Prof Walter Jaoko, the director of Kenya AIDS Vaccine Initiative speaks during a Science Media Café organised by the Media for Environment Science, Health and Agriculture in Nairobi on September 9, 2022.

Prof Walter Jaoko: How Africa can prevent the next pandemic

Prof Walter Jaoko, the director of Kenya AIDS Vaccine Initiative speaks during a Science Media Café organised by the Media for Environment Science, Health and Agriculture in Nairobi on September 9, 2022.

African governments are not prepared to tackle the next pandemic, a professor of medical microbiology and tropical medicine at the Kenya AIDS Vaccine Initiative (KAVI) has warned.

Prof Walter Jaoko, the director of KAVI and former Department of Medical Microbiology at the University of Nairobi chairperson, said the level of epidemic preparedness in the continent is at its lowest.

Speaking during a Science Media Café in Nairobi on Friday organised by the Media for Environment Science, Health and Agriculture (MESHA), he said the Epidemic Preparedness Index paints a grim picture of disaster management in Africa.

“We know the next epidemic will come and the question is whether we are prepared. Epidemic Preparedness Index is a tool used to try and determine how prepared countries are. The tool shows that most African countries are not prepared,” said Prof Jaoko.

Jaoko, who has over 30 years of experience in teaching and research in various aspects of infectious diseases transmission, pathology, treatment, prevention and control, noted that one of the biggest impediments is the lack of adequate funding.

“African governments need to set aside enough funds to prepare for the next pandemic. They need to set up national public health institutes that can plan and organise how to handle the next pandemic,” added Jaoko.

African Union

He added: “African governments need to work closely with the African Union (AU). The AU has a mechanism through the African Centre for Disease Control and Prevention (CDC) which will give them guidelines and tools on what needs to be done as we wait for the next pandemic.”

“We need to have health care workers that are well trained for epidemic preparedness. We also need to strengthen our public health institutes and care facilities by equipping them well with equipment and drugs,” he added.

He observed that in 2001 the Abuja Declaration called upon the African Union member countries to commit to health system preparedness by allocating at least 15 per cent of their annual budgets to the health sector. 

Kenya’s 2022/2023 overall budget estimates of Sh3.31 trillion gave health its biggest allocation ever of Sh146 billion which translates to about 4.41 per cent of the total budget.

In the last financial year of 2021/2022, the health budget was allocated Sh121.1 billion.

However, this massive budgetary allocation still fell short of the Abuja declaration even as Director-General of the World Health Organization (WHO) Tedros Adhanom Ghebreyesus reminded countries to increase their investments in the health sector.

 
“There is enough evidence health spending is an investment, not a cost. Health is not a luxury, but a human right; not simply an outcome of development, but the foundation of social, economic and political stability and security,” said Dr Tedros.

Prof Jaoko reiterated that health is a major component of any nation’s development.

“Without a healthy population, a country will record a zero development record.”

He called upon the African governments to fulfil their commitments by increasing the health sector budgets as per the Abuja Declaration signed 21 years ago. 

He said, with the current harsh economic conditions in Africa, the level of funding by African governments may not easily be fulfilled.

However, he urged the African governments to collaborate with other stakeholders and form Private Public Partnerships and commit some money which is topped by the private sector.

“Private sector has a keen interest in health because they are also major stakeholders as they would like to have a healthy workforce to meet their objectives to prepare adequately to fight future epidemics,” he said.

Address corruption

Prof Jaoko called on African governments to address corruption that has led to the embezzlement of billions of shillings in the health and other sectors.

“African governments should put in place mechanisms to ensure the health sector money is safe and secure,” he added.

On African researchers, Prof Jaoko said the continent has a huge potential for research and development but the lack of funding by the African governments remains a major hindrance.

“A lot of research happening in Africa is funded by bilateral partners. It is only South Africa that has set sufficient funds to boost research in their country.”

He said the National Research Fund Kenya is grossly underfunded and is not working well.

“I urge the government to become a little bit more serious and pump in more funds for research as we have a pool of researchers in Kenya willing to conduct various types of research in the health sector,” he said.

fmureithi@ke.nationmedia.com

Joan Wasike, County Laboratory coordinator, Bungoma, western Kenya, receives her booster vaccine at the launch. Looking on are County Health Services Director Dr Johnstone Akatu and Health Executive Dr Anthony Walela.  Photo Credit: Gabriel Ingubu.

County of Bungoma launches 10-day campaign to upscale COVID-19
vaccination

By Gabriel Ingubu

Joan Wasike, County Laboratory coordinator, Bungoma, western Kenya, receives her booster vaccine at the launch. Looking on are County Health Services Director Dr Johnstone Akatu and Health Executive Dr Anthony Walela. Photo Credit: Gabriel Ingubu.

Kenya’s Bungoma County has launched a rapid results initiative to administer over 170,000  COVID-19 vaccine doses in 10 days.

Speaking during the launch, county Health Executive Dr Anthony Walela asked all the stakeholders in his department and the elite from the county to be good ambassadors of the vaccination programme by encouraging other residents to take the jab.

“So far our county stands at 32 per cent in vaccine uptake yet for us to be declared safe it should be 80 per cent,” said Dr Walela.

The county  is listed among 24 others  that are high risk areas, yet its vaccine uptake is still very low. “ 

Data obtained from the Health Department indicates that 577,032 people have taken the first dose and only 224,500 have taken two doses.

