research & publications

SRH RESEARCH

Results by County (Approx)
  • 277 results found
  • Barriers and facilitators adolescent females living with HIV face in accessing contraceptive services: a qualitative assessment of providers’ perceptions in western Kenya

    Avoiding unintended pregnancies is important for the health of adolescents living with HIV and has the additional benefit of preventing potential vertical HIV transmission. Health facility providers represent an untapped resource in understanding the barriers and facilitators adolescents living with HIV face when accessing contraception. By understanding these barriers and facilitators to contraceptive use among adolescent females living with HIV, this study aimed to understand how best to promote contraception within this marginalized population.


    Read more

  • 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


    Read more

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

    Background


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


    Read more

  • Cervical HIV-1 RNA shedding after cryotherapy among HIV-positive women with cervical intraepithelial neoplasia stage 2 or 3

    Background

    In resource-limited settings, `see and treat' has been promoted as an economical and effective method to detect and treat cervical intraepithelial neoplasia (CIN) . In such a program, women are examined for cervical neoplasia using visual inspection with acetic acid (VIA) and are treated on the same day with cryotherapy to remove any cervical lesions . This method is inexpensive to administer and decreases loss to follow-up by combining diagnosis and treatment on the same day . As a result, a `see and treat' program can handle a large number of patients and address the immense backlog of women needing cervical cancer screening in resource-limited settings.


    Read More

  • Risk factors for cervical precancer detection among previously unscreened HIV-infected women in Western Kenya

    Background


    HIV and cervical cancer are intersecting epidemics in many low-resource settings, yet there are few accurate estimates of the scope of this public health challenge. To understand disease prevalence and risk factors for cervical intraepithelial neoplasia 2 or greater (CIN2+), we conducted a cross-sectional study of women undergoing cervical cancer screening as part of routine HIV care in Kisumu, Kenya. Women were offered screening with visual inspection with acetic acid, followed by confirmation with colposcopy and biopsy as needed. Univariable and multivariable analyses were carried out to determine clinical and demographic predictors of prevalent CIN2+.

    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

  • Comparison of HPV DNA testing in cervical exfoliated cells and tissue biopsies among HIV-positive women in Kenya

     Background 

    HIV-positive women are infected with human papillomavirus (HPV) (especially with multiple types), and develop cervical intraepithelial neoplasia (CIN) and cervical cancer more frequently than HIV-negative women. We compared HPV DNA prevalence obtained using a GP5+/6+ PCR assay in cervical exfoliated cells to that in biopsies of 468 HIV-positive women from Nairobi, Kenya. HPV prevalence was higher in cells than biopsies and the difference was greatest in 94 women with a combination normal cytology/normal biopsy (prevalence ratio, PR=3.7; 95% confidence interval, CI: 2.4–5.7). PR diminished with the increase in lesion severity (PR in 58 women with high-grade squamous intraepithelial lesions (HSIL)/CIN2-3 =1.1; 95% CI: 1.0–1.2).


    Read More

  • High prevalence of curable sexually transmitted infections among pregnant women in a rural county hospital in Kilifi, Kenya

    Background

    Women attending antenatal care (ANC) in resource-limited countries are frequently screened for syphilis and HIV, but rarely for other sexually transmitted infections (STIs). We assessed the prevalence of curable STIs, defined as infection with either Chlamydia trachomatis or Neisseria gonorrhoeae or Trichomonas vaginalis, from July to September 2015.


    Read More

  • Heterosexual behaviours among men who sell sex to men in coastal Kenya

    Background

    Reviews of HIV prevalence and incidence studies demonstrate the high HIV burden and unmet need for HIV care among men who have sex with men (MSM) populations in all sub-Saharan settings where studies have been undertaken . Transactional activities are commonly documented by men recruited to MSM surveys in Africa, and in these surveys MSM reporting recent sex work often have a higher HIV prevalence than MSM who do not.


