research & publications

HIV RESEARCH

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  • 552 results found
  • 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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  • 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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  • Younger age at HAART initiation is associated with more rapid growth reconstitution

    Worldwide, more than 2.5 million children are infected with human immunodeficiency virus (HIV-1), nearly 90% of whom are living in sub-Saharan Africa. A common feature of HIV-1 infection in children is growth failure. HIV-1-infected infants tend to have substantially lower weight and height compared to HIV-1-uninfected children of similar age. In Africa, many HIV-1-infected children also lack adequate nutrition. Malnourished HIV-1-infected children struggle to meet metabolic demands of growth and development, and poor nutrient status weakens the immune system and decreases the likelihood of survival. Growth faltering has been reported in up to 50% of untreated HIV-1-infected children in resource-limited settings.

    Highly active antiretroviral therapy (HAART) suppresses viral replication and results in immune recovery and growth reconstitution in HIV-1-infected children. Although HAART improves growth in pediatric HIV-1, the pattern and determinants of growth reconstitution following HAART are not well defined. In the US, HIV-1-infected children generally achieve normal weight-forage Z-scores (WAZ) within a year of HAART initiation and experience improvement in height-for-age Z-scores (HAZ) by 2 years. In Africa, baseline WAZ and HAZ in untreated HIV-1-infected children are substantially lower (typically with Z-scores <−2 which is <2nd percentile) than reported in US/European cohorts (Z-scores >−0.5, or >30th percentile).


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  • ART treatment costs and retention in care in Kenya: a cohort study in three rural outpatient clinics

    Background:

    After almost 10 years of PEPFAR funding for antiretroviral therapy (ART) treatment programmes in Kenya, little is known about the cost of care provided to HIV-positive patients receiving ART. With some 430,000 ART patients, understanding and managing costs is essential to treatment programme sustainability.


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  • Measuring adherence to antiretroviral therapy in children and adolescents in western Kenya

    Introduction :

    High levels of adherence to antiretroviral therapy (ART) are central to HIV management. The objective of this study was to compare multiple measures of adherence and investigate factors associated with adherence among HIV-infected children in western Kenya.


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  • Risk factors for cervical pre cancer 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.


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  • Effectiveness of option B HAART in prevention of mother-to-child transmission (PMTCT) in pregnant HIV women

    Background :

    Ensuring that no baby is born with HIV is an essential step towards achieving an AIDS-free generation. To achieve this, strategies that decouple links between childbirth and HIV transmission are necessary. Traditional forms of prevention of mother-to-child transmission of HIV (PMTCT), has been recommended. Recognizing the importance and challenges of combination of methods to achieve rapid PMTCT, the World Health Organization (WHO) recommended option B Highly Active Antiretroviral Therapy (HAART) for all HIV-positive pregnant women. This study aimed to evaluate the effectiveness of the HAART in PMTCT. A cohort of HIV-infected pregnant women in Kenya were obtained from the DREAM Center, Nairobi. The study participants underwent adherence counselling and Option B of HAART [Nevirapine(NVP) + Lamivudine + Zidovudine] at the fourth week of gestation followed by an intravenous NVP administration intrapartum and postpartum NVP syrup to the respective infants for six weeks. Absolute pre-HAART and post-HAART CD4 counts and viral loads counts were determined. Comparison of the CD4 counts and viral loads before and after administration of HAART were done using Wilcoxon’s Matched Pairs Signed-Ranks Test.


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  • Home Visits during Pregnancy Enhance Male Partner HIV Counseling and Testing in Kenya: A Randomized Clinical Trial

    Background :

    HIV testing male partners of pregnant women may decrease HIV transmission to women and promote uptake of prevention of mother-to-child HIV transmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) clinics. We hypothesized that home visits to offer HIV testing to partners of women attending ANC would increase partner HIV testing.


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  • Prevention of mother-to-child transmission of HIV in Kenya: challenges to implementation

    Background :

    The prevention of mother-to-child transmission of human immunodeficiency virus (HIV) is lauded as one of the more successful HIV prevention measures. However, despite some gains in the prevention of mother-to-child transmission of HIV (PMTCT) in sub-Saharan Africa, mother-to-child transmission rates are still high. In Kenya, mother-to-child transmission is considered one of the greatest health challenges and scaling up PMTCT services is crucial to its elimination by 2015. However, guideline implementation faces barriers that challenge scale-up of services. The objective of this paper is to identify barriers to PMTCT implementation in the context of a randomized control trial on the use of structured mobile phone messages in PMTCT.


