research & publications

CO-MORBIDITIES RESEARCH

Results by County (Approx)
  • 97 results found
  • A comparison of tuberculosis control activities in the private and public health sectors Kenya

    LLPI

    Eunice Wandia Mailu 

     

    Text For Abstract

    Many resource-poor countries have a large and expanding private health sector and there is growing evidence that increasing numbers of patients with tuberculosis (TB) seek care from private-for-profit providers. In recent years the World Health Organization (WHO) has begun to address the issue of private-for-profit providers in TB prevention and care through an evolving global strategy called Public-Private Mix (PPM). PPM for TB care and control is defined as the involvement of all health care providers in TB control so as to promote the use of International Standards for TB Care in all health sectors and thereby achieve national and global TB control targets (World Health Organization, 2012). In 2014, the WHO launched the End TB strategy with an ambitious goal of ending the global TB epidemic by 2035. One of the components of the Second Pillar of the End TB Strategy fully embraces PPM and emphasizes the importance of engaging communities, Civil Society Organizations (CSOs) and all public and private care providers (World Health Organization, 2014). 

     

    Study Objectives

    The aim of this study is to assess, at the national level, TB control activities in the private-for-profit health sector in Kenya between 2013 and 2017 and compare the findings with what has been reported in the public health sector (including government, FBO and NGO sectors).Specific objectives The completeness of data collection for selected key variables Numbers of notified TB cases per year by socio-demographic and clinical characteristics including type and category TB-HIV collaborative activities, including HIV testing uptake, and use of ART and CPT for those found to be co-infected Treatment outcomes of all notified TB cases and in relation to HIV status. 

     

    Study Site 

    Kenya 


  • Comparison of trends in tuberculosis incidence among adults living with HIV and adults without HIV--Kenya, 1998-2012

    BACKGROUND


    In Kenya, the comparative incidences of tuberculosis among persons with and without HIV have not been described, and the differential impact of public health interventions on tuberculosis incidence in the two groups is unknown.


    This study compares tuberculosis incidence among persons with and without HIV to uncover distinct trends in the epidemiology of tuberculosis in these two populations.


    Read more

  • Autopsy study of HIV-1-positive and HIV-1-negative adult medical patients in Nairobi, Kenya.

    HIV infection has now been consistently identified as the major cause of death in young Africans in both urban and rural areas. In Africa, several studies have defined the clinical presentation of HIV disease but there have only been a limited number of autopsy studies. Because of the scarcity of autopsy data and the possibility of differing type and frequency of opportunistic infections between different geographic locations we set out to study consecutive new adult medical admissions to a tertiary referral hospital in Nairobi and perform autopsies on a sample of HIV-1-positive and HIV-1-negative patients who died in the hospital ward. 


    Read more

  • High rate of pneumococcal bacteremia in a prospective cohort of older children and adults in an area of high HIV prevalence in rural western Kenya

    Background

    The burden of disease caused by Streptococcus pneumoniae (pneumococcus) in young African children is well-established . A recent analysis estimated over 4 million cases and almost a half-million deaths from pneumococcal disease occur among African children < 5 years old annually . The burden of pneumococcal disease in older children and adults in Africa, particularly in rural settings, is less well-characterized, although is likely substantial. Several studies in Africa have shown pneumococcus to be one of the principal causes of severe bacterial bloodstream infections in hospitalized adults, along with Mycobacterium tuberculosis and non-typhi salmonellae .


    Read More

  • Risk Factors for Inadequate TB Case Finding in Rural Western Kenya: A Comparison of Actively and Passively Identified TB Patients

    Background


    The findings of a prevalence survey conducted in western Kenya, in a population with 14.9% HIV prevalence suggested inadequate case finding. We found a high burden of infectious and largely undiagnosed pulmonary tuberculosis (PTB), that a quarter of the prevalent cases had not yet sought care, and a low case detection rate.


    Read More

  • Active Tuberculosis Is Associated with Worse Clinical Outcomes in HIV-Infected African Patients on Antiretroviral Therapy

    The global burden of tuberculosis (TB) and HIV co-infections is immense. Of the 8.7 million incident cases of TB in 2011, an estimated 1.13 million (13%) were infected with HIV, of whom 430,000 (38%) died. [1] The highest rates of HIV co-infection were reported for TB patients in the African Region where 46% of those with a HIV test were HIV-positive. In some countries in the region, this figure was as high as 70%. [1]. Africa is responsible for 79% of the HIV/TB infections globally.  In Kenya, 106,000 cases of TB were registered in 2010 with 41% being HIV co-infected .

    Read More

  • Effectiveness of anti-tuberculosis treatment among patients receiving highly active antiretroviral therapy at Vihiga district hospital in 2007.

    Background.

    In Kenya there is need for proper co-ordination of antiretroviral therapy (ART) and tuberculosis (TB) treatment as most (60%) of the TB patients are also human immunodeficiency virus (HIV) positive. This study aims to determine the difference in response to TB treatment among HIV-negative TB patients and HIV-positive TB patients receiving delayed highly active antiretroviral therapy (HAART) at Vihiga District Hospital.


