CIRCULATION OF MULTIPLE GENOTYPES OF TORQUE TENO VIRUS (TTV) IN SUBJECTS WITH AND WITHOUT HIV VIRUS INFECTION

Dennis Mwala¹, Dufton Mwaengo^{1, 2}, OnyambuF³, Kirima JM⁴, Omu Anzala^{2, 5}

¹University of Nairobi Institute of Tropical and Infectious Diseases (UNITID), Nairobi, Kenya

²Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya

³University of Nairobi, Molecular Infectious Diseases and Research Laboratory

⁴Meru Teaching and Referral Hospital (MTRH)

⁵KAVI-Institute of Clinical Research

Background

DNA viruses can belong to any of the three major Baltimore classes identifiable as group I (dsDNA viruses), group II (ssDNA viruses) or group VII (dsDNA with RT) based on whether they possess a single stranded DNA or a double stranded DNA with or without a reverse transcriptase. Torque teno virus (TTV) is a member of group II DNA viruses that contains a circular negative sense genome. This virus was previously classified as a circoviridae member but currently has been reclassified as a member of the family Anelloviridae. This thin necklace shaped virus,as seen on electron micrographs, is also described in earlier literature as the transfusion transmitted virus still bearing the abbreviations TTV.A review of studies done in Africa provides scanty information on the distribution of this virus. The only data currently available is on studies done in Gambia, DRC, Nigeria, Egypt, South Africa, Sudan, Ivory Coast, Uganda and Tanzania mostly these studies explored the prevalence of the virus from the general population but have not documented the genotypic characteristics of this virus whenever encountered.

Methodology

This study aimed to use both serological and molecular tools to investigate and document on the prevalence and the genotypic characteristics of the TTV strains circulating in Kenya in both high risk groups and low risk groups.

Results

So far a total of 144 samples have been collected (70 cases and 74 controls). The samples have been stored in -70^oC freezers at the UNITID facility. We started by only screening for human TTV in this series of assays mainly by PCR. A total of 53 samples are positive for TTV out of the 144 screened. That is 32 cases and 21 controls. This accounts for preliminary estimation of 36.8% prevalence. The initial sequencing has been done on 5 representative samples of TTV and the preliminary results indicated that a single individual can be infected by multiple genotypes of the virus. Only 4 genotypes have been observed (genotypes 1, 3, 4 and 5).

Conclusion

Multiple strains of the TTV virus are circulating in healthy subjects and HIV infected subjects in Kenya and genotypes 1, 3, 4 and 5 are the most likely frequent isolates to be encountered.

SCALING UP IMPLEMENTATION AND USAGE OF EMR IN MIGORI COUNTY

Name: Zachariah Onteri Mitaki

Registration No.:  W82/89454/2016

Fellowship: Health Informatics

Institutional Affiliation: Migori County Health Department

ABSTRACT

Adopting new practices in health on a large scale requires systematic approaches to planning, implementation, and follow-up; and often calls for profound and lasting changes in health systems. Any systematic approach must include addressing the policy dimensions of scaling up. Without attention to the policies that underlie health systems and health services, the scale-up of promising pilot projects is not likely to succeed and be sustained.

The health sector in Kenya is one of the most funded programmes with multiple stakeholders and partners participating in the endeavour of ensuring a healthy nation. The National government, county governments and donors are working to fight many diseases, including HIV/AIDS, and to make improvements in a number of health areas. As Programs and associated projects to support HIV/AIDS grow, accountability for funding and results reported is becoming increasingly important. The proposed scaling up project of sites using Kenya EMR seeks to aid the Migori County Health Department in the collection, tabulation, and interpretation of data and information in an organized manner to provide a broad picture of the services rendered and to guide management decisions. Upon implementation, the EMR system should support monitoring, supervision, evaluation, operations research, resource allocation, and performance appraisals.

The need for the EMR was identified after keen analysis of the OCA report which identified the need for ICT based reporting; and with consultation with the PLP mentor who emphasized of the need for quality data for the purposes of decision making.

This project seeks to provide continuous information on HIV activities. It also aims to assess how appropriately and adequately each programmatic component is being implemented, administered, and managed. This will help inform policy decisions towards achieving the UNAIDS 90-90-90.

According to the OCA report, the Migori County Health department had low capacity in health informatics. ICT infrastructure was inadequate, no ICT based reporting and there was minimal ICT human resources and training. This project aims to bridge the gap by implementing a system that helps in the availability of ICT based reporting.

College of Health Sciences e-Learning Portal

The University of Nairobi's Fellowship in Healthcare Capacity Building for Sustainable Development aims to build the capacity of Kenyan Health Care Workers and Local Organizations in the health sector through an academic model. Under this program, 2-year post-masters Fellowship Programs and 9-month Post-Graduate Diplomas are offered under 5 training specializations namely: 1) Program Management, 2) Monitoring and Evaluation, 3) Health Economics, 4) Health Informatics and 5) Epidemiology and Biostatistics. Certificate programs which are 7-weeks long are also offered to provide an opportunity for Health Care Workers to access professional training to acquire skill sets that are critical for sustainable and innovative implementation of health programs.

http://echs.uonbi.ac.ke/ 

Online tutors training workshop held at KCB Leadership Center

The Fellowship in Healthcare Capacity Building for Sustainable Development Program held an Online Tutor Training Workshop from 15th – 17th July, 2019 at the KCB Leadership Center.
The 3-day training was aimed at building the human resource capacity of faculty to support learners through the college e- Learning Portal http://echs.uonbi.ac.ke.
This portal hosts a  Learning Management System (LMS) where a three-tier training program namely; 2-Year post-masters fellowship, 9-month post-graduate diploma and 7-week certificate courses are being offered online.

