Can Domestic Food Production Provide Future Urban Populations with Food and Nutrition Security?—Insights from Bangladesh, Kenya and Uganda

Population growth and urbanization increasingly put pressure on our planet's availability of areas needed for food production. The dependencies on domestically produced food are increasingly judged favourable, following the consequences of the Ukrainian war, with escalating fuel and grain prices and less accessibilities to low-income groups. It is, however, unclear whether land is domestically available. Applying a food system approach, the main aim of this article is to investigate spatial foodsheds and theoretical self-sufficiency for food production needed to supply increasing future populations in a selection of cities, including estimates for Dhaka in Bangladesh, Nairobi in Kenya and Kampala in Uganda. The projected foodshed scenario areas for the years 2020 and 2050 are estimated for the production of three core products currently extensively produced and consumed in the three countries. They show that it is not possible to feed an ever-increasing urban population based on domestic production alone. International trade, new technological developments and new consumer demands for less area-intensive food production systems may give solutions to the immense challenge of feeding the world's population with nutritious food in 2050. However, to ensure fair and inclusive transition pathways for low-income groups: (1) affordability and accessibility of trade opportunities, technologies and products, (2) a common vision aiming for the SDGs, including SDG2: Zero hunger and SDG11: Sustainable Cities and Communities as well as (3) best practices in co-creation and cooperation with the most vulnerable urban and rural populations, are highly needed.

Caring Interventions for the Most Vulnerable Populations in Economically Disadvantaged Areas during the Coronavirus (COVID-19) Pandemic by Non-Governmental Organizations in Kenya

This paper deals with COVID-19-hit Kenyan slums and the numerous interventions civil society organizations implemented during the first waves of the pandemic since it was initially detected in March 2020. As part of a comprehensive project using mixed methodology, including desk research and key informant interviews, community-based organizations and non-governmental organizations, together with other stakeholders of their collaborative networks, were investigated regarding the roles that they played, the projects they carried out, and the interventions they were involved in in the mitigation of the negative impacts of COVID-19. This paper investigates how COVID-19 actually hit Kenyan slums and how it affected civil society organizations during the pandemic. © 2023 by the authors.

COVID Challenges for Trials in Low-to-Middle-Income Countries

While the substantial majority of clinical trials still take place in countries classified by the World Bank as high income, a review of clinical trial registrations on the World Health Organization (WHO) International Clinical Trials Registry Platform and clinicaltrials.gov shows that a significant and growing number are being conducted in LMICs, with major centers in Eastern Europe, the Middle East, Brazil, China, India, and South Africa. COVID-19 will likely have a longlasting effect on global supply chains.11 The U.S. and more than 50 other countries are restricting or considering restrictions on exports of supplies that are needed to mitigate the effects of COVID-19 locally.12 Internationally, the World Trade Organization and the World Customs Organization issued a joint statement noting the disruptive impact of the virus on global supply chains and pledged to cooperate to facilitate trade in essential goods.13 LMICs are struggling to obtain limited hospital supplies in the global market in competition with the U.S., the European Union, Japan, and similar high-income buyers, as recent reporting about the COVID-19 outbreak in Nigeria shows.14 Clinical trial sites in LMICs that cannot obtain needed supplies in-country could obtain them from a study sponsor, assuming the products can be legally imported and shipments to that country are not cost-prohibitive in light of global freight and logistic disruptions. [...]informed consent forms and study institutional review board (IRB) and independent ethics committee (IEC) approvals may need to be revisited in light of local conditions. Clint D. Hermes is an attorney at Bass, Berry & Sims References 1. https://main.icmr.nic.in/sites/default/files/guidelines/EC_Guidance_ COVID19_06_05_2020.pdf 2. http://www.sahpra.org.za/wp-content/uploads/2020/03/SAHPRACommunication_COVID_19-Final-25032020.pdf 3. https://pharmacyboardkenya.org/files/?file=Clinical_Trials_During_ COVID-19_Pandemic.pdf 4. http://portal.anvisa.gov.br/documents/219201/4340788/SEI_ ANVISA+-+0989653+-+Nota+Técnica14.pdf/6b48273f-550f-47618ba1-4e731a87b526 5. https://www.gob.mx/cofepris/articulos/medidas-extraordinarias-enrelacion-a-estudios-clinicos-ante-la-pandemia-de-covid-19 6. https://ensayosclinicos-repec.ins.gob.pe/images/Nueva_actualización_12.12.19/Actualización_2020/Comunicado_N_002-2020.pdf 7. https://www.imf.org/en/Topics/imf-and-covid19/Policy-Responsesto-COVID-19 8. https://www.bsg.ox.ac.uk/research/research-projects/coronavirusgovernment-response-tracker 9. https://covidtracker.bsg.ox.ac.uk/stringency-map 10.https://www.who.int/news-room/commentaries/detail/immunitypassports-in-the-context-of-covid-19 11. https://www.weforum.org/agenda/2020/04/supply-chains-leadership-business-economics-trade-coronavirus-covid19/ 12. https://www.weforum.org/agenda/2020/03/covid-19-coronaviruslessons-past-supply-chain-disruptions/ 13.http://www.wcoomd.org/en/media/newsroom/2020/april/wco-wtojoint-statement-on-covid-19-related-trade-measures.aspx 14.https://www.nytimes.com/2020/05/17/world/africa/coronaviruskano-nigeria-hotspot.html 15. https://mp.weixin.qq.com/s/amB7fBxLw8KSR9DcUsbTWg