“I would like my health team to be pro-active enough so that we reach the 352,532 yet to receive their second dose,” said Dr Walela.

Bungoma is considered a hotspot for COVID-19 infections because of long-distance truck stopovers at all markets along Eldoret-Malaba road, which leads to Uganda with Bukembe and Kanduyi being the busiest.

The initiative comes amid calls on journalists to use all platforms available to increase awareness among pregnant women to take the jab.

 

Speaking during a cross-border science café organised by MESHA and AVACon July 6, 2022, Jean Nachega, Associate Professor of Medicine, Infectious Diseases, Microbiology and Epidemiology at Graduate School of Public Health, Pittsburgh University, emphasised that pregnant women reduce their immunity, especially during their last trimester, so protecting them should be given a priority.

According to Bungoma County Director of Health Services Dr Johnstone  Akatu, 171 teams of three people each have been sent on an outreach mission across the county to administer the vaccine at health facilities, worship centres, and at strategic places like government offices.

“Research on COVID-19 is still ongoing. Recently we were giving the vaccine to those aged 15 years and above and now we can administer the vaccine to children from the age of 12 years upwards,” said Akatu. He also urged his staff to keep testing, saying that in the second week of July, 98 people tested positive, yet many people have relaxed their guard against the infection.

At the launch of the initiative, 16 people were vaccinated within one hour.

Among the counties enlisted to participate in the programme are Baringo, Bungoma, Busia, Elgeyo Marakwet, Embu, Homa Bay, Kituyi, Kajiado, Kericho, Kisii, Lamu, Makueni, Meru, Migori, Mombasa, Murang`a, Nandi, Nyamira, Trans nzoia, Turkana, Nyandarua, Samburu, Tharaka Nithi and Uasin Gishu.

If the counties realise their targets within the 10 days, it will be a boost for the national government to reach its target of vaccinating 25 million people by December 2022.

International Aids Society President and International Co-Chair of AIDS 2022, Dr Adeeba Kamarulzaman

Momentum builds to deliver long-acting PrEP for HIV prevention

Photo: International Aids Society President and International Co-Chair of AIDS 2022, Dr Adeeba Kamarulzaman 

By Mike Mwaniki I mikemwaniki2016@gmail.com

Oral PrEP was first approved by the US Food and Drug Administration a decade ago, but uptake and adherence have been limited, partly because some people have difficulty taking daily pills.

In recent years, studies have shown that cabotegravir-LA (CAB-LA), administered by injection once every two months, is a safe and effective alternative to oral PrEP.

CAB-LA is approved for PrEP only in the US, but its maker, ViiV Healthcare, has submitted marketing applications in additional countries.

Speaking during the 24th International Aids Conference held in Montreal, Canada, the International Aids Society President and International Co-Chair of AIDS 2022, Dr Adeeba Kamarulzaman said, “Long-acting PrEP could play a major role in ending the HIV pandemic, but right now, very few people can get it.

“Scaling up affordable access to this game-changing prevention tool must be a top global priority.”

During the conference, researchers presented new data confirming that CAB-LA is safe and effective for PrEP in trans and cisgender women. The World Health Organisation (WHO) also released its first guidelines for CAB-LA for PrEP, and ViiV Healthcare and the Medicines Patent Pool announced that they have signed a voluntary licensing agreement for patents relating to CAB-LA for PrEP. 

Finally, WHO, Unitaid, UNAIDS and The Global Fund announced the launch of a global coalition to accelerate access to long-acting PrEP with AVAC as the secretariat.

Researchers announced the first trans-specific analysis of data from the landmark HPTN 083 study confirming that CAB-LA is a safe and highly effective HIV prevention option for transgender women.

HPTN 083 is a Phase 3 study comparing CAB-LA to daily oral TDF/FTC for HIV prevention in cisgender men and trans women who have sex with men.

In 2020, researchers announced that HPTN 083 had demonstrated a 66 per cent reduced risk of HIV acquisition for CAB-LA compared to TDF/FTC.

The new analysis, which was presented at AIDS 2022 by Beatriz Grinsztejn of the Evandro Chagas National Institute of Infectious Diseases – Fiocruz (Brazil), reports on the safety, prevention efficacy and pharmacokinetics of CAB-LA in trans women during the blinded phase of HPTN 083.

Of 4,566 study participants, 570 (12.5 per cent) were trans women, 330 (57.9 per cent) of whom reported use of gender-affirming hormonal therapy.

HIV incidence among trans women was lower in the CAB-LA group (0.54 per cent) than in the TDF/FTC group (1.80 per cent).

CAB-LA was well tolerated in trans women and, importantly, initial findings suggest there is no impact of gender-affirming hormonal therapy on CAB concentrations

New data from the HPTN 084 study shows that among individuals assigned female at birth, CAB-LA continues to be superior to daily oral TDF/FTC in preventing HIV infection.

HPTN 084 is an ongoing Phase 3 randomised controlled trial of CAB-LA for PrEP in individuals assigned female at birth.

In late 2020, a planned interim review found that CAB-LA was superior to daily oral TDF/FTC for HIV prevention in this population.

The blinded portion of the trial was then stopped; participants were subsequently unblinded and continued on their original randomised study regimen pending a protocol amendment to offer open-label CAB-LA.

