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Angela McLigeyo,1 Kevin Owuor,1 Evelyne Ng’ang’a,1 Jonathan Mwangi,2 Paul Wekesa1 1Center for Health Solutions - Kenya, Nairobi, Kenya; 2Division of Global HIV & TB, Centers for Disease Control and Prevention (CDC), Nairobi, KenyaCorrespondence: Paul Wekesa, Centre for Health Solutions – Kenya, CVS Plaza, 4th Floor, Kasuku Road, off Lenana Road, P.O. Box 23248-00100 GPO, Nairobi, Kenya, Tel +254 20 271 0077, Email pwekesa@chskenya.orgIntroduction: Kaposi’s sarcoma (KS) is the most common HIV-associated malignancy in Sub Saharan Africa. In 2018, it was the 7th most common cancer and the 10th most common cause of cancer death in Kenya. This study aimed to describe the baseline and clinical characteristics and treatment response observed following combined antiretroviral treatment (ART) and chemotherapy in KS patients.Methods: This was a descriptive analysis of patients aged ≥ 15 years treated for KS and HIV at 11 treatment hubs in Central Kenya between 2011 and 2014. Data on baseline and clinical characteristics, ART and chemotherapy regimens as well as treatment responses were collected from patient files and KS registers.Results: A total of 95 patients presenting with clinically suspected KS with no history of prior treatment with chemotherapy were reviewed. All had histological diagnostic samples taken with 67 (71%) having confirmed KS. All were on ART, either newly initiated or continuing on ART, and 63 of the 67 (94.0%) confirmed to have KS received chemotherapy. Among the 67 patients with confirmed KS, mean age was 37.2 years (± 13.2) and 40 (59.7%) were male. More than 80% had normal baseline and follow-up BMI, and 34 (50.7%) were on a TDF-based regimen, 52 (77.6%) were treated with the Adriamycin, bleomycin and vinblastine protocol, and 55 (82.1%) had KS diagnosis before HIV diagnosis. All 67 patients had mucocutaneous lesions. Complete, partial response and stable disease occurred in 27 (40.3%), 10 (14.9%) and 7 (10.4%), respectively, 11 (16.4%) defaulted care during treatment, six patients died during treatment, four patients died before treatment while two patients had progressive disease during chemotherapy.Conclusion: The diagnosis of KS preceded HIV in the majority of cases reviewed, with histology helpful to reduce misdiagnosis. Patients generally complied with their chemotherapy, with overall good response rate for this intervention implemented at primary health-care facilities.Keywords: HIV, Kaposi’s sarcoma, characteristics, treatment, response, adults

BackgroundDespite the recognised links between food insecurity and parenting, few studies have evaluated the perceived impacts of livelihood or food security interventions on parental practices, intra-household functioning, adolescent behaviour and psychosocial outcomes in HIV-affected households in sub-Saharan Africa.AimsThe study aimed to understand the perceived effects of food security on parenting practices and how this was experienced by both adolescent girls (aged 13-19 years) and their caregivers in rural Kenya.MethodWe conducted semi-structured, individual interviews with 62 caregiver-adolescent dyads who were participants in the adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in the Shamba Maisha agricultural and finance intervention trial (NCT01548599). Data were analysed following the principles of thematic analysis.ResultsCompared to control households, the Shamba Maisha intervention households had improved food security and strengthened economic security, which, in turn, improved parenting practices. Intervention households described changes in parenting experiences, including decreased parental stress, reduced absenteeism and harsh parenting and improved caregiver- adolescent relationships. These positive caregiving practices, in turn, contributed to improved mental health and fewer behavioural problems among adolescent girls. Changes in the control households were less noticeable.ConclusionThese findings demonstrate how an income-generating agricultural intervention may improve food security and positively affect parenting practices, intra-household dynamics and adolescent psychosocial well-being and behaviour. Further research is needed to explore how to harness the social benefits of agricultural interventions to best address the critical intersections among food insecurity, parenting practices and adolescent mental health.