Shoulder to shoulder, Broadening the Men's Shed movement

Sheds were often hard hit by the COVID-19 pandemic, forced to close for significant periods of time, this had some impact on the mental health of Shedders and family members. A reprint of the earlier book would not necessarily lend itself to the comprehensive reflection and evidence needed to illustrate the growth and adaptability of the movement over nearly three decades. [...]Shoulder to Shoulder: Broadening the Men's Shed Movement documents the story of the broadening of the movement into many more countries, and of its growing relevance to diverse cohorts, for example, younger folk, non-Anglo speaking community members, and women. The book provides case studies and detailed descriptions of the origin and function of Sheds in a growing number of countries showing that Shedders' lives have been changed for the better, particularly those who were disconnected, isolated or were adjusting to life as retirees, widowers or with chronic health issues.

Development of a model of care based on the chronic care and collaborative care models to improve cardiometabolic health in low-to- middle income countries

Background: Non-communicable diseases (NCDs) are rising in low middle income countries (LMICs) mainly driven by cardiometabolic disease (cardiovascular disease, diabetes, and hypertension). Aim(s): To develop a model of care, based on the chronic care model and collaborative care model, to improve care, outcomes and risk factor control for adults with cardio metabolic disease in LMICs in the Covid-19 era. This will contribute to the sustainable development goals of promoting good health, well-being and reducing inequalities. Method(s): Using an iterative consultative approach with healthcare workers, clients, and community leaders in Kenya, Ghana and Mozambique, we developed a model of care, which includes core features from chronic care models: self-management support;decision support;clinical information systems;delivery system design;and community linkages. Result(s): We produced a culturally adapted self-management education programme, a training package for educators delivering the programme, as well as a training package for community and healthcare professional leaders to increase awareness and self-care for cardiometabolic disease. Given the lack of a robust health information system, we are offering a global registry to provide real world data on patient management and quality of care for people with type 2 diabetes, hypertension, heart failure and chronic kidney disease. Conclusion(s): This intervention will be tested in a mixed-methods single-arm feasibility study in five sites across three African countries: Kenya, Ghana, Mozambique.

Reactivation of Surgical Campaigns after the Covid Pandemic: Surgeons in Action with Hernia International Foundations in 2022

Aim: The Cirujanos en Accion and Hernia International foundations carried out their own and collaborative surgical campaigns in developing countries. In 2020 and 2021 the programme had to be suspended due to Covid. In 2022 we restarted our actions, analysed the difficulties of reactivation and described the campaigns that had been carried out and those that had to be delayed. Material/ Methods: We describe the 9 campaigns of Surgeons in Action, our own and in collaboration with Hernia International and our own campaign to the region of Naborno Karabakh, planned for September and cancelled 24 hours before departure due to the resurgence of armed conflict. An analysis is made of volunteers, places, type (adults or children or mixed), collaborations with other foundations, patients operated and procedures done according to pathologies, integration with local staff with exchange of knowledge. Result(s): Made in 8 countries (Benin, Camerun, Gambia (2), Kenya, Liberia, Mozambique, Tanzania, Sierra Leone) and postponed in one country, the Naborno Karabakh region of Armenia. 85 volunteers (25 general and 10 paediatric surgeons, 19 anaesthetists, 3 intensivists, 23 nurses, 5 audiovisuals);local staff;1144 patients (473 children, 671 adults), 1325 procedures for various pathologies (hernias, goitres, hydroceles, undescendend testis, soft tissue tumours, etc.) Conclusion(s): 9 campaigns have been carried out successfully and new locations have been opened with a good projection for the coming years, and we have experienced difficulties with the cancellation of a mega-campaign in an area with geopolitical conflicts - to be taken into account in the future.

