Kenyan Patients Research Articles

Genetic diversity of nontuberculous mycobacteria among symptomatic tuberculosis negative patients in Kenya.

Non-Tuberculous Mycobacteria (NTM) transmission to humans occurs through inhalation of dust particles or vaporized water containing NTM leading to pulmonary manifestations. NTM infections are often misdiagnosed for tuberculosis (TB) due to their similar clinical and radiological manifestations. We, therefore, performed a species-level identification of NTM in symptomatic TB negative patients through sequencing of the hsp65 gene. We conducted a cross-sectional study at the National Tuberculosis Reference Laboratory in the period between January to November 2020. One hundred and sixty-six mycobacterial culture-positive samples that tested negative for TB using capilia underwent Polymerase Chain Reaction targeting the hsp65 gene. Isolates showing a band with gel electrophoresis at 441 bp position were sequenced using Sanger technology. Geneious software was used to analyze the obtained sequences, and the National Center for Biotechnology Information gene database identified NTM species for each isolate. A phylogenetic tree was constructed from the DNA sequences and evolutionary distances computed using the general time-reversible method. Pearson chi-square was used to determine the association between NTM infection and participants' characteristics. Our study identified 43 different NTM species. The dominant NTM belonged to Mycobacterium avium complex 37 (31%). Slow-growing NTM were the majority at 86 (71%) while rapid-growing NTM were 36 (29%). A significant association (P<0.05) was observed for regions and age, while patient type had a weak likelihood of NTM infection. Our study characterized the diversity of NTM in Kenya for the first time and showed that species belonging to M. Avium Complex are the most prevalent in the country.

Effect of health education on costs of treatment and household's income among tuberculosis patients in Kenya: a randomized control trial

Effect of health education on costs of treatment and household's income among tuberculosis patients in Kenya: a randomized control trial

Quality of Life and Symptom Burden in Cancer Patients in Kenya

Quality of Life and Symptom Burden in Cancer Patients in Kenya

Operationalisation of Model for Dynamics of COVID-19 in Kenya: Trajectory of Omicron Wave in Kenya

Kenya has experienced five COVID-19 surges driven by Alpha, Beta, Delta (2x), and Omicron. These waves are accurately predicted by the OTOI-NARIMA model. Consequently, in Kenyan Lake Region Economic Bloc (LREB), private sector and NGO partnerships have been forged to strengthen regional health systems and prepare effectively for epidemic resurgence. The co-development and implementation of the so-called “LREB COVID-Dx” digital platform enable efficient epidemic monitoring in semi-real time, referral of patients, optimal use of limited resources, and community of practice among regional health practitioners. In this paper, we describe the practical implementation of the OTOI-NARIMA model and COVID-Dx digitized platform in Kenyan COVID-19 reality, with emphasis on the latest Omicron wave. In estimating the trajectory of Omicron wave, 612 data points of daily case infections are used. The order of moving average is calculated and corresponds to reproduction number, R0. The series are normalized, superimposed, and used to derive OTOI-NARIMA model. The model is estimated and interpreted. Test statistics including Ljung-Box test, ACF, and PACF are conducted. The COVID-Dx data digitization is used to inform epidemic preparedness. The OTOI-NARIMA model in general successfully established the periodicity and seasonality of COVID-19 resurgences in Kenya. The model is used to inform preparedness, including vaccines rollout. During alert stages of the wave, on December 4, 2021, the model was reused to nowcast the trajectory of the wave. Omicron wave was projected to peak in Kenya between November 23, 2021, and January 4, 2022. The wave showed strong likelihood of declining after January 29, 2022. In reality, Omicron wave was experienced from November 27, 2021, to January 29, 2022. The model predicted that Omicron variant will have run its full course by June 22, 2022, and possibly replaced by another variant, recombinant or sub-variant. According to OTOI-NARIMA model, dominant variants are replaced after every six months, which gives insights into suitable periods for administration of vaccine boosters. The total number of Kenyan patients (symptomatic or asymptomatic) during Omicron resurgence was estimated to be ~4.5 million. The total number of patients hospitalized during the wave is estimated to be ~2000. Effective, efficient, and economical response to Omicron resurgence in LREB benefitted from meticulous infusion of mathematical modelling and digitization of relevant data for epidemic preparedness and rapid decision making. The study has two limitations: Incomplete merging of stochastic processes and deterministic methods; calculating with accuracy the period it takes to fully replace a dominant COVID-19 variant. These two limitations may be considered for further research.

