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Young PW, Musingila P, Kingwara L, Voetsch AC, Zielinski-Gutierrez E, Bulterys M, Kim AA, Bronson MA, Parekh BS, Dobbs T, Patel H, Reid G, Achia T, Keter A, Mwalili S, Ogollah FM, Ondondo R, Longwe H, Chege D, Bowen N, Umuro M, Ngugi C, Justman J, Cherutich P, De Cock KM. HIV Incidence, Recent HIV Infection, and Associated Factors, Kenya, 2007-2018. AIDS Res Hum Retroviruses 2023; 39:57-67. [PMID: 36401361 PMCID: PMC9942172 DOI: 10.1089/aid.2022.0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Nationally representative surveys provide an opportunity to assess trends in recent human immunodeficiency virus (HIV) infection based on assays for recent HIV infection. We assessed HIV incidence in Kenya in 2018 and trends in recent HIV infection among adolescents and adults in Kenya using nationally representative household surveys conducted in 2007, 2012, and 2018. To assess trends, we defined a recent HIV infection testing algorithm (RITA) that classified as recently infected (<12 months) those HIV-positive participants that were recent on the HIV-1 limiting antigen (LAg)-avidity assay without evidence of antiretroviral use. We assessed factors associated with recent and long-term (≥12 months) HIV infection versus no infection using a multinomial logit model while accounting for complex survey design. Of 1,523 HIV-positive participants in 2018, 11 were classified as recent. Annual HIV incidence was 0.14% in 2018 [95% confidence interval (CI) 0.057-0.23], representing 35,900 (95% CI 16,300-55,600) new infections per year in Kenya among persons aged 15-64 years. The percentage of HIV infections that were determined to be recent was similar in 2007 and 2012 but fell significantly from 2012 to 2018 [adjusted odds ratio (aOR) = 0.31, p < .001]. Compared to no HIV infection, being aged 25-34 versus 35-64 years (aOR = 4.2, 95% CI 1.4-13), having more lifetime sex partners (aOR = 5.2, 95% CI 1.6-17 for 2-3 partners and aOR = 8.6, 95% CI 2.8-26 for ≥4 partners vs. 0-1 partners), and never having tested for HIV (aOR = 4.1, 95% CI 1.5-11) were independently associated with recent HIV infection. Although HIV remains a public health priority in Kenya, HIV incidence estimates and trends in recent HIV infection support a significant decrease in new HIV infections from 2012 to 2018, a period of rapid expansion in HIV diagnosis, prevention, and treatment.
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Affiliation(s)
- Peter Wesley Young
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Maputo, Mozambique.,Address correspondence to: Peter Wesley Young, U.S. Embassy Maputo, Avenida Marginal nr 5467, Sommerschield, Distrito Municipal de KaMpfumo, Caixa Postal 783, CEP 0101-11 Maputo, Mozambique
| | - Paul Musingila
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Leonard Kingwara
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Andrew C. Voetsch
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Emily Zielinski-Gutierrez
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya.,Central America Regional Office, U.S. Centers for Disease Control and Prevention, Guatemala City, Guatemala
| | - Marc Bulterys
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Andrea A. Kim
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Megan A. Bronson
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bharat S. Parekh
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Trudy Dobbs
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hetal Patel
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Giles Reid
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Thomas Achia
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Alfred Keter
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Samuel Mwalili
- Department of Statistics and Actuarial Sciences, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Raphael Ondondo
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Herbert Longwe
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Duncan Chege
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | - Nancy Bowen
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | - Mamo Umuro
- National Public Health Laboratory, Ministry of Health, Nairobi, Kenya
| | | | - Jessica Justman
- Survey Unit, ICAP at Columbia University, New York, New York, USA
| | | | - Kevin M. De Cock
- Division of Global HIV & TB, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
