ECHO answers unresolved questions but opens Pandora’s box

In culmination of what has been a sore point of speculation for nearly three decades, it is now a matter of scientific evidence that women using the injectable contraceptive Depo-Provera, commonly known as Depo, are not more likely to acquire HIV than their counterparts using implant or the copper-T coil for contraception.

This finding is particularly important for countries in sub-Saharan African countries where Depo, a progestin-only injectable, is widely used and HIV rates are high.

The Evidence for Contraceptive Options and HIV Outcomes (ECHO) study, whose results were released on June 13, 2019 in Durban-South Africa, has provided solid evidence on how the three contraceptive methods stack up in relation to a woman’s risk of HIV acquisition.

 “The ECHO study was conducted because of conflicting data. Some observational studies had indicated that using certain hormonal contraceptive methods increased the risk of HIV acquisition. Other studies did not show any such correlation,” said Imeldah Wakhungu, ECHO study coordinator for the Kisumu site.

In 2017, the World Health Organization released a most telling pointer of how dominant these contradictions were by releasing guidelines summarizing that women at risk of HIV can use progestin-only injectable but that they should be informed of possible risk.

The significance of the ECHO study in putting to rest these fears that have dominated public health spaces for years cannot be overestimated. And what cannot be under-estimated is the Pandora’s box that the study has opened.

“ECHO provides the highest quality evidence because women need to know whether certain contraceptives place them at increased risk of acquiring HIV,” said Dr Nelly Mugo during the release of the results.

She explained that three contraceptives in the ECHO study are currently prioritized and are widely used for their efficacy and safety. Ultimately, the study sought to answer one primary public health question and three secondary ones.

“ECHO compared the risk of HIV acquisition by pitting three comparable contraceptives against each other.

Efficacy, safety and continuation or discontinuation were closely monitored,” Dr Mugo explained.

This study started in December 2015 and participants’ follow-up concluded in October 2018.

In the end, the study found that HIV incidence was very high across all three methods and that there was no substantial statistical difference in HIV acquisition across all three methods.

Of note, 397 women out of 7,829 who participated in the study aged 16 through 35 years acquired HIV during study follow up over a period of 18 months.

“This is significant because the women were not profiled for individual risk of HIV acquisition and were offered HIV prevention services including PrEP throughout the study,”

noted Dr Mugo.

The door has been opened for speculations that HIV interventions in Kenya, South Africa, Eswatini and Zambia where the 12 ECHO study sites were set up have failed to stop infections among young women.

Overall, fears are now rife that years of HIV control measures have not borne fruit where they are needed the most and there is a need to reevaluate where women’s risk for HIV exposure lies.

Other HIV experts have raised concerns that the study does not fully answer some key public health questions because it settled on an age group that has been documented for its vulnerability to HIV acquisition.

This vulnerability is based on age, gender and economic status.

Furthermore, this is the age group that is most active sexually.

At the landmark 2018 HIV Prevention, Care and Treatment Scientific Conference where hundreds of participants gathered in Nairobi for over four days, in September 2018, it is the failure to prevent new HIV infections among young women 15 to 24 years that particularly stood out.

At the time, Anthony Chazara, LVCT Health and Youth Programme made a statement that completely resonates with the ECHO study.

“When you talk about new HIV infections, these are people who are negative today and HIV positive tomorrow.

Young people account for about half of these new HIV infections and this is a worrying statistic,” he said.

Adding that: “More than half of all new HIV infections occur among adolescents and young people aged 15 to 24 years which is a sharp rise from 29 percent in 2013.”

In just 18 months, a study that started with 7,829 women testing negative for HIV culminated with 397 testing positive.

It is therefore a matter of scientific fact that young women continue to be disproportionally affected by HIV and that this is not limited to countries where the 12 ECHO sites were set up but across Africa.

Throughout Africa, research shows that HIV infections among young women are double or triple those of their male peers.

In Kenya alone, young women are almost twice as likely to acquire HIV compared to young men.

According to National AIDS and STI Control Programme (NASCOP), due to their vulnerability to HIV, young women 15 to 24 years account for 33 percent of the total number of new HIV infections.

