Evidence for population level declines in adult HIV prevalence in Kenya.

The HIV/AIDS epidemic in Kenya has been tracked through annual sentinel surveillance in antenatal clinics since 1990. The system started with 13 sites and now has over 35. Behaviours have been measured through national Demographic and Health Surveys in 1993, 1998, and 2003. The surveillance data indicate that prevalence has declined substantially starting in 1998 in five of the original 13 sites and starting in 2000 in another four sites. No decline is evident in the other five original sites although the 2004 estimate is the lowest recorded. Nationally, adult prevalence has declined from 10% in the late 1990s to under 7% today. Surveys indicate that both age at first sex and use of condoms are rising and that the percentage of adults with multiple partners is falling. It is clear that HIV prevalence is now declining in Kenya in a pattern similar to that seen in Uganda but seven or eight years later. Although the coverage of preventive interventions has expanded rapidly since 2000 this expansion was too late to account for the beginnings of the decline in prevalence. More work is needed to understand fully the causes of this decline, but it is encouraging to see Kenya join the small list of countries experiencing significant declines in HIV prevalence.

Women and HIV in Busia: their recognition and understanding of the disease.

A cross-sectional survey of women within the age range of 15-63 years was carried out between June and September, 1994 in Busia District. The purpose was to determine women's recognition and understanding of HIV/AIDS.A total of 333 women were orally interviewed by trained investigators using questionnaires.98.8% admitted having heard about AIDS while 1.2% had not; 78.1% had seen at least one or more AIDS patients. Although knowledge about causation of AIDS was extremely poor, 98.0% and 95.2% mentioned at least one correct mode of transmission of HIV and signs/symptoms, respectively. 78.1% had seen one or more patients of AIDS and majority (75.0%) said most of these patients belonged to the young (adolescents/middle) age groups. Most (98.8%) knew there is no cure drug for AIDS presently; however, 89.8% had heard about the condom, 77.5% had seen them. 74.7% knew HIV infection could be prevented or controlled by proper use of the condom.

Women and leprosy: time-lag in seeking treatment.

A total of fifty women leprosy patients were orally interviewed in 1992 in a study to determine the magnitude of the problem of delay in seeking treatment in leprosy. The study was carried out in Busia District. The possible socio-cultural risk factors for the delay were also determined. Questionnaires were used in the collection of data. Results obtained indicated a high illiteracy level (82%) and low socio-economic status. Majority of the women were married (64%), many had a family history of leprosy. Knowledge about causative agent for leprosy was poor although majority knew the disease was disabling. A high proportion had problems getting to health units while many held misconceptions about the place to seek medical treatment and the mode of treatment. Many also believed family and community members and some of the health staff held negative attitude about leprosy and, hence, the patients; 64% sort treatment long after disease onset (2-10 years and above). Thus, the problem of delay in seeking medical treatment among female leprosy patients is high and bears socio-economic and social-cultu ral connotations as well as lack of adequate knowledge on the disease.

Case-control study of BCG vaccination as a risk factor for leprosy and tuberculosis in western Kenya.

A case-control study was carried out in western Kenya to measure the protection imparted by BCG against leprosy and tuberculosis. The study involved 69 newly diagnosed leprosy cases, 238 age-, sex- and neighborhood-matched controls, and 144 newly diagnosed, sputum-smear-positive tuberculosis cases along with 432 age-, sex- and neighborhood-matched controls. Information on BCG vaccination history was inferred from scars. Using matched analysis, the protection imparted by BCG against leprosy was estimated to be 81% [95% confidence interval (CI) = 67-90] with no apparent difference in protection against paucibacillary [vaccine efficacy (VE) = 83%, 95% CI = 58-92] and multibacillary leprosy (VE = 76%; 95% CI = 30-91). The effectiveness against tuberculosis was appreciably lower (VE = 22%) and was not statistically significant (95% CI = -20-51).

A case control study on human immunodeficiency virus-1 (HIV-1) infection as a risk factor for tuberculosis and leprosy in western Kenya.

