Western Kenya has extremely high rates of morbidity and mortality attributable to infectious diseases. This makes research on the epidemiology and control of infectious diseases of high relevance to the population in Western Kenya and internationally relevant.
CDC’s work in Western Kenya started over 35 years ago in collaboration with the Kenya Medical Research Institute (KEMRI). Initial research focused on the epidemiology and control of malaria, and this has contributed to the development and evaluation of each of the pillars of malaria control to date (intermittent preventive treatment in pregnancy, insecticide-treated bed-nets, indoor residual spraying, and effective case management). Over time, other priority infectious diseases were added to the portfolio, including HIV, tuberculosis, respiratory infections and diarrheal diseases, neglected tropical diseases (NTDs), and (surveillance for) emerging infectious diseases. An extensive research infrastructure has been built in Western Kenya, including a health and demographic surveillance system covering a population of 240,000 people, two clinical research sites (in Kisumu and Siaya), high quality laboratory capacity and a cadre of experienced field and research staff.
In addition to research collaboration, extensive collaboration between CDC, KEMRI and other partners has developed in programme implementation of PEPFAR (Presidential Emergency Programme for AIDS Relief). While the priority of PEPFAR is service provision for the control of HIV/AIDS, this effort is relevant for the research programme as well for two main reasons. It is important to determine the impact of PEPFAR activities, and research helps to focus and improve PEPFAR activities. Two examples of the latter were: the demonstration in a multi-centre trial, in which CDC and KEMRI participated, of the strong protective effect of the early start of antiretroviral therapy in discordant couples on the risk of infection of the uninfected partner, leading to the Treatment as Prevention strategy which is now in place as the standard practice for discordant couples in Kenya; and the Kisumu Breastfeeding study to evaluate the safety, adherence and efficacy of zidovudine (AZT), lamivudine (3TC) and nevirapine (NVP) or nelfinavir (NFV) for PMTCT among breastfeeding HIV-infected women in resource limited settings, informing PMTCT guidelines.
The tuberculosis research portfolio includes clinical trials on diagnostics (including studies in the network of the NIH funded TB Research Unit) and drugs (network studies of the AIDS Clinical Trials Group and Tuberculosis Trials Consortium). Moreover, a population-based study is conducted to document the impact of improved TB case finding and TB prevention, the latter focusing primarily on the HIV infected population.