Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author
Assessment of clinical and traditional male circumcision services in Bungoma District, Kenya: complication rates and operational needs
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- Cost effectiveness and delivery study for future HIV vaccines. Author
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- Economic growth, education, and AIDS in Kenya. Author
- Economic growth, education and AIDS in Kenya: a long-run analysis. Abstract
- Quantification of genital human immunodeficiency virus type 1 (HIV-1) DNA in specimens from women with low plasma HIV-1 RNA levels typical of HIV-1 nontransmitters. Author
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- Mombasa Antiretroviral Therapy Program: monitoring and evaluation plan for pharmaceutical and laboratory capacity building activities, February 2004. Author
- Infant feeding practices among HIV infected women receiving prevention of mother-to-child transmission services at Kitale District Hospital, Kenya. Source
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- Self-reported adherence to single dose nevirapine in the prevention of mother to child transmission of HIV at Kitale District Hospital. Source
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- Enhancing exposure of HIV-1 neutralization epitopes through mutations in gp41. Author
- Constructing a stigma and discrimination index: hopes, dreams, and lessons learned. Author
- Utility of antenatal HIV surveillance data to evaluate prevention of mother-to-child HIV transmission programs in resource-limited settings. Author
- Longitudinal comparison of chemokines in breastmilk early postpartum among HIV-1-infected and uninfected Kenyan women. Author
- Breast milk alpha-defensins are associated with HIV type 1 RNA and CC chemokines in breast milk but not vertical HIV type 1 transmission. Author
Assessment of clinical and traditional male circumcision services in Bungoma District, Kenya: complication rates and operational needs. Author: Bailey, R. C. and . = Egesah O. Source: Special report. Abstract: Over 40 observational studies and one clinical trial have found that male circumcision (MC) has a protective effect against HIV acquisition of between 40% and 88%. Most recently, Auvert et al. (2005) found in a randomized controlled trial (RCT) in Orange Farm, South Africa, that MC had a protective effect of 60% in intention to treat analysis. When the dissolution effect of cross-overs was taken into account in a per protocol analysis, the protective effect was found to be 76%. Currently, there are two additional RCTs of MC underway in sub-Saharan Africa - one in Rakai, Uganda and the other in Kisumu, Kenya. The results of these two additional trials are expected to be available in 2006-2007. If these trials find MC to be effective in reducing HIV incidence, the results, combined with the evidence from observational studies and biological investigations showing high susceptibility of human foreskin to HIV infection, are likely to compel the international health community to consider promotion of MC in countries where circumcision is little practiced and the epidemic is primarily among heterosexuals. However, lack of crucial information concerning the feasibility, safety and costs of implementing MC services is likely to impede progress toward building support for timely introduction of MC as an HIV prevention strategy. History has shown repeatedly, whether in the arena of HIV prevention or other health-related interventions, that the time from discovery to implementation of effective interventions has been tragically long due to the years necessary to collect information crucial for addressing operational issues and for building political will. (excerpt) Cost effectiveness and delivery study for future HIV vaccines. Author: Barth-Jones, D. C.; Cheng, H.; Kang, L. Y.; Kenya, P. R.; Odera, D.; Mosqueira, N. R.; Mendoza, W.; Portela, M. C.; Brito, C.; Tangcharoensathien, V.; Akaleephan, C.; Supantamart, S.; Patcharanarumol, W.; de Macedo Brigido, L. F.; Fonseca, M. G.; Sanchez, M.; Chang, M. L.; Osmanov, S.; Avrett, S.; Esparza, J., and Griffiths, U. Source: AIDS. 2005 Sep 2; 19(13):w1-6. Abstract: Research teams from five countries, Brazil, China, Kenya, Peru and Thailand, have initiated a policy-maker survey on vaccine delivery, cost studies for future HIV vaccination programmes, and associated simulation modeling exercises analysing the relative cost-effectiveness of potential HIV