80 results on '"Kioko J"'
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2. Is genetic fidelity maintained following the cryopreservation of the seeds of the endangered African pepper bark ( Warburgia salutaris )?
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Kioko, J., primary, Berjak, P., additional, Pammenter, N., additional, Lamb, J., additional, and Gumede, Z., additional
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- 2003
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3. GENETIC DIVERSITY IN BAMBARA GROUNDNUT (Vigna subterranean) AS REVEALED BY MOLECULAR WEIGHTS OF THE SEEDS’ PROTEINS
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Oludare, A. J., primary, Kioko, J. I., primary, Akeem, A. A., primary, Olumide, A. T., primary, Justina, K. R., primary, Adejoke, I. M., primary, Oyinade, D. A., primary, Moradeke, C. D., primary, and Aderonke, O., primary
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- 2018
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4. Notes from the Field: Ongoing Cholera Outbreak - Kenya, 2014-2016
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Kathryn G. Curran, Daniel Macharia, Kigen H, Kioko J, Catherine K, Muraguri N, George G, Waweru B, Rupa Narra, Githuku J, Joel M. Montgomery, Zeinab Gura, John Neatherlin, Samuel J. Crowe, Njeru I, Rotich J, Sara A. Lowther, Tura Galgalo, Mark Obonyo, Waqo Boru, O'Reilly Ce, De Cock Km, and Langat D
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Serotype ,Adult ,Diarrhea ,Male ,Pediatrics ,medicine.medical_specialty ,Health (social science) ,Isolation (health care) ,Epidemiology ,Health, Toxicology and Mutagenesis ,030231 tropical medicine ,Vital signs ,Cholera outbreak ,Severe dehydration ,Vibrio cholerae O139 ,Disease Outbreaks ,03 medical and health sciences ,0302 clinical medicine ,Health Information Management ,Cholera ,Environmental health ,medicine ,Humans ,030212 general & internal medicine ,business.industry ,Vibrio cholerae O1 ,Outbreak ,General Medicine ,medicine.disease ,Kenya ,medicine.symptom ,business - Abstract
On January 6, 2015, a man aged 40 years was admitted to Kenyatta National Hospital in Nairobi, Kenya, with acute watery diarrhea. The patient was found to be infected with toxigenic Vibrio cholerae serogroup O1, serotype Inaba. A subsequent review of surveillance reports identified four patients in Nairobi County during the preceding month who met either of the Kenya Ministry of Health suspected cholera case definitions: 1) severe dehydration or death from acute watery diarrhea (more than four episodes in 12 hours) in a patient aged ≥5 years, or 2) acute watery diarrhea in a patient aged ≥2 years in an area where there was an outbreak of cholera. An outbreak investigation was immediately initiated. A confirmed cholera case was defined as isolation of V. cholerae O1 or O139 from the stool of a patient with suspected cholera or a suspected cholera case that was epidemiologically linked to a confirmed case. By January 15, 2016, a total of 11,033 suspected or confirmed cases had been reported from 22 of Kenya's 47 counties (Table). The outbreak is ongoing.
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- 2016
5. Effects of Antenatal Care and HIV Treatment Integration on Elements of the PMTCT Cascade: Results from the SHAIP Cluster-Randomized Controlled Trial in Kenya
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Turan, JM, Turan, JM, Onono, M, Steinfeld, RL, Shade, SB, Owuor, K, Washington, S, Bukusi, EA, Ackers, ML, Kioko, J, Interis, EC, Cohen, CR, Turan, JM, Turan, JM, Onono, M, Steinfeld, RL, Shade, SB, Owuor, K, Washington, S, Bukusi, EA, Ackers, ML, Kioko, J, Interis, EC, and Cohen, CR
- Abstract
Background: Integrating antenatal care (ANC) and HIV care may improve uptake and retention in services along the prevention of mother-to-child transmission (PMTCT) cascade. This study aimed to determine whether integration of HIV services into ANC settings improves PMTCT service utilization outcomes. Methods: ANC clinics in rural Kenya were randomized to integrated (6 clinics, 569 women) or nonintegrated (6 clinics, 603 women) services. Intervention clinics provided all HIV services, including highly active antiretroviral therapy (HAART), whereas control clinics provided PMTCT services but referred women to HIV care clinics within the same facility. PMTCT utilization outcomes among HIV-infected women (maternal HIV care enrollment, HAART initiation, and 3-month infant HIV testing uptake) were compared using generalized estimating equations and Cox regression. Results: HIV care enrollment was higher in intervention compared with control clinics [69% versus 36%; odds ratio 3.94, 95% confidence interval (CI): 1.14 to 13.63]. Median time to enrollment was significantly shorter among intervention arm women (0 versus 8 days, hazard ratio 2.20, 95% CI: 1.62 to 3.01). Eligible women in the intervention arm were more likely to initiate HAART (40% versus 17%; odds ratio 3.22, 95% CI: 1.81 to 5.72). Infant testing was more common in the intervention arm (25% versus 18%), however, not statistically different. No significant differences were detected in postnatal service uptake or maternal retention. Conclusions: Service integration increased maternal HIV care enrollment and HAART uptake. However, PMTCT utilization outcomes were still suboptimal, and postnatal service utilization remained poor in both study arms. Further improvements in the PMTCT cascade will require additional research and interventions.
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- 2015
6. Assessing the effect of decentralisation of laboratory diagnosis for drug-resistant tuberculosis in Kenya
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Sharma, A., primary, Musau, S., additional, Heilig, C. M., additional, Okumu, A. O., additional, Opiyo, E. O., additional, Basiye, F. L., additional, Miruka, F. O., additional, Kioko, J. K., additional, Sitienei, J. K., additional, and Cain, K. P., additional
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- 2015
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7. Notes on birds of Seronera area, Serengeti National Park, Tanzania
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Glass, A, Prestridge, C, Gharat, Y, Ndibalema, V, and Kioko, J
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The Serengeti Ecosystem is a natural heaven for research and tourism. Such activities have often focused on large mammal species, with minimal regard for birds, even though the park is an Important Bird Area. This study explored bird abundance in the Seronera area of Serengeti National Park, one of the most visited sections of the park. Understanding the variety and abundance of birds in the Seronera area is useful for enhancing tourism. Bird point counts were undertaken in riverine, wooded bushland, and grassland habitats. A total of 99 bird species were observed within a three day visit to the park, with most individuals (38.9%) being Gramnivores. The density of birds was dependent on the habitat type; with the riverine having the greatest density, mostly of the order Galliformes. These findings could be integrated into the tourism planning and marketing for the park so as to diversify tourism activities. Several sections of the Seronera area within the riverine and wooded bushland areas could be designated as birding areas, where guided walks could be undertaken and other activities such as game drives are limited.
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- 2013
8. Introduction and transmission of 2009 pandemic Influenza A (H1N1) Virus--Kenya, June-July 2009
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Tabu, C., Sharif, S., Okoth, P., Kioko, J., Nzioka, C., Muthoka, P., Ope, M., Makama, S., Kalani, R., Ochieng, W., Simwa, J., Schnabel, D., Bulimo, W., Achilla, R., Onsongo, J., Njenga, K., Breiman, R., Kearney, A., Sick, A., Harris, R., Lebo, E., Munyua, P., Wakhule, L., Waiboci-Muhia, L., Gikundi, S., Gikunju, S., Omballa, V., Nderitu, L., Mayieka, L., Kabura, W., Omulo, S., Odhiambo, D., Wachira, C., Kikwai, G., Feikin, D., and Katz, M.
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Epidemics -- Health aspects ,Influenza viruses -- Health aspects ,Influenza -- Health aspects ,Public health -- Health aspects ,Health ,World Health Organization - Abstract
In April 2009, in the United States, the first cases of 2009 pandemic influenza A (H1N1) virus infection were reported (1). On June 11, the World Health Organization (WHO) declared [...]
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- 2009
9. Observations on in vitro behaviour of the zygotic axes of fluted pumpkin
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S. Adesola Ajayi, Berjak, P., Kioko, J. I., Dulloo, M. E., and Vodouhe, R. S.
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Fluted pumpkin, embryonic axes, greening, microbial contamination - Abstract
Fluted pumpkin, Telfairia occidentalis Hook. f., is an important leaf and seed vegetable and a local medicinal plant across West Africa. Many biological constraints have become potent threats to the existence of the plant necessitating an urgent need to collect and conserve the existing narrow genetic diversity. However, conservation by seed storage is impossible because the seed is recalcitrant, that is desiccation- and chilling-sensitive. Micropropagation is the only immediate alternative option for the conservation of fluted pumpkin germplasm. In order to facilitate this, the behaviour of excised embryonic axes and shoot tips of fluted pumpkin under in vitro conditions were investigated. Systemic infection of seeds from field led to frequent and high microbial contamination in culture. There was interaction between the type of microbial contamination and the storage environment of seeds prior to excision of the axes. Axes greened under low light intensity and root growth was dependent on the orientation of the axes. In general, zygotic axes of the plant are easy to grow in vitro under a range of nutrient media and culture conditions
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- 2009
10. Conservation of genetic resources naturally occurring as recalcitrant seeds.
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Berjak, P., primary, Mycock, D. J., additional, Walker, M., additional, Kioko, J. I., additional, Pammenter, N. W., additional, and Wesley-Smith, J., additional
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11. Interspecific variation in large mammal responses to human observers along a conservation gradient with variable hunting pressure
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Kiffner, C., primary, Kioko, J., additional, Kissui, B., additional, Painter, C., additional, Serota, M., additional, White, C., additional, and Yager, P., additional
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- 2014
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12. The effect of long-term mowing and ungulate exclusion on grass species composition and soil nutrient status on the Athi-Kapiti plains, central Kenya
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Berliner, D., primary and Kioko, J., additional
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- 1999
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13. Effects of differential drying rates on viability retention of recalcitrant seeds of Ekebergia capensis
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Pammenter, N. W., primary, Greggains, Valerie, additional, Kioko, J. I., additional, Wesley-Smith, J., additional, Berjak, Patricia, additional, and Finch-Savage, W. E., additional
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- 1998
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14. In utero exposure to helminth and mycobacterial antigens generates cytokine responses similar to that observed in adults.