    Read More

  • Scaling up implementation of ART: Organizational culture and early mortality of patients initiated on ART in Nairobi, Kenya

    Background

    Scaling up the antiretroviral (ART) program in Kenya has involved a strategy of using clinical guidelines coupled with decentralization of treatment sites. However decentralization pushes clinical responsibility downwards to health facilities run by lower cadre staff. Whether the organizational culture in health facilities affects the outcomes despite the use of clinical guidelines has not been explored. This study aimed to demonstrate the relationship between organizational culture and early mortality and those lost to follow up (LTFU) among patients enrolled for HIV care.


    Read More

  • Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya

    Background;


    KDH is located in Kericho among the tea fields and plantations of Kenya's southern Rift Valley Province 260 kilometers northwest of Nairobi. As a Ministry of Health (MoH) facility under the Ministry of Medical Services, KDH provides services to a rural, largely uninsured population, representative of the national statistic indicating that 46% of the population lives below the poverty line


    .Read More


  • Integrating Tuberculosis and HIV Services in rural Kenya: uptake and outcomes

    Background:

    An estimated 35.3 million persons worldwide were living with the human immunodeficiency virus (HIV) in 2012, while 8.6 million people developed tuberculosis (TB), the majority of them in sub-Saharan Africa. Kenya is one of the world’s 22 high TB burden2 and high HIV burden countries.


    Read more

  • A trial to investigate the usefulness of a different antibiotic (fosfomycin) to treat severe infections in newborns (NeoFosfo)

    What is this research about?

    Young children admitted to hospital with signs of infection are treated with antibiotics. However, bacteria are increasingly becoming resistant to the antibiotics that are normally used. This may make it harder to recover from their illnesses. In Africa, alternative drugs that work are expensive and may themselves cause the bacteria to become resistant. New alternatives are therefore needed. One drug that might be able to be used as an alternative is Fosfomycin. This drug is used in Europe and America to treat some infections in adults and children. The drug can now be obtained cheaply since it has come off patent. Since it has not been used a lot in this part of the world the risk of bacterial resistance is likely to be low. However, more information about the drug is needed to inform the best dose to use in newborns.


    Download
  • Pilot implementation of a contact tracing intervention for tuberculosis case detection in Kisumu County, Kenya

    Abstract

    Leveraging an existing community health strategy, a contact tracing intervention was piloted under routine programmatic conditions at three facilities in Kisumu County, Kenya. Data collected during a 6-month period were compared to existing programmatic data. After implementation of the intervention, we found enhanced programmatic contact tracing practices, noting an increase in the proportions of index cases traced, symptomatic contacts referred, referred contacts presenting to a facility for tuberculosis screening, and eligible contacts started on isoniazid preventive therapy. As contact tracing is scaled up, health ministries should consider the adoption of similar contact tracing interventions to improve contact tracing practices.


    Read more

  • MORTALITY AFTER CLINICAL MANAGEMENT OF AIDS-ASSOCIATED CRYPTOCOCCAL MENINGITIS IN KENYA.

    BACKGROUND:

    Cryptococcal meningitis (CM) is an increasingly prevalent infection among HIV/AIDS patients and is becoming a leading cause of morbidity and mortality in Africa. The short-term prognosis and management of patients with CM may be improved by identifying factors leading to mortality in patients with CM.


    Read more

  • Pilot implementation of a contact tracing intervention for tuberculosis case detection in Kisumu County, Kenya

    Leveraging an existing community health strategy, a contact tracing intervention was piloted under routine programmatic conditions at three facilities in Kisumu County, Kenya. Data collected during a 6-month period were compared to existing programmatic data. After implementation of the intervention, we found enhanced programmatic contact tracing practices, noting an increase in the proportions of index cases traced, symptomatic contacts referred, referred contacts presenting to a facility for tuberculosis screening, and eligible contacts started on isoniazid preventive therapy. As contact tracing is scaled up, health ministries should consider the adoption of similar contact tracing interventions to improve contact tracing practices.


    Read more

  • Incremental Yield of Including Determine-TB LAM Assay in Diagnostic Algorithms for Hospitalized and Ambulatory HIV-Positive Patients in Kenya.

    BACKGROUND:

    Determine-TB LAM assay is a urine point-of-care test useful for TB diagnosis in HIV-positive patients. We assessed the incremental diagnostic yield of adding LAM to algorithms based on clinical signs, sputum smear-microscopy, chest X-ray and Xpert MTB/RIF in HIV-positive patients with symptoms of pulmonary TB (PTB).


    METHODS:

    Prospective observational cohort of ambulatory (either severely ill or CD4<200cells/μl or with Body Mass Index<17Kg/m2) and hospitalized symptomatic HIV-positive adults in Kenya. Incremental diagnostic yield of adding LAM was the difference in the proportion of confirmed TB patients (positive Xpert or MTB culture) diagnosed by the algorithm with LAM compared to the algorithm without LAM. The multivariable mortality model was adjusted for age, sex, clinical severity, BMI, CD4, ART initiation, LAM result and TB confirmation.


    Read more

  • Incidence and correlates of tuberculosis IGRA conversion among HIV-infected postpartum women

    Abstract


    SETTING:

    Prevention of maternal-to-child transmission program at a tertiary care hospital in Nairobi, Kenya. The risk of acquiring Mycobacterium tuberculosis infection among peripartum human immunodeficiency virus (HIV) infected women is poorly defined.