This update, which was presented at AIDS 2022 by Sinead Delany-Moretiwe of the University of the Witwatersrand (South Africa), reports that 23 incident infections (3 CAB-LA, 20 TDF/FTC) were detected in the 12-month unblinded period.

Of these, two (1 CAB-LA, 1 TDF/FTC) occurred during the blinded phase, and only one of the CAB-LA cases had ever received an injection.

 

Cumulatively, 62 incident HIV infections (6 CAB, 56 TDF/FTC) have been observed over 6,626 person-years of follow-up (HIV incidence 0.94 per cent). In addition, no new safety concerns were identified.  
Also during the press conference, WHO released new guidelines for the use of CAB-LA as PrEP for HIV and called for countries to consider this safe and highly effective prevention option for people at substantial risk of HIV infection.

The guidelines will support countries as they plan for CAB-LA introduction and facilitate urgently needed operational research.  

The WHO’s Director (Global HIV, Hepatitis and Sexually Transmitted Infections programme) Meg Doherty said, “Long-acting cabotegravir is a safe and highly effective HIV prevention tool, but isn’t yet available outside study settings. We hope these new guidelines will help accelerate country efforts to start to plan and deliver CAB-LA alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring.”

At the same time, ViiV Healthcare and the Medicines Patent Pool (MPP) announced that they had signed a voluntary licensing agreement for patents relating to CAB-LA for HIV PrEP to help enable access in least developed, low-income, lower-middle-income and sub-Saharan African countries.

Through this agreement, selected generic manufacturers will have the opportunity to develop, manufacture and supply generic versions of CAB-LA for PrEP in 90 countries, subject to required regulatory approvals.

ViiV Healthcare and MPP will now work closely with stakeholders and selected generic manufacturers to enable access to generic CAB-LA for PrEP as soon as possible.

The MPP Executive Director, Charles Gore, said, “We are delighted to sign this voluntary licence with ViiV for cabotegravir LA for PrEP.

 “Long-acting technologies open up a whole new dimension that facilitates medicine uptake, and this product brings a much-needed option for those at risk.

ViiV Healthcare Chief Executive Deborah Waterhouse said, “This announcement represents a potentially game-changing moment in HIV prevention. Enabling at-scale access to generic cabotegravir LA for PrEP could play a significant role in averting the transmission of HIV, particularly amongst women and adolescent girls, and help end the HIV epidemic.

During the occasion, the new Coalition to Accelerate Access to Long-Acting PrEP was launched.

Convened by WHO, Unitaid, UNAIDS and The Global Fund, and with AVAC as the secretariat, the coalition will coordinate key stakeholder activities on PrEP access, including jointly developing strategies to identify and overcome access challenges for new PrEP options in the near to medium term (especially related to ViiV’s injectable CAB, including generics) and the medium to longer term (related to future PrEP products).

“New HIV prevention options now reaching the market, such as injectable cabotegravir, hold the promise to transform HIV prevention,” said Unitaid Deputy Director Tenu Avafia.

“But we must move far more quickly than we did with oral PrEP if we are to have real impact on the epidemic. This new coalition being formed will prioritise the acceleration of affordable, equitable and widespread access to injectable long-acting cabotegravir for PrEP without delay.”

The Global CAB facilitator at Afrocab, Jacque Wambui said, Afrocab and our community partners are excited about this announcement.

“Since we began mobilising community partners around the world almost six months ago, we have been encouraged to see the responsiveness and engagement from global partners that have made this announcement possible.”

Ms Wambui added, “However, we recognise this is just the first step on this path for long-acting cabotegravir for PrEP.

“Speedy technology transfer and low-cost pricing have still not been secured. Until then, the promise of accessible, affordable CAB-LA will not be realised. Afrocab and our community partners will continue to advocate around these issues until they are resolved.”

A study has revealed that though COVID-19 vaccines have been found to be safe and effective during pregnancy, only 13 of the sub-Saharan Africa countries recommend the vaccination for pregnant women.

Pregnant? You need that COVID jab right about now!

Njeri Murigi (healthjournalist3@gmail.com)

That many African countries have not recommended COVID-19 vaccines for pregnant women is proving to be a time bomb.

A new study now recommends prioritizing vaccinating of pregnant women in Africa against the coronavirus.

The study dubbed “Severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) Infection and Pregnancy in Sub-Saharan Africa” indicates that pregnancy puts women at higher risk of severe medical complications or death from COVID-19.

“Pregnancy is natural immunosuppression, as the body is struggling to accommodate two people. The body needs to build a lot of antibodies to fight microbe infections because of this. That is why vaccination during pregnancy is important because it helps build antibodies that can help protect both the mother and the baby,” Prof Jean Nachega, the lead researcher for this study, said during the release of the study findings to journalists from Kenya, Uganda, Zambia, and Zimbabwe.

The study analysed health records from 1,315 women treated at hospitals in six countries in the sub-Saharan Africa between March 2020 and March 2021. Roughly one third of the sampled women were pregnant and had tested positive for the coronavirus. Another third of the women were pregnant, but had tested negative. The remainder were not pregnant, but had tested positive for COVID-19.

The researchers tested how pregnancy, infection with the coronavirus and conditions such as HIV, TB, malaria and sickle cell anemia affected a woman’s likelihood of severe disease or death.