In comparison, NASCOP statistics show that young men account for an estimated 16 percent of the new HIV infections.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, biological factors, limited access to health care, education and jobs, and health systems that do not address the needs of young people.

There is also the question of deepseated attitudes that young women have as well as their own perceptions of HIV risk. Surveys have shown that young women are still more fearful of an unplanned pregnancy than HIV.

These fears were astoundingly confirmed by the ECHO study which was summarily characterized by high sexually transmitted infections, high incidences of HIV, low condom uptake and notably low pregnancy rates. Reported pregnancies were mainly among women who had at some point discontinued assigned methods.


Millions to suffer from drug resistance globally by 2050

About 700,000 people die annually due to drug resistance globally and the number is expected to increase to 10 million people annually by 2050, a health expert has warned.

A Kenya health ministry official in charge of Antimicrobial Resistance (AMR), Dr Evelyn Wesangula said cases of resistance have become more common not just in Kenya but in the sub-Saharan Africa region.

The World Health Organisation (WHO) warns that the prospect of the world entering a ‘post-antibiotic era’, where common infections can no longer be cured, is real.

Speaking during a MESHA conference held on Thursday at Ngong Hills Hotel, Dr Wesangula said increased cases of drug resistance is posing a threat to the significant gains made in the fight against diseases, a health expert has warned.

While there are many causes of antimicrobial resistance, Dr Wesangula singled out both over use and underuse of the antibiotics as some issues which led to this public health concern.

She said the free-for all access of drugs in pharmacies, drugstores and market places, unregulated prescription in health facilities and from animals to humans as among causes for resistance.

Dr Wesangula said apart from long hospitalisation due to drugs resistance many lives are lost– a situation which should compel governments to act.

“It is a problem with a wide range of consequences. Those who have resistance will face long hospitalisation or will have to try different medicines which is costly.

“This also has an implication on their personal economy and development. If you come to think of sub-saharan region, we have a higher disease burden hence resistance to antibiotics must be a serious cause for worry.” she explained.

According to WHO, AMR occurs when micro-organisms (bacteria, fungi and viruses) change when they are exposed to drugs such as antibiotics leading to prolonged untreated illnesses.

Dr. Wesangula, there is need to intensify efforts such as enforcement of the law to have adhered to prescription procedures for antibiotics.

Like, Kenya, Malawi has similar challenges such as free – for – all access to antibiotics due to weak enforcement mechanisms of the law.

But National Coordinator for AMR in the Ministry of Health in Malawi, Dr Watipaso Kasambara said one strategy they have employed is raising public awareness on the gravity of drug resistance as well as equipping medical staff with appropriate knowledge so as to manage prescription of antibiotics in hospitals among other  interventions.

“Creation of a special unit to look at AMR is one effort by the Malawi government which demonstrates commitment in dealing with the problem at hand,” according to Dr Kasambara.



Young women’s HIV burden worries experts

As curtains fell on what has been a landmark scientific conference on the prevention, care and treatment of HIV, it was clear that there are many strides made in the right direction.

Notably, the national adult HIV prevalence has been on a steady decline in the last seven years.

According to the National AIDS and STI Control Programme (NASCOP), “annual new infections are less than a third of what they were in 1993” when the epidemic was at its strongest.

There are now better antiretroviral regimens that are accessible and consequently, more people on treatment inspiring experts to declare that the country may well be on its last mile towards achieving the 95-95-95 dream.

This is essentially a fast track plan to halt the spread of HIV by 2020 and to eventually end the epidemic by 2030.

Initially dubbed the 90-90-90 Aids eradication strategy, the goal is to have 90 percent of people living with HIV tested, 90 percent of those diagnosed with HIV put on treatment and 90 percent of those on treatment achieving durable viral suppression.

Based on advances in the treatment and care of HIV, experts are now aiming for 95-95-95.

Nonetheless, experts are alarmed that this success story has been clouded by failure to prevent new infections among young women 15 to 24 years.

“When you talk about new HIV infections, these are people who are negative today and HIV positive tomorrow.

Young people account for about half of these new HIV infections and this is a worrying statistic,” said Anthony Chazara, LVCT Health and Youth Programme.