    OBJECTIVE:

    To determine the incidence of and co-factors for interferon-gamma release assay (IGRA) conversion among postpartum HIV-infected women using T-SPOT.TB.


    Read more

  • Implementation and Operational Research: Feasibility of Using Tuberculin Skin Test Screening for Initiation of 36-Month Isoniazid Preventive Therapy in HIV-Infected Patients in Resource-Constrained Settings

    Introduction:

    The tuberculin skin test (TST) can be used to identify HIV-infected people who would benefit the most from long-term isoniazid preventive therapy (IPT). However, in resource-constrained settings, implementation of the TST can be challenging. The objectives of this study were to assess the feasibility of implementing the TST for IPT initiation and to estimate the proportion of TST-positive incidence among HIV-positive patients in 2 high tuberculosis and HIV burden settings

  • Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya.

    Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN.


    Read more

  • Comparative Yield of Different Diagnostic Tests for Tuberculosis among People Living with HIV in Western Kenya.

    BACKGROUND:

    Diagnosis followed by effective treatment of tuberculosis (TB) reduces transmission and saves lives in persons living with HIV (PLHIV). Sputum smear microscopy is widely used for diagnosis, despite limited sensitivity in PLHIV. Evidence is needed to determine the optimal diagnostic approach for these patients.


    METHODS:

    From May 2011 through June 2012, we recruited PLHIV from 15 HIV treatment centers in western Kenya. We collected up to three sputum specimens for Ziehl-Neelsen (ZN) and fluorescence microscopy (FM), GeneXpert MTB/RIF (Xpert), and culture, regardless of symptoms. We calculated the incremental yield of each test, stratifying results by CD4 cell count and specimen type; data were analyzed to account for complex sampling.


    Read more

  • Identifying common barriers and facilitators to linkage and retention in chronic disease care in western Kenya.

    BACKGROUND:

    Sub-Saharan Africa is increasingly being challenged in providing care and treatment for chronic diseases, both communicable and non-communicable. In order to address the challenges of linkage to and retention in chronic disease management, there is the need to understand the factors that can influence engagement in care. We conducted a qualitative study to identify barriers and facilitators to linkage and retention in chronic care for HIV, tuberculosis (TB) and Hypertension (HTN) as part of the Academic Model Providing Access to Healthcare (AMPATH) program in western Kenya.


    Read more

  • Performance of Clinical Screening Algorithms for Tuberculosis Intensified Case Finding among People Living with HIV in Western Kenya.

    OBJECTIVE:

    To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya.


    DESIGN:

    Prospective cohort study.


    METHODS:

    PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and "Improving Diagnosis of TB in HIV-infected persons" (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey.


    Read more

  • Using Survival Analysis to Identify Risk Factors for Treatment Interruption among New and Retreatment Tuberculosis Patients in Kenya.

    Despite high tuberculosis (TB) treatment success rate, treatment adherence is one of the major obstacles to tuberculosis control in Kenya. Our objective was to identify patient-related factors that were associated with time to TB treatment interruption and the geographic distribution of the risk of treatment interruption by county.


    Read more

  • Treatment outcomes of drug-resistant tuberculosis patients in Kenya.

    Abstract


    SETTING: Successful treatment of drug-resistant tuberculosis (DR-TB) is crucial in preventing disease transmission and reducing related morbidity and mortality. A standardised DR-TB treatment regimen is used in Kenya. Although patients on treatment are monitored, no evaluation of factors affecting treatment outcomes has yet been performed.



    Read more

  • Tuberculosis screening outcomes for newly diagnosed persons living with HIV, Nyanza Province, Kenya, 2009.

    To describe routine tuberculosis (TB) screening and diagnostic practices among newly enrolled people living with HIV (PLHIV) prior to the implementation of World Health Organization recommended TB intensified case finding.


    Read more

  • Impact Of Health Facility And Community Linkages In Tb Contact Tracing

    Background


    WHO and Center for Disease Control and Prevention recommends infection control to reduce the risk of Tuberculosis (TB) transmission. In Kirogo Chest Clinic there was an identified gap of tracing contact of smear positive TB client who were not identified early hence presenting later with active TB. Earlier in 2012 and 2013, health workers requested TB clients to tell their contacts to come to the clinic or bring them along in their next clinic. This was a challenge as most of the contacts never came. To address this, the staff held a multidisciplinary team meeting, discussed the issue and engaged the Community Health Volunteers (CHVs) for identification and tracking at community level. They liaised with the Public Health Officer who linked the chest clinic with CHVs working in the Community Units.