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Makokha EP, Ondondo RO, Kimani DK, Gachuki T, Basiye F, Njeru M, Junghae M, Downer M, Umuro M, Mburu M, Mwangi J. Enhancing accreditation outcomes for medical laboratories on the Strengthening Laboratory Management Toward Accreditation programme in Kenya via a rapid results initiative. Afr J Lab Med 2022; 11:1614. [PMID: 35747559 PMCID: PMC9210179 DOI: 10.4102/ajlm.v11i1.1614] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 03/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Since 2010, Kenya has used SLIPTA to prepare and improve quality management systems in medical laboratories to achieve ISO 15189 accreditation. However, less than 10% of enrolled laboratories had done so in the initial seven years of SLMTA implementation. Objective We described Kenya’s experience in accelerating medical laboratories on SLMTA to attain ISO 15189 accreditation. Methods From March 2017 to July 2017, an aggressive top-down approach through high-level management stakeholder engagement for buy-in, needs-based expedited SLIPTA mentorship and on-site support as a rapid results initiative (RRI) was implemented in 39 laboratories whose quality improvement process had stagnated for 2–7 years. In July 2017, SLIPTA baseline and exit audit average scores on quality essential elements were compared to assess performance. Results After RRI, laboratories achieving greater than a 2-star SLMTA rating increased significantly from 15 (38%) at baseline to 33 (85%) (p < 0.001). Overall, 34/39 (87%) laboratories received ISO 15189 accreditation within two years of RRI, leading to a 330% increase in the number of accredited laboratories in Kenya. The most improved of the 12 quality system essentials were Equipment Management (mean increase 95% CI: 5.31 ± 1.89) and Facilities and Biosafety (mean increase [95% CI: 4.05 ± 1.78]) (both: p < 0.0001). Information Management and Corrective Action Management remained the most challenging to improve, despite RRI interventions. Conclusion High-level advocacy and targeted mentorship through RRI dramatically improved laboratory accreditation in Kenya. Similar approaches of strengthening SLIPTA implementation could improve SLMTA outcomes in other countries with similar challenges.
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Affiliation(s)
- Ernest P Makokha
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Raphael O Ondondo
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Daniel K Kimani
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Thomas Gachuki
- National HIV Reference Laboratory, Division of Public Health Laboratories, Ministry of Health, Nairobi, Kenya
| | - Frank Basiye
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Mercy Njeru
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Muthoni Junghae
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Marie Downer
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Mamo Umuro
- National HIV Reference Laboratory, Division of Public Health Laboratories, Ministry of Health, Nairobi, Kenya
| | - Margaret Mburu
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jane Mwangi
- Laboratory Services Branch, Division of Global HIV & TB, United States Centers for Disease Control and Prevention, Nairobi, Kenya
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Debes AK, Murt KN, Waswa E, Githinji G, Umuro M, Mbogori C, Roskosky M, Ram M, Shaffer A, Sack DA, Boru W. Laboratory and Field Evaluation of the Crystal VC-O1 Cholera Rapid Diagnostic Test. Am J Trop Med Hyg 2021; 104:2017-2023. [PMID: 33819171 PMCID: PMC8176501 DOI: 10.4269/ajtmh.20-1280] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/22/2021] [Indexed: 11/26/2022] Open
Abstract
Cholera is a severe acute, highly transmissible diarrheal disease which affects many low- and middle-income countries. Outbreaks of cholera are confirmed using microbiological culture, and additional cases during the outbreak are generally identified based on clinical case definitions, rather than laboratory confirmation. Many low-resource areas where cholera occurs lack the capacity to perform culture in an expeditious manner. A simple, reliable, and low-cost rapid diagnostic test (RDT) would improve identification of cases allowing rapid response to outbreaks. Several commercial RDTs are available for cholera testing with two lines to detect either serotypes O1 and O139; however, issues with sensitivity and specificity have not been optimal with these bivalent tests. Here, we report an evaluation of a new commercially available cholera dipstick test which detects only serotype O1. In both laboratory and field studies in Kenya, we demonstrate high sensitivity (97.5%), specificity (100%), and positive predictive value (100%) of this new RDT targeting only serogroup O1. This is the first field evaluation for the new Crystal VC-O1 RDT; however, with these high-performance metrics, this RDT could significantly improve cholera outbreak detection and improve surveillance for better understanding of cholera disease burden.
