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Noninfectious comorbid diseases (NCDs) contribute to morbidity and mortality in human immunodeficiency virus (HIV)-infected populations in resource-rich countries. With antiretroviral therapy (ART) scale-up in Africa, understanding burden NCD informs public health strategy. At enrollment, participants at 11 HIV clinics in Kenya, Uganda, Tanzania, and Nigeria underwent medical history, physical, laboratory, and neuropsychological assessments to identify elevated blood pressure, hypercholesterolemia, dysglycemia, renal insufficiency, and cognitive impairment. Poisson regression models estimated adjusted relative risks (ARRs) and 95% confidence intervals (CIs) for the number of NCDs associated with factors of interest. Logistic regression was used to evaluate each NCD separately among HIV-infected participants. Among 2720 participants with complete NCD data, 2159 (79.4%) were HIV-infected. Of those, 1426 (66.0%) were taking ART and 813 (37.7%) had at least 1 NCD. HIV infection was associated with more NCDs, especially with ART (ARR, 1.42; 95% CI, 1.22-1.66). In addition to age, body mass index, and program site, ART usage was associated with more NCDs (ARR, 1.50; 95% CI, 1.27-1.78 for virologically suppressed and ARR, 1.38; 95% CI, 1.13-1.68 for viremic) among HIV-infected participants. In participants taking ART, CD4 nadir below 200 cells/mm3 was associated with more NCDs (ARR, 1.43; 95% CI, 1.06-1.93). ART use was independently associated with hypercholesterolemia and dysglycemia. Program site was significantly associated with all comorbidities except renal insufficiency. HIV infection was a risk for NCDs, which were common in HIV-infected participants, geographically variable, and largely consistent with metabolic complications of first-line ART.

Introduction With increased use of antiretroviral therapy (ART), HIV mortality rates are declining and people living with HIV (PLWH) are surviving longer. We characterized CD4 recovery and viral suppression among adults aged < 50 and ≥ 50 years living with HIV who initiated ART in the African Cohort Study (AFRICOS). Methods Beginning in January 2013, PLWH at twelve clinics in Kenya, Uganda, Tanzania and Nigeria underwent medical history review, CD4 and viral load testing as part of the ongoing African Cohort Study (AFRICOS). ART-naïve PLWH who initiated ART within 30 days of enrollment and had at least one year of follow-up were included in these analyses. To compare ART response in participants < 50 years and ≥ 50 years old, changes in CD4 count and viral load suppression after ART initiation were examined at different time points using linear and binomial regression with generalized estimating equations. Variables for time since ART initiation and the interaction between age group and time on ART were included in the model to evaluate longitudinal changes in CD4 recovery and viral suppression by age. Results Between January 2013 and September 2019, 2918 PLHV were enrolled in the cohort. Of these, 443 were ART naïve and initiated on ART within 30 days of enrollment, with 90% (n = 399) aged < 50 years old at ART initiation. At ART initiation, participants aged 50 and older had a higher median CD4 count compared to participants younger than 50 years of age although it did not reach statistical significance (306 cells/mm 3 , IQR:130–547 vs. 277cells/mm 3 , IQR: 132–437). In adjusted models examining CD4 recovery and viral suppression there were no significant differences by age group over time. By the end of follow-up viral suppression was high among both groups of adults (96% of adults ≥ 50 years old and 92% of adults < 50 years old). Conclusion This study found no difference in long-term CD4 recovery or viral suppression by age at ART initiation. We found that particularly among younger adults participants had lower median CD4 counts at ART initiation, suggesting the importance of identifying and putting this population on treatment earlier in the disease course.