The findings were grim. Pregnant women who were hospitalised in sub-Saharan Africa were five times more likely to die in the hospital if they tested positive for the coronavirus. Being pregnant doubled the odds that a woman admitted to a hospital with COVID-19 would die.

According to the study, though COVID-19 vaccines have been found to be safe and effective during pregnancy, only 13 of the sub-Saharan Africa countries currently recommend COVID-19 vaccination for some or all pregnant women. Globally, about 110 countries have recommended vaccination for this category. 

“Most African governments are yet to start vaccinating pregnant women on basis that the vaccine could harm them, or their fetuses and babies, yet it has been extensively demonstrated that that’s not the case,” said Prof Nachega.

According to the study, despite the fact that women of childbearing age need to be vaccinated against COVID-19 during or even before pregnancy, high rates of vaccine hesitancy in sub-Saharan Africa is a big challenge. According to the report, only about 19 per cent of women intend to get the vaccine.

“The most important implication of this study is to advocate for COVID vaccination in women of childbearing age. We decided to conduct this research because few data are available on COVID-19 outcomes among pregnant women in sub-Saharan Africa (SSA), where high-risk comorbidities are prevalent. We investigated the impact of pregnancy on SARS-CoV-2 infection and of SARS-CoV-2 infection on pregnancy to generate evidence for health policy and clinical practice,” he revealed.

The Centers for Disease Control and Prevention (CDC) recommends Covid-19 jabs for everyone aged at least six months, including pregnant and breastfeeding women, those trying to get pregnant, or might become pregnant in the future. It also recommends boosters for the same groups if eligible. 

More evidence continues to show that COVID-19 vaccination before and during pregnancy is safe, effective, and beneficial to both mother and child. The benefits of receiving a COVID-19 jab therefore far much outweigh any potential risks of vaccination during pregnancy.

Pfizer-BioNTech or Moderna (mRNA COVID-19 vaccines) are preferred over the J&J/Janssen ones for primary and booster vaccination. The J&J/Janssen vaccine may, however be considered in some instances, according to researchers. 

Judy Abong’o, Rangwe Sub-county Aids and STI Coordinator (SCASCO) is worried at the rising number of teenage girls getting pregnant whom she said leave the girls pre-disposed to HIV infection.

Unprotected sex among adolescents blamed for big HIV burden in western Kenya

By Carol Otieno Miyawa  I lolwecarol@gmail.com

The rampant cases of teen pregnancy in Rangwe, Homa Bay County means many young girls have sex without protection, raising their chances of acquiring HIV.

Rangwe Sub-county AIDS and STIs Coordinator Judith Abong’o said because of this unprotected sex, the sub-county records 2,000 new HIV infections yearly.

“The teenage girls and adolescents need to be taught by their elders about sex, unwanted pregnancy and HIV.

“There have been a lot of teenage pregnancies in the area. We even received some information about an 11year old that got pregnant,” said Ms Abong’o during a MESHA science café in Rangwe.

She said Rangwe has a total population of 125,000, and 18.2 per cent of them are living with HIV. 

Out of the 13,495 people living with the virus, 13,205 are under medication, she said, adding that in 2020, the new infections of all ages was 1,313.

Abong’o said argues that adolescents are part of what contributes to the rise in HIV infections and teen pregnancy is a major burden in controlling the spread of HIV.

Rose Achieng’, mother to a victim of teenage pregnancy, said she struggled to take care of the 15-year-old girl after she got pregnant.

“Since she gave birth it has not been easy. She had to drop out of school. I had to counsel her as a mother who has experienced the burden of parenting and illiteracy. She agreed to go back to school after giving birth,” said Achieng.

Even though the girl is back in school, Achieng still has the burden of raising the child.

“I have to look for school fees, food and cater for the baby’s needs. I am a widow, I have been trying so hard for my family but it is still difficult,” she narrated.

Despite that the struggle, she says she is doing everything she can to give the girl and her other four children a better future.

Abong’o said gender based violence has also contributed to the increase in HIV/AIDS cases.  

She said when violence breaks within the households some children usually to run away into the streets, where they are at risk of sexual abuse. If they are HIV positive, the condition deteriorates because they have no food to improve their immunity and no one to administer treatment to them.

“Gender-based violence also leads spouses to finding ways to alternative to satisfy themselves sexually outside the violent marriage,” said Abong’o.

Helen Aoko, a mother of eight and a victim of gender-based violence, narrates how it has taken a toll on her life.

“There has never been happiness in my marriage. My husband used to beat me in front of my children. Of all the children, only one has been able to attend college,” she says.

“Some days back, my husband molested a 12-year-old mentally disturbed child. He was arrested and released on bond but the case is still ongoing. All the household duties now fall on me as I have become the bread winner.”

Abong’o said to reduce the HIV burden, women should be empowered, they should get jobs and have income so that they stop being misused by their male counterparts, especially in regions where fishing is the main source of income.

Justus Ochola, the Homa Bay County Aids and STI Coordinator (CASCO): The HIV situation in Homa Bay County in western Kenya still worries health officials.

The triple threat: How teen pregnancy, gender-based violence raise HIV infections

By John Riaga I oukoriaga@gmail.com

Born HIV positive, defiled by a man she knew as her grandfather and faced with the risk of an unwanted pregnancy at the tender age of 10, Philomena Kamala (not her real name) has seen it all in life.

