Hepatitis C virus (HCV) infection in Africa: a review

Hepatitis C virus (HCV) is a viral pandemic and a leading cause of chronic liver disease. This review highlights the epidemiology and management of Hepatitis C in Africa. We searched for articles on medline using the terms, "Hepatitis C", "Prevalence", "Epidemiology", "Africa" and "Treatment". The bibliographies of the articles found were used to find other references. We included articles published after 1995 only. The data was summarized and presented in tables and figures. Africa has the highest WHO estimated regional HCV prevalence (5.3%). Egypt has the highest prevalence (17.5%) of HCV in the world. Genotypes commonly found in Africa are 1, 4 and 5. Genotype 3 is found in Egypt and parts of Central Africa. Blood transfusion is a major means of acquisition of HCV infection. While treatment with peginterferon and ribavirin is recommended for patients with chronic HCV, no data were found on their use in Africa. Neither were there any data on definitive management (liver transplantation) for those with end stage disease. Data on HCV infection in Africa are scarce. This suggests that hepatitis C is still a neglected disease in many countries. Limited data exist in literature on HCV in Africa.Pan African Medical Journal 2013; 14:4

Research Brief 10-02-HNP

Despite the knowledge and information available about HIV, stigma is still present. The affects of stigma are real and tangible. Globally HIV positive people are marginalized and often dread that their HIV status will adversely affect them socially. The belief that HIV-infected people are somehow deviant, or misconceptions about the mode of transmission fuels anxiety, fear, and distrust, which translates into barriers to adequate health care, emotional distress, and actions that can have adverse affects on health outcomes. When working with HIV-infected individuals and those at risk of becoming infected with HIV, the impact of stigma can be crippling to research. Stigma associated with HIV has had a significant role in the ability to recruit and retain eligible study subjects for a nutrition based HIV study, Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children (HNP). While this study specifically focused on HIV-infected women living in Kenya, the generalization gathered could be extrapolated to other populations. It is recommended that similar studies conduct focus groups with the study population prior to piloting, to ensure stakeholder input and an understanding of the particular challenges and concerns within a local context. Future studies should also employ individuals known in the community that the population trusts to assist with recruitment. Finally, factors that identify study staff, or associate subjects with the study should be minimal to reduce the risk of disclosing a subject’s HIV status.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Research Brief 08-02-HNP

Preliminary evidence suggests that improved nutrition early in human immunodeficiency virus (HIV) infection may delay progression to acquired immunodeficiency syndrome (AIDS) and delay the initiation or improve the effectiveness of antiretroviral drug therapy (ART). The scientific community has evolved in its appreciation of the value of food as an integral component of comprehensive care for individuals with HIV infection and AIDS. It is now well recognized that those who are food insecure and malnourished are more likely to fail drug treatment regimens. Body mass index (BMI) < 18 at the initiation of ART is strongly predictive of death. In addition, weight loss during the first four weeks of ART is also associated with death. A higher BMI is protective and is associated with better responses with ART. Patient response to nutrition intervention, however, may be confounded by the stage of HIV progression and other infections. That is, those who are in the earlier stages of the disease may respond better to aggressive nutrition intervention. The HIV Nutrition Project (HNP), "Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children," will evaluate the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, researchers will study if the inclusion of meat added as an ingredient to a biscuit, when compared to soy or wheat, will best protect the immune system and prevent severe infection, prevent the loss of body mass and enhance the quality of life. These women are not yet receiving antiretroviral drugs and therefore not yet experiencing metabolic inefficiencies associated with AIDS.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Building comprehensive and sustainable health informatics institutions in developing countries: Moi University experience

Current approaches for capacity building in Health Informatics (HI) in developing countries mostly focus on training, and often rely on support from foreign entities. In this paper, we describe a comprehensive and multidimensional capacity-building framework by Lansang & Dennis, and its application for HI capacity building as implemented in a higher-education institution in Kenya. This framework incorporates training, learning-by-doing, partnerships, and centers of excellence. At Moi University (Kenya), the training dimensions include an accredited Masters in HI Program, PhD in HI, and HI short courses. Learning-by-doing occurs through work within MOH facilities at the AMPATH care and treatment program serving 3 million people. Moi University has formed strategic HI partnerships with Regenstrief Institute, Inc. (USA), University of Bergen (Norway), and Makerere University (Uganda), among others. The University has also created an Institute of Biomedical Informatics to serve as an HI Center of Excellence in the region. This Institute has divisions in Training, Research, Service and Administration. The HI capacity-building approach by Moi provides a model for adoption by other institutions in resource-limited settings