    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

  • Effect of engaging cultural institutions and culturally-sensitive facility-based delivery on maternal and newborn health service utilization in Garissa

    PI: Abdhalah Ziraba

    Affiliation: APHRC

    Approving ERC: AMREF

    Approval Date: 22/02/2018

    Duration: 21 months

    Background:

    The “Afya Kwa Ukoo” project is a collaborative formative study between the African Population Health and Research Center (APHRC), Sisters Maternity Home (SIMAHO) and Preventative Health Care and Epidemiology Consultancy (PHCEC). The study aims to test strategies to promote institutional deliveries and uptake of other maternal and child health services among sedentary (pastoral dropouts) residents in Garissa in Kenya.


  • Assessment on Coverage and market share of medical abortion drugs in Kenya

    PI: Edward Kubai

    Affiliation: Marie Stopes Kenya

    Approving ERC: AMREF

    Approval Date: 04/10/2018

    Duration: Not indicated

    Background:

    Exploring the coverage of MA products and market share of its MA brands along with the brands of a competitor. Currently no coverage study has been carried out on MA products in Kenya. What is currently not known is how many people/women in need of MA that have access and are covered. Similarly, not much is known on the quality of provision of MA in most of outlets. The coverage study is aimed at filling this information gap of which areas are covered or not, in relation to access to outlets / facilities selling or providing MA. It will also provide data on quality standards of Misoprostol provision relating to adherence to recommended prices, merchandising, promotion, provider training, and other criteria that may influence its’ delivery, purchase and use.


  • Evaluation of Staying Alive Project’s contribution to reduction of mortality and morbidity in Maternal and Newborn Health in West Pokot County

    PI: DAVID ALNWICK

    Affiliation: IPE GLOBAL AFRICA

    Approving ERC: AMREF

    Approval Date: 9/10/2017

    Duration: 200 days

    Background:  

    In rural Kenya maternal and child survival has always been a challenge for the government. The poverty level where most people survive on less than a dollar a day has made it difficult for families to access basic health care.


  • Implementing a management decision support system to improve quality of maternal and newborn health services in health facilities of Embakasi East and South, Nairobi.

    PI: FRIDA NJOGU

    Affiliation: LEXLINK CONSULTING

    Approving ERC: AMREF

    Approval Date: 9/19/2017

    Duration: 21 months

    Background: 

    Kenya has unacceptably high maternal and newborn mortality. While skilled delivery rates are high in Nairobi, outcomes particularly in informal settings are poor, suggesting poor quality of services.

  • Leadership and Decision making on Female Genital Mutilation/Cutting among the Maasai in Kajiado County: Case of the Beaded stick and Beyond

    PI: TABITHER GITAU

    Affiliation: INDEPENDENT CONSULTANT FOR KIT

    Approving ERC: AMREF

    Approval Date: 2/10/2017

    Duration: October-November 2017

    Background:

    The Maasai practice polygamy, female genital mutilation/cutting and child marriage. Among these traditional practices, the FGM/C rite is done to initiate a girl into womanhood.


  • Assessement of Drivers of Migration and Sexual Reproductive Health and Rights Needs of Young Migrants Between The Ages of 15-24 Years in Nairobi

    PI: EZEKIEL NGURE

    Affiliation: UNITED NATIONS POPULATION FUND,KENYAN COUNTRY OFFICE AND DANISH REFUGEE COUNCIL

    Approving ERC: AMREF

    Approval Date: 11/10/2017

    Duration: 4 months(September to December 2017)

    Background: 

    More than half of refugees and asylum seekers in Kenya are below the age of 18 years.

  • Baseline Survey For Integrated Alternative Rite Passage And Water Sanitation Hygiene Project In Kajiado County

    PI: DENGE LUGAYO

    Affiliation: AMREF HEALTH AFRICA IN KENYA

    Approving ERC: AMREF

    Approval Date: 11/10/2017

    Duration: September and October 2017

    Background: 

    Access to improved water sources in Kenya is currently at 63% while sanitation lags behind at only 30%(WHO/UNICEF, 2015).

  • Assessment of youth education on family planning in Lwala, Migori County, Kenya

    PI: KAITLIN GECK

    Affiliation: VANDERBILT UNIVERSITY SCHOOL OF MEDICINE & INSTITUTE OF GLOBAL HEALTHV

    Approving ERC: AMREF

    Approval Date: 11/30/2017

    Duration: January- March, 2018

    Background: 

    Lwala Community Alliance serves to build the capacity of people of North Kamagambo in Migori County, Kenya to advance their own comprehensive well-being. Part of this initiative includes providing contraceptives and education about family planning.


