research & publications

HIV RESEARCH

Results by County (Approx)
  • 421 results found
  • 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).


    Read More

  • 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.


    Download
  • 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.


    Download
  • 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.


    Download
  • 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.

    Download
  • 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. 

    Download
  • 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.


    Read More

  • 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. 


    Read More

  • 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.


    Read More

  • 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.


    Read More

  • 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


    Read More

  • 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.


    Read More

  • 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 .


    Read More

  • 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 .


    Read More

  • 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).


    Read More

  • 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.


    Read More

  • 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 .


    Read More

  • 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. 


    Read More

  • 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.

    Read More

  • 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.

    Read More

  • 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.

    Read More

  • 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

    .

    Read More

  • ‘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.

    Read More


  • 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.


    Read more

  • 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.


    Read More

  • 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.

    Download
  • `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 .



    Download
  • 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.


    Read More

  • 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.


    Read More

  • 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.


    Read More

  • 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%.

    Read More

  • 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.


    Read More

  • 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


    Read More

  • Barriers and facilitators to pre-exposure prophylaxis (PrEP) eligibility screening and ongoing HIV testing among target populations in Bondo and Rarieda, Kenya: Results of a consultation with community stakeholders

    Background

    As pre-exposure prophylaxis (PrEP) moves closer to availability in developing countries, practical considerations for implementation become important. We conducted a consultation with district-level community stakeholders experienced in HIV-prevention interventions with at-risk populations in Bondo and Rarieda, Kenya to generate locally grounded approaches to the future rollout of oral PrEP to four populations: fishermen, widows, female sex workers, and serodiscordant couples.

  • Male circumcision for HIV prevention: a prospective study of complications in clinical and traditional settings in Bungoma, Kenya.

    Background.


    Male circumcision reduces the risk of HIV acquisition by approximately 60%. Male circumcision services are now being introduced in selected populations in sub-Saharan Africa and further interventions are being planned. A serious concern is whether male circumcision can be provided safely to large numbers of adult males in developing countries.


    Read More

  • Scaling up implementation of ART: Organizational culture and early mortality of patients initiated on ART in Nairobi, Kenya

    Background

    Scaling up the antiretroviral (ART) program in Kenya has involved a strategy of using clinical guidelines coupled with decentralization of treatment sites. However decentralization pushes clinical responsibility downwards to health facilities run by lower cadre staff. Whether the organizational culture in health facilities affects the outcomes despite the use of clinical guidelines has not been explored. This study aimed to demonstrate the relationship between organizational culture and early mortality and those lost to follow up (LTFU) among patients enrolled for HIV care.


    Read More

  • High HIV risk in a cohort of male sex workers from Nairobi, Kenya

    Background


    Men who have sex with men (MSM) are at high risk of HIV-1 acquisition and transmission, yet there remains limited data in the African context, and for men who sell sex to men (MSM SW) in particular. We enrolled 507 male sex workers in a Nairobi-based prospective cohort study during 2009-2012. All participants were offered HIV/STI screening, counselling and completed a baseline questionnaire. Baseline HIV prevalence was 40.0% (95% CI 35.8% to 44.3%). Prevalent HIV infection was associated with age, less postsecondary education, marijuana use, fewer female partners and lower rates of prior HIV testing. Most participants (73%) reported at least two of insertive anal, receptive anal and insertive vaginal sex in the past 3 months. Vaginal sex was reported by 37% of participants, and exclusive MSM status was associated with higher HIV rates.

    Download
  • Triple-Antiretroviral Prophylaxis to Prevent Mother-ToChild HIV Transmission through Breastfeeding—The Kisumu Breastfeeding Study, Kenya: A Clinical Trial

    Background:

    Effective strategies are needed for the prevention of mother-to-child HIV transmission (PMTCT) in resourcelimited

    settings. The Kisumu Breastfeeding Study was a single-arm open label trial conducted between July 2003 and

    February 2009. The overall aim was to investigate whether a maternal triple-antiretroviral regimen that was designed to

    maximally suppress viral load in late pregnancy and the first 6 mo of lactation was a safe, well-tolerated, and effective

    PMTCT intervention.