vaccination strategies. The survey assesses challenges and opportunities for future country-level HIV vaccination strategies, providing data on the vaccine characteristics (e.g. vaccine efficacies for susceptibility, infectiousness and disease progression) and vaccination programme strategies to be considered in the cost-effectiveness modeling analyses. The study will provide decision-makers with modeling data on vaccination policy considerations that will assist in developing country-level capacities for future HIV vaccine policy adoption and effective delivery systems, and will help delineate the long-term financial requirements for sustainable HIV vaccination programmes. The WHO-UNAIDS HIV Vaccine Initiative and the collaborating researchers welcome comments or questions from policy makers, health professionals and other stakeholders in the public and private sectors about this effort to help advance policy and capacity related to future potential HIV vaccines. Economic growth, education, and AIDS in Kenya. Author: Bell C; Bruhns R, and Gersbach, H. Source: Development Outreach. 2007 Jun; [7] p. Abstract: An AIDS epidemic threatens Kenya with a long wave of premature adult mortality, and thus with an enduring setback to the formation of human capital and economic growth. According to UNAIDS (2004), about 1.2 million Kenyans were HIV-positive (out of a population of just over 30 million) in 2003, roughly 150,000 died of the disease in that year, and some 650,000 children had been left as orphans. One independent estimate puts the cumulative number of deaths due to AIDS in Kenya from 1984 to 2000 at no less than 1.5 million. We developed a model to analyze the prospects for the formation of human capital and economic growth in Kenya, even as the AIDS epidemic threatens that country with a long wave of premature adult mortality. The model is then used to analyze the social profitability of programs to promote education and combat the epidemic. (excerpt) Economic growth, education and AIDS in Kenya: a long-run analysis. Abstract: The AIDS epidemic threatens Kenya with a long wave of premature adult mortality, and thus with an enduring setback to the formation of human capital and economic growth. To investigate this possibility, we develop a model with three overlapping generations, calibrate it to the demographic and economic series from 1950 until 1990, and then perform simulations for the period ending in 2050 under alternative assumptions about demographic developments, including the counterfactual in which there is no epidemic. Although AIDS does not bring about a catastrophic economic collapse, it does cause large economic costs - and very many deaths. Programs that subsidize post-primary education and combat the epidemic are both socially profitable - the latter strikingly so, due to its indirect effects on the expected returns to education - and a combination of the two interventions profits from a modest long-run synergy effect. (author's) Quantification of genital human immunodeficiency virus type 1 (HIV-1) DNA in specimens from women with low plasma HIV-1 RNA levels typical of HIV-1 nontransmitters. Author: Benki, S.; McClelland, R. S.; Emery, S.; Baeten, J. M.; Richardson, B. A.; Lavreys, L.; Mandaliya, K., and Overbaugh, J. Source: J Clin Microbiol. 2006 Dec; 44(12):4357-62. Abstract: Studies of human immunodeficiency virus type 1 (HIV-1) transmission suggest that genital HIV-1 RNA and DNA may both be determinants of HIV-1 infectivity. Despite its potential role in HIV-1 transmission, there are limited quantitative data on genital HIV-1 DNA. Here we validated an in-house real-time PCR method for quantification of HIV-1 DNA in genital specimens. In reactions with 100 genomes to 1 genome isolated from a cell line containing one HIV-1 provirus/cell, this real-time PCR assay is linear and agrees closely with a commercially available real-time PCR assay specific for a cellular housekeeping gene. In mock genital samples spiked with low numbers of HIV-1-infected cells such that the expected HIV-1 DNA copy number/reaction was 100, 10, or 5, the average copy number/reaction was 80.2 (standard deviation [SD], 28.3), 9.1 (SD, 5.4), or 3.1 (SD, 2.1), respectively. We used this method to examine genital HIV-1 DNA levels in specimens from women whose low plasma HIV-1 RNA levels are typical of HIV-1 nontransmitters. The median HIV-1 DNA copy number in endocervical secretions from these women (1.8 HIV-1 DNA copies/10,000 cells) was lower than that for women with higher