Browsing by Author "Nzivo, Mirriam M."

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    HIV Virologic Failure among Patients with Persistent Low-Level Viremia in Nairobi, Kenya: It Is Time to Review the >1000 Virologic Failure Threshold
    (Hindawi, 2023-04-27) Nzivo, Mirriam M.; Waruhiu, Cecilia N.; Kang’ethe, James M.; Budambula, Nancy L. M.
    Persistent low-level viremia (PLLV) of 200-999 copies/ml has been reported as a risk factor for HIV virologic failure (VF). This retrospective study was aimed at characterizing patients with PLLV, determining factors associated with VF, and determining the effect of regimen change. Data were extracted from electronic medical records for HIV care and treatment. Patients’ characteristics (N = 705) were as follows: a mean age of 42 years, majority female (55%), and 51% married. A majority (78.7%) had a history of opportunistic infections in their ART lifetime. To determine factors associated with VF, 187 records on patients who maintained PLLV and 12 on deceased patients at the time of data review were eliminated from the analysis, leaving 506 patient records. Out of the 506, 89% (451/506) suppressed VL to nondetectable levels while 11% (55/506) had VF, and the difference was significant (P = 0:0001). Virologic failure was significantly associated with ages 10-30 years (P < 0:05). Baseline VL ≥ 1000 (OR 3.929; P = 0:002) and 200-999 copies/ml (OR 4.062; P = 0:004) were associated with VF. During PLLV, factors associated with VF included the following: PLLV of 200-999 copies/ml (P < 0:05), viral blips (OR 4.545; P = 0:0001), mean maximum VL (P < 0:05), and age (P = 0:043). Married marital status was inversely associated with VF (OR 0.318; P = 0:026). Regimen change was not significantly associated with virologic outcomes. However, patients who switched regimens to the second line had a high risk of VF (P = 0:028; OR 3.203). Regimen change was significantly high (P < 0:05) among adolescents and patients with a start regimen of 2NRTI+1NNRTI. Most of the PLLV patients (89%) achieved nondetectable VL after their continued ART monitoring for at least 12 months. Therefore, PLLV was not an indicator of VF. However, a consistent VL of ≥200-999 copies/ml at baseline and more than 12 months of ART care and treatment were significantly associated with VF. Patients with VL 200-999 copies/ml, adolescents, and young adults require intensive ART monitoring and support.
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    Mutations and Epidemiology of SARS-CoV-2 Compared to Selected Corona Viruses during the First Six Months of the COVID-19 Pandemic: A Review
    (2021-06) Nzivo, Mirriam M.; Budambula, Nancy
    Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus (CoV) disease 2019 (COVID-19). This study compared the genome, mutations, and infectivity/ transmissibility of SARS-CoV-2 with selected betacoronaviruses (beta-CoVs). This study further examined the origin, risk factors, and outbreaks caused by beta-CoVs. We searched the following databases for relevant studies: PubMed, Google Scholar, and the World Health Organization COVID-19 database. A close relationship between SARS-CoV-2 and SARS bat-like CoV RaTG13 (98.9%) was found at the amino acid level, followed by pangolin CoVs. Non-synonymous mutations occur at high frequencies in the open reading frame (ORF) 1ab, spike (S) protein, and nucleocapsid. Mutations P323L and D614G in the RNA-dependent RNA polymerase (RdRp) and S protein, respectively, occur at a high frequency globally. Mutations at position 3037 in the nonstructural protein (Nsp) 3, 14408 (RdRp), and 23403 (S) confer transmissibility to SARS-CoV-2. SARS-CoV-2 has higher infectivity and transmissibility than SARS-CoV, which shares the same receptor. Although bats are confirmed reservoirs, intermediate hosts are currently unknown. Smoking, old age, diabetes, cardiovascular diseases, and hypertension have all been associated with COVID-19. Within six months of its outbreak, COVID-19 was reported in all countries worldwide, whereas SARS was reported in 28 countries and Middle East respiratory syndrome (MERS) in 5 countries. However, the fatality rate of MERS (65%) was higher than that of COVID-19 (4.9%) and SARS (6.6%). Identifying the SARS-CoV-2 intermediate hosts will help prevent future outbreaks. Attention should be given to the pangolin CoVs. Variations in the S gene may confer transmissibility and infectivity.
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    Performance appraisal training of employees: A strategy to enhance employees’ performance in public teacher training colleges in Kenya
    (Academic Journals, 2021-06) Miriti, Justine M.; Kirima, Lucy K.; Nzivo, Mirriam M.; Thuranira, Simon; Budambula, Nancy
    Human Resource (HR) practices like performance appraisal (PA) training are meant to ensure that employees are equipped with the knowledge and skills needed for the attainment of organisational goals. However, gaps still exist on the relationship between PA employees’ training and employees’ performance. This study aimed to establish the relationship between PA training and employees’ performance in Public Teacher Training Colleges (PTTCs) in Kenya. A cross-sectional survey study was conducted among 282 employees comprising 185 appraisee’s and 97 appraisers in all the 27 PTTCs. Proportionate stratified sampling technique was used and a self-administered semi-structured questionnaire was used to collect sociodemographic data and PA practices. Linear regression analysis indicated that PA training contribution to employee’s performance was not significant (R2 = 0.001). Appraisee’s preferred quarterly appraisal trainings and appraisers preferred those conducted twice a year (P=0.0054; P=0.0025), respectively. Personal request (P=0.0086) was the basic selection criterion considered for appraisers to attend PA training whereas for appraisee’s, the management considered individual performance (P=0.0011). The PA training among appraisers focused on corruption prevention and service delivery (P=0.0031; P=0.0232 respectively) whereas for appraisee’s, it focused on conflict resolutions (P=0.0299). Additional courses besides PA training were intended to enhance employees’ personal development (P=0.0002). Appraisers opined that the relevance of PA training on employees’ personal development was not relevant at all (P=0.013) and ineffective (P=0.0055). Results suggest well-designed PA programs that guarantee employees’ personal development and career progression enhances their commitment and may positively affect their performance.