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Affiliation(s)
- Amanda K. Debes
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Kelsey N. Murt
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | | | | | | | | | - Mellisa Roskosky
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Malathi Ram
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Allison Shaffer
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - David A. Sack
- Department of International Health, Johns Hopkins School of Public Health, Baltimore, Maryland
| | - Waqo Boru
- Ministry of Health, Nairobi, Kenya
- Field Epidemiology and Laboratory Training Program, Nairobi, Kenya
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Mwau M, Umuro M, Odhiambo CO. Experience from a pilot point-of-care CD4 enumeration programme in Kenya. Afr J Lab Med 2016; 5:439. [PMID: 28879121 PMCID: PMC5433820 DOI: 10.4102/ajlm.v5i2.439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 08/11/2016] [Indexed: 01/16/2023] Open
Affiliation(s)
- Matilu Mwau
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Mamo Umuro
- National Public Health Laboratory Services, Nairobi, Kenya
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Ly KN, Kim AA, Umuro M, Drobenuic J, Williamson JM, Montgomery JM, Fields BS, Teshale EH. Prevalence of Hepatitis B Virus Infection in Kenya, 2007. Am J Trop Med Hyg 2016; 95:348-53. [PMID: 27273644 DOI: 10.4269/ajtmh.16-0059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/28/2016] [Indexed: 12/15/2022] Open
Abstract
Current estimates put the prevalence of hepatitis B virus (HBV) infection in Kenya at 5-8%. We determined the HBV infection prevalence in the human immunodeficiency virus (HIV)-negative Kenyan adult and adolescent population based on samples collected from a national survey. We analyzed data from HIV-negative participants in the 2007 Kenya AIDS Indicator Survey to estimate the HBV infection prevalence. We defined past or present HBV infection as presence of total hepatitis B core antibody (HBcAb), and chronic HBV infection (CHBI) as presence of both total HBcAb and hepatitis B surface antigen (HBsAg). We calculated crude and adjusted odds of HBV infection by demographic characteristics and risk factors using logistic regression analyses. Of 1,091 participants aged 15-64 years, approximately 31.5% (95% confidence interval [CI] = 28.0-35.3%) had exposure to HBV, corresponding to approximately 6.1 million (CI = 5.4-6.8 million) with past or present HBV infection. The estimated prevalence of CHBI was 2.1% (95% CI = 1.4-3.1%), corresponding to approximately 398,000 (CI = 261,000-602,000) with CHBI. CHBI is a major public health problem in Kenya, affecting approximately 400,000 persons. Knowing the HBV infection prevalence at baseline is important for planning and public health policy decision making and for monitoring the impact of viral hepatitis prevention programs.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Andrea A Kim
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mamo Umuro
- National Public Health Laboratory Services, Ministry of Health, Nairobi, Kenya
| | - Jan Drobenuic
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John M Williamson
- Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M Montgomery
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Barry S Fields
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Eyasu H Teshale
