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Search Results: 1 - 10 of 1235 matches for " Kennedy Otwombe "
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Improving national data collection systems from voluntary counselling and testing centres in Kenya
Otwombe,Kennedy N; Wanyungu,John; Nduku,Kilonzo; Taegtmeyer,Miriam;
Bulletin of the World Health Organization , 2007, DOI: 10.1590/S0042-96862007000400017
Abstract: problem: voluntary counselling and testing (vct) data from the registered sites in kenya have been fraught with challenges, leading to insufficient statistics in the national office for planning purposes. an exercise was carried out to determine the barriers to the flow of data in vct sites in kenya. approach: a record-based survey was conducted at 332 vct sites in kenya. data from on-site records were compared with those in the national office. the exercise was conducted in 2004 between 5 september and 15 october. local setting: all registered vct sites in kenya. relevant changes: after the exercise, various measures to enhance vct data collection and reporting were implemented. they include the provision of a uniform data collection and reporting tool to all the districts in the country, the strengthening of a feedback mechanism to update provinces and districts on their reporting status and increased support to the data component of the national quality assurance for vct. lessons learned: periodical field visits by the national officials to offer on-the-job training about data management to data collectors and to address data quality issues can dramatically improve the quality and completeness of vct reports. the perceived relevance of the data and the data collection process to those working at the sites is the critical factor for data quality and timeliness of reporting.
A Review of the Study Designs and Statistical Methods Used in the Determination of Predictors of All-Cause Mortality in HIV-Infected Cohorts: 2002–2011
Kennedy N. Otwombe, Max Petzold, Neil Martinson, Tobias Chirwa
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0087356
Abstract: Background Research in the predictors of all-cause mortality in HIV-infected people has widely been reported in literature. Making an informed decision requires understanding the methods used. Objectives We present a review on study designs, statistical methods and their appropriateness in original articles reporting on predictors of all-cause mortality in HIV-infected people between January 2002 and December 2011. Statistical methods were compared between 2002–2006 and 2007–2011. Time-to-event analysis techniques were considered appropriate. Data Sources Pubmed/Medline. Study Eligibility Criteria Original English-language articles were abstracted. Letters to the editor, editorials, reviews, systematic reviews, meta-analysis, case reports and any other ineligible articles were excluded. Results A total of 189 studies were identified (n = 91 in 2002–2006 and n = 98 in 2007–2011) out of which 130 (69%) were prospective and 56 (30%) were retrospective. One hundred and eighty-two (96%) studies described their sample using descriptive statistics while 32 (17%) made comparisons using t-tests. Kaplan-Meier methods for time-to-event analysis were commonly used in the earlier period (n = 69, 76% vs. n = 53, 54%, p = 0.002). Predictors of mortality in the two periods were commonly determined using Cox regression analysis (n = 67, 75% vs. n = 63, 64%, p = 0.12). Only 7 (4%) used advanced survival analysis methods of Cox regression analysis with frailty in which 6 (3%) were used in the later period. Thirty-two (17%) used logistic regression while 8 (4%) used other methods. There were significantly more articles from the first period using appropriate methods compared to the second (n = 80, 88% vs. n = 69, 70%, p-value = 0.003). Conclusion Descriptive statistics and survival analysis techniques remain the most common methods of analysis in publications on predictors of all-cause mortality in HIV-infected cohorts while prospective research designs are favoured. Sophisticated techniques of time-dependent Cox regression and Cox regression with frailty are scarce. This motivates for more training in the use of advanced time-to-event methods.