Introduction World Health Organization (WHO) guidelines have shifted over time to recommend earlier initiation of antiretroviral therapy (ART) and now encourage ART initiation on the day of HIV diagnosis, if possible. However, barriers to ART access may delay initiation in resource‐limited settings. We characterized temporal trends and other factors influencing the interval between HIV diagnosis and ART initiation among participants enrolled in a clinic‐based cohort across four African countries. Methods The African Cohort Study enrols adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria. Participants provide a medical history, complete a physical examination and undergo laboratory assessments every six months. Participants with recorded dates of HIV diagnosis were categorized by WHO guideline era (<2006, 2006 to 2009, 2010 to 2012, 2013 to 2015, ≥2016) at the time of diagnosis. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for time to ART initiation. Results and discussion From January 2013 to September 2019, a total of 2888 adults living with HIV enrolled with known diagnosis dates. Median time to ART initiation decreased from 22.0 months (interquartile range (IQR) 4.0 to 77.3) among participants diagnosed prior to 2006 to 0.5 months (IQR 0.2 to 1.8) among those diagnosed in 2016 and later. Comparing those same periods, CD4 nadir increased from a median of 166 cells/mm3 (IQR: 81 to 286) to 298 cells/mm3 (IQR: 151 to 501). In the final adjusted model, participants diagnosed in each subsequent WHO guideline era had increased rates of ART initiation compared to those diagnosed before 2006. CD4 nadir ≥500 cells/mm3 was independently associated with a lower rate of ART initiation as compared to CD4 nadir <200 cells/mm3 (HR: 0.32; 95% CI: 0.28 to 0.37). Age >50 years at diagnosis was independently associated with shorter time to ART initiation as compared to 18 to 29 years (HR: 1.38; 95% CI: 1.19 to 1.61). Conclusions Consistent with changing guidelines, the interval between diagnosis and ART initiation has decreased over time. Still, many adults living with HIV initiated treatment with low CD4, highlighting the need to diagnose HIV earlier while improving access to immediate ART after diagnosis.

Anemia results in increased morbidity and mortality, underscoring the need to better understand its pathophysiology amongst HIV-exposed and infected children in sub-Saharan Africa, the region where most infant HIV exposure and infections occur. This analysis used samples obtained from children in the Kisumu Breastfeeding Study (KiBS). KiBS was a longitudinal phase IIB, open-label, one-arm clinical trial, designed to investigate the safety, tolerability and effectiveness of a maternal triple-antiretroviral (ARV) regimen for prevention of mother-to-child transmission (PMTCT) of HIV, during late pregnancy and early infancy while breastfeeding. Blood samples from 482 children were obtained at birth, 2, 6, 10 and 14 weeks and 6, 9, 12, 18 and 24 months. Severity of anemia was graded using the NIH Division of AIDS (DAIDS) toxicity tables. We describe the proportion of children with anemia and anomalies in red blood cell parameters at various time points over 24 months and compare rates of anemia between HIV-infected and HIV-uninfected children and by mothers' ARV regimen and infant malaria infection. The proportion of children with anemia significantly increased after the breastfeeding period in both HIV-infected and HIV-uninfected children with higher proportion among HIV-infected children compared to HIV-uninfected children (RR: 1.72; CI: 1.22-2.44, p = 0.002). Maternal triple-antiretroviral regimen was not associated with infant anemia (p = 0.11). There was no significant difference in mean hemoglobin between HIV-uninfected children with and without malaria at each time point except at 24 months. A relatively lower proportion of children with severe anemia during the breastfeeding period suggest that exposure to mother's triple antiretroviral combinations through breast milk, posed minimal risk of hematologic toxicity.

World Health Organization (WHO) guidelines have shifted over time to recommend earlier initiation of antiretroviral therapy (ART) and now encourage ART initiation on the day of HIV diagnosis, if possible. However, barriers to ART access may delay initiation in resource?limited settings. We characterized temporal trends and other factors influencing the interval between HIV diagnosis and ART initiation among participants enrolled in a clinic?based cohort across four African countries. The African Cohort Study enrols adults engaged in care at 12 sites in Uganda, Kenya, Tanzania and Nigeria. Participants provide a medical history, complete a physical examination and undergo laboratory assessments every six months. Participants with recorded dates of HIV diagnosis were categorized by WHO guideline era (<2006, 2006 to 2009, 2010 to 2012, 2013 to 2015, ?2016) at the time of diagnosis. Cox proportional hazard modelling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CI) for time to ART initiation. From January 2013 to September 2019, a total of 2888 adults living with HIV enrolled with known diagnosis dates. Median time to ART initiation decreased from 22.0 months (interquartile range (IQR) 4.0 to 77.3) among participants diagnosed prior to 2006 to 0.5 months (IQR 0.2 to 1.8) among those diagnosed in 2016 and later. Comparing those same periods, CD4 nadir increased from a median of 166 cells/mm[sup.3] (IQR: 81 to 286) to 298 cells/mm[sup.3] (IQR: 151 to 501). In the final adjusted model, participants diagnosed in each subsequent WHO guideline era had increased rates of ART initiation compared to those diagnosed before 2006. CD4 nadir ?500 cells/mm[sup.3] was independently associated with a lower rate of ART initiation as compared to CD4 nadir <200 cells/mm[sup.3] (HR: 0.32; 95% CI: 0.28 to 0.37). Age >50 years at diagnosis was independently associated with shorter time to ART initiation as compared to 18 to 29 years (HR: 1.38; 95% CI: 1.19 to 1.61). Consistent with changing guidelines, the interval between diagnosis and ART initiation has decreased over time. Still, many adults living with HIV initiated treatment with low CD4, highlighting the need to diagnose HIV earlier while improving access to immediate ART after diagnosis.