Orphaned by HIV and AIDS, Kamala and her three siblings are under the care of their frail grandmother in a remote village in Pala Wang’a area of Karachuonyo North Sub-county and she has to contend with the double tragedy of seeing her oppressor – her grandfather – every day.

The 70-year-old was arrested and arraigned but is out on bond as the case continues.

Kamala’s tragedy is the epitome of what is now known as the triple threat of HIV infection, Sexual Gender Based Violence (SGBV) and teenage pregnancy.

Though lucky not to have conceived after her ordeal, essentially escaping from being part of the statistics of teenage mothers, Kamala may have infected her grandfather with HIV.

“Because of the loose ends in our justice system, this perpetrator is out on bond with no record of being tested to know his status. We do not know where or who else he has had intercourse with. That is our dilemma,” said Justus Ochola, the Homa Bay County Aids and STI Coordinator (CASCO).

Homa Bay County ranks among the top on all the three parameters of the triple threat.

The county was among the first in Kenya to start offering treatment for HIV in 1999. Today, Karachuonyo North Sub-county has a total of 22,000 people living with HIV on treatment.

On teenage pregnancies, the county reports a 33 per cent prevalence rate.

Ochola said, “This means that out of 100 girls of age 10-19 years, 33 will have had their first pregnancy.”

This data ranks the county as the second highest in teenage pregnancy in the entire country, second to Narok County.

Ochola said Homa Bay also has a very high number of reported cases of SGBV. Between January and April this year, there have been 1,441 cases of SGBV reported.

“These three threats are correlated and as a county we are dealing with them wholesomely,” he said.

Debrah Locho (not her real name) is a 40-year-old widow from a nearby village. Eight years ago, her 13-year-old daughter, then in Standard Five at a local primary school, was raped and impregnated by a stranger. The man had arrived in the village a few days earlier in search of menial jobs.

 

He timed one morning when Locho had travelled and defiled her daughter, then he disappeared without a trace.

“With the suspect not known by anyone and therefore nobody to arrest, we had to cope with the pregnancy. My daughter agreed to carry it to term, following intensive counselling because she had contemplated abortion,” said Locho.

Lucky to test negative, Locho’s daughter today is happily married after accepting to go back to school and finished her education. Most of the victims of teenage pregnancies are not as lucky, they end up testing positive for HIV and some drop out of school.

According to Karachuonyo North Sub-county Aids Coordinator Joseph Ondu, the fact that the perpetrators are not easily identified complicates the struggle to contain the situation.

“Since most of the perpetrators happen to be close relatives of their victims, there is always a rush to set up Kangaroo courts to quickly dispense of such cases, with the suspects getting away with the crimes,” said Ondu.

In the neighbouring Rangwe Sub-county, locals have devised measures, including taking both teenage mothers and their agemates of the opposite gender back to school in a bid to tame the rising the cases of teenage pregnancy.

Local Aids Coordinator Judy Abong’o said with a rising number of teenage girls getting pregnant, they got pre-disposed to HIV infection.

“Here too, the triple threat is real with teenage pregnancies and SGBV playing a key role in the rise in cases of new infections. That is why we have doubled our efforts through various interventions,” said Abong’o.

Rose Achieng Orwa, 46, said she is happy that though she may never get to know who raped her 14-year-old daughter and made her pregnant, the girl accepted to go back to school to complete her secondary education.

“Not knowing the perpetrator is just one problem, the other is the burden of taking care of my grandchild while the mother is in school since I have five other children,” said Achieng.

Ochola, who led a team of health journalists from the Media for Environment, Science, Health and Agriculture (MESHA) on a science café field visit to the two sub-counties, said out of the eight sub-counties in Homa Bay, Karachuonyo ranked second to Ndhiwa in HIV prevalence.

The county has 126,000 people living with HIV.

Ochola said there was a rescue centre put up in Makongeni area but it still required support in terms of materials such as consumables.

“In order for the centre to serve its intended purpose fully, we still need volunteers and partners to help out with items like sanitary towels, food stuff and other items,” he said.

Ms-Millicent-Kanyala-a-peer-educator-at-Madiany-Sub-County-Hospital-1-728x728

How community groups help people living with HIV achieve viral load suppression

Jennifer Atieno, 54, has been living with HIV for the last 12 years.

Ever since she tested positive to the virus and was enrolled for antiretroviral therapy (ART), Atieno has been taking her medication without failure.

When we, a group of journalists from the Media for Environment, Science, Health and Agriculture (MESHA) met her last week, she was in a group of other women and men who are also living with HIV in a homestead in Rarieda, Siaya County, in western Kenya.

They formed the group to encourage and advise each other to live positively with the virus. Their group known as Nyakongo Group has 12 members, who meet once every three months.

“In this group we discuss how best we can live and protect ourselves with regard to drugs we all take,” she said.

Before the group was established, Atieno got her medicine from a health facility after every three months. However, since last year when they formed the group she has been able to limit the number of hospital visits and save on transport.

“Each of us contributes Ksh10 and we give to one of us who goes to the facility and bring medicine for the 12 of us. We then agree on whose home we meet then each of us takes their drugs for the three months,” she said.

Nyakongo is one of the Community ART Groups (CAGs) under a programme supported by the Centre for Health Solutions (CHS), a Non-Governmental Organisation (NGO). The NGO has trained peer educators working under the programme.

“The groups should only visit hospitals twice a year because clients are supposed to take home drugs meant for six months,” said Millicent Kanyala, a peer educator at Madiany Sub-county Hospital in Siaya County.