Dr Lillian Njagi from Kenyatta National Hospital concurs: “More than half of all new HIV infections occurred among adolescents and young people aged 15 to 24 years which is a sharp rise from 29 percent in 2013.”

According to NASCOP’s latest estimates, 1.5 million people were living with HIV with youths accounting for 280,000 of these numbers.

Speaking at the conference, Dr Njagi was particularly concerned that young women continue to be disproportionally affected by HIV.

Across Africa, HIV infections among young women are double or triple those of their male peers. “In Kenya, young women are almost twice as likely to acquire HIV compared to young men,” she emphasized.

Due to their vulnerability to HIV, young women 15 to 24 years account for 33 percent of the total number of new HIV infections. In comparison, NASCOP statistics show that young men account for an estimated 16 percent of the new HIV infections.

Experts attribute this high HIV prevalence to gender inequalities, violence against women, limited access to health care, lack of access to education and jobs, and health systems that do not address the needs of young people. During the entire period of the conference, experts belaboured the fact that the face of HIV has significantly changed.

People living with HIV are no longer as sickly as they used to be. It is therefore now possible for a HIV positive individual with a very high viral load and therefore highly infectious to appear healthy.

This has shaped the attitudes that young women have as well as their own perceptions of being at risk of infections.

Surveys have shown that young women are still more fearful of an unplanned pregnancy than HIV. But there are other factors that have served as obstacles to the prevention of HIV among young women. Experts said

that biology does not help. Teenage girls’ immature genital tract is more prone to abrasions during sex, opening entry points for the virus.

Experts were also quick to clarify that besides sex, the age of the male partner is a defining factor. “The trends are showing that HIV prevalence is high among women aged 15 to 24 and among men aged 35 to 45. This is because of the intergenerational relationships,” Chazara expounded.

The age of the young woman herself is also a factor. Women who had their first sexual encounter before the age of 15 years faced twice the risk of getting infected with HIV.

Importantly, experts belabored the point that interventions are in the pipeline to address the needs of young people in the prevention, care and treatment of HIV.

According to Dr Irene Mukui of NASCOP, “There is a lot of discussion and focus on the youth to figure out how to prevent new HIV infections, to ensure those infected are on treatment and that they have good treatment outcomes once they start taking antiretroviral drugs (ARVs).” With experts drumming support on increasing awareness and knowledge of HIV prevention among young people, these efforts are bearing fruits.

Nonetheless, more young men than women have demonstrated adequate knowledge of HIV prevention.

In the Kenya Health and Demographic Survey (KDHS) 2008, an estimated 48 percent of young women and 55 percent of young men “demonstrated adequate knowledge of HIV prevention compared to 73 percent of young women and 82 percent of young men in 2014.”

There is still no consensus on teaching young people about HIV and sexual health. This remains a debatable controversial issue with the most recent KDHS 2014 finding that an estimated 40 percent of adults were “against educating young people about condoms” for fear that it might be taken as encouragement for them to have sex.

Such fears and controversies notwithstanding, the figures have spoken and raised the alarm. Without urgent and young people tailored interventions, the HIV prevalence among young people will become the epidemic.



15 years and counting: Researcher’s relentless charge against HIV

Despite the difference in opinion about the statistics on HIV/AIDS in Nyanza, the concern of scientists in the region is much focused on how best to treat and reduce new HIV infections.

Mr. Arthur Ogendo, a Senior Research Officer working for Kenya Medical Research Institute Centre (KEMRI/CDC) in Kisumu, Kenya gives an insight on how they are rolling out the fight against HIV/AIDS even as the search for cure continues. Mr Ogendo has for the last 15 years, dedicated his life to researching on how his own people from Nyanza can participate in eliminating HIV from the face of the earth using people based solutions.

Our member, Christine Ochogo of Radio Nam Lolwe, recently met the ever smiling researcher in Kisumu during our eighth media science café and fielded the following questions to him.

Tell us about yourself.

I am Arthur Ogendo, a senior Research Officer at KEMRI/CDC Kisumu, The organization hosts various research on areas of Malaria, TB, HIV and other infectious diseases. I am a public health specialist currently working in the epidemiology and health research.

