Quantification of print, radio and television exposure among previous blood donors in Kenya: an opportunity for encouraging repeat donation in a resource-limited setting?

Blood services in sub-Saharan Africa experience blood shortages and low retention of voluntary, non-remunerated donors. To boost collections by encouraging repeat donations, the Kenya National Blood Transfusion Service is exploring the likelihood of reaching previous donors through targeted print, radio and television advertising. We analysed data from a national AIDS Indicator Survey to determine whether previous donors have significant exposure to media. Respondents reporting history of blood donation had significantly higher exposure to print, radio and television media than those without history of blood donation. Targeted media campaigns encouraging repeat donation are likely to reach previous donors even in resource-limited settings.

Reduced risk of transfusion-transmitted HIV in Kenya through centrally co-ordinated blood centres, stringent donor selection and effective p24 antigen-HIV antibody screening.

BACKGROUND: Following a 1994 study showing a high rate of transfusion-associated HIV, Kenya implemented WHO blood safety recommendations including: organizing the Kenya National Blood Transfusion Service (NBTS), stringent blood donor selection, and universal screening with fourth-generation p24 antigen and HIV antibody assays. Here, we estimate the risk of transfusion-associated HIV transmission in Kenya resulting from NBTS laboratory error and consider the potential safety benefit of instituting pooled nucleic acid testing (NAT) to reduce window period transmission. METHODS: From November to December 2008 in one NBTS regional centre, and from March to June 2009 in all six NBTS regional centres, every third unit of blood screened negative for HIV by the national algorithm was selected. Dried blood spots were prepared and sent to a reference laboratory for further testing, including NAT. Test results from the reference laboratory and NBTS were compared. Risk of transfusion-associated HIV transmission owing to laboratory error and the estimated yield of implementing NAT were calculated. FINDINGS: No cases of laboratory error were detected in 12,435 units tested. We estimate that during the study period, the percentage of units reactive for HIV by NAT but non-reactive by the national algorithm was 0·0% (95% exact binomial confidence interval, 0·00-0·024%). INTERPRETATION: By adopting WHO blood safety strategies for resource-limited settings, Kenya has substantially reduced the risk of transfusion-associated HIV infection. As the national testing and donor selection algorithm is effective, implementing NAT is unlikely to add a significant safety benefit. These findings should encourage other countries in the region to fully adopt the WHO strategies.

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.

Differential of HIV prevalence in women and men who attended sexually transmitted disease clinics at HIV sentinel surveillance sites in Kenya, 1990-2001.

Several studies in sub-Saharan Africa have reported that HIV prevalence in young women is higher than in young men. We used data from Kenya HIV sentinel surveillance conducted from 1990 to 2001 among sexually transmitted disease (STD) patients (15-49 years old) to investigate consistency of gender differentials over time and their risk factors. Of the 15,889 STD patients, the HIV prevalence ranged from 16.0% in 1990 to 41.8% in 1997. The odds ratios (ORs) of HIV infection for women compared to men decreased by age; women 15-24 years were nearly twice as likely as men of the same ages to be HIV infected (OR 1.7 [1.5-2.0]), but risk in those >44 years was almost equal (OR 0.8 [95% CI 0.7-1.2]). The odds of HIV infection for women compared to men were twice in unmarried patients (OR 2.1 [95% CI 1.8-2.3]). This association persisted after controlling for age groups or marital status, residence, level of education, and presence of STD syndromes. This pattern had been consistent over 12 years. Adolescent women with symptoms of STDs should be a focus for the HIV/STD intervention programmes because of their high risk for HIV.

HIV-1 ICD p24 antigen detection in ugandan infants: use in early diagnosis of infection and as a marker of disease progression.

The objective of this study was to determine the use of immune-complex dissociated (ICD) p24 antigen detection for the diagnosis and prognosis of HIV-1 infection in Ugandan children. Plasma collected prospectively from children born to HIV-1 infected Ugandan women was stored and later analyzed for the presence of neutralizable HIV-1 p24 antigen using the Coulter ICD p24 antigen and neutralization kits. HIV-1 infection status, disease progression, and survival of the children were determined. Specimens from 311 children born to HIV-1 infected women, including 138 HIV-1 infected children, and 113 children born to negative women were tested. Sixty-nine (50%) infected children were p24 antigen positive at least once. For early HIV-1 diagnosis, the specificity and positive predictive value of the assay were consistently high (>95% and >83% respectively), but the sensitivity was low (6-53%), especially in the first months of life. The presence of p24 antigenemia in the first two years of life was associated with poor survival (20%) by 80 months of age compared with infected children without antigenemia (43%, P < 0.001). Early detection of p24 antigen (6 months, P < 0.001). The data suggest that ICD p24 antigen detection is not a sensitive method for the determination of infant HIV-1 status in our cohort of HIV-1 infected Ugandan children tested in the first two years of life. There was a strong correlation, however, between the presence and time of onset of p24 antigenemia and mortality among HIV-1 infected children.