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Malhotra, I, primary, Ouma, J, additional, Wamachi, A, additional, Kioko, J, additional, Mungai, P, additional, Omollo, A, additional, Elson, L, additional, Koech, D, additional, Kazura, J W, additional, and King, C L, additional
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- 1997
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15. Responses to dehydration and conservation of the non-orthodox seeds of Warburgia salutaris.
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Kioko, J. I., Berjak, P., and Pammenter, N. W.
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SEEDS , *SEED dispersal , *GERMINATION , *PLANTS , *PLANT embryology - Abstract
Seeds from naturally-ripened fruits of Warbutgia salutaris, for which viability retention on slow air-drying has not been achieved, survived relatively rapid dehydration in silica gel to water contents at which they could be cryopreserved by immersion in liquid nitrogen, Subcellular events during natural seed maturation were attenuated when premature fruits were harvested and stored, perhaps explaining improved responses to desiccation and cryopreservation presently reported for mature seeds. However, the desiccated mature seeds did not survive for more than a few weeks when stored at 16°C or 25°C, and lost viability far more rapidly at 6 ± 2°C, revealing their chilling-sensitivity. Seedlings were readily established from seeds retrieved from cryostorage and germinated in bottom-heated sand-beds at 25°C [ABSTRACT FROM AUTHOR]
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- 2003
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16. Cattle Egret Bubulcus ibis interactions with large mammals in the Tarangire-Manyara Ecosystem, Northern Tanzania
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Kioko, J., Boyd, E., Schaeffer, E., Tareen, S., and Christian Kiffner
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While Cattle Egrets Bubulcus ibis are globally widespread, their ecology is not fully understood. Surveys of the species were undertaken in November 2012, and April 2013, in Lake Manyara National Park, Manyara Ranch, and outside the two protected areas. We investigated the effects of host identity, habitat type and host animal behaviour on Cattle Egret numbers and distribution. Cattle Egrets associated more with grazers than with mixed-feeders or browsers, and chose large-bodied animals over small-bodied ones. They preferred wetland and grassland, over bushland. These findings underscore the importance of wetland management and the maintenance of healthy grasslands for the future of Cattle Egrets. Declines in large-bodied mammal species are likely to negatively affect them.
17. Introduction and transmission of 2009 pandemic influenza A (H1N1) virus - Kenya, June-July 2009
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Tabu, C., Sharif, C., Okoth, P., Kioko, J., Nzioka, C., Muthoka, P., Ope, M., Makama, S., Kalani, R., Ochieng, W., Simwa, J., Schnabel, D., Bulimo, W., Achilla, R., Onsongo, J., Njenga, K., Breiman, R., Kearney, A., Anna Sick-Samuels, Harris, R., Lebo, E., Munyua, P., Wakhule, L., Waiboci-Muhia, L., Gikundi, S., Gikunju, S., Omballa, V., Nderitu, L., Mayieka, L., Kabura, W., Omulo, S., Odhiambo, D., Wachira, C., Kikwai, G., Feikin, D., and Katz, M.
18. Student levels of engagement in learning: A case study of Cape Peninsula University of Technology (CPUT)
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Eunice Ivala and Kioko, J.
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Student engagement, engagement construct, an engaged university, South African Survey of Student Engagement - Abstract
South Africa is currently faced with the challenge of undesirably low throughput rates in higher education. The need to keep students interested and motivated to succeed are key objectives of many lecturers and institutions. Empirical studies have shown that one of the factors influencing student success at university is student engagement. This paper presents lecturers’ and students’ perspectives on levels of student engagement in four (Engineering, Business, Applied Sciences, and Informatics and Design) of the six faculties at CPUT as well as factors that contribute to and constrain these levels of engagement in learning. Finally, the paper offers some practical strategies for promoting student engagement and success in learning.Keywords: Student engagement, engagement construct, an engaged university, South African Survey of Student Engagement
19. Programmatic mapping and estimating the population size of female sex workers, men who have sex with men, people who inject drugs and transgender populations in Kenya.
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Musimbi J, Musyoki H, Mugambi M, Kaosa S, Kioko J, Aluko D, Wanjiru W, Wambua S, Prakash R, Isac S, Bhattacharjee P, and Emmanuel F
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- Humans, Kenya epidemiology, Male, Female, Prospective Studies, Adult, Population Density, Sex Workers statistics & numerical data, Transgender Persons statistics & numerical data, Substance Abuse, Intravenous epidemiology, HIV Infections epidemiology, HIV Infections prevention & control, Homosexuality, Male statistics & numerical data
- Abstract
Introduction: Effective coverage of Human Immunodeficiency Virus prevention services for Key Populations (KPs) including female sex workers (FSWs), men who have sex with men (MSM), people who inject drugs (PWID) and transgender (TG) people necessitates periodic validation of physical venues and size estimates. Kenya conducted a robust size estimation of KPs in 2012 and a repeat mapping and size estimation exercise was conducted in 2018 to update KP Size Estimates and sub-typologies within each County for calculation of realistic program indicators., Methods: A prospective mixed methods programmatic mapping approach adopted comprised two steps. The first step involved consolidating and documenting all known venues where KPs congregate while the second step included visiting and validating these venues confirming their active status. Data were collected in 34 out of 47 Counties in Kenya between January and March 2018. Data collected included estimated number of KPs (range), venue typology and timing of operation of each venue., Results: We estimated a total number of 167,940 (129,271 to 206,609) FSWs; 32,580 (24,704 to 40,455) MSM; 16,063 (12,426 to 19,691) PWIDs and 4,305 (2,826 to 5,783) transgender people congregating at 10,250, 1,729, 401 and 1,218 venues respectively. Majority of the venues for FSW (81%), MSM (64%) and transgender people (67%) were bars with and without lodging, PWIDs were mostly found on streets and injecting dens (70%). Around 9% of FSW and MSM and11% of PWIDs were below the age of 18 years., Conclusion: This study provided information on young KPs, female PWIDs, MSWs and for the first time, TG people in Kenya. The exercise updated size estimates of KPs by typology and provided new evidence for resource allocation, planning of interventions and targets. Programmatic mapping continues to be a useful approach supporting programs to achieve high levels of coverage and prioritize resources., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Musimbi J et al.)
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- 2024
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20. The contribution of community-based conservation models to conserving large herbivore populations.
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Kiffner C, Foley CAH, Lee DE, Bond ML, Kioko J, Kissui BM, Lobora AL, Foley LS, and Nelson F
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- Animals, Tanzania, Elephants physiology, Population Dynamics, Population Density, Giraffes physiology, Equidae physiology, Conservation of Natural Resources methods, Herbivory, Ecosystem
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In East Africa, community-based conservation models (CBCMs) have been established to support the conservation of wildlife in fragmented landscapes like the Tarangire Ecosystem, Tanzania. To assess how different management approaches maintained large herbivore populations, we conducted line distance surveys and estimated seasonal densities of elephant, giraffe, zebra, and wildebeest in six management units, including three CBCMs, two national parks (positive controls), and one area with little conservation interventions (negative control). Using a Monte-Carlo approach to propagate uncertainties from the density estimates and trend analysis, we analyzed the resulting time series (2011-2019). Densities of the target species were consistently low in the site with little conservation interventions. In contrast, densities of zebra and wildebeest in CBCMs were similar to national parks, providing evidence that CBCMs contributed to the stabilization of these migratory populations in the central part of the ecosystem. CBCMs also supported giraffe and elephant densities similar to those found in national parks. In contrast, the functional connectivity of Lake Manyara National Park has not been augmented by CBCMs. Our analysis suggests that CBCMs can effectively conserve large herbivores, and that maintaining connectivity through CBCMs should be prioritized., (© 2024. The Author(s).)
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- 2024
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21. Describing the effect of COVID-19 on sexual and healthcare-seeking behaviours of men who have sex with men in three counties in Kenya: a cross-sectional study.
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Shaw SY, Biegun JCS, Leung S, Isac S, Musyoki HK, Mugambi M, Kioko J, Musimbi J, Olango K, Kuria S, Ongaro MK, Walimbwa J, Emmanuel F, Blanchard J, Pickles M, Mishra S, Becker ML, Lazarus L, Lorway R, and Bhattacharjee P
- Abstract
Background: While the COVID-19 pandemic disrupted HIV preventative services in sub-Saharan Africa, little is known about the specific impacts the pandemic has had on men who have sex with men (MSM) in Kenya., Methods: Data were from an HIV self-testing intervention implemented in Kisumu, Mombasa and Kiambu counties in Kenya. Baseline data collection took place from May to July 2019, and endline in August-October 2020, coinciding with the lifting of some COVID-19 mitigation measures. Using endline data, this study characterised the impact the pandemic had on participants' risk behaviours, experience of violence and behaviours related to HIV. Logistic regression was used to understand factors related to changes in risk behaviours and experiences of violence; adjusted AORs (AORs) and 95% CIs are reported., Results: Median age was 24 years (IQR: 21-27). Most respondents (93.9%) reported no change or a decrease in the number of sexual partners (median number of male sexual partners: 2, IQR: 2-4). Some participants reported an increase in alcohol (10%) and drug (16%) consumption, while 40% and 28% reported decreases in alcohol and drug consumption, respectively. Approximately 3% and 10% reported an increase in violence from intimate partners and police/authorities, respectively. Compared with those with primary education, those with post-secondary education were 60% less likely to report an increase in the number of male sexual partners per week (AOR: 0.4, 95% CI: 0.2 to 0.9), while those who were HIV positive were at twofold the odds of reporting an increase or sustained levels of violence from intimate partners (AOR: 2.0, 95% CI: 1.1 to 4.0)., Conclusion: The results of this study demonstrate heterogeneity in participants' access to preventative HIV and clinical care services in Kenya after the onset of the COVID-19 epidemic. These results indicate the importance of responding to specific needs of MSM and adapting programmes during times of crisis., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)
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- 2024
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22. A sub-national HIV epidemic appraisal in Kenya: a new approach for identifying priority geographies, populations and programmes for optimizing coverage for HIV prevention.