Modelling the cost-effectiveness of essential and advanced critical care for COVID-19 patients in Kenya

BackgroundCase management of symptomatic COVID-19 patients is a key health system intervention. The Kenyan government embarked to fill capacity gaps in essential and advanced critical care (ACC) needed for the...

Association between social psychological status and efavirenz and nevirapine plasma concentration among HIV patients in Kenya

HIV-related stigma, lack of disclosure and social support are still hindrances to HIV testing, care, and prevention. We assessed the association of these social-psychological statuses with nevirapine (NVP) and efavirenz (EFV) plasma concentrations among HIV patients in Kenya. Blood samples were obtained from 254 and 312 consenting HIV patients on NVP- and EFV-based first-line antiretroviral therapy (ART), respectively, and a detailed structured questionnaire was administered. The ARV plasma concentration was measured by liquid chromatography-tandem mass spectrometry (LC–MS/MS). There were 68.1% and 65.4% of the patients on NVP and EFV, respectively, who did not feel guilty for being HIV positive. The disclosure rates were approximately 96.1% and 94.6% of patients on NVP and EFV, respectively. Approximately 85% and 78.2% of patients on NVP and EFV, respectively, received social support as much as needed. There were 54.3% and 14.2% compared to 31.7% and 4.5% patients on NVP and EFV, respectively, with supratherapeutic and suboptimal plasma concentrations. Multivariate quantile regression analysis showed that feeling guilty for being HIV positive was associated with increased 954 ng/mL NVP plasma concentrations (95% CI 192.7 to 2156.6; p = 0.014) but not associated with EFV plasma concentrations (adjusted β = 347.7, 95% CI = − 153.4 to 848.7; p = 0.173). Feeling worthless for being HIV positive was associated with increased NVP plasma concentrations (adjusted β = 852, 95% CI = 64.3 to 1639.7; p = 0.034) and not with EFV plasma concentrations (adjusted β = − 143.3, 95% CI = − 759.2 to 472.5; p = 0.647). Being certain of telling the primary sexual partner about HIV-positive status was associated with increased EFV plasma concentrations (adjusted β 363, 95% CI, 97.9 to 628.1; p = 0.007) but not with NVP plasma concentrations (adjusted β = 341.5, 95% CI = − 1357 to 2040; p = 0.692). Disclosing HIV status to neighbors was associated with increased NVP plasma concentrations (adjusted β = 1731, 95% CI = 376 to 3086; p = 0.012) but not with EFV plasma concentrations (adjusted β = − 251, 95% CI = − 1714.1 to 1212.1; p = 0.736). Obtaining transportation to the hospital whenever needed was associated with a reduction in NVP plasma concentrations (adjusted β = − 1143.3, 95% CI = − 1914.3 to − 372.4; p = 0.004) but not with EFV plasma concentrations (adjusted β = − 6.6, 95% CI = − 377.8 to 364.7; p = 0.972). HIV stigma, lack disclosure and inadequate social support are still experienced by HIV-infected patients in Kenya. A significant proportion of patients receiving the NVP-based regimen had supra- and subtherapeutic plasma concentrations compared to EFV. Social-psychological factors negatively impact adherence and are associated with increased NVP plasma concentration compared to EFV.

A Review of the Sub-Classification of Lymph Node Biopsies Reported as Reactive Lymphadenitis at Kenyatta National Hospital, Kenya

Lymphadenopathy is common in both adult and paediatric patients in Kenya. It has a broad differential diagnosis, the most common being non-specific reactive lymphoid hyperplasia. Prevalence and morbidity of malignancies in early stages, such as micro lymphoma in reactive lymphadenitis remains poorly investigated.