  • Empiric Therapy of Helminth Co-infection to Reduce HIV-1 Disease Progression (THE or PHE)

    Over 25 million HIV-1 infected individuals are currently living in Africa and as many as 50-90% may be co-infected with soil transmitted helminths such as roundworms, hookworms or whipworms. Helminth infection in HIV-1-infected individuals may increase HIV-1 RNA levels and increase the rate of progression of HIV-1 to AIDS. Studies have also shown that successful treatment of helminth co-infection (as documented by clearance of helminth eggs in stool) led to a significant decrease in HIV-1 plasma viral load (-0.36 log10). This change in viral load was significantly greater than that seen in those individuals without documented clearance of their helminth co-infection (+0.67 log10) (p=0.04). Studies conducted in Africa have shown an estimated 2.5-fold increased risk for sexual transmission of the HIV-1 for each log increase in plasma HIV-1 viral load. In addition to direct effects on plasma viral load, the rate of CD4 cell decline in helminth infected individuals may be directly impacted by the significant immune activation seen with such co-infection. The investigators propose a randomized controlled trial examining the potential benefits of routine empiric helminth eradication in HIV-1 infected adults who do not yet qualify for antiretroviral (ARV) therapy in Kenya. The current standard of care of symptomatic diagnosis and treatment will be compared to a systematic empiric scheduled de-worming program for HIV infected adults. The investigators will compare markers of disease progression including rate of CD4 decline and changes in HIV-1 RNA levels between the two treatment arms.


    Read more

  • High HIV, HCV And TB Burden Among People Who Use Drugs On Medically Assisted Therapy At Malindi Hospital

    BACKGROUND:

    Globally, people who inject drugs are disproportionately burdened by HIV, tuberculosis and hepatitis. A UNODC study reported 18.3% HIV prevalence among Kenya’s PWID (females 44.5% versus 16% for males) with PWID in Malindi having 21.9% prevalence second highest after Nairobi’s 27.7%. Hepatitis prevalence among PWID significantly higher HCV 22.2%, HBV 24.3%. The high burden of BBIs is attributed to risky injecting and sexual behaviours, compounded by criminalization of drug use, limited health care access, stigmatization and marginalization.


    Objectives:

    Reducing morbidity, mortality and other harms associated with drug-use among people who inject drugs through medically assisted therapy (MAT) at Malindi Sub-County Hospital.


    Methods:

    All eligible persons who injected/used drugs were screened at baseline for urine drug toxicology to confirm opioid use, as well as for HIV, HCV, HBV, pregnancy (female clients), and GeneXpert (if suspected with tuberculosis infection).


    Results:

    By mid-2016, a total 350 clients were enrolled for MAT. Of these, 12% [42] tested HIV positive – females 26.1% (11) versus 73.8 %( 31) males. HCV prevalence was 2.5%, 11.1 % (1) among females versus 88.8% for males. HBV prevalence was 1.7% [6clients], 16.6 % (1) for females versus 83.3% (5) for males. HIV/HCV co-infection was 2.28% overall (8), all males, while 1 male client had HIV/HBV/HCV co-infection. TB prevalence was 4.57%, females 12.5% (2) versus 87.5% (14) for males while TB/HIV coinfection was 6.2%, all males. The burden of non-communicable diseases was low among MAT clients (2 diabetics, 2 hypertensive and 1 thyrotoxicosis). One client with prior history of abdominal surgery developed intestinal obstruction while on methadone. All MAT clients with co-morbidities linked to other services: CCC, Chest Clinic, Sopc, Gopc, Dental clinic and Mopc for comprehensive care. 90% of HIV positive clients received ART and CTX as DOTS while others took at home. Follow up CD4 and Viral Load testing confirmed clinical improvement among MAT clients on treatment. All clients on anti-TB take their dose as DOT at the MAT centre.


    Conclusions, recommendations and implications:

    HIV prevalence among MAT clients more than twice the national HIV prevalence, followed by HCV prevalence. Males have significantly higher HCV burden compared to HIV-burdened females. Daily supervised dispensing of ARVs and anti-TB drugs with methadone improves compliance and treatment outcomes, while reducing risk of drug-resistance and associated mortality. However, high demand for MAT among non-injecting drug users may compromise treatment access for injecting drug users, while stigma and absence of effective hepatitis prevention and treatment interventions compromising quality of care thereby, contributing to sub-optimal adherence. There is urgent need for closing the treatment gap for HIV, TB and hepatitis among PWID in order to reach 90-90-90 targets.



  • OUTCOMES OF RESECTABLE PULMONARY ASPERGILLOMA IN A HIGH TUBERCULOSIS PREVALENCE SETTING BACKGROUND

    BACKGROUND:

    Pulmonary aspergillomata usually develop in patients with underlying structural lung diseases. The mainstay of therapy is considered to be lung resection surgery - both for aspergillomata treatment and prevention of life-threatening haemoptysis


    AIMS AND OBJECTIVES:

    In the present study, we assessed the outcomes of patients with aspergillomata presented to a multi-disciplinary forum for resection and primarily assessed the proportion of patients who had surgery at the end of the follow-up period as well as the time duration to surgery.


    METHODS:

    The medical records of all patients diagnosed as having pulmonary aspergillomata and presented to a multidisciplinary forum for possible surgical resection at the Tygerberg Hospital, between January 2013 and December 2015, were retrospectively reviewed.


