research & publications

HIV RESEARCH

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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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  • 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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  • 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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  • 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

  • Successes and Challenges in an Integrated Tuberculosis/HIV Clinic in a Rural, Resource-Limited Setting: Experiences from Kericho, Kenya

    Background;


    KDH is located in Kericho among the tea fields and plantations of Kenya's southern Rift Valley Province 260 kilometers northwest of Nairobi. As a Ministry of Health (MoH) facility under the Ministry of Medical Services, KDH provides services to a rural, largely uninsured population, representative of the national statistic indicating that 46% of the population lives below the poverty line


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  • Delivery of ASRH & HIV Services for Adolescents with Disabilities : An Analysis of Capacity and Appropriateness of Community Based Approach in Siaya County, Kenya

    PI: Paul Mbaga

    Affiliation: University of Kwazulu Natal

    Approving ERC: AMREF

    Approval Date: 21/07/2017

    Duration: 6 months

    Background:


    Progress in accessing adolescent sexual & reproductive health (ASRH) and HIV care for persons with disabilities (PWD) in Sub-Saharan Africa has remained slow. In Kenya, like in the rest of the region, poor public financing for health; inadequate staffing; lack of equipment and commodities; inefficiencies including poor governance and management; are real maladies of the health system despite the growing ASRH& HIV care needs for PWD who face constant risk of HIV/STI; unplanned pregnancies; unsafe abortions; sexual and gender based violence. 


  • Study of The Effect of the Premise Mobile Application on Patient Engagement and Treatment Adherence Amongst Girls and Young Women Ages 15-24 in Kisumu County Kenya

    PI: Mariciana Onono

    Affiliation: Kenya Medical Research Institute

    Approving ERC: AMREF

    Approval Date: 18/05/2017

    Duration: 10 months

    Background:


    Through the DREAMS Innovation Challenge award from the United States - Department of State’s President's Emergency Plan for AIDS Relief (PEPFAR), University of California San Francisco (UCSF), Kenya Medical Research Institute (KEMRI) and PREMISE Data Corporation aim to validate an assumption that Premise platform can improve adherence of HIV/AIDS patients. Strict adherence to antiretroviral therapy (ART) is key to sustained Human Immunodeficiency Virus (HIV) suppression, reduced risk of drug resistance, and decreased risk of HIV transmission. Adolescent girls and young women (AGYW) are especially at risk and their adherence rates are typically lower than the rest of the population.

  • Formative Assessment of Antenatal Care,Prevention of Mother-To-Child Transmission and Other HIV Services for Adolescent Girls and Young Women in Kakamega County, Western Kenya

    PI: Rose Masaba

    Affiliation: Elizabeth Glazier Paedriatrics AIDS Foundation

    Approving ERC: AMREF

    Approval Date: 03/05/2017

    Duration: 10 months

    Background:

    Adolescent girls and young women face unique challenges. Despite commendable advances in HIV treatment, HIV and AIDS-related stigma and discrimination remain major barriers to effective HIV prevention and provision of maternal health services. In Kenya, adolescents face significant barriers in accessing health services or protecting their own health. Kakamega County is one of the most affected with adolescents and young people aged 15-24 years contributing to 32% of all new HIV infections in the County.

  • Impact of the Philips Community Life Center on the community in terms of access to care and patient satisfaction

    PI: Lizette Krist

    Affiliation: PHILIPS Health Research Africa

    Approving ERC: AMREF

    Approval Date: 03/05/2017

    Duration: 6months

    Background:  


    Assessing the impact of the CLC on the community in terms of access to care and patient satisfaction, determine the added value of a Community Life Center, Identify suggestions for improvements and learn about some determinants of low access to care or patient satisfaction. 


  • Financial Incentives to Increase Pediatric HIV Testing Pilot Study (FIT-Pilot) (FIT-Pilot)

    Background:

    The aim of the pilot study is to evaluate the feasibility, acceptability and costs of a financial incentive intervention to motivate pediatric HIV testing in Western Kenya. The study will evaluate 3 cash incentive values and determine percent uptake of testing. A post-test questionnaire will explore parental satisfaction, mechanisms of incentive effectiveness and the impact of testing on emotional health and pediatric healthcare utilization.