Factors Associated with Not Testing For HIV and Consistent Condom Use among Men in Soweto, South Africa
Sakhile Mhlongo, Janan Dietrich, Kennedy N. Otwombe, Gavin Robertson, Thomas J. Coates, Glenda Gray
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0062637
Abstract: Background Besides access to medical male circumcision, HIV testing, access to condoms and consistent condom use are additional strategies men can use to prevent HIV acquisition. We examine male behavior toward testing and condom use. Objective To determine factors associated with never testing for HIV and consistent condom use among men who never test in Soweto. Methods A cross-sectional survey in Soweto was conducted in 1539 men aged 18–32 years in 2007. Data were collected on socio-demographic and behavioral characteristics to determine factors associated with not testing and consistent condom use. Results Over two thirds (71%) of men had not had an HIV test and the majority (55%, n = 602) were young (18–23). Of those not testing, condom use was poor (44%, n = 304). Men who were 18–23 years (aOR: 2.261, CI: 1.534–3.331), with primary (aOR: 2.096, CI: 1.058–4.153) or high school (aOR: 1.622, CI: 1.078–2.439) education, had sex in the last 6 months (aOR: 1.703, CI: 1.055–2.751), and had ≥1 sexual partner (aOR: 1.749, CI: 1.196–2.557) were more likely not to test. Of those reporting condom use (n = 1036, 67%), consistent condom use was 43% (n = 451). HIV testing did not correlate with condom use. Conclusion Low rates of both condom use and HIV testing among men in a high HIV prevalence setting are worrisome and indicate an urgent need to develop innovative behavioral strategies to address this shortfall. Condom use is poor in this population whether tested or not tested for HIV, indicating no association between condom use and HIV testing.
The Effect of a Maturing Antiretroviral Program on Early Mortality for Patients with Advanced Immune-Suppression in Soweto, South Africa
Kennedy N. Otwombe, Fatima Laher, Thandeka Tutu-Gxashe, Glenda Gray, Lerato Mohapi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081538
Abstract: Objective We hypothesize that time to initiate care and maturity of a treatment program impact on outcome of severely immuno-compromised patients with higher risk of mortality. Design We conducted a retrospective cohort analysis at the Perinatal HIV Research Unit Adult ART clinic, Soweto, South Africa. Methods Eligibility criteria for this analysis were: attendance for minimum one visit between August 2004 and August 2010, age >18 years, CD4 count < 50 cells/mm3 and ART-na?ve at screening. We followed participants up to one year after ART initiation. We defined years 2004-2007 and 2008-2010 as the early and late eras respectively. Chi-square test and survival analysis methods were used for mortality comparisons between eras. Results Of 2357 patients eligible for antiretroviral treatment, 395 (17%) had CD4 counts < 50 cells/mm3 and ART-na?ve at screening. Overall 261 (66%) were women. Patients had similar median age (35 vs. 33.5 years, p=0.08), time to HAART initiation (7 days, p=0.18) and baseline CD4 count (20 vs. 23 cells/mm3, p=0.5) between eras. Overall 63 (16%) patients died in their first year of treatment (2 per 100 person-months) and the main cause of death was tuberculosis (n=23, 37%). The proportion of deaths (52/262 vs. 11/133, p=0.003) and time to death from enrolment (logrank p=0.04) were significantly different between eras. Conclusion Mortality decreased as the ART program matured in Soweto while time to initiation of treatment remained similar in both eras. Because ART guidelines were consistent during both eras, it is possible that with time, management of patients improved as expertise was gained.
CD4 Counts and Viral Loads of Newly Diagnosed HIV-Infected Individuals: Implications for Treatment as Prevention
Sarishen Govender, Kennedy Otwombe, Thandekile Essien, Ravindre Panchia, Guy de Bruyn, Lerato Mohapi, Glenda Gray, Neil Martinson
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0090754
Abstract: Objective To report the viral load and CD4 count in HIV-infected, antiretroviral na?ve, first -time HIV-testers, not immediately eligible for treatment initiation by current South Africa treatment guidelines. Design This was a cross-sectional study in a high-volume, free-of-charge HIV testing centre in Soweto, South Africa. Methods We enrolled first time HIV testers and collected demographic and risk-behaviour data and measured CD4 count and viral load. Results Between March and October 2011, a total of 4793 adults attended VCT and 1062 (22%) tested positive. Of the 1062, 799 (75%) were ART na?ve and 348/799 (44%) were first-time HIV testers. Of this group of 348, 225 (65%) were female. Overall their median age, CD4 count and viral load was 34 years (IQR: 28-41), 364 (IQR: 238-542) cells/mm3 and 13,000 (IQR: 2050-98171) copies/ml, respectively. Female first time HIV testers had higher CD4 counts (419 IQR: 262-582 vs. 303 IQR: 199-418 cells/mm3) and lower viral loads (9,100 vs. 34,000 copies/ml) compared to males. Of 183 participants with CD4 count >350 cells/mm3, 62 (34%) had viral loads > 10,000 copies/ml. Conclusions A large proportion of HIV infected adults not qualifying for immediate ART at the CD4 count threshold of 350 cells/mm3 have high viral loads. HIV-infected men at their first HIV diagnosis are more likely to have lower CD4 counts and higher viral loads than women.