    RESULTS:

    Fifty nine patients were included, with a mean (SD) age of 44.5 (± 8.8) years. Thirty six (61.0%) were male, and 13 (22.0%) were infected with human immunodeficiency virus (HIV). A previous history of pulmonary tuberculosis was identified in 83.1% of the patients. One or both upper lobes were involved in 58 of 59 patients (98.3%) and six patients (10.2%) had involvement of more than one lobe. Haemoptysis was the most frequent indication for surgery occurring in 56 patients (94.9%). Eleven patients (18.6%) reported ongoing respiratory symptoms within 90 days following discussion. After discussion, nine patients (15.3%) were considered unfit for surgery. Of those accepted, only 23 (46%) underwent surgical resection, as of 1 June 2016. The median time from presentation to surgery was 190 days (IQR: 134 – 351). Eighteen patients (78.3%) underwent resection of a single lobe, two (8.7%) had double lobectomies and three (13.0%) had pneumonectomies. There was no post-operative mortality. One patient developed bleeding, persistent air leak and aspiration pneumonia post- operatively requiring mechanical ventilation and an extended stay. Three further patients were hospitalised for >7 days, post-operatively. Fungal elements were identified in seventeen specimens (73.9%) of the resected lung. Following surgery, only two patient reported ongoing respiratory symptoms by day 90. Three of the 50 patients (6.0%) died prior to surgery from unknown causes. The reasons for delays and lack of surgery were varied and included: miscommunication (n=3); lack of transport (n=2); hospital bed shortage (n=1); refusal to consent (n=2); loss-to-follow-up (n=12); clinical improvement (n=3); clinical worsening (n=3) and lack of theatre space due to emergency procedures (n=1).


    CONCLUSION:

    Lung resection surgery is considered the mainstay of therapy for pulmonary aspergillomata. However, in our institution, less than half of the patients accepted actually received surgery, waiting times were long (>1yr in 25%) and were associated with mortality. Barriers to prompt surgery are complex, but should be urgently addressed.


  • Prevalence Of Vitamin D Deficiency In Adult Human Immunodeficiency Virus Infected Persons At Mbagathi District Hospital.

    BACKGROUND

    The introduction and increased availability of highly active antiretroviral therapy (HAART) has led to significant reduction in mortality in Human Immunodeficiency Virus (HIV) infected patients. With the increased survival rates HIV infected patients are now at risk of chronic age associated non communicable diseases including bone, metabolic, renal, and cardiovascular conditions. Vitamin D deficiency (VDD) in HIV infected patients has been associated with disease progression and increased mortality. Both HIV and HAART have been shown to increase the risk of vitamin D deficiency. Furthermore, supplementation of vitamin D has been shown to reduce bone mineral density loss related to HAART by up to 50%.


    STUDY OBJECTIVE

    To determine the prevalence of vitamin D deficiency in adult HIV infected persons at Mbagathi district hospital.


    METHODS

    This was a hospital based cross sectional descriptive study conducted between October 2015 and December 2015 involving adult HIV infected persons attending the Comprehensive Care Clinic at Mbagathi district hospital. Medical history was obtained via direct interview and recorded in the study proforma. Blood was then drawn for serum 25 hydroxycholecalciferol (25-VD) and creatinine analysis.


    RESULTS

    A total of 128 HIV infected persons were evaluated, 68% of the patients were females. The population was relatively young with a mean age of 41.4 years. Eight (6.3%) patients were classified as vitamin D deficient (25-VD <20 ng/ml), while thirty eight (29.7%) had vitamin D insufficiency (25-VD 21-29 ng/ml) and eighty two (64%) patients had normal levels (25-VD 30-100 ng/ml). HAART naïve patients were 5.3 times more likely to have vitamin D deficiency. We did not find any associations between vitamin D and age, gender, World Health Organization (WHO) stage, estimated glomerular filtration rate (eGFR) and body mass index (BMI).


    CONCLUSION

    Prevalence of Vitamin D deficiency was found to be low in our study population.


  • Non-Communicable Diseases in HIV infected patients; types, risk factors and services offered in HIV clinics in Kenya

    Background:

    Universal access to ART has resulted in a reduction in HIV related morbidity and mortality. The increase in lifespan has however been accompanied by emergence of several Non-Communicable Diseases (NCDs). NCDs in HIV develop as a consequence of chronic inflammation, immunologic dysfunction, ART side effects, aging, and lifestyle factors. For purposes of this analysis, NCDs include diabetes mellitus (DM), hypertension, obesity, cardiovascular disease, and chronic kidney disease. NCD management is important to sustain gains made in controlling HIV infection and to prevent the double burden of disease in developing countries. This presents a challenge because the patients require close monitoring, have drug-drug interactions, suffer from pill burden and poor adherence. In addition, weaknesses in the health systems e.g. inadequate numbers of healthcare workers and capacity, lack of referral systems, poor access to laboratory tests and imaging, inadequate drugs, as well as lack of data, patient awareness and funding impedes the control NCDs.


    Methodology:

    Systems for screening and management of NCDs in HIV patients were set up . We reviewed patient charts for HIV infected patients with NCD followed up in 25 of these health facilities 3 years after setting up the systems. We analyzed for type of NCD, risk factors, services offered, and adherence using descriptive statistics.


