research & publications

HIV RESEARCH

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  • 'I am treated well if I adhere to my HIV medication': putting patient-provider interactions in context through insights from qualitative research in five sub-Saharan African countries.

    Background:

    The nature of patient-provider interactions and communication is widely documented to significantly impact on patient experiences, treatment adherence and health outcomes. Yet little is known about the broader contextual factors and dynamics that shape patient-provider interactions in high HIV prevalence and limited-resource settings. Drawing on qualitative research from five sub-Saharan African countries, we seek to unpack local dynamics that serve to hinder or facilitate productive patient-provider interactions.


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  • 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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  • Improvements in Physical Well being over the First Two Years on Antiretroviral Therapy in Western Kenya

    Background:

    Improvements in physical wellbeing during the first six months on antiretroviral therapy (ART) are well known, but little is known regarding more long-term follow-up. We conducted a prospective cohort study among 222 HIV-positive adult tea plantation workers in western Kenya to assess wellbeing over their first two years on ART.


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  • Traditional healers, faith healers and medical practitioners: the contribution of medical pluralism to bottlenecks along the cascade of care for HIV/AIDS in Eastern and Southern Africa

    Background:

    There are concerns that medical pluralism may delay patients' progression through the HIV cascade-of-care. However, the pathways of impact through which medical pluralism influence the care of people living with HIV (PLHIV) in African settings remain unclear. We sought to establish the manifestation of medical pluralism among PLHIV, and explore mechanisms through which medical pluralism contributes bottlenecks along the HIV care cascade.

  • 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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  • Influence of faith-based organisations on HIV prevention strategies in Africa: a systematic review

    Background :

    The HIV/AIDS epidemic remains of global significance and there is a need to target sub-Saharan Africa since it is the hardest hit region worldwide. Religion and more specifically faith-based organisations can have an effect on socio-cultural factors that increase or decrease the risk of infection; and offer preventative interventions to the wider community.


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  • Barriers to Antiretroviral Initiation in HIV-1-Discordant Couples

    BACKGROUND :

    In Kenya and much of sub-Saharan Africa, nearly half of all couples affected by HIV are discordant. Antiretroviral therapy (ART) slows disease progression in HIV-1-infected individuals, and reduces transmission to uninfected partners. We examined time to ART initiation and factors associated with delayed initiation in HIV-1-discordant couples in Nairobi.


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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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  • 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.


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  • HIV-positive parents, HIV-positive children, and HIV-negative children’s perspectives on disclosure of a parent’s and child’s illness in Kenya

    Background:

    HIV disclosure from parent to child is complex and challenging to HIV-positive parents and healthcare professionals. The purpose of the study was to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. Sixteen HIV-positive parents, seven HIV-positive children, and five HIV-negative children completed semistructured, in-depth interviews.


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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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  • Widow cleansing and inheritance among the Luo in Kenya: the need for additional women-centered HIV prevention options.

    Background:

    The customs of widow cleansing and widow inheritance are practiced in several communities throughout sub-Saharan Africa. In the Nyanza Province of Kenya, according to tradition, Luo widows are expected to engage in sexual intercourse with a "cleanser," without the use of a condom, in order to remove the impurity ascribed to her after her husband's death. Luo couples, including widows, are also expected to engage in sex preceding specific agricultural activities, building homes, funerals, weddings, and other significant cultural and social events. Widows who are inherited for the purpose of fulfilling cultural obligation have a higher prevalence of HIV than those who remain un-inherited or are inherited for the purpose of companionship.


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  • Advanced HIV disease at presentation to care in Nairobi, Kenya: late diagnosis or delayed linkage to care?—a cross-sectional study

    Background :

    Presenting to care with advanced HIV is common in sub-Saharan Africa and increases the risk of severe disease and death; however, it remains unclear whether this is a consequence of late diagnosis or a delay in seeking care after diagnosis. The objectives of this cross-sectional study were to determine factors associated with advanced HIV at presentation to care and whether this was due to late diagnosis or delays in accessing care.