“But they cannot go with the whole six months’ drugs, so they are given drugs for the first three months, then the refills are done after three months.”

CHS allows clients to voluntarily choose a community group they want to belong to. Members of each group has members who are familiar with each other to allow openness and peer interaction without fear of being stigmatised. Each group has a leader and the names and contacts of members are contained in the CAGs’ diary book.

“The diary informs me of when each group is supposed to visit the facility. So, I prepare the drugs well in advance and call their peer leader and tell them the date they will be taking drugs in their community,” said Kanyala.

CAGs are a model for ART distribution, where groups of people living with HIV rotate for clinic visits and drug refills while dispensing drugs to their peers in the community and ensuring peer support.

“The uptake is steadily good and every member wants to join community groups. So far, we have 90 community groups with a total of 822 members. In 2017 we only had 22 groups,” said George Nyakora, adherence counsellor at Madiany Sub-county Hospital.

In 2017 when Madiany Sub-county Hospital launched the programme, viral load (the amount of HIV in the blood) suppression was at 84 per cent. Mr Nyakora says this model has since helped the facility to achieve a viral load suppression of 96 per cent as at November 2021.

“Initially in 2017 the suppression cut off point was 1,000 copies/mL, currently it is 400 copies/mL. Anyone who achieves viral load suppression of below 400 copies/mL is considered to be doing well in terms of ART uptake,” said Nyakora.

He said viral load that is more than 400 copies/mL means the immunity level has dropped or is dropping and the likelihood of contracting opportunistic infections is very high.

***A MESHA (www.meshascience.org) Feature – December 2021

 

By Tebby Otieno

One Health the gateway to human, animal and environment wellbeing, say experts

Applied research through the One Health approach will lead to health investments that will accelerate economic development and reduce social inequalities, experts have advised.

Speaking to science, health and environment journalists, Delia Randolph, professor of food safety systems at the Natural Resources Institute in the UK, said One Health allows for integrated thinking across three sectors – human health, animal health and environment health.

Randolph, also a contributing scientist at the International Livestock Research Institute (ILRI), said One Health is therefore a collaborative, multisectoral, trans-disciplinary approach that cuts across the local, regional, national and global levels.

Bernard Bett from the One Health Research, Education and Outreach Centre (OHRECA) said One Health and the Sustainable Development Goals (SDGs) are closely linked.

One Health, he said, contributes to SDGs 1, 2, 3, 12 and 17 (no poverty, zero hunger, good health and well-being, responsible consumption and production, partnership). More so, the One Health approach contributes to SDGs 5, 6, 10, 15 (gender equality, water and sanitation, reduced inequality, life on land).

“Ending poverty and other deprivations goes hand in hand with improvements on health, education, reduced inequalities and economic growth,” said Mr Bett.

He said based on the One Health approach, genomic analysis of SARS-CoV-2, the virus that causes COVID-19, has boosted the capacity of COVID surveillance in Kenya.

In this regard, he said, testing for SARS-CoV-2 using qPCR has been ongoing at ILRI since 2020. A total of 24,398 samples have been tested and results shared with the Ministry of Health (MoH).

The ILRI laboratory where genomic analysis is ongoing is part of a network of facilities in the country that is supporting COVID-19 genomic surveillance.

Genomic analysis is the identification, measurement or comparison of genomic features such as DNA sequence, structural variation and gene expression. Essentially, genomics is the study of genes that makes it possible to predict, diagnose and treat diseases more precisely.

Bett said the genomics laboratory “has received additional funding to the tune of $1 million from the Rockefeller Foundation to support genomic surveillance of SARS-CoV-2 in the Eastern Africa region.

He also delved into intersectoral collaborations for rabies control in Machakos, saying that Kenya has increased coverage of control measures.

This is a step in the right direction as rabies remains a serious public health issue. Canine rabies, he said, causes an estimated 55,000 deaths annually across Africa and Asia.

As such, with the most effective strategy towards minimising human exposure being controlling rabies in dogs, OHRECA and VSF Germany are in collaboration to develop sustainable and scalable vaccination strategies for rabies through the One Health approach. Bett said that through the collaboration, the target is to vaccinate 200,000 dogs per year.

“New knowledge on the impact of climate and land use change on zoonotic diseases occurrence is being used for contingency planning,” he said.

OHRECA is leading studies to identify drivers of Crimean Congo hemorrhagic fever in Burkina Faso and Rift Valley in Kenya.

On institutionalising One Health in Kenya, Dr Athman Mwatondo, who is the co-head of Zoonotic Disease Unit at the Ministry of Health, said the Unit was formed between line ministries of human and animal health.

Established in 2012 through a Memorandum of Understanding (MoU), the Unit’s structural office is in Kenyatta National Hospital grounds, at the MoH grounds.

The Zoonotic Unit, Mwatondo said, has a mission to “establish and maintain active collaboration at the animal, human, and ecosystem interface towards better prevention and control of zoonotic disease.”

The Unit’s priority areas of outbreak investigation and response include the Rift Valley fever, anthrax and rabies, with a view to particularly eliminating rabies.

Mwatondo spoke of the need to create sustainable county level One Health platforms that will facilitate the devolution of the One Health approach.