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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Kim AA, Parekh BS, Umuro M, Galgalo T, Bunnell R, Makokha E, Dobbs T, Murithi P, Muraguri N, De Cock KM, Mermin J. Identifying Risk Factors for Recent HIV Infection in Kenya Using a Recent Infection Testing Algorithm: Results from a Nationally Representative Population-Based Survey. PLoS One 2016; 11:e0155498. [PMID: 27195800 PMCID: PMC4873043 DOI: 10.1371/journal.pone.0155498] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 05/01/2016] [Indexed: 11/25/2022] Open
Abstract
Introduction A recent infection testing algorithm (RITA) that can distinguish recent from long-standing HIV infection can be applied to nationally representative population-based surveys to characterize and identify risk factors for recent infection in a country. Materials and Methods We applied a RITA using the Limiting Antigen Avidity Enzyme Immunoassay (LAg) on stored HIV-positive samples from the 2007 Kenya AIDS Indicator Survey. The case definition for recent infection included testing recent on LAg and having no evidence of antiretroviral therapy use. Multivariate analysis was conducted to determine factors associated with recent and long-standing infection compared to HIV-uninfected persons. All estimates were weighted to adjust for sampling probability and nonresponse. Results Of 1,025 HIV-antibody-positive specimens, 64 (6.2%) met the case definition for recent infection and 961 (93.8%) met the case definition for long-standing infection. Compared to HIV-uninfected individuals, factors associated with higher adjusted odds of recent infection were living in Nairobi (adjusted odds ratio [AOR] 11.37; confidence interval [CI] 2.64–48.87) and Nyanza (AOR 4.55; CI 1.39–14.89) provinces compared to Western province; being widowed (AOR 8.04; CI 1.42–45.50) or currently married (AOR 6.42; CI 1.55–26.58) compared to being never married; having had ≥ 2 sexual partners in the last year (AOR 2.86; CI 1.51–5.41); not using a condom at last sex in the past year (AOR 1.61; CI 1.34–1.93); reporting a sexually transmitted infection (STI) diagnosis or symptoms of STI in the past year (AOR 1.97; CI 1.05–8.37); and being aged <30 years with: 1) HSV-2 infection (AOR 8.84; CI 2.62–29.85), 2) male genital ulcer disease (AOR 8.70; CI 2.36–32.08), or 3) lack of male circumcision (AOR 17.83; CI 2.19–144.90). Compared to HIV-uninfected persons, factors associated with higher adjusted odds of long-standing infection included living in Coast (AOR 1.55; CI 1.04–2.32) and Nyanza (AOR 2.33; CI 1.67–3.25) provinces compared to Western province; being separated/divorced (AOR 1.87; CI 1.16–3.01) or widowed (AOR 2.83; CI 1.78–4.45) compared to being never married; having ever used a condom (AOR 1.61; CI 1.34–1.93); and having a STI diagnosis or symptoms of STI in the past year (AOR 1.89; CI 1.20–2.97). Factors associated with lower adjusted odds of long-standing infection included using a condom at last sex in the past year (AOR 0.47; CI 0.36–0.61), having no HSV2-infection at aged <30 years (AOR 0.38; CI 0.20–0.75) or being an uncircumcised male aged <30 years (AOR 0.30; CI 0.15–0.61). Conclusion We identified factors associated with increased risk of recent and longstanding HIV infection using a RITA applied to blood specimens collected in a nationally representative survey. Though some false-recent cases may have been present in our sample, the correlates of recent infection identified were epidemiologically and biologically plausible. These methods can be used as a model for other countries with similar epidemics to inform targeted combination prevention strategies aimed to drastically decrease new infections in the population.