Effective training practices for non-specialist providers to promote high-quality mental health intervention delivery: A narrative review with four case studies from Kenya, Ethiopia, and the United States

Mental health needs and disparities are widespread and have been exacerbated by the COVID-19 pandemic, with the greatest burden being on marginalized individuals worldwide. The World Health Organization developed the Mental Health Gap Action Programme to address growing global mental health needs by promoting task sharing in the delivery of psychosocial and psychological interventions. However, little is known about the training needed for non-specialists to deliver these interventions with high levels of competence and fidelity. This article provides a brief conceptual overview of the evidence concerning the training of non-specialists carrying out task-sharing psychosocial and psychological interventions while utilizing illustrative case studies from Kenya, Ethiopia, and the United States to highlight findings from the literature. In this article, the authors discuss the importance of tailoring training to the skills and needs of the non-specialist providers and their roles in the delivery of an intervention. This narrative review with four case studies advocates for training that recognizes the expertise that non-specialist providers bring to intervention delivery, including how they promote culturally responsive care within their communities.Copyright © 2023 The Author(s).

Sustainable access of quality seeds of genetically engineered crops in Eastern Africa - Case study of Bt Cotton.

The genetically engineered bollworm-resistant Bt cotton hybrid varieties offer opportunities for reducing crop losses and enhancing productivity. In Eastern Africa region, Sudan, Ethiopia, and Kenya have approved and released Bt cotton in 2012, in 2018, and in 2019, respectively. The region has potential to grow cotton in over 5 million hectares. For commercial plantings in Ethiopia, Sudan and Kenya, hybrid Bt cotton seeds have been imported from India. Due to the COVID-19 pandemic-induced supply chain disruptions, high shipment costs, bureaucratic procedures for importing seeds, and foreign exchange shortages, farmers have not been able to access Bt cotton seeds. Stakeholders are seeking local production of seeds to provide sustainable access by farmers at affordable cost. Country case studies reveal the importance of enhancing capacity for local seed production and extension advisory services. Revival of the cotton sector needs enhanced public-private partnerships to pave the way for sustainable seeds access in the region.

Poverty Reduction through Growth, Redistribution and Social Inclusion in Times of COVID-19: Kenyan Evidence on the Underlying Mechanisms

The paper looks at the nexus between growth, poverty, inequality and redistribution in Africa, using Kenya as a case study. The existing literature shows a strong causal link from growth to poverty reduction. This link is the basis for the pro-poor poverty reduction strategy. There is evidence from the AERC studies that, poverty reduction in a given period is associated with higher growth rates in successive periods that are inequality-reducing and conceptually long lasting. This virtuous spiral of poverty reduction, higher growth and less inequality over time, is the basis for the pro-growth poverty reduction strategy that has recently been emphasized in the literature (Thorbecke and Ouyang, 2022). The two poverty reduction strategies, a pro-poor strategy and a pro-growth poverty reduction one, complement each other, sustaining household escapes from poverty over time. The paper provides evidence from Kenya showing that human capital formation is the key mechanism underlying the virtuous spiral of lower poverty, higher growth and less inequality as the economy progresses through time. A perspective on robustness of the virtuous spiral in the context of COVID-19 and other pandemics is offered in the concluding section of the paper.

Human interactions with bats and bat coronaviruses in rural Côte d'Ivoire.

