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IntroductionIdentifying the optimal approaches to offering HIV prevention to meet the needs of those at risk is a high priority, particularly given the expanding toolkit of biomedical HIV prevention options. An ongoing study in rural East African communities evaluated the uptake of choices in product, testing mode and location of care delivery through a structured patient-centred HIV prevention delivery model. In this qualitative study, we sought to understand clients' experiences of this "dynamic choice prevention model" (DCP) and highlight pathways of action to inform HIV prevention delivery models.MethodsIn-depth semi-structured interviews were conducted from November 2021 through March 2022 with a purposively selected sample of n = 56 participants in DCP trials (across outpatient departments, antenatal clinics and community settings), and n = 21 healthcare providers (total n = 77). A seven-person multi-regional team translated and inductively coded transcript data. We used a framework analysis approach to identify emergent themes.ResultsIndividuals taking up HIV pre-exposure prophylaxis (PrEP) reported feelings of relief, liberation from fears of acquiring HIV and satisfaction with being able to take action despite partners' behaviours. Couples used a range of approaches afforded by the study to persuade partners to get tested and opt for PrEP. Post-exposure prophylaxis (PEP) use was less common, although women welcomed it in the event of sexual coercion or assault. Participants discussed switching from PEP to PrEP after familiarizing themselves with usage and ascertaining ongoing risk. Participants felt respected by providers, trusted them and appreciated being able to contact them directly for telephone support. Prevention uptake was hindered by stigma, limited experience with and knowledge of prevention methods, gendered and generational power dynamics within intimate partnerships and families, and negative perceptions of methods due to the products themselves. Participants anticipated long-acting injectable PrEP could solve their challenges regarding pill size, daily pill burden and the likelihood of unwanted disclosure.ConclusionsDiverse preferences and barriers to uptake of prevention require a choice of HIV prevention options, locations and delivery modalities-but in addition, flexible, competent and friendly care provision is crucial to promote uptake. Helping clients feel valued, and addressing their unique needs and challenges, enables their agency to prioritize their health.

Polygamy is the practice of marriage to multiple partners. Approximately 6-11% of households in Uganda and 4-11% of households in Kenya are polygamous. The complex families produced by polygamous marriage customs give rise to additional considerations for healthcare providers and public health messaging around HIV care. Using 27 in-depth, semi-structured qualitative interviews with participants in two studies in rural Kenya and Uganda, we analysed challenges and opportunities that polygamous families presented in the diagnosis, treatment and prevention of HIV, and provider roles in improving HIV outcomes in these families. Overall, prevention methods seemed more justifiable to families where co-wives live far apart than when all members live in the same household. In treatment, diagnosis of one member did not always lead to disclosure to other members, creating an adverse home environment; but sometimes diagnosis of one wife led not only to diagnosis of the other, but also to greater household support.

Understanding risk perception and risk-taking among youth can inform targeted prevention efforts. Using a health beliefs model-informed framework, we analysed 8 semi-structured, gender-specific focus group discussions with 93 youth 15-24 years old (48% male, 52% female), drawn from the SEARCH trial in rural Kenya and Uganda in 2017-2018, coinciding with the widespread introduction of PrEP. Highly connected social networks and widespread uptake of antiretrovirals shaped youth HIV risk perception. Amid conflicting information about HIV prevention methods, youth felt exposed to multiple HIV risk factors like the high prevalence of HIV, belief that people with HIV(PWH) purposefully infect others, dislike of condoms, and doubts about PrEP efficacy. Young women also reported minimal sexual autonomy in the context of economic disadvantages, the ubiquity of intergenerational and transactional sex, and peer pressure from other women to have many boyfriends. Young men likewise reported vulnerability to intergenerational sex, but also adopted a sexual conquest mentality. Comprehensive sexuality education and economic empowerment, through credible and trusted sources, may moderate risk-taking. Messaging should leverage youth's social networks to spread fact-based, gender- and age-appropriate information. PrEP should be offered alongside other reproductive health services to address both pregnancy concerns and reduce HIV risk.