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  • Application of psychosocial models to Home-Based Testing and Counseling (HBTC) for increased uptake and household coverage in a large informal urban settlement in Kenya.

    Background:

    Home Based Testing and Counselling (HBTC) aims at reaching individuals who have low HIV risk perception and experience barriers which prevent them from seeking HIV testing and counseling (HTC) services. Saturating the community with HTC is needed to achieve the ambitious 90-90-90 targets of knowledge of HIV status, ARV treatment and viral suppression. This paper describes the use of health belief model and community participation principles in HBTC to achieve increased household coverage and HTC uptake.


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  • HIV testing preferences among long distance truck drivers in Kenya: a discrete choice experiment

    Background:

    Providing HIV testing services to truck drivers in Africa is crucial but has proven challenging. The introduction of HIV self-testing promises to provide expanded service delivery options for clients, potentially increasing demand for services and expanding coverage – especially important for high-risk and difficult-to-reach populations. This study examines the preferences regarding HIV testing service delivery models, among long distance truck drivers to identify testing services that would appeal to this population. 


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  • Offering self-administered oral HIV testing to truck drivers in Kenya to increase testing: a randomized controlled trial.

    Background:

    Truck drivers in sub-Saharan Africa are at high risk for HIV. We conducted a randomized controlled trial among 305 truck drivers from two North Star Alliance roadside wellness clinics in Kenya to see if offering HIV testing choices would increase HIV testing uptake. Participants were randomized to be offered (1) a provider-administered rapid blood (finger-prick) HIV test (i.e., standard of care [SOC]) or (2) a Choice between SOC or a self-administered oral rapid HIV test with provider supervision in the clinic.


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  • Differences in acute retroviral syndrome by HIV-1 subtype in a multicentre cohort study in Africa

    Background:

    Prompt identification and treatment of adults newly infected with HIV-1 can dramatically reduce onward transmission and improve the health of the infected individual . Identifying adults with acute HIV-1 infection (AHI), a substantial portion of whom seek urgent care even in resource-constrained settings , therefore has tremendous public health importance . Unfortunately, AHI detection has not been emphasized in Sub-Saharan Africa (sSA), where the epidemic burden is greatest .

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  • Designing HIV Testing Algorithms Based on 2015 WHO Guidelines Using Data from Six Sites in Sub-Saharan Africa

    Background:

    The HIV rapid diagnostic tests  are the main diagnostic tools for HIV screening and diagnosis in resource-constrained settings . Given the potential for the severe medical, psychological, and social impacts of HIV misdiagnosis and the evidence of elevated false-positive results from some settings, it is imperative that HIV diagnosis is confirmed to be both sensitive and specific.Our objective was to evaluate the performance of HIV testing algorithms based on WHO recommendations, using data from specimens collected at six HIV testing and counseling sites in sub-Saharan Africa.

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  • HIV misdiagnosis in sub-Saharan Africa: performance of diagnostic algorithms at six testing sites

    Introduction:

    We evaluated the diagnostic accuracy of HIV testing algorithms at six programmes in five sub-Saharan African countries.


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  • Use of personal digital assistants for data collection in a multi-site AIDS stigma study in rural south Nyanza, Kenya.

    Background:

    Studies conducted in resource-poor settings face special challenges in data collection and management. These challenges include high illiteracy levels in the local communities, lack of skilled data collectors, and inadequate infrastructure including unreliable telecommunication networks. Good Clinical Data Management (GCDM) as defined by Good Clinical Practice- International Conference of Harmonization (GCP-ICH) may be burdensome, making data collection and management processes highly complicated. Even in developed countries, some clinical trial groups are unable to establish paper or electronic data systems that fully comply with the GCP-ICH guidelines.


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  • A clinician-nurse model to reduce early mortality and increase clinic retention among high-risk HIV-infected patients initiating combination antiretroviral treatment

    Background :

    In resource-poor settings, mortality is at its highest during the first 3 months after combination antiretroviral treatment (cART) initiation. A clear predictor of mortality during this period is having a low CD4 count at the time of treatment initiation. The objective of this study was to evaluate the effect on survival and clinic retention of a nurse-based rapid assessment clinic for high-risk individuals initiating cART in a resource-constrained setting.