Progress thus far includes the epidemiological investigation of a Rift Valley fever outbreak in humans and livestock in Kenya in 2018. Outbreaks of the Rift Valley fever were recorded in Wajir and Siaya counties in 2018, Murang’a from 2019 to 2021 and Isiolo in 2020 and 2021.

There was also an investigation of recurrent anthrax outbreaks in humans, livestock and wildlife from 2014 to 2017.

Mwatondo said rabies elimination activities include improving access to post-exposure prophylaxis and rabies education and awareness. Thus far, he said, there has been coordinated mass dog vaccinations in two pilot counties.

Mwatondo said the challenges in implementing the One Health approach include difficulties in coordinating multiple partners and operationalisation difficulties such as high staff turnover.

He said there is a need for domestic funding of One Health activities for sustainability purposes and to understand and adapt because the One Health approach is not a one size fits all.

By Joyce Chimbi

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Surgeries take back seat as Coronavirus rages

In March last year when COVID-19 was first detected in Kenya, the country’s 47 governors rushed to set up isolation centres in their respective counties.
The centres were to be equipped to deal with the rising numbers of patients who had contracted the disease.

Several months later, hospitals were jammed with COVID-19 patients, forcing governors to redeploy healthcare workers to concentrate on battling the pandemic.

This move led to stalling of some critical medical procedures and services such as surgery, leaving those in need in pain after Intensive Care Units (ICU) were dedicated to deal with serious COVID-19 patients.

For healthcare workers in most public hospitals, it was a delicate balancing act, as they dealt with the pandemic while trying not to ignore other critical medical procedures that patients needed.

At the Coast General Teaching and Referral Hospital (CGTRH) – the largest hospital in the Coast region, which serves Kwale, Kilifi, Taita Taveta, Tana River, Lamu and Mombasa counties – surgeons were forced to come up with alternative plans to help prevent their patients from succumbing to their ailments.

“I had to take care of my patients. Because there were no surgeries; it meant taking care of their medical condition through medicines just to keep them going,” said Dr Peter Sore, a cardiac and thoracic surgeon who heads the heart clinic at CGTRH.

Dr Sore said surgeons at the hospital were forced to come up with initiatives to manage patients suffering from chronic illnesses.
The specialist had planned to operate his critically ill patients only to shelve their surgeries due to COVID-19 and instead focused on relieving their pain.

“It was sad watching our helpless patients die; we could not do anything since theatres had been turned into COVID-19 facilities,” On March 22 this year, the doctor was heartbroken when the much awaited resumption of open heart surgery at CGTRH was cancelled.

“Everything was set for resumption of the open heart surgery. We were collaborating with our specialist colleagues from Kenyatta National Hospital who were to travel to Mombasa for the operations, but could not after President Uhuru Kenyatta announced lockdown in five counties with high infection rates including Nairobi. That was a major setback,” said Dr Sore.

At his clinic in the facility, he used to attend to 25 patients but nowadays only 10 patients turn up. “Surgeries are crucial for patients’ survival,” said Dr Sore.

CGTRH has six main operational theatres. However, shortage of ICU staff has been another major challenge.

“Some of the staff who were manning the ICU for surgical patients were redeployed to take care of those battling the virus. It was sad that surgeries could not be performed because

ICUs were converted to COVID-19 facilities to take care of those battling the virus,” added the senior doctor.

The specialist is among doctors who have been conducting surgeries on COVID-19 patients with surgical issues.

Dr Sore said he was distressed when some of his patients succumbed at home due to the pandemic.

“My patients were afraid of the hospital, saying they could contract COVID-19, but their conditions, which needed surgeries, worsened day by day. I knew things were really bad when one of my patients who needed an endoscopy succumbed because we could not do the crucial surgery to save his life,” said the medic with over 30 years’ experience.

To ascertain the extent of COVID-19 impact on healthcare, Dr Sore advised the government to conduct research to show how the disease has affected Kenyans.

“COVID-19 has affected surgery practice, slowing down our work and leaving our patients in agony. We have new procedures; before conducting any surgery, you have to do a COVID-19 test,” he said.

Dr Hemed Twahir, an official of the Mombasa County COVID-19 Response Committee, said the pandemic has brought to the fore critical health issues that should be addressed.

“The most important lesson I have learnt is why we must enhance and strengthen primary healthcare. A lot of what is happening could have been handled better and a lot of positives that have been witnessed is because we have managed to strengthen primary healthcare,” said Dr Twahir.

The medical director at the Aga Khan Hospital in Mombasa lauded the government for incorporating community health workers who have enhanced contact tracing and hygiene in communities.

“The basic primary healthcare unit is very crucial. In the future, we should learn that treating a problem is more expensive than prevention. I have learnt that you cannot deal with a pandemic on your own,” Dr Twahir added.

The pediatrician said the world managed to control Spanish flu in 1918 better than it has done with coronavirus.

“Because there wasn’t as much traveling as currently. If we put ourselves together globally, we can come up with appropriate good outcomes. Within a year of coronavirus vaccine, we have had malaria vaccine coming up, that is a very big lesson,” he said.

Due to the pandemic, Dr Twahir said most hospitals have now strengthened their health systems, especially for critical healthcare.

“For a long time a lot of health institutions all over the country were lacking critical care, essential things like oxygen and ICU. But COVID-19 has taught us that we need to be prepared in taking care of critical care patients, counties have now gotten ready,” said the pediatrician.

