Evaluating the effectiveness of the HIV adolescent package of care (APOC) training on viral load suppression in Kenya.

OBJECTIVES: To evaluate the effectiveness of the implementation of the adolescent package of care (APOC) training on adolescent viral suppression at Family AIDS Care & Education Services (FACES)-supported sites. STUDY DESIGN: The effect of APOC training was evaluated based on viral load suppression (<1000 copies/mL) of 10-19-year-olds in 13 FACES-supported sites in six months before (January 2015-August 2016) and after (November 2015-March 2017) the APOC training for each site. METHODS: Patient-level data were abstracted from the FACES electronic medical records (OpenMRS) and the National AIDS and STI Control Programme viral load website. Information on adolescent clinic day implementation and utilization of an APOC checklist as a proxy for services provided at each site was collected. Generalized estimating equations with repeated measures clustered by patients were used for bivariate and multivariate modeling to assess factors associated with viral suppression. RESULTS: In the pretraining period, 60% of adolescents received services at clinics offering adolescent clinic days compared to 95% in the post-training period. Among those tested, 65% were virally suppressed during the pretraining period compared to 72% during the post-training period (odds ratio [OR] = 1.31, 95% confidence interval [CI] 1.12, 1.53, P < 0.01). In multivariable analysis, there was no statistically significant change in viral load suppression due to APOC training (adjusted OR [aOR] = 0.97, 95% CI: 0.72, 1.30, P = 0.84). However, at clinics offering adolescent-friendly clinic days, adolescents were nearly 2 times more likely to be virally suppressed than at facilities not offering these specialized clinic days (aOR = 1.86, 95% CI: 1.04, 3.32, P = 0.04). CONCLUSIONS: This study suggests that adolescent clinic days greatly improve adolescent viral load suppression and should be considered for implementation across HIV programs.

First Report of the Green Rosette Variant of Groundnut Rosette Disease in Kenya.

Groundnut (Arachis hypogaea L.) is an important food crop in sub-Saharan Africa. One of the major production constraints is groundnut rosette disease, which is caused by a complex of two viruses, groundnut rosette assistor luteovirus (GRAV) and groundnut rosette umbravirus (GRV) together with the associated satellite RNA (satRNA) (1). Two main forms of the disease have been described: chlorotic and the green rosette. Variants of the satRNA have been shown to be largely responsible for the different forms of the disease (1). Chlorotic rosette has been the predominant form in all of sub-Saharan Africa while green rosette has been reported in the western and southern regions of Africa (2). During the 1997-1998 crop season, disease surveys conducted in Kenya showed the incidence of the rosette disease in farmers' fields to be 24 to 40% in a total of 23 fields surveyed in the western regions of the country (Homabay, Kendubay, Kisumu) and 30% in 8 fields sampled in the Rift Valley (Cheplamus, Marigat) regions. Representative peanut plants showing rosette symptoms were analyzed for the presence of GRV by reverse transcription polymerase chain reaction (RT-PCR). With primers specific to a portion of ORF4 of GRV RNA (3), RT-PCR gave a product of expected size (approximately 300 bp). The PCR product was cloned in pGEM-T vector and sequenced. The sequenced region showed 89% nucleotide sequence identity with published GRV sequences. Green rosette was observed on groundnut cultivars Nyaela Red and Homabay Local in the Kendu Bay region. The incidence of the green rosette was 5.3% of the plants with rosette symptoms. References: (1) A. F. Murant and I. K. Kumar. Ann. Appl. Biol. 117:85, 1990. (2) R. A. Naidu et al. Ann. Appl. Biol. 132:525, 1998. (3). M. E. Taliansky et al. J. Gen. Virol. 77:2335, 1996.