Implementing self-injection (SI) of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) is a key self-care strategy for sexual and reproductive health, but SI uptake remains low, and assertions about the potential of SI to increase women's control over contraceptive use lack evidence. We sought to qualitatively explore how women with diverse contraceptive experiences-including those with and without experience using SI-view the benefits and challenges of SI as compared to other methods. We conducted 241 in-depth interviews with women across four sub-Saharan African countries and found alignment between the perceived and experienced benefits of SI across our diverse sample. Through the benefits of privacy, easier access, and self-management, we found SI can promote greater control over the contraceptive experience by facilitating a woman's ability to act on her preferences and control who is involved in or aware of her contraceptive use. Interviews revealed SI's potential is, however, constrained by inherent limitations in the method; for example, it is often not private or accessible enough and many fear injecting themselves. SI has the most potential when implemented with programmatic solutions that mitigate challenges women experience or anticipate and allow more women to benefit from the privacy, easier access, and self-management that SI offers.

This article presents implications of education and training policies on Technical and Vocational Education and Training (TVET) from the pre-colonial Kenya to date based on systematic review of education policies and related literature. In the pre-colonial period the non-formal and informal vocational training was demand driven, relevant and flexible. Throughout the colonial period, the Kenyan natives developed negative attitude towards formal TVET because it was introduced and managed to suit the aspirations of missionaries and colonialists and so were there commendations of the various education commissions. At independence, and to appeal to the populace, the administrative and policy direction in the Country reinforced this negativity. On the other hand, there were indications that the government and policy makers saw TVET as a key solution to industrialization and the perennial youth unemployment menace. Through out the sixties, seventies, eighties and nineties the government's enthusiasm for TVET resulted in inertia, gaining momentum in the turn of the millennium and peaking with the promulgation of the Kenya Vision 2030 and the Kenya 2010 Constitution. However, well-meaning policies are yet to translate in production of adequate and competent middle level professionals to drive innovative economy and industrialization. As a way forward, the government needs to take the lead and coordinate reforms in this multifaceted and policy crowded field with many players, and create a robust TVET ecosystem to accelerate production of right skills for jobs in the Country.

BackgroundAdolescent girls may experience poor psychological well-being, such as social isolation, shame, anxiety, hopelessness, and despair linked to food insecurity.ObjectivesThis study aimed to investigate the experiences with and perceived effects of a household-level income-generating agricultural intervention on the psychological well-being of adolescent girls in human immunodeficiency virus (HIV)-affected households in southwestern Kenya.MethodsWe conducted 62 in-depth interviews with HIV-affected adolescent girls and caregiver dyads in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in Shamba Maisha (NCT01548599), a multisectoral agricultural and finance intervention trial aimed to improve food security and HIV health indicators. Participants were purposively sampled to ensure diversity in terms of age and location. Data were audiotaped, transcribed, translated, and uploaded into Dedoose (Sociocultural Research Consultants, LLC) software for management. Data were analyzed thematically based on reports from Dedoose.ResultsWe found evidence that a household-level structural intervention aimed at increasing food and financial security among persons living with HIV can contribute to better psychological well-being among adolescent girls residing in these households. The intervention also affected: 1) reduction of social isolation, 2) reduction of shame and stigma, 3) increased attendance and concentration in school, 4) improved caregiver mental health, and 5) reduced parental aggression and improved household communication. These associations were reported more commonly among those in the intervention arm than the control arm.ConclusionsThis study extends existing research by demonstrating how multisectoral structural interventions delivered at a household level can improve the psychological well-being of adolescents. We recommend that future research test livelihood interventions designed specifically for adolescent girls that integrate food-security interventions with other elements to address the social and psychological consequences of food insecurity holistically. This trial was registered at clinicaltrials.gov as NCT03741634.

Interferon lambda 4 (IFN-λ4) is a novel type-III interferon that can be expressed only by carriers of the genetic variant rs368234815-dG within the first exon of the IFNL4 gene. Genetic inability to produce IFN-λ4 (in carriers of the rs368234815-TT/TT genotype) has been associated with improved clearance of hepatitis C virus (HCV) infection. The IFN-λ4-expressing rs368234815-dG allele (IFNL4-dG) is most common (up to 78%) in West sub-Saharan Africa (SSA), compared to 35% of Europeans and 5% of individuals from East Asia. The negative selection of IFNL4-dG outside Africa suggests that its retention in African populations could provide survival benefits, most likely in children. To explore this hypothesis, we conducted a comprehensive association analysis between IFNL4 genotypes and the risk of childhood Burkitt lymphoma (BL), a lethal infection-associated cancer most common in SSA. We used genetic, epidemiologic, and clinical data for 4,038 children from the Epidemiology of Burkitt Lymphoma in East African Children and Minors (EMBLEM) and the Malawi Infections and Childhood Cancer case-control studies. Generalized linear mixed models fit with the logit link controlling for age, sex, country, P. falciparum infection status, population stratification, and relatedness found no significant association between BL risk and 3 coding genetic variants within IFNL4 (rs368234815, rs117648444, and rs142981501) and their combinations. Because BL occurs in children 6-9 years of age who survived early childhood infections, our results suggest that additional studies should explore the associations of IFNL4-dG allele in younger children. This comprehensive study represents an important baseline in defining the health effects of IFN-λ4 in African populations.