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Affiliation(s)
- Andrea A. Kim
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV and Tuberculosis (DGHT), Nairobi, Kenya
- * E-mail:
| | | | - Mamo Umuro
- Kenya Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya
| | - Tura Galgalo
- Kenya Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya
| | - Rebecca Bunnell
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV and Tuberculosis (DGHT), Nairobi, Kenya
| | - Ernest Makokha
- US Centers for Disease Control and Prevention (CDC), Center for Global Health (CGH), Division of Global HIV and Tuberculosis (DGHT), Nairobi, Kenya
| | - Trudy Dobbs
- US CDC, CGH, DGHT, Atlanta, Georgia, United States of America
| | - Patrick Murithi
- Kenya Ministry of Health, National AIDS Control Council, Nairobi, Kenya
| | - Nicholas Muraguri
- Kenya Ministry of Health, National AIDS and STI Control Programme, Nairobi, Kenya
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Sirengo M, Rutherford GW, Otieno-Nyunya B, Kellogg TA, Kimanga D, Muraguri N, Umuro M, Mirjahangir J, Stein E, Ndisha M, Kim AA. Evaluation of Kenya's readiness to transition from sentinel surveillance to routine HIV testing for antenatal clinic-based HIV surveillance. BMC Infect Dis 2016; 16:113. [PMID: 26945861 PMCID: PMC4779556 DOI: 10.1186/s12879-016-1434-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/15/2016] [Indexed: 12/02/2022] Open
Abstract
Background Sentinel surveillance for HIV among women attending antenatal clinics using unlinked anonymous testing is a cornerstone of HIV surveillance in sub-Saharan Africa. Increased use of routine antenatal HIV testing allows consideration of using these programmatic data rather than sentinel surveillance data for HIV surveillance. Methods To gauge Kenya’s readiness to discontinue sentinel surveillance, we evaluated whether recommended World Health Organization standards were fulfilled by conducting data and administrative reviews of antenatal clinics that offered both routine testing and sentinel surveillance in 2010. Results The proportion of tests that were HIV-positive among women aged 15–49 years was 6.2 % (95 % confidence interval [CI] 4.6–7.7 %] in sentinel surveillance and 6.5 % (95 % CI 5.1–8.0 %) in routine testing. The agreement of HIV test results between sentinel surveillance and routine testing was 98.0 %, but 24.1 % of specimens that tested positive in sentinel surveillance were recorded as negative in routine testing. Data completeness was moderate, with HIV test results recorded for 87.8 % of women who received routine testing. Conclusions Additional preparation is required before routine antenatal HIV testing data can supplant sentinel surveillance in Kenya. As the quality of program data has markedly improved since 2010 a repeat evaluation of the use of routine antenatal HIV testing data in lieu of ANC sentinel surveillance is recommended.
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Affiliation(s)
- Martin Sirengo
- Ministry of Health, National AIDS and STI Control Programme, Kenyatta National Hospital Grounds, 19361-00202, Nairobi, Kenya.
| | - George W Rutherford
- Global Health Sciences, University of California, San Francisco, California, USA.
| | - Boaz Otieno-Nyunya
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya.
| | - Timothy A Kellogg
- Global Health Sciences, University of California, San Francisco, California, USA.
| | - Davies Kimanga
- Ministry of Health, National AIDS and STI Control Programme, Kenyatta National Hospital Grounds, 19361-00202, Nairobi, Kenya.
| | - Nicholas Muraguri
- Ministry of Health, National AIDS and STI Control Programme, Kenyatta National Hospital Grounds, 19361-00202, Nairobi, Kenya.
| | - Mamo Umuro
- Ministry of Health, National Public Health Laboratory Services, Nairobi, Kenya.
| | - Joy Mirjahangir
- Global Health Sciences, University of California, San Francisco, California, USA.
| | - Ellen Stein
- Global Health Sciences, University of California, San Francisco, California, USA.
| | | | - Andrea A Kim
- Division of Global HIV and Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya.