Anemia is a multifactorial condition; approaches to address it must recognize that the causal factors represent an ecology consisting of internal (biology, genetics, and health) and external (social/behavioral/demographic and physical) environments. In this paper, we present an approach for selecting interventions, followed by a description of key issues related to the multiple available interventions for prevention and reduction of anemia. We address interventions for anemia using the following 2 main categories: 1) those that address nutrients alone, and, 2) those that address nonnutritional causes of anemia. The emphasis will be on interventions of public health relevance, but we also consider the clinical context. We also focus on interventions at different stages of the life course, with a particular focus on women of reproductive age and preschool-age children, and present evidence on various factors to consider when selecting an intervention-inflammation, genetic mutations, nutrient delivery, bioavailability, and safety. Each section on an intervention domain concludes with a brief discussion of key research areas.

Higher education institutions play a pivotal role in instilling green economy and sustainable development principles in students. There are complex environmental challenges, and breaking through this complexity necessitates the incorporation of green economy learning to assist students in understanding these complex connections. This study explores the inculcation of interdisciplinary learning at the Master's level of assessed green economy aspects among ten schools. It explores green economy topics in courses and the degree of action-oriented learning. Results from the total respondents (N=227), indicate, among the existing green aspects in sampled schools, the sustainable use of natural resources (n=108, 47.6%) thematic area was the most dominant across the Master's courses. Examination of green learning in schools shows a disparity amongst schools where the school with the most examined green aspects was engineering and technology (93.8%) with the school of economics as least examined (75%). Cumulatively, green aspects, even with skewed disparity, were taught across the ten schools (p = 0.000). It is recommended that university programs should enhance regular reviews of curriculum and coursework in different disciplines, to set precedence on emerging green economy studies and their relevance.

UNLABELLED: IntroductionInnovative interventions are needed to improve HIV outcomes among adolescents and young adults (AYAs) living with HIV. Engaging AYAs in intervention development could increase effectiveness and youth acceptance, yet research is limited. We applied human-centred design (HCD) to refine adherence-support interventions pretrial and assessed HCD workshop acceptability. METHODS: We applied an iterative, four-phased HCD process in Kenya that included: (1) systematic review of extant knowledge, (2) prioritisation of design challenges, (3) a co-creation workshop and (4) translation tables to pair insights with trial intervention adaptations. The co-creation workshop was co-led by youth facilitators employing participatory activities to inform intervention adaptations. Iterative data analysis included rapid thematic analysis of visualised workshop outputs and notes using affinity mapping and dialogue to identify key themes. We conducted a survey to assess workshop acceptability among participants. RESULTS: Twenty-two participants engaged in the 4-day workshop. Co-creation activities yielded recommendations for improving planned interventions (eg, message frequency and content; strategies to engage hard-to-reach participants), critical principles to employ across interventions (eg, personalisation, AYA empowerment) and identification of unanticipated AYA HIV treatment priorities (eg, drug holidays, transition from adolescent to adult services). We revised intervention content, peer navigator training materials and study inclusion criteria in response to findings. The youth-led HCD workshop was highly acceptable to participants. CONCLUSIONS: Research employing HCD among youth can improve interventions preimplementation through empathy, youth-led inquiry and real-time problem solving. Peer navigation may be most influential in improving retention when engagement with young people is based on mutual trust, respect, privacy and extends beyond HIV-specific support. Identifying opportunities for personalisation and adaptation within intervention delivery is important for AYAs. Patient engagement interventions that target young people should prioritise improved transition between youth and adult services, youth HIV status disclosure, AYA empowerment and healthcare worker responsiveness in interactions and episodic adherence interruptions.

