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DTBE in Kenya

map of Kenya

Capital City: Nairobi
Area*:582,646 sq. km. (224, 960 sq. mi.)
Population (est.), 2010*: 39 million
Estimated TB Incidence, 2010**: 298/100,000
Estimated TB Prevalence, 2010**: 283/100,000
Adult HIV Prevalence Rate, 2009***: 6.3%
Number of people living with HIV (PLHIV), 2009***: 1.5 million
Percent of tested TB patients who were HIV+, 2010**: 41%

*Source: www.state.gov
**Source: WHO Global TB Control Report 2011
***Source: UNAIDS, Report on the Global AIDS Epidemic, 2010

Background

Kenya has one of the highest HIV prevalence rates in East Africa and is among the world’s 22 high burden tuberculosis (TB) countries.  The Centers for Disease Control and Prevention (CDC) has had a significant presence in Kenya since 2000, with a particularly strong partnership with the Kenya Medical Research Institute (KEMRI).  CDC’s Division of Tuberculosis Elimination (DTBE) has been working closely with KEMRI to conduct programmatically relevant research on TB and TB/HIV over the past several years.  Kisumu, Kenya recently became a research site for the CDC/DTBE TB Trials Consortium (TBTC).

Recent Accomplishments & Ongoing Collaborations

Program Strengthening and Epidemiology

IEIP Surveillance System:  In 2010, CDC/DTBE completed an evaluation of the International Emerging Infections Program (IEIP) surveillance system established in Kenya in mid-2004 for enhanced infectious disease surveillance, detection, and training.  The assessment found that the current system relies on passive case finding – which means patients are not being explicitly worked-up for TB when they present for care at the facilities included in the system and TB is not systematically identified and included in the system.  This structure probably misses many TB cases.  However, the system does provide a platform for building up active case-finding for TB – which means, in part, systematically screening for TB cases based on presence of certain symptoms.  CDC/DTBE has provided specific recommendations for integrating TB case finding into the IEIP system. 

Multidrug-Resistant TB (MDR TB), TB/HIV, and Other At-Risk Populations

Improving Diagnosis of Tuberculosis in Persons Living with HIV (PLHIV):  In 2011, CDC/DTBE and the Division of Global HIV/AIDS conducted a study of intensified TB case finding in adults with HIV.  This study also assessed the use of new diagnostics, including Cepheid’s GeneXpert.  The project is based on results from a CDC/DTBE and U.S. Agency for International Development South East Asia study, which identified a highly sensitive approach to TB screening.  The study in Kenya evaluated both that algorithm and the algorithm proposed by the Kenya Ministry of Health.  Results from this study will inform the Ministry’s ultimate decision about which approach is best in Kenya.  Liquid culture was done for all patients to enhance TB diagnosis and to serve as the gold standard for calculation of sensitivity and specificity of the symptom screen and new diagnostics.

TB Risk Assessment of Staff in Hospitals: CDC/DTBE is conducting an assessment of the risk of TB among hospital staff In Kisumu to determine the magnitude of risk in these outpatient settings.  It will serve as a baseline for future infection control interventions and guide infection control implementation in outpatient settings and rational scale-up of infection control interventions.

TB Vaccine Trials:  CDC/DTBE will take part in overseeing the Phase II, double-blind, randomized, placebo-controlled study to evaluate the safety and efficacy of AERAS-402, a newly developed TB vaccine candidate, in BCG-vaccinated, HIV-uninfected infants without evidence of TB.  The study is being conducted in several sites including Uganda, South Africa, and Kenya.

 
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