Gilbert Kokwaro

The involvement and engagement of adolescents in community-based HIV prevention programmes are crucial for enhancing the effectiveness and sustainability o

Objectives The increasing burden of cardiovascular diseases (CVDs) in Kenya threatens its healthcare system. There is a need for innovative models that improve equitable access to CVD prevention services. Community markets are social establishments with untapped potential to promote public health. This is a multiphased feasibility study that explores the potential of Health Kiosks in Markets (HEKIMA) to improve access to CVD prevention services. In this formative phase, the aim was to assess the readiness of primary healthcare centres (HCs) and community markets to jointly deliver CVD prevention services. Design Mixed methods using concept mapping and readiness surveys. Concept mapping with 35 stakeholders from different sectors (health and non-health) to identify feasible priorities for HEKIMA. The readiness questionnaire contained 193 items which were based on the guidance of the WHO Handbook for Monitoring the Building Blocks of Health Systems and adapted to suit the context of a single HC. Setting Vihiga County is located in western Kenya and has a population of 590 013. A total of 18 HCs and 19 markets were assessed, with 10 HCs and 15 markets included in the evaluation. Results 91 statements were generated from concept mapping and distilled into 8 clusters, namely equipment and supplies, access and referral, communication, manpower, networks and linkages, practice, service delivery and health promotion. Agreed actions for HEKIMA were provision of efficient quality services, health promotion and partnerships sensitive to the local context. HCs and markets had established governance systems and basic infrastructure. The majority of the HCs lacked essential CVD medications. No HC–market interface existed but there was willingness for a partnership. Conclusion There was strong consensus that an HC–market interface via community health worker manned kiosks could have a positive impact on health systems, markets and CVD prevention in vulnerable communities. However, significant infrastructural, technical and resource gaps were observed that need to be addressed.

This study investigated the impact of the COVID-19 pandemic on essential medicine availability in Kenya’s health system. Key informant interviews were conducted, and the data were analyzed using NVIVO software. Six themes emerged, aligning with the WHO health system building blocks. These themes provided insights into the experiences, challenges, and opportunities regarding essential medicine availability during the pandemic. The initial response involved reallocating resources, affecting the procurement of essential medicines at national and county levels. To enhance preparedness, investments are crucial in strengthening financial systems and policies, improving supply chain resilience, and promoting local production through regulatory enhancements. These strategies aim to build resilient health systems and self-reliance, particularly for countries transitioning from donor aid. The findings underscore the importance of effective preparedness to ensure the availability of essential medicines during emergencies like the COVID-19 pandemic

Background: Epidemics and disease outbreaks are the occurrence of cases of disease in excess of what would be normally expected. Epidemic-prone diseases, including emerging and re-emerging diseases, constitute the greatest threat to public health security and disruption of social and economic development. When cases of epidemics are diagnosed in specific areas, an outbreak response is triggered to stop the spread swiftly, keeping as few people as possible from being infected. In the past 20 years, the sub-Saharan region has witnessed a marked increase in the number of outbreaks in pandemics, such as cholera, dengue, A/H5N 1 influenza, and rift valley fever, among others. And while many of the efforts toward containment have been individually studied, we have no recent studies that examine them collectively in order to draw appropriate comparisons, no recent studies that have especially focused on hard-to-reach areas, and none that have applied a health systems lens. This study thus details a scoping review of short-term health system responses to epidemics across hard-to-reach areas in sub-Saharan Africa. Methods: A scoping review will be undertaken following PRISMA guidelines for scoping reviews. A modified Donabedian framework will be used to help in understanding approaches used in the immediate health system responses to disease outbreaks. The review will focus on published and unpublished studies that report short-term health systems responses during disease outbreaks in sub-Saharan Africa. These will be gleaned from PubMed, google scholar and Cochrane electronic databases, supplemented by a Google advanced search. In addition, manual searches will be carried out through related articles and websites. Two authors will independently screen the studies and extract data. Disagreements will be resolved by discussions, and a third reviewer will decide if there is no consensus. Data will be charted, coded, and narratively synthesized. Outcome: We anticipate developing a document that will show the different approaches health systems responded with to epidemics in the short term and that will contribute to strengthening future short-term responses to disease outbreaks by identifying best practices and innovative ideas. In addition, the study will highlight possible knowledge gaps that need to be filled with new research.

HIV-1 is highly variable genetically and at protein level, a property it uses to subvert antiviral immunity and treatment. The aim of this study was to assess if HIV subtype differences were associated with variations in glycosylation patterns and co-receptor tropism among HAART patients experiencing different virologic treatment outcomes. A total of 118 HIV env C2V3 sequence isolates generated previously from 59 Kenyan patients receiving highly active antiretroviral therapy (HAART) were examined for tropism and glycosylation patterns. For analysis of Potential N-linked glycosylation sites (PNGs), amino acid sequences generated by the NCBI’s Translate tool were applied to the HIVAlign and the N-glycosite tool within the Los Alamos Database. Viral tropism was assessed using Geno2Pheno (G2P), WebPSSM and Phenoseq platforms as well as using Raymond’s and Esbjörnsson’s rules. Chi square test was used to determine independent variables association and ANOVA applied on scale variables. At respective False Positive Rate (FPR) cut-offs of 5% (p = 0.045), 10% (p = 0.016) and 20% (p = 0.005) for CXCR4 usage within the Geno2Pheno platform, HIV-1 subtype and viral tropism were significantly associated in a chi square test. Raymond’s rule (p = 0.024) and WebPSSM (p = 0.05), but not Phenoseq or Esbjörnsson showed significant associations between subtype and tropism. Relative to other platforms used, Raymond’s and Esbjörnsson’s rules showed higher proportions of X4 variants, while WebPSSM resulted in lower proportions of X4 variants across subtypes. The mean glycosylation density differed significantly between subtypes at positions, N277 (p = 0.034), N296 (p = 0.036), N302 (p = 0.034) and N366 (p = 0.004), with HIV-1D most heavily glycosylated of the subtypes. R5 isolates had fewer PNGs than X4 isolates, but these differences were not significant except at position N262 (p = 0.040). Cell-associated isolates from virologic treatment success subjects were more glycosylated than cell-free isolates from virologic treatment failures both for the NXT (p = 0.016), and for all the patterns (p = 0.011). These data reveal significant associations of HIV-1 subtype diversity, viral co-receptor tropism, viral suppression and envelope glycosylation. These associations have important implications for designing therapy and vaccines against HIV. Heavy glycosylation and preference for CXCR4 usage of HIV-1D may explain rapid disease progression in patients infected with these strains.