IntroductionWidowed women make up 18-40% of the 12 million women living with HIV in eastern and southern Africa. Widowhood has also been associated with greater HIV morbidity and mortality. We compared the effectiveness of a multisectoral climate adaptive agricultural livelihood intervention (called Shamba Maisha) on food insecurity, and HIV related health outcomes among widowed and married women living with HIV in western Kenya.MethodsWe implemented Shamba Maisha (NCT02815579) using a cluster-randomized control trial design. The intervention arm received an US$175 in-kind loan to purchase a micro-irrigation pump, seeds, and fertilizer, and received eight training sessions on sustainable agriculture and financial management. Study outcomes were measured every 6 months over a 24-month follow-up period and trends in outcomes assessed using multilevel mixed-effects models.ResultsThe trial enrolled 232 (61.5%) married and 145 (38.5%) widowed women. Widowed women (mean age 42.8 ± 8.4 years) were older than married women (35.8 ± 9.0 years) (p

BackgroundInfants who are HIV-exposed and uninfected have suboptimal growth patterns compared to those who are HIV-unexposed and uninfected. However, little is known about how these patterns persist beyond 1 year of life.ObjectivesThis study aimed to examine whether infant body composition and growth trajectories differed by HIV exposure during the first 2 years of life among Kenyan infants using advanced growth modeling.MethodsRepeated infant body composition and growth measurements (mean: 6; range: 2-7) were obtained from 6 weeks to 23 months in the Pith Moromo cohort in Western Kenya (n = 295, 50% HIV-exposed and uninfected, 50% male). Body composition trajectory groups were fitted using latent class mixed modeling (LCMM) and associations between HIV exposure and growth trajectories were examined using logistic regression analysis.ResultsAll infants exhibited poor growth. However, HIV-exposed infants generally grew suboptimally than unexposed infants. Across all body composition models except for the sum of skinfolds, HIV-exposed infants had a higher likelihood of belonging to the suboptimal growth groups identified by LCMM than the HIV-unexposed infants. Notably, HIV-exposed infants were 3.3 times more likely (95% CI: 1.5-7.4) to belong to the length-for-age z-score growth class that remained at a z-score of < -2, indicating stunted growth. HIV-exposed infants were also 2.6 times more likely (95% CI: 1.2-5.4) to belong to the weight-for-length-for-age z-score growth class that remained between 0 and -1, and were 4.2 times more likely (95% CI: 1.9-9.3) to belong to the weight-for-age z-score growth class that indicated poor weight gain besides stunted linear growth.ConclusionsIn a cohort of Kenyan infants, HIV-exposed infants grew suboptimally compared to HIV-unexposed infants beyond 1 year of age. These growth patterns and longer-term effects should be further investigated to support the ongoing efforts to reduce early-life HIV exposure-related health disparities.

Few studies have explored land access, a structural driver of health, and women's participation in livelihood interventions to improve food security and HIV outcomes. This qualitative study, embedded within Shamba Maisha (NCT02815579)-a randomized controlled trial (RCT) examining the impact of a multisectoral intervention among farmers living with HIV in western Kenya-sought to explore the influence of perceived access to and control of land on agricultural productivity, investments, and benefits. Thirty in-depth interviews (IDIs) were conducted with purposively sampled men and women, 3 to 6 months after receiving intervention inputs; data were deductively and inductively coded and analyzed. Farming practices and participation in Shamba Maisha were dependent on land tenure and participants' perceived strength of claim over their land, with participants who perceived themselves to be land insecure less likely to make long-term agricultural investments. Land tenure was influenced by a number of factors and posed unique challenges for women which negatively impacted uptake and success in the intervention. Data underscore the importance of secure land tenure for the success of similar interventions, especially for women; future interventions should integrate land security programming for improved outcomes for all.