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  • Patient Satisfaction with Integrated HIV and Antenatal Care Services In Rural Kenya

    Background:

    Antenatal clinics in Kenya have reported high HIV prevalence rates, up to 31% in some parts of the country (NASCOP, 2005; WHO, UNAIDS, & UNICEF, 2009; Gray et al., 2005) with 70% of infected adults living in rural areas (NASCOP 2008). However, it is estimated that only 56% of HIV-infected pregnant women in Kenya access basic services for the prevention of mother-to-child transmission (PMTCT) (WHO, UNAIDS, and UNICEF, 2009).A cluster randomized controlled trial was initiated in Kenya to determine if full integration (FI) of HIV care, including HAART, into antenatal care (ANC) clinics improves health outcomes among HIV-infected women and exposed infants, compared to a non-integrated (NI) model. This paper examines ANC clients’ satisfaction with and preferences regarding HIV-integrated services.


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  • Electronic medical record systems are associated with appropriate placement of HIV patients on antiretroviral therapy in rural health facilities in Kenya: a retrospective pre-post study

    Background:

    There is little evidence that electronic medical record (EMR) use is associated with better compliance with clinical guidelines on initiation of antiretroviral therapy (ART) among ART-eligible HIV patients. We assessed the effect of transitioning from paper-based to an EMR-based system on appropriate placement on ART among eligible patients.


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  • Estimating HIV Incidence Using a Cross-Sectional Survey: Comparison of Three Approaches in a Hyperendemic Setting, Ndhiwa Subcounty, Kenya, 2012.

    Background:

    Estimating HIV incidence is critical for identifying groups at risk for HIV infection, planning and targeting interventions, and evaluating these interventions over time. The use of reliable estimation methods for HIV incidence is thus of high importance. The aim of this study was to compare methods for estimating HIV incidence in a population-based cross-sectional survey.


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  • Factors Associated with Acceptability of HIV Self-Testing Among Health Care Workers in Kenya

    Background:

    Health care workers (HCWs) based in sub-Saharan Africa are at high risk of HIV infection, both from their sexual relations and from occupational exposure. It is estimated that 2 million needle stick injuries (NSIs) occur among HCWs per year worldwide. The World Health Organization (WHO) estimates that 40 % of the hepatitis B and C infections and 2.5 % of the HIV infections among HCWs are attributable to NSIs . In many sub-Saharan African countries, the number of available trained HCWs has historically been inadequate, and countries have suffered from scarcities of almost all cadres of HCWs, primarily due to morbidity and mortality as a result of HIV and AIDS .This paper examines the acceptability of an unsupervised facility-based HIV self-testing (HIV-ST) intervention among HCWs and their partners and factors associated with uptake of HIVST among HCWs.


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  • Gender differentials on the health consequences of care-giving to people with AIDS-related illness among older informal carers in two slums in Nairobi, Kenya.

    Background:

    Informal caregivers, most often older people, provide valuable care and support for people ill due to AIDS, especially in poor-resource settings with inadequate health care systems and limited access to antiretroviral therapy. The negative health consequences associated with care-giving may vary depending on various factors that act to mediate the extent of the effects on the caregiver. This paper investigates the association between care-giving and poor health among older carers to people living with AIDS, and examines potential within-gender differences in reporting poor health.


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  • Participation in a mobile health intervention trial to improve retention in HIV care: does gender matter?

    Background:

    To be consistent with the United Nations’ sustainable development goals on gender equality, mobile health (mHealth) programmes should aim to use communications technology to promote the empowerment of women. We conducted a pre-trial analysis of data from the WelTel Retain study on retention in HIV care to assess gender-based differences in phone access, phone sharing and concerns about receiving text messages from a healthcare provider.