Mombasa Governor Hassan Joho resolved to improve accessibility to quality and dignified affordable healthcare with heavy investment in medical infrastructure, equipment and human capital.

“We are strengthening the local healthcare systems, enhancing training and capacity building of our medical staff while also increasing awareness of respiratory complications in the community,” he said.

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Telemedicine’s vital role in HIV management during the pandemic

Not only did COVID-19 trigger panic among people living with HIV as the initial fear, anxiety and stigma created scenes reminiscent of when HIV/Aids was declared a national disaster, it also triggered a series of events that could have serious ramifications for them.

HIV experts and activists such as Justus Oluoch based in Kisumu County now decry the great shift from HIV/Aids prevention and response to COVID-19. It all began with the Kenya Medical Research Institute suspending all HIV viral load testing to focus on the coronavirus back in April 2020.

“Granted, the pandemic was unexpected and extremely overwhelming, so something had to give, especially because ours is a cash strapped health infrastructure,” Oluoch, also a clinician working in a Prevention of Mother to Child Transmission (PMTCT) programme, explains.

“Machines used to process HIV samples for viral load tests and Gene-Xpert machines used to test tuberculosis (TB), which is a prevalent HIV-defining disease, are being used to process coronavirus samples,” he expounds.

In the last decade, research has shown the extent to which a viral load test is critical for initiating patients newly tested for HIV on treatment and is routinely used in monitoring and management of HIV patients throughout their lives.

Oluoch cautions that at the moment, nationwide, viral load tests cannot be undertaken because of a stock out of viral tubes used to collect samples, also a consequence of the pandemic.

These, among many other challenges, have necessitated the activation of telemedicine to ensure HIV patients continue to receive optimum care and at the same time are protected from COVID-19.

Telemedicine has especially become critical within the context of lockdowns and travel restrictions and, a fear of patents visiting health facilities for fear of contracting COVID-19.

“I lived in Kisumu County when I first got tested and my interactions with nurses and clinicians were very good. I was responding very well to treatment and my viral load was very low or what they call undetectable levels, which means that I could not transmit HIV,” says Francis Onyango*.

Four years ago, Onyango got a job transfer to Nakuru County where he is still based. However, he did not transfer to a facility in Nakuru for fear of stigma in case his HIV status was discovered. Besides, he preferred his primary facility back at home because HIV case management was very good.

And his story is not unique especially among patients who visit health facilities for routine check-ups every one month or every three months, depending on circumstances.
Some patients have faced serious difficulties as lockdowns and travel restrictions have characterised the last 16 months of the pandemic in the country.

“This is why telemedicine has become important in the management of HIV patients. Besides those seeking treatment far from their areas of operations, some counties are expansive and patients rarely seek treatment in their areas of residence.

People move from one sub-county to the neighbouring sub-county in search of treatment because stigma and discrimination is still a reality,” Olouch says.

Anita Nyambura, a consultant laboratory technician with a private hospital in Nakuru County, states that telemedicine is the provision of health services, in this case for people living with HIV through a wide range of platform such as video, phone calls, social media and mobile phone apps designed for this very purposes.

She says that telemedicine is especially popular among adolescents and young people and across age and gender as it minimises clinical visits.

“Patients responding well to treatment are often provided with antiretroviral drugs to last them for a period of three months and in the intervening period, they maintain contact with their health care providers through telemedicine,” Nyambura expounds.

She adds that one of the primary benefits of telemedicine is that it helps retain patients in HIV care, especially those who live far from their primary health facility.
Telemedicine also provides privacy for patients concerned about revelation of their status if they are seen attending a HIV clinic. The system also provides flexibility in terms of booking and scheduling appointments.

“Retaining patients in HIV care and treatment is critical especially because patients lost to follow up or patients who have not visited their primary health facility for more than 30 days and are feared to have stopped treatment, are vulnerable to advanced HIV disease,” says Olouch.

“Advanced HIV disease or progressed HIV patients have a low CD4 count of less than 200. They have a high viral load, meaning that the amount of HIV in their body is very high.

They can easily transmit it and they are extremely vulnerable to diseases such as TB, meningitis and now, we are seeing a type of cancer called Kaposi sarcoma and cervical cancer among women of reproductive age,” he expounds.

Emerging research into the use of telemedicine to manage HIV patients has shown high patient satisfaction rates and a willingness among patients recruited into ongoing studies to continue with the new approach.

Despite emerging data showing that telemedicine is important in providing critical care for HIV patients, the approach is still in its nascent stage but nevertheless gaining pace.

In Kenya, for instance, as of February 2021 and in a move necessitated by the pandemic, the Kenya Medical Practitioners and Dentists Board Council (KMPDC) had approved 20 hospitals to roll out telemedicine services amid COVID-19 containment measures.

“Telemedicine is not an innovation that you roll out just because you can, it needs regulation and issued approvals are subject to review every three months. Still, the country is yet to enact laws regulating telemedicine but in the meantime, the e-Health guidelines of 2019 provide a guiding framework,” Nyambura observes.

She further says this approach may present a number of challenges especially in the prevention of HIV as it seems to work best among patients already in HIV care and treatment who are responding well to treatment.

Nevertheless, as the pandemic unfolds and with a need to keep HIV patients protected from COVID-19, telemedicine is a critical intervention that simply cannot be ignored, experts emphasise.

*Names changed to protect identity