Much of the methodological literature on rapid qualitative analysis describes processes used by a relatively small number of researchers focusing on one study site and using rapid analysis to replace a traditional analytical approach. In this paper, we describe the experiences of a transnational research consortium integrating both rapid and traditional qualitative analysis approaches to develop social theory while also informing program design. Research was conducted by the Innovations for Choice and Autonomy (ICAN) consortium, which seeks to understand how self-injection of the contraceptive subcutaneous depot medroxyprogesterone acetate (DMPA-SC) can be implemented in a way that best meets women's needs, as defined by women themselves. Consortium members are based in Kenya, Uganda, Malawi, Nigeria, and the United States. Data for the ICAN study was collected in all four countries in sub-Saharan Africa. In order to both illuminate social phenomena across study sites and inform the program design component of the study, researchers developed tools meant to gather both in-depth information about women's contraceptive decision-making and data targeted specifically to program design during the formative qualitative phase of the study. Using these two bodies of data, researchers then simultaneously conducted both a traditional qualitative and rapid analysis to meet multiple study objectives. To complete the traditional analysis, researchers coded interview transcripts and kept analytical memos, while also drawing on data collected by tools developed for the rapid analysis. Rapid analysis consisted of simultaneously collecting data and reviewing notes developed specifically for this analysis. We conclude that integrating traditional and rapid qualitative analysis enabled us to meet the needs of a complex transnational study with the added benefit of grounding our program design work in more robust primary data than normally is available for studies using a human-centered design approach to intervention development. However, the realities of conducting a multi-faceted study across multiple countries and contexts made truly "rapid" analysis challenging.

Reliable access to safe and acceptable water in sufficient quantities (i.e., water security) is important for medication adherence and limiting pathogen exposure, yet prior studies have only considered the role of food security as a social determinant of HIV-related health. Therefore, the objective of this analysis was to assess the relationships between household water insecurity and HIV-related outcomes among adults living with HIV in western Kenya (N = 716). We conducted a cross-sectional analysis of baseline data from Shamba Maisha (NCT02815579), a cluster randomized controlled trial of a multisectoral agricultural and asset loan intervention. Baseline data were collected from June 2016 to December 2017. We assessed associations between water insecurity and HIV-related outcomes, adjusting for clinical and behavioral confounders, including food insecurity. Each five-unit higher household water insecurity score (range: 0-51) was associated with 1.21 higher odds of having a viral load ≥ 1000 copies/mL (95% CI 1.07, 1.36) and 1.26 higher odds of AIDS-defining illness (95% CI 1.11, 1.42). Household water insecurity was not associated with CD4 cell count (B: 0.27; 95% CI -3.59, 13.05). HIV treatment and support programs should consider assessing and addressing water insecurity in addition to food insecurity to optimize HIV outcomes.

BackgroundHousehold food insecurity (FI) and water insecurity (WI) are prevalent public health issues that can co-occur. Few studies have concurrently assessed their associations with health outcomes, particularly among people living with HIV.ObjectivesWe aimed to investigate the associations between FI and WI and how they relate to physical and mental health.MethodsFood-insecure adult smallholder farmers living with HIV in western Kenya were recruited to participate in a cluster-randomized controlled trial of a multisectoral agricultural and asset loan intervention. We used baseline data on experiences of FI (using the Household Food Insecurity Access Scale, range: 0-27) and WI (using a modified scale developed for this region, range: 0-51) in the prior month (n = 716). Outcomes included probable depression (using the Hopkins Symptom Checklist), fatigue and diarrhea in the prior month, and overall mental and physical health (using the Medical Outcomes Study HIV Health Survey, range: 0-100). We first assessed Pearson correlations between FI, WI, and sociodemographic characteristics. We then developed 3 regressions for each health outcome (control variables and FI; control variables and WI; control variables, FI, and WI) and compared model fit indexes.ResultsCorrelations between household FI, WI, and wealth were low, meaning they measure distinct constructs. FI and WI were associated with numerous physical and mental health outcomes; accounting for both resource insecurities typically provided the best model fit. For instance, when controlling for FI, each 10-point higher WI score was associated with a 6.42-point lower physical health score (P