Uncomplicated gastroschisis care in the US and Kenya: Treatment at two tertiary care centers

BackgroundGastroschisis is a common birth defect with < 5% mortality in high income countries, but mortality in sub Saharan Africa remains high. We sought to compare gastroschisis management strategies and patient outcomes at tertiary pediatric referral centers in the United States and Kenya. MethodsThis retrospective chart review examined uncomplicated gastroschisis patients treated at Riley Hospital for Children in Indianapolis, USA (n = 110), and Shoe4Africa Children's Hospital in Eldoret, Kenya (n = 75), from 2010 to 2018. Analyzed were completed using Chi square, Fisher's exact, and independent samples t tests and medians tests at the 95% significance level. ResultsSurvival in the American cohort was double that of the Kenyan cohort (99.1% vs 45.3%, p< 0.001). Sterile bag use for bowel containment was lower in Kenya (81.3% vs 98.1%, p< 0.001), but silo use was comparable at both institutions (p = 0.811). Kenyan patients had earlier median enteral feeding initiation (4vs 10 days, p< 0.001) and accelerated achievement of full enteral feeding (10vs 23 days, p< 0.001), but none received TPN. Despite earlier feeding, Kenyan patients displayed a higher prevalence of wound infections (70.8% vs 17.1%, p< 0.001) and sepsis (43.9% vs 4.8%, p< 0.001). In Kenya, survivors and non survivors displayed no difference in sterile bag use, hemodynamic stability, all cause infection rates, or antibiotic free hospital days. Defect closure (p< 0.001) and enteral feeding initiation (p< 0.001) were most predictive of survival. ConclusionImproving immediate response strategies for gastroschisis in Kenya could improve survival and decrease infection rates. Care strategies in the US can center on earlier enteral feeding initiation to reduce time to full feeding.Level of evidence: Level III.

Impacts of Social Support on Quality of Life of Cancer Patients in Kenya

Background: Cancer is the second leading cause of death worldwide after cardiovascular disease and accounts for 1 in 6 deaths. In Kenya, It accounts for 7% of all death. One of the major concerns in determination of patients’ quality of life is their social wellbeing. Cancer patients’ response to diagnosis and treatment is dependent on both professional and social support they receive. Lack of social support has been linked with increase in depression, anxiety and lack of coping resulting to decreased emotional wellbeing as well as poor quality of life. Therefore, the aim of the study was to determine the impact of social support on quality of life of cancer patients in Kenya. Methods: A descriptive cross-sectional research design was used for the study. Closed self-administered questionnaires were used for data collection which included the Quality of Life Patient/Cancer Survivor Version (QOL-CSV) questionnaire and the multidimensional Scale of Perceived Social Support questionnaire. Both were adopted and modified for the study. The study included 108 cancer patients selected through systematic random sampling technique. Results: Majority of the cancer patients had good social support from family and significant others with most reporting lack of social support from friends. Bivariate analysis showed statistically significant relationship between quality of life with family social support, significant others social support, and financial support. Financial support, Family and significant others social support were identified to be predictors of quality of life. Conclusions: Social support is an important element in determination of patients’ quality of life. Health care workers, family and friends should not only focus on the diagnosis and treatment of the cancer but also should consider the social wellbeing of the patients. They play a major role in improving the patients’ social wellbeing hence the overall quality of life.

HEALTHCARE PROVIDER PATIENT NONVERBAL COMMUNICATIVE BEHAVIOUR ON DIABETES MELLITUS MANAGEMENT PRACTICES IN SELECTED HOSPITALS IN KENYA

Purpose: To examine the effect of healthcare provider patient communication nonverbal communicative behaviour on diabetes mellitus management practices in selected hospital in Kenya.&#x0D; Methodology: This was a causal comparative research design study with application of quantitative methodology. The study was carried out at Kenyatta National Hospital (KNH) and MP Shah Hospital. Systematic random sampling was used to sample patients. 400 participants were involved in the study and comprised 313 patients at KNH and 87 patients at MP Shah Hospital studied between the months of February 2019 and November 2019. The researcher administered questionnaire was used to collect data. The results were summarized using percentages and means or medians for categorical and continuous data respectively. Comparisons were done using chi square test of association of categorical variables and independent t-test for comparison of means. Linear regression and ANOVA were used to test for associations and hypothesis between healthcare provider patient nonverbal communicative behaviour (NVCB) and diabetes mellitus management practices (DMMPs).&#x0D; Findings: The rating of nonverbal communicative behavior was significantly higher at MP Shah Hospital than at KNH, p=0.010. Nonverbal communicative behavior had positive significant effect on diabetes mellitus management practices in Kenya [β=0.15, (95% CI 0.03, 0.27), p=0.016] with similar outcome at KNH [β=0.20, (95% CI 0.08, 0.33), p=0.002] and not at MP Shah Hospital [β=0.03, (95% CI 0.37, 0.42), p=0.899]. Thus, the null hypothesis was rejected in Kenya; the null hypothesis was rejected at KNH; the null hypothesis was not rejected at MP Shah Hospital. Therefore, there was significant effect of NVCB on DMMPs in Kenya, at KNH and not at MP Shah Hospital.&#x0D; Unique contribution to theory, practice and policy: Nonverbal communicative behaviour was responsible for improved performance in diabetes mellitus management practices among patients in Kenya and at KNH. At MP Shah Hospital, NVCB was not responsible for improvement in the DMMPs. The findings reinforce uncertainty reduction and communication accommodation theories basis in the dyadic interaction between patients and healthcare providers. Therefore, NVCB needs to be well conceptualized and incorporated at the health ministry and medical training institutions to equip medical workers with the required communication skills.