  • Improving access and utilisation of maternal and newborn health services: a Mid-Term Evaluation of the Uzazi Salama Project in Samburu County,Kenya Maternal Neonatal Health Project

    PI: DIANA MUKAMI

    Affiliation: AMREF HEALTH AFRICA

    Approving ERC: AMREF

    Approval Date: 7/6/2017

    Duration: 3 months

    Background:

    The Uzazi Salama initiative endeavours to significantly decrease the maternal mortality and morbidity in the County thus improving the County’s Maternal and New-born Health (MNH) outcomes.


  • Investigating the social co-construction of masculinity(ies) and sexual development among very young male adolescents in urban slums in Nairobi, Kenya

    PI: Beatrice Maina

    Affiliation: University of Witwatersrand

    Approving ERC: AMREF

    Approval Date: 13/11/17

    Duration: 2 years

    Background: 

    Investigate the social co-construction of masculinities and sexual development among VYMA aged 10 – 14 years living in Korogocho slum of Nairobi, Kenya and to examine how slum contexts shape the co-construction of masculinities. 

  • Knowledge of Obstetric Danger Signs among Community Health Providers: A Comparative Analysis

    PI: Sarah Heerboth

    Affiliation: Vanderbilt University School of Medicine,

    Approving ERC: AMREF

    Approval Date: 11/1/2018

    Duration: 3 months

    Background: 

    Lwala Community Alliance is a community led organization that serves the people of North Kamagambo in Migori County, Kenya.


  • End-Term Evaluation of Putting African Mothers, New Born and Children First Action; Addressing Social Disparities in Maternal, Newborn And Child Health, Nutrition And Family Planning through a Health Related Poverty Initiative in Mwingi Central and Mwingi West in Kitui County.

    PI: Samuel Okumu

    Affiliation: Amref Health Africa in Kenya

    Approving ERC: AMREF

    Approval Date: 16/02/2018

    Duration: 5 years

    Background: 

    Amref Health Africa in Kenya, with funding from European Union and Amref Health Africa in Italy has been implementing a five year project named “Putting African Mothers, newborn and children first” in Kitui County.


  • Improving Adolescent Girls’ Sexual And Reproductive Health In Kenya By Developing Girls Circles Using The H3 Methodology

    PI: Caroline Kisia

    Affiliation: Action Africa Help International

    Approving ERC: AMREF

    Approval Date: 26/01/2018

    Duration: 18 months

    Background: 

    Kenyan adolescent girls living in pastoral communities are vulnerable to Sexual Reproductive Health and Rights (SRHR) challenges such as: early and unintended pregnancy, unsafe abortion, HIV/AIDS, sexually transmitted infections, and gender based violence/discrimination.


  • Teenage pregnancy in Homa Bay County:A rapid assessment to determine the cause and possible solutions to teenage pregnancies in Homa Bay County

    PI: Peter Gichangi

    Affiliation: Internation Centre for Reproductive Health

    Approving ERC: AMREF

    Approval Date: 19/06/2017

    Duration: 2 months

    Background:  


    Adolescent pregnancies are more likely in poor, uneducated and rural communities. In some countries, becoming pregnant outside marriage is not uncommon. By contrast, some girls may face social pressure to marry and, once married, to have children. More than 30% of girls in low- and middle-income countries marry before they are 18; around 14% before they are 15. (WHO, 2014). In Kenya, teenage pregnancy is not only a reproductive health issue, but is also a multi facet issue as it directly affects the current and future socio-economic well-being of women. 


  • 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. 


  • HSV-2 Suppression to Reduce Maternal HIV-1 RNA Levels During Pregnancy and Breastfeeding (VIP)

    Background:

    Each year over 500,000 children become HIV-1-infected in sub-Saharan Africa after exposure to maternal virus in blood, genital secretions, and breast milk. Identifying feasible, safe, and affordable interventions that prevent mother-to-child transmission remains a priority for HIV-1 prevention research. Interventions to reduce breast milk HIV-1 transmission are lacking and most urgently needed.