IntroductionIntimate partner violence and food insecurity are both structural drivers of HIV acquisition, care, and treatment, but little is known about how the 2 conditions intersect in the lives of those already living with HIV.MethodsThis study examined cross-sectional baseline data (collected in January 2016-December 2017) from an ongoing trial in southwestern Kenya. Trained interviewers asked enrolled participants living with HIV aged 18-60 years about household food insecurity (using the Household Food Insecurity Access Scale), intimate partner violence (using an adapted WHO multicountry study instrument), and sociodemographics. Negative binomial regression was used to examine the association between food insecurity and partner violence victimization (among women) or perpetration (among men). Secondary data were analyzed in August 2019-March 2020.ResultsOf 720 participants, more than half of women reported experiencing intimate partner violence (57.6%) and most men reported perpetrating it (58.4%). Participants reporting any partner violence had higher Household Food Insecurity Access Scale scores (21.8) compared with those reporting no violence (21.3, p=0.02). Each categorical change in food insecurity (mild, moderate, severe) was associated with a 41% increased risk of an additional partner violence episode. In models controlling for relationship status, wealth, season of interview (lean versus not lean), and baseline physical health, each 1-point increase in food insecurity was associated with a 6% higher risk of violence victimization among women and 4% greater risk of men perpetrating partner violence.ConclusionsThis study highlights the interconnected nature of intimate partner violence and food insecurity among women and men living with HIV. This relationship suggests that enhancing food security may be a useful intervention strategy to prevent intimate partner violence and improve HIV-related health outcomes.

The objective of this study was to determine the association between the number of adolescents in a household and depressive symptoms among adult caregivers living with HIV. We examined cross-sectional baseline data among adults enrolled in the Shamba Maisha multisectoral agricultural intervention (n = 705) in the Nyanza region of Kenya (NCT02815579). Each additional adolescent 15-19 years in a household was associated with a 1.35 (95% CI 1.06-1.71) higher odds of depressive symptoms among women, but not men, adjusting for potential confounders. Interventions to support the mental health of adults living with HIV may target women caring for dependent adolescents 15-19 years.

Food insecurity (FI), low social support, and low health-related quality of life (HRQoL) are associated with self-reported nonadherence to antiretroviral therapy (ART) among postpartum women, but these relationships have not been evaluated using objective adherence indicators. Hair samples were therefore analyzed among 83 postpartum Kenyan women living with HIV on efavirenz and nevirapine ART drug regimens in an observational cohort (NCT02974972). FI (0-27), social support (0-40), and HRQoL (8-40) in the prior month were also assessed. In multivariable models, each point increase in FI and decrease in HRQoL were associated with a 45.1% (95% CI: -64.3%, -15.6%) and 10.5% decrease (95% CI: 1.0%, 22.1%) in hair ART drug concentrations respectively, when social support was held constant. A significant interaction between social support and FI (β = 0.02, p = 0.017) indicated that greater social support was predicted to mitigate the negative impacts of FI on ART adherence. Addressing these modifiable barriers could improve ART adherence during this critical period.

Background:Food insecurity remains a major obstacle to achieving health and well-being for individuals living with HIV in western Kenya. Studies have shown that pregnant women are vulnerable to experiencing food insecurity worldwide, with significant consequences for both maternal and child health. The Shamba Maisha cluster randomized controlled trial in western Kenya (which means "farming for life" in Swahili) tested the effects of a multisectoral livelihood intervention consisting of agricultural and finance trainings, farm inputs, and a loan on health and food security among 746 farmers living with HIV in Kisumu, Homa Bay, and Migori Counties. Objectives:We conducted a qualitative substudy within the Shamba Maisha trial to understand the experiences and perspectives of pregnant women living with HIV enrolled in the trial. Methods:Thirty women who had experienced a pregnancy during the Shamba Maisha study period, comprising 20 women in the intervention arm and 10 women in the control arm, completed in-depth interviews using a semistructured interview guide. Results:Intervention participants interviewed noted improvements in maternal nutrition compared with previous pregnancies, which they attributed to the livelihood intervention. Key identified pathways to improved nutrition included improved access to vegetables, increased variety of diet through vegetable sales, and improved nutritional awareness. Women in the intervention arm also perceived increased weight gain compared with prior pregnancies and increased strength and energy throughout pregnancy. Conclusions:Livelihood interventions represent a promising solution to alleviate food insecurity for pregnant women in order to improve maternal and child health outcomes.This trial was registered at clinicaltrials.gov as NCT02815579.

