An estimated 35.3 million persons worldwide were living with the human immunodeficiency virus (HIV) in 2012, while 8.6 million people developed tuberculosis (TB), the majority of them in sub-Saharan Africa. Kenya is one of the world’s 22 high TB burden2 and high HIV burden countries.
Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN.
WHO and Center for Disease Control and Prevention recommends infection control to reduce the risk of Tuberculosis (TB) transmission. In Kirogo Chest Clinic there was an identified gap of tracing contact of smear positive TB client who were not identified early hence presenting later with active TB. Earlier in 2012 and 2013, health workers requested TB clients to tell their contacts to come to the clinic or bring them along in their next clinic. This was a challenge as most of the contacts never came. To address this, the staff held a multidisciplinary team meeting, discussed the issue and engaged the Community Health Volunteers (CHVs) for identification and tracking at community level. They liaised with the Public Health Officer who linked the chest clinic with CHVs working in the Community Units.
Herpes simplex virus type 2 (HSV-2) is an important cause of genital ulcers and can increase HIV-1 transmission risk. Our objective was to determine the incidence and correlates of HSV-2 infection in HIV-1-seronegative Kenyan men reporting high-risk sexual behaviour, compared to high-risk HIV-1-seronegative women in the same community.
Methods Cohort participants were screened for prevalent HIV-1 infection. HIV-1-uninfected participants had regularly scheduled follow-up visits, with HIV counseling and testing and collection of demographic and behavioral data. Archived blood samples were tested for HSV-2.
HSV-2 prevalence was 22.0% in men and 50.8% in women (p<0.001). HSV-2 incidence in men was 9.0 per 100 person-years, and was associated with incident HIV-1 infection (adjusted incidence rate ratio [aIRR] 3.9, 95% CI 1.3–12.4). Use of soap for genital washing was protective (aIRR 0.3, 95% CI 0.1–0.8). Receptive anal intercourse had a borderline association with HSV-2 acquisition in men (aIRR 2.0, 95% CI 1.0–4.1, p=0.057), and weakened the association with incident HIV-1. Among women, HSV-2 incidence was 22.1 per 100 person-years (p < 0.001 compared to incidence in men), and was associated with incident HIV-1 infection (aIRR 8.9, 95% CI 3.6–21.8) and vaginal washing with soap (aIRR 1.9, 95% CI 1.0–3.4).
HSV-2 incidence in these men and women is among the highest reported, and is associated with HIV-1 acquisition. While vaginal washing with soap may increase HSV-2 risk in women, genital hygiene may be protective in men.
The African continent has immense depth of culture, warmth and a very special heartbeat
1 that makes it an unmatched home to approximately 973 million people . However, despite
its tremendous potential and resources, the continent carries a heavy disease morbidity
and mortality burden mostly impacted by Human Immune deficiency virus (HIV),
Tuberculosis (TB) and Malaria.
Globally, there are an estimated 33 million people living with HIV and 2 million people died
due to Acquired Immune Deficiency Syndrome (AIDS) in 2007. Africa bears a
disproportionate share of the global burden of HIV. Sub-Saharan Africa is home to 67% of all
people living with HIV and Southern Africa alone accounts for 35% of HIV infections and
38% of AIDS deaths in 2007. An estimated 370,000 children younger than 15 years were
infected with HIV in 2007, and almost 90% live in sub-Saharan Africa. Nearly 12 million
2 children under age 18 have lost one or both parents to HIV within the region .
WHO estimates that 9.27 million new cases of TB occurred in 2007. Among the 15 countries
with the highest TB incidence rates, 13 are in Africa, a phenomenon linked to high rates of
HIV co-infection. In 2007, as in previous years, the African Region accounted for 79% of HIV-
3 positive TB cases .
Of the estimated 247 million episodes of malaria in 2006, 86% were in the African region.
Eighty percent (80%) of the cases recorded in Africa were in 13 countries, and over half were
in Nigeria, Democratic Republic of the Congo, Ethiopia, United Republic of Tanzania and
Kenya. Of the estimated 881 000 malaria deaths globally in 2006, 91% were in Africa and
4 85% were children under 5 years of age .
The scale-up of treatment for HIV and multidrug-resistant tuberculosis (MDR-TB) in developing countries requires a long-term relationship with the patient, accurate and accessible records of each patient’s history, and methods to track his/her progress. Recent studies have shown up to 24% loss to follow-up of HIV patients in Africa during treatment and many patients not being started on treatment at all. Some programs for prevention of maternal–child transmission have more than 80% loss to follow-up of babies born to HIV-positive mothers. These patients are at great risk of dying or developing drug resistance if their antiretroviral therapy is interrupted. Similar problems have been found in the scale-up of MDR-TB treatment.
The SEARCH study is a cluster randomized community trial of 32 communities each with approximately 10,000 residents. Community health campaigns will be conducted in all study communities and will offer HIV testing and multi-disease prevention and treatment services. The intervention is antiretroviral therapy (ART), independent of CD4 cell count, delivered in a streamlined approach for all HIV infected adults and children. Components of streamlined care include ongoing HIV combination prevention strategies including male circumcision. Control communities ART treatment will follow country guidelines.
HIV incidence will be measured using an efficient community cohort design (ECCO) comprised of three key elements: A) baseline household community level census, B) community health campaigns (CHC) incorporating HIV testing that use unique identifiers to link individuals between successive waves of the intervention, and C) tracking and evaluation of individuals who do not participate in CHCs.