research & publications

HIV RESEARCH

Results by County (Approx)
  • 641 results found
  • I never thought that it would happen …” Experiences of HIV seroconverters among HIV discordant partnerships in a prospective HIV prevention study in Kenya

    Background


    In spite of access to behavioral and biomedical HIV prevention strategies, HIV transmission occurs. For HIV serodiscordant couples, prevention programs can be tailored to address individual and couples’ needs to preserve their relationship while minimizing HIV risk. Programs for serodiscordant couples may benefit from learning from experiences of couples who transmit HIV. 


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  • Uptake and Acceptability of Oral HIV Self-Testing among Community Pharmacy Clients in Kenya: A Feasibility Study

    Background


    While HIV testing and counselling is a key entry point for treatment as prevention, over half of HIV-infected adults in Kenya are unaware they are infected. Offering HIV self-testing (HST) at community pharmacies may enhance detection of undiagnosed infections. We assessed the feasibility of pharmacy-based HST in Coastal Kenya.


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  • Finding Hidden HIV Clusters to Support Geographic-Oriented HIV Interventions in Kenya

    Background


    In a spatially well known and dispersed HIV epidemic, identifying geographic clusters with significantly higher HIV prevalence is important for focusing interventions for people living with HIV (PLHIV).



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  • Pregnancy and HIV transmission among HIV‐discordant couples in a clinical trial in Kisumu, Kenya

    BACKGROUND  

      

    A large proportion of new HIV infections in sub‐Saharan Africa occur in stable HIV‐discordant partnerships. In some couples, the strong desire to conceive a child may lead to risky behaviour despite knowledge of discordant serostatus. The objective was to compare HIV transmission between discordant couples who did and did not conceive during participation in a clinical trial


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  • Comparison of trends in tuberculosis incidence among adults living with HIV and adults without HIV--Kenya, 1998-2012

    BACKGROUND


    In Kenya, the comparative incidences of tuberculosis among persons with and without HIV have not been described, and the differential impact of public health interventions on tuberculosis incidence in the two groups is unknown.


    This study compares tuberculosis incidence among persons with and without HIV to uncover distinct trends in the epidemiology of tuberculosis in these two populations.


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  • Integrating family planning into HIV care in western Kenya: HIV care providers’ perspectives and experiences one year following integration

    Background


    With high rates of unintended pregnancy in sub-Saharan Africa, integration of family planning (FP) into HIV care is being explored as a strategy to reduce unmet need for contraception. Perspectives and experiences of healthcare providers are critical in order to create sustainable models of integrated care. This qualitative study offers insight into how HIV care providers view and experience the benefits and challenges of providing integrated FP/HIV services in Nyanza Province, Kenya. 


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  • “They make money off of us”: a phenomenological analysis of consumer perceptions of corruption in Kenya’s HIV response system

    Background 


    Problems with misallocation and redirection of critical resources and benefits intended for PLHIV are not uncommon in Kenya. This study explores corruption in Kenya’s HIV response system and the implications for health outcomes from the perspective of people living with HIV (PLHIV)


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  • Understanding HIV risks among adolescent girls and young women in informal settlements of Nairobi, Kenya: Lessons for DREAMS

    Background


    High incidence of HIV infection among adolescent girls and young women (AGYW) has been attributed to the numerous and often layered vulnerabilities that they encounter including violence against women, unfavourable power relations that are worsened by age-disparate sexual relations, and limited access to sexual and reproductive health information and services. For AGYW living in urban informal settlements (slums), these vulnerabilities are compounded by pervasive poverty, fragmented social networks, and limited access to social services including health and education. In this paper, we assess sexual risk behaviours and their correlates among AGYW in two slum settlements in Nairobi, Kenya, prior to the implementation of interventions under the Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) Partnership.


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  • Autopsy study of HIV-1-positive and HIV-1-negative adult medical patients in Nairobi, Kenya.