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Banadakoppa Manjappa R, Bhattacharjee P, Shaw SY, Gitonga J, Kioko J, Songok F, Emmanuel F, Arimi P, Musyoki H, Masha RL, and Blanchard J
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- Humans, Kenya epidemiology, Male, Prevalence, Female, Adolescent, Incidence, Epidemics prevention & control, Adult, Young Adult, HIV Infections epidemiology, HIV Infections prevention & control, HIV Infections transmission
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Introduction: The HIV Prevention 2025 Roadmap, developed by UNAIDS, recommends the adoption of a precision prevention approach focused on priority populations and geographies. With reduction in new HIV acquisitions in many countries, designing a differentiated HIV prevention response, using a Programme Science approach, based on the understanding of the epidemic and transmission dynamics at a sub-national level, is critical., Methods: To support strategic planning, an epidemic appraisal at the sub-national level across 47 counties, with the 2019 population ranging from 0.14 million in Lamu to 4.40 million in Nairobi City, was conducted in Kenya using several existing data sources. Using 2021 Spectrum/EPP/Naomi model estimates of national and sub-national HIV incidence and prevalence, counties with high HIV incidence and prevalence were identified for geographic prioritization. The size of local key population (KP) networks and HIV prevalence in key and general populations were used to define epidemic typology and prioritize populations for HIV prevention programmes. Analysis of routine programme monitoring data for 2021 was used to assess coverage gaps in HIV prevention programmes, including prevention of vertical transmission, anti-retroviral therapy, KP programmes, adolescent girls and young women programme, and voluntary male medical circumcision programme., Results: Ten counties with more than 1000 incident acquisitions in 2021 accounted for 57% of new acquisitions. Twenty-four counties were grouped into the concentrated epidemic type-due to their low prevalence in the general population, high prevalence in KPs and relatively higher density of female sex workers and men who have sex with men populations. Four counties reflected a generalized epidemic, where HIV prevalence was more than 10% and 30%, respectively, among the general and key populations. The remaining 19 counties were classified as having mixed epidemics. Gaps in programmes were identified and counties where these gaps need to be addressed were also prioritized., Conclusions: The HIV burden in Kenya is unevenly distributed and hence the mix of prevention strategies may vary according to the epidemic typology of the county. Prioritization of programmes based not only on disease burden and epidemic typology, but also on the prevailing gaps in coverage for reducing inequities is a key aspect of this appraisal., (© 2024 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of International AIDS Society.)
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- 2024
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23. Expanding options for HIV testing: A process evaluation of a community-led HIV self-testing intervention among men who have sex with men in Kenya.
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Melon M, Kombo B, Mugambi M, Njiraini M, Olango K, Migot M, Kuria S, Kyana M, Mwakazi P, Kioko J, Kaosa S, Mensah M, Thomann M, Musimbi J, Musyoki H, Bhattacharjee P, Lorway R, and Lazarus L
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- Humans, Male, Kenya epidemiology, Adult, Young Adult, Mass Screening methods, COVID-19 epidemiology, COVID-19 prevention & control, Patient Acceptance of Health Care statistics & numerical data, Middle Aged, Self-Testing, Homosexuality, Male, HIV Infections diagnosis, HIV Infections epidemiology, HIV Infections prevention & control, HIV Testing methods
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Background: Men who have sex with men (MSM) in Kenya continue to face barriers to HIV testing, which leads to delays in HIV prevention and care. An HIV self-testing (HIVST) intervention was implemented in three Kenyan counties to increase coverage and frequency of HIV testing among MSM communities with high HIV prevalence. The evaluation study examined how HIVST can increase testing among MSM who are unaware of their status by increasing coverage, frequency, and early uptake of testing and support linkages to prevention and treatment. We share results from the process evaluation of the intervention implemented in partnership with MSM-led organizations., Methods: For a 12-month period between August 2019 and July 2020, the project team conducted in-depth interviews with HIVST users, monthly meetings with programme implementation teams, and monthly monitoring data reviews. Polling booth surveys were also conducted with participants. The process evaluation explored the fidelity, feasibility, coverage, acceptability, quality, and effectiveness of the HIVST intervention., Results: An average of 793 MSM received 1,041 HIVST kits on a monthly basis through different distribution channels. Of those who received HIVST kits, 67% were distributed to infrequent testers and non-testers. Testing frequency among users increased to 82% for those who had a recent test during the previous three months, compared to 58% of HIVST non-users. There was a high linkage to care and treatment services (84%) among those who tested reactive for HIV at endline. MSM shared preferring HIVST kits because of its convenience and privacy. During the COVID-19 pandemic, adaptations to the intervention were made to support ongoing HIV testing and linkages to services., Conclusion: The introduction of HIVST in MSM-led HIV prevention programmes was feasible with high acceptability. The involvement of the MSM community in the design, implementation and evaluation of the intervention was a key factor to intervention success., Competing Interests: No competing interests were disclosed., (Copyright: © 2024 Melon M et al.)
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- 2024
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24. Assessing awareness and use of HIV self-testing kits after the introduction of a community-based HIV self-testing programme among men who have sex with men in Kenya.
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Shaw SY, Leung S, Isac S, Musyoki H, Mugambi M, Kioko J, Musimbi J, Olango K, Kuria S, Ongaro MK, Walimbwa J, Melon M, Emmanuel F, Moses S, Blanchard JF, Pickles M, Lazarus L, Lorway RR, Becker ML, Mishra S, and Bhattacharjee P
- Abstract
Men who have sex with men (MSM) bear a disproportionate burden of new HIV infections in Kenya, while experiencing discrimination, leading to suboptimal levels of HIV care. HIV self-testing (HIVST) is a tool to increase HIV screening and earlier diagnosis; however, questions remain regarding how best to scale-up HIVST to MSM in Kenya. The main objective of this study was to examine changes in knowledge and use of HIVST after implementation of a community-led HIVST project. Participants were MSM recruited from Kisumu, Mombasa, and Kiambu counties. Data were collected from two rounds (Round 1: 2019; Round 2: 2020) of serial cross-sectional integrated biological and behavioural assessments (IBBA), pre-, and post-project implementation. Two main outcomes were measured: 1) whether the respondent had ever heard of HIVST; and 2) whether they had ever used HIVST kits. Changes in outcomes between IBBA rounds were examined using modified multivariable Poisson regression models; adjusted prevalence ratios (aPR) and 95% confidence intervals (95% CI) are reported. A total of 2,328 respondents were included in main analyses. The proportion of respondents who had heard of HIVST increased from 75% in Round 1 to 94% in Round 2 (aPR: 1.2, 95% CI: 1.2-1.3), while those reporting using an HIVST kit increased from 20% to 53% (aPR: 2.3, 95% CI: 2.0-2.6). Higher levels of education and HIV programme awareness were associated with both outcomes. Awareness and use of HIVST kits increased after implementation of a community-led HIVST implementation project, demonstrating the importance of integration with existing community groups., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Shaw et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)
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- 2023
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25. HIV acquisition prior to entry into formal sex work: inference from next-generation viral sequencing.
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Neufeld B, Cholette F, Sandstrom P, Musyoki H, Ma H, Kaosa S, Kioko J, Isac S, Bhattacharjee P, Cheuk E, Pickles M, Mwatelah R, Capiña R, Daniuk C, Mckinnon LR, Blanchard J, Mishra S, and Becker M
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- Adolescent, Humans, Female, Sex Work, Cross-Sectional Studies, Kenya epidemiology, Sexual Behavior, High-Throughput Nucleotide Sequencing, HIV Infections prevention & control, Sex Workers
- Abstract
Objective: To infer the timing of HIV acquisition in relation to self-reported events in the sexual life course of adolescent girls and young women (AGYW) who self-identify as female sex workers (FSW) in Mombasa, Kenya., Design: Next-generation viral sequencing of samples of AGYW living with HIV in the Transitions study, a cross-sectional bio-behavioural survey of AGYW aged 14-24 years in Mombasa, Kenya., Method: Dried blood spot specimens were collected from study participants ( n = 37, all FSW). A portion of the HIV pol gene was sequenced using an in-house next-generation sequencing assay for HIV drug resistance mutation genotyping. Estimated time since infection (ETI) was inferred using the HIV EVO web-based tool ( https://hiv.biozentrum.unibas.ch/ETI/ ), and data on self-reported events were obtained from the survey., Results: The median ETI among FSW was 3.4 (interquartile range = 1.7, 6.3) years, with a median ETI of 1.5 years prior to entry into formal sex work. We estimated that 74.1% (95% confidence interval = 53.7-88.9%) of participants living with HIV and who self-identified as FSW likely acquired HIV prior to self-identification as a sex worker., Conclusions: Findings suggest a large fraction of prevalent HIV infection among AGYW engaged in sex work stems from acquisition prior to entry into formal sex work. Current HIV prevention programs tailored for sex workers may miss key opportunities for HIV prevention as they are designed to reach women after entry into formal sex work, signaling a need for tailored programs to reach high-risk AGYW earlier on in their sexual life course., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)
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- 2023
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26. Population dynamics of the Manyara monkey ( Cercopithecus mitis manyaraensis ) and vervet monkey ( Chlorocebus pygerythrus ) in Lake Manyara National Park, Tanzania.
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Kiffner C, Kioko J, Butynski TM, de Jong YA, and Zinner D
- Abstract
Estimating population densities and their trends over time is essential for understanding primate ecology and for guiding conservation efforts. From 2011 through to 2019, we counted two guenon species during seasonal road transect surveys in Lake Manyara National Park: the Tanzania-endemic Manyara monkey Cercopithecus mitis manyaraensis (International Union for Conservation of Nature and Natural Resources, IUCN, Red List category of "endangered") and the vervet monkey Chlorocebus pygerythrus (Red List category of "least concern"). To account for imperfect detectability, we analysed the data in a line distance sampling framework, fitted species-specific detection functions, and subsequently estimated seasonal densities. To test for seasonal differences and yearly trends in the species-specific density estimates, we fitted generalized additive models. Seasonal point density estimates fluctuated considerably during the 9 years (2011-2019) of our study, ranging from 3 to 29 individuals km - 2 for Manyara monkeys and from 19 to 83 individuals km - 2 for vervet monkeys. Densities of both taxa did not differ seasonally, and we did not detect marked directional population trends. Our study illustrates the utility and limitations of line distance sampling for long-term primate monitoring. Beyond informing primate ecology and management, our results highlight the conservation importance of Lake Manyara National Park for primate conservation., Competing Interests: At least one of the (co-)authors is a member of the editorial board of . The peer-review process was guided by an independent editor, and the authors also have no other competing interests to declare., (Copyright: © 2022 Christian Kiffner et al.)