plasma HIV-1 RNA levels (16.6 HIV-1 DNA copies/10,000 cells) (P=0.04), as was the median HIV-1 DNA copy number in vaginal secretions (undetectable versus 1.0 HIV-1 DNA copies/10,000 cells). These data suggest that women with low plasma HIV-1 RNA and thus a predicted low risk of HIV-1 transmission have low levels of genital HIV-1 cell-associated virus. The assay described here can be utilized in future efforts to examine the role of cell-associated HIV-1 in transmission. Prevalence of malnutrition in human immunodeficiency virus/acquired immunodeficiency syndrome orphans in the Nyanza province of Kenya: a comparison of conventional indexes with a composite index of anthropometric failure. Author: Berger, M. R.; Fields-Gardner, C.; Wagle, A., and Hollenbeck, C. B. Source: J Am Diet Assoc. 2008 Jun; 108(6):1014-7. Abstract: The prevalence of undernutrition in children is commonly reported using a conventional index, which identifies three conventional categories: stunting, underweight, and wasting. Recently, a composite index of anthropometric failure was developed to categorize undernutrition into seven mutually exclusive categories, including single failures (stunting, underweight, or wasting) and multiple failures (stunting and underweight, stunting and wasting, underweight and wasting, and stunting and underweight and wasting). This cross-sectional study used baseline data gathered during a feeding program targeting orphans and vulnerable children impacted by human immunodeficiency virus and/or acquired immunodeficiency syndrome (HIV/AIDS) in Kenya to compare the conventional index with the composite index of anthropometric failure. Children younger than 5 years of age who participated in the feeding trial were included in the analysis (n=170). The conventional index found that the prevalence of undernutrition included 31.2% stunted, 14.1% underweight, and 5.9% wasted children, whereas the composite index of anthropometric failure estimated a more severe overall prevalence rate (38.2%); thus, the conventional index did not uncover the complexity of malnutrition experienced. Of the 53 children classified as stunted by the conventional index, the composite index of anthropometric failure identified 36 (67.9%) as stunted and 17 (32.1%) as stunted and underweight. Thus, the composite index of anthropometric failure was able to distinguish children with multiple anthropometric failures. In total, multiple anthropometric failures were found in 22 of the 65 children with anthropometric failure. These data suggest that the complexity and prevalence of undernutrition may be underestimated using the conventional index because it does not identify children experiencing multiple anthropometric failures. The ability of the composite index of anthropometric failure to identify children with multiple anthropometric failures may have profound implications for prioritizing, designing, and targeting nutritional interventions. Mombasa Antiretroviral Therapy Program: monitoring and evaluation plan for pharmaceutical and laboratory capacity building activities, February 2004. Author: Bhattarai, H. R. and Walkowiak H. Abstract: The Mombasa ART Program proposal document, jointly proposed by a partnership of FHI/IMPACT Project, Population Council/Horizons Project and MSH/RPM Plus already contains the outline of the overarching monitoring and evaluation framework and some indicators. This document is intended to supplement the original proposal to describe in detail the monitoring and evaluation (M&E) of pharmaceutical and laboratory capacity building activities for which RPM Plus is responsible. This document outlines the M&E procedures and indicators for monitoring the pharmaceutical and laboratory capacity building activities and also the link with the envisaged unified M&E system of the program. Although this is a supplemental document, primary program goals and objectives are repeated below so that the document can serve as a stand alone reference. (excerpt) Infant feeding practices among HIV infected women receiving prevention of mother-to-child transmission services at Kitale District Hospital, Kenya. Source: East Afr Med J. 2008 Apr; 85(4):156-61. Abstract: Objectives: To determine the types and modes of infant feeding practices among the HIV infected mothers on prevention of mother-to-child transmission (PMTCT) and attending MCH-FP clinic at Kitale District Hospital, Kenya. Design: Descriptive cross-sectional study. Setting: Kitale District Hospital in Western Kenya within