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  • Healthcare-seeking behaviour of HIV-infected mothers and male partners in Nairobi, Kenya

    Background:

    Healthcare-seeking behaviours of HIV-infected mothers in sub-Saharan Africa are poorly characterized and typically focus on individual health conditions rather than overall health. We conducted a qualitative study to understand how HIV-infected mothers, their male partners, and their HIV-exposed infants seek medical services. We performed 32 in-depth interviews (17 female, 15 male) and four focus group discussions (FGDs) among HIV-infected postpartum women and their male partners in Nairobi, Kenya.


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  • Living with HIV post-diagnosis: a qualitative study of the experiences of Nairobi slum residents

    Background:

    Sub-Saharan Africa (SSA) is the region most affected by the HIV/AIDS pandemic, accounting for over 68% of the total global burden. A total of 1.6 million Kenyans are currently living with HIV and Kenyan adult HIV prevalence is estimated to be at 6.2%, higher than that of the SSA region (4.9%)

    The introduction of antiretroviral therapy (ART) has improved the prognosis of HIV, with the potential to transform it into a chronic condition. Access to ART in low and middle income countries has expanded rapidly, with 6.6 million people now receiving treatment, nearly half of those eligible for treatment. Seventy-two per cent of Kenyan adults and children with advanced HIV infection receive ARV. With ART, the future life opportunities of PLWHA can change, including those related to sexuality and reproduction.


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  • Delivering safer conception services to HIV serodiscordant couples in Kenya: perspectives from healthcare providers and HIV serodiscordant couples

    Background:

    For HIV serodiscordant couples in resource-limited settings, pregnancy is common despite the risk of sexual and/or perinatal HIV transmission. Some safer conception strategies to reduce HIV transmission during pregnancy attempts are available but often not used for reasons including knowledge, accessibility, preference and others. We sought to understand Kenyan health providers’ and HIV serodiscordant couples’ perspectives and experiences with safer conception.


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  • A Community-based Oral Health Promotion Model for HIV Patients in Nairobi, East District in Kenya: a Study Protocol

    BACKGROUND:
    General HIV-related orofacial lesions, most commonly oropharyngeal candidiasis, have a typical clinical appearance and can be recognized by members of the community. Although affected patients often experience pain leading to compromised eating and swallowing, barriers such as social stigma and lack of knowledge regarding available services may prevent them from seeking early care. Educating the community about these lesions through community health workers (CHWs) who are democratically elected community members may encourage individuals affected to seek early oral healthcare in the health facilities. A health facility (HF) is a health centre mainly run by clinical officers (CO), i.e. personnel with a 3-year medical training, and nurses. This study aims to evaluate the effect of a CHW training programme on: i) their knowledge and recognition of HIV-related oral-facial lesions at a community level; and ii) referral of affected patients from the community to the HFs.

  • Stage of HIV presentation at initial clinic visit following a community-based HIV testing campaign in rural Kenya

    Background :

    The Kenyan Ministry of Health and partners implemented a community-based integrated prevention campaign (IPC) in Western Kenya in 2008. The aim of this study was to determine whether the IPC, compared to Voluntary Counselling and Testing (VCT) services, was able to identify HIV positive individuals earlier in the clinical course of HIV infection following testing.


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  • Integrating Tuberculosis and HIV Services in rural Kenya: uptake and outcomes

    Background:

    An estimated 35.3 million persons worldwide were living with the human immunodeficiency virus (HIV) in 2012, while 8.6 million people developed tuberculosis (TB), the majority of them in sub-Saharan Africa. Kenya is one of the world’s 22 high TB burden2 and high HIV burden countries.


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  • When families fail: shifting expectations of care among people living with HIV in Nairobi, Kenya

    Background:

    The availability of free antiretroviral treatment in public health facilities since 2004 has contributed to the increasing biomedicalization of AIDS care in Kenya. This has been accompanied by a reduction of funding for community-based care and support organizations since the 2008 global economic crisis and a consequent donor divestment from HIV projects in Africa. This paper explores the ways that HIV interventions, including support groups, home-based care and antiretroviral treatments have shaped expectations regarding relations of care in the low-income area of Kibera in Nairobi, Kenya, over the last decade.