    HIV infection has now been consistently identified as the major cause of death in young Africans in both urban and rural areas. In Africa, several studies have defined the clinical presentation of HIV disease but there have only been a limited number of autopsy studies. Because of the scarcity of autopsy data and the possibility of differing type and frequency of opportunistic infections between different geographic locations we set out to study consecutive new adult medical admissions to a tertiary referral hospital in Nairobi and perform autopsies on a sample of HIV-1-positive and HIV-1-negative patients who died in the hospital ward. 


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  • Prevalence and factors associated with metabolic syndrome in an urban population of adults living with HIV in Nairobi, Kenya

    Metabolic syndrome affects 20-25% of the adult population globally. It predisposes to cardiovascular disease and Type 2 diabetes. Studies in other countries suggest a high prevalence of metabolic syndrome among HIV-infected patients but no studies have been reported in Kenya. The objective of this study was to assess the prevalence and factors associated with metabolic syndrome in adult HIV-infected patients in an urban population in Nairobi, Kenya.


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  • HIV-1 Superinfection Occurs Less Frequently Than Initial Infection in a Cohort of High-Risk Kenyan Women

    Background


    HIV superinfection (reinfection) has been reported in several settings, but no study has been designed and powered to rigorously compare its incidence to that of initial infection. Determining whether HIV infection reduces the risk of superinfection is critical to understanding whether an immune response to natural HIV infection is protective. This study compares the incidence of initial infection and superinfection in a prospective seroincident cohort of high-risk women in Mombasa, Kenya. 


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  • EFFECTS OF HIV/AIDS ON MATERNITY CARE PROVIDERS IN KENYA

    Background

    The most recent population-based survey data indicated that 6.7% of Kenyan adults were infected with HIV in 2003, and more recent estimates based on antenatal sentinel surveillance data suggest a decline to 5.1% nationally in 2006. Rates are higher in Nyanza Province, with 15.1% prevalence in adults (18.3% of women and 11.6% of men) (National AIDS and STI Control Programme of the Ministry of Health, 2005), and antenatal surveillance estimates in districts of Nyanza Province range from 2.8% to 21.0% (National AIDS Control Council & National AIDS and STD Control Programme, June 2007). HIV prevalence has ranged from 26−35% among antenatal care (ANC) patients at the provincial hospital in Kisumu in recent years (Van't Hoog et al., 2005).


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  • Preferences for daily or intermittent pre-exposure prophylaxis regimensand ability to anticipate sex among HIV uninfected members of Kenyan HIVserodiscordant couples

    Background

    Pre-exposure prophylaxis (PrEP) is a promising new strategy for the prevention of HIVinfection. Clinical trials have demonstrated that oral tenofovir (TDF) and combination emtricitabine/tenofovir (FTC/TDF), when taken daily, are effective for HIV prevention in several populations, includingheterosexual men and women, men who have sex with men (MSM)[3], and injection drug users . However, the effectiveness of PrEP depends strongly on participant adherence. In two clinical trials that did not demonstrate PrEP efficacy , low adherence is the leading hypothesis to explain the lack of HIV protection.


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  • Antiretroviral therapy, labor productivity, and gender: a longitudinal cohort study of tea pluckers in Kenya

    Background


    While the biomedical effectiveness of antiretroviral therapy (ART) for HIV/AIDS is well established , far less is known about the “social effectiveness” of ART for adults in sub-Saharan Africa. Social effectiveness can be defined as a patient’s contribution to household welfare after initiating ART, as compared to what their contribution would have been in the absence of HIV infection. One primary way that working-aged adults contribute to household welfare is by generating income in either the formal or informal sector. Because HIV/AIDS typically affects adults in their prime working ages , if treatment is to be truly socially effective, it must not only keep patients alive, but also allow them to work productively and engage in other normal daily activities.


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  • Brief Report: Sexual Violence Against HIV-Positive Women in the Nyanza Region of Kenya: Is Condom Negotiation an Instigator?

    Background

    The association between intimate partner violence (IPV) and HIV infection among women is well established and thought to be bidirectional. Although prospective data show that IPV is a risk factor for subsequent HIV infection among women, the evidence for how HIV infection triggers subsequent IPV is emerging only now. Respondents in qualitative studies of HIV+ women living in South Africa and Swaziland state that diagnosis and disclosure of HIV to an intimate partner is itself a trigger for IPV.