Bats are presumed reservoirs of diverse α- and ß- coronaviruses (CoVs) and understanding the diversity of bat-CoVs and the role bats play in CoV transmission is highly relevant in the context of the current COVID pandemic. We sampled bats in Côte d'Ivoire (2016-2018) living at ecotones between anthropogenic and wild habitats in the Marahoué National Park, a recently encroached protected area, to detect and characterize the CoVs circulating in bats and humans. A total of 314 bats were captured, mostly during the rainy season (78%), and CoV RNA was detected in three of the bats (0.96%). A CoV RNA sequence similar to Chaerephon bat coronavirus/Kenya/KY22/2006 (BtKY22) was found in a Chaerephon cf. pumilus and a Mops sp. fecal swab, while a CoV RNA sequence similar to the two almost identical Kenya bat coronaviruses BtKY55 and BtKY56 (BtKY55/56) was detected in an Epomops buettikoferi oral swab. Phylogenetic analyses indicated differences in the degree of evolutionary host-virus co-speciation for BtKY22 and BtKY55/56. To assess potential for human exposure to these viruses, we conducted human syndromic and community-based surveillance in clinics and high-risk communities. We collected data on participant characteristics, livelihoods, animal contact, and high-risk behaviors that may be associated with exposure to zoonotic diseases. We then collected biological samples for viral testing from 401 people. PCR testing of these biological samples revealed no evidence of CoV infection among the enrolled individuals. We identified higher levels of exposure to bats in people working in crop production and in hunting, trapping and fishing. Finally, we used the 'Spillover' risk-ranking tool to assess the potential for viral spillover and concluded that, while there is no evidence to suggest imminent risk of spillover for these CoVs, their host range and other traits suggest caution and vigilance are warranted in people with high exposure risk.

Digital welfare state and problem arising: an exploration and future research agenda

PurposeThe penetration of technology and the strengthening of evidence-based policies have paved the way for the automated delivery of social services. This study aims to discuss the inherent risks of this automatization, particularly those associated with the discrimination, exclusion and inequality problem, which the authors package under the theoretical umbrella of a digital welfare state (DWS).Design/methodology/approachThis conceptual article reviews the literature on the welfare DWS, with an empirical focus on the recent experience of selected countries from India, Kenya and Sweden. These countries reflect three different types of welfare regimes but are connected by the same digital social risk. The authors' exploration also includes questions about what this DWS has in common with and how it differs from the previous era. This article illustrates that there has been a very similar trajectory in regards to the development of the DWS and the associated risks in the examined countries.FindingsDWS has triggered new social risks (e.g. discrimination, exclusion and inequality in welfare access) that are a result of data breaches experienced by citizens. Further, vulnerable groups in the digital age should be viewed not only as those who lack access to welfare services, such as education, health and employment, but also as those without internet access, without digital skills and excluded from the DWS system.Originality/valueThe article calls for the development of scholarly research into the DWS in particular and the contemporary one in general. The authors also predict that a critical aspect of the future regime typology rests in the ability to mobilize resources to address contemporary digital risks, as every country is equally vulnerable to them. Overall, this article can be considered to be one of the initial works that focus on cross-national comparison across different meta-welfare regimes.

Randomized regulation: the impact of minimum quality standards on health markets

We report results from the first randomization of a regulatory reform in the health sector. The reform established minimum quality standards for patient safety, an issue that has become increasingly salient following the Ebola and COVID-19 epidemics. In our experiment, all 1348 health facilities in three Kenyan counties were classified into 273 markets, and the markets were then randomly allocated to treatment and control groups. Government inspectors visited health facilities and, depending on the results of their inspection, recommended closure or a timeline for improvements. The intervention increased compliance with patient safety measures in both public and private facilities (more so in the latter) and reallocated patients from private to public facilities without increasing out-of-pocket payments or decreasing facility use. In treated markets, improvements were equally marked throughout the quality distribution, consistent with a simple model of vertical differentiation in oligopolies. Our paper thus establishes the use of experimental techniques to study regulatory reforms and, in doing so, shows that minimum standards can improve quality across the board without adversely affecting utilization.

Assessing disease risk perceptions of wild meat in savanna borderland settlements in Kenya and Tanzania