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- 2022
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27. HIV prevention programme with young women who sell sex in Mombasa, Kenya: learnings for scale-up.
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Bhattacharjee P, Musau A, Manguro G, Ongwen P, Mutegi J, Kioko J, Lazarus L, Isac S, Musyoki H, Hontelez J, and Were D
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- Female, Humans, Kenya, Sexual Behavior, Acquired Immunodeficiency Syndrome, HIV Infections, Pre-Exposure Prophylaxis
- Abstract
Introduction: In 2018, the National AIDS and sexually transmitted infection (STI) Control Programme developed a national guidelines to facilitate the inclusion of young women who sell sex (YWSS) in the HIV prevention response in Kenya. Following that, a 1-year pilot intervention, where a package of structural, behavioural and biomedical services was provided to 1376 cisgender YWSS to address their HIV-related risk and vulnerability, was implemented., Methods: Through a mixed-methods, pre/post study design, we assessed the effectiveness of the pilot, and elucidated implementation lessons learnt. The three data sources used included: (1) monthly routine programme monitoring data collected between October 2019 and September 2020 to assess the reach and coverage; (2) two polling booth surveys, conducted before and after implementation, to determine the effectiveness; and (3) focus group discussions and key informant interviews conducted before and after intervention to assess the feasibility of the intervention. Descriptive analysis was performed to produce proportions and comparative statistics., Results: During the intervention, 1376 YWSS were registered in the programme, 28% were below 19 years of age and 88% of the registered YWSS were active in the last month of intervention. In the survey, respondents reported increases in HIV-related knowledge (61.7% vs. 90%, p <0.001), ever usage of pre-exposure prophylaxis (8.5% vs. 32.2%, p < 0.001); current usage of pre-exposure prophylaxis (5.3% vs. 21.1%, p<0.002); ever testing for HIV (87.2% vs. 95.6%, p <0.04) and any clinic visit (35.1 vs. 61.1, p <0.001). However, increase in harassment by family (11.7% vs. 23.3%, p<0.04) and discrimination at educational institutions (5.3% vs. 14.4%, p<0.04) was also reported. In qualitative assessment, respondents reported early signs of success, and identified missed opportunities and made recommendations for scale-up., Conclusions: Our intervention successfully rolled out HIV prevention services for YWSS in Mombasa, Kenya, and demonstrated that programming for YWSS is feasible and can effectively be done through YWSS peer-led combination prevention approaches. However, while reported uptake of treatment and prevention services increased, there was also an increase in reported harassment and discrimination requiring further attention. Lessons learnt from the pilot intervention can inform replication and scale-up of such interventions in Kenya., (© 2022 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
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- 2022
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28. The development of task sharing policy and guidelines in Kenya.
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Kinuthia R, Verani A, Gross J, Kiriinya R, Hepburn K, Kioko J, Langat A, Katana A, Waudo A, and Rogers M
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- Child, Health Policy, Health Resources, Humans, Kenya, Health Workforce, Universal Health Insurance
- Abstract
Background: The global critical shortage of health workers prevents expansion of healthcare services and universal health coverage. Like most countries in sub-Saharan Africa, Kenya's healthcare workforce density of 13.8 health workers per 10,000 population falls below the World Health Organization (WHO) recommendation of at least 44.5 doctors, nurses, and midwives per 10,000 population. In response to the health worker shortage, the WHO recommends task sharing, a strategy that can increase access to quality health services. To improve the utilization of human and financial health resources in Kenya for HIV and other essential health services, the Kenya Ministry of Health (MOH) in collaboration with various institutions developed national task sharing policy and guidelines (TSP). To advance task sharing, this article describes the process of developing, adopting, and implementing the Kenya TSP., Case Presentation: The development and approval of Kenya's TSP occurred from February 2015 to May 2017. The U.S. Centers for Disease Control and Prevention (CDC) allocated funding to Emory University through the United States President's Emergency Plan for AIDS Relief (PEPFAR) Advancing Children's Treatment initiative. After obtaining support from leadership in Kenya's MOH and health professional institutions, the TSP team conducted a desk review of policies, guidelines, scopes of practice, task analyses, grey literature, and peer-reviewed research. Subsequently, a Policy Advisory Committee was established to guide the process and worked collaboratively to form technical working groups that arrived at consensus and drafted the policy. The collaborative, multidisciplinary process led to the identification of gaps in service delivery resulting from health workforce shortages. This facilitated the development of the Kenya TSP, which provides a general orientation of task sharing in Kenya. The guidelines list priority tasks for sharing by various cadres as informed by evidence, such as HIV testing and counseling tasks. The TSP documents were disseminated to all county healthcare facilities in Kenya, yet implementation was stopped by order of the judiciary in 2019 after a legal challenge from an association of medical laboratorians., Conclusions: Task sharing may increase access to healthcare services in resource-limited settings. To advance task sharing, TSP and clinical practice could be harmonized, and necessary adjustments made to other policies that regulate practice (e.g., scopes of practice). Revisions to pre-service training curricula could be conducted to ensure health professionals have the requisite competencies to perform shared tasks. Monitoring and evaluation can help ensure that task sharing is implemented appropriately to ensure quality outcomes., (© 2022. The Author(s).)
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- 2022
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29. Predicting wildlife corridors for multiple species in an East African ungulate community.
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Riggio J, Foreman K, Freedman E, Gottlieb B, Hendler D, Radomille D, Rodriguez R, Yamashita T, Kioko J, and Kiffner C
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- Animals, Animals, Wild, Conservation of Natural Resources methods, Ecosystem
- Abstract
Wildlife corridors are typically designed for single species, yet holistic conservation approaches require corridors suitable for multiple species. Modelling habitat linkages for wildlife is based on several modelling steps (each involving multiple choices), and in the case of multi-species corridors, an approach to optimize single species corridors to few or a single functional corridor for multiple species. To model robust corridors for multiple species and simultaneously evaluate the impact of methodological choices, we develop a multi-method approach to delineate corridors that effectively capture movement of multiple wildlife species, while limiting the area required. Using wildlife presence data collected along ground-based line transects between Lake Manyara and Tarangire National Parks, Tanzania, we assessed species-habitat association in both ensemble and stacked species distribution frameworks and used these to estimate linearly and non-linearly scaled landscape resistances for seven ungulate species. We evaluated habitat suitability and least-cost and circuit theory-based connectivity models for each species individually and generated a multi-species corridor. Our results revealed that species-habitat relationships and subsequent corridors differed across species, but the pattern of predicted landscape connectivity across the study area was similar for all seven species regardless of method (circuit theory or least-cost) and scaling of the habitat suitability-based cost surface (linear or non-linear). Stacked species distribution models were highly correlated with the seven species for all model outputs (r = 0.79 to 0.97), while having the greatest overlap with the individual species least-cost corridors (linear model: 61.6%; non-linear model: 60.2%). Zebra was the best single-species proxy for landscape connectivity. Overall, we show that multi-species corridors based on stacked species distribution models achieve relatively low cumulative costs for savanna ungulates as compared to their respective single-species corridors. Given the challenges and costs involved in acquiring data and parameterizing corridor models for multiple species, zebra may act as a suitable proxy species for ungulate corridor conservation in this system., Competing Interests: The authors have declared that no competing interests exist.
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- 2022
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30. Road-based line distance surveys overestimate densities of olive baboons.
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Kiffner C, Paciência FMD, Henrich G, Kaitila R, Chuma IS, Mbaryo P, Knauf S, Kioko J, and Zinner D
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- Animals, Data Collection methods, Environmental Monitoring methods, Papio anubis physiology, Population Density, Population Dynamics
- Abstract
Estimating population density and population dynamics is essential for understanding primate ecology and relies on robust methods. While distance sampling theory provides a robust framework for estimating animal abundance, implementing a constrained, non-systematic transect design could bias density estimates. Here, we assessed potential bias associated with line distance sampling surveys along roads based on a case study with olive baboons (Papio anubis) in Lake Manyara National Park (Tanzania). This was achieved by comparing density estimates of olive baboons derived from road transect surveys with density estimates derived from estimating the maximum number of social groups (via sleeping site counts) and multiplying this metric with the estimated average size of social groups. From 2011 to 2019, we counted olive baboons along road transects, estimated survey-specific densities in a distance sampling framework, and assessed temporal population trends. Based on the fitted half-normal detection function, the mean density was 132.5 baboons km-2 (95% CI: 110.4-159.2), however, detection models did not fit well due to heaping of sightings on and near the transects. Density estimates were associated with relatively wide confidence intervals that were mostly caused by encounter rate variance. Based on a generalized additive model, baboon densities were greater during the rainy seasons compared to the dry seasons but did not show marked annual trends. Compared to estimates derived from the alternative method (sleeping site survey), distance sampling along road transects overestimated the abundance of baboons more than threefold. Possibly, this overestimation was caused by the preferred use of roads by baboons. While being a frequently used technique (due to its relative ease of implementation compared to spatially randomized survey techniques), inferring population density of baboons (and possibly other species) based on road transects should be treated with caution. Beyond these methodological concerns and considering only the most conservative estimates, baboon densities in LMNP are among the highest across their geographic distribution range., Competing Interests: The authors have declared that no competing interests exist.
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- 2022
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31. Camera-trap data do not indicate scaling of diel activity and cathemerality with body mass in an East African mammal assemblage.
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Clauss M, Scriba M, Kioko J, Ganzhorn JU, and Kiffner C
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Diel activity patterns of animal species reflect constraints imposed by morphological, physiological, and behavioral trade-offs, but these trade-offs are rarely quantified for multispecies assemblages. Based on a systematic year-long camera-trap study in the species-rich mammal assemblage of Lake Manyara National Park (Tanzania), we estimated activity levels (hours active per day) and circadian rhythms of 17 herbivore and 11 faunivore species to determine the effects of body mass and trophic level on activity levels and cathemerality (the degree to which species are active throughout the day and night). Using generalized least squares and phylogenetic generalized least squares analyses, we found no support for the hypothesis that trophic level is positively associated with activity levels. We found no support for activity levels to scale positively with body mass in herbivores or to differ between ruminants and nonruminants; in faunivores, we also did not detect relationships between body mass and activity levels. Cathemerality was positively associated with activity levels but did not scale significantly with body mass. Overall, our findings caution against trophic level or body mass-associated generalized conclusions with regard to diel activity patterns., Competing Interests: None declared., (© 2021 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)
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- 2021
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32. Mapping virtual platforms to estimate the population size of men who have sex with men (MSM) who use internet to find sexual partners: implications to enhance HIV prevention among MSM in Kenya.