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  • Developing a Family-Based HIV Prevention Intervention in Rural Kenya: Challenges in Conducting Community-Based Participatory Research

    Background

    Community-based participatory research (CBPR) introduces new ethical challenges for HIV prevention studies in low-resource international settings. We describe a CBPR study in rural Kenya to develop and pilot a family-based HIV prevention and mental health promotion intervention. Academic partners (APs) worked with a community advisory committee (CAC) during formative research, intervention development, and a pilot trial. Ethical challenges emerged related to: negotiating power imbalances between APs and the CAC; CAC members’ shifting roles as part of the CAC and wider community; and anticipated challenges in decision making about sustainability. Factors contributing to ethical dilemmas included low access to education, scarcity of financial resources, and the shortage of HIV-related services despite high prevalence


  • The incidence of first-line antiretroviral treatment changes and related factors among HIV-infected sex workers in Nairobi, Kenya

    Background

    The pressing need to scale-up combined antiretroviral therapy (cART) in resource-poor settings has resulted in a growing number of patients receiving simple standardised doses of the first-line regimens . A majority of the 24.0 to 28.7 million people infected with human immunodeficiency virus (HIV) live in the resource-poor setting of sub-Saharan Africa . Kenya has the fourth-largest HIV epidemic in the world with over 1.6 million HIV-infected people. Out of 880 000 adults eligible for cART, 656 359 Kenyans are on cART . In spite of the current deficit in treatment with cART, several factors remain a hindrance to the improvement of long-term availability of HIV treatment in Kenya.


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  • Knowledge of HIV Transmission and Associated Factors among HIV-Positive and HIV-Negative Patients in Rural Kenya

    Background

    Knowledge of HIV transmission is a prerequisite to practicing safer behaviors to prevent HIV infections and may be expected to vary by region because of cultural and socioeconomic determinants. A cross-sectional study was conducted in rural Kenya using a standardized questionnaire assessing HIV transmission knowledge, socio-demographic and other characteristics.

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  • A qualitative study of secondary distribution of HIV self-test kits by female sex workers in Kenya

    Background


    Promoting awareness of serostatus and frequent HIV testing is especially important among high risk populations such as female sex workers (FSW) and their sexual partners. HIV self-testing is an approach that is gaining ground in sub-Saharan Africa as a strategy to increase knowledge of HIV status and promote safer sexual decisions. However, little is known about self-test distribution strategies that are optimal for increasing testing access among hard-to-reach and high risk individuals. We conducted a qualitative study with 18 FSW who participated in a larger study that provided them with five oral fluid-based self-tests, training on how to use the tests, and encouragement to offer the self-tests to their sexual partners using their discretion. 

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  • How intersectional constructions of sexuality, culture, and masculinity shape identities and sexual decision-making among men who have sex with men in coastal Kenya

    Background


    Men who have sex with men are increasingly recognised as one of the most vulnerable HIV risk groups in Kenya. Se between men is highly stigmatised in Kenya, and efforts to provide sexual health services to men who have sex with men require a deeper understanding of their lived experiences; this includes how suchmen in Kenya construct their sexual identities, and how these constructions affect sexual decision-making. Adult self-identified men who have sex with men (n=26) in Malindi, Kenya participated in individual interviews to examine sociocultural processes influencing sexual identity construction and decision-making. Four key themes were identified: (i) tensions between perceptions of ‘homosexuality’ versus being ‘African’; (ii) gender-stereotyped beliefs about sexual positioning; (iii) socioeconomic status and limitations to personal agency; (iv) objectification and commodification of non-normative sexualities. Findings from this analysis emphasise the need to conceive of same-sex sexuality and HIV risk as context-dependent social phenomena. Multiple sociocultural axes were found to converge and shape sexual identity and sexual decision-making among this population. These axes and their interactive effects should be considered in the design of future interventions and other public health programmes for men who have sex with men in this region.