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  • HIV-associated mortality in the era of antiretroviral therapy scale-up – Nairobi, Kenya, 2015

    Background:

    Declines in HIV prevalence and increases in antiretroviral treatment coverage have been documented in Kenya, but population-level mortality associated with HIV has not been directly measured. In urban areas where a majority of deaths pass through mortuaries, mortuary-based studies have the potential to contribute to our understanding of excess mortality among HIV-infected persons. We used results from a cross-sectional mortuary-based HIV surveillance study to estimate the association between HIV and mortality for Nairobi, the capital city of Kenya.


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  • Automating indicator data reporting from health facility Electronic Medical Reporting (EMR) to a national aggregate data system in Kenya: An Interoperability field-test using OpenMRS and DHIS2

    Background:

    Developing countries are increasingly strengthening national health information systems (HIS) for evidence-based decision-making. However, the inability to report indicator data automatically from electronic medical record systems (EMR) hinders this process. Data are often printed and manually re-entered into aggregate reporting systems. This affects data completeness, accuracy, reporting timeliness, and burdens staff who support routine indicator reporting from patient-level data.


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  • Comprehensive Characterization of Humoral Correlates of Human Immunodeficiency Virus 1 Superinfection Acquisition in High-risk Kenyan Women

    Background:

    HIV-1 superinfection, in which an infected individual acquires a second HIV-1 infection from a different partner, is one of the only settings in which HIV acquisition occurs in the context of a pre-existing immune response to natural HIV infection. There is evidence that initial infection provides some protection from superinfection, particularly after 6 months of initial infection, when development of broad immunity occurs. Comparison of the immune response of superinfected individuals at the time of superinfection acquisition to that of individuals who remain singly infected despite continued exposure can shed light on immune correlates of HIV acquisition to inform prophylactic vaccine design.


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  • The HIV and AIDS Tribunal of Kenya: An Effective Mechanism for the Enforcement of HIV-related Human Rights?

    Abstract

    Established under Section 25 of the HIV Prevention and Control Act of 2006, the HIV and AIDS Tribunal of Kenya is the only HIV-specific statutory body in the world with the mandate to adjudicate cases relating to violations of HIV-related human rights. Yet, very limited research has been done on this tribunal. Based on findings from a desk research and semi-structured interviews of key informants conducted in Kenya, this article analyzes the composition, mandate, procedures, practice, and cases of the tribunal with the aim to appreciate its contribution to the advancement of human rights in the context of HIV. It concludes that, after a sluggish start, the HIV and AIDS Tribunal of Kenya is now keeping its promise to advance the human rights of people living with and affected by HIV in Kenya, notably through addressing barriers to access to justice, swift ruling, and purposeful application of the law. The article, however, highlights various challenges still affecting the tribunal and its effectiveness, and cautions about the replication of this model in other jurisdictions without a full appraisal.


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  • Task-shifting alcohol interventions for HIV+ persons in Kenya: a cost-benefit analysis.

    BACKGROUND:

    Among HIV+ patients, alcohol use is a highly prevalent risk factor for both HIV transmission and poor adherence to HIV treatment. The large-scale implementation of effective interventions for treating alcohol problems remains a challenge in low-income countries with generalized HIV epidemics. It is essential to consider an intervention's cost-effectiveness in dollars-per-health-outcome, and the long-term economic impact -or "return on investment" in monetary terms.



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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.


    METHODS:

    Staff at five pharmacies, supported by on-site research assistants, recruited adult clients (≥18 years) seeking services indicative of HIV risk. Participants were offered oral HST kits (OraQuick®) at US$1 per test. Within one week of buying a test, participants were contacted for post-test data collection and counselling. The primary outcome was test uptake, defined as the proportion of invited clients who bought tests. Views of participating pharmacy staff were solicited in feedback sessions during and after the study.


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  • Jaboya ("Sex for Fish"): A Qualitative Analysis of Contextual Risk Factors for Extramarital Partnerships in the Fishing Communities in Western Kenya.