Traditional engagement with local governments often relies on financial and human resources from international or local partners, leading to direct implementation by organizations, which can hinder sustainability. While some organizations include sustainability indicators, few focus on transferring technical and financial ownership to governments. The Challenge Initiative (TCI) uses a phased coaching model-lead, assist, observe, and monitor-to build local government capacity for scaling family planning (FP) and adolescent and youth sexual and reproductive health (AYSRH) programs. TCI ensures local governments take the lead from day one, coaching them to manage and implement these programs sustainably, improving management, coordination, planning, budgeting, and data-driven decision-making. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted with stakeholders across 24 TCI sites in 8 countries-Benin, Kenya, India, Niger, Nigeria, Senegal, Tanzania, and Uganda-from October 2020 to March 2021. A total of 175 IDIs and 14 FGDs were conducted with 343 master coaches (52 TCI staff, 164 local government staff) and 127 coachees. Participants included TCI staff, local government officials, and health providers at both facility and community levels, all of whom received coaching. Examples were gathered to assess the impact of TCI's coaching model on government FP and AYSRH programs. TCI documented improvements in local government and health service provider leadership, management, and coordination of health programs through its coaching interventions. It linked health system outcomes to its coaching approach, building a cadre of master coaches and coachees at all levels. This strengthened local governments' capacity to lead and sustain the scale-up of FP and AYSRH programs beyond TCI's direct support. Improved monitoring and tracking of coaching quality is needed for further insights.

Abstract We are in a race against time to combat climate change and increase food production by 70% to feed the ever‐growing world population, which is expected to double by 2050. Agricultural research plays a vital role in improving crops and livestock through breeding programs and good agricultural practices, enabling sustainable agriculture and food systems. While advanced molecular breeding technologies have been widely adopted, phenotyping as an essential aspect of agricultural research and breeding programs has seen little development in most African institutions and remains a traditional method. However, the concept of high‐throughput phenotyping (HTP) has been gaining momentum, particularly in the context of unmanned aerial vehicle (UAV)‐based phenotyping. Although research into UAV‐based phenotyping is still limited, this paper aimed to provide a comprehensive overview and understanding of the use of UAV platforms and image analytics for HTP in agricultural research and to identify the key challenges and opportunities in this area. The paper discusses field phenotyping concepts, UAV classification and specifications, use cases of UAV‐based phenotyping, UAV imaging systems for phenotyping, and image processing and analytics methods. However, more research is required to optimize UAVs’ performance for image data acquisition, as limited studies have focused on the effect of UAVs’ operational parameters on data acquisition.

Cactus pear fruits are rich sources of nutritional (essential vitamins, amino acids and minerals) and antioxidant compounds (flavonoids, carotenes, betalains, ascorbic acid and quercetin). The fruit is cultivated for fresh markets and also serves as nutraceutical and functional food, finding application in various forms such as juice, jam, wine, syrup and in dairy products. However, short postharvest life and negative perception has contributed to its underutilization in the local context. Total titratable acidity (TTA) and total soluble solids (TSS) are among the desirable attributes used to assess postharvest quality of Cactus pears. A portable near-infrared spectrometer (NIRS) can non-destructively determine the internal quality of Cactus pears’ thus reducing postharvest losses. This study evaluated the potential of a handheld NIRS coupled with chemometrics of partial least square regression (PLSR) for rapid, non-destructive, and simultaneous determination of TTA and TSS in intact Cactus pear fruits. Cactus pears at different stages of maturity were sampled from Laikipia county, in Kenya, and immediately subjected to spectral data acquisition and wet-chemistry analyses. The PLSR was used to train and validate predictive models for the determination of TTA and TSS content in intact Cactus pears. The prediction model for TTA gave an R-squared (R2) of 0.73, root mean squared error of prediction (RMSEP) of 0.28% citric acid, and residual predictive deviation (RPD) of 1.97. Additionally, the TSS model resulted in R2 of 0.75, RMSEP of 1.60° Brix, and RPD of 2.06. Overall, these findings highlight the effectiveness of NIRS in non-destructive measurement of TTA and TSS levels in whole Cactus pears. However, with further refinement and optimization of these models, the full potential of this technique for swift and precise assessment of these parameters in whole Cactus pears can be realized. This would greatly benefit farmers and processors by reducing expenses associated with quality assessment and facilitating market entry of Cactus pear derived food products.