Care of children with HIV infection and AIDS in Africa.

PIP: HIV/AIDS is a major cause of pediatric morbidity and mortality, especially in Africa. The UN Joint Program on HIV/AIDS (UNAIDS) estimates that 85% of the 2.6 million children with HIV infection are from sub-Saharan Africa. About 650,000 children are living with HIV/AIDS and approximately 1000 infected infants are born every day in Africa. Since few of the 7 million infected African women have access to HIV testing and counseling, not to mention interventions such as AZT to reduce the risk of HIV transmission to their infants, the high incidence of HIV-infected children in Africa will likely continue for some time. The countries of east and southern Africa and several countries in west Africa have the highest HIV prevalence rates in the world. The development of cost-effective strategies to provide care and improve the quality of life of HIV-infected infants and children in Africa should be a priority area for increased research and support. The authors describe progress in understanding the natural history of HIV infection in African children, review strategies for managing HIV-infected children in resource-poor settings, and discuss issues of community response and counseling for children.^ieng

Human immunodeficiency virus and AIDS in Uganda.

HIV-1 infection, initially described as "slim disease", was first recognized in Uganda in 1982, and is now a predominant health problem. Approximately 1.5 million Ugandans are now infected, largely through heterosexual transmission. In many areas half of adult deaths are now caused by HIV. Seroprevalence rates in urban antenatal clinics have been dropping in the last several years, as have rates in young adults in two rural community cohorts where the epidemic is long established. Tuberculosis cases and admissions have increased dramatically. Among the clinical manifestations of HIV in Uganda, epidemic Kaposi sarcoma, cryptococcal meningitis, suspected toxoplasmosis and cardiomyopathy, as well as atypical or extrapulmonary tuberculosis are seen with increasing frequency. Mother to child transmission of HIV accounts for about 10% of total cases, with a transmission rate of 26% in two studies. Epidemiological and clinical research programs are well developed in Uganda, especially in areas of tuberculosis, maternal and paediatric HIV infection and sexually transmitted infections. Societal openness, a multisectoral approach by the government and innovative programmes, including large-scale HIV testing and counselling and the pioneering work of The AIDS Support Organization (TASO), distinguish the Ugandan response to the epidemic.

PIP: In 1982 the first cases of "slim disease" in Uganda were identified in Rakai District. This disease was not recognized as AIDS until 1985. AIDS is now a serious public health problem for Ugandans. Currently, about 1.5 million Ugandans have HIV infection, acquired mainly via heterosexual transmission; about 10% acquired HIV infection via the mother-child transmission route. In two studies, the mother-child HIV transmission rate reached 26%. 400,000-450,000 Ugandans have died from HIV/AIDS. HIV/AIDS is associated with the death of about 50% of adults in some areas of Uganda. Between 1993 and 1995, there has been a significant decrease in HIV seroprevalence among pregnant women in Kampala as well as in two rural communities. Cases and hospital admissions of tuberculosis (TB) have risen markedly in Uganda. Clinical manifestations of HIV infection include Kaposi's sarcoma, cryptococcal meningitis, toxoplasmosis, cardiomyopathy, and atypical or extrapulmonary TB. Uganda has well-developed HIV-focused epidemiologic and clinical research programs, particularly those addressing TB, maternal-child HIV transmission, and sexually transmitted diseases (STDs). The response to the HIV/AIDS epidemic in Uganda has been unique. The government has openly addressed it since the late 1980s, and this has opened the doors to the creation of innovative services for education, testing, and counseling and care for AIDS patients. Both the government and nongovernmental organizations have developed extensive HIV prevention programs. The AIDS Support Organization provides counseling and care for more than 35,000 persons with HIV/AIDS and has trained hundreds of counselors. Two possible reasons for the decline in the HIV seroprevalence that is now emerging in Uganda include: the AIDS epidemic either has reached a natural plateau or behavioral change has made a difference, improved treatment of STDs, and increasing availability and use of condoms has contributed to the reduction in HIV seroprevalence.