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  • Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp

    Background :

    Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011–2013) were compared on outcome measures that included viral suppression and adherence to ART.


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  • Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp

    Background :

    Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011–2013) were compared on outcome measures that included viral suppression and adherence to ART.


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  • Low levels of viral suppression among refugees and host nationals accessing antiretroviral therapy in a Kenyan refugee camp

    Background :

    Refugees and host nationals who accessed antiretroviral therapy (ART) in a remote refugee camp in Kakuma, Kenya (2011–2013) were compared on outcome measures that included viral suppression and adherence to ART.


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  • Using theories of practice to understand HIV-positive persons varied engagement with HIV services: a qualitative study in six Sub-Saharan African countries.

    Background:

    This article considers the potential of 'theories of practice' for studying and understanding varied (dis)engagement with HIV care and treatment services and begins to unpack the assemblage of elements and practices that shape the nature and duration of individuals' interactions with HIV services.


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  • Is the promise of methadone Kenya’s solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study

    Background:

    Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the ‘promise of methadone’ to Kenya.


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  • Is the promise of methadone Kenya's solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study.

    Background:

    Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs ((PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the ‘promise of methadone’ to Kenya.WID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the ‘promise of methadone’ to Kenya.


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  • Protocol of a randomised controlled trial characterising the immune responses induced by varicella-zoster virus (VZV) vaccination in healthy Kenyan women: setting the stage for a potential VZV-based HIV vaccine

    Background:

    A protective HIV vaccine would be expected to induce durable effector immune responses at the mucosa, restricting HIV infection at its portal of entry. We hypothesise that use of varicella-zoster virus (VZV) as an HIV delivery vector could generate sustained and robust tissue-based immunity against HIV antigens to provide long-term protection against HIV. Given that HIV uniquely targets immune-activated T cells, the development of human vaccines against HIV must also involve a specific examination of the safety of the vector. Thus, we aim to evaluate the effects of VZV vaccination on the recipients’ immune activation state, and on VZV-specific circulating humoral and cellular responses in addition to those at the cervical and rectal mucosa.


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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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  • Self-care among caregivers of people living with HIV and AIDS in Kakola location, Nyando District, Kisumu County, Kenya

    Background:

     A study by World Health Organization approximated that in developing countries, the need for long-term care will increase by as much as 40% in the coming years. HIV/AIDS has been cited as one of the challenges in long-term care. As demand for long-term care increases, the assumption that extended family networks can meet all the needs of their members deteriorates. The community-based survey employed descriptive cross-sectional design, involving primary caregivers of PLWHAs in Kakola location who had practiced care giving for more than 3 months.


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  • Increasing HIV-1 Pre-Treatment Drug Resistance among Antiretroviral-Naïve Adults Initiating Treatment between 2006 and 2014 in Nairobi, Kenya

    Background:

    Antiretroviral-naïve adults initiating antiretroviral therapy (ART) in Nairobi, Kenya were tested for HIV-1 drug resistance at codons K103N, Y181C, G190A, M184V, and K65R using an oligonucleotide ligation assay (OLA). Prevalence of pre-treatment drug resistance (PDR) increased from 3.89% in 2006 to 10.93% in 2014 (p<0.001), and 95% of those with resistance had at least one non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation. Resistance to tenofovir (K65R) was found in 2014 but not in 2006.Since the widespread introduction of antiretroviral (ARV) therapy (ART) in sub-Saharan Africa there has been concern that HIV-1 drug resistance will become prevalent. Cross-sectional studies have found varying levels of pre-treatment HIV drug resistance (PDR) among ARV-naïve adults that is associated with earlier ART rollout on the continent. This study enrolled ARV-naïve adults at two separate time points in 2006 and 2014 at a single clinic site in Nairobi, Kenya and measured PDR using an oligonucleotide ligation assay (OLA).


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  • 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.


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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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  • 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.


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  • “It's because they care”: understanding pathways to classroom concentration problems among HIV-affected children and youth in Western Kenya

    Background:

    Children and young people living in households affected by HIV are experiencing poorer educational outcomes compared to their peers. This article explores how different forms of marginalisation interface and manifest themselves in classroom concentration problems, undermining their education. This mixed qualitative methods study was conducted with teachers and pupils from three primary and three secondary schools in the Siaya County of Western Kenya. 