    Read More

  • Financial Incentives to Increase Pediatric HIV Testing (FIT)

    Background:

    The purpose of this study is to determine whether giving small financial incentives will motivate parents to test their children for HIV.The study will be a randomized controlled trial (RCT) with 5 arms with equal allocation to each arm: no incentive, or one of 4 different levels of financial incentive. We will randomize 800 parents with children of unknown status at HIV treatment clinics in Western Kenya.


    Read More

  • Study of Cell Phone SMS Messages for Prevention of Maternal to Child Transmission of HIV

    Background:

    Optimal development of sustainable health systems must use locally relevant infrastructure. Mobile phone technology, driven primarily by local market forces rather than foreign assistance, is spreading rapidly through African communities to improve people's personal and business communications. Here, the investigators propose using a structured mobile phone communications system for prevention of mother to child transmission of HIV (PMTCT). The system is designed to improve antenatal linkage to care, provide reminders to take PMTCT medications, and improve post-natal support and follow-up, even when mothers deliver at home. In addition to benefits in PMTCT related outcomes, this model allows evaluation of the intervention in a public health setting with the ultimate goal of advancing regional health systems development. The overall goal of of the study is to assess if mobile phones and SMS text messages can be used to help improve prevention of maternal to child transmission (PMTCT) of HIV services by strengthening health systems.


    Read More

  • 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.


    Read More

  • End-Users’ Product Preference Across Three Multipurpose Prevention Technology Delivery Forms: Baseline Results from Young Women in Kenya and South Africa

    Background:

    Multipurpose prevention technologies (MPTs) are biomedical interventions that provide protection from both sexually transmitted infections, such as HIV, and unintended pregnancy. A dual-purpose product that combines HIV and pregnancy prevention could offer advantages over single-indication products. In recent population-based surveys, 4 in 10 women in Kenya and 89% of women ages 18–24 in South Africa were current users of modern contraceptive methods. A contraceptive product that also confers protection against HIV could lead to greater coverage of prevention methods in these countries than a single-purpose HIV prevention method.


    Read more

  • Financial Incentives to Increase Pediatric HIV Testing Pilot Study

    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.

    Read more

  • ARVs to Prevent Breastmilk HIV:Viral and Immune Responses

    Background:

    Identifying new approaches for preventing breastmilk transmission of HIV-1 is an important research priority. To this end, clinical trials are underway to evaluate the efficacy of HAART (zidovudine, lamivudine, nevirapine) during late pregnancy/lactation versus zidovudine/nevirapine peripartum for prevention of breastmilk HIV-1 transmission. It is important to understand the mechanism of effect of these antiretroviral (ARV) strategies on prevention of breastmilk HIV-1 transmission.


    Read more

  • Persistently HIV-1 seronegative Nairobi sex workers are susceptible to in vitro infection

    Background:

    Several studies have reported on individuals that remain persistently seronegative despite repeated exposure to the HIV type 1 (HIV-1). These have included health care workers with accidental exposure (1), infants born to infected mothers (2-4), needle-sharing intravenous drug users (5), individuals engaged in unprotected sexual intercourse (6,7) and prostitutes (8,9). The risk for infection among these cohorts varied greatly, and T cell-mediated immunity, as measured by interleukin (IL)-2 production, lymphocyte proliferation in response to HIV-derived peptides or HIV-specific cytotoxic T lymphocytes, was thought to contribute to resistance in these cases (1-4,6,7,9,10). The proposed mechanism involved priming of T cell responses with low antigenic doses, and generation of cytokine-mediated T helper cell type 1 (Th1) immune responses, which upregulate cellular effector functions and downregulate T cell help for B cells .


    Read more

  • End-Users' Product Preference Across Three Multipurpose Prevention Technology Delivery Forms: Baseline Results from Young Women in Kenya and South Africa.