Motorcycle taxis in Sub-Saharan Africa are an essential component of the urban transport mix, providing vital services - such as access to markets, education and health facilities - to city dwellers across the continent. Transport regulators and policymakers have nonetheless remained reluctant to engage with this expanding sector, which seems to be the preferred mode of transport. Primary data were collected in five Sub-Saharan African countries during the last quarter of 2020 using qualitative interviews with key stakeholders relevant to the urban motorcycle taxi sector and quantitative motorcycle taxi operator surveys. There is a substantial prospect to come up with best practices within this sector by identifying and learning from the experiences of various stakeholders including motorcycle taxi and motor tricycle taxi operators, unions, institutions, traffic police, and users of these services. In addition, the data shows that there are ample opportunities for increased collaboration between the stakeholders, to ensure the sector’s continuous contribution to socio-economic development. Planning for a more sustainable and integrated transport system in Sub-Saharan African cities requires acknowledging the significant position taken up in this by the motorcycle and tricycle taxi.

Amaranth is a hardy leafy vegetable, with most of its species able to grow wildly even under harsh environmental conditions. It is an important vegetable among many African communities, including those in East Africa. However, whether and how water stress affects its nutritional profile is still unclear. The objective of this study was therefore to determine the effect of water deficit stress on accumulation of selected nutrients, metabolites and on transcription of specific biosynthesis genes in leaf amaranth. Ten accessions of amaranth were grown in a greenhouse at temperatures between 25 °C to 27 °C. Half of the plants were subjected to drought stress conditions from the third week after transplanting, the other half were watered normally as a control for three days. Putative genes involved in the biosynthetic pathways of oxalates, vitamin C and carotenoids were identified and their expression levels were compared under well-watered and water deficit stress conditions in the amaranth plants. Nutritional analysis of the leaves was also done for oxalates, vitamin C, carotenoids, flavonoids, phenolic acids, calcium, iron and zinc. There was no significant (P≤0.05)change in calcium, iron and zinc content due to the stress, while antioxidant biochemical components were significantly (P≤0.05) increased. Correlation analysis showed low correlation coefficients between the expression of most genes and the concentration of respective biochemical components. However, the GDP-L-galactose phosphorylase (GGP/VTC2) gene was up-regulated in all the accessions and showed a significant association with vitamin C content. There was also a significant correlation between the lycopene beta cyclase (LCY) gene with total carotenoids. All genes of the same pathways showed significant correlations. Significant partial correlations were also evident in gene-gene pair of the same pathway vs associated components. In conclusion, water deficit stress increased the accumulation of carotenoids, flavonoids and phenolic acids, as well as vitamin C. It also resulted in changes in gene expression patterns. While a single gene in a pathway did not strongly affect a particular component, changes in vitamin C levels were associated with expression levels of GGP/VTC2 gene.

Background Tuberculosis (TB) is a leading cause of death worldwide with over 90% of reported cases occurring in low- and middle-income countries (LMICs). Pre-treatment loss to follow-up (PTLFU) is a key contributor to TB mortality and infection transmission. Objectives We performed a scoping review to map available evidence on interventions to reduce PTLFU in adults with pulmonary TB, identify gaps in existing knowledge, and develop a conceptual framework to guide intervention implementation. Methods We searched eight electronic databases up to February 6 2024, medRxiv for pre-prints, and reference lists of included studies. Two review authors independently selected studies and extracted data using a predesigned form. We analysed data descriptively, presented findings in a narrative summary and developed a conceptual framework based on the Practical, Robust Implementation, and Sustainability Model to map the factors for effective intervention implementation. Results We reviewed 1262 records and included 17 studies. Most studies were randomized controlled trials (8/17, 47%). Intervention barriers included stigma and inadequate resources; enablers included mobile phones and TB testing and results on the same day. We identified eight interventions that reduced PTLFU: treatment support groups; mobile notifications; community health workers; integrated HIV/TB services; Xpert MTB/RIF as the initial diagnostic test; computer-aided detection with chest radiography screening; active linkage to care; and multi-component strategies. Conclusion Given the variation of healthcare settings, TB programs should consider contextual factors such as user acceptability, political commitment, resources, and infrastructure before adopting an intervention. Future research should utilize qualitative study designs, be people-centred, and include social and economic factors affecting PTLFU.

