Uzima University College

Globally 36.7 million people have HIV, and in Kenya it is estimated that 1.5 million are infected. The HCV burden is estimated to be 32 million in sub Saharan Africa with Kenya having a prevalence of less <1%. In Kenya Injection Drug Users [IDU’s] are estimated to be 50,000. There is increased public concern on the rising cases of injection substance users, which has also led to increased HIV prevalence in Mombasa County, which stands at 8.6%. This is above Kenya’s prevalence rate, which is at 6.3%. Lymphopaenias among the HIV and HCV co-infected IDU’s has also not been explored and therefore this study was aimed to address this gap. Through this study significant fibrosis and lymphopaenias among HIV- and HCV-co-infected injection substance users were determined. While HIV promotes acceleration of HCV infections towards fibrotic liver disease, HCV increases immunosuppression in HIV infections, leading to early acquired immunodeficiency syndrome (AIDS) and death in untreated cases. Liver disease related to hepatitis C virus (HCV) and human immunodeficiency virus (HIV) infection may affect the immune status of the injection substance users. Limited data exists on significant fibrosis and lymphopaenia among human immunodeficiency virus and hepatitis C virus co-infected injection drug users. This was a cross-sectional study involving consenting adult (≥18 years) IDUs at Bomu Hospital, Mombasa, Kenya. The study groups were HCV-/HIV- IDUs (n=114); HCV-/HIV+ IDUs (n=73); HCV+/HIV- IDUs (n=19); and HCV+/HIV+ co-infected (n=17). A total of 223 participants were recruited. Socio-demographic and clinical characteristics data were collected using a pre-tested structured participant questionnaire. Consenting participants were serologically screened for the hepatitis C virus and also screened for the human immunodeficiency virus using the national algorithm of testing. Immunological status was tested by the BD FACS Calibur flow cytometer. Immunologic staging was based on the CD4 count, where lymphopaenia was a count of <500 cells/µl. Platelets alongside aspartate aminotransferase (AST) and alanine aminotransferase (ALT) were also determined. The aspartate aminotransferase to platelet ratio index (APRI), fibrosis 4 index (FIB 4) and non-alcoholic fatty liver score (NAFLD) were used to determine significant fibrosis. APRI approached significant difference (P=0.054) across the groups. Age showed significance P 0.001 and gender P<0.0001. The AST levels across the groups are P=0.001. In immunological staging, lymphopaenia was more profound in HIV mono-infected injection drug users (65.8%), HCV/HIV co-infected injection substance users (41.2%), HCV/HIV uninfected (21.1%) and lastly HCV mono-infected injection substance users (15.8%). From the results it can be concluded that HCV/HIV co-infection among IDU’s, is associated with high burden of significant fibrosis and lymphopaenia. Significant fibrosis was more pronounced across groups with HCV mono-infected IDUs leading, while lymphopaenia was most severe in HIV mono-infected IDUs (65.8%). The HCV/HIV co-infected burden of both significant fibrosis and lymphopaenia (41.2%) is progressively high. These findings highlight the profound impact of HIV and HCV on liver disease progression and immune suppression. This emphasises the urgent need for early screening, monitoring and integrated management of co-infected individuals to reduce morbidity and mortality in this vulnerable population.

Introduction: Patients with cancer, just like other patients, need extensive round-the-clock care. Caregiving improves their well-being and quality of life. However, caregiving to people with cancer comes with a lot of challenges and is sometimes a burden to the caregiver. With time, this burden may predispose the caregivers to mental health challenges like anxiety and depression. This study aimed to determine the prevalence and extent of anxiety and depressive symptoms among caregivers of patients with cancer in the Nyanza Region of Kenya. Methods: A cross-sectional design was used. Convenience sampling and snowballing were used to recruit 147 study participants. Pretested interview-guided structured questionnaires, slight modifications of the Hospital Anxiety and Depression Scale. Data was analyzed and visualized using GraphPad Prism version 5.03. Results: The mean age of participants was 41.19 (± 2.510) years, 85(58.1) were females and spent an average of 12.35 (± 1.194) hours providing care daily. The prevalence of anxiety and depression were 28.6% and 32.7% respectively. For anxiety, 56 (38.1%) were normal, 49(33.3%) were borderline abnormal and 42(28.6%) were anxious. For depression, 33(22.4%) were normal, 66(44.9%) were borderline abnormal and 48(32.7%) were depressed. For the self-rating of their mental health status since starting caregiving roles, 47(32.3%) were neither satisfied nor dissatisfied, 38(25.8%) were strongly satisfied, 33(22.6%) were satisfied, 24(16.1%) were dissatisfied, and 5(3.2%) were strongly dissatisfied. Conclusion: The prevalence and extent of anxiety and depression are relatively high in caregivers of people with cancer compared to the general population. Many caregivers are on the borderline for both anxiety and depression, representing a poor trend in the mental health of this vulnerable group of people. There is a need for continuous mental health screening of caregivers for early diagnosis and treatment. Interventions addressing mental health resilience in caregivers should be a part of cancer care.