    Extramarital partnerships exacerbate high HIV prevalence rates in many communities in sub-Saharan Africa. We explored contextual risk factors and suggested interventions to reduce extramarital partnerships among couples in the fishing communities on Lake Victoria, Kenya. We conducted 12 focus group discussions with 9-10 participants each (N = 118) and 16 in-depth interviews (N = 16) with fishermen and their spouses. Couples who participated were consented and separated for simultaneous gender-matched discussions/interviews. Interview topics included courtship and marriage, relationship and sexual satisfaction, extramarital relationships and how to intervene on HIV risks. Coding, analysis, and interpretation of the transcripts followed grounded theory tenets that allow analytical themes to emerge from the participants. Our results showed that extramarital partnerships were perceived to be widespread and were attributed to factors related to sexual satisfaction such as women needing more foreplay before intercourse, discrepancies in sexual desire, and boredom with the current sexual repertoire.


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  • A rapid assessment of post-disclosure experiences of urban HIV-positive and HIV-negative school-aged children in Kenya

    Abstract

    There has been limited involvement of HIV-negative children in HIV disclosure studies; most studies conducted on the effects of disclosure on children have been with HIV-positive children and HIV-positive mother-child dyads. Seven HIV-positive and five HIV-negative children participated in a larger study conducted to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. In this study, the experiences of these 12 children after receiving disclosure of their own and their parents' illnesses respectively are presented. Each child underwent an in-depth qualitative semi-structured digitally recorded interview. The recorded interviews were transcribed and loaded into NVivo8 for phenomenological data analysis. Five themes emerged from the data, indicating that HIV-positive and negative children appear to have differing post-disclosure experiences revolving around acceptance of illness, stigma and discrimination, medication consumption, sexual awareness, and use of coping mechanisms. Following disclosure, HIV-negative children accepted their parents' illnesses within a few hours to a few weeks; HIV-positive children took weeks to months to accept their own illnesses. HIV-negative children knew of high levels of stigma and discrimination within the community; HIV-positive children reported experiencing indirect incidences of stigma and discrimination. HIV-negative children wanted their parents to take their medications, stay healthy, and pay their school fees so they could have a better life in the future; HIV-positive children viewed medication consumption as an ordeal necessary to keep them healthy. HIV-negative children wanted their parents to speak to them about sexual-related matters; HIV-positive children had lingering questions about relationships, use of condoms, marriage, and childbearing options. All but one preadolescent HIV-positive child had self-identified a person to speak with for social support. When feeling overwhelmed by their circumstances, the children self-withdrew and performed positive activities (e.g., praying, watching TV, listening to the radio, singing, dancing) to help themselves feel better. Many HIV-affected families have a combination of HIV-positive and negative siblings within the household. Pending further studies conducted with larger sample sizes, the results of this study should assist healthcare professionals to better facilitate disclosure between HIV-positive parents and their children of mixed HIV statuses. 


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  • Community Perceptions of Community Health Workers (CHWs) and Their Roles in Management for HIV, Tuberculosis and Hypertension in Western Kenya.

    Given shortages of health care providers and a rise in the number of people living with both communicable and non-communicable diseases, Community Health Workers (CHWs) are increasingly incorporated into health care programs. We sought to explore community perceptions of CHWs including perceptions of their roles in chronic disease management as part of the Academic Model Providing Access to Healthcare Program (AMPATH) in western Kenya. In depth interviews and focus group discussions were conducted between July 2012 and August 2013. Study participants were purposively sampled from three AMPATH sites: Chulaimbo, Teso and Turbo, and included patients within the AMPATH program receiving HIV, tuberculosis (TB), and hypertension (HTN) care, as well as caregivers of children with HIV, community leaders, and health care workers. Participants were asked to describe their perceptions of AMPATH CHWs, including identifying the various roles they play in engagement in care for chronic diseases including HIV, TB and HTN.


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  • Uptake and linkage into care over one year of providing HIV testing and counselling through community and health facility testing modalities in urban informal settlement of Kibera, Nairobi Kenya.

    BACKGROUND:

    We examine the uptake of HIV Testing and Counselling (HTC) and linkage into care over one year of providing HTC through community and health facility testing modalities among people living in Kibera informal urban settlement in Nairobi Kenya.


