Objectives To determine the factors associated with poor outcomes among people living with HIV (PLHIV) started on anti- retroviral therapy before and after implementation of “Test and treat” program in 18 facilities in Coastal Kenya. Methods A retrospective cohort study design was used to study PLHIV aged > 15 years and started on ART in the periods of April to August 2016, and April to August 2017, then followed up for 24 months. Primary outcome was retention defined as being alive and on ARVs after 24 months. Death and loss to follow-up were considered as poor outcomes. Kaplan–Meier survival methods were used to describe time to primary outcome. Cox proportional regression analysis was used to determine factors associated with poor outcomes. Results 86 patients (470 before test and treat, and 316 after test and treat cohorts) were enrolled. Overall, the median [IQR] age was 39.3 [32.5–47.5] years and 539 (69%) were female. After 24 months, retention rates for the before (68%) and after (64%) test and start groups were similar (absolute difference: -4.0%, 95%CI: -11-3.1, P = 0.27). There were 240(31%, 95%CI 27 to 34%) PLHIV with poor outcomes, 102 (32%) and 138 (29%) occurred among the test and treat group, and delayed treatment patients respectively. In multivariable regression model, test and treat had no significant effect on risk of poor outcomes (aHR = 1.17, 95%CI 0.89–1.54). Increasing age (aHR = 0.98, 95%CI 0.97–0.99), formal employment (aHR = 0.42, 95%CI 0.23–0.76) and not being employed (aHR = 0.53, 95%CI 0.34–0.81) were negatively associated with poor outcomes. The risk of poor outcomes was higher among males compared to female patients (aHR = 1.37, 95%CI 1.03–1.82) and among divorced/separated patients compared to the married (aHR = 1.44, 95%CI 1.04–1.99). Conclusion Retention patterns for the “test and treat” cohort were comparable to those who started ART before “test and treat”. Patients who are males, young, divorced/separated, with poor socio-economic status had higher risks for poor clinical outcomes. Interventions targeting PLHIV who are young, male and economically disadvantaged provide an opportunity to improve the long-term outcomes.

Couples’ HIV Counseling and Testing (CHCT) is an essential component of an effective response to AIDS pandemic worldwide and serves as an entry point to HIV care and support. However, it has become increasingly apparent that couples have overlooked the services yet they are too at risk of HIV infection. This study sought to determine level of acceptance of CHCT among pregnant women attending antenatal care services in Likoni sub-County, Mombasa County, Kenya. A descriptive cross-sectional study design was used with structured questionnaires and an observation checklist to collect data from couples while an interview schedule was used to solicit data from health care workers. Results showed uptake of CHCT in the study area was relatively low (33.5%). Statistically significant associations were found between CHCT and demographic factors such as education (χ2 = 29.54; p = 0.005), marital status (χ2 = 12.41; p = 0.010), occupation (χ2 = 18.18; p < 0.001), income (χ2 = 23.02; p < 0.001). In operation factors, statistically significant associations were found between CHCT and distance to health facility (χ2 = 8.31; p = 0.040), means of transport (χ2 = 10.28, p = 0.040), cost of transport (χ2 = 10.92; p = 0.010), appropriateness and convenience of time allocated (χ2 = 11.88, p <, 0.001), an individual’s working hours per day (χ2 = 14.46; p < 0.001), and education/information on CHCT (χ2 = 5.97; p = 0.020). In HIV related knowledge, attitude and practice of couples on HIV risk behavior, significant associations were found between CHCT and prevention of discordant partners from contracting HIV (χ2 = 53.71; p < 0.001), helping couples adhere to ART (χ2 = 43.34; p  < 0.001), helping to reduce morbidity and mortality due to HIV and other opportunistic infections (χ2 = 48.66; p < 0.001), increasing trust among partners (χ2 = 45.16; p < 0.001), and increasing marital cohesion among partners (χ2 = 65.78; p < 0.001). Logistic regression revealed that determinants of CHCT were significant for married status (p < 0.001), unemployed (p = 0.020), that CHCT increases trust among partners (p = 0.020), and that CHCT increases marital cohesion among partners (p = 0.001). Based on these findings, there is need to improve awareness on CHCT to enhance positive attitudes towards couples testing.

Physico-chemical properties and micobial contamination of three local brews (Mnazi, Mchuchula and M'bangara) consumed in Mombasa County were assessed. The bacteria concentration enumeration was determined by incubation of each sample for two days at 35°C to 37°C on plates containing colony forming units (CFUs) on Aerobic plate count (APC) agar and Lactic acid bacteria (LAB) on Rogosa agar plates. Growth on plates were positive for heterotrophic and LAB bacteria Mwakio et al.; MRJI, 20(4): 1-9, 2017; Article no.MRJI.28061 2 with high levels recorded in 10 -2 aliquots of each sample. M'bagara recorded higher levels of LAB (201.0±24.79), with Mnazi and Mchuchula having slightly low levels of LAB of 182.0±26.96 and 129.0±5.20 respectively despite some of the plates not being used for enumeration since they had above 250 CFUs. Yeast detection and enumeration was also determined. Low numbers of yeast cells were recorded in M'bangara (30.0±5.72), with Mchuchula recording the highest number of yeast cells (66.30±3.07). Physico-chemical properties determined included colour, acidity, pH and alcohol in terms of volume i.e Alcohol by Volume (ABV). M'bangara recorded the highest titratable acidity (0.9±0.04), and lowest pH (2.7±0.07) whereas the highest ABV levels were recorded in M'bangara (4.6±0.12). Confirmatory results for total coliforms, feacal coliforms and E. coli indicate the absence of contamination from sewage material. There were significant variation (p>0.05) in terms of physico-chemical properties and microbial contamination in the three analyzed local brews. In this study, local brews consumed in Mombasa County contain non-miocrobial and microbial contaminants which may be related to effects of consumption of these brews. Original Research Article

Motorcycle accidents remain one of the main global concerns despite extensive research and interventions. The African region has the highest road fatality rates globally, in spite of being the least motorized region. Kenya has an estimated road fatality rate of 20.9 per 100,000 people, higher than that of the European region. There has been an increased use of motorcycles in Kenya over the last decade, so has the number of deaths from motorcycle injury. This study was aimed to establish the determinants of accident occurrence among commercial motorcycle riders in Kaloleni sub-County, Kilifi County, Kenya. A self- administered structured questionnaire was used to collect data from 279 commercial motorcycle riders. Factors associated with accident occurrence were analysed using both bivariate and multivariate analysis. Results showed that 29.2% of the respondents had been involved in a road traffic accident in the past 12 months by the time of the study. Factors that were independently associated with motorcycle accidents included riding experience of more than 8 years (p = 0.040), alcohol use (p = 0.040), slippery roads (p = 0.020) and pot holes on roads (p = <0.001). Moreover, participants acquired their riding skills from friends (64.9%) or self-trained (33.6%). It can be concluded that motorcycle accidents is still a major public health problem in the study area due to the recorded high rate. Thus, it is recommended that all motorcyclists should be well trained and issued with riding license after attending formal training, and strict penalties imposed against anybody contravening road traffic rules. Moreover, roads should be continuously improved to reduce accident rates.