A case control study was undertaken in Western Kenya from April 1989 to August 1990 to evaluate HIV-1 infection as a risk factor for tuberculosis and leprosy. The study involved 144 newly diagnosed sputum smear positive tuberculosis cases with 432 age, sex and neighbourhood-matched controls, and 132 diagnosed leprosy cases with 384 matched controls. Odds ratios obtained by conditional logistic regression (matched) analysis were 4.9 (95% CI 2.6, 6.8), and 1.8 (95% CI 0.9, 3.2), for the association between HIV-1 and tuberculosis and leprosy respectively. Approximately 31% of tuberculosis cases among males, and 11% of cases among females, were attributable to HIV infection.

PIP: Between April, 1989, and August 1990. in Busia, Siaya, Kisumu, and South Nyanza districts of Western Kenya, health workers recruited 144 sputum smear positive tuberculosis (TB) cases and 432 age, sex, and neighborhood matched controls. They also recruited 132 newly detected leprosy cases and 384 matched controls. Researchers wanted to determine the association between HIV-1 and TB and between HIV-1 and leprosy. TB cases were more likely to be HIV-1 seropositive than were their controls, regardless of age (odds ratio = 4.9). Less than 30-year-old female TB patients were less likely to be HIV-1 seropositive than were less than 30-year-old male TB patients (OR, 2.8 vs. 8.1), while the opposite was true for older TB patients (OR, 19.6 vs. 2.6). Though not statistically different, the OR was greater for certain TB cases than for possible TB cases (13.7 vs. 3.5) and for BCG negative cases than for BCG positive cases (16.5 vs. 3.1). Etiologic fractions indicated that HIV infection was responsible for 31% of TB cases among males and 11% of TB cases among females. Overall, leprosy cases and controls had lower HIV seropositivity rates than did their TB counterparts (OR, 1.8 vs. 4.9). Even though none of the ORs for the association between HIV infection and leprosy were statistically significant from unity, the fact that ORs were greater than unity in all (1.4-2.4) but 1 group (5-29 year old females, OR = 0.5) indicated a possible trend towards positive association. Though not statistically different, polar lepromatous type of leprosy and the leprosy category of histopathologically confirmed cases had the highest ORs (3.7 and 1.9, respectively). Multibacillary leprosy cases had a higher OR than did paucibacillary leprosy (2 vs. 1.6).

Multidrug therapy for treatment of paucibacillary leprosy in western Kenya--preliminary communications.

A prospective study is being undertaken in Western Kenya to evaluate the effectiveness and tolerability of WHO-MDT, while at the same time comparing it to a modified multidrug regimen, which is rifampicin 1500mg at the onset supervised, and repeated after 3 months and dapsone 100mg daily for 6 months. Preliminary analysis done on 127 cases admitted into the study are presented. The inactivity index observed between 0-12 weeks was 20% for WHO-MDT and 47% for modified-MDT (p less than 0.01). The inactivity index observed between 0-24 weeks was 63.3% for WHO-MDT and 82.3% for modified-MDT (p less than 0.05). The inactivity index observed between 0-32 weeks was 83% for WHO-MDT, and 88% for modified-MDT. Type 1 reaction was noted in 23.3% on those on WHO-MDT, and 20.3% on those cases on modified-MDT (p greater than 0.1). Compliance rate was 93.8% for those on WHO-MDT and 95.2% on those on modified MDT. All regimens were well tolerated. These preliminary results indicate that MDT is effective in treatment of paucibacillary leprosy, and also that clinical cure can be achieved in much shorter duration, particularly with higher dosage of rifampicin.

Dapsone resistant leprosy, the western Kenya experience.

41 patients out of 804 registered lepromatous (LL) and borderline lepromatous (BL) patients were studied for possible dapsone resistance by series of biopsy specimens, skin smears and clinical examination. These patients were drawn from a pool of 4384 registered leprosy patients in the west Kenya Leprosy Control Project area. Six out of fourty one cases (14.6%) were confirmed as dapsone resistant by series of biopsy specimens taken when patients were on supervised dapsone therapy; 11 patients (26.8%) were suspected to be resistant and 24 patients (58.6%) responded well to dapsone therapy. All the confirmed cases were lepromatous leprosy cases. We therefore found that there is dapsone resistance here with a maximal prevalence rate of 7 per 1000 in all lepromatous cases and 14.6% in clinically suspicious cases.