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Ochieng C, Ahenda P, Vittor AY, Nyoka R, Gikunju S, Wachira C, Waiboci L, Umuro M, Kim AA, Nderitu L, Juma B, Montgomery JM, Breiman RF, Fields B. Seroprevalence of Infections with Dengue, Rift Valley Fever and Chikungunya Viruses in Kenya, 2007. PLoS One 2015; 10:e0132645. [PMID: 26177451 PMCID: PMC4503415 DOI: 10.1371/journal.pone.0132645] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 06/16/2015] [Indexed: 11/26/2022] Open
Abstract
Arthropod-borne viruses are a major constituent of emerging infectious diseases worldwide, but limited data are available on the prevalence, distribution, and risk factors for transmission in Kenya and East Africa. In this study, we used 1,091 HIV-negative blood specimens from the 2007 Kenya AIDS Indicator Survey (KAIS 2007) to test for the presence of IgG antibodies to dengue virus (DENV), chikungunya virus (CHIKV) and Rift Valley fever virus (RVFV).The KAIS 2007 was a national population-based survey conducted by the Government of Kenya to provide comprehensive information needed to address the HIV/AIDS epidemic. Antibody testing for arboviruses was performed on stored blood specimens from KAIS 2007 through a two-step sandwich IgG ELISA using either commercially available kits or CDC-developed assays. Out of the 1,091 samples tested, 210 (19.2%) were positive for IgG antibodies against at least one of the three arboviruses. DENV was the most common of the three viruses tested (12.5% positive), followed by RVFV and CHIKV (4.5% and 0.97%, respectively). For DENV and RVFV, the participant’s province of residence was significantly associated (P≤.01) with seropositivity. Seroprevalence of DENV and RVFV increased with age, while there was no correlation between province of residence/age and seropositivity for CHIKV. Females had twelve times higher odds of exposure to CHIK as opposed to DENV and RVFV where both males and females had the same odds of exposure. Lack of education was significantly associated with a higher odds of previous infection with either DENV or RVFV (p <0.01). These data show that a number of people are at risk of arbovirus infections depending on their geographic location in Kenya and transmission of these pathogens is greater than previously appreciated. This poses a public health risk, especially for DENV.
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Affiliation(s)
- Caroline Ochieng
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
- * E-mail:
| | - Petronella Ahenda
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Amy Y. Vittor
- Division of Infectious Diseases and Global Medicine, Emerging Pathogens Institute, University of Florida, Gainesville, Florida, United States of America
| | - Raymond Nyoka
- Global Disease Detection Program, United States Center for Disease Control and Prevention, Nairobi, Kenya
| | - Stella Gikunju
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Cyrus Wachira
- Center for Global Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Mamo Umuro
- Ministry of Public Health and Sanitation, Nairobi, Kenya
| | - Andrea A. Kim
- Global Disease Detection Program, United States Center for Disease Control and Prevention, Nairobi, Kenya
| | | | - Bonventure Juma
- Global Disease Detection Program, United States Center for Disease Control and Prevention, Nairobi, Kenya
| | - Joel M. Montgomery
- Global Disease Detection Program, United States Center for Disease Control and Prevention, Nairobi, Kenya
| | - Robert F. Breiman
- Global Disease Detection Program, United States Center for Disease Control and Prevention, Nairobi, Kenya
- Emory University, Atlanta, Georgia, United States of America
| | - Barry Fields
- Global Disease Detection Program, United States Center for Disease Control and Prevention, Nairobi, Kenya
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Gachuki T, Sewe R, Mwangi J, Turgeon D, Garcia M, Luman ET, Umuro M. Attaining ISO 15189 accreditation through SLMTA: A journey by Kenya's National HIV Reference Laboratory. Afr J Lab Med 2014; 3:216. [PMID: 26753130 PMCID: PMC4703332 DOI: 10.4102/ajlm.v3i2.216] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background The National HIV Reference Laboratory (NHRL) serves as Kenya’s referral HIV laboratory, offering specialised testing and external quality assessment, as well as operating the national HIV serology proficiency scheme. In 2010, the Kenya Ministry of Health established a goal for NHRL to achieve international accreditation. Objectives This study chronicles the journey that NHRL took in pursuit of accreditation, along with the challenges and lessons learned. Methods NHRL participated in the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme from 2010–2011. Improvement projects were undertaken to address gaps in the 12 quality system essentials through development of work plans, team formation, training and mentorship of personnel. Audits were conducted and the scores used to track progress along a five-star grading scale. Standard quality indicators (turn-around time, specimen rejection rates and service interruptions) were measured. Costs of improvement projects and accreditation were estimated based on expenditures. Results NHRL scored 45% (zero stars) at baseline in March 2010 and 95% (five stars) after programme completion in October 2011; in 2013 it became the first public health laboratory in Kenya to attain ISO 15189 accreditation. From 2010–2013, turn-around times decreased by 50% – 95%, specimen rejections decreased by 93% and service interruptions dropped from 15 to zero days. Laboratory expenditures associated with achieving accreditation were approximately US $36 500. Conclusion International accreditation is achievable through SLMTA, even for a laboratory with limited initial quality management systems. Key success factors were dedication to a shared goal, leadership commitment, team formation and effective mentorship. Countries wishing to achieve accreditation must ensure adequate funding and support.