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  • Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study

    Background :

    Women’s ability to safely disclose their HIV-positive status to male partners is essential for uptake and continued use of prevention of mother-to-child transmission (PMTCT) services. However, little is known about the acceptability of potential approaches for facilitating partner disclosure. To lay the groundwork for developing an intervention, we conducted formative qualitative research to elicit feedback on three approaches for safe HIV disclosure for pregnant women and male partners in rural Kenya.


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  • HIV, Violence and Women: Unmet mental health care needs

    Background :

    HIV-infected (HIV+) women have high rates of Gender Based Violence (GBV). Studies of GBV find that approximately 50-90% of survivors develop mood and anxiety disorders. Given that women in sub-Saharan African constitute the largest population of HIV+ individuals in the world and the region's high GBV prevalence, mental health research with HIV+ women affected by GBV (HIV+GBV+) in this region is urgently needed.


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  • Cross-sectional survey of treatment practices for urethritis at pharmacies, private clinics and government health facilities in coastal Kenya: many missed opportunities for HIV prevention.

    Background:

    While bacterial sexually transmitted infections (STIs) are important co- factors for HIV transmission, STI control has received little attention in recent years. The aim of this study was to assess STI treatment and HIV testing referral practices among health providers in Kenya.


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  • HIV type 1 drug resistance patterns among patients failing first and second line antiretroviral therapy in Nairobi, Kenya

    Background:

    The ever-expanding roll out of antiretroviral therapy in poor resource settings without routine virological monitoring has been accompanied with development of drug resistance that has resulted in limited treatment success.


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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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  • Process and Outcome Evaluation of a Community Intervention for Orphan Adolescents in Western Kenya

    Background:

    HIV/AIDS continues to be one of the most serious challenges to global health, with 33.3 million people living with the disease in 2009.In Sub-Saharan Africa (SSA), where the vast majority of new cases and deaths occur, an estimated 15 million orphans have lost one or both parents. Orphan youth are more likely to face malnutrition,school drop-out, poor psycho social well-being and earlier sexual debut . Despite recognition of these vulnerabilities, challenges in caring for orphans persist, and orphan groups are only peripherally included in HIV prevention research.

    In SSA, a surviving parent, grandparent, aunt or uncle are the main caregivers for orphans, while some exceptionally vulnerable children live in orphan-headed households.Care in orphanages has been deemed expensive and cost ineffective, often resulting in worse outcomes for children due to high child-to-staff ratios, lack of social bonding and life skills, and stigma. Although care by biological relatives is preferred, families in high prevalence, low resource communities have become overwhelmed by the numbers and needs of orphans, and remaining HIV-infected parents or other caregivers may themselves die before the orphan reaches adulthood.


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  • "If I am given antiretrovirals I will think I am nearing the grave:" Kenyan HIV serodiscordant couples' attitudes regarding early initiation of antiretroviral therapy

    Background:

    Initiation of antiretroviral therapy (ART) by HIV-infected persons – that is, at higher CD4+ cell counts (>350 cells/μl) – is a potent HIV prevention strategy.The WHO recommends ART initiation irrespective of CD4+ cell count for HIV-infected members of HIV serodiscordant couples.Studies from a variety of settings have reported that some HIV-infected individuals are not willing to initiate ART, but few studies have directly explored early ART initiation. Among 181 HIV-infected Kenyan individuals with CD4+ cell counts higher than 350 cells/μl and known HIV-uninfected partners, approximately 40% reported reluctance to consider early ART, citing side-effects, stigma, pill burden, and ART resistance.In the control arm of HIV Prevention Trials Network (HPTN) 052, nearly 20% of HIV-infected participants declined ART when offered after the trial demonstrated HIV protection – many stating that they were not ready to begin ART or believed their CD4+ cell count was too high .Recent studies have suggested that higher CD4+ cell counts are associated with delayed ART initiation or refusal .