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  • Subtypes of Human Immunodeficiency Virus Type 1 and Disease Stage among Women in Nairobi, Kenya

    Background

    In sub-Saharan Africa, where the effects of human immunodeficiency virus type 1 (HIV-1) have been most devastating, there are multiple subtypes of this virus. The distribution of different subtypes within African populations is generally not linked to particular risk behaviors. Thus, Africa is an ideal setting in which to examine the diversity and mixing of viruses from different subtypes on a population basis. In this setting, it is also possible to address whether infection with a particular subtype is associated with differences in disease stage. To address these questions, we analyzed the HIV-1 subtype, plasma viral loads, and CD4 lymphocyte levels in 320 women from Nairobi, Kenya. Subtype was determined by a combination of heteroduplex mobility assays and sequence analyses of envelope genes, using geographically diverse subtype reference sequences as well as envelope sequences of known subtype from Kenya. 


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  • Perceptions of HIV infected patients on the use of cell phone as a tool to support their antiretroviral adherence; a cross-sectional study in a large referral hospital in Kenya

    Background

    The World Health Organization (WHO) intensified their advocacy on the provision of antiretroviral therapy (ART) to reduce Acquired Immuno Deficiency Syndrome (AIDS)-related deaths and alleviate fears about HIV in the year 2003. In embracing this advocacy, Kenya expanded its ART coverage tremendously with percentage of adults receiving ART increasing from 55.3% in the year 2008 to 70.4% in the year 2009 . This consequently intensified the need for more ART programmes in Kenya for successful control and prevention of HIV-related mortality which is affecting the country’s economy by a large margin. In response to this need, the Kenyan government released free ART drugs with the aim of lowering the HIV-related mortality rates. However several studies have shown that drug adherence has remained a challenge even after the provision of free medication .


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  • Performance of Clinical Algorithms for HIV-1 Diagnosis and Antiretroviral Initiation among HIV-1-Exposed Children Aged Less Than 18 Months in Kenya

    Background

    Ninety percent of HIV-1-infected children live in sub-Saharan Africa. In the absence of diagnosis and antiretroviral therapy (ART), approximately 50% die before 2 years.


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  • Effectiveness of a community-based positive prevention intervention for people living with HIV who are not receiving antiretroviral treatment: a prospective cohort study

    Background:

    We report effectiveness of an HIV-prevention intervention delivered by community health workers (CHWs) in Mombasa, Kenya, to PLHIV who have not initiated or who have discontinued ART—an often difficult-to-reach population because they fall outside the ambit of health care and prevention services.


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  • A nested case-control study of sexual practices and risk factors for prevalent HIV-1 infection among young men in Kisumu, Kenya

    Background


    By the end of 2005, The Joint United Program on HIV/AIDS estimated that approximately 38.6 million people (33.4-46.0) were living with HIV and over 60% of them resided in sub-Saharan Africa.1 While evidence suggests HIV incidence is declining in some parts of sub-Saharan Africa1, , it is estimated that 2.7 million people became infected with HIV in 2005, reaffirming the need to refine and implement improved prevention strategies. Thus, to evaluate risk factors for prevalent HIV-1 infection, we analyzed cross-sectional data from a nested sample of 1337 uncircumcised men aged 18-24 years participating in the context of a randomized controlled trial (RCT) of male circumcision (MC) to reduce HIV-1 incidence in Kisumu, Kenya.


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  • HIV Type 1 in a Rural Coastal Town in Kenya Shows Multiple Introductions with Many Subtypes and Much Recombination

    Background

    The extent of HIV-1 diversity was examined among patients attending a rural district hospital in a coastal area of Kenya. The pol gene was sequenced in samples from 153 patients. Subtypes were designated using the REGA, SCUEAL, and jpHMM programs. The most common subtype was A1, followed by C and D; A2 and G were also detected. However, a large proportion of the samples was found to be recombinants, which clustered within the pure subtype branches. Phylogeographic analysis of Kilifi sequences compared with those from other regions of Africa showed that while many sequences were closely related to sequences from Kenya, others were most closely related to known sequences from other parts of Africa, including West Africa. Overall, these data indicate that there have been multiple introductions of HIV-1 into this small rural town and surroundings with ongoing diversity being generated by recombination.