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Affiliation(s)
- Thomas Gachuki
- Kenya Ministry of Health, National HIV Reference Laboratory, Kenya
| | - Risper Sewe
- Kenya Ministry of Health, National HIV Reference Laboratory, Kenya
| | - Jane Mwangi
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - David Turgeon
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mary Garcia
- Clinical Pathology Laboratories, Austin, Texas, United States
| | - Elizabeth T Luman
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Mamo Umuro
- Kenya Ministry of Health, National HIV Reference Laboratory, Kenya
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Odhiambo JO, Kellogg TA, Kim AA, Ng'ang'a L, Mukui I, Umuro M, Mohammed I, De Cock KM, Kimanga DO, Schwarcz S. Antiretroviral treatment scale-up among persons living with HIV in Kenya: results from a nationally representative survey. J Acquir Immune Defic Syndr 2014; 66 Suppl 1:S116-22. [PMID: 24732815 DOI: 10.1097/qai.0000000000000122] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2007, 29% of HIV-infected Kenyans in need of antiretroviral therapy (ART), based on an immunologic criterion of CD4 ≤350 cells per microliter, were receiving ART. Since then, substantial treatment scale-up has occurred in the country. We analyzed data from the second Kenya AIDS Indicator Survey (KAIS 2012) to assess progress of treatment scale-up in Kenya. METHODS KAIS 2012 was a nationally representative survey of persons aged 18 months to 64 years that collected information on HIV status, care, and treatment. ART eligibility was defined based on 2 standards: (1) 2011 Kenya eligibility criteria for ART initiation: CD4 ≤350 cells per microliter or co-infection with active tuberculosis and (2) 2013 World Health Organization (WHO) eligibility criteria for ART initiation: CD4 ≤500 cells per microliter, co-infection with active tuberculosis, currently pregnant or breastfeeding, and infected partners in serodiscordant relationships. Blood specimens were tested for HIV antibodies and HIV-positive specimens tested for CD4 cell counts. RESULTS Among 13,720 adults and adolescents aged 15-64 years, 11,626 provided a blood sample, and 648 were HIV infected. Overall, 58.8% [95% confidence interval (CI): 52.0 to 65.5) were eligible for treatment using the 2011 Kenya eligibility criteria and 77.4% (95% CI: 72.4 to 82.4) using the 2013 WHO eligibility criteria. Coverage of ART was 60.5% (95% CI: 50.8 to 70.2) using the 2011 Kenya eligibility criteria and 45.9% (95% CI: 37.7 to 54.2) using the 2013 WHO eligibility criteria. CONCLUSIONS ART coverage has increased from 29% in 2007 to 61% in 2012. If Kenya adopts the 2013 WHO guidelines for ART initiation, need for ART increases by an additional 19 percentage points and current coverage decreases by an additional 15 percentage points, representing an additional 214,000 persons who will need to be reached.
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Affiliation(s)
- Jacob O Odhiambo
- *Kenya Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya; †Global Health Sciences, University of California, San Francisco, San Francisco, CA; ‡Division of Global HIV/AIDS Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya; §National AIDS and Sexually Transmitted Infection (STI) Control Programme, Ministry of Health, Nairobi, Kenya; and ‖National Public Health Laboratories Services, Ministry of Health, Nairobi, Kenya
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