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Emmanuel F, Kioko J, Musyoki H, Kaosa S, Ongaro MK, Kuria S, Olango K, Musimbi J, Walimbwa J, Blanchard J, Isac S, and Bhattacharjee P
- Abstract
Introduction: Men who have sex with men (MSM) in Kenya face a disproportionate HIV disease burden. Over the last few years, the use of virtual platforms and internet sites to seek male sexual partners has increased manyfold in Kenya. New approaches are required to map, estimate and profile MSM who operate through virtual platforms to design interventions for them. Methods: This study was conducted in three counties in Kenya: Kiambu, Kisumu and Mombasa with MSM who use virtual platforms such as geosocial networking (GSN) and social networking applications to find and connect with male sex partners. The platforms were profiled through a multi-stage approach and the number of MSM associated with these platforms were estimated. In the final stage, 435 respondents randomly selected from the virtual platforms were interviewed in a secure location after informed consent. Data analysis focused on calculating an estimate of MSM for each virtual platform in each site, adjusting for duplicate profiles and multiple registrations. Results: We identified 24 GSN apps, 18 Facebook accounts/pages and 18 WhatsApp groups across the three counties, with Facebook being the preferred platform. Kiambu had the highest number of estimated MSM at 3,635 (95%CI = 3,335 to 3,990) followed by Kisumu at 1,567 (95%CI = 1,480 to 1,665) and Mombasa at 1,469 (95%CI = 1,335 to 1,604) who used virtual platforms to find other male sexual partners. On average, each MSM had 3.7 profiles on multiple platforms, with an average of 2.1 profiles used in the past month. Conclusions: The use of conventional population size estimation approaches that focus on physical sites alone may underestimate the total number of MSM in a geography. Virtual mapping should be used in conjunction with conventional hot spot based size estimation methodologies to estimate numbers of MSM to set programmatic targets., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Emmanuel F et al.)
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- 2020
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33. HIV testing amid COVID-19: community efforts to reach men who have sex with men in three Kenyan counties.
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Odinga MM, Kuria S, Muindi O, Mwakazi P, Njraini M, Melon M, Kombo B, Kaosa S, Kioko J, Musimbi J, Musyoki H, Bhattacharjee P, and Lorway R
- Abstract
In comparison to European and American countries, Kenya has been less impacted by the COVID-19 pandemic in terms of reported cases and mortalities. However, everyday life has been dramatically affected by highly restrictive government-imposed measures such as stay-at-home curfews, prohibitions on mobility across national and county boundaries, and strict policing, especially of the urban poor, which has culminated in violence. This open letter highlights the effects of these measures on how three community-based organizations (CBOs) deliver HIV programs and services to highly stigmatized communities of men who have sex with men living in the counties of Kisumu, Kiambu and Mombasa. In particular, emphasis is placed on how HIV testing programs, which are supported by systematic peer outreach, are being disrupted at a time when global policymakers call for expanded HIV testing and treatment targets among key populations. While COVID 19 measures have greatly undermined local efforts to deliver health services to members and strengthen existing HIV testing programs, each of the three CBOs has taken innovative steps to adapt to the restrictions and to the COVID-19 pandemic itself. Although HIV testing in clinical spaces among those who were once regular and occasional program attendees dropped off noticeably in the early months of the COVID-19 lockdown, the program eventually began to rebound as outreach approaches shifted to virtual platforms and strategies. Importantly and unexpectedly, HIV self-testing kits proved to fill a major gap in clinic-based HIV testing at a time of crisis., Competing Interests: No competing interests were disclosed., (Copyright: © 2020 Odinga MM et al.)
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- 2020
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34. Legal and institutional foundations for universal health coverage, Kenya.
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Mbindyo R, Kioko J, Siyoi F, Cheruiyot S, Wangai M, Onsongo J, Omwoyo A, Kisia C, and Miriti K
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- Health Facilities, Human Rights, Humans, Kenya, Health Services Accessibility, Universal Health Insurance
- Abstract
Kenya's Constitution of 2010 triggered a cascade of reforms across all sectors to align with new constitutional standards, including devolution and a comprehensive bill of rights. The constitution acts as a platform to advance health rights and to restructure policy, legal, institutional and regulatory frameworks towards reversing chronic gaps and improving health outcomes. These constitutionally mandated health reforms are complex. All parts of the health system are transforming concurrently, with several new laws enacted and public health bodies established. Implementing such complex change was hampered by inadequate tools and approaches. To gain a picture of the extent of the health reforms over the first 10 years of the constitution, we developed an adapted health-system framework, guided by World Health Organization concepts and definitions. We applied the framework to document the health laws and public bodies already enacted and currently in progress, and compared the extent of transformation before and after the 2010 Constitution. Our analysis revealed multiple structures (laws and implementing public bodies) formed across the health system, with many new stewardship structures aligned to devolution, but with fragmentation within the regulation sub-function. By deconstructing normative health-system functions, the framework enabled an all-inclusive mapping of various health-system attributes (functions, laws and implementing bodies). We believe our framework is a useful tool for countries who wish to develop and implement a conducive legal foundation for universal health coverage. Constitutional reform is a mobilizing force for large leaps in health institutional change, boosting two aspects of feasibility for change: stakeholder acceptance and authority to proceed., ((c) 2020 The authors; licensee World Health Organization.)
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- 2020
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35. Long-term persistence of wildlife populations in a pastoral area.
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Kiffner C, Kioko J, Baylis J, Beckwith C, Brunner C, Burns C, Chavez-Molina V, Cotton S, Glazik L, Loftis E, Moran M, O'Neill C, Theisinger O, and Kissui B
- Abstract
Facilitating coexistence between people and wildlife is a major conservation challenge in East Africa. Some conservation models aim to balance the needs of people and wildlife, but the effectiveness of these models is rarely assessed. Using a case-study approach, we assessed the ecological performance of a pastoral area in northern Tanzania (Manyara Ranch) and established a long-term wildlife population monitoring program (carried out intermittently from 2003 to 2008 and regularly from 2011 to 2019) embedded in a distance sampling framework. By comparing density estimates of the road transect-based long-term monitoring to estimates derived from systematically distributed transects, we found that the bias associated with nonrandom placement of transects was nonsignificant. Overall, cattle and sheep and goat reached the greatest densities and several wildlife species occurred at densities similar (zebra, wildebeest, waterbuck, Kirk's dik-dik) or possibly even greater (giraffe, eland, lesser kudu, Grant's gazelle, Thomson's gazelle) than in adjacent national parks in the same ecosystem. Generalized linear mixed models suggested that most wildlife species (8 out of 14) reached greatest densities during the dry season, that wildlife population densities either remained constant or increased over the 17-year period, and that herbivorous livestock species remained constant, while domestic dog population decreased over time. Cross-species correlations did not provide evidence for interference competition between grazing or mixed livestock species and wildlife species but indicate possible negative relationships between domestic dog and warthog populations. Overall, wildlife and livestock populations in Manyara Ranch appear to coexist over the 17-year span. Most likely, this is facilitated by existing connectivity to adjacent protected areas, effective anti-poaching efforts, spatio-temporal grazing restrictions, favorable environmental conditions of the ranch, and spatial heterogeneity of surface water and habitats. This long-term case study illustrates the potential of rangelands to simultaneously support wildlife conservation and human livelihood goals if livestock grazing is restricted in space, time, and numbers., Competing Interests: None declared., (© 2020 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)
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- 2020
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36. A protracted cholera outbreak among residents in an urban setting, Nairobi county, Kenya, 2015.
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Kigen HT, Boru W, Gura Z, Githuka G, Mulembani R, Rotich J, Abdi I, Galgalo T, Githuku J, Obonyo M, Muli R, Njeru I, Langat D, Nsubuga P, Kioko J, and Lowther S
- Subjects
- Adolescent, Adult, Case-Control Studies, Child, Child, Preschool, Female, Humans, Infant, Kenya epidemiology, Male, Middle Aged, Risk Factors, Sanitation standards, Young Adult, Cholera epidemiology, Diarrhea epidemiology, Disease Outbreaks, Urban Population
- Abstract
Introduction: in 2015, a cholera outbreak was confirmed in Nairobi county, Kenya, which we investigated to identify risk factors for infection and recommend control measures., Methods: we analyzed national cholera surveillance data to describe epidemiological patterns and carried out a case-control study to find reasons for the Nairobi county outbreak. Suspected cholera cases were Nairobi residents aged >2 years with acute watery diarrhea (>4 stools/≤12 hours) and illness onset 1-14 May 2015. Confirmed cases had Vibrio cholerae isolated from stool. Case-patients were frequency-matched to persons without diarrhea (1:2 by age group, residence), interviewed using standardized questionaires. Logistic regression identified factors associated with case status. Household water was analyzed for fecal coliforms and Escherichia coli., Results: during December 2014-June 2015, 4,218 cholera cases including 282 (6.7%) confirmed cases and 79 deaths (case-fatality rate [CFR] 1.9%) were reported from 14 of 47 Kenyan counties. Nairobi county reported 781 (19.0 %) cases (attack rate, 18/100,000 persons), including 607 (78%) hospitalisations, 20 deaths (CFR 2.6%) and 55 laboratory-confirmed cases (7.0%). Seven (70%) of 10 water samples from communal water points had coliforms; one had Escherichia coli. Factors associated with cholera in Nairobi were drinking untreated water (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 2.3-18.8), lacking health education (aOR 2.4, CI 1.1-7.9) and eating food outside home (aOR 2.4, 95% CI 1.2-5.7)., Conclusion: we recommend safe water, health education, avoiding eating foods prepared outside home and improved sanitation in Nairobi county. Adherence to these practices could have prevented this protacted cholera outbreak., Competing Interests: The authors declare no competing interests., (Copyright: Hudson Taabukk Kigen et al.)