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  • Association of Attitudes and Beliefs towards Antiretroviral Therapy with HIV-Seroprevalence in the General Population of Kisumu, Kenya

    Background

    Since antiretroviral therapy (ART) became available in the developed world, the prevalence of unprotected sex and the incidence of sexually transmitted infections (STIs) and HIV have increased. We hypothesized that a similar phenomenon may be occurring in sub-Saharan Africa concomitant with the scale-up of HIV treatment


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  • Estimation and Short-Term Prediction of the Course of the HIV Epidemic Using Demographic and Health Survey Methodology-Like Data

    Background

    Mathematical models have played important roles in the understanding of epidemics and in the study of the impacts of various behavioral or medical measures. However, modeling accurately the future spread of an epidemic requires context-specific parameters that are difficult to estimate because of lack of data. Our objective is to propose a methodology to estimate context-specific parameters using Demographic and Health Survey (DHS)-like data that can be used in mathematical modeling of short-term HIV spreading.


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  • Short-Term Mobility and the Risk of HIV Infection among Married Couples in the Fishing Communities along Lake Victoria, Kenya

    Background

    Population mobility within and across countries is intrinsic to development in Africa, yielding positive socio-economic benefits especially to the poorest individuals and households . However, in the region and globally, mobility has been associated with the spread of sexually transmitted infections (STI) including HIV .


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  • Lessons learned from respondent-driven sampling recruitment in Nairobi: experiences from the field

    Background

    Population groups such as men who have sex with men, female sex workers and people who inject drugs are considered key populations (KP) at risk for HIV infection worldwide. In addition to being at increased risk for HIV, these populations are typically hidden and hard to reach for surveillance activities because some of their behaviors are stigmatized or illegal. In Kenya, men who have sex with men, female sex workers and people who inject drugs, long distance truck drivers, members of fishing communities and their sex partners are recognized as the most important KP . These population groups are considered to engage frequently in high risk behaviors, such as unprotected anal and/or vaginal intercourse, have concurrent multiple sexual partnerships, and share needles that are likely to result in HIV or sexually transmitted infections (STI) infection . The burden of HIV infection and other adverse sexual and reproductive health outcomes is higher among KP than among the general population. HIV prevalence rates among KP in Kenya are between 18 and 30 % compared to approximately 5.6 % of the general adult population .


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  • Determinants of failure to access care in mothers referred to HIV treatment programs in Nairobi, Kenya

    Background

    During the last five years, large donor support from programs such as the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, TB, and malaria (GFATM) has enabled massive scaled up of HIV care programs in many African countries. With a goal toward universal access of HIV treatment and prevention to all who need them, efforts under the 3×5 campaign sought to treat three million people with antiretroviral therapy (ARTs) by 2005. By 2007, increased coverage of antiretroviral treatment in poorer countries resulted in three million people in developing countries with access to highly active antiretroviral therapy (HAART), and an estimated 200,000 children receiving treatment (United Nations, 2009).


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  • Influence of gender on loss to follow-up in a large HIV treatment programme in western Kenya

    Background


    Approximately 33 million people worldwide are living with human immunodeficiency virus (HIV) infection or acquired immunodeficiency syndrome (AIDS), and the majority are in sub-Saharan Africa.1 The use of combination antiretroviral therapy (cART) in sub-Saharan Africa and other resource-constrained settings has been massively scaled up since 2004: in 2008, more than 4 million adults were being treated.2 Moreover, cART has significantly reduced mortality and improved life expectancy.3–5 Nevertheless, the effectiveness of care is threatened by the high number of patients who are lost to follow-up.6 There is an urgent need to understand why patients are lost to follow-up and to develop interventions to improve retention.


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  • A Prospective Cohort Study of Intimate Partner Violence and Unprotected Sex in HIV-Positive Female Sex Workers in Mombasa, Kenya

    Background

    In Africa, female sex workers (FSWs) are a key population that is disproportionately affected by violence [16, 17], substance use problems [18], and HIV . In Kenya, FSWs represent an estimated 1 % of the population and contribute 14 % of new HIV transmissions . Prior studies on violence against FSWs in relation to HIV acquisition and transmission have focused on exposure to violence from clients and other men .