Wild meat hunting and trade across African savannas is widespread. We interviewed 299 people in rural settlements along the Kenya-Tanzania border to examine impacts of COVID-19 on wild meat consumption and perceptions about wild meat activities associated with zoonotic disease risks. Education level played a key part in understanding COVID-19 transmission. Information about the pandemic was mostly acquired from the media. Nearly all respondents recognized that COVID-19 originated in China. As many as 70% reported no impact of COVID-19 on wild meat consumption;some believed that there was an increase. Over half of the respondents believed that consumption of wild meat leads to food-borne illnesses. Respondents recognized disease risks such as anthrax and brucellosis and accepted that people slaughtering and handling wild meat with open cuts were at greater risk. Ungulates were the most consumed animals, followed by birds, rodents, and shrews. Respondents perceived that hyenas, monkeys, donkeys, and snakes were riskier to eat. More than 90% of the respondents understood that handwashing with soap reduces risks of disease transmission. Country level (11 answers), education and gender (three answers each) and household economy (158 answers) were significant. Country differences were linked to differences in nature legislation;50% of Kenyan respondents believed that wild meat should not be sold because of conservation concerns. Men were more worried about getting COVID-19 from live animals and perceived that wildlife should not be sold because of conservation reasons. Overall, there was a very strong inclination to stop buying wild meat if other meats were less expensive. Our results allow us to better understand the impact of the COVID-19 pandemic on wild meat-related activities. Differences between countries can frame the attitudes to wild meat since wild meat trade and consumption were found to be country specific.

Outbreaks of different viral etiologies amidst COVID-19 pandemic

The COVID-19 pandemic has severely affected public health system and surveillance of other communicable diseases across the globe. The lockdown, travel constraints and COVID phobia turned down the number of people with illness visiting to the clinics or hospitals. Besides this, the heavy workload of SARS-CoV-2 diagnosis has led to the reduction in differential diagnosis of other diseases. Consequently, it added to the underlying burden of many diseases which remained under-diagnosed. Amidst the pandemic, the rise of emerging and re-emerging infectious diseases was observed worldwide and reported to the World Health Organization i.e., Crimean Congo Hemorrhagic Fever (2022, Iraq;2021 India), Nipah virus (2021, India), Zika virus (2021, India), and H5N1 influenza (2021, India), Monkeypox (2022, multicountry outbreak), Ebola virus disease (2022, DRC, Uganda;2021, DRC, Guinea;2020, DRC), Marburg (2022, Ghana;2021, Guinea), Yellow fever (2022, Uganda, Kenya, West and Central Africa;2021, Ghana, Venezuela, Nigeria;2020, Senegal, Guinea, Nigeria, Gabon;2020, Ethiopia, Sudan, Uganda), Dengue (2022, Nepal, Pakistan, Sao Tome, Temor-Leste;2021, Pakistan), Middle east respiratory syndrome coronavirus (2022, Oman, Qatar;2021, Saudi Arabia, UAE;2020, Saudi Arabia, UAE), Rift valley fever (2021, Kenya;2020, Mauritania), wild poliovirus type 1 (2022, Mozambique), Lassa fever (2022, Guinea, Togo, Nigeria;2020, Nigeria), Avian Influenza (H3N8) (2022, China), Avian Influenza (H5N1) (2022, USA), H10N3 influenza (2021, China), Hepatitis E virus (2022, Sudan), Measles (2022, Malawi, Afghanistan;2020, Burundi, Mexico), Mayaro virus disease (2020, French Guiana), Oropouche virus disease (2020, French Guiana). All these diseases were associated with high morbidity and burdened the public health system during the COVID-19 pandemic. During this critical public health menace, majority of the laboratory workforce was mobilized to the SARS-CoV-2 diagnosis. This has limited the surveillance efforts that likely led to under diagnosis and under-detection of many infectious pathogens. Lockdowns and travel limitations also put a hold on human and animal surveillance studies to assess the prevalence of these zoonotic viruses. In addition, lack of supplies and laboratory personnel and an overburdened workforce negatively impacted differential diagnosis of the diseases. This is especially critical given the common symptoms between COVID-19 and other pathogens causing respiratory illnesses. Additionally, the vaccination programs against various vaccine preventable diseases were also hampered which might have added to the disease burden. Despite these challenges, the world is better prepared to detect and respond to emerging/re-emerging pathogens. India now has more than 3000 COVID-19 diagnostic laboratories and an enhanced hospital infrastructure. In addition, mobile BSL-3 facilities are being validated for onsite sampling and testing in remote areas during outbreak situations and surveillance activities. This will undoubtedly be valuable as the COVID-19 pandemic evolves as well as during future outbreaks and epidemics. In conclusion, an increase in the emergence and re-emergence of viruses demonstrates that other infectious diseases have been neglected during the COVID-19 pandemic. Lessons learned from the infrastructure strengthening, collaborations with multiple stakeholders, increased laboratory and manufacturing capacity, large-scale COVID-19 surveillance, extensive network for laboratory diagnosis, and intervention strategies can be implemented to provide quick, concerted responses against the future threats associated with other zoonotic pathogens.