In the wake of climate change and dwindling natural resources, system of rice intensification has been fronted as an approach to improve rice production in several countries. Besides the benefits such as improved rice productivity, reduced water usage that have widely been observed, there is need to quantify the economic benefits of system of rice intensification accrued to farmers, thereby promoting it as an innovation to improve livelihoods of rice farmers. This aim of this paper is to quantify the economic benefits of undertaking SRI among smallholder rice farmers. We introduced SRI among smallholder farmers in a rural setting in western Kenya, Oluch irrigation scheme, through an innovation platform approach. Over the period of four years (2016–2019), we quantify the benefits accrued to the uptake of the technology among adopters of the technology. Our comparisons are in reference to a baseline study conducted prior to the full-scale promotion of SRI in the study area. Our study findings reveal that the uptake of specific SRI practices increased by at least 30–80%, and acreage under rice farming increased by 50%. Besides, SRI required more production costs per acre (63% increase), although SRI had at least 28.6% higher return per shilling invested. Our findings underscore previous results in the literature that SRI is associated with not only productivity but also economic benefits justifying the need for scaling especially among smallholder farmers. Nonetheless, efficient approaches to scaling such promising technologies are necessary to enhance productivity and subsequently improve livelihoods.

Given the current trends in incidence and underlying healthcare systems vulnerabilities, Africa could become the next epicenter of the COVID-19 pandemic. As the pandemic transitions to more widespread community transmission, how can the lessons learned thus far be consolidated to effectively curb the spread of COVID-19 while minimizing social disruption and negative humanitarian and economic consequences?

This study aims at providing expertise for preparing public-based flood mapping and estimating flood risks in growing urban areas. To model and predict the magnitude of flood risk areas, an integrated Analytical Hierarchy Process (AHP) and Geographic Information System (GIS) analysis techniques are used for the case of Eldoret Municipality in Kenya. The flood risk vulnerability mapping follows a multi-parametric approach and integrates some of the flooding causative factors such as rainfall distribution, elevation and slope, drainage network and density, land-use/land-cover and soil type. From the vulnerability mapping, urban flood risk index (UFRI) for the case study area, which is determined by the degree of vulnerability and exposure is also derived. The results are validated using flood depth measurements, with a minimum average difference of 0.01 m and a maximum average difference of 0.37 m in depth of observed flooding in the different flood prone areas. Similarly with respect to area extents, a maximum error of not more than 8% was observed in the highly vulnerable flood zones. In addition, the Consistency Ratio which shows an acceptable level of 0.09 was calculated and further validated the strength of the proposed approach.

At the beginning of the first wave of the pandemic in April 2020, 88% (43/49) of African countries had implemented stringent nonpharmaceutical intervention including some level of closure of the public transport system, staying-at-home measures, and travel restrictions, but these measures have since been relaxed in most countries [2]. A survey by WHO conducted between April and June 2020 showed that 19 of 33 (58%) African countries had a potential risk of antiretroviral (ARV) treatment service disruption [5]. [...]58% (7/12) of the countries reported having less than 3 months’ supply of ARVs in-country [5]. Countries have also reported potential disruptions in other HIV services including testing, viral load monitoring, prevention services like voluntary medical male circumcision services, preexposure prophylaxis, early infant diagnosis for prevention of mother-to-child transmission, among others [5]. Modeling studies predict that a 25% decline in the distribution of insecticide-treated nets (ITNs) and access to artemisinin-based combination therapy (ACT) would lead to a 12% increase in malaria cases and a 35% increase in deaths [29].

Assembling Export Markets explores the new ‘frontier regions’ of the global fresh produce market that has emerged in Ghana over the past decade. -Represents a major and empirically rich contribution to the emerging field of the social studies of economization and marketization -Offers one of the first ethnographic accounts on the making of global commodity chains ‘from below’ -Denaturalizes global markets by unpacking their local engagement, materially entangled construction, need for maintenance, and fragile character -Offers a trans-disciplinary engagement with the construction and extension of market relations in two frontier regions of global capitalism -Critically examines the opportunities and risks for firms and farms in Ghana entering global fresh produce markets