Research Brief 08-03-HNP

In sub-Saharan Africa, an estimated 28 million people are living with the human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). In 2001, Moi University in Eldoret, Kenya joined with Kenya’s second national referral hospital, Moi Teaching and Referral Hospital (MTRH) and Indiana University (IU) to establish the Academic Model Providing Access To Healthcare (AMPATH). AMPATH’s missions were to (1) provide high-quality patient care; (2) educate patients and health care providers; and (3) establish a laboratory for clinical research in HIV/AIDS (http://medicine.iupui.edu/kenya/hiv.aids.html). Leveraging the power of an academic medical partnership, AMPATH has quickly become one of the largest and most comprehensive HIV/AIDS control systems in sub-Saharan Africa, providing a comprehensive system of care that has been described as a model of sustainable development (Tobias, 2006). Delivery of services occurs in the public sector through hospitals and health centers run by Kenya’s Ministry of Health. AMPATH currently implements prevention activities that touch the lives of millions of persons in a wide geographic area. The research arm of AMPATH, created to facilitate and manage the international research agenda being generated by Kenyan and US faculty, includes the Global Livestock CRSP’s HIV Nutrition Project (HNP), “Increasing Animal Source Foods in Diets of HIV-infected Kenyan Women and Their Children,” which is a collaborative initiative between AMPATH and faculty from Moi University, Indiana University and the University of California, Los Angeles.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Research Brief 08-01-HNP

Many of the 28 million people with human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) estimated to be living in sub-Saharan Africa also suffer from malnutrition. Reproductive-aged women, their infants and young children are among the most vulnerable to malnutrition and progression of HIV to AIDS. As seen in eastern and southern Africa, mortality is increased in the malnourished. The HIV Nutrition Project (HNP) researchers will be evaluating the effect of protein quality and micronutrients found in meat on the health and nutritional well-being of women living with HIV in rural Kenya and the health and development of their children. By means of a randomized nutrition feeding intervention, the study will determine if meat in the diets of HIV-infected women and their children (1) protects the immune system and prevents severe infection, (2) prevents the loss of lean body mass, enhancing the quality of life among these drug naive women and enabling women to carry out their activities of daily living, and (3) supports the growth and development of their vulnerable children when compared to those given supplements with the same amount of energy, but with either soya or wheat protein. The intervention food with beef protein provides significantly more vitamin B12, lysine and bio-available iron and zinc when compared to the soya and wheat supplements. Deficiencies of these nutrients may hasten HIV disease progression.This publication was made possible through support provided by the Office of Agriculture, Bureau of Economic Growth, Agriculture and Trade, under Grant No. PCE-G-00-98-00036-00 to University of California, Davis. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID

Morbidity and nutrition status of rural drug-naïve Kenyan women living with HIV

This paper describes morbidity in a group of HIV-positive drug-naïve rural women in western Kenya. A total of 226 drug-naïve HIV-positive women were evaluated for baseline morbidity, immune function, and anthropometry before a food-based nutrition intervention. Kenyan nurses visited women in their homes and conducted semi-structured interviews regarding symptoms and physical signs experienced at the time of the visit and during the previous week and physical inspection. Blood and urine samples were examined for determination of immune function (CD4, CD8, and total lymphocyte counts), anaemia, malaria, and pregnancy status. Intradermal skin testing with tuberculin (PPD), candida, and tetanus toxoid antigens was also performed to evaluate cell-mediated immunity. Anthropometry was measured, and body mass index (BMI) was calculated. Seventy-six per cent of the women reported being sick on the day of the interview or within the previous week. Illnesses considered serious were reported by 13.7% of women. The most frequent morbidity episodes reported were upper respiratory tract infections (13.3%), suspected malaria (5.85%), skeletal pain (4.87%), and stomach pain (4.42%). The most common morbidity signs on physical inspection were respiratory symptoms, most commonly rhinorrhea and coughing. Confirmed malaria and severe diarrhea were significantly associated with a higher BMI

A clinician-nurse model to reduce early mortality and increase clinic retention among high-risk HIV-infected patients initiating combination antiretroviral treatment

<p>Abstract</p> <p>Background</p> <p>In resource-poor settings, mortality is at its highest during the first 3 months after combination antiretroviral treatment (cART) initiation. A clear predictor of mortality during this period is having a low CD4 count at the time of treatment initiation. The objective of this study was to evaluate the effect on survival and clinic retention of a nurse-based rapid assessment clinic for high-risk individuals initiating cART in a resource-constrained setting.</p> <p>Methods</p> <p>The USAID-AMPATH Partnership has enrolled more than 140,000 patients at 25 clinics throughout western Kenya. High Risk Express Care (HREC) provides weekly or bi-weekly rapid contacts with nurses for individuals initiating cART with CD4 counts of ≤100 cells/mm³. All HIV-infected individuals aged 14 years or older initiating cART with CD4 counts of ≤100 cells/mm³were eligible for enrolment into HREC and for analysis. Adjusted hazard ratios (AHRs) control for potential confounding using propensity score methods.</p> <p>Results</p> <p>Between March 2007 and March 2009, 4,958 patients initiated cART with CD4 counts of ≤100 cells/mm³. After adjusting for age, sex, CD4 count, use of cotrimoxazole, treatment for tuberculosis, travel time to clinic and type of clinic, individuals in HREC had reduced mortality (AHR: 0.59; 95% confidence interval: 0.45-0.77), and reduced loss to follow up (AHR: 0.62; 95% CI: 0.55-0.70) compared with individuals in routine care. Overall, patients in HREC were much more likely to be alive and in care after a median of nearly 11 months of follow up (AHR: 0.62; 95% CI: 0.57-0.67).</p> <p>Conclusions</p> <p>Frequent monitoring by dedicated nurses in the early months of cART can significantly reduce mortality and loss to follow up among high-risk patients initiating treatment in resource-constrained settings.</p