Kindly tell us more about the researches you have participated in on HIV.

KEMRI and CDC established a HIV Research Branch in 2000. The branch started with two major studies, one conducted in Asembo, Siaya County and another in Kisumu County both in western Kenya.

The research in Asembo was a Baseline cross sectional survey (BCS) that took a look at HIV infection prevalence and the one in Kisumu was known as Kisumu Breast feeding Study (KiBS) that majored on how to prevent transmission of HIV virus through breast feeding amongst women who are lactating before and after delivery.

What are the finding on the two studies?

In Asembo, the research revealed that there was high prevalence of HIV Infection of 15% as at 2003.

However, this has since reduced due to concerted efforts on behavioral and medical methods being initiated in the region.

In Kisumu the research informed Prevention of Mother to Child Transmission (PMTCT) Policy that mothers can be put on triple ARV for PMTCT was safe tolerable and efficacious . ART was administered to mothers before they deliver and continue with the drugs after delivery to protect the child from being infected with HIV virus through breastfeeding.

What other studies have KEMRI/ CDC conducted in relation to HIV?

Between 2010 and 2013, we did a study that looked at whether early initiation of ARVs treatment would reduce the risk of HIV transmission among HIV sero discordant couples. The study was sponsored by US national Institute of Health (NIH).

Participants were placed onto into two groups, one being on survivors whose CD4 cell count was at above 550 per ml and those whose CD4 count was at 250 per ml or below as per the national guidelines on ART initiation at that time (2010).

We found out that those who started Antiretroviral Therapy (ART) early when their CD4 cell count was high, had more health benefits and the risk of cross infecting their partners reduces by 96%. This was considered a scientific breakthrough.

This has now informed the WHO and Government of Kenya’s health ministry to adopt a ‘test and treat’ policy where infected individuals begin ART treatment immediately irrespective of their CD4 count, to reduce the risk of HIV transmission.

What about the study on vaccines and drugs?

We are coming up with a number of interventions to help in prevention and further spread of HIV/AIDS which include Voluntary Male Circumcision, use of vaginal ring, pills (Truvada), a pilot vaccine, implants among others.

Currently we are conducting a study on antibody mediated prevention (AMP) study. Vaccines are intended to induce immune responses (antibodies) in the body system but sometimes this is a slow process and may not be effective againstthe HIV virus. Antibodies are proteins produced by the body to fight germs in the blood. Therefore we are looking whether infusing antibodies directly into attacking the white blood cells. This

study is targeting about 80 participants who we will be followed up for four to five years.

We in CDC/KEMRI are also focusing on long-term pre- exposure prophylaxis (PrEP) for the population of young women. We are looking at superiority between Cabotegravir and Truvada as a PrEP. Carbotegravir drug has been proven to be effective among HIV-negative older women and it was time to investigate its efficacy in young women who are sexually active.

What are some of the challenges you face in the fight against HIV?

Research is very expensive and we as scientists have been relying a lot on donor funding which is now decreasing.

We are now advocating for the County governments to consider allocating more funding to HIV programs to avoid over reliance on donors who are proving to be unreliable due to changing times and priorities.

What role do you think the media can play in the fight against HIV?

The media plays an important role in dissemination of information and we scientist work best in collaboration with them to pass to the masses information on our progress in HIV research.

Why do scientists fear the media?

Scientists are sensitive to misfacts as reported by the media. We are accountable to our partners and collaborators fear being misquoted or misreported on our research be it on HIV or any other subject.

This calls for consistent and responsible journalism to avoid interfering with the progress made so far as well as avoid misrepresentation of scientific facts. We abhor the media to consult with us when not sure as they do articles because fact checking helps readers and listeners to get the correct information.

What is your patting shot?

Everybody is at risk of contracting HIV and the fight against the virus need concerted efforts from all people despite the County or region or country one comes from.

The society needs to be informed more about HIV on prevention and proper management in a bid to have a HIV free generation to come.

Scientists are still searching for a vaccine that may one day prevent infection of HIV/ AIDS infection and they are hopeful that the vaccine will soon be available. In the meantime, everybody has the responsibility to prevent HIV transmission but embracing behavior change and seeking treatment as necessary.

