research & publications

HIV RESEARCH

Results by County (Approx)
  • 623 results found
  • Trends in survival of children born with HIV: The Western story

    LLPI 

    Dr. Edith Apondi 

     

    Text For Abstract 

    HIV infection in children has shifted from a subacute illness with high childhood mortality to a chronic illness with very long term survival with the increase in high-quality ART access globally. The survival of children living with HIV is however largely not characterized in Sub Saharan Africa where ART access has just recently improved, and where mortality is affected by many other factors besides ART access.  The gains that have been made with improvements in HIV care in children have rarely been longitudinally defined across a pediatric cohort by HIV care programs, and many studies are limited by short study periods 

     

    Study Objectives 

    Broad Objective: To conduct a survival analysis and characterize the adverse events among HIV-infected children on ART in Western 

     

    Study Site 

    AMPATH 

     

    Date Approved 

    9th July, 2018 


  • Scale up of PrEP integrated in public health HIV care clinics: a protocol for a stepped-wedge cluster-randomized rollout in Kenya

    Background


    Antiretroviral therapy (ART) for HIV-infected persons and pre-exposure prophylaxis (PrEP) for uninfected persons are extraordinarily effective strategies for HIV prevention. In Africa, the region which shoulders the highest HIV burden, HIV care is principally delivered through public health HIV care clinics, offering an existing platform to incorporate PrEP delivery and maximize ART and PrEP synergies. However, successfully bringing this integrated approach to scale requires an implementation science evaluation in public health settings.


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  • Low Prevalence of Transmitted HIV Type 1 Drug Resistance Among Antiretroviral-Naive Adults in a Rural HIV Clinic in Kenya

    Background

    Low levels of HIV-1 transmitted drug resistance (TDR) have previously been reported from many parts of sub-Saharan Africa (sSA). However, recent data, mostly from urban settings, suggest an increase in the prevalence of HIV-1 TDR. Our objective was to determine the prevalence of TDR mutations among HIV-1-infected, antiretroviral (ARV)-naive adults enrolling for care in a rural HIV clinic in Kenya. Two cross-sectional studies were carried out between July 2008 and June 2010. Plasma samples from ARV-naive adults ( >15 years old) at the time of registering for care after HIV diagnosis and before starting ARVs were used.


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  • Adoption of routine virologic testing and predictors of virologic failure among HIV-infected children on antiretroviral treatment in western Kenya

    Access to routine virologic monitoring, critical to ensuring treatment success, remains limited in low- and middle-income countries. This study reports on implementation of routine viral load (VL) monitoring and risk factors for virologic failure among HIV-infected children on antiretroviral treatment (ART) in Western Kenya.


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  • Perceived Social Support and Depression amongst Pregnant and Postnatal Women with HIV in Nyanza, Kenya

    Background


    In order for prevention of mother-to-child HIV transmission (PMTCT) programs to be effective, they must identify pregnant women living with HIV, provide them with antiretroviral treatment (ART), support medication adherence, and retain patients to ensure that infants receive the appropriate care including final determination of HIV status. Previous research has demonstrated that depression is a barrier to retention in PMTCT programs and that perceived social support is a key facilitator.


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  • Leveraging peer-based support to facilitate HIV care in Kenya

    Background

    Patients with HIV admitted to hospitals in sub-Saharan Africa (SSA) are a particularly vulnerable group. Many of these patients have been lost to follow-up as a result of health system deficiencies in HIV diagnosis, linkage to and retention in care, and antiretroviral therapy (ART) adherence. Patient navigators are a potential solution to overcoming barriers to care for vulnerable populations. Patient navigators are trained, culturally sensitive healthcare workers who help guide patients through the complex care continuum. Many patient navigators share the same disease as their patients and are called “peer navigators” within the literature


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  • Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations

    Despite the importance of ART adherence, supportive interventions have generally not been implemented at scale. The objective of this review is to summarize the recommendations of clinical, research, and public health experts for scalable ART adherence interventions in resource‐limited settings.


    Some of the interventions highlighted in this paper are quite applicable to the Kenyan context.


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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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  • 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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  • 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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  • 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


  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • 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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  • Utilization rates and perceptions of (VCT) services in Kisii Central District, Kenya.

    Background.


    Voluntary counseling and testing (VCT) services have been set up in most Districts in Kenya due to the rising surge of HIV/AIDS. However, the use of these services among married persons has not been fully explored. In Kissi, the issue of VCT is pressing as the rate of HIV prevalence is close to 3%. In 2006, about 20 000 clients came for VCT services in Kenya yet only 165 of these were married persons. In the Keumbu sub-district hospital, of the more than 1000 clients that came for VCT services, approximately 29% were married persons. This paper therefore aims at determining the utilization of VCT services by married persons in the study area. The qualitative data was obtained principally through two focus group discussions (FGDs) in which the respondents were asked to comment on their use of VCT services while the quantitative data was obtained from interviews with 245 respondents. The qualitative data was analyzed through verbatim transcription while for the quantitative data; the responses were coded and populated into SPSS from which the frequencies and percentages were calculated. The results show that actual use of the VCT services is low (28.1%) but slightly higher among female respondents than males. The low usage may be attributed to (a) fear of results, (b) death anxiety, (c) lack of confidentiality and lastly, (d) fear of stigmatization. Female respondents were found to have a greater awareness of VCT and thus its potential use.


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  • 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.


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  • 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.

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  • 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.

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  • 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]. 

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  • 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 .


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  • 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.


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  • 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.


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  • Health Care Utilization and Access to Human Immunodeficiency Virus (HIV) Testing and Care and Treatment Services in a Rural Area with High HIV Prevalence, Nyanza Province, Kenya, 2007

    Understanding local population health care use characteristics are important in order to strategically initiate or scale-up healthcare services and allocate financial and human resources efficiently. Geographic accessibility, travel time, waiting time, age, health status, income, service costs, and education are factors shown to be associated with health care use and improvements in facility physical infrastructure, staffing, and commodity availability and implementation of free high-quality healthcare have demonstrated increases in health care utilization. Routine national surveys tend to collect data on individuals' general health care use but often lack specific data on the healthcare service location. Spatial data provide opportunities to examine geographic factors associated with healthcare facility selection.

    As the global human immunodeficiency virus (HIV) pandemic enters its fourth decade, recent surveys in many affected countries in Africa have shown substantial increases in the proportion of adults that are aware of HIV, familiar with its transmission routes, and knowledgeable as to the benefits of receiving HIV care services, including antiretroviral treatment (ART).The once seemingly insurmountable logistical and financial barriers of the late 1990s and early 2000s to knowing one's HIV status and receipt of HIV clinical services have greatly decreased with the development and distribution of inexpensive rapid HIV test kits, the availability of generic antiretroviral drugs, and financial and technical support for commodity management systems, infrastructure, and human resources through international donors, (e.g., the President's Emergency Plan for AIDS Relief and the Global Fund) However, despite these advances and the increasing availability of free, quality HIV services, HIV health care utilization remains suboptimal; most country adult testing rates remain below 40%,16,18,20 and programs are challenged to increase early uptake of HIV care and ART services among HIV-infected individuals to control and reduce the spread of acquired immunodeficiency syndrome (AIDS).

    Demographic and spatial factors associated with persons' health care utilization and access to HIV services can provide insight into a population's health-seeking behavior and inform future program planning and service delivery. We present an analysis of population-based survey data to assess geographic and sociodemographic indicators associated with access to healthcare services collected as part of community preparatory work prior to the initiation of community home-based HIV counseling and testing (HBCT) services.


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  • 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.

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  • 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].

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  • 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.

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  • 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).

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