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  • Prevalence and correlates of home delivery amongst HIV-infected women attending care at a rural public health facility in Coastal Kenya

    Background

    Home delivery, referring to pregnant women giving birth in the absence of a skilled birth attendant, is a significant contributor to maternal mortality, and is encouragingly reported to be on a decline in the general population in resource limited settings. However, much less is known about home delivery amongst HIV-infected women in sub-Saharan Africa (sSA). We described the prevalence and correlates of home delivery among HIV-infected women attending care at a rural public health facility in Kilifi, Coastal Kenya. 


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  • Predictors of Linkage to Care Following Community-Based HIV Counseling and Testing in Rural Kenya

    Background

    Despite innovations in HIV counseling and testing (HCT), important gaps remain in understanding linkage to care. We followed a cohort diagnosed with HIV through a community-based HCT campaign that trained persons living with HIV/AIDS (PLHA) as navigators. Individual, interpersonal, and institutional predictors of linkage were assessed using survival analysis of self-reported time to enrollment. Of 483 persons consenting to follow-up, 305 (63.2%) enrolled in HIV care within 3 months. Proportions linking to care were similar across sexes, barring a sub-sample of men aged 18–25 years who were highly unlikely to enroll. Men were more likely to enroll if they had disclosed to their spouse, and women if they had disclosed to family. Women who anticipated violence or relationship breakup were less likely to link to care. Enrollment rates were significantly higher among participants receiving a PLHA visit, suggesting that a navigator approach may improve linkage from community-based HCT campaigns.

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  • Reasons for Ineligibility in Phase 1 and 2A HIV Vaccine Clinical Trials at Kenya Aids Vaccine Initiative (KAVI), Kenya

    Background

    The majority of the people living with HIV are in sub-Saharan Africa (68%) with some countries having disturbingly high HIV prevalence rates. In 2009, Sub-Saharan Africa had an overall HIV prevalence rate of 5% . In some populations, the HIV prevalence rate is much higher than average; for example in 2009 the prevalence rates for Botswana were 24.8%, for South Africa 17.8%, and for Swaziland 25.9% . Although the current control measures may have lowered the HIV prevalence in some countries, scientists generally believe that a safe, effective, accessible and affordable preventive HIV vaccine is the best hope for stopping the HIV epidemic. In this regard, sub-Saharan Africa, which endures most of the HIV epidemic, must play its rightful role in research and development, not only of preventive HIV vaccines, but also discovery and development of new anti-retroviral drugs.

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  • HIV-1 virologic failure and acquired drug resistance among first-line antiretroviral experienced adults at a rural HIV clinic in coastal Kenya: a cross-sectional study

    Background

    By the end of 2011, approximately 34 million people were living with HIV globally, with almost all (97%) coming from low and middle income countries (LMIC) . In the same year, more than 8 million HIV-infected individuals in LMIC were receiving antiretroviral therapy (ART), up from just 400,000 in 2003 . In Kenya, approximately 10,000 HIV-infected individuals were on ART in 2003. By the end of 2011, more than 400,000 individuals had initiated ART in the country . The increase in the number of people with access to ART has resulted in substantial declines in HIV related incidence, morbidity and mortality . However, emerging HIV-drug resistance and subsequent treatment failure threatens to reverse these gains. This is especially important in sub-Saharan Africa (sSA) where the scale up of ART has not always been done in tandem with the relevant support for virological monitoring and HIVDR testing.

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  • Comparison of developmental milestone attainment in early treated HIV-infected infants versus HIV-unexposed infants: a prospective cohort study

    Background

    Ninety percent of HIV-infected infants worldwide are born in sub-Saharan Africa, where opportunities for early HIV diagnosis are frequently missed. Infant HIV diagnosis often does not occur until after onset of symptomatic HIV . HIV-infected infants have a particularly high early viral burden  and rapid disease progression , and the window of opportunity to minimize the HIV reservoir in the brain is likely short. Early pre-ART disease progression may be associated with neuronal damage that is not salvageable. Conversely, effective ART may provide benefit, if initiated very early in infancy. In cohorts of infants with no or limited access to early ART, 30–36% and 26–36% had mental and motor delays, respectively

    .