the maternal and child health and family planning (MCH-FP) and comprehensive care clinics. Subjects: A total of 146 respondents who had delivered 150 babies were recruited for this study. Results: Thirty five percent (52/150) of the babies were exclusively breastfed while 50% (75/150) were not breastfed at all and 14% (21/150) of the babies received mixed feeding. The length of exclusive breastfeeding ranged from 1-6 months with most (53%) women exclusively breastfeeding for two to three months. Only 13% of the women exclusively breastfed for five to six months. There was a strong relationship between mode of infant feeding and spouse's awareness of HIV status. Mothers who had disclosed their HIV status to their spouses were more likely not to breastfeed than mothers who had not disclosed their status (p < 0.05%). The choice of infant feeding method was also influenced by the socio-economic status of the mothers and nevirapine uptake. The level of education did not influence the mode of infant feeding. Conclusion: Infant feeding decisions were mainly influenced by the male partner's involvement and the socio economic status of the mother. Half of the respondents did not breastfeed at all. The duration of exclusive breastfeeding rarely reached six months. To encourage women to adhere to good infant feeding practices, involvement of their partners, family members as well as the community for support should be encouraged. Self-reported adherence to single dose nevirapine in the prevention of mother to child transmission of HIV at Kitale District Hospital. Source: East Afr Med J. 2007 Dec; 84(12):571-6. Abstract: Objectives: To evaluate the uptake and adherence to single dose nevirapine among HIV positive mothers. Design: Descriptive cross-sectional study. Setting: The maternal and child health and family planning (MCH-FP) clinics in Kitale district hospital, Western Kenya. Subjects: HIV positive postnatal women attending MCH-FP clinic who had gone through the PMTCT programme. Results: A total of 146 respondents were recruited for this study. Most (90%) of them reported swallowing their nevirapine tablets, however only 55 swallowed their tablets within 4-12 hours before delivery. The most important factor affecting nevirapine adherence was place or delivery (p<0.05). Most (71%) of mothers who did not swallow their nevirapine delivered at home. Women attending ANC for two times or less young women under 20 years of age and single women were also less likely to swallow their nevirapine (p < 0.05). Most (91%) of the babies received their nevirapine syrup with 98% of them getting it within 72 hours of delivery. Eighty eight percent of babies who did not take their nevirapine were delivered at home. Babies whose mothers did not take their nevirapine were also more likely to miss it. Conclusions: Self reported adherence to take home nevirapine is high. However mothers who deliver in a health facility were more likely to access nevirapine both for themselves and their babies than those delivering at home. Enhancing exposure of HIV-1 neutralization epitopes through mutations in gp41. Author: Blish, C. A.; Nguyen, M. A., and Overbaugh, J. Source: PLoS Med. 2008 Jan 3; 5(1):e9. Abstract: Background: The generation of broadly neutralizing antibodies is a priority in the design of vaccines against HIV-1. Unfortunately, most antibodies to HIV-1 are narrow in their specificity, and a basic understanding of how to develop antibodies with broad neutralizing activity is needed. Designing methods to target antibodies to conserved HIV-1 epitopes may allow for the generation of broadly neutralizing antibodies and aid the global fight against AIDS by providing new approaches to block HIV-1 infection. Using a naturally occurring HIV-1 Envelope (Env) variant as a template, we sought to identify features of Env that would enhance exposure of conserved HIV-1 epitopes. Methods and findings: Within a cohort study of high-risk women in Mombasa, Kenya, we previously identified a subtype A HIV-1 Env variant in one participant that was unusually sensitive to neutralization. Using site-directed mutagenesis, the unusual neutralization sensitivity of this variant was mapped to two amino acid mutations within conserved sites in the transmembrane subunit (gp41) of the HIV-1 Env protein. These two mutations, when introduced into a neutralization-resistant variant from the same participant, resulted in 3- to >360-fold enhanced neutralization by monoclonal antibodies specific for conserved regions