W73. SUPPRESSION OF THE INFLAMMATORY RESPONSE IN SCHIZOPHRENIA HIPSC-DERIVED NEURAL PROGENITORS: A GENE-ENVIRONMENT INTERACTION STUDY

Cognitive deficits are typically seen in schizophrenia and in the prodrome, and are a major predictor of functional outcomes in patients. In Africa, few studies have investigated neurocognition in psychosis, which presents a gap in our understanding of the heterogeneity of the illness. In this study, we assessed neurocognition among the largest sample of psychosis-risk participants recruited in the continent to date.The study was conducted in Kenya, and involved 295 psychiatric medication-naïve participants at clinical high-risk (CHR) for psychosis and healthy controls, aged 15–25 yrs. Psychosis-risk status was determined separately using the Structured Interview of Psychosis-Risk Syndromes (i.e. CHR) and by self-report with the Washington Early Recognition Center Affectivity and Psychosis Screen. Eleven tests were administered using the University of Pennsylvania Computerized Neurocognitive Battery. Test performance across groups were investigated, as well as demographic and clinical effects.Fewer participants were designated as being at psychosis-risk with structured interview (n = 47; CHR) than with self-report (n = 155). A MANOVA of cognitive test performance was significant only when groups were ascertained based on self-report (p = 0.03), with decreased performance in the risk group on verbal intelligence (p = 0.003; d = 0.39), emotion recognition (p = 0.003; d = 0.36), sensorimotor processing (p = 0.01; d = 0.31) and verbal memory (p = 0.035; d = 0.21). Only verbal intelligence was significantly worse in the CHR group compared to controls (p = 0.036; d = 0.45). There were no significant age and gender relationships.Deficits across multiple cognitive domains are present in Kenyan psychosis-risk youth, most significantly in verbal intelligence. The pattern of cognitive deficits and an absence of gender effects may represent ethnicity-specific phenotypes of the psychosis-risk state. Longitudinal studies of neurocognition in Kenyan patients who convert to psychosis may enhance risk prediction in this population, and facilitate targeted interventions.

Supporting Kenyan women with advanced breast cancer through a network and assessing their needs and quality of life.

IntroductionMetastatic breast cancer (MBC) patients have several unmet needs. The needs and quality of life of MBC women living in sub-Saharan Africa (SSA) are understudied. Facilitating the interaction of various caregivers is beneficial in addressing the needs. Internet-based resources play an important role in reaching out to these patients. We aimed to bring the various stakeholders into a joint network force, create a web-based portal, understand the needs of MBC patients, and assess the utilization of web-based resources for women from Kenya.MethodsA network of various stakeholders considered crucial in the care of Kenyan women with MBC was created. We conducted educational camps and assessed their needs, quality of life (QoL), and knowledge. We assessed the impact of utilizing web-based resources by MBC patients from here.ResultsWe formed a network involving partners and launched the first dedicated website for MBC from Kenya. The website has received 13,944 visits and 310,379 hits in 2 years. One hundred fourteen women living with MBC were interviewed, and our findings show that psychological needs (63%), physical support needs (60%), and health care system needs (55%) are leading areas of needs that increase with rural residence (p = 0.001), less education (p = 0.003), and aggressive treatments (p = 0.008). Quality of life (QoL) confirmed better scores with urban residence (p = 0.002), internet access (p = 0.010), and stable disease (p = 0.042).ConclusionsCreating a network of caregivers provides opportunities for cohesive efforts in understanding the psychosocial and medical needs of patients with MBC. Internet-based resources are an effective way of reaching out to them. Kenyan patients show extremely good uptake of internet-based resources.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00520-021-06539-5.