Background Tuberculosis (TB) is a leading cause of death worldwide with over 90% of reported cases occurring in low- and middle-income countries (LMICs). Pre-treatment loss to follow-up (PTLFU) is a key contributor to TB mortality and infection transmission. Objectives We performed a scoping review to map available evidence on interventions to reduce PTLFU in adults with pulmonary TB, identify gaps in existing knowledge, and develop a conceptual framework to guide intervention implementation. Methods We searched eight electronic databases up to February 6 2024, medRxiv for pre-prints, and reference lists of included studies. Two review authors independently selected studies and extracted data using a predesigned form. We analysed data descriptively, presented findings in a narrative summary and developed a conceptual framework based on the Practical, Robust Implementation, and Sustainability Model to map the factors for effective intervention implementation. Results We reviewed 1262 records and included 17 studies. Most studies were randomized controlled trials (8/17, 47%). Intervention barriers included stigma and inadequate resources; enablers included mobile phones and TB testing and results on the same day. We identified eight interventions that reduced PTLFU: treatment support groups; mobile notifications; community health workers; integrated HIV/TB services; Xpert MTB/RIF as the initial diagnostic test; computer-aided detection with chest radiography screening; active linkage to care; and multi-component strategies. Conclusion Given the variation of healthcare settings, TB programs should consider contextual factors such as user acceptability, political commitment, resources, and infrastructure before adopting an intervention. Future research should utilize qualitative study designs, be people-centred, and include social and economic factors affecting PTLFU.

Background The alcohol industry uses many of the tobacco industry’s strategies to influence policy-making, yet unlike the Framework Convention on Tobacco Control, there is no intergovernmental guidance on protecting policies from alcohol industry influence. Systematic assessment of alcohol industry penetration and government safeguards is also lacking. Here, we aimed to identify the nature and extent of industry penetration in a cross-section of jurisdictions. Using these data, we suggested ways to protect alcohol policies and policy-makers from undue industry influence.Methods As part of the International Alcohol Control Study, researchers from 24 jurisdictions documented whether 22 indicators of alcohol industry penetration and government safeguards were present or absent in their location. Several sources of publicly available information were used, such as government or alcohol industry reports, websites, media releases, news articles and research articles. We summarised the responses quantitatively by indicator and jurisdiction. We also extracted examples provided of industry penetration and government safeguards.Results There were high levels of alcohol industry penetration overall. Notably, all jurisdictions reported the presence of transnational alcohol corporations, and most (63%) reported government officials or politicians having held industry roles. There were multiple examples of government partnerships or agreements with the alcohol industry as corporate social responsibility activities, and government incentives for the industry in the early COVID-19 pandemic. In contrast, government safeguards against alcohol industry influence were limited, with only the Philippines reporting a policy to restrict government interactions with the alcohol industry. It was challenging to obtain publicly available information on multiple indicators of alcohol industry penetration.Conclusion Governments need to put in place stronger measures to protect policies from alcohol industry influence, including restricting interactions and partnerships with the alcohol industry, limiting political contributions and enhancing transparency. Data collection can be improved by measuring these government safeguards in future studies.