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  • The Association of HIV Counseling and Testing with HIV Risk Behaviors in a Random Population-based Survey in Kisumu, Kenya

    Background:

    Voluntary counseling and testing (VCT) traditionally involves an individual actively seeking out HIV testing at a specific testing facility and includes targeted pre- and post-test counseling. This model of VCT has played an essential role in the public health response to HIV in both resource-rich and resource-limited countries. In Kenya, VCT has been promoted as a cost-effective prevention tool, with the potential to stimulate behavior change in individuals who learn their HIV status. With the increasing availability of anti-retroviral therapy (ART) in Kenya over the past 5 years, VCT has taken on the additional role as a point of entry into care. Despite increased access to treatment, the number of HIV-infected people still far outstrips the country’s resources, with ART reaching less than 25% of eligible adults . Effective prevention measures remain crucial to controlling the epidemic.


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  • Circumcision preference among women and uncircumcised men prior to scale-up of male circumcision for HIV prevention in Kisumu, Kenya

    Background:

    Following the endorsement by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) of male circumcision as an additional strategy to HIV prevention, initiatives to introduce safe, voluntary medical male circumcision (VMMC) services commenced in 2008 in several sub-Saharan African communities. Information regarding perceptions of circumcision as a method of HIV prevention, however, is largely limited to data collected before this important endorsement and the associated increase in the availability of VMMC services. To address this, we completed a community-based survey of male circumcision (MC) perceptions in the major non-circumcising community in Kenya, which is the current focus of VMMC programs in the country.


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  • Attitudes and beliefs about anti-retroviral therapy are associated with high risk sexual behaviors among the general population of Kisumu, Kenya

    Background:

    In Kenya approximately 1.4 million people are infected with HIV (National AIDS and STI Control Programme, July 2008). Since 2001 access to antiretroviral therapy (ART) in developing countries has moved to the forefront of the global health agenda. By the end of 2009 ART coverage in Kenya reached approximately 42–55% of people in need (Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector, 2010). As ART availability continues to increase in sub-Saharan Africa, global health organizations have recognized the importance of maintaining the gains made through HIV prevention (Bringing HIV Prevention to Scale: an urgent global priority, 2007; HIV Prevention in the Era of Expanded Treatment Access, 2004). However, there is risk that an overemphasis on treatment programs will detract from prevention efforts and lead to reduced public concern about HIV and increased HIV risk behaviors (a phenomenon termed “risk compensation”).


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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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  • HIV mortality in urban slums of Nairobi, Kenya 2003–2010: a period effect analysis

    Background :

    It has been almost a decade since HIV was declared a national disaster in Kenya. Antiretroviral therapy (ART) provision has been a mainstay of HIV treatment efforts globally. In Kenya, the government started ART provision in 2003 with significantly scale-up after 2006. This study aims to demonstrate changes in population-level HIV mortality in two high HIV prevalence slums in Nairobi with respect to the initiation and subsequent scale-up of the national ART program.


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  • Gender-Specific Combination HIV Prevention for Youth in High-Burden Settings: The MP3 Youth Observational Pilot Study Protocol

    Background :

    Nearly three decades into the epidemic, sub-Saharan Africa (SSA) remains the region most heavily affected by human immunodeficiency virus (HIV), with nearly 70% of the 34 million people living with HIV globally residing in the region. In SSA, female and male youth (15 to 24 years) are at a disproportionately high risk of HIV infection compared to adults. As such, there is a need to target HIV prevention strategies to youth and to tailor them to a gender-specific context. This protocol describes the process for the multi-staged approach in the design of the MP3 Youth pilot study, a gender-specific, combination, HIV prevention intervention for youth in Kenya.