Quality of Life-Scores among Palliative Care Cancer Patients in Kenya

Quality of Life-Scores among Palliative Care Cancer Patients in Kenya

Socio-Demographic Characteristics Associated with Quality of Life-Scores among Palliative Care Cancer Patients in Kenya

Socio-Demographic Characteristics Associated with Quality of Life-Scores among Palliative Care Cancer Patients in Kenya

Determinants of household catastrophic costs for drug sensitive tuberculosis patients in Kenya

BackgroundDespite free diagnosis and treatment for tuberculosis (TB), the costs during treatment impose a significant financial burden on patients and their households. The study sought to identify the determinants for catastrophic costs among patients with drug-sensitive TB (DSTB) and their households in Kenya.MethodsThe data was collected during the 2017 Kenya national patient cost survey from a nationally representative sample (n = 1071). Treatment related costs and productivity losses were estimated. Total costs exceeding 20% of household income were defined as catastrophic and used as the outcome. Multivariable Poisson regression analysis was performed to measure the association between selected individual, household and disease characteristics and occurrence of catastrophic costs. A deterministic sensitivity analysis was carried using different thresholds and the significant predictors were explored.ResultsThe proportion of catastrophic costs among DSTB patients was 27% (n = 294). Patients with catastrophic costs had higher median productivity losses, 39 h [interquartile range (IQR): 20–104], and total median costs of USD 567 (IQR: 299–1144). The incidence of catastrophic costs had a dose response with household expenditure. The poorest quintile was 6.2 times [95% confidence intervals (CI): 4.0–9.7] more likely to incur catastrophic costs compared to the richest. The prevalence of catastrophic costs decreased with increasing household expenditure quintiles (proportion of catastrophic costs: 59.7%, 32.9%, 23.6%, 15.9%, and 9.5%) from the lowest quintile (Q1) to the highest quintile (Q5). Other determinants included hospitalization: prevalence ratio (PR) = 2.8 (95% CI: 1.8–4.5) and delayed treatment: PR = 1.5 (95% CI: 1.3–1.7). Protective factors included receiving care at a public health facility: PR = 0.8 (95% CI: 0.6–1.0), and a higher body mass index (BMI): PR = 0.97 (95% CI: 0.96–0.98). Pre TB expenditure, hospitalization and BMI were significant predictors in all sensitivity analysis scenarios.ConclusionsThere are significant inequities in the occurrence of catastrophic costs. Social protection interventions in addition to existing medical and public health interventions are important to implement for patients most at risk of incurring catastrophic costs.Graphic abstract

Geographical Variability in Paromomycin Pharmacokinetics Does Not Explain Efficacy Differences between Eastern African and Indian Visceral Leishmaniasis Patients.

IntroductionIntramuscular paromomycin monotherapy to treat visceral leishmaniasis (VL) has been shown to be effective for Indian patients, while a similar regimen resulted in lower efficacy in Eastern Africa, which could be related to differences in paromomycin pharmacokinetics.MethodsPharmacokinetic data were available from two randomized controlled trials in VL patients from Eastern Africa and India. African patients received intramuscular paromomycin monotherapy (20 mg/kg for 21 days) or combination therapy (15 mg/kg for 17 days) with sodium stibogluconate. Indian patients received paromomycin monotherapy (15 mg/kg for 21 days). A population pharmacokinetic model was developed for paromomycin in Eastern African and Indian VL patients.ResultsSeventy-four African patients (388 observations) and 528 Indian patients (1321 observations) were included in this pharmacokinetic analysis. A one-compartment model with first-order kinetics of absorption and elimination best described paromomycin in plasma. Bioavailability (relative standard error) was 1.17 (5.18%) times higher in Kenyan and Sudanese patients, and 2.46 (24.5%) times higher in Ethiopian patients, compared with Indian patients. Ethiopian patients had an approximately fourfold slower absorption rate constant of 0.446 h–1 (18.2%). Area under the plasma concentration-time curve for 24 h at steady-state (AUCτ,SS) for 15 mg/kg/day (median [interquartile range]) was higher in Kenya and Sudan (172.7 µg·h/mL [145.9–214.3]) and Ethiopia (230.1 µg·h/mL [146.3–591.2]) compared with India (97.26 µg·h/mL [80.83–123.4]).ConclusionThe developed model provides detailed insight into the pharmacokinetic differences among Eastern African countries and India, however the resulting differences in paromomycin exposure do not seem to explain the geographical differences in paromomycin efficacy in the treatment of VL patients.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40262-021-01036-8.

