Performance of elite maize genotypes under selected sustainable intensification options in Kenya.

Combining different cropping and tillage systems with different genotypes across several cropping seasons can reveal opportunities for sustainable intensification (SI). The objective of this study was to assess the performance of six maize genotypes under intercropping with conservation tillage (no-till) - two promising options for SI. The experiment was carried out over three years (or six cropping seasons) at Kiboko Research Station, Kenya with sole cropping and mouldboard ploughing as baseline production systems. Results showed that maize genotypes and cropping systems had a significant effect on yield, but the effect of tillage was not significant. Moreover, there was no significant interactive effects of the tested factors on maize yield. The maize genotype CKH10085 had the highest yield of 7.7 t ha-1 under sole cropping yet it also recorded the largest yield penalty due to intercropping of 1.1 t ha-1. On the other hand, genotype CKH10717 maintained the same average yield of 7.1 t ha-1 in both conventional and conservation tillage systems. The commercial genotype genotype CKH10080 and CKH08051 were more stable than the other experimental genotypes under the variable growing and management conditions. These two genotypes are of intermediate maturity and drought tolerance, two critical attributes to improved maize production. Intercropping reduced maize yields due to increased competition, for example the overall yield of sole cropping was 7.1 t ha-1 compared with 6.4 t ha-1 under intercropping; representing an overall yield penalty of 0.7 t ha-1. The differences in performance of maize genotypes revealed opportunities to deploy genotypes to reduce risk or maximize yield, depending on the biophysical circumstances and the production objective of the farmer.

Integrating human papillomavirus testing as a point-of care service using GeneXpert platforms: Findings and lessons from a Kenyan pilot study (2019-2020).

BACKGROUND: Globally, cervical cancer is a major public health problem, with about 604,000 new cases and over 340,000 deaths in 2020. In Kenya, it is the leading cause of cancer deaths, with over 3,000 women dying in 2020 alone. Both the Kenyan cancer screening guidelines and the World Health Organization's Global Cervical Cancer Elimination Strategy recommend human papillomavirus (HPV) testing as the primary screening test. However, HPV testing is not widely available in the public healthcare system in Kenya. We conducted a pilot study using a point of care (POC) HPV test to inform national roll-out. METHODS: The pilot was implemented from October 2019 to December 2020, in nine health facilities across six counties. We utilized the GeneXpert platform (Cepheid, Sunnyvale, CA, USA), currently used for TB, Viral load testing and early infant diagnosis for HIV, for HPV screening. Visual inspection with acetic acid (VIA) was used for triage of HPV-positive women, as recommended in national guidelines. Quality assurance (QA) was performed by the National Oncology Reference Laboratory (NORL), using the COBAS 4800 platform (Roche Molecular System, Pleasanton, CF, USA). HPV testing was done using either self or clinician-collected samples. We assessed the following screening performance indicators: screening coverage, screen test positivity, triage compliance, triage positivity and treatment compliance. Test agreement between local GeneXpert and central comparator high-risk HPV (hrHPV) testing for a random set of specimens was calculated as overall concordance and kappa value. We conducted a final evaluation and applied the Nominal Group Technique (NGT) to identify implementation challenges and opportunities. KEY FINDINGS: The screening coverage of target population was 27.0% (4500/16,666); 52.8% (2376/4500) were between 30-49 years of age. HPV positivity rate was 22.8% (1027/4500). Only 10% (105/1027) of HPV positive cases were triaged with VIA/VILI; 21% (22/105) tested VIA/VILI positive, and 73% (16/22) received treatment (15 received cryotherapy, 1 was referred for biopsy). The median HPV testing turnaround time (TAT) was 24 hours (IQR 2-48 hours). Invalid sample rate was 2.0% (91/4500). Concordance between the Cepheid and COBAS was 86.2% (kappa value = 0.71). Of 1042 healthcare workers, only 5.6% (58/1042) were trained in cervical cancer screening and treatment, and only 69% (40/58) of those trained were stationed at service provision areas. Testing capacity was identifed as the main challenge, while the community strategy was the main opportunity. CONCLUSION: HPV testing can be performed on GeneXpert as a near point of care platform. However, triage compliance and testing TAT were major concerns. We recommend strengthening of the screening-triage-treatment cascade and expansion of testing capacity, before adoption of a GeneXpert-based HPV screening among other near point of care platforms in Kenya.