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  • ‘Wamepotea’ (They have become lost): Outcomes of HIV-positive and HIV-exposed children lost to follow-up from a large HIV treatment program in western Kenya

    Background


    The Joint United Nations Program on HIV/AIDS (UNAIDS) has estimated that as of the end of 2008, there were approximately 2.1 million children living with HIV/AIDS . Also in 2008, 430,000 children became newly HIV-positive, while another 280,000 died of AIDS . Despite the well-documented fact that combination antiretroviral therapy(cART)in HIV-positive children improves survival, physical growth and other important clinical outcomes , only38% of children in urgent need of cART are actually receiving therapy . Unfortunately not only do pediatric HIV care programs face significant challenges with regard to expanding access for new children, maintaining care for already enrolled children can be difficult.

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  • Time to Complete Wound Healing in HIV-Positive and HIV-Negative Men following Medical Male Circumcision in Kisumu, Kenya: A Prospective Cohort Study

    Background

    While voluntary medical male circumcision (VMMC) has been shown to be protective against HIV-acquisition, the procedure may place men and their partners at risk of HIV infection in the period following circumcision if sex is resumed before the wound is healed. This prospective cohort study evaluates post-circumcision wound healing to determine whether the 42-day post-circumcision abstinence period, recommended by the World Health Organization and adopted by VMMC programs, is optimal.


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  • PrEP for key populations in combination HIV prevention in Nairobi: a mathematical modelling study

    Background


    The HIV epidemic in the population of Nairobi as a whole is in decline, but a concentrated sub-epidemic persists in key populations. We aimed to identify an optimal portfolio of interventions to reduce HIV incidence for a given budget and to identify the circumstances in which pre-exposure prophylaxis (PrEP) could be used in Nairobi, Kenya.


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  • Partners and Clients of Female Sex Workers in an Informal Urban Settlement in Nairobi, Kenya

    Background

    Female sex workers (FSWs) have long been recognized as important factors in the sub-Saharan African HIV epidemic because of their high number of sexual partners (D’Costa et al. 1985; Ngugi et al 1988). More recent research highlights the value of distinguishing sexual partners as either clients or romantic partners, with the latter represented by husbands and/or lovers. In this regard, Voeten et al. (2007) found that in Nyanza Province, Kenya, FSWs recorded a greater number of vaginal intercourse acts without a male condom with regular, or romantic, partners than with clients.

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  • `If I am given antiretrovirals I will think I am nearing the grave': Kenyan HIV serodiscordant couples' attitudes regarding early initiation of antiretroviral therapy

    Background

    Initiation of antiretroviral therapy (ART) by HIV-infected persons – that is, at higher CD4+ cell counts (>350 cells/μl) – is a potent HIV prevention strategy . The WHO recommends ART initiation irrespective of CD4+ cell count for HIV-infected members of HIV serodiscordant couples . Studies from a variety of settings have reported that some HIV-infected individuals are not willing to initiate ART , but few studies have directly explored early ART initiation. Among 181 HIV-infected Kenyan individuals with CD4+ cell counts higher than 350 cells/μl and known HIV-uninfected partners, approximately 40% reported reluctance to consider early ART, citing side-effects, stigma, pill burden, and ART resistance. In the control arm of HIV Prevention Trials Network (HPTN) 052, nearly 20% of HIV-infected participants declined ART when offered after the trial demonstrated HIV protection – many stating that they were not ready to begin ART or believed their CD4+ cell count was too high. Recent studies have suggested that higher CD4+ cell counts are associated with delayed ART initiation or refusal .



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  • Genetic Analysis of HIV-1 Subtypes in Nairobi, Kenya

    Background

    Genetic analysis of a viral infection helps in following its spread in a given population, in tracking the routes of infection and, where applicable, in vaccine design. Additionally, sequence analysis of the viral genome provides information about patterns of genetic divergence that may have occurred during viral evolution.


