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Can mental health services break the cycle perpetuating HIV hotspots in Sub-Saharan Africa?


In 1920, the HIV virus crossed over from the animal kingdom and settled in the human world. Chimpanzees, residing in now what is known as the Democratic Republic of Congo, were being hunted by the humans for their meat. Unknown to the humans, the chimps carried with them the Simian Immunodeficiency Virus, which mutated to the HIV virus in humans.

In the 1980s, as Russia battled with the Chernobyl disaster, a global crisis emerged. The world at large was awoken to the existence of the HIV virus; the immune deficiency resulting from it was thus named AIDS. Years later, in spite of advancements in the medical field that include the development of a vaccine, the world is still at battle with the virus. In 2020, there were approximately 37.7 million people across the globe with HIV. Of these, 36 million were adults and 1.7 million were children aged 0-14 years. More than half were women and girls.

In the same year, closer home, the National Aids Control Council (NACC) reported 41,416 new HIV infections in Kenya. The top five HIV high-prevalence counties with a prevalence of more than 9% were Homa Bay, Kisumu, Siaya, Migori and Busia; the country’s overall prevalence is at 4.9%.

And in 2021, a team of Strathmore researchers from the Centre of Health Analytics and Modelling (CHAM) led by Prof. Samuel Mwalili from the Strathmore Institute of Mathematical Sciences (SIMS), is now studying the correlation between HIV hotspots in Nyanza and mental health. Matumaini, meaning hope, is funded by the National Institutes of Health, and was awarded in May this year. It is a collaboration with NYU School of Medicine (main recipient of grant), University of Cincinnati, StrongMinds, Kenya Ministry of Health, Zambia Ministry of Health and CIDZR, Zambia.


The five-year grant, worth Kshs. 50 M, will seek to identify, explain and predict hotspots using math fractals. As hotspots are unlikely to achieve HIV epidemic control through existing efforts, the study will identify if different types of hotspots require different HIV responses as well as creating new strategies for predicting and targeting HIV hotspots

“We want to find out in Nyanza, where the prevalence is higher than in other areas of the country, is the spread of HIV uniform or are there pockets? Do these pockets happen by chance? In particular, we want to understand why HIV incidence remains high in these areas despite the measures put in place,” says the adjunct professor in Mathematics and Statistics.

In relation to mental health, the researchers will investigate if optimal HIV response in hotspots includes treating depression. The link between mental health and HIV is crucial to the reducing number of incidences. A higher number of mental health cases increases HIV incidence due to an increase in risky behaviour such as multiple partners and alcohol abuse that leads to irresponsible sexual behaviour.

In turn, a HIV diagnosis, may topple over one’s sense of self-worth, carries with it stigma and a higher likelihood of suffering from mental health disorders, particularly depression. This disrupts HIV care and prevention as a HIV patient suffering from depression will be less likely to seek HIV treatment initiation and adhere to treatment. It is expected that the study will provide first HIV allocative efficiency analysis to include depression treatment. The solutions garnered from this study will not only be used in HIV treatment but in areas where mental health is prevalent.

The Matumaini grant will incorporate graduate student researchers through scholarships in both Masters and PhD level in Biomathematics, a field not yet fully embraced in the region. “Due to the experience we’ve had with the Covid-19 pandemic, more people now appreciate and understand more about disease dynamics and the importance of modelling, which will translate to a higher uptake in the programme numbers.”

As part of addressing the modelling needs in Kenya and Africa, Prof. Mwalili began CHAM, a new research centre nestled in SIMS. He has so far been involved in modelling the impact of misinformation on the Covid-19 vaccination drive through a grant funded by KEMRI Wellcome Trust.

“When I worked at CDC, I realized that much of the modelling was done by countries beyond Africa. I picked up a wealth of experience while I was at the Institute for Disease Modelling in Seattle, and Imperial College in London. I’m here to grow the Centre from ground zero into the next big thing.”


This article was written by Wambui Gachari. 


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