busia County achieved the 100% target for triggering. There was a significant decline of the proportions per county in the process of claiming, verifying and certifying ODF villages however Busia, Siaya and Vihiga were leading across the counties. The proportion of CLTS facilitators and CLTS certified villages per county were incongruent.Conclusion: There was low uptake of CLTS from the triggering phase to the certification phase due to plausible factors such as inadequate monitoring of the CLTS process, inadequate funding of CLTS programmeming and conflicting work demands on the CLTS facilitators leading to reduced momentum as observed in Uganda

Trends of reported outpatient malaria cases to assess the Test, Treat and Track (T3) policy in Kenya

Background: Kenya reports over six million malaria cases annually. In 2012 the country adopted the Test, Treat and Track (T3) policy to ensure that all suspected malaria cases are tested, confirmed cases are treated with quality-assured drugs and timely accurate malaria surveillance are in place to guide policy and practice.Objective: To describe the trends of confirmed outpatient malaria cases and the consumption of artemisinin-based combination therapy (ACT) in the government health facilities in Kenya following the roll out of the T3 initiative.Design: A retrospective review study.Setting: All government health facilities in the 47 counties.Subjects: Secondary data on all outpatient malaria cases and ACT consumed as reported in the District Helth Information Software (DHIS).Results: Total malaria cases decreased from 8.5 to 6.8million cases in 2012 and 2015, respectively. Confirmed malaria cases increased from 1.97 (23%) to 4.9 (72%) million cases. The greatest decrease in total malaria cases and the greatest rise in confirmation of suspected cases occurred in the lower level health facilities. More confirmation of suspected cases occurred in the malaria endemic regions compared to other epidemiological zones. Excess ACT consumption reduced by 46% to reach 27% in 2015.Conclusion: Though there was increased confirmation of suspected malaria, still onethird of the outpatients were treated clinically in 2015. About one-third of ACTs were also used in excess in 2015. There is need for enhanced efforts to adhere to the T3 policy and malaria elimination guidelines

An assessment of water, sanitation and hygiene (wash) practices and quality of routinely collected data in Machakos County Kenya

Background: Poor water, sanitation, and hygiene (WASH) practices, predispose to childhood morbidity and mortality globally, and especially from diarrhoeal diseases. Machakos County in its community strategy utilises Community Health Workers (CHWs) to promote WASH practices and to collect household based data using a structured reporting tool. There is no published data on WASH in Machakos County.Objectives: To assess (i) WASH practices, and (ii) completeness and accuracy of routinely collected data on household water, sanitation and hygiene with reported childhood diarrhoea cases of all community units in Machakos County, Kenya.Design: Descriptive ecological studySetting: Machakos County, KenyaSubjects: Household unitsResults: A total of 137,540 households were served by the CHWs between January and December 2014. The number of households was not updated as per ministry of health recommendation, after six months hence the denominator remained constant. There was a high uptake of households with treated drinking water (92%), availability of hand washing facilities in (89%) and availability of functional pit latrines (98%). A total of 4,012 diarrhoea cases were reported in the County, with an average of 90 cases every month, except in the month of August where 3,020 cases of diarrhoea were reported. There was no apparent relationship observed between WASH practices and occurrence of under five diarrhoea cases.Conclusion: Water, sanitation and hygiene practices at community level in Machakos County are in keeping with post 2015 WASH targets and indicators, with few cases of under-five diarrhoea reported. Data quality and completeness need to be addressed for effective programme evaluation

Scientific Communication: Reporting on Mental Health Illness (MHI) in Kenya: how well are we doing?

No Abstrac

Editorial: Structured operational research and training in the public health sector: the Kenyan experience

No Abstrac

Switching to second-line antiretroviral therapy in resource-limited settings: comparison of programmes with and without viral load monitoring.

In high-income countries, viral load is routinely measured to detect failure of antiretroviral therapy (ART) and guide switching to second-line ART. Viral load monitoring is not generally available in resource-limited settings. We examined switching from nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line regimens to protease inhibitor-based regimens in Africa, South America and Asia