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

    Background;


    There are an estimated 33 million people in the world

    infected with HIV, 60% of whom reside in sub-Saharan

    Africa [1]. Emerging data indicate that a large proportion

    of new infections in this region occur in stable HIVdiscordant

    relationships [2,3]. Prevention efforts in this

    population have focused on couples-based HIV testing to

    equip partners with knowledge of their serostatus in order

    to motivate behaviour change [4]. 

    Download
  • The Performance of Children Prenatally Exposed to HIV on the A-Not-B Task in Kilifi, Kenya: A Preliminary Study

    Background


    Children born to human immunodeficiency virus (HIV) positive mothers are at risk for poor cognitive outcomes . Impairments have been observed regardless of the children’s own HIV status . The mother’s status may impact upon the child’s development in a number of ways: (a) vertical transmission and subsequent HIV involvement in the central nervous system; (b) compromise the prenatal environment leading to higher incidences of low-birth weight and prematurity; and (c) compromise the postnatal environment through exposure to stressors such as suboptimal stimulation at home. Executive Functions, those behaviors that enable us to exert control over more automatic responses , are strongly associated with the development of the pre-frontal cortex .


    Read More


  • Community-Based Evaluation of PMTCT Uptake in Nyanza Province, Kenya

    Background


    Facility-based assessments of prevention of mother-to-child HIV transmission (PMTCT) programs may overestimate population coverage. There are few community-based studies that evaluate PMTCT coverage and uptake.


    Read More


    Read More

  • Perspectives on HIV Pre- and Post- Exposure Prophylaxes (PrEP and PEP) among Female and Male Sex Workers in Mombasa, Kenya: Implications for Integrating Biomedical Prevention into Sexual Health Services

    Background;


    Pre- and post-exposure prophylaxis (PrEP and PEP) can reduce the risk of HIV acquisition, yet often are inaccessible to and underutilized by most-vulnerable populations, including sex workers in sub-Saharan Africa. Based on in-depth interviews with 21 female and 23 male HIV-negative sex workers in Mombasa, Kenya, we found that awareness and knowledge of PrEP and PEP were low, although willingness to use both was high. Participants felt PrEP would be empowering and give added protection against infection, although some expressed concerns about side effects. Despite its availability, few knew about PEP and even fewer had used it, but most who had would use it again. Sex workers valued confidentiality, privacy, trustworthiness, and convenient location in health services and wanted thorough HIV/STI assessments. These findings suggest the importance of situating PrEP and PEP within sex worker-friendly health services and conducting outreach to promote these biomedical prevention methods for Kenyan sex workers.


    Read More


    Read More

  • Attitudes toward Family Planning among HIV-Positive Pregnant Women Enrolled in a Prevention of Mother-To-Child Transmission Study in Kisumu, Kenya

    Background

    Preventing unintended pregnancies among HIV-positive women through family planning (FP) reduces pregnancy-related morbidity and mortality, decreases the number of pediatric HIV infections, and has also proven to be a cost-effective way to prevent mother-to-child HIV transmission. A key element of a comprehensive HIV prevention agenda, aimed at avoiding unintended pregnancies, is recognizing the attitudes towards FP among HIV-positive women and their spouse or partner. In this study, we analyze FP attitudes among HIV-infected pregnant women enrolled in a PMTCT clinical trial in Western Kenya.


    Read More


    Read More

  • Identifying sustainable interventions for HIV epidemic control in Siaya County

    PI: Paul Wekesa

    Affiliation: Centre for Health Solutions (CHS)

    Approving ERC: AMREF

    Approval Date: 03/05/2018

    Duration: 5 years(2016-2021)

    Background:

     HIV response globally has been enhanced by the fast-track approach towards epidemic control by 2030. The Joint United Nations Program on HIV/AIDS (UNAIDS) aims to incrementally avert 17.6 million HIV infections and 10.8 million AIDS-related deaths between 2016 and 2030. In 2015, global antiretroviral therapy (ART) coverage peaked at 46% which led to a 26% decline in AIDS related deaths compared to 2010. CHS will be implementing “Shinda Project: Implementation and Expansion of High Quality HIV Care, Prevention & Treatment” in Siaya County, Kenya with funding from US Presidential Emergency Fund for AIDS Response (PEPFAR), through the Centre for Disease Control and Prevention (CDC)-Kenya Objectives