An antibody present in everybody that attacks malaria infected erythrocytes  [PDF]
James Kennedy
Journal of Biomedical Science and Engineering (JBiSE) , 2013, DOI: 10.4236/jbise.2013.67A1001
Abstract: These malaria targeting antibodies are band 3 antibodies and they recognize a special configuration of a molecule called band 3 that is present on erythrocytes. The special band 3 configuration is present on the surface of senescent erythrocytes, malaria infected erythrocytes, the erythrocytes of certain hemoglobinnopathies such as sickle cell disease and on the erythrocytes of some metabolic disorders such as G6PD. Note that these hemoglobinopathies and metabolic disorders all aid in the survival of falciparum malaria to such an extent that their incidence is increased in falciparum endemic areas [1-3]. Though there are many adhesive molecules involved in the pathology of falciparum malaria and sickle cell anemia, the focus here is on the band 3 molecules.
Using VCT statistics from Kenya in understanding the association between gender and HIV
K N Otwombe, P N Ndindi, C Ajema, J Wanyungu
SAHARA J (Journal of Social Aspects of HIV/AIDS Research Alliance) , 2007,
Abstract: This paper demonstrates the importance of utilising official statistics from the voluntary counselling and testing centres (VCT) to determine the association between gender and HIV infection rates in Kenya.The study design adopted was a record based survey of data collected from VCT sites in Kenya between the second quarter of 2001 and the second quarter of 2004. Of those who were tested, significantly more females tested positive (P<0.0001) and had twice as high a chance of being infected by HIV (Odds ratio 2.27 with CI 2.23 to 2.31) than males.We conclude that VCT statistics may lead to better planning of services and gender sensitive interventions if utilised well. Cette communication montre l'importance de l'utilisation des chiffres officiels de centres de consultation et de dépistage volontaires (CDV) lors- qu'on établie un lien entre le genre et le taux d'infection par le VIH au Kenya. Le plan d'étude suivi était celui d'une recherche basée sur des dossiers de données recueillies du CDV au Kenya entre le deuxième trimestre de l'an 2001 et le deuxième trimestre de l'an 2004. Parmi les personnes dépistées, plus de femmes étaient séropositives (P<0,0001) et elles avaient deux fois plus de chance d'être infectées par le VIH (Odds ration 2.27 with CI 2.23 to 2.31) que des hommes. En conclusion, nous estimons que les chiffres du CDV peuvent mener à une planification de services et des interventions sensibles au genre s'ils sont utilisés à bien.
