Can data from programs for the prevention of mother-to-child transmission of HIV be used for HIV surveillance in Kenya?

OBJECTIVE: In Africa, HIV surveillance is conducted among antenatal clinic (ANC) attendees using unlinked-anonymous testing (UAT). In Kenya, the utility of prevention of mother-to-child transmission (PMTCT) program data for HIV surveillance was evaluated. METHODS: UAT and PMTCT data were compared at the same clinics and for the same time (2003 UAT survey) period. The HIV testing uptake for PMTCT was defined as the number of ANC attendees tested for HIV out of those who had their first ANC visit during the ANC surveillance period. Odds ratios and 95% confidence intervals were calculated to determine associations between demographic characteristics and HIV testing acceptance. RESULTS: Of 39 ANC-UAT sites, six had PMTCT data. PMTCT data were recorded across several logbooks with varying quality. For PMTCT, 2,239 women were offered HIV testing and 1,258 (56%) accepted; for UAT, 1,852 women were sampled. Median UAT-based HIV prevalence was 12.8% (range, 8.1%-26.3%) compared with 14.4% (range, 7.0%-27.2%) in PMTCT. HIV testing acceptance for PMTCT ranged from 48% to 69% across clinics, and was more likely among primigravidae than multigravidae. CONCLUSION: Because of varying PMTCT data quality and varying HIV testing acceptance for PMTCT, PMTCT-based HIV prevalence estimates cannot currently replace UAT-based estimates in Kenya.

Risk factors for malaria among expatriates living in Kampala, Uganda: the need for adherence to chemoprophylactic regimens

This investigation was conducted in response to a report of an increased number of malaria cases among United States Embassy personnel in Kampala; Uganda in the spring of 1992. The objectives of the investigation were to determine if an outbreak had occurred; to identify potential risk factors for malaria in this population; and to assess the effectiveness of various chemoprophylactic regimens. The risk of developing malaria during the first half of 1992 was more than six times greater than during the same time period in 1991 (relative risk [RR] = 6.6; 95CONFIDENCE INTERVAL [ci] = 1.6-27.8) and almost seven times greater than all the previous six years combined (RR=6.8; 95CI = 2.9-15.9). In this outbreak; children and young adults less than 20 years of age had more than a three-fold increase in risk (RR=3.7; 95CI=0.7-19.8) than those in the 20-39 year-old- age group. African-Americans had a six-fold increased risk compared with Caucasians (RR=6.0; 95CI = 1.6-22.7). Those who did not tale any drug prophylaxis were 10 times more likely to develop malaria (RR=10.0; 95CI=2.7-37.0) than those who took mefloquine; dexycycline; or chloroquine plus proguanil. In this setting; weekly mefloquine was 82 more effective and chloroquine plus proguanil was 92more effective than weekly chloroquine alone. This outbreak underscores the need for compliance with appropriate chempprophylactic regimens in preventing malaria infection. Source: Am.J.Trop.Med. Hyg. 1995 March; 52(3):207-12