    Results:

    A total of 416 patients with HIV and NCDs were assessed of which 75% had hypertension, 13% had diabetes, 6% were obese, 3% had heart diseases and 2% had chronic kidney disease. The mean age was 48.6 years and males accounted for 24.4% of these patients. Risk factors included smoking (8.6%), alcohol consumption (11.5%), BMI>25 (60.9%) and family history of DM, hypertension or heart disease (34%). Regarding service delivery systems for NCDs in the HIV clinic, 66.0% of the patients had coordinated appointments compared to none at baseline, 55.2% were referred for specialist review, and 74.0% received education related to NCD management compared to none at baseline. The types of messages given during education were promotion of physical activity given to 54.0% of the patients, dietary counseling to 76.1% of the patients and weight loss promotion given to 51.8% of the patients. ART adherence was assessed in 94.1% of the patients out of who 69.6% had good adherence, 4.0% had fair adherence, 2.6% had poor adherence and the remaining patients did not have their adherence level recorded. NCD medication adherence assessment was done in 88.9% of the patients out of who 60.0% had good adherence, 12.7% had fair adherence, 5.8% had poor adherence while the rest did not have their adherence levels recorded. In regard to routine clinical and laboratory monitoring, 93.3% had their BP recorded at every visit, 10.8% had annual lipid profile done, 25.1% had annual creatinine done, 27.2% received random blood sugar test, 5.9% had cardiovascular risk estimation done prior to treatment commencement and only 2.7% had GFR estimation done. Only 1% of the patients received all the monitoring services, 92.7% of the patients received some of the tests and 6.2% received none of these tests.


    Conclusion:

    A lot has been invested in setting up chronic care models for the control of HIV. Lessons learnt here can form a foundation for setting up systems for integrated management of patients with both HIV and NCDs.



  • Cardiovascular health knowledge and preventive practices in people living with HIV in Kenya.

    Background

    Traditional cardiovascular disease (CVD) risk factors contribute to increase risk of CVD in people living with HIV (PLWH). Of all world regions, sub-Saharan Africa has the highest prevalence of HIV yet little is known about PLWH’s CVD knowledge and self- perceived risk for coronary heart disease (CHD). In this study, we assessed PLWH’s knowledge, perception and attitude towards cardiovascular diseases and their prevention.


    Methods

    We conducted a cross-sectional study in the largest HIV care program in western Kenya. Trained research assistants used validated questionnaires to assess CVD risk patterns. We used logistic regression analysis to identify associations between knowledge with demographic variables, HIV disease characteristics, and individuals CVD risk patterns.


    Results

    There were 300 participants in the study; median age (IQR) was 40 (33–46) years and 64% women. The prevalence of dyslipidemia, overweight and obesity were 70%, 33% and 8%, respectively. Participant’s knowledge of risk factors was low with a mean (SD) score of 1.3 (1.3) out of possible 10. Most (77.7%) could not identify any warning signs for heart attack. Higher education was a strong predictor of CVD risk knowledge (6.72, 95% CI 1.98-22.84, P<0.0001). Self-risk perception towards CHD was low (31%) and majority had inappropriate attitude towards CVD risk reduction.


    Conclusion

    Despite a high burden of cardiovascular risk factors, PLWH in Kenya lack CVD knowledge and do not perceived themselves at risk for CHD. These results emphasis the need for behavior changes interventions to address the stigma and promote positive health behaviors among the high risk HIV population in Kenya.



  • Factors associated with herpes simplex virus type 2 incidence in a cohort of human immunodeficiency virus type 1-seronegative Kenyan men and women reporting high-risk sexual behavior.

    Background

    Herpes simplex virus type 2 (HSV-2) is an important cause of genital ulcers and can increase HIV-1 transmission risk. Our objective was to determine the incidence and correlates of HSV-2 infection in HIV-1-seronegative Kenyan men reporting high-risk sexual behaviour, compared to high-risk HIV-1-seronegative women in the same community.


    Methods Cohort participants were screened for prevalent HIV-1 infection. HIV-1-uninfected participants had regularly scheduled follow-up visits, with HIV counseling and testing and collection of demographic and behavioral data. Archived blood samples were tested for HSV-2.


    Results

    HSV-2 prevalence was 22.0% in men and 50.8% in women (p<0.001). HSV-2 incidence in men was 9.0 per 100 person-years, and was associated with incident HIV-1 infection (adjusted incidence rate ratio [aIRR] 3.9, 95% CI 1.3–12.4). Use of soap for genital washing was protective (aIRR 0.3, 95% CI 0.1–0.8). Receptive anal intercourse had a borderline association with HSV-2 acquisition in men (aIRR 2.0, 95% CI 1.0–4.1, p=0.057), and weakened the association with incident HIV-1. Among women, HSV-2 incidence was 22.1 per 100 person-years (p < 0.001 compared to incidence in men), and was associated with incident HIV-1 infection (aIRR 8.9, 95% CI 3.6–21.8) and vaginal washing with soap (aIRR 1.9, 95% CI 1.0–3.4).


    Conclusions

    HSV-2 incidence in these men and women is among the highest reported, and is associated with HIV-1 acquisition. While vaginal washing with soap may increase HSV-2 risk in women, genital hygiene may be protective in men.