Does early initiation of ART in infants affect virological and resistance outcomes? Data from the CHER trial after 6 years of follow-up
Violari A,Cotton M,Otwombe K,Hunt G
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18085
Abstract: Purpose of the study Virological outcomes and resistance patterns in children initiating protease inhibitor (PI)-based antiretroviral therapy (ART) immediately following HIV-1 diagnosis are not well described. Challenges include maintaining adherence in asymptomatic patients with very high pre-ART viral loads. The CHER trial compared deferred but continuous ART (arm 1) with early limited ART (arms 2 and 3). Methods LPV/r+ZDV+3TC was commenced either immediately (in 250 of 252 children randomized in arms 2 and 3) or at clinical/immunological progression (103 of 125 children in arm 1). Interruption of ART occurred after 40 (arm 2) or 96 weeks (arm 3) and re-initiation with LPV/r + ZDV + 3TC was based on immunologic/clinical criteria. Viral load was measured on all children with a stored specimen at their last visit, having been on initial or restarted ART following interruption (arms 2 and 3) for at least 24 weeks. Children in arms 1, 2 and 3 not initiating ART due to death (16, 0, 0), LTFU (2, 2, 0) or other reason (4, 0, 0) are excluded. Resistance testing was performed on samples with a viral load (VL) ≥1000 c/mL together with the matched baseline sample, if available. Reverse transcriptase (NRTI and NNRTI) and PI inhibitor mutations were analyzed using a validated in-house population-based sequencing assay and the IAS 2011 mutation list. Summary of results A total of 377 infants were enrolled; median was age 7.4 (interquartile range (IQR) 6.7 to 8.9) weeks and median baseline viral load was log10 5.7. By end of study (June 2011), 353/377 children had started LPV/r + ZDV + 3TC. Median (IQR) age at ART initiation in arms 1, 2 and 3 was 26.1 (19.9 to 40), 7.4 (6.6 to 8.7) and 7.5 (6.6 to 9.0) weeks. Median (IQR) duration on ART was 240 (216 to 252), 243 (200 to 260) and 240 (194 to 257) weeks in arms 1, 2 and 3, respectively. HIV-1 RNA was <400 c/mL in 88/101 (87%), 95/113 (84%) and 97/117 (83%) (P=0.96). Twenty-two of thirty-two children with VL >1000 c/mL (2/5, 8/14, 12/13 in arms 1, 2 and 3) have had resistance tests to date; nine (41%) had mutations. There were seven with M184V mutations (1, 4, 2 in arms 1, 2 and 3); two with major PI mutations (V82A/L76V) (one in each of arms 1 and 2); and two with major NNRTI mutations (K103N/M230L) (one in each of arms 2 and 3). Two of ten children tested to date had NNRTI mutations prior to starting PI-based triple therapy. Conclusions Virological response on ART was excellent in this large cohort of infants initiating LPV/r+ZDV+3TC at a very young age, with no differences between randomized strategies, suggestin
A Dimensional Approach to Measuring Antidepressant Response: Implications for Agomelatine  [PDF]
Sidney H. Kennedy, Anna Cyriac
Psychology (PSYCH) , 2012, DOI: 10.4236/psych.2012.310130
Abstract: Current antidepressant treatments for Major Depressive Disorder (MDD) have limited efficacy and effectiveness. While measurement of response and remission is typically based on overall symptom reduction, the utilization of a dimensional approach, involving mood, cognitive and neurovegetative symptoms, may be more effective in predicting response to different antidepressant classes. In addition to these dimensions, evaluation of function is increasingly recognized as an important patient indicator of antidepressant efficacy. This paper reviews the efficacy of second generation antidepressant classes across the proposed symptom dimensions, and explores the potential benefits of agomelatine. While further research is required, agomelatine generally performed well in the mood dimension including measures of depressed mood, anxiety and anhedonia without inducing emotional blunting. Improvements in daytime alertness and clear thinking, combined with measures of subjective and objective sleep differentiate agomelatine from other currently available antidepressants, and likely contribute to favourable functional outcomes.
Scaling Symmetry and Integrable Spherical Hydrostatics  [PDF]
Sidney Bludman, Dallas C. Kennedy
Journal of Modern Physics (JMP) , 2013, DOI: 10.4236/jmp.2013.44069
Abstract:

Any symmetry reduces a second-order differential equation to a first integral: variational symmetries of the action (exemplified by central field dynamics) lead to conservation laws, but symmetries of only the equations of motion (exemplified by scale-invariant hydrostatics) yield first-order non-conservation laws between invariants. We obtain these non- conservation laws by extending Noethers Theorem to non-variational symmetries and present an innovative variational formulation of spherical adiabatic hydrostatics. For the scale-invariant case, this novel synthesis of group theory, hydrostatics, and astrophysics allows us to recover all the known properties of polytropes and define a core radius, inside which polytropes of index n share a common core mass density structure, and outside of which their envelopes differ. The Emden solutions (regular solutions of the Lane-Emden equation) are obtained, along with useful approximations. An appendix discusses the n = 3 polytrope in order to emphasize how the same mechanical structure allows different thermal structures in relativistic degenerate white dwarfs and zero age main sequence stars.

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