A University Collaboration in Creating a Powered Air Purifying Respirator: An Emergency Innovative Response

Purpose of Study In March of 2020, the World Health Organization declared the coronavirus (COVID-19) a global pandemic. As the number of cases increased worldwide, existing hospital infrastructure struggled to keep up with the demand for equipment and supplies.This exposed healthcare workers to contracting the disease. The purpose of this study is to demonstrate an emergency innovation response in overcoming shortages of personal protective equipment within a university hospital setting, with a special focus on powered air purifying respirators (PAPRs). Methods Used The Center for Medical Innovation (CMI)-a center designed to promote research and development of high-impact healthcare products at the University of Utah (UofU)-enlisted university engineers to develop an open source PAPR system made from readily available commercial materials. Parts were selected to meet filtration, airflow, and protection specifications as outlined by industry standards. Commercially available parts consistent with these specifications were assembled into a novel PAPR system which utilized 3D printed pieces on demand to achieve compatibility. Once assembled, each PAPR went through protection testing to demonstrate health worker safety. A fit factor of 200 is the minimum requirement needed as defined by NIOSH. Testing procedures were carried out with industry standard equipment. Summary of Results A human centered design approach was utilized in iterating versions of the product based on repeated fit testing. Failures were addressed in subsequent models. All PAPRs passed fit testing with a score of > 1000. Following the lean processing standard of just in time inventory, materials to fabricate 1000 PAPRs were procured and assembled on demand. PAPRs are now being used by the UofU Hospital as well as other affiliate entities globally and are filling the gap needed for PPE. Approximately 200 units have been donated to Navajo Nations hospitals in the state of Utah and others have been donated to university sister entities in India, Nepal, and Kenya. Conclusions The Center for Medical Innovation at the University of Utah has facilitated a rapid emergency innovative response in filling the PPE needs locally and abroad by creating this open source accessible PAPR system.

Impact of Covid-19 Induced Program Adaptations on Hiv Suppression in Three Countries

Background: The pandemic response measures have had significant global economic and health impacts with transient reductions in HIV clinic attendance and self-reported anti-retroviral therapy (ART) adherence reported in prior studies. Since viral suppression (VS) is an indication of ART adherence and effective service delivery, we assessed VS in the context of the COVID-19 pandemic in 3 African countries Methods: Since 2013, the African Cohort Study (AFRICOS) has enrolled individuals 18 years or older with and without HIV, in an approximate 5:1 ratio, at 12 clinics across 5 HIV care programs in Tanzania Uganda, Kenya, and Nigeria. For people living with HIV (PLWH), ART history was extracted from medical records and viral load was assessed at each visit. This assesses VS (< 1000 c/ml) before and during the COVID-19 pandemic (categorized into 4 surges and a consolidated non-surge period;defined in Table 1) among PLWH. Tanzania was excluded due to inadequate pandemic data. Logistic regression with generalized estimating equations, clustered by participant, was used to estimate odds ratios (ORs) and 95% confidence intervals (CI) comparing VS before and during COVID-19. Models are adjusted for age, sex, and program. Result(s): Of the 1741 study participants, 368 are from Uganda, 1156 are from Kenya, and 217 are from Nigeria;730 are males, 1011 are females, and 147 are under the age of 30. PLWH were less likely to be virally suppressed during the first surge period (OR 0.85, CI 0.46-1.56), but VS significantly increased during the second surge period (OR 1.95, CI 1.23-3.04) compared to the pre-COVID period. The third and fourth surge periods also saw a higher VS (table 1). Females are more likely to be virally suppressed than males (OR 1.58, CI 1.09- 2.29) and PLWH ages 40-49 have higher VS (OR 2.43, CI 1.32-4.48) compared to PLWH under. PLWH at the AFRICOS sites in Kenya and Nigeria show lower VS than the Ugandan cohort (ORs 0.46, CI 0.26-0.79 and OR 0.32, CI 0.17-0.60 respectively). Conclusion(s): The initial drop in VS may be attributed to reduced clinic access due to lockdowns. Many HIV programs supported by the President's Emergency Plan for AIDS Relief (PEPFAR) adapted their strategies to serve PLWH by scaling up community ART dispensing and multi-month dispensing (MMD) of ART for stable clients, which could have led to increased VS during the other surge periods.