of both gp41 and the Env surface subunit, gp120, >780-fold enhanced neutralization by soluble CD4, and >35-fold enhanced neutralization by the antibodies found within a pool of plasmas from unrelated individuals. Enhanced neutralization sensitivity was not explained by differences in Env infectivity, Env concentration, Env shedding, or apparent differences in fusion kinetics. Furthermore, introduction of these mutations into unrelated viral Env sequences, including those from both another subtype A variant and a subtype B variant, resulted in enhanced neutralization susceptibility to gp41- and gp120-specific antibodies, and to plasma antibodies. This enhanced neutralization sensitivity exceeded 1,000-fold in several cases. Conclusions: Two amino acid mutations within gp41 were identified that expose multiple discontinuous neutralization epitopes on diverse HIV-1 Env proteins. These exposed epitopes were shielded on the unmodified viral Env proteins, and several of the exposed epitopes encompass desired target regions for protective antibodies. Env proteins containing these modifications could act as a scaffold for presentation of such conserved domains, and may aid in developing methods to target antibodies to such regions. Constructing a stigma and discrimination index: hopes, dreams, and lessons learned. Author: Bollinger, L. Abstract: Without a consistent methodology to measure stigma and discrimination (S&D), it is difficult to monitor and evaluate reduction interventions. Although some indices have been developed, no standardized method has been adopted that encompasses all relevant dimensions of S&D. This activity's objectives were to design an index on HIV/AIDS-related stigma and discrimination based on existing studies of S&D indicators, prepare and test a survey, field the survey in various countries, and finally, create an index for each of the countries surveyed. The indicators were developed in conjunction with the USAID Interagency Working Group (IWG) on Stigma and Discrimination and formed part of an effort headed by the UNAIDS Secretariat and International Planned Parenthood Federation, which were designing a similar index. This index was different than other indices developed by Futures Group, which are calculated based on expert opinion obtained through surveys. For this index, much larger samples were needed, including three different population groups (community, facility/provider, persons living with HIV). Thus, instead of gathering expert opinions, existing studies that reported results for the relevant indicators were reviewed, and the index was constructed based on these results. The survey was implemented and studies were gathered in Mexico, Kenya, South Africa, and Tanzania. These countries were selected because they were most likely to have relevant studies. (excerpt) Utility of antenatal HIV surveillance data to evaluate prevention of mother-to-child HIV transmission programs in resource-limited settings. Author: Bolu, O.; Anand, A.; Swartzendruber, A.; Hladik, W.; Marum, L. H.; Sheikh, A. A.; Woldu, A.; Ismail, S.; Mahomva, A.; Greby, S., and Sabin, K. Source: Am J Obstet Gynecol. 2007 Sep; 197(3 Suppl):S17-25. Abstract: Prevention of mother-to-child human immunodeficiency virus (HIV) transmission (PMTCT) programs are expanding in resource-limited countries and are increasingly implemented in antenatal clinics (ANC) in which HIV sentinel surveillance is conducted. ANC sentinel surveillance data can be used to evaluate the first visit of a pregnant woman to PMTCT programs. We analyzed data from Kenya and Ethiopia, where information on PMTCT test acceptance was collected on the 2005 ANC sentinel surveillance forms. For Zimbabwe, we compared the 2005 ANC sentinel surveillance data to the PMTCT program data. ANC surveillance data allowed us to calculate the number of HIV-positive women not participating in the PMTCT program. The percentage of HIV-positive women missed by the PMTCT program was 17% in Kenya, 57% Ethiopia, and 59% Zimbabwe. The HIV prevalence among women participating in PMTCT differed from women who did not. ANC sentinel surveillance can be used to evaluate and improve the first encounter in PMTCT programs. Countries should collect PMTCT-related program data through ANC surveillance to strengthen the PMTCT program. Longitudinal comparison of chemokines in breastmilk early postpartum among HIV-1-infected and uninfected Kenyan women. Author: Bosire, R.; Guthrie, B. L.; Lohman-Payne, B.; Mabuka, J.; Majiwa, M.; Wariua, G.; Mbori-Ngacha, D.; Richardson, B.; John-Stewart, G., and