    Read more

  • Diagnosing acute and prevalent HIV-1 infection in young African adults seeking care for fever: a systematic review and audit of current practice

    Fever is a common complaint in HIV-1 infected adults and may be a presenting sign of acute HIV-1 infection (AHI). We investigated the extent to which HIV-1 infection was considered in the diagnostic evaluation of febrile adults in sub-Saharan Africa (SSA) through a systematic review of published literature and guidelines in the period 2003–2014. We also performed a detailed audit of current practice for the evaluation of febrile young adults in coastal Kenya. Our review identified 43 studies investigating the aetiology of fever in adult outpatients in SSA. While the guidelines identified recommend testing for HIV-1 infection, none mentioned AHI. In our audit of current practice at nine health facilities, only 189 out of 1173 (16.1%) patients, aged 18–29 years, were tested for HIV-1. In a detailed record review, only 2 out of 39 (5.1%) young adults seeking care for fever were tested for HIV-1, and the possibility of AHI was not mentioned. Available literature on adult outpatients presenting with fever is heavily focused on diagnosing malaria and guidelines are poorly defined in terms of evaluating aetiologies other than malaria. Current practice in coastal Kenya shows poor uptake of provider-initiated HIV-1 testing and AHI is not currently considered in the differential diagnosis.

    Download
  • EndTB (expand new drugs for TB) observational study: treatment of MDR-TB with regimens containing bedaquiline or delamanid.

    To describe patient outcomes and assess factors associated with unfavorable outcomes(treatment failure,lost to follow up and death

  • Factors associated with smear positivity after first line intensive phase treatment among TB patients in Kilifi County.

    To determine factors associated with smear positivity after first line  intensive phase treatment among TB patients

  • Factors associated with quality of sputum specimens and the effectiveness of customized audio visual instructions in sputum production for improved diagnosis of pulmonary tuberculosis

    To determine the factors associated wit the quality of sputum specimens and effectiveness of customized audio visual instructions in sputum production for improved TB diagnosis

  • An Open-Label, Non-Randomized Study of Pharmacokinetic Interactions among Depot Medroxyprogesterone Acetate (DMPA), Rifapentine (RIF) and Efavirenz (EFV) in women co-infected with Human Immunodeficiency Virus (HIV) and Tuberculosis (TB).

    To estimate the optimal dosing frequency of depot MPA (DMPA) for HIV abd TB co-infected women taking EFV- based combination ARV theraphy and RIF containing TB treatment based on a target MPA conc.>0.1mg/ml

  • CMV and HIV status and its impact on Hepatitis B vaccine response.

    To identify factors such as plasma HIV RNA and CD4+ T-cells count that impact HCP B vaccine durability in HIV+ children and adolescents previously vaccinated against Hepatitis B virus.

  • Effectiveness of customized audio visual instructions on mobile phones for production of improved sputum quality in diagnosis of tuberculosis.

    To determine the effectiveness of customized audio visual instructions on mobile phones for production of improved sputum quality ion diagnosis of tuberculosis

  • Mapping antifungal, antibacterial drug resistance and the quality of antimicrobial agents against fungal and bacterial pathogens from smear negative and retreatment cases in high TB prevalence Counties in Kenya

    To map out the rates of fungal and non-mycobacteriological bacterial infections and determeine drug quality in relation to antifungal and antibacterial drug resistance in TB smear negative relapse and treatment cases in selected counties in Kenya

  • Mapping antifungal, antibacterial drug resistance and the quality of antimicrobial agents against fungal and bacterial pathogens from smear negative and retreatment cases in high TB prevalence Counties in Kenya

    To map out the rates of fungal and non-mycobacteriological bacterial infections and determeine drug quality in relation to antifungal and antibacterial drug resistance in TB smear negative relapse and treatment cases in selected counties in Kenya

  • Mapping antifungal, antibacterial drug resistance and the quality of antimicrobial agents against fungal and bacterial pathogens from smear negative and retreatment cases in high TB prevalence Counties in Kenya

    To map out the rates of fungal and non-mycobacteriological bacterial infections and determeine drug quality in relation to antifungal and antibacterial drug resistance in TB smear negative relapse and treatment cases in selected counties in Kenya

  • Mapping antifungal, antibacterial drug resistance and the quality of antimicrobial agents against fungal and bacterial pathogens from smear negative and retreatment cases in high TB prevalence Counties in Kenya

    To map out the rates of fungal and non-mycobacteriological bacterial infections and determine drug quality in relation to anti fungal and antibacterial drug resistance in TB smear negative relapse and treatment cases in selected counties in Kenya

  • Diagnosis & treatment of tuberculosis in HIV co-infected patients

    Human immunodeficiency virus (HIV) associated tuberculosis (TB) remains a major global public health challenge, with an estimated 1.4 million patients worldwide. Co-infection with HIV leads to challenges in both the diagnosis and treatment of tuberculosis. Further, there has been an increase in rates of drug resistant tuberculosis, including multi-drug (MDR-TB) and extensively drug resistant TB (XDRTB), which are difficult to treat and contribute to increased mortality. Because of the poor performance of sputum smear microscopy in HIV-infected patients, newer diagnostic tests are urgently required that are not only sensitive and specific but easy to use in remote and resource-constrained settings. The treatment of co-infected patients requires antituberculosis and antiretroviral drugs to be administered concomitantly; challenges include pill burden and patient compliance, drug interactions, overlapping toxic effects, and immune reconstitution inflammatory syndrome. Also important questions about the duration and schedule of anti-TB drug regimens and timing of antiretroviral therapy remain unanswered. From a programmatic point of view, screening of all HIV-infected persons for TB and vice-versa requires good co-ordination and communication between the TB and AIDS control programmes. Linkage of co-infected patients to antiretroviral treatment centres is critical if early mortality is to be prevented. We present here an overview of existing diagnostic strategies, new tests in the pipeline and recommendations for treatment of patients with HIV-TB dual infection.