    Background:

    A multipurpose prevention technology (MPT) that combines HIV and pregnancy prevention is a promising women's health intervention, particularly for young women. However, little is known about the drivers of acceptability and product choice for MPTs in this population. This paper explores approval ratings and stated choice across three different MPT delivery forms among potential end-users.


    Read more

  • Successful increase in contraceptive uptake among Kenyan HIV-1-serodiscordant couples enrolled in an HIV-1 prevention trial.

    Background:

    Sub-Saharan Africa has the highest prevalence and incidence of HIV-1 infection in the world, and the region also has high fertility rates, with approximately 14 million pregnancies annually considered unintended. As an example, in Kenya, HIV-1 seroprevalence is 7.1%, 60% of HIV-1 infected adults are women, the total fertility rate is 4.7 births per woman, and it has been estimated that there is a 25% unmet need for family planning among married women.


    Read more

  • Increased Risk of HIV-1 Transmission in Pregnancy: A Prospective Study among African HIV-1 Serodiscordant Couples

    Background :

    Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners.


    Read more

  • A Prospective Study of Frequency and Correlates of Intimate Partner Violence among African Heterosexual HIV Serodiscordant Couples

    Background :

    Intimate partner violence (IPV) is common worldwide and is an important consideration in couples HIV voluntary counseling and testing (CVCT), especially for HIV serodiscordant couples (i.e., in which only one member is HIV infected).


    Read more

  • Social Exchange and Sexual Behavior in Young Women's Premarital Relationships in Kenya.

    Background:

    Although HIV incidence in sub-Saharan Africa has been in slow decline, the epidemic continues in the region, with an estimated 1.8 million people newly infected in 2009 alone (Joint United Nations Program on HIV/AIDS [UNAIDS], 2010). Importantly, young women are disproportionately affected (Gouws, Staneckib, Lyerla, & Ghys, 2008; UNAIDS, 2010). In Kenya, women ages 20–24 are four times more likely to be HIV positive (7.4%) than men of the same age group (1.9%) (National AIDS and STI Control Programme [NASCOP], 2009). Researchers and policymakers have paid increasing attention to the role of transactional sex, or the exchange of money and gifts (what we refer to as “transfers”) within non-marital relationships, as a key explanation for the gender difference in infection rates (Côté et al., 2004; Dunkle, Jewkes, Brown, Gray, McIntryre, & Harlow, 2004; Hope, 2007). 

  • Contraceptive method and pregnancy incidence among African women in HIV-1 serodiscordant partnerships

    Background :

    Effective contraception reduces unintended pregnancies and is a central strategy to reduce vertical HIV-1 transmission for HIV-1 infected women.


    Read more

  • 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.


    Read more

  • Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs

    Background :

    HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.


    Read more

  • Correlates of prevalent sexually transmitted infections among participants screened for an HIV incidence cohort study in Kisumu, Kenya

    Background :

    We determined the prevalence of four sexually transmitted infections and the demographic and behavioural correlates associated with having one or more sexually transmitted infections among participants in an HIV incidence cohort study in Kisumu, western Kenya.


    Read more

  • Correlates of prevalent sexually transmitted infections among participants screened for an HIV incidence cohort study in Kisumu, Kenya

    Background :

    We determined the prevalence of four sexually transmitted infections and the demographic and behavioural correlates associated with having one or more sexually transmitted infections among participants in an HIV incidence cohort study in Kisumu, western Kenya.


    Read more

  • Correlates of prevalent HIV infection among adults and adolescents in the Kisumu incidence cohort study, Kisumu, Kenya.

    Background:

    To more effectively control HIV epidemics, correlates of HIV infection need to be better understood, and prevention strategies adapted to account for risk patterns linked to particular settings or situations. Several factors have been associated with HIV infection in sub-Saharan Africa, including extramarital sex, multiple sexual partners,inconsistent or lack of condom use, the absence of male circumcision,and most recently, hormonal contraceptive use. Physiological factors, such as having a sexually transmitted infection (STI), particularly ulcerative genital diseases such as herpes simplex virus type 2 (HSV-2), have also been found to increase infectiousness and susceptibility to HIV infection via a variety of biological mechanisms.