    Socially constructed perceptions of HIV are important to understand refusal, uptake, and adherence to HIV treatment and prevention. In high-income settings, the social definition of HIV has been shifted from a universally fatal disease to a chronic, manageable illness because of the advent of highly effective ART.The reconceptualization of HIVas a treatable disease has a profound social and psychological impact: restored hope, a return to normalcy, and potentially reduced stigma, but also the burden of managing an ongoing, unpredictable illness and adhering to treatment. It is hypothesized that the transition of HIV to a chronic illness will reduce stigma, an important barrier to engagement in HIV services, as HIV-infected individuals on ART can remain healthy and maintain a `normal' identity and life, concealing their HIV status and avoiding potential negative reactions from others. Less has been described about reconceptualization of HIV as a chronic, treatable illness in Africa, where ART availability is more recent and is generally initiated at low CD4+ cell counts. Particularly unknown is the conceptualization of earlier initiation of ART. This qualitative study explored HIV serodiscordant couples' attitudes toward the early initiation of ART.


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  • My intention was a child but I was very afraid: Fertility intentions and HIV risk perceptions among HIV serodiscordant couples experiencing pregnancy in Kenya

    Background:

    Natural conception poses substantial risk of HIV transmission in HIV serodiscordant partnerships (Kisakye, Akena & Kaye, 2010; Mathews et al.,2013; Nattabi, Thompson, Orach & Earnest 2012) yet fertility rates in such partnerships are often high (Heffron et al., 2010; Ngure et al., 2012). Fertility desires among HIV-infected men and women are strong and influenced by personal, interpersonal, and cultural factors (Chen, Phillips, Kanouse, Collins & Miu, 2001; Cooper et al., 2009; Kaida et al.,2013; Nattabi, Thompson, Orach & Earnest, 2009; Paiva et al., 2007). Assisted reproductive technologies (Mathews, Baeten, Celum & Bangsberg,2010), antiretroviral therapy (ART) to reduce the infectiousness of HIV-infected persons (Cohen et al.,2011), and pre-exposure prophylaxis (PrEP) for HIV-uninfected persons (Baeten et al., 2012) offer new approaches to reduce the risk of horizontal HIV transmission during conception.

    Few studies have explored how HIV serodiscordant couples balance fertility desires against their HIV risk and men are rarely included in these studies. We sought to explore fertility intentions, risk considerations, and the acceptability of potential risk reduction strategies among both members of Kenyan HIV serodiscordant couples who recently conceived, to inform interventions to reduce HIV transmission risk during peri-conception in serodiscordant relationships.


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

    Background:

    Antiretroviral treatment (ART) and pre-exposure prophylaxis (PrEP) have demonstrated efficacy as new human immunodeficiency virus-1 (HIV-1) prevention approaches for HIV-1 serodiscordant couples.


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  • Achieving Pregnancy Safely: Perspectives on Timed Vaginal Insemination among HIV-Serodiscordant Couples and their Healthcare Providers in Kisumu, Kenya

    Background:

    In African culture, reproduction is linked to individual identity, worth, and social status (Ujiji et al., 2010; Cooper et al., 2007). Successful antiretroviral therapy (ART) has prompted HIV-infected individuals to pursue fulfillment of childbearing desires. Heterosexual HIV-sero discordant couples may account for at least 50% of new HIV infections in Kenya, and transmission nearly doubles in partnerships where pregnancy occurs (Guthrie et al., 2007; Dunkle et al., 2008; Matthews et al., 2010; Coburn et al., 2011; Brubaker et al., 2011). HIV-serodiscordant couples desiring children knowingly risk HIV transmission with unprotected intercourse. Risk reduction strategies to decrease or eliminate unprotected intercourse for conception should represent a critical target for HIV prevention initiatives.

    Timed vaginal insemination (TVI) during the fertile period is a simple, low-cost intervention requiring a syringe and a water-based lubricated condom. However, socio-cultural perceptions concerning the use of assisted reproductive methods for achieving pregnancy outside of unprotected penile-vaginal penetration may not be acceptable from a cultural or a personal perspective (Horbst, 2012). Prior to initiating an observational study evaluating acceptability and feasibility of TVI (ClinicalTrials.gov identifier: NCT01468753), we conducted formative research in Kisumu, Kenya to assess how HIV-serodiscordant couples and healthcare providers would approach TVI.