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- 2020
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37. HIV prevalence, testing and treatment among men who have sex with men through engagement in virtual sexual networks in Kenya: a cross-sectional bio-behavioural study.
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Bhattacharjee P, Isac S, Musyoki H, Emmanuel F, Olango K, Kuria S, Ongaro MK, Walimbwa J, Musimbi J, Mugambi M, Kaosa S, Kioko J, Njraini M, Melon M, Onyoni J, Bartilol K, Becker M, Lorway R, Pickles M, Moses S, Blanchard J, and Mishra S
- Subjects
- Adult, Anti-Retroviral Agents therapeutic use, Continuity of Patient Care, Cross-Sectional Studies, HIV Infections diagnosis, HIV Infections drug therapy, Humans, Kenya epidemiology, Logistic Models, Male, Prevalence, Sexual and Gender Minorities, Surveys and Questionnaires, Unsafe Sex, Young Adult, HIV Infections epidemiology, Homosexuality, Male statistics & numerical data, Internet, Sexual Partners
- Abstract
Introduction: In Kenya, men who have sex with men (MSM) are increasingly using virtual sites, including web-based apps, to meet sex partners. We examined HIV testing, HIV prevalence, awareness of HIV-positive status and linkage to antiretroviral therapy (ART), for HIV-positive MSM who solely met partners via physical sites (PMSM), compared with those who did so in virtual sites (either solely via virtual sites (VMSM), or via both virtual and physical sites (DMSM))., Methods: We conducted a cross-sectional bio-behavioural survey of 1200 MSM, 15 years and above, in three counties in Kenya between May and July 2019, using random sampling of physical and virtual sites. We classified participants as PMSM, DMSM and VMSM, based on where they met sex partners, and compared the following between groups using chi-square tests: (i) proportion tested; (ii) HIV prevalence and (iii) HIV care continuum among MSM living with HIV. We then performed multivariable logistic regression to measure independent associations between network engagement and HIV status., Results: 177 (14.7%), 768 (64.0%) and 255 (21.2%), of participants were classified as PMSM, DMSM and VMSM respectively. 68.4%, 70.4% and 78.5% of PMSM, DMSM and VMSM, respectively, reported an HIV test in the previous six months. HIV prevalence was 8.5% (PMSM), 15.4% (DMSM) and 26.7% (VMSM), p < 0.001. Among those living with HIV, 46.7% (PMSM), 41.5% (DMSM) and 29.4% (VMSM) were diagnosed and aware of their status; and 40.0%, 35.6% and 26.5% were on antiretroviral treatment. After adjustment for other predictors, MSM engaged in virtual networks remained at a two to threefold higher risk of prevalent HIV: VMSM versus PMSM (adjusted odds ratio 3.88 (95% confidence interval (CI) 1.84 to 8.17) p < 0.001); DMSM versus PMSM (2.00 (95% CI 1.03 to 3.87), p = 0.040)., Conclusions: Engagement in virtual networks is associated with elevated HIV risk, irrespective of individual-level risk factors. Understanding the difference in characteristics among MSM-seeking partners in different sites will help HIV programmes to develop subpopulation-specific interventions., (© 2020 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
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- 2020
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38. Low program access despite high burden of sexual, structural, and reproductive health vulnerabilities among young women who sell sex in Mombasa, Kenya.
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Roberts E, Ma H, Bhattacharjee P, Musyoki HK, Gichangi P, Avery L, Musimbi J, Tsang J, Kaosa S, Kioko J, Becker ML, and Mishra S
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- Adolescent, Adult, Age Factors, Cross-Sectional Studies, Female, Humans, Kenya epidemiology, Prevalence, Young Adult, Reproductive Health statistics & numerical data, Sex Offenses statistics & numerical data, Sex Workers statistics & numerical data, Sexual Behavior statistics & numerical data
- Abstract
Background: Across Sub-Saharan Africa, young women who sell sex (YSW) face institutional barriers in accessing sexual health and HIV prevention programs designed for female sex workers. In 2018, Kenya developed a national framework to guide service provision for YSW aged 14-24 years. To help inform the implementation of the framework, we estimated the burden of vulnerabilities related to the Sustainable Development Goals (SDGs related to health and gender equality) and program contact among YSW., Methods: We used data from Transitions, a 2015 bio-behavioural cross-sectional survey of 408 YSW aged 14-24 years in Mombasa, Kenya. We estimated the prevalence of sexual (inconsistent condom use), structural (financial, violence), and reproductive health vulnerabilities; and characterized engagement with local HIV programs tailored to sex workers. We then compared the prevalence of vulnerabilities by age group (14-18 years, N = 117; 19-24 years, N = 291) and by program contact (ever contacted by local program for sex workers)., Results: 47.3% reported inconsistent condom use with any partner in the previous week (no difference by age-group, p = 1.00). Structural vulnerabilities were common and did not vary by age: 83.6% did not have a regular source of income; 29.9 and 29.2% had experienced physical and sexual violence, respectively. 26.5% reported at least one pregnancy before age 18, and 18.5% used a non-reliable form of contraception with little variability by age. 25.7% were aware of at least one program, and only 13.7% of YSW had ever been contacted by a program (8.5% of those aged 14-18 years; and 15.8% of those aged 19-24 years, p = 0.06). Sexual, structural, and reproductive health vulnerabilities did not vary by program contact., Conclusions: SDG-related vulnerabilities begin early in the lives of YSW who are not currently reached by programs designed for female sex workers.
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- 2020
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39. Community-based wildlife management area supports similar mammal species richness and densities compared to a national park.
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Kiffner C, Thomas S, Speaker T, O'Connor V, Schwarz P, Kioko J, and Kissui B
- Abstract
Community-based conservation models have been widely implemented across Africa to improve wildlife conservation and livelihoods of rural communities. In Tanzania, communities can set aside land and formally register it as Wildlife Management Area (WMA), which allows them to generate revenue via consumptive or nonconsumptive utilization of wildlife. The key, yet often untested, assumption of this model is that economic benefits accrued from wildlife motivate sustainable management of wildlife. To test the ecological effectiveness (here defined as persistence of wildlife populations) of Burunge Wildlife Management Area (BWMA), we employed a participatory monitoring approach involving WMA personnel. At intermittent intervals between 2011 and 2018, we estimated mammal species richness and population densities of ten mammal species (African elephant, giraffe, buffalo, zebra, wildebeest, waterbuck, warthog, impala, Kirk's dik-dik, and vervet monkey) along line transects. We compared mammal species accumulation curves and density estimates with those of time-matched road transect surveys conducted in adjacent Tarangire National Park (TNP). Mammal species richness estimates were similar in both areas, yet observed species richness per transect was greater in TNP compared to BWMA. Species-specific density estimates of time-matched surveys were mostly not significantly different between BWMA and TNP, but elephants occasionally reached greater densities in TNP compared to BWMA. In BWMA, elephant, wildebeest, and impala populations showed significant increases from 2011 to 2018. These results suggest that community-based conservation models can support mammal communities and densities that are similar to national park baselines. In light of the ecological success of this case study, we emphasize the need for continued efforts to ensure that the BWMA is effective. This will require adaptive management to counteract potential negative repercussions of wildlife populations on peoples' livelihoods. This study can be used as a model to evaluate the effectiveness of wildlife management areas across Tanzania., Competing Interests: None declared., (© 2019 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)
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- 2019
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40. Comparative knowledge, attitudes, and practices regarding anthrax, brucellosis, and rabies in three districts of northern Tanzania.
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Kiffner C, Latzer M, Vise R, Benson H, Hammon E, and Kioko J
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- Adult, Animals, Female, Health Behavior, Health Education, Humans, Linear Models, Male, Middle Aged, Rural Population, Surveys and Questionnaires, Tanzania epidemiology, Anthrax psychology, Brucellosis psychology, Health Knowledge, Attitudes, Practice, Rabies psychology, Zoonoses psychology
- Abstract
Background: Knowledge, attitudes, and practices (KAP) surveys regarding zoonotic diseases are crucial to understanding the extent of knowledge among citizens and for guiding health-related education programs., Method: Employing a structured questionnaire, we interviewed residents (n = 388) in three districts of northern Tanzania (Karatu n = 128, Monduli n = 114, Babati n = 146) to assess knowledge, attitudes and reported practices regarding three zoonotic diseases that occur in the region (anthrax, brucellosis, and rabies). We used generalized linear mixed effects models and multi-model inference to identify demographic correlates of knowledge., Results: Proportional average district- and disease- specific knowledge scores ranged from 0.14-0.61. We found positive correlations between age and knowledge of symptoms, causes and treatments of anthrax (three districts), brucellosis (three districts), and rabies (one district). Gender, ethnic identity, formal education and ownership of livestock or dogs had variable effects on knowledge among the interviewed population. Risk perceptions regarding different diseases varied across districts and were positively correlated with knowledge of the specific diseases. Direct interactions with livestock and domestic dogs were reported to occur across all demographic groups, suggesting that most people living in rural settings of our study area are potentially exposed to zoonotic diseases. Behaviors which may favor transmission of specific pathogens (such as consumption of raw milk or meat) were occasionally reported and varied by district. Wildlife was generally regarded as negative or neutral with regard to overall veterinary and human health., Conclusion: The combination of variable knowledge about zoonotic diseases in the three districts, reported occurrence of practices that are conducive to pathogen transmission, and previously documented circulation of pathogens causing anthrax, brucellosis and rabies in our study system, call for health education programs embedded in a holistic One Health approach.
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- 2019
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41. HIV prevention programme cascades: insights from HIV programme monitoring for female sex workers in Kenya.