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  • A Study of Zidovudine/Lamivudine and Either Nevirapine or Nelfinavir for Reduction of Mother-to-child HIV Transmission During Breastfeeding (KiBS)

    Background:

    Approximately 800,000 HIV-infected infants are born each year, two thirds of them in sub-Saharan Africa. The rate of HIV transmission from mother to infant is estimated at 13-48% in the absence of antiretroviral treatment. Interventions currently available to prevent mother to child transmission in resource-limited settings among breastfeeding populations child HIV transmission during the breastfeeding period. Because safe alternatives to breastfeeding are not currently a viable option for many HIV-infected women in sub-Saharan Africa, it is important to identify interventions to decrease transmission to the infant during this period.


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  • Cell Phone Intervention to Support Antiretroviral Therapy (ART) Adherence in Kenya

    Background:

    A clinical study to evaluate the use of cell phones to support drug adherence and follow-up of patients taking antiretroviral therapy (ART) for treatment of HIV. The intervention involves health-care providers sending regular short-message-service (SMS) text messages to patients and following up their responses. The hypothesis is that the cell phone intervention will improve ART adherence and health outcomes compared with the current standard of care.


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  • The Efficacy of the HIV/AIDS Symptom Management Manual

    Background:

    People living with HIV/AIDS encounter many psychological, physiological, and cognitive symptoms, such as pain, diarrhea, fever, fatigue, depression, and confusion. These symptoms have been found to restrict a person's daily life significantly. Self-management of multiple HIV and medication side effects symptoms and maintaining optimal quality of life have, therefore, become major daily tasks for people living with HIV/AIDS.


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  • Gendered Differences in the Perceived Risks and Benefits of Oral PrEP Among HIV Serodiscordant Couples in Kenya

    Background:

    Pre-exposure prophylaxis (PrEP) is effective for preventing HIV among HIV serodiscordant heterosexual couples. Gender roles may influence perceived personal and social risks related to HIV prevention behaviors and may affect use of PrEP. In this study, interviews and focus groups were conducted with 68 individuals from 34 mutually disclosed serodiscordant heterosexual partnerships in Thika, Kenya.


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  • Willingness of Kenyan HIV-1 serodiscordant couples to use antiretroviral based HIV-1 prevention strategies

    Background:

    Antiretroviral-based HIV-1 prevention strategies – specifically, antiretroviral treatment (ART) to reduce the infectiousness of HIV-1 infected persons (including when initiated at CD4 counts at or above current WHO guidelines) and pre-exposure prophylaxis (PrEP) to protect HIV-1 uninfected persons from HIV-1 acquisition – are among the most promising new approaches for decreasing HIV-1 spread.1 Stable HIV-1 serodiscordant couples are central to the African HIV-1 epidemic and could be a prime target population for antiretroviral-based HIV-1 prevention; results of landmark clinical trials have recently demonstrated substantial efficacy for these strategies to reduce HIV-1 risk in this population. To limit costs, policies for ART and PrEP in couples could recommend staged use – e.g., PrEP until the HIV-1 infected partner initiates ART – rather than concurrent use of both strategies in the same couple.4 Thus, understanding couples' preferences for and concerns about antiretrovirals for HIV-1 prevention is important to inform guidelines for the use of early ART and PrEP.


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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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  • Prevalence, Perceptions and Correlates of Pediatric HIV Disclosure in an HIV Treatment Program in Kenya

    Background:

    Disclosure to HIV-infected children regarding their diagnosis is important as expanding numbers of HIV-infected children attain adolescence and may become sexually active. In order to define correlates of pediatric disclosure and facilitate development of models for disclosure, we conducted a cross-sectional survey of primary caregivers of HIV-1 infected children aged 6 to 16 years attending a pediatric HIV treatment program in Nairobi, Kenya. We conducted focus group discussions with a subset of caregivers to further refine perceptions of disclosure.


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  • Changes in plasma viral load and penile viral shedding after circumcision among HIV-positive men in Kisumu, Kenya

    Background :

    We conducted a prospective cohort study of HIV-positive men ages 18-35 years in Kisumu, Kenya to determine if medical circumcision of ART-naive HIV-positive men leads to increased viral load and penile viral shedding.


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