Neurocognition in Kenyan youth at clinical high risk for psychosis

IntroductionCognitive deficits are typically seen in schizophrenia and in the prodrome, and are a major predictor of functional outcomes in patients. In Africa, few studies have investigated neurocognition in psychosis, which presents a gap in our understanding of the heterogeneity of the illness. In this study, we assessed neurocognition among the largest sample of psychosis-risk participants recruited in the continent to date. MethodsThe study was conducted in Kenya, and involved 295 psychiatric medication-naïve participants at clinical high-risk (CHR) for psychosis and healthy controls, aged 15–25 yrs. Psychosis-risk status was determined separately using the Structured Interview of Psychosis-Risk Syndromes (i.e. CHR) and by self-report with the Washington Early Recognition Center Affectivity and Psychosis Screen. Eleven tests were administered using the University of Pennsylvania Computerized Neurocognitive Battery. Test performance across groups were investigated, as well as demographic and clinical effects. ResultsFewer participants were designated as being at psychosis-risk with structured interview (n = 47; CHR) than with self-report (n = 155). A MANOVA of cognitive test performance was significant only when groups were ascertained based on self-report (p = 0.03), with decreased performance in the risk group on verbal intelligence (p = 0.003; d = 0.39), emotion recognition (p = 0.003; d = 0.36), sensorimotor processing (p = 0.01; d = 0.31) and verbal memory (p = 0.035; d = 0.21). Only verbal intelligence was significantly worse in the CHR group compared to controls (p = 0.036; d = 0.45). There were no significant age and gender relationships. ConclusionDeficits across multiple cognitive domains are present in Kenyan psychosis-risk youth, most significantly in verbal intelligence. The pattern of cognitive deficits and an absence of gender effects may represent ethnicity-specific phenotypes of the psychosis-risk state. Longitudinal studies of neurocognition in Kenyan patients who convert to psychosis may enhance risk prediction in this population, and facilitate targeted interventions.

Simultaneous quantification of vincristine and its major M1 metabolite from dried blood spot samples of Kenyan pediatric cancer patients by UPLC-MS/MS

Vincristine (VCR) is an integral part of chemotherapy regimens in the US and in developing countries. There is a paucity of information about its disposition and optimal therapeutic dosing. VCR is preferentially metabolized to its major M1 metabolite by the polymorphic CYP3A5 enzyme, which may be clinically significant as CYP3A5 expression varies across populations. Thus, it is important to monitor both VCR and M1 and characterize their dispositions. A previously developed HPLC-MS/MS method for VCR quantification was not sensitive enough to quantify the M1 metabolite beyond 1 h post VCR dose (not published). Establishing a highly sensitive assay is a pre-requisite to simultaneously quantify and monitor VCR and M1, which will enable characterization of drug exposure and dispositions of both analytes in a pediatric cancer population. The addition of formic acid during the extraction process enhanced M1 extraction from DBS samples. A sensitive, accurate, and precise UPLC-MS/MS assay method for the simultaneous quantification of VCR and M1 from human dried blood spots (DBS) was developed and validated. Chromatographic separation was performed on Inertsil ODS-3 C18 column (5 μm, 3.0 × 150 mm). A gradient elution of mobile phase A (methanol-0.2 % formic acid in water, 20:80 v/v) and mobile phase B (methanol-0.2 % formic acid in water, 80:20 v/v) was used with a flow rate of 0.4 mL/min and a total run time of 5 min. The analytes were ionized by electrospray ionization in the positive ion mode. The linearity range for both analytes in DBS were 0.6−100 ng/mL for VCR and 0.4−100 ng/mL for M1. The intra- and inter-day accuracies for VCR and M1 were 93.10–117.17 % and 95.88–111.21 %, respectively. While their intra- and inter-day precisions were 1.05–10.11 % and 5.78–8.91 %, respectively. The extraction recovery of VCR from DBS paper was 35.3–39.4 % and 10.4–13.4 % for M1, with no carryover observed for both analytes. This is the first analytical method to report the simultaneous quantification of VCR and M1 from human DBS. For the first time, concentrations of M1 from DBS patient samples were obtained beyond 1 h post VCR dose. The developed method was successfully employed to monitor both compounds and perform pharmacokinetic analysis in a population of Kenyan pediatric cancer patients.