Farquhar, C. Source: Breastfeed Med. 2007 Sep; 2(3):129-38. Abstract: Breastmilk chemokines have been associated with increased HIV-1 RNA levels in breastmilk and altered risk of mother-to-child HIV-1 transmission. To characterize CC and CXC chemokines in breastmilk postpartum, we collected breastmilk specimens at regular intervals for 6 months after delivery from women with and without HIV-1 infection and used commercial ELISA kits to measure breastmilk concentrations of MIP-1alpha, MIP-1beta, RANTES, and SDF-1alpha. Among 54 HIV-1-infected and 26 uninfected women, mean chemokine levels were compared cross-sectionally and longitudinally at days 5 and 10, and months 1 and 3 postpartum. For both HIV-1-infected and uninfected women, breastmilk chemokine levels were highest at day 5 for MIP-1alpha, MIP-1beta, and SDF-1alpha, and subsequently decreased. RANTES levels remained constant over the follow-up period among HIV-1-uninfected women, and increased moderately among HIV-1-infected women. For MIP-1beta and RANTES, breastmilk levels were significantly higher among HIV-1-infected women compared to uninfected women early postpartum. In addition, HIV-1-infected women transmitting HIV-1 to their infant had consistently higher breastmilk RANTES levels than those who did not transmit, with the greatest difference observed at 1 month (2.68 vs. 2.21 log10 pg/mL, respectively; p = 0.007). In summary, all four chemokines were most elevated within the first month postpartum, a period of high transmission risk via breastmilk. MIP-1beta and RANTES levels in breastmilk were higher among HIV-1-infected women than among uninfected women, and breastmilk RANTES was positively associated with vertical transmission in this study, consistent with results from our earlier cohort. Breast milk alpha-defensins are associated with HIV type 1 RNA and CC chemokines in breast milk but not vertical HIV type 1 transmission. Author: Bosire, R.; John-Stewart, G. C.; Mabuka, J. M.; Wariua, G.; Gichuhi, C.; Wamalwa, D.; Ruzinski, J.; Goodman, R.; Lohman, B.; Mbori-Ngacha, D. A.; Overbaugh, J., and Farquhar, C. Source: AIDS Res Hum Retroviruses. 2007 Feb; 23(2):198-203. Abstract: Alpha-defensins are proteins exhibiting in vitro anti-HIV-1 activity that may protect against mother-to-child transmission of HIV-1 via breast milk. Correlates of alpha-defensins in breast milk and transmission risk were determined in a cohort of HIV-1-infected pregnant women in Nairobi followed for 12 months postpartum with their infants. Maternal blood was collected antenatally and at delivery for HIV-1 viral load and infant HIV-1 infection status was determined < 48 h after birth and at months 1, 3, 6, 9, and 12. Breast milk specimens collected at month 1 were assayed for alpha-defensins, HIV-1 RNA, subclinical mastitis, and CC and CXC chemokines. We detected alpha-defensins in breast milk specimens from 108 (42%) of 260 HIV-1-infected women. Women with detectable alpha-defensins (> or =50 pg/ml) had a median concentration of 320 pg/ml and significantly higher mean breast milk HIV-1 RNA levels than women with undetectable alpha-defensins (2.9 log(10) copies/ml versus 2.5 log(10) copies/ml, p = 0.003). Increased alpha-defensins concentrations in breast milk were also associated with subclinical mastitis (Na (+)/K(+) ratio > 1) and increased breast milk chemokine levels. Overall, 40 (15%) infants were HIV-1 uninfected at birth and subsequently acquired HIV-1. There was no significant association between month 1 alpha-defensins and risk of HIV-1 transmission. In conclusion, alpha-defensins were associated with breast milk HIV-1 viral load, chemokine levels, and subclinical mastitis, all of which may alter risk of infant HIV-1 acquisition. Despite these associations there was no significant relationship between breast milk alpha-defensins and mother-to-child transmission, suggesting a complex interplay between breast milk HIV-1, inflammation, and antiinfective factors. Directory: sites -> default -> files files -> Answer True False 2 points Question 2 files -> Northern England’s set-jetting locations files -> Nstructions for Acquiring Excess Equipment online, through the 1033 Program files -> Occupational health and safety files -> The Black Panther Party’s Ten Point Program files -> International programs roel profile files -> Fermi Questions a guide for Teachers, Students, and Event Supervisors Lloyd Abrams, Ph. D. 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