The perception and impression that those who hail from counties or regions where HIV prevalence is low are at less risk of contracting the virus is a misconception.



Stigma and side-effects slowing PrEP adoption

The idea of providing an antiretroviral (ARV) medication as pre-exposure prophylaxis (PrEP) to prevent acquisition of HIV infection by persons at high risk is now well established.

However, the full public health impact will be realized only when PrEP is implemented effectively at scale.

The UNAIDS has projected delivery of PrEP to 3 million persons by 2020 while the National AIDS & STI Control Program (NASCOP) projected upto 500,000 persons on PrEP by 2022 according to the national Framework for Implementation of PrEP in Kenya issued in 2017.

By George Juma I

Data from UNAIDS 2013 show that over 7000 young women get new HIV infections contract globally every week.

Despite having oral PrEP and other researches being conducted to get more forms of the vaccine which can satisfy the taste of users ,the oral vaccine has not been utilized maximally because of arrays of factors including peer pressure, inaccessibility of PrEPS to users among others.

Josephine Nyaboke (not real name) a PrEP user champion in Migori County says issues regarding the packaging of Prep, peer pressure among other remains some of the major challenges she is facing when championing for PrEP use among the youths and the adolescent. She said other side effect of PrEP on usersat the early stages of use has also made many of her clients to abandon the pill.

Nyaboke who currently has 47 clients introduce to the vaccine that she monitors every month to ensure that the drugs adherence level is met also said that delay in the issuance of PrEP at the health facilities has discouraged many of her clients.

The perception of many has been that the PrEP is only used by Key population which includes sex workers, discordant, truck drivers and men sleeping with men, however this is not the cases.

Nyaboke said she started using PrEP in 2017 after having felt at risk of contracting HIV due to the long distance relationship she is in adding that her boyfriend and the parents accepted her proposal.

During this year’s AIDS 2018 Conference in Amsterdam four weeks ago, PrEP was arguably the dominant subject with far more sessions devoted to it than any other topic and will probably also dominate the HIV Research for Prevention (HIVR4P) Conference in Madrid from October 21 – 25,This is a global scientific meeting dedicated exclusively to biomedical HIV prevention and research.

Kenya has made significant progress in the reduction of new HIV infections in the past decade through the scale up of comprehensive HIV treatment and prevention programs including PrEP. Despite this progress, over 70,000 Kenyans mostly aged 15-24 get new HIV infections every year. The story is the same across most of sub Saharan Africa where numerous PrEP initiation programs started in the last year. So far, Kenya has initiated PrEP in about 25,000 people at risk – but retention is a big problem.

Scientists suggest there could be several potential barriers to effective PrEP implementation that could derail the program if not addressed urgently. According to Dr. Dismas Oketch from the Kenya Medical Research Institute, there are anecdotal reports about stigma to PrEP use, lack of knowledge of and access to PrEP, skewed expectations from PrEP adopters, side effects as well as shame and hesitation to demand PrEP; which could negatively affect retention and adherence to PrEP.

Speaking to Sayansi in August in Kisumu during a science café organized by MESHA and AVAC, Dr. Oketch further reiterated that there could be some disconnect between what PrEP providers intend for PrEP and what what PrEP users want from PrEP leading to those who were initially enthusiastic about PrEP withdrawing from it. Ideally, PrEP use is not for everyone and should be limited to individuals at risk and during periods of higher risk when other HIV prevention alternatives are not sufficient.

He says the current trend shows that many people are not using PrEP as expected because of various reasons which they scientist continue to investigate. “Side effects and stigma remain the two most important reasons for PrEP discontinuation.” Despite these threats, Dr. Oketch believes “it is far much better individually, principally, socially and economically to prevent HIV than to treat a lifelong infection of HIV/AIDS.” As a result the KEMRI is exploring other alternatives to PrEP delivery than the daily oral pill. This new PrEP pipeline will include long acting injectable PrEP, PrEP implants and PrEP intravaginal rings.

Latest research conducted by non governmental organization, IMPACT Research and Development Organization (IRDO) in Kisumu early this year shows that sixty four percent of potential PrEP users would prefer the injectables.