  • Estimates of the size of key populations at risk for HIV infection: men who have sex with men, female sex workers and injecting drug users in Nairobi, Kenya

    Background

    Throughout the world, HIV disproportionately affects marginalised populations, particularly men who have sex with men (MSM), female sex workers (FSW) and intravenous drug users (IDU).However, little is known about their role in the HIV epidemics of sub-Saharan Africa where the general population is also severely affected. Societal marginalisation may contribute to the lack of appropriate prevention programmes focusing on these populations, which in turn, may contribute to ongoing HIV transmission. Also, partly due to their stigmatisation, the true size of these populations is unknown, leading to an underestimation of potential need for prevention, treatment and care programmes, The situation may be exacerbated in countries where their very existence may be denied.

    Read More


  • Prevalence of HIV, Sexually Transmitted Infections, and Risk Behaviours Among Female Sex Workers in Nairobi, Kenya: Results of a Respondent Driven Sampling Study

    Background

    Female sex workers (FSWs) continue to bear a high burden of HIV infection in many countries and are an important target population for a public health response to HIV/AIDS [1–5]. However, because behaviors associated with FSWs are considered to be illegal and highly stigmatized in many countries, it is often difficult to conduct probability-based surveys designed to provide representative estimates of biologic and behavioral factors among FSWs [6].

    Read More

  • HIV and STI Prevalence and Injection Behaviors Among People Who Inject Drugs in Nairobi: Results from a 2011 Bio-behavioral Study Using Respondent-Driven Sampling

    Background

    Injection drug behaviors have been recognized as key facilitators of HIV transmission since the beginning of the epidemic [1–3]. In 2010, there were an estimated 15.9 million (ranging from 11 to 21.2 million) people who injected drugs (PWID) globally, with one in five estimated to be HIV-positive [2]. While Southeast and East Asia have the largest number of PWID [4], recent evidence shows an increase in injection drug use and associated HIV infections in sub-Saharan Africa, where the burden of HIV is already the highest in the world [5–16]. Despite a lack of comprehensive evidence, it is clear that PWID in sub-Saharan Africa are at great risk for acquiring and transmitting HIV in the context of few prevention interventions targeted toward this population and lack of capacity to handle key populations at risk for HIV such as men who have sex with men, sex workers, and PWID, in the current state of the burdened healthcare system.

    Read More

  • Triple-Antiretroviral Prophylaxis to Prevent Mother-To-Child HIV Transmission through Breastfeeding—The Kisumu Breastfeeding Study, Kenya: A Clinical Trial

    Background

    Every year, about half a million children become infected with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). Nearly all these newly infected children live in resource-limited countries and most acquire HIV from their mother, so-called mother-to-child transmission (MTCT). Without intervention, 25%–50% of babies born to HIV-positive mothers become infected with HIV during pregnancy, delivery, or breastfeeding. This infection rate can be reduced by treating mother and child with antiretroviral (ARV) drugs. A single dose of nevirapine (a “non-nucleoside reverse transcriptase inhibitor” or NNRTI) given to the mother at the start of labor and to her baby soon after birth nearly halves the risk of MTCT. Further reductions in risk can be achieved by giving mother and baby three ARVs—an NNRTI and two nucleoside reverse transcriptase inhibitors (NRTIs such as zidovudine and lamivudine)—during pregnancy and perinatally (around the time of birth).

    Read More

  • Men Who Have Sex With Men in Kisumu, Kenya: Comfort in Accessing Health Services and Willingness to Participate in HIV Prevention Studies

    Background,


    Men who have sex with men (MSM) are a crucial and marginalized at risk population for HIV in Africa but are poorly studied. Like other areas of Africa, homosexuality is illegal in Kenya. We assessed MSM comfort in accessing health services and willingness to participate in HIV prevention research in Kisumu, Kenya—an area of high HIV prevalence.

    Read More,