PhD Seminar: 26th July 2019

Presenter: Maurice Kodhiambo Onditi

Topic: Socio-Economic and Health Systems Determinants of Access to Paediatric Malaria Treatment in Homabay County

OPTIMIZED RETENTION IN CARE MODEL FOR NEWLY DIAGNOSED HIV CLIENTS IN KISUMU COUNTY REFERRAL HOSPITAL

Name: Willis Gasami Kiriago

Registration No.:  W82/89464/2016

Fellowship: Program Management Track

ABSTRACT

Kisumu County is one of the 47 counties in Kenya. The county has a diverse background comprising of urban and rural set-ups as well as a rich ethnic, racial and cultural diversity. There are seven sub counties within Kisumu County where the major economic mainstay of the residents include: Fishing, Farming (rice and sugarcane growing) and Trade. With the prevalence rate of 19.3%, the county ranks third among the 9 counties that account for the highest number of new HIV infections in the country. Having one of the highest HIV incidence and prevalence in Kenya, Kisumu County is working to prioritize and optimize HIV service delivery right from the community to all of its level 2 – level 6 health facilities. In this regard Kisumu county referral hospital is one of the high volume health facility that offers HIV services right at the heart of Kisumu city. Due to its strategic position KCRH has 17600 clients ever enrolled in care with 5400 active registered HIV clients. This number could increase three fold were it not for clients who drop out right after HIV diagnosis. The metropolitan environment with mass transit of people makes it hard to track and retain the newly HIV diagnosed clients in care and treatment within KCRH. This coupled with other operationalchallenges are hindering the achievement of 959595 UNAIDS targets for Kisumu County. There is therefore need to bring on board innovative approaches  especially targeting high volume facilities to help in facilitating and resolving the said challenges. 

Efficient and effective innovations and strategies can therefore play a pivotal role in closing some of these gaps, the project sought to design and implement a retention in care strategy that aimed at retaining newly diagnosed HIV clients in care and treatment hence strengthening the quality of care and achievement of the 959595 targets in KCRH and Kisumu county as a whole.

Upon designing the RIC model, it was piloted in KCRH for 6 months. Over that period cases of HIV positive clients who missed to be enrolled in care and treatment reduced significantly, proving that program data can help to inform designing of innovative interventions that can significantly help to improve RIC among HIV positive clients without much strain on existing health system infrastructure.

HEALTH CARE HUMAN RESOURCE CAPACITY BUILDING INITIATIVES INFLUENCING SUSTAINABILITY OF HIV/AIDS SERVICES AT SIAYA COUNTY REFERRAL HOSPITAL, KENYA

Name: Gloria Chelang’at Kitur

Registration No.: W82/89462/2016

Fellowship: Program Management

Institutional Affiliation:  Siaya County Referral Hospital

ABSTRACT

The HIV prevalence in Siaya County is 24.8 percent (4.2 times higher than the national prevalence) according to the Kenya HIV Estimates 2015. It is estimated that by the end of 2015, a total of 126,411 people were living with HIV in the County. There is a need for improvement in the County’s cascade of care to achieve the unmet gaps of the UNAIDS 95:95:95 targets in identification, linkage, and viral suppression. Timely HIV diagnosis, optimal linkage and retention to care for persons diagnosed with HIV, increased coverage of ART and viral suppression can only be achieved with a competent Healthcare workforce. The Kenya Healthcare system however, experiences an acute shortage of qualified and competent Human Resources for Health (HRH) in addition to their uneven distribution both geographically and within facilities. Focusing on Siaya County Referral Hospital (SCRH), this project sought to determine the Healthcare Human Resource Capacity Building Initiatives Influencing Sustainability of HIV/AIDS Services at Siaya County Referral Hospital. Project objectives included: to identify the human resource capacity gaps in terms of knowledge, skills, competencies and numbers; to identify the human resource capacity building initiatives currently being applied at Siaya County Referral Hospital; to determine the influence of terms of engagement, remuneration, performance appraisal, work environment and turnover intent of staff; and to identify the program level challenges faced by development partners all influencing sustainability of HIV/AIDS services at Siaya County Referral Hospital. A sample of forty SCRH staff, four hospital executives and two program officers was drawn. Questionnaires and Interview Schedules were used to collect primary data for the baseline survey. The survey findings revealed the major human resource capacity gap was staff numbers with specific skills and competencies. The widely used human resource capacity building initiative at SCRH was formal training and on-job training/mentorship. The terms of engagement, remuneration, performance appraisal and work environment greatly influenced the staff turnover intent and ultimately employee satisfaction. Lack of sustainability plans for the HIV programs at SCRH was a major challenge. It was therefore recommended that an SCRH Human Resource Capacity Building Committee be established whose mandate, in conjunction with the SCRH Management Team, Siaya County Health Management Team and the HIV Program Development Partner, would be to develop a HR Needs Assessment Report, a HR Capacity Building Plan, a Staff Engagement and Performance Status Report which would guide the development and implementation of a HIV Program Sustainability Plan for SCRH. The project could eventually be rolled out to the sub-county hospitals in Siaya County as well as other facilities offering HIV clinical services in Nyanza region and Kenya at large.