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  • Volunteer motivators for participating in HIV vaccine clinical trials in Nairobi, Kenya

    Background

    1.5 million Kenyans are living with HIV/AIDS as per 2015 estimates. Though there is a notable decline in new HIV infections, continued effort is still needed to develop an efficacious, accessible and affordable HIV vaccine. HIV vaccine clinical trials bear risks, hence a need to understand volunteer motivators for enrolment, retention and follow-up. Understanding the factors that motivate volunteers to participate in a clinical trial can help to strategize, refine targeting and thus increase enrolment of volunteers in future HIV vaccine clinical trials. The health belief model classifies motivators into social benefits such as ‘advancing research’ and collaboration with science, and personal benefits such as health benefits and financial interests.


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  • Exclusive breastfeeding among women taking HAART for PMTCT of HIV-1 in the Kisumu Breastfeeding Study

    Background

    One of the most effective ways to promote the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings is to encourage HIV-positive mothers to practice exclusive breastfeeding (EBF) for the first 6 months post-partum while they receive antiretroviral therapy (ARV). Although EBF reduces mortality in this context, its practice has been low. We studied the rate of adherence to EBF and assessed associated maternal and infant characteristics using data from a phase II PMTCT clinical trial conducted in Western Kenya which included a counseling intervention to encourage EBF by all participants.


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  • Evidence of injection drug use in Kisumu, Kenya: Implications for HIV prevention

    Background

    Injection drug use is increasingly contributing to the HIV epidemic across sub-Saharan Africa. This paper provides the first descriptive analysis of injection drug use in western Kenya, where HIV prevalence is already highest in the nation at 15.1%.

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  • HIV infection and sexual partnerships and behaviour among adolescent girls in Nairobi, Kenya

    BACKGROUND

    Young people in sub-Saharan Africa continue to be one of the populations at greatest risk for HIV infection, and the risk is particularly high among young women. In Kenya, the 2008 Demographic and Health Survey (DHS) reported the median age of sexual debut among Kenyan women was approximately 18 years.2 The prevalence of HIV among girls 15–19 years old was 3%, which was four times the HIV prevalence among boys of the same age.2 In Africa, individual sexual risk behaviours such as young age at sexual debut, multiple partners and commercial sex work have been associated with increased risk of HIV acquisition among young adults.


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  • Navigating the risks of prevention of mother to child transmission (PMTCT) of HIV services in Kibera, Kenya: Barriers to engaging and remaining in care

    Background.


    Despite the availability of evidence-based interventions to prevent mother to child transmission (PMTCT) of HIV, an estimated 150,000 incident HIV infections and 110,000 AIDS related deaths occurred among children less than 15 years of age in 2015


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  • Understanding Barriers to Scaling Up HIV Assisted Partner Services in Kenya

    Background.

    Assisted partner services (APS) are more effective than passive referral in identifying new cases of HIV in many settings. Understanding the barriers to the uptake of APS in sub-Saharan Africa is important before its scale up. In this qualitative study, we explored client, community, and healthcare worker barriers to APS within a cluster randomized trial of APS in Kenya. We conducted 20 in-depth interviews with clients who declined enrollment in the APS study and 9 focus group discussions with health advisors, HIV testing and counseling (HTC) counselors, and the general HTC client population. Two analysts coded the data using an open coding approach and identified major themes and subthemes. Many participants reported needing more time to process an HIV-positive result before providing partner information. Lack of trust in the HTC counselor led many to fear a breach of confidentiality, which exacerbated the fears of stigma in the community and relationship conflicts. The type of relationship affected the decision to provide partner information, and the lack of understanding of APS at the community level contributed to the discomfort in enrolling in the study. Establishing trust between the client and HTC counselor may increase uptake of APS in Kenya. A client's decision to provide partner information may depend on the type of relationship he or she is in, and alternative methods of disclosure may need to be offered to accommodate different contexts. Spreading awareness about APS in the community may make clients more comfortable providing partner information.


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