The sustainability of fresh fruits and vegetables value chains is challenged by high levels of food loss and waste (FLW) in resource-limited economies. In Kenya, where smallholder farmers dominate the food production sector, FLW in fruits and vegetables is estimated at 30-40%. This study investigated the ecosystem of FLW solution providers in Kenya, examining the challenges faced in developing and scaling interventions, and identifying successful strategies to overcome these barriers. A qualitative approach was employed. Primary data on FLW was obtained from solution providers through key informant interviews. The FLW solution providers were categorized as either successful or partially successful based on their commercial viability and operational tenure. The study utilized purposive sampling and a structured interview guide. The study identified several key challenges faced by FLW solution providers which comprised insufficient technical knowledge in food processing and machine operation, limited financial capacity for both operation and scaling, inconsistent supply of raw materials due to seasonality, competition from established companies and artificial products, slow market penetration, and low product acceptability (for partially successful providers). Successful solution providers employed various strategies to overcome these challenges including partnering with universities, governmental and non-governmental organizations for research, development, and initial financing; undertaking comprehensive technical and commercial viability assessments before scaling; adopting product differentiation to capture diverse markets; utilizing preservation techniques like drying and establishing off-take contracts to counter supply inconsistencies and establishing stable external markets and reliable business to business models. The study also revealed the potential for gender-inclusive impact, as many solution providers tend to employ more women due to the nature of the work. The findings highlight the critical role of partnerships, comprehensive market research, and adaptive strategies in developing successful FLW solutions. The contrast between successful and partially successful solution providers underscores the importance of comprehensive planning, technical expertise, and market-oriented approaches. By learning from successful solution providers and addressing key challenges, stakeholders can create more sustainable and effective interventions to reduce FLW and improve food security and nutrition status, and enhance the livelihoods of smallholder farmers.

BackgroundPoint of care hemoglobin meters play key roles in increasing access to anemia screening in antenatal care especially in settings with limited access to laboratories. We aimed to determine the diagnostic accuracy of a non-invasive spot-check hemoglobin (SpHb) meter, Masimo Rad-67® Pulse CO-Oximeter®, in the diagnosis of anemia in pregnant women attending antenatal care clinics in Kilifi, Kenya.MethodsThis was a diagnostic accuracy study that retrospectively evaluated SpHb against a validated reference standard of laboratory assessed hemoglobin (Lab Hb) by a SYSMEX XN-330 automated hematology analyzer. The study was nested within a prospective pregnancy cohort study that recruited unselected pregnant women from antenatal care clinics in two public hospitals in Kilifi County, coastal Kenya. Records with both SpHb and Lab Hb were selected from pregnancy visits between May 2021 and December 2022. Linear regression and Bland-Altman analysis were performed to compare the two tests and diagnostic accuracy parameters obtained for the diagnosis of anemia.ResultsA total of 2,975 records (from 2,203 unique participants), with paired SpHb and Lab Hb were analyzed. Linear regression showed a significant but weak positive correlation, a proportional bias of 0.44 (95% CI 0.41–0.47) and a constant of 7.59 (95% CI 7.30–7.87, p

Developing countries facing population growth and increased energy demand present simultaneous challenges regarding wastewater treatment and electricity supply. Constructed wetland-microbial fuel cells (CW-MFCs) offer a dual solution to the challenges of insufficient electricity and wastewater treatment by integrating indigenous plant species. CW-MFCs provide sustainable power generation and wastewater treatment. This approach can enhance sustainability and foster a circular economy by utilising plant-derived byproducts as an added product. Current research indicates various novel designs for effective wastewater treatment and potential power generation. Future studies focusing on rural settings and upscaling operations can apply advanced techniques like mass spectrophotometry and metagenomics to refine the technology for grid use. Developing CW-MFC technology will catapult the idea of developing a robust strategy for addressing power supply and sanitation issues in developing regions. This will also aid in continuous research into system optimisation and microbial communities, aiding long-term viability.

Key Clinical Message A 3 ‐year‐old boy presented with a forehead nodular mass, which was excised and confirmed histologically as Juvenile Xanthogranulomma (JXG). It affects children with a predilection for the head and neck region. A relatively rare, benign, histiocytic proliferative cutaneous disorder with a potential for malignancy. A prompt and wide resection is recommended.