This paper highlights the results of a research conducted in Bungoma County of Kenya between 2008-2009. The objective of the study was to investigate the attitudes of teachers and students towards the impact of availability and use of daily newspapers on students' speaking competence in English language. The study was based on the Communicative Language Teaching Approach and the theory underlying this approach is Krashen's Second Language Acquisition, the monitor model. The study used the mixed methods research approach adopting a correlation research design. Stratified, purposive and simple random sampling techniques were used to get the sample. The sample involved 16 teachers of English language and 135 form three students. The questionnaire, students' focused group discussions, and interview guide were used to collect data from the students and teachers respectively. The data collected was analyzed using both descriptive and inferential statistics. The hypotheses were tested using non-parametric inferential statistics--Mann-Whitney U-test. From the analysis and interpretation of data, it was deduced that students who used daily newspapers showed better speaking competence in English language than those who did not use them. Consequently, it is recommended that the use of the daily newspapers as an instructional resource in teaching speaking skills in English language should be encouraged and improved in secondary schools in Kenya.

Background/objectivesBody composition changes markedly during reproduction. In sub-Saharan Africa, impacts of HIV infection on body composition across pregnancy and lactation in the context of Option B+ antiretroviral therapy are unknown. Therefore, we sought to evaluate the role of HIV infection on body composition during pregnancy and lactation among Kenyan women.Subjects/methodsA cohort of pregnant women (n = 333; 50.5% HIV+, receiving ART) were enrolled at seven clinics in western Kenya. Two prenatal (mean ± SD: 23.6 ± 4.4 and 33.4 ± 2.0 weeks gestation) and three postpartum (6, 14, and 36 weeks) measurements included: individual-level food insecurity, height, weight, fat mass (FM), and fat-free mass (FFM) by bioimpedance analysis (BIA), mid-upper arm circumference (MUAC), and triceps skinfold (TSF), allowing for AMA (arm muscle area) and AFA (arm fat area) derivation. Multivariable longitudinal regression models were used to relate HIV to body composition changes.ResultsIn longitudinal models, HIV-infected women had lower weight (ß = -3.0 kg, p = 0.003), fat mass (ß = -1.5 kg, p = 0.02), fat-free mass (ß = -1.5 kg, p = 0.01), TSF (ß = -2.6 mm, p

BackgroundFemale positive/male negative HIV-serodiscordant couples express a desire for children and may engage in condomless sex to become pregnant. Current guidelines recommend antiretroviral treatment in HIV-serodiscordant couples, yet HIV RNA viral suppression may not be routinely assessed or guaranteed and pre-exposure prophylaxis may not be readily available. Therefore, options for becoming pregnant while limiting HIV transmission should be offered and accessible to HIV-affected couples desiring children.MethodsA prospective pilot study of female positive/male negative HIV-serodiscordant couples desiring children was conducted to evaluate the acceptability, feasibility, and effectiveness of timed vaginal insemination. Eligible women were 18-34 years with regular menses. Prior to timed vaginal insemination, couples were observed for two months, and tested and treated for sexually transmitted infections. Timed vaginal insemination was performed for up to six menstrual cycles. A fertility evaluation and HIV RNA viral load assessment was offered to couples who did not become pregnant.FindingsForty female positive/male negative HIV-serodiscordant couples were enrolled; 17 (42.5%) exited prior to timed vaginal insemination. Twenty-three couples (57.5%) were introduced to timed vaginal insemination; eight (34.8%) achieved pregnancy, and six live births resulted without a case of HIV transmission. Seven couples completed a fertility evaluation. Four women had no demonstrable tubal patency bilaterally; one male partner had decreased sperm motility. Five women had unilateral/bilateral tubal patency; and seven women had an HIV RNA viral load (≥ 400 copies/mL).ConclusionTimed vaginal insemination is an acceptable, feasible, and effective method for attempting pregnancy. Given the desire for children and inadequate viral suppression, interventions to support safely becoming pregnant should be integrated into HIV prevention programs.

The concept of classification of organisms in Biology seems to pose a problem to Secondary School students in Kenya. Though, the topic is important for understanding of the basic elements of the subject. The Examinations Council in Kenya has identified teacher centred pedagogical techniques as one of the main causes for this. Project based learning technique has been successfully used as an instructional technique in countries like Japan and United States of America to improve students' academic achievement and positive attitude development among students in science practicals in Biology. The study therefore investigated the influence of project based learning technique on achievement of students in classification of organisms among Secondary Schools in Kenya with particular focus on academic achievement and attitude development. Quasi experimental design was employed. Stratified random sampling technique was used to select eight classes from four secondary schools with a total of 360 students. Students' Attitude Questionnaires and Classification Achievement Test were used as instruments. Analysis of Variance and t-test were employed in data analysis. The study revealed that project based learning technique enabled students to improve in academic achievement as well as developing positive attitude towards classification of organisms. The study recommends to the Ministry of Education and its agencies to adopt project based learning technique among other student centred instructional techniques for teaching of practical oriented concepts like Classification of Organisms.

