Publications by authors named "Kevin De Cock"

Despite earlier attempts to define global health, the discipline's boundaries are unclear, its priorities defined more by funding from high-income countries from the Global North than by global health trends. Governance and resource allocation are challenged by movements such as decolonizing global health. Inherent contradictions within global health derive from its historical evolution from tropical medicine and international health, as well as recent trends in infectious diseases.

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  • Kenya's Ministry of Health and the US CDC Kenya have collaborated for 40 years to address various disease threats, including during the COVID-19 pandemic.
  • Together, they implemented joint activities to reduce COVID-19's impact on Kenya's population, including establishing emergency operations centers and enhancing surveillance and training programs.
  • The pandemic prompted the Kenyan government to launch a national public health institute in January 2022 to strengthen public health efforts against current and future health threats.
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  • - The study utilized data from the 2018 Kenya Population-Based HIV Impact Assessment (KENPHIA) to estimate pediatric HIV prevalence and assess factors related to infection among children under 15 years in Kenya.
  • - Of the 9,072 participants, only 57 children tested positive for HIV, resulting in a prevalence rate of 0.7%, which translates to an estimated 138,900 HIV-positive children in the country.
  • - Findings indicated that being orphaned or having a caregiver unaware of their child's HIV status significantly increased the odds of infection, with many HIV-positive children lacking access to treatment and viral suppression.
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Nationally representative surveys provide an opportunity to assess trends in recent human immunodeficiency virus (HIV) infection based on assays for recent HIV infection. We assessed HIV incidence in Kenya in 2018 and trends in recent HIV infection among adolescents and adults in Kenya using nationally representative household surveys conducted in 2007, 2012, and 2018. To assess trends, we defined a recent HIV infection testing algorithm (RITA) that classified as recently infected (<12 months) those HIV-positive participants that were recent on the HIV-1 limiting antigen (LAg)-avidity assay without evidence of antiretroviral use.

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During 2020, the COVID-19 pandemic disrupted the delivery of HIV prevention and treatment services globally. To mitigate the negative consequences of the pandemic, service providers and communities adapted and accelerated an array of HIV interventions to meet the needs of people living with HIV and people at risk of acquiring HIV in diverse geographical and epidemiological settings. As a result of these adaptations, services such as HIV treatment showed programmatic resilience and remained relatively stable in 2020 and into the first half of 2021.

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Background: For assessing the HIV epidemic in Kenya, a series of independent HIV indicator household-based surveys of similar design can be used to investigate the trends in key indicators relevant to HIV prevention and control and to describe geographic and sociodemographic disparities, assess the impact of interventions, and develop strategies. We developed methods and tools to facilitate a robust analysis of trends across three national household-based surveys conducted in Kenya in 2007, 2012, and 2018.

Methods: We used data from the 2007 and 2012 Kenya AIDS Indicator surveys (KAIS 2007 and KAIS 2012) and the 2018 Kenya Population-based HIV Impact Assessment (KENPHIA 2018).

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  • Reviewed medical charts from two mortuaries in Kisumu County, Kenya, to determine the underlying causes of death (UCOD) for 456 decedents; found that HIV/AIDS was the leading cause.
  • The study revealed an all-cause mortality rate of 1,086 deaths per 100,000 population, with significant differences in mortality rates for noncommunicable diseases between genders.
  • There was a high rate of incorrect UCOD recorded, with only 29.2% agreement between the notified and ascertained causes, indicating a need for better documentation practices to improve mortality statistics.
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Background: Accurate data on HIV-related mortality are necessary to evaluate the impact of HIV interventions. In low- and middle-income countries (LMIC), mortality data obtained through civil registration are often of poor quality. Though not commonly conducted, mortuary surveillance is a potential complementary source of data on HIV-associated mortality.

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June 2021 marks the 40th anniversary of the first description of AIDS. On the 30th anniversary, we defined priorities as improving use of existing interventions, clarifying optimal use of HIV testing and antiretroviral therapy for prevention and treatment, continuing research, and ensuring sustainability of the response. Despite scientific and programmatic progress, the end of AIDS is not in sight.

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The UNAIDS 90-90-90 Fast-Track targets provide a framework for assessing coverage of HIV testing services (HTS) and awareness of HIV status - the "first 90." In Kenya, the bulk of HIV testing targets are aligned to the five highest HIV-burden counties. However, we do not know if most of the new HIV diagnoses are in these five highest-burden counties or elsewhere.