SARS-CoV-2 INFECTION AMONG PERSONS WHO INJECT DRUGS AND THEIR PARTNERS IN KENYA

Background: Despite increased social vulnerability and barriers to care, there has been a paucity of data on SARS-CoV-2 incidence among key populations in sub-Saharan Africa. We seek to characterize active infections and define transmission dynamics of SARS-CoV-2 among people who inject drugs (PWID) and their sexual and injecting partners from Nairobi and the coastal region in Kenya. Method(s): This was a nested cross-sectional study of SARS-CoV-2 infection from April to July 2021 within a cohort study of assisted partner services for PWID in Kenya. A total of 1000 PWID and their partners (500 living with and 500 living without HIV) were recruited for SARS-CoV-2 antibody testing, of whom 440 were randomly selected to provide self-collected nasal swabs for real-time PCR testing. Whole genome sequencing (WGS) was completed on a limited subset of samples (N=23) with cycle threshold values 32.0. Phylogenetic tree construction and analysis was performed using the Nextstrain pipeline and compared with publicly available SARS-CoV-2 sequences from GenBank. Result(s): A total of 438 (99.5%) participants provided samples for SARS-CoV-2 PCR testing. Median age was 37 (IQR 32-42);128 (29.2%) were female;and 222 (50.7%) were living with HIV. The overall prevalence of SARS-CoV-2 infection identified by RT-PCR was 86 (19.6%). In univariate analyses, there was no increased relative risk of SARSCoV- 2 infection related to positive HIV status, frequenting an injection den, methadone treatment, unstable housing, report of any high-risk exposure, or having a sexual or injecting partner diagnosed with COVID-19 or who died from COVID-19 or flu-like illness. Eight samples were successfully sequenced via WGS and classified as WHO variants of concern: 3 Delta, 3 Alpha, and 2 Beta. Seven were classified into clades predominantly circulating in Kenya during 2021. Notably, two sequences were identical and matched identically to another Kenyan sequence, which is consistent with, though not indictive of, a transmission linkage. Conclusion(s): Overall, the risk of SARS-CoV-2 infection in this population of PWID and their partners was not significantly associated with risk factors related to injection drug use. At a genomic level, the SARS-CoV-2 strains in this study were consistent with contemporary Kenyan lineages circulating during the time and not unique to PWID. Prevention efforts, therefore, must also focus on marginalized groups for control given the substantial amount of mixing that likely occurs between populations.

INTEGRATION OF SARS-CoV-2 RAPID ANTIGEN TEST IN HEALTH SERVICES IN KENYA AND CAMEROON

Background: Early diagnosis of COVID-19 is key to prevent severe cases and poor outcomes in vulnerable populations, including pregnant women and people living with HIV or infected with tuberculosis (TB). The feasibility of integration of SARS-CoV-2 antigen rapid diagnostic testing (Ag-RDT) into maternal neonatal, and child Health (MNCH);HIV;and TB clinics is unknown. Method(s): We analyzed data from a SARS-CoV-2 screen and test program implemented in 50 health facilities (25 in Kenya and 25 in Cameroon), integrating SARS-CoV-2 Ag-RDT in MNCH, HIV, and TB clinics between May and October 2022. Clients aged two and older attending MNCH, HIV, and TB clinics were offered SARS-CoV-2 screening, and those eligible were tested using SARS-CoV-2 Ag-RDT. Routine SARS-CoV-2 program data were captured through dedicated paper forms in Cameroon or an electronic medical record (EMR) interface in Kenya and transferred to a database for analysis. We estimated the proportion of clients screened and tested and the SARS-CoV-2 positivity rates. Result(s): Overall, 527,184 attendee visits were reported in Cameroon (282,404) and Kenya (244,780), with screening for COVID-19 symptoms and exposure performed in 256,033 (48.5%) with substantive variations between countries (62.6% in Cameroon and 32.4% in Kenya). Among the 256,033 screened, 19,058 (7.4%) were eligible for testing (9.0% in Cameroon and 3.9% in Kenya), of whom 12,925 (67.8%) were tested for SARS-CoV-2 with substantial variation in testing rates between countries (61.9% in Cameroon and 97.9% in Kenya) and clinics (59.9% in MNCH, 68.7% in HIV, and 92.8% in TB clinics). A total of 390 (3.0%) positive tests were identified (329 (3.3%) in Cameroon and 61 (2.0%) in Kenya). The estimated case detection rate was 1.26 (95% CI=0.76-1.75) per 1,000 attendee visits in Cameroon and 0.49 (95% CI=0.12-0.86) per 1,000 attendee visits in Kenya. Country integration strategy, facility level, setting, and clinic were independently associated with screening (Table 1) and testing. Conclusion(s): Integration of SARS-CoV-2 Ag-RDT in HIV, TB, and MNCH clinics was feasible in both countries despite challenges with low screening rates in Kenya and low testing rates in Cameroon. Decentralization of SARS-CoV-2 testing at different facility clinics allowed detection of SARS-CoV-2 cases among vulnerable populations. Integration strategies should consider facility settings (rural compared to urban) and additional human resources in high volume facilities to improve screening and testing rates.