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Bhattacharjee P, Musyoki HK, Becker M, Musimbi J, Kaosa S, Kioko J, Mishra S, Isac SK, Moses S, and Blanchard JF
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- Adult, Condoms, Female, HIV Infections epidemiology, Humans, Kenya epidemiology, HIV Infections prevention & control, Sex Workers statistics & numerical data
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Introduction: HIV prevention cascades have emerged as a programme management and monitoring tool that outlines the sequential steps of an HIV prevention programme. We describe the application of an HIV combination prevention programme cascade framework to monitor and improve HIV prevention interventions for female sex workers (FSWs) in Kenya., Methods: Two data sources were analysed: (1) annual programme outcome surveys conducted using a polling booth survey methodology in 2017 among 4393 FSWs, and (2) routine programme monitoring data collected by (a) 92 implementing partners between July 2017 and June 2018, and (b) Learning Site in Mombasa (2014 to 2015) and Nairobi (2013). We present national, sub-national and implementing partner level cascades., Results: At the national level, the population size estimates for FSW were 133,675 while the programme coverage targets were 174,073. Programme targets as denominator, during the period 2017 to 2018, 156,220 (90%) FSWs received peer education and contact, 148,713 (85%) received condoms and 83,053 (48%) received condoms as per their estimated need. At the outcome level, 92% of FSWs used condoms at the last sex with their client but 73% reported consistent condom use. Although 96% of FSWs had ever tested for HIV, 85% had tested in the last three months. Seventy-nine per cent of the HIV-positive FSWs were enrolled in HIV care, 73% were currently enrolled on antiretroviral therapy (ART) and 52% had attended an ART clinic in the last month. In the last six months, 48% of the FSWs had experienced police violence but 24% received violence support. National and sub-national level cascades showed proportions of FSWs lost at each step of programme implementation and variability in programme achievement. Hotspot and sub-population level cascades, presented as examples, demonstrate development and use of these cascades at the implementation level., Conclusions: HIV prevention programme cascades, drawing on multiple data sources to provide an understanding of gaps in programme outputs and outcomes, can provide powerful information for monitoring and improving HIV prevention programmes for FSWs at all levels of implementation and decision-making. Complexity of prevention programmes and the paucity of consistent data can pose a challenge to development of these cascades., (© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.)
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- 2019
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42. Changes in HIV prevention programme outcomes among key populations in Kenya: Data from periodic surveys.
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Musyoki H, Bhattacharjee P, Blanchard AK, Kioko J, Kaosa S, Anthony J, Javalkar P, Musimbi J, Malaba SJ, Olwande C, Blanchard JF, Sirengo M, Isac S, and Moses S
- Subjects
- Adolescent, Adult, Anti-HIV Agents therapeutic use, Condoms statistics & numerical data, Female, HIV Infections diagnosis, HIV Infections drug therapy, Homosexuality, Male, Humans, Kenya, Male, National Health Programs, Needle-Exchange Programs statistics & numerical data, Risk-Taking, Sex Workers, Substance Abuse, Intravenous, Surveys and Questionnaires, Young Adult, HIV Infections prevention & control
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The Kenya National AIDS and STI Control Programme (NASCOP) conducted annual polling booth surveys (PBS) in 2014 and 2015 to measure outcomes from the national HIV prevention programme for key populations (KPs), comprising behavioural, biomedical and structural interventions. KPs included female sex workers (FSWs), men who have sex with men (MSM) and people who inject drugs (PWID). We compared survey results from the first and second rounds. Comparing the second to the first round, significantly more FSWs (93% vs. 88%, p<0.001) and MSM (77% vs. 58%, p<0.001) reported condom use at last sex with a paying client, and at last anal sex among MSM (80% vs. 77%, p<0.05) and PWID (48% vs. 27%, p<0.01). However, condom use with regular partners remained low, at less than 53% for FSWs and 69% for MSM. Among PWID, there was a significant increase in use of new needles and syringes at last injection (93% vs. 88%, p<0.001), and a significant decrease in reported non-availability of clean needles (23% vs. 36%, p<0.001). The number of overdoses in the past six months reduced significantly but remained high (40% vs. 51%, p<0.001). FSWs and MSM reported significantly higher HIV testing, and in all KP groups, over 93% reported ever having been tested for HIV. Among the respondents self-reporting to have tested HIV positive (24% of FSW, 22% of MSM and 19% of PWID), 80% of FSWs, 70% of MSM, and 73% of PWID reported currently taking antiretroviral therapy (ART). While the experience of forced intercourse by partners declined among FSWs (18% vs. 22%, p<0.01) and MSM (13% vs. 17%, p<0.01), more FSWs reported violence by law enforcement personnel (49% vs. 44%, p<0.001). These findings provide valuable information on the programme's progress, and a signpost for the integrated behavioural, biomedical and structural interventions to achieve their HIV prevention targets., Competing Interests: The authors have declared that no competing interests exist.
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- 2018
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43. Large mammal declines and the incipient loss of mammal-bird mutualisms in an African savanna ecosystem.
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Diplock N, Johnston K, Mellon A, Mitchell L, Moore M, Schneider D, Taylor A, Whitney J, Zegar K, Kioko J, and Kiffner C
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- Animals, Grassland, Humans, Tanzania epidemiology, Birds, Ecosystem, Mammals, Symbiosis physiology
- Abstract
Over the past half-century, large mammal populations have declined substantially throughout East Africa, mainly due to habitat loss and unsustainable direct exploitation. While it has been acknowledged that the loss of large mammals can have direct and cascading effects on community composition and ecosystem characteristics, limited quantitative work has been done on how declines of large herbivore populations impacts the abundance of mutualistic symbionts. Using a space-for-time observational approach, we quantified the large mammal community alongside the densities, host preferences and behaviors of mutualistic red-billed oxpeckers (Buphagus erythrorhynchus), and yellow-billed oxpeckers (Buphagus africanus) in northern Tanzania. At the landscape scale, mammal community composition was substantially less diverse in highly human-dominated areas when compared with more protected areas, with an observed complete loss of large wild mammal species in two study areas. Mirroring this trend, oxpecker densities were lowest in the least protected areas, and highest in fully protected areas. Using resource selection functions implemented via generalized linear models at different scales, we found that oxpeckers (1) were predominantly (67% of red-billed oxpeckers; 70% of yellow-billed oxpeckers) feeding on larger (between 500kg and 1500kg) ungulate host species within the mammal community, (2) usually preferred feeding on larger individuals (adults and males) within a specific host species population, and (3) preferred hosts that were more tolerant of their presence. In particular, cattle were especially intolerant of oxpecker presence and were relatively effective in displacing oxpeckers. We found little evidence that oxpecker feeding was parasitic across all host species; wound feeding was only observed on giraffe, comprising 6% and 4% of feeding behavior in red-billed and yellow-billed oxpeckers respectively. Thus, a loss of large-bodied and oxpecker tolerant host species is a likely explanation for declines of oxpecker populations in human dominated landscapes, which may have further cascading effects., Competing Interests: The authors have declared that no competing interests exist.
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- 2018
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44. Key Programme Science lessons from an HIV prevention 'Learning Site' for sex workers in Mombasa, Kenya.
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McClarty LM, Bhattacharjee P, Isac S, Emmanuel F, Kioko J, Njiraini M, Gichangi P, Okoth CD, Musimbi-Mbole J, Blanchard JF, Moses S, Muysyoki H, and Becker ML
- Subjects
- Acquired Immunodeficiency Syndrome epidemiology, Condoms supply & distribution, Female, HIV Infections epidemiology, Health Services statistics & numerical data, Humans, Kenya epidemiology, Lubricants supply & distribution, Male, Sex Work, Sex Workers psychology, Acquired Immunodeficiency Syndrome prevention & control, HIV Infections prevention & control, Learning, Sex Workers education
- Abstract
Objectives: In 2013, Kenya's National AIDS and STI Control Programme established a Learning Site (LS) in Mombasa County to support and strengthen capacity for HIV prevention programming within organisations working with sex workers. A defining feature of LS was the use of a Programme Science approach throughout its development and implementation. We provide an overview of the key components of LS, present findings from 23 months of programme monitoring data, and highlight key Programme Science lessons from its implementation and monitoring., Methods: Routine monitoring data collected from September 2013 through July 2015 are presented. Individual-level service utilisation data were collected monthly and indicators of interest were analysed over time to illustrate trends in enrolment, programme coverage and service utilisation among sex workers in Mombasa County., Results: Over the monitoring period, outreach programme enrolment occurred rapidly; condom distribution targets were met consistently; rates of STI screening remained high and diagnoses declined; and reporting of and response to violent incidents increased. At the same time, enrolment in LS clinics was relatively low among female sex workers, and HIV testing at LS was low among both female and male sex workers., Conclusion: Lessons learnt from operationalising the Programme Science framework through the Mombasa LS can inform the development and implementation of similar LS in different geographical and epidemiological contexts. Importantly, meaningful involvement of sex workers in the design, implementation and monitoring processes ensures that overall programme performance is optimised in the context of local, 'on-the-ground' realities. Additionally, learnings from LS highlight the importance of introducing enhanced monitoring and evaluations systems into complex programmes to better understand and explain programme dynamics over time., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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45. Systems, supplies, and staff: a mixed-methods study of health care workers' experiences and health facility preparedness during a large national cholera outbreak, Kenya 2015.
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Curran KG, Wells E, Crowe SJ, Narra R, Oremo J, Boru W, Githuku J, Obonyo M, De Cock KM, Montgomery JM, Makayotto L, Langat D, Lowther SA, O'Reilly C, Gura Z, and Kioko J
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- Checklist, Community Health Workers organization & administration, Focus Groups, Health Education, Humans, Infection Control organization & administration, Kenya epidemiology, Laboratories organization & administration, Politics, Qualitative Research, Cholera epidemiology, Cholera prevention & control, Community Health Workers psychology, Delivery of Health Care organization & administration, Disease Outbreaks prevention & control, Equipment and Supplies supply & distribution, Health Facility Administration
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Background: From December 2014 to September 2016, a cholera outbreak in Kenya, the largest since 2010, caused 16,840 reported cases and 256 deaths. The outbreak affected 30 of Kenya's 47 counties and occurred shortly after the decentralization of many healthcare services to the county level. This mixed-methods study, conducted June-July 2015, assessed cholera preparedness in Homa Bay, Nairobi, and Mombasa counties and explored clinic- and community-based health care workers' (HCW) experiences during outbreak response., Methods: Counties were selected based on cumulative cholera burden and geographic characteristics. We conducted 44 health facility cholera preparedness checklists (according to national guidelines) and 8 focus group discussions (FGDs). Frequencies from preparedness checklists were generated. To determine key themes from FGDs, inductive and deductive codes were applied; MAX software for qualitative data analysis (MAXQDA) was used to identify patterns., Results: Some facilities lacked key materials for treating cholera patients, diagnosing cases, and maintaining infection control. Overall, 82% (36/44) of health facilities had oral rehydration salts, 65% (28/43) had IV fluids, 27% (12/44) had rectal swabs, 11% (5/44) had Cary-Blair transport media, and 86% (38/44) had gloves. A considerable number of facilities lacked disease reporting forms (34%, 14/41) and cholera treatment guidelines (37%, 16/43). In FDGs, HCWs described confusion regarding roles and reporting during the outbreak, which highlighted issues in coordination and management structures within the health system. Similar to checklist findings, FGD participants described supply challenges affecting laboratory preparedness and infection prevention and control. Perceived successes included community engagement, health education, strong collaboration between clinic and community HCWs, and HCWs' personal passion to help others., Conclusions: The confusion over roles, reporting, and management found in this evaluation highlights a need to adapt, implement, and communicate health strategies at the county level, in order to inform and train HCWs during health system transformations. International, national, and county stakeholders could strengthen preparedness and response for cholera and other public health emergencies in Kenya, and thereby strengthen global health security, through further investment in the existing Integrated Disease Surveillance and Response structure and national cholera prevention and control plan, and the adoption of county-specific cholera control plans.