    Download
  • Innovations for improving tuberculosis case-finding, prevention and treatment among PLHIV in resource-constrained settings

    Despite the evidence that isoniazid preventative therapy (IPT) reduces overall tuberculosis incidence, it is estimated that 5% of people living with HIV (PLHIV) have been screened for TB and 0.2% have been offered IPT. To improve TB case-finding, IPT initiation, and IPT completion among PLHIV in western Kenya, the Kenya TB Tech project was initiated. The first stage of TB Tech, reported here, describes processes and outcomes associated with using human-centered design techniques to develop a highly usable TB reminder system among pilot clinics. The second stage, a randomized clinical trial, assesses the clinical impacts of this reminders system.

    Download
  • A Clinical Decision Support System for Integrating Tuberculosis and HIV Care in Kenya: A Human-Centered Design Approach

    With the aim of integrating HIV and tuberculosis care in rural Kenya, a team of researchers, clinicians, and technologists used the human-centered design approach to facilitate design, development, and deployment processes of new patient-specific TB clinical decision support system for medical providers. In Kenya, approximately 1.6 million people are living with HIV and have a 20-times higher risk of dying of tuberculosis. Although tuberculosis prevention and treatment medication is widely available, proven to save lives, and prioritized by the World Health Organization, ensuring that it reaches the most vulnerable communities remains challenging. Human-centered design, used in the fields of industrial design and information technology for decades, is an approach to improving the effectiveness and impact of innovations that has been scarcely used in the health field. Using this approach, our team followed a 3-step process, involving mixed methods assessment to (1) understand the situation through the collection and analysis of site observation sessions and key informant interviews; (2) develop a new clinical decision support system through iterative prototyping, end-user engagement, and usability testing; and, (3) implement and evaluate the system across 24 clinics in rural West Kenya. Through the application of this approach, we found that human-centered design facilitated the process of digital innovation in a complex and resource-constrained context.

    Download
  • Factors Associated with Default from Treatment among Tuberculosis Patients in Nairobi Province, Kenya

    Tuberculosis is caused mainly by Mycobacterium tuberculosis.' It affects all tissues and organs except hair teeth and nails. Over 2 billion people were estimated to be infected with the tubercle bacilli in 2005. The immune system is able to contain the bacillus. Only 10% of infections progress to clinical disease. Over 90% of global TB cases and deaths occur in the developing countries. The WHO estimates an incidence of 207,311 new cases in Kenya and 44,576 tuberculosis related deaths annually. Kenya is ranked io" among countries with high tuberculosis burden. Tuberculosis treatment requires use of combination of drugs for 6-8 months. Adherence is vital for successful cure and prevention of drug resistance and treatment failure. In the year 2005, 7.6% of patients defaulted from treatment nationally. The high default rate in the country impedes the achievement of the global target to successfully treat 85% of detected TB cases. Treatment adherence is a complex issue and improving treatment outcomes for tuberculosis requires a full understanding of the factors that prevent people from taking medicines correctly and those that help them complete their treatment. Determination of predictive factors for default was thus justified for early interventions and for policy and strategy formulation to address non-compliance of TB treatment. Default from treatment enhances risk of developing multi-drug resistant tuberculosis, lowers treatment success rates and increases cost of treatment. The objective of this study was to determine factors associated with default from tuberculosis treatment in Nairobi. A Case-Control study was used. Defaulters formed the case and the successfully treated the control group. Secondary data from conveniently sampled treatment facilities was used. Further, cases and controls were traced and interviewed using a structured questionnaire. The response variable was default outcome. Independent variables included drug side-effects, knowledge on TB, access to health care, stigmatization, HIV co-infection and demographic and socioeconomic factors among others. Data was analyzed using SPSS and Epi Info statistical software. Descriptive statistics and analyses of contingency tables to determine association were used. Chi-Square, Fishers exact tests and confidence intervals were used to establish significance. Multivariate logistic regression modeling of associated factors and Kaplan-Meier method to determine probability of staying in treatment over time were employed. Results revealed a 16.7% prevalence of treatment default in Nairobi. Default occurred most frequently during the initial three months of treatment. Among defaulters who were AFB smear positive at initiation of treatment, 47.7% defaulted before conversion was confirmed. Major reasons for default included ignorance, traveling, feeling better, side effects, opting for herbal medication, alcohol use, inadequate food, poor facility factors and stigma. Factors independently associated with default included HIV co-infection (OR 1.56, P<O.OOl), the male sex (OR 1.43, P<O.OOl), history of previous default (OR 2.33, P=0.017), herbal medication use (OR 5.7, P=0.017), low income (OR 5.57, P=0.04), inadequate knowledge on TB (OR 8.67, P=0.017) and alcohol use (OR 4.97, P=0.007). Findings from this study indicate that enhanced health education on TB, pre-treatment counseling, advocacy on treatment compliance, social support and integration of TB and HIV services should be prioritized by MOH so as to address tuberculosis treatment default.

    Download