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  • A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya.

    Despite the recognized links between food insecurity, poverty, and the risk of HIV/AIDS, few randomized trials have evaluated the impact of livelihood interventions on HIV risk behaviors. The current study draws upon data collected from a qualitative process evaluation that was embedded into a pilot randomized controlled trial that tested whether a multisectoral agricultural intervention (Shamba Maisha) affected the HIV-related health of HIV-positive adults in rural Kenya.


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  • Economic Context and HIV Vulnerability in Adolescents and Young Adults Living in Urban Slums in Kenya: A Qualitative Analysis Based on Scarcity Theory.

    Abstract

    Urban slum adolescents and young adults have disproportionately high rates of HIV compared to rural and non-slum urban youth. Yet, few studies have examined youth's perceptions of the economic drivers of HIV. Informed by traditional and behavioral economics, we applied a scarcity theoretical framework to qualitatively examine how poverty influences sexual risk behaviors among adolescents and young adults. Focus group discussions with one hundred twenty youth in Kenyan's urban slums were transcribed, coded, and analyzed using interpretive phenomenology.



  • Should HIV testing for all pregnant women continue? Cost-effectiveness of universal antenatal testing compared to focused approaches across high to very low HIV prevalence settings.

    INTRODUCTION:

    HIV testing is the entry point for the elimination of mother-to-child transmission of HIV. Decreasing external funding for the HIV response in some low- and middle-income countries has triggered the question of whether a focused approach to HIV testing targeting pregnant women in high-burden areas should be considered. This study aimed at determining and comparing the cost-effectiveness of universal and focused HIV testing approaches for pregnant women across high to very low HIV prevalence settings.


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  • Multiple HPV infections in female sex workers in Western Kenya: implications for prophylactic vaccines within this sub population.

    BACKGROUND:

    Whilst the imputed role of High Risk (HR) HPV infection in the development of cervical lesions and cancer has been established, the high number of HPV genotypes that Female Sex workers (FSW) harbour warrants that the synergistic effects of potential HR (pHR) and HR HPV genotypes be elucidated to assess the potential impact of prophylactic vaccines. This population in Kenya also harbours a number of other vaginal infections and STIs, including bacterial vaginosis (BV), trichomonas vaginalis (TV) and candida spp. The aims of this cross-sectional analysis in Kenya are to explore the epidemiology of abnormal cytology and the pairing of pHR/HPV genotypes in HIV-negative and HIV-infected FSW.


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  • Dengue and Chikungunya Virus Infections among Young Febrile Adults Evaluated for Acute HIV-1 Infection in Coastal Kenya.

    BACKGROUND: 

    Fever is common among patients seeking care in sub-Saharan Africa (sSA), but causes other than malaria are rarely diagnosed. We assessed dengue and chikungunya virus infections among young febrile adults evaluated for acute HIV infection (AHI) and malaria in coastal Kenya.


    METHODS:

    We tested plasma samples obtained in a cross-sectional study from febrile adult patients aged 18-35 years evaluated for AHI and malaria at urgent care seeking at seven health facilities in coastal Kenya in 2014-2015. Dengue virus (DENV) and chikungunya virus (CHIKV) were amplified using quantitative real-time reverse-transcription polymerase chain reaction. We conducted logistic regression analyses to determine independent predictors of dengue virus infection.


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  • Risk Factors for Hypoxia and Tachypnea Among Adolescents with Vertically-Acquired HIV in Nairobi.

    BACKGROUND:

    Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya.


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  • Association between menopause and unprotected sex in high-risk HIV-positive women in Mombasa, Kenya.

    OBJECTIVE:

    Many HIV-positive women now live well beyond menopause. Postmenopausal women are no longer at risk for pregnancy, and some studies suggest they may use condoms less often than premenopausal women. This study tests the hypothesis that, in HIV-positive women who report trading sex for cash or in-kind payment, unprotected sex is more common at postmenopausal visits compared to premenopausal visits.


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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). Although they might not be directly responsible for health care fund management, PLHIV and their advocacy efforts have been central to the development of HIV system response and they have a vested interest in ensuring proper governance.

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