    Read More


    Read More

  • Cost-effectiveness of cervical cancer screening and preventative cryotherapy at an HIV treatment clinic in Kenya

    Background:

    Cancer is a growing cause of mortality worldwide, and cervical cancer is one of the leading causes of cancer death in sub-Saharan Africa (SSA). Although preventable if detected early, cervical cancer is one of the most prevalent cancers on the continent with 75,000 incident cases per year. In addition to the cancer burden, more than 10 million women are infected with HIV and are therefore at greater risk for cervical cancer and early mortality, making early detection and prevention critical for this already vulnerable population . 


    Reducing cervical cancer among HIV-infected women is a primary focus of the Pink Ribbon Red Ribbon Initiative, a joint public–private international program launched in 2011 supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) . The initiative promotes integrating cervical cancer screening and treatment into HIV treatment clinics in sub-Saharan Africa.


    Read More

  • Risk factors for postpartum depression in women living with HIV attending Prevention of Mother–to-Child Transmission (PMTCT) Clinic at Kenyatta National Hospital, Nairobi

    Background:

    Mothers with HIV face a range of psychosocial problems, including postpartum depression (PPD) (Vesga-Lopez, Blanco, Keyes, Olfson, Grant, & Hasin, 2008) which impacts HIV disease progression in the mother and has lasting impacts for child health (Hartley, Pretorius, Mohamed, Laughton, Madhi, Cotton & Seedat, 2010). Depression is a highly prevalent co-morbidity among HIV+ individuals (Owe-Larsson, Sall, Salamon, Allgulander, 2009). It is inversely correlated with self-esteem, infant health status, and years of formal education (Ross, Sawatphanit, Mizuno & Takeo, 2011). High prevalence of depressive symptoms amongst pregnant HIV+ women areassociated with increased risk of adverse pregnancy outcomes and poor quality of life (Kapetanovic, Dass-Brailsford, Nora & Talisman, 2014). Additionally, women with HIV experience lower levels of emotional support available to them (Bonacquisti, Geller, Aaron, 2014).

    Perinatal depression is reported to be as high as 30–50 % in South Africa (Chibanda et al., 2010; Hartley et al., 2011; Rochat, Tomlinson, Barnighausen, Newell, and Stein, 2011; Stewart et al., 2010). In Nyanza province of Kenya HIV prevalence is as high as 20.7% in antenatal care settings (Dillabaugh et al., 2012). Stigma is known as a substantial barrier in adhering to and accessing HIV/AIDS care. Furthermore stigma contributes to depressive symptomatology (Rao et al., 2012) compounding the negative impact on women living with HIV.


    Read More

  • Treatment interruption after 2-year antiretroviral treatment (ART) initiated during acute/early HIV in infancy: a randomized trial

    Background:

    Early antiretroviral treatment (ART) is recommended for HIV-infected infants based on significant benefits of early versus eligibility-deferred ART. Prior to widespread ART use, some HIV-infected untreated children had long-term non-progression (LTNP). It is plausible that some children who would be LTNP without therapy, as well as others who control virus following early ART, could benefit from treatment interruption (TI) after immune recovery. This approach could reduce ART toxicity or resistance and preserve ART regimens for later in life.The objective of this study was to compare outcomes in treatment interruption versus continued ART among early-treated infants.


    Read More

  • Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya.

    Background:

    In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to antiretroviral therapy. Therefore, in these settings, timed unprotected intercourse without assurance of HIV viral suppression may pose unnecessary risks. Timed vaginal insemination, a simple and affordable intervention, can be considered an adjunct method and option of safer conception for HIV prevention with treatment of the HIV-infected partner and/or pre-exposure prophylaxis.


    Read More

  • Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge

    Background:

    Adolescents have the highest HIV incidence of any age group and are the only age group in which HIV-related mortality increased between 2005 and 2013. While substantial progress has been made in HIV testing and treatment for adult populations, there has been less programmatic focus on adolescents (aged 10–19 years) and young adults (aged 20–24 years). Eighty-three per cent of all adolescents living with HIV reside in sub-Saharan Africa (SSA), and yet just 9–13% of adolescent boys and girls in the region have tested for HIV in the past year.


    Read More

  • 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.


    Read More