According to Dr.Kawango Agot is a researcher working with the IRDO, the research which involved commercial sex workers also revealed that 21 percent of potential PrEP users prefer oral tablets while only 15 percent prefer the intravaginal ring.

In the study, Dr.Kawango said the sample group was placed on injectable, pills and ring Preps all placebo for a period of one month each to established the experience and taste of each participant.

Mrs Josephine Odoyo,a researcher with the Kenya Medical Research Institute (KEMRI) at Lumumba centre in Kisumu county, says PrEP users have been giving a lot of feedback regarding the size of the pill, colour and even packaging of the pill.

The feedback they have been receiving from nearly 2000 users of PrEP, have occasioned new researches to see that the drugs is user friendly.



Why we need HIV vaccines like yesterday

More than 20 years ago, just after I had completed my secondary education, I was diagnosed with HIV. At that time, I thought I now had full self responsibility to my life. I had dreams, just like any other young person. This was the worst news I heard at that moment.

My life came to a standstill for awhile. Everything around me was now dictated by my diagnosis. My education, my career and family dreams were shattered and my parents and siblings were affected even more than myself. Ever since then, life has never been normal, It is not normal, It will never be normal for me even if a cure is found.

I have been to hell and back because of HIV on all fronts. Most notable and physical was my onset of treatment. Twice, I have reacted very badly to medication to the point of almost losing my life. At one point, I thought death would be more relieving than the pain and discomfort I was feeling. I am alive today mainly for having had access to competent, quick medical attention and strong family support at that time. In my more than 20 years work in the HIV field, I do not know of any HIV positive individual who has had it easy both socially and medically. I know some that have even died due to drug reactions, stigma and late diagnosis and lack of access to care and support. We musk a lot; because that is what society wants to see or wants us to portray.


Why am I saying all this?

I want to repeat, it is not normal. I do not wish this to happen to our children who have dreams and a full life ahead of them. I would not wish HIV infection to happen even to my worst enemy. It is for these reasons I am joining the prevention advocates. I will do whatever it takes within my ability to speak out and support prevention efforts to stop any single HIV infection where I can. I will support the HIV vaccines initiative because if it succeeds, it will be one of the biggest breakthroughs in the fight against HIV.

It is no longer about me People spoke for us; I am alive today because of the many voices that stood up for us – people living positively with HIV (PLWHIV). My immediate family takes the biggest credit. They read anything and everything they could come across that would enable them to help me and understand me.

But it still has never been normal and it will never be for me. As an existential fact, we are alone. Many a times I am alone, pain, drugs swallowing, loss of appetite….I am alone.

This can, and could have been prevented. I am going to spend the remaining part of my life, advocating for all forms of prevention…. but education and vaccines are going to take centre stage of my advocacy work. For we all know, PREVENTION IS BETTER THAN CURE.

The face of HIV today is young people. As a mother, and as a person who got infected at that tender age, the news about new HIV infections among young people churns my stomach.

I look forward to seeing how advocates are going to be engaged in the HIV vaccine initiatives and I am more than happy and willing to take on this assignment very seriously to let communities know and understand the importance of HIV vaccine and prevention.

Inviolata Mwali Mmbwavi is the National Coordinator International Community of Women Living with HIV Kenya Chapter (ICW-K)



New device to encourage taking of PrEP drugs

A new device is being developed to encourage individuals at risk of contracting HIV to take their daily dosage of Pre-exposure prophylaxis (PrEP).

Wise Pill was developed as an HIV prevention technique to help take control and take charge of new infections. The device is currently being tested.

To increase the uptake of PrEP among the youth, who are the largest consumers of technology, this invention has been incorporated with IT to help them take their drugs daily.

According to Wise Pill adherence study coordinator, Kamolo Kevin, the program is aimed at getting more young ladies to use the gadget but since it is still on study, they are currently testing its efficacy among 175 girls within Kisumu county.

“This is a generation that studies done previously have shown have had difficulties to adhere to the uptake of PrEP,” Kamollo said.