Give and Take: Developmental Foreign Aid and the Pharmaceutical Industry in East Africa by Nitsan Chorev (review)

Nitsan Chorev's Give and Take is an in-depth and well-researched comparative historical analysis of the kind of foreign aid that facilitated the development and growth of the pharmaceutical industry in East Africa. [...]the decision to purchase locally manufactured drugs for "rations kits” in Kenya, but not in Tanzania or Uganda, was instrumental in the growth of the Kenyan industry and equally detrimental to the fledgling Tanzanian and virtually nonexistent Ugandan pharmaceutical sectors. [...]Chorev shows how this creation of a market, which expands significantly in the wake of HIV/AIDS, was only part of the equation. [...]the remarkable value of Chorev's work has only been amplified since its publication by the highly unequal global distribution of COVID-19 vaccines, particularly in Africa, and a subsequent edition might include a prefatory note on the relevance of Give and Take to the COVID pandemic.

Effectiveness of Dolutegravir in People on Rifampin-Based Tuberculosis Treatment

Background: Tenofovir-lamivudine-dolutegravir (TLD) is the WHO-preferred first-line regimen for people with HIV, but drug-drug interactions between dolutegravir (DTG) and rifampin (RIF) require an additional 50mg DTG (TLD+50) in people receiving tuberculosis (TB)/HIV co-treatment. RIF is a key drug in TB treatment, but is a potent inducer of metabolizing enzymes and efflux transporters, which can markedly lower drug concentrations. There are limited data on the effectiveness of TLD+50 in people with TB/HIV from program settings. Method(s): We conducted a prospective, observational study at 12 sites in 6 countries (Haiti, Kenya, Malawi, South Africa, Uganda, Zimbabwe). Participants received concomitant TLD+50 and RIF-based TB treatment provided as standard of care by HIV and TB treatment programs. Primary outcome was HIV-1 RNA <1000 copies/mL (cpm) at end of TB treatment. New DTG resistance mutations were defined as those present at end of TB treatment but not present at start. Result(s): From 11/2019-6/2021, we enrolled 91 participants with TB/HIV, including 75 ART-naive participants (82%) starting TLD+50 after a median of 15 days on TB treatment, 10 ART-naive participants (11%) starting TLD+50 and RIF together, 5 (5%) starting TB treatment and changing to TLD+50 after a median of 3.3y on TLD, and 1 (1%) starting RIF and TLD+50 after changing from EFV/3TC/TDF. Median age was 37y (IQR 32-43), 35% were female, 100% cis-gender, median CD4 count was 120 cells/mm3 (IQR 50-295), 87% had HIV-1 RNA >1000 copies/mL. Two participants died during TB treatment (week 4 disseminated TB, week 12 suspected COVID-19), 1 interrupted TLD+50 due to jaundice;and 1 discontinued TB treatment due to drug-induced liver injury. Among 89 surviving participants, 6 were lost to follow-up and a further 10 had no HIV-1 RNA result due to missed or remote visits. Primary virologic outcome was therefore assessed in 73 (80%), of whom 69 (95%, Wald 95% CI 89-100%) had HIV-1 RNA <=1000 cpm;68 (93%) had HIV-1 RNA <200 cpm. No sex specific differences in viral suppression were observed. No DTG resistance mutations were detected among 4 participants with HIV-1 RNA >1000 cpm. Conclusion(s): Concomitant RIF-containing TB treatment and TLD+50 was welltolerated and achieved excellent viral suppression in a cohort of predominantly ART-naive people with TB/HIV. These multi-country data from program settings support feasibility and effectiveness of current treatment approaches for TB/ HIV co-infection.