Mathematics is a key subject which students cannot avoid if they have to lead a bright future. Despite the introduction and implementation of different teaching methods and strategies suggested by researchers the achievement of students in mathematics at school level has persistently been poor, hence the need to explore the influence of different instructional approaches. The purpose of this study was to find out the extent to which instructional practices influenced students' achievement in secondary school mathematics. This entails the use of Behavioral Objective-Based (BOB), Peer Instruction enriched with Concept Tests (PICT), both BOB and PICT (BO-PICT) and Conventional Instruction (TI). The theoretical framework which guided this study was social constructivism theory. The study adopted quasi-experimental, utilizing pretest posttest non-equivalent group design. The target population for the study was all the 3056 form three students in the 38 secondary schools in Mumias sub-county. Disproportionate stratified sampling and simple random sampling was used to select 327 students who took part in the study. Mathematics Achievement Test (MAT) was used to collect data. Data was analyzed using both descriptive and inferential statistics. Findings revealed that there was a significant difference in achievement, between all Experimental groups (BOB, PICT and BO-PICT) and the control group in favor of the Experimental groups. There was a significant difference between means of groups that used BOB and BO-PICT as well as PICT and BO-PICT. Those ones who used BOB and PICT were found to have similar achievement in the learning of mathematics. Based on the findings, BOB, PICT and BO-PICT were found to be viable instructional strategies that could promote performance in mathematics.

More than 500 human cases of flea-borne typhus have been reported from Los Angeles and Orange Counties over the past 20 years. Only West Nile virus exceeds flea-borne typhus as an important vector-borne disease in these counties. Despite this, flea-borne typhus garners insignificant public attention compared to West Nile virus. In Los Angeles County alone there were 121 human cases of flea-borne typhus from 2000 to 2009, and 292 human cases from 2010 to 2015. Results from previous studies in Los Angeles and Orange Counties identified a suburban cycle of flea-borne typhus transmission involving backyard wildlife, pets, and the cat flea Ctenocephalides felis. Prior studies and recent observations in Los Angeles County showed that the flea burden of opossums and feral cats is onerously high, and the cat flea is the main vector of the pathogens (Rickettsia typhi and R. felis) responsible for human typhus. The rise of cases in recent years has been accompanied by policy changes in public and private animal control groups that manage nuisance animals in Los Angeles and Orange Counties. Instead of trapping and removing strays and supporting a policy of not feeding wild or stray animals, some governmental agencies and private organizations prefer trap, neuter, and release (TNR) programs and support rehabilitating/relocating feral animals. We believe these policy changes have contributed to the increased incidence of human typhus.

The application of computer technology in education is a relatively new approach that is trying to justify inclusion in the Kenyan school curriculum. Being abstract, with a dynamic nature that does not manifest itself visibly, the process of cell division has posed difficulties for teachers. Consequently, a computer simulation program, using animated colour graphic images capable of presenting the dynamic nature of the process through a multi-sensory approach, was developed from the existing school biology syllabus and implemented for a period of 4 weeks. Data was collected and analysed to help unravel what was actually happening as the teachers and the students interacted with the computer simulation program and/or instructional materials during cell division lessons. Results indicate that the computer simulation program created a community of meaning makers by enabling learners to aggregate their insights through co-elaboration and self-teaching while interrogating the learning experiences presented by the simulation. Support is provided for the idea that the use of computer simulations can greatly enhance pupils' understanding of cell division concepts.

ObjectiveTo determine if a health talk on family planning (FP) by community clinic health assistants (CCHAs) will improve knowledge, attitudes and behavioral intentions about contraception in HIV-infected individuals.MethodsA 15-min FP health talk was given by CCHAs in six rural HIV clinics to a sample of 49 HIV-infected men and women. Effects of the health talk were assessed through a questionnaire administered before the health talk and after completion of the participant's clinic visit.ResultsFollowing the health talk, there was a significant increase in knowledge about contraceptives (p