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  • Preventing HIV infection without targeting the virus: how reducing HIV target cells at the genital tract is a new approach to HIV prevention

    Background:

    According to the latest UNAIDS report, 36.7 million people are living with HIV/AIDS worldwide. Despite the development of new antiretroviral drugs and better access to care and prevention programs, the number of new HIV cases has remained over 2 million per annum over the past 10 years with a very slow rate of decline . Clearly, existing prevention methods are not sufficient and new approaches are required. However, to develop new biomedical prevention methods, we need a better understanding of the factors driving susceptibility to HIV infection.


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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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  • HIV-Positive Status Disclosure and Use of Essential PMTCT and Maternal Health Services in Rural Kenya

    Background:

    In sub-Saharan Africa, women's disclosure of HIV-positive status to others may affect their use of services for prevention of mother-to-child transmission of HIV (PMTCT) of HIV and maternal and child health—including antenatal care, antiretroviral drugs (ARVs) for PMTCT, and skilled birth attendance.


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  • Prospective comparison of two models of integrating early infant male circumcision with maternal child health services in Kenya: The Mtoto Msafi Mbili Study

    Background:

    Numerous observational studies and three randomized controlled trials have shown male circumcision to be approximately 60% effective in reducing HIV acquisition in heterosexual men in sub-Saharan Africa .WHO/UNAIDS urges male circumcision be offered as one component of a comprehensive HIV prevention package and recommends that countries consider early infant male circumcision (EIMC) as a long-term sustainable HIV prevention strategy. Large scale EIMC would represent a transition from managing the HIV epidemic as an emergency towards a focus on sustainable, long-term solutions to this major global health challenge. Recognizing this, the Kenyan Government’s national strategy to scale up voluntary medical male circumcision includes plans to transition from adolescent and adult male circumcision (AMC) to predominantly EIMC .


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  • Pharmacokinetics-based adherence measures for antiretroviral therapy in HIV-infected Kenyan children

    Background:

    Traditional medication adherence measures do not account for the pharmacokinetic (PK) properties of the drugs, potentially misrepresenting true therapeutic exposure.


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  • Preferences for PrEP or iPrEP regimens and ability to anticipate sex among HIV uninfected members of Kenyan HIV serodiscordant couples

    Background:

    Pre-exposure prophylaxis (PrEP) is a promising new strategy for the prevention of HIV infection.Clinical trials have demonstrated that oral tenofovir (TDF) and combination emtricitabine/tenofovir (FTC/TDF), when taken daily, are effective for HIV prevention in several populations, including heterosexual men and women,men who have sex with men (MSM) and injection drug users .However, the effectiveness of PrEP depends strongly on participant adherence. In two clinical trials that did not demonstrate PrEP efficacy ,low adherence is the leading hypothesis to explain the lack of HIV protection.

    Intermittent PrEP (iPrEP) has been proposed as an alternative to daily PrEP to reduce cost, toxicity, and patient burden and to improve adherence among those who find daily pill-taking challenging or unacceptable.Optimal iPrEP dosing approaches are under investigation for both adherence and pharmacological characteristics; proposed regimens include a fixed dose several days per week, event-dependent dosing(e.g. before and/or after sexual intercourse), or some combination thereof.Oral iPrEP has been efficacious in animal models and is currently being evaluated in studies among MSM and heterosexual men and women comparing FTC/TDF in fixed and event-dependent dosing strategies .Topical iPrEP, using 1% tenofovir gel, was found effective in reducing HIV risk in women, using a strategy of one pre-intercourse dose within 12 hours before sex and one post-intercourse dose within 12 hours after sex.


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  • Jamii Bora: A Home-Based Couples Intervention

    Background:

    Despite the potential for anti-retroviral therapy (ART) to ensure maternal health and reduce vertical HIV transmission to as low as 1%, HIV-related maternal deaths and HIV infection among infants remain unacceptably high across sub-Saharan Africa. Prevention of mother-to-child transmission (PMTCT) requires a complex series of interventions throughout pregnancy and after birth, and only an estimated 15-30% of eligible women complete this "PMTCT cascade". Drop-offs can occur in the PMTCT cascade if women refuse HIV testing, do not disclose their HIV status, or avoid essential health services because they fear negative consequences for their relationship with their male partner. Engaging both partners of a couple during pregnancy has the potential to enhance health decisions, increase healthcare utilization, and ultimately improve maternal, paternal, and infant health. The goal of this study is to develop and pilot a home-based couples intervention that includes safe HIV testing and disclosure for couples, alongside information and counseling for family health during the perinatal period.