Zinner Syndrome is a rare congenital anomaly involving unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. We report a symptomatic case managed conservatively. A 19-year-old male presented with 6 months of intermittent pelvic pain, dysuria, and ejaculatory discomfort. Examination was unremarkable. Ultrasonography showed right renal agenesis and a pelvic cyst. MRI confirmed a 2.8 cm cystic dilatation of the right seminal vesicle with vas deferens dilatation and absent right kidney. No ectopic renal tissue was seen. Semen analysis revealed oligospermia. Given mild symptoms and fertility concerns, he was treated conservatively with NSAIDs and antibiotics, resulting in symptom improvement within 4 weeks. Surveillance was planned. Zinner Syndrome should be considered in young males with unexplained pelvic or ejaculatory symptoms. MRI is essential for accurate diagnosis. Conservative treatment is suitable for mild cases, reserving surgery for progressive symptoms or fertility issues.

Abstract Purpose: HIV/AIDS is a highly prevalent infectious diseasemostly in sub-Saharan Africa,and several strategies have been put in place to reduce its spread. This study aimed to assess the determinants of shame in the stigmatization of self-reported women with HIV in Kenya. Methods: The data used in this study were obtained from the 2022 KDHS. The statistical analysis included 332 women aged 15-49 years who reported that their test results indicated that they were HIV positive, and the analysis considered the complex survey design; hence, weights were applied. All the statistical analyses were conducted using STATA 17. Results:Women whose HIV status was disclosed by someone else (AOR=1.98, 95% CI: 1.08-3.65, P=0.028) had significantly greater odds of feeling ashamed than did their counterparts whose status was not disclosed. Although not statistically significant, beingaged 20-24 years (AOR=3.65, 95% CI: 0.66-20.14, P=0.24) and experiencingverbal abuse from healthcare workers (AOR=3.73, 95% CI: 0.84-16.56, P=0.08) werealso factors associated withincreased odds of experiencingshame. Conclusion: Factors contributing to shame among HIV-positive women include community gossip, unauthorized disclosure of status, verbal harassment, and negative treatment by health workers; addressing these problems is very important for addressing HIV-related stigma, improving HIV testing rates, and ensuring better access to treatment, especially among women living in rural areas.

Problem Management Plus (PM+) is a psychological intervention that seeks to address common mental disorders among individuals exposed to adversity. Thus far, the potential for delivering PM+ by mobile phones has not been evaluated. To adapt PM+ for telephone delivery (ten weekly sessions of about 45 min each) and preliminarily evaluate its acceptability and feasibility with young people living with HIV (YLWH) in coastal Kenya. This was a mixed-method formative research. Qualitative data collection included consultations with stakeholders, conducting key informant interviews with HIV care providers and focus group discussions with potential end-users, i.e. YLWH. Moreover, brief exit interviews with recipients of the adapted PM+ were conducted. Quantitative acceptability and feasibility indicators and outcome measures were tracked/assessed during PM+ preliminary implementation involving 70 YLWH. From the qualitative inquiries, the adapted PM+ emerged as contextually appropriate, acceptable and feasible for mobile phone delivery, despite some concerns around missing nonverbal cues and poor network connectivity. High recruitment (85%) and fair programme retention (69%) were observed. Intervention sessions over the telephone lasted 46 min on average (range 42-55 min). Preliminary feasibility data indicated that the adapted PM+ has the potential of reducing common mental disorders among YLWH from the Kenyan coast. PM+ is acceptable and can feasibly be delivered via mobile phone to YLWH in coastal Kenya. This study sets the stage for a future fully powered, randomised controlled trial assessing the efficacy of the adapted PM+ in this or a similar setting.

BackgroundThis is the concluding paper of our 11-paper supplement, “Community health workers at the dawn of a new era”.MethodsWe relied on our collective experience, an extensive body of literature about community health workers (CHWs), and the other papers in this supplement to identify the most pressing challenges facing CHW programmes and approaches for strengthening CHW programmes.ResultsCHWs are increasingly being recognized as a critical resource for achieving national and global health goals. These goals include achieving the health-related Sustainable Development Goals of Universal Health Coverage, ending preventable child and maternal deaths, and making a major contribution to the control of HIV, tuberculosis, malaria, and noncommunicable diseases. CHWs can also play a critical role in responding to current and future pandemics. For these reasons, we argue that CHWs are now at the dawn of a new era. While CHW programmes have long been an underfunded afterthought, they are now front and centre as the emerging foundation of health systems. Despite this increased attention, CHW programmes continue to face the same pressing challenges: inadequate financing, lack of supplies and commodities, low compensation of CHWs, and inadequate supervision. We outline approaches for strengthening CHW programmes, arguing that their enormous potential will only be realized when investment and health system support matches rhetoric. Rigorous monitoring, evaluation, and implementation research are also needed to enable CHW programmes to continuously improve their quality and effectiveness.ConclusionA marked increase in sustainable funding for CHW programmes is needed, and this will require increased domestic political support for prioritizing CHW programmes as economies grow and additional health-related funding becomes available. The paradigm shift called for here will be an important step in accelerating progress in achieving current global health goals and in reaching the goal of Health for All.

ABSTRACT Climate change manifesting in inconsistent rainfall has affected subsistence agriculture, posing a threat to food security in South Africa. Women are central in food production, hence this study explores their experiences of climate change, focusing on the challenges and adaptation strategies. The study was conducted in KwaZulu-Natal, using a qualitative approach. The study found that women have been experiencing a reduction in harvests, owing to drought. Additionally, diversification of livelihoods through fishing has been affected, as water sources have also dried up. Interventions that capacitate and equip rural communities with technologies and resources to implement climate-smart agricultural solutions are recommended.