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Since 1979, multiple CDC Kenya programs have supported the development of diagnostic expertise and laboratory capacity in Kenya. In 2004, CDC's Global Disease Detection (GDD) program within the Division of Global Health Protection in Kenya (DGHP-Kenya) initiated close collaboration with Kenya Medical Research Institute (KEMRI) and developed a laboratory partnership called the Diagnostic and Laboratory Systems Program (DLSP). DLSP built onto previous efforts by malaria, human immunodeficiency virus (HIV) and tuberculosis (TB) programs and supported the expansion of the diagnostic expertise and capacity in KEMRI and the Ministry of Health.

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Background: Studies indicate that responses to HIV-2 treatment regimens are worse than responses to HIV-1 regimens during the first 12 months of treatment, but longer-term treatment responses are poorly described. We utilized data from Côte d'Ivoire's RETRO-CI laboratory to examine long-term responses to HIV-2 treatment.

Methods: Adult (≥15 years) patients with baseline CD4 counts < 500 cells/μl that initiated treatment at one of two HIV treatment centers in Abidjan, Côte d'Ivoire between 1998 and 2004 were included in this retrospective cohort study.

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Homa Bay, Siaya, and Kisumu counties in western Kenya have the highest estimated HIV prevalence (16.3-21.0%) in the country, and struggle to meet program targets for HIV testing services (HTS).

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Objective: To compare alternative methods of adjusting self-reported knowledge of HIV-positive status and antiretroviral (ARV) therapy use based on undetectable viral load (UVL) and ARV detection in blood.

Design: Post hoc analysis of nationally representative household survey to compare alternative biomarker-based adjustments to population HIV indicators.

Methods: We reclassified HIV-positive participants aged 15-64 years in the 2012 Kenya AIDS Indicator Survey (KAIS) who were unaware of their HIV-positive status by self-report as aware and on antiretroviral treatment if either ARVs were detected or viral load was undetectable (<550 copies/ml) on dried blood spots.

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Objective: HIV-associated mortality rates in Africa decreased by 10-20% annually in 2003-2011, after the introduction of antiretroviral therapy (ART). We sought to document HIV-associated mortality rates in the general population in Kenya after 2011 in an era of expanded access to ART.

Design: We obtained data on mortality rates and migration from a health and demographic surveillance system (HDSS) in Gem, western Kenya, and data for HDSS residents aged 15-64 years from home-based HIV counseling and testing (HBCT) rounds in 2011, 2012, 2013, and 2016.

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Background: Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya.

Methods: Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 to March 3, 2015.

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Article Synopsis
  • The Kenyan HIV treatment program has significantly improved survival rates among people living with HIV (PLHIV), while noncommunicable diseases (NCDs) have emerged as a major health concern over the past decade.
  • A study reviewed medical records from over 3,000 HIV-infected adults to assess the prevalence and incidence of four major NCDs: cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes.
  • Findings revealed that 11.5% of PLHIV had a documented NCD, with elevated blood pressure being the most common, yet only a small fraction had a diagnosis of hypertension in their records; men were found to have a higher incidence rate of NCDs compared to women.
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  • The study highlights the implementation of a pilot HIV-related mortuary surveillance system in two large mortuaries in Nairobi, Kenya, to assess HIV mortality rates, given the lack of comprehensive vital statistics in low to medium-income countries.
  • The system focused on determining HIV positivity and cause-specific mortality rates among cadavers aged 15 and over, revealing an overall HIV positivity rate of 19.5%, with a notable difference between genders (14.6% for men vs. 29.5% for women).
  • The evaluation followed CDC guidelines to assess the system’s performance attributes, including its simplicity, flexibility, and data quality, to identify strengths and weaknesses for future improvements.
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Background: HIV is a major driver of the tuberculosis epidemic in sub-Saharan Africa. The population-level impact of antiretroviral therapy (ART) scale-up on tuberculosis rates in this region has not been well studied. We conducted a descriptive analysis to examine evidence of population-level effect of ART on tuberculosis by comparing trends in estimated tuberculosis notification rates, by HIV status, for countries in sub-Saharan Africa.

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  • - Dadaab Refugee Camp in Kenya is home to approximately 340,000 refugees and faced a cholera outbreak starting in November 2015, when two residents showed symptoms of acute watery diarrhea linked to Vibrio cholerae.
  • - Following the initial cases, there was a swift escalation, with 45 more confirmed cases reported within a week, prompting a coordinated response from various health organizations, including the UN, Médecins Sans Frontières, and local health authorities.
  • - To mitigate future cholera risks, it's crucial to enhance water, sanitation, and hygiene facilities, as well as to improve disease surveillance systems in the camp and its surrounding areas.
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