The Prevalence and Associated Factors of Hypertension among HIV Patients.

Background The dual burden of cardiovascular diseases and Human Immunodeficiency Virus (HIV) in sub-Saharan Africa is of public health concern. Persons living with HIV are 1.5–2 times more likely to develop CVD risk factors compared to the noninfected individuals. Hypertension is a major risk factor leading to the rising CVD epidemic in SSA. However, the burden of hypertension among HIV patients in Kenya is not well documented. Objective This study determined the prevalence and the associated factors of hypertension among HIV patients receiving regular care at Thika Level 5 Hospital Comprehensive Care Clinic (CCC), within metropolitan Nairobi, Kenya. Methods The current cross-sectional study involved review of patients' records/charts. Charts for adult patients seen in the last 6 months at Thika Level 5 Hospital CCC were included in the study. Hypertension was defined as systolic blood pressure ≥140 mmHg and/or diastolic blood pressure ≥90 mmHg on two different readings one month apart, while overweight/obesity was defined as body mass index (BMI) ≥ 25 kg/m2. Results In a sample of 939 HIV patients, the majority, 68.8% (646), were female. The patients' ages ranged from 18 to 84 years with a median age of 44 (IQR 37–51) years. The mean BMI was higher for females (25.8 kg/m2) compared to that of males (23.1 kg/m2). However, the prevalence of hypertension was higher among males (25.3%) compared to females (16.9%). Age >40 years (AOR = 2.80, p ≤ 0.001), male sex (AOR = 2.10; p=0.04), history of alcohol consumption (AOR = 2.56, p ≤ 0.001), and being overweight/obese (AOR = 2.77 p ≤ 0.001) were significantly associated with hypertension. The antiretroviral (ARV) regimen and, additionally, the duration of antiretroviral therapy had no association with being hypertensive. Conclusion The prevalence of hypertension is high among HIV patients. Traditional cardiovascular risk factors were associated with hypertension, but no association was observed with ART regime or duration of ARV use. There is a need to integrate hypertension management into regular HIV care.

FACTORS INFLUENCING CONTROL OF BLOOD PRESSURE LEVELS AMONG HYPERTENSIVE ADULT PATIENTS IN SELECTED HOSPITALS, KAKAMEGA COUNTY, KENYA

Purpose: The study aimed to investigate the factors influencing blood pressure levels in hypertensive adult patients in Kenya's Kakamega County. The specific objectives were as follows: to assess patient factors that influence blood pressure levels among hypertensive adult patients in Kakamega County, examine health-care provider factors that influence blood pressure levels in hypertensive adult patients; determine institutional factors that influence blood pressure levels in hypertensive adult patients in Kakamega County based on the clinical recommendations for cardiovascular disease management from 2018.&#x0D; Methodology: The researcher used a cross-sectional analytical study design. Patients and health care providers were requested to sign a written consent before data was collected using a questionnaire and an observation checklist. Quantitative data were evaluated using descriptive and inferential statistics, statistical package for social sciences version 22, with a statistically significant p-value of 0.05. The strength of the relationship between the variables and the patient's blood pressure level was tested using multiple regression.&#x0D; Findings: The findings showed that the number of years a patient was told he or she had hypertension patient sensitization about the disease (p = 0.04), the patient's BMI (p = 0.01), BP stability at the time of admission (0.0001), having a treatment supporter to advise the patient when to take medications (0.04). The health care provider's age group and knowledge about the disease (p = 0.02) was all separately correlated with blood pressure control. According to the current analysis, in Kakamega County, being a male without adequate patient sensitization about the hypertension disease made patients to be more likely to have uncontrolled blood pressure levels.&#x0D; Unique contribution to theory, practice and policy: The study recommends a model that combines patient and health-care system variables emphasizing on patient sensitization about the hypertension disease, modifiable and modifiable risk factors should be created in attempt to have blood pressure controlled.