The device is under study by Kenya Medical Research Institute’s Centre for Microbiology Research (KEMRI-CMR) and helps young adult women carry their prep wherever they go. The device has two compartments that carry 15 tablets each and a participant is supposed to take a tablet each day at a specific time of their choice.

Kamolo said participants using the device were trained before one was handed over to them to ensure they do not interfere with the kit.

“We train them how to open inside.

And when she (participant) gets to open it, it sends a signal to our server,” he said.

To certify whether the participant indeed took their tablets, they give a report each time they go back to the facility which is then counter checked by the servers at KEMRI.

“We also conduct tests to confirm the amount of drug in the participant’s blood. This will help confirm whether participant was taking the drug,” Kamollo explained.

To ensure that the participant never misses to take the daily dosage, she can be prompted by an SMS from the server at the specific time she is supposed to take the drug.

“During registration, members request for the kind of sms to be sent to them as a prompt,” Kamollo said.

With the device easy to conceal as a power bank, Kamollo said they hoped  that the results of the study will help the community on HIV prevention and generally the uptake of drugs.

But in a separate interview, Dr. Elizabeth Irungu, KEMRI, stressed that PrEP was not meant for everybody.

“It is for people who are at risk of acquiring HIV and they just need to be identified or identify themselves and visit a facility to take the pill daily. If the risk is gone, stop. If the risk is back, start,” Dr. Irungu said.

She added, “We need to be sure that you’re HIV negative and not positive. HIV positive individuals should take ARVs not PrEP.”

Other than United States of America, the study on the wise pill gadget is taking place in Kisumu and Thika in Kenya.



Premature babies: Letting them thrive

The voices of preemies mothers came out with a plea to the medical world to let them thrive in reference to various ways in which measures can be taken to enhance the survival rates of the preemies.

To help our readers understand more about the tribulations of preemie mothers in Africa, we sought to hear the story of a real experience from Ms Glena Nyamwaya.

And this is her story; It all started in April 2016 when I had gone to visit my grandmother together with my family. As soon as we got to the compound and alit from the car, I felt a cold sensation going down my leg. I lifted my maxi skirt up to reveal my worst fear. My water had broken prematurely, in a remote village of Kisii, a 45 minute drive away from Kisii town. Unfortunately I was the only driver in tow, so I had to bravely get back on the driver’s seat and get myself to hospital, all the while tears rolling down my face.

To cut the long story short, I got to the hospital and since they could not deal with my case, I was evacuated and driven through the night to Aga Khan Hospital, Nairobi, nearly 400km away arriving at 3 am. My obstetrician received me and tried the best he could to keep the pregnancy as I was only 26 weeks pregnant.

But two days later, I went into labour and delivered a 780grams baby boy. As fate would have it, Junior passed on 7 days after staying in the NICU due to complications and infections he had suffered. I refused to let this situation bring me down and conceived again in June that year. This time round the doctor established that a small cyst on my cervix had triggered the premature labour and carried out a MacDonald stitch procedure to secure the pregnancy for a longer term.

But the scenario would play out yet again as on my 27th week, two days before my doctor’s appointment, I was awoken at 4 a.m. by a gash of amniotic fluid. I was scared and sneaked out to go to the hospital fearing for the worst, without letting anyone in the house know.

I drove to hospital and admitted myself having called my doctor who agreed to meet me there. I was monitored and put on bed rest and on the evening of the following day, the doctor made the call to remove the MacDonald stitch and trigger labour as most of the amniotic fluid had leaked and the baby was at risk of contracting infections.

On the same night at about 1am, my angel Samantha Malaika came into this world weighing 1.1kg. Although my fears and wounds from the previous experience were still fresh, the glow in her little eyes gave me optimism. She would later lose weight to weigh 850gms before she started the upward trend.

I got a scare one day after her doctor prescribed sodium injections to counter her deficiency. She reacted to the sodium badly and even had to be resuscitated at some point when her tiny body gave in. Fortunately the medical team managed to get her lungs back to work and she was put on oxygen for three days. Other than that,

Samantha had minimal complications and was discharged after 45 days in hospital. The greatest challenge however was raising money to cater for the two hefty medical bills in one year. To date, her progress is impressive and her milestones just slightly delayed.