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- 2018
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46. Environmental Assessment and Blood Lead Levels of Children in Owino Uhuru and Bangladesh Settlements in Kenya.
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Etiang' NA, Arvelo W, Galgalo T, Amwayi S, Gura Z, Kioko J, Omondi G, Patta S, Lowther SA, and Brown MJ
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Background: Lead exposure is linked to intellectual disability and anemia in children. The United States Centers for Disease Control and Prevention (CDC) recommends biomonitoring of blood lead levels (BLLs) in children with BLL ≥5 μg/dL and chelation therapy for those with BLL ≥45 μg/dL., Objectives: This study aimed to determine blood and environmental lead levels and risk factors associated with elevated BLL among children from Owino Uhuru and Bangladesh settlements in Mombasa County, Kenya., Methods: The present study is a population-based, cross-sectional study of children aged 12-59 months randomly selected from households in two neighboring settlements, Owino Uhuru, which has a lead smelter, and Bangladesh settlement (no smelter). Structured questionnaires were administered to parents and 1-3 ml venous blood drawn from each child was tested for lead using a LeadCare
® II portable analyzer. Environmental samples collected from half of the sampled households were tested for lead using graphite furnace atomic absorption spectroscopy., Results: We enrolled 130 children, 65 from each settlement. Fifty-nine (45%) were males and the median age was 39 months (interquartile range (IQR): 30-52 months). BLLs ranged from 1 μg/dL to 31 μg/dL, with 45 (69%) children from Owino Uhuru and 18 (28%) children from Bangladesh settlement with BLLs >5 μg/dL. For Owino Uhuru, the geometric mean BLL in children was 7.4 μg/dL (geometric standard deviation (GSD); 1.9) compared to 3.7 μg/dL (GSD: 1.9) in Bangladesh settlement (p<0.05). The geometric mean lead concentration of soil samples from Owino Uhuru was 146.5 mg/Kg (GSD: 5.2) and 11.5 mg/Kg (GSD: 3.9) (p<0.001) in Bangladesh settlement. Children who resided <200 m from the lead smelter were more likely to have a BLL ≥5 μg/dL than children residing ≥200 m from the lead smelter (adjusted odds ratio (aOR): 33.6 (95% confidence interval (CI): 7.4-153.3). Males were also more likely than females to have a BLL ≥5 μg/dL (39, 62%) compared to a BLL<5 μg/dL [aOR: 2.4 (95% CI: 1.0-5.5)]., Conclusions: Children in Owino Uhuru had significantly higher BLLs compared with children in Bangladesh settlement. Interventions to diminish continued exposure to lead in the settlement should be undertaken. Continued monitoring of levels in children with detectable levels can evaluate whether interventions to reduce exposure are effective., Participant Consent: Obtained., Ethics Approval: Scientific approval for the study was obtained from the Ministry of Health, lead poisoning technical working group. Since this investigation was considered a public health response of immediate concern, expedited ethical approval was obtained from the Kenya Medical Research Institute and further approval from the Mombasa County Department of Health Services. The investigation was considered a non-research public health response activity by the CDC., Competing Interests: The authors declare no competing financial interests.- Published
- 2018
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47. Catalysts for implementation of One Health in Kenya.
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Mwatondo A, Munyua P, Gura Z, Muturi M, Osoro E, Obonyo M, Bitek A, Oyas H, Mbabu M, Kioko J, Njenga K, Lowther S, and Thumbi SM
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- Animals, Cooperative Behavior, Hemorrhagic Fever, Ebola epidemiology, Hemorrhagic Fever, Ebola prevention & control, Humans, Kenya, Zika Virus Infection epidemiology, Zika Virus Infection prevention & control, Disease Outbreaks prevention & control, One Health, Public Health
- Abstract
The recent Zika outbreak in the Americas, Ebola epidemic in West Africa and the increased frequency and impact of emerging and re-emerging infections of animal origin have increased the calls for greater preparedness in early detection and responses to public health events. One-Health approaches that emphasize collaborations between human health, animal health and environmental health sectors for the prevention, early detection and response to disease outbreaks have been hailed as a key strategy. Here we highlight three main efforts that have progressed the implementation of One Health in Kenya.
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- 2017
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48. Effects of acaricide treatment and host intrinsic factors on tick acquisition and mortality in Boran cattle.
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Grzeda E, Maurer T, Dannemann C, Kibiriti LO, Kioko J, and Kiffner C
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- Animals, Animals, Wild parasitology, Cattle, Cattle Diseases drug therapy, Cattle Diseases parasitology, Female, Host-Parasite Interactions physiology, Longitudinal Studies, Male, Tanzania, Acaricides pharmacology, Chlorpyrifos pharmacology, Pyrethrins pharmacology, Rhipicephalus drug effects, Tick Infestations drug therapy, Tick Infestations veterinary
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Ticks and associated pathogens pose serious threats to the health of livestock. To assess the efficacy of acaricide dip treatment (cypermethrin, chlorpyrifos, piperonyl butoxide, citronella), we assessed post-treatment tick acquisition and tick mortality of free-ranging Boran cattle inhabiting a wildlife-cattle ranch in Northern Tanzania. Because host intrinsic variables and exposure to ticks may substantially affect tick acquisition, we incorporated host sex, body mass, health condition, and distance traveled in models of tick acquisition. Using generalized linear mixed models that accounted for non-independence of individuals, we found that tick species richness increased with host body mass but was not significantly related to other factors. In contrast, tick abundance increased with time since acaricide treatment, was positively correlated with host body mass, and was higher in female than male cattle. Distance traveled and health condition did not predict tick acquisition. Overall, these patterns were similar when separately analyzing acquisition of the more common tick species (Rhipicephalus pulchellus, R. sanguineus sensu lato, and R. praetextatus). Logistic regression models suggested that tick mortality was high for a few days after acaricide dip treatment but declined steeply post-treatment; 3.5 days after treatment, only 50% of ticks were dead, and mortality declined further thereafter. Our results provide new information regarding tick acquisition patterns in this system including female-biased tick parasitism and support for the hypothesis that increased host body mass provides greater resources and thus supports higher ectoparasite abundance and species richness. The limited acaricide duration of action and effectiveness on all tick species calls for adjusting tick management practices.
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- 2017
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49. Strengthening health systems in Africa: a case study of the Kenya field epidemiology training program for local frontline health workers.
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Roka ZG, Githuku J, Obonyo M, Boru W, Galgalo T, Amwayi S, Kioko J, Njoroge D, and Ransom JA
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The logistical and operational challenges to improve public health practice capacity across Africa are well documented. This report describes Kenya's Field Epidemiology and Laboratory Training Program's (KFELTP) experience in implementing frontline public health worker training to transfer knowledge and practical skills that help strengthen their abilities to detect, document, respond to, and report unusual health events. Between May 2014 and May 2015, KFELTP hosted five training courses across the country to address practice gaps among local public health workers. Participants completed a 10-week process: two 1-week didactic courses, a 7-week field project, and a final 1-week course to present and defend the findings of their field project. The first year was a pilot period to determine whether the program could fit into the existing 2-year KFELTP model and whether this frontline-level training would have an impact on local practice. At the end of the first year, KFELTP certified 167 frontline health workers in field epidemiology and data management. This paper concludes that local, national, and international partnerships are critical for improving local public health response capacity and workforce development training in an African setting., Competing Interests: Not applicable.Not applicable.The authors declare that have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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- 2017
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50. Factors associated with cholera in Kenya, 2008-2013.
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Cowman G, Otipo S, Njeru I, Achia T, Thirumurthy H, Bartram J, and Kioko J
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- Humans, Kenya epidemiology, Poverty, Regression Analysis, Risk, Sanitation, Socioeconomic Factors, Urban Population, Cholera epidemiology, Disease Outbreaks statistics & numerical data, Public Health, Water standards
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Introduction: Kenya experienced widespread cholera outbreaks in 1997-1999 and 2007-2010. The re-emergence of cholera in Kenya in 2015 indicates that cholera remains a public health threat. Understanding past outbreaks is important for preventing future outbreaks. This study investigated the relationship between cholera occurrence in Kenya and various environmental and demographic factors related to water, sanitation, socio-economic status, education, urbanization and availability of health facilities during the time period 2008-2013., Methods: The primary outcome analyzed was the number of cholera cases at the district level, obtained from the Kenya Ministry of Health's national cholera surveillance records. Values of independent variables were obtained from the 2009 Kenya Population and Housing Census and other national surveys. The data were analyzed using a zero-inflated negative binomial regression model., Results: Multivariate analysis indicated that the risk of cholera was associated with open defecation, use of unimproved water sources, poverty headcount ratio and the number of health facilities per 100,000 population (p < 0.05). No statistically significant association was found between cholera occurrence and education, percentage of population living in urban areas or population density., Conclusion: The Sustainable Development Goals and Kenya's blueprint for development, Kenya Vision 2030 , call for access to sanitation facilities and clean water for all by 2030. Kenya has made important economic strides in recent years but continues to be affected by diseases like cholera that are associated with low socio-economic status. Further expansion of access to sanitation facilities and clean water is necessary for preventing cholera in Kenya.
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- 2017
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