BackgroundPopulation mobility is prevalent and complex in sub-Saharan Africa, and can disrupt HIV care and fuel onward transmission. While differentiated care models show promise for meeting the needs of mobile populations by addressing care cascade gaps, the voices of mobile populations need to be included when designing care delivery models. We assessed the unmet needs of mobile populations and engaged mobile stakeholders in the design and implementation of service delivery to improve care outcomes for mobile people living with HIV (PLHIV).MethodsCBPR was conducted in 12 rural communities in Kenya and Uganda participating in a mobility study within the Sustainable East Africa Research in Community Health (SEARCH) test-and-treat trial (NCT# 01864603) from 2016 to 2019. Annual gender-balanced meetings with between 17 and 33 mobile community stakeholders per meeting were conducted in local languages to gather information on mobility and its influence on HIV-related outcomes. Discussions were audio-recorded, transcribed and translated into English. Findings were shared at subsequent meetings to engage mobile stakeholders in interpretation. At year three, intervention ideas to address mobile populations' needs were elicited. After refinement, these intervention options were presented to the same communities for prioritization the following year, using a participatory ranking approach.ResultsTransit hubs, trading centers, and beach sites were identified as desirable service locations. Communities prioritized mobile health 'cards' with electronic medical records and peer-delivered home-based services. Mobile health clinics, longer antiretroviral refills, and 24/7 (after service) were less desirable options. Care challenges included: lack of transfer letters to other clinics; inability to adhere to scheduled appointments, medication regimens, and monitoring of treatment outcomes while mobile amongst others.ConclusionsIterative discussions with mobile community stakeholders elicited communities' health priorities and identified challenges to achieving HIV care cascade outcomes. Understanding the mobility patterns and unique needs of mobile populations through responsive community engagement is critical.

Few studies have explored land access, a structural driver of health, and women's participation in livelihood interventions to improve food security and HIV outcomes. This qualitative study, embedded within Shamba Maisha (NCT02815579)-a randomized controlled trial (RCT) examining the impact of a multisectoral intervention among farmers living with HIV in western Kenya-sought to explore the influence of perceived access to and control of land on agricultural productivity, investments, and benefits. Thirty in-depth interviews (IDIs) were conducted with purposively sampled men and women, 3 to 6 months after receiving intervention inputs; data were deductively and inductively coded and analyzed. Farming practices and participation in Shamba Maisha were dependent on land tenure and participants' perceived strength of claim over their land, with participants who perceived themselves to be land insecure less likely to make long-term agricultural investments. Land tenure was influenced by a number of factors and posed unique challenges for women which negatively impacted uptake and success in the intervention. Data underscore the importance of secure land tenure for the success of similar interventions, especially for women; future interventions should integrate land security programming for improved outcomes for all.

BackgroundAntiretroviral therapy (ART) assures major gains in health outcomes among people living with HIV, however, this benefit may not be realized by all due to care interruptions. Mobile populations comprise a subgroup that is likely to have sub-optimal care engagement, resulting in discontinuation of ART. We sought to evaluate the barriers to care engagement among highly mobile individuals living with HIV and explore options aimed at improving engagement in care for this group.MethodsQualitative in-depth interviews were conducted in 2020 among a purposive sample of twelve persons living with HIV and eight health care providers in western Kenya, within a mixed methods study of mobility in communities participating in the SEARCH trial (NCT01864603). We explored the barriers to care engagement among mobile individuals living with HIV and explored different options aimed at enhancing care engagement. These included options such as a coded card containing treatment details, alternative drug packaging to conceal drug identity, longer refills to cover travel period, wrist bands with data storage capability to enable data transfer and "warm handoff" by providers to new clinics upon transfer. Data were inductively analyzed to understand the barriers and acceptability of potential interventions to address them.ResultsStigma and lack of disclosure, rigid work schedules, and unpredictability of travel were major barriers to care engagement for highly mobile individuals living with HIV. Additionally, lack of flexibility in clinic schedules and poor provider attitude were identified as health-system-associated barriers to care engagement. Options that enhance flexibility, convenience and access to care were viewed as the most effective means of addressing the barriers to care by both patients and providers. The most preferred option was a coded card with treatment details followed by alternative drug packaging to conceal drug identity due to stigma and longer refills to cover travel periods.ConclusionHighly mobile individuals living with HIV desire responsive, flexible, convenient and patient-centered care delivery models to enhance care engagement. They embraced simple health delivery improvements such as coded cards, alternative drug packaging and longer refills to address challenges of mobility.