From shiny shoes to muddy reality: understanding how meso-state actors negotiate the implementation gap in participatory forest management

Recent research on participatory forest management (PFM) in the global south has highlighted the existence of a widespread “implementation gap” between the ambitious intent enshrined in legislation and the often partial, disappointing rollout of devolved forest governance on the ground. Here, through an ethnographic case study of forest officers (FOs) in Kenya, we draw on a framework of critical institutionalism to examine how key meso-level actors, or “interface bureaucrats,” negotiate and challenge this implementation gap in everyday forest governance. We go beyond consideration of institutional bricolage in isolation or as an aggregate category, to analyze how bricolage as aggregation, alteration, and/or articulation is variously driven, shaped, and constrained by FOs’ multiple accountabilities and agency. Our analysis highlights the locally specific, contingent, and mutually reinforcing nature of accountability, agency and bricolage, and their explanatory power in relation to the performance and nature of “actually existing” PFM

BREATHER Plus clinical trial design: A randomised non-inferiority trial evaluating the efficacy, safety and acceptability of short cycle (five days on, two days off) dolutegravir/tenofovir-based triple antiretroviral therapy (ART) compared to daily ART in virologically suppressed adolescents living with HIV aged 12 to <20 years in sub-Saharan Africa

Background: Novel strategies to improve ART adherence, retention in care and quality of life among adolescents living with HIV (ALHIV) are needed. Short-Cycle Therapy (SCT) with 4/5 sequential days on ART, 2/3 days off ART per week has shown non-inferior virological outcomes and high acceptability, but most data are in adults and are very limited for dolutegravir (DTG)-based SCT. Methods: BREATHER Plus is an ongoing 96-week non-inferiority randomised trial evaluating efficacy, safety and acceptability of SCT (5 sequential days on, 2 days off at the weekend) with DTG/tenofovir (TNV)-based triple ART versus continuous (daily) therapy (CT) in ALHIV. Participants are aged 12 to <20 years in Kenya/South Africa/Uganda/Zimbabwe, virologically suppressed (Viral Load (VL) <50copies/mL) for ≥12 months at enrollment, with no prior treatment failure. Randomisation is 1:1 to SCT versus CT. VL monitoring for clinical management is 6–12 monthly aligning with standard-of-care. The primary outcome is confirmed virological rebound ≥50 copies/mL by 96 weeks. The trial employs the Smooth Away From Expected (SAFE) non-inferiority frontier, where the non-inferiority margin depends on the observed event risk in the CT arm. Secondary outcomes include HIV resistance, toxicities, patient-reported outcomes and cost-effectiveness. Enrolment of 470 participants completed in June 2023. Discussion: BREATHER Plus is the first randomised trial specifically evaluating DTG/TNV-triple based SCT. Rapid roll-out of DTG and a pragmatic approach to VL monitoring mean results will be generalisable to ALHIV across sub-Saharan Africa. If SCT provides non-inferior virological suppression to CT, it may offer choice for ALHIV on how they take their ART

Toxic cyanobacteria and their toxins in standing waters of Kenya: implications for water resource use

Phytoplankton biodiversity studies in Kenya's standing waters were carried out between 2001 and 2003. Toxin producing cyanobacteria were recorded in twelve water bodies. Microcystis and Anabaena were the most common species in freshwaters while Anabaena and Anabaenopsis were common in alkaline saline lakes. Seven lakes with cyanobacteria blooms and a hot spring had detectable levels of microcystins and anatoxin-a. Cell bound microcystins (LR equivalents) concentration ranged from 1.6–19800 μg g−1 Dry Weight (DW) while anatoxin-a varied from below the limit of detection to 1260 μg g−1 DW. In alkaline-saline lakes, microcystins and anatoxin-a were also present in stomach contents and liver samples of dead flamingos. Monoculture strains of A. fusiformis from Lakes Sonachi and Bogoria had detectable levels of microcystins while anatoxin-a was present in strains isolated from Lakes Sonachi, Bogoria and Nakuru. Two freshwater sites, Nyanza Gulf (L. Victoria) and Lake Baringo recorded cyanotoxin concentration exceeding WHO's upper limit of 1.0 μg l−1 for drinking water. The results confirm that cyanotoxins could have played a role in the mortality of flamingos in Lakes Bogoria and Nakuru. The implications of these findings on water resource use, measures to be taken to reduce the risk of exposure and eutrophication control steps to reduce cyanobacteria bloom formation are considered in this paper.</jats:p