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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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  • 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,1,2 multiple sexual partners,3–6 inconsistent or lack of condom use,7–10 the absence of male circumcision,11–13 and most recently, hormonal contraceptive use.14–16 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.

    Nyanza Province in western Kenya has the highest HIV prevalence of any province in Kenya. While HIV prevalence among adults aged 15–64 years decreased nationally from 7.2% in 2007 to 5.6% in 2012, prevalence in Nyanza Province slightly increased from 14.9 to 15.1% during this period.18 Similar to other African countries, women in Kenya are disproportionately affected by HIV. The 2012 Kenya AIDS Indicator Survey18 showed that among 15- to 64-year-olds, a higher proportion of women (6.9%) were infected with HIV than men (4.4%). A 2003 cross-sectional survey among 13–34-year-olds in rural Asembo, Nyanza Province, found an HIV prevalence of 3.5% among women 15–19 years of age compared to a prevalence of 1% among their male counterparts.6 Similarly, a gender disparity in prevalence was found among 20–24-year-olds (7.4% among women and 1.9% among men).

    Given known challenges of undertaking HIV prevention research in resource-poor setting,20 and for specific populations such as adolescents,21,22 the availability of HIV prevalence and incidence estimates are important in designing and implementing HIV research or programmatic activities. The high prevalence of HIV in Nyanza Province makes it an ideal location to conduct research, including clinical trials, and to evaluate HIV biomedical interventions/strategies. Using data from the Kisumu Incidence Cohort Study (KICoS), one of the few detailed HIV risk factor incidence cohort studies in Kenya since the inception of the U.S. President’s Emergency Plan for AIDS Relief, we assessed the prevalence of HIV among young adults aged 16–34 for study eligibility and identified factors associated with HIV infection. The purpose of the analysis is to determine HIV prevalence and identify correlates of HIV infection among men and women residing in Kisumu.


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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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  • HIV Status and Treatment Influence on Fertility Desires Among Women Newly Becoming Eligible for Antiretroviral Therapy in Western Kenya: Insights From a Qualitative Study

    BACKGROUND:


    Factors influencing fertility desires among HIV-infected individuals remain poorly understood. With new recommendations for universal HIV treatment and increasing antiretroviral therapy (ART) access, we sought to evaluate how access to early ART influences fertility desires among HIV-infected ART-naïve women.


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  • Feasibility and acceptability of HIV self-testing among pre-exposure prophylaxis users in Kenya

    Introduction: HIV testing is key to the delivery of pre-exposure prophylaxis (PrEP): testing HIV-uninfected at-risk persons is the first step for PrEP initiation and ongoing HIV testing is an essential part of PrEP delivery. Thus, novel and cost-effective HIV-testing approaches to streamline delivery of PrEP are urgently needed. Within a demonstration project of PrEP for HIV prevention among high-risk HIV serodiscordant couples in Kenya (the Partners Demonstration Project), we conducted a pilot evaluation of HIV self-testing.

    Methods: Clinic visits were scheduled quarterly and included in-clinic HIV testing using fingerstick rapid HIV tests and refills of PrEP prescriptions. HIV oral fluid self-test kits were provided for participants to use in the two-month interval between scheduled quarterly clinic visits. Acceptability of HIV self-testing was assessed using both quantitative and qualitative methods.

    Results: We found that 222 of 226 (98%) HIV-uninfected persons who were offered accepted self-testing. Nearly all (96.8%) reported that using the self-testing kit was easy. More than half (54.5%) reportedly did not share the HIV results from self-testing with anyone and almost all (98.7%) the participants did not share the HIV self-testing kits with anyone. Many participants reported that HIV self-testing was empowering and reduced anxiety associated with waiting between clinic HIV tests.

    Conclusions: HIV self-testing was highly acceptable and may therefore be a feasible strategy to efficiently permit routine HIV testing between PrEP refills.


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  • HIV AND AIDS-RELATED STIGMA AND DISCRIMINATION: PERSPECTIVE OF PEOPLE LIVING WITH HIV AND AIDS IN GARISSA COUNTY, KENYA

    Abstract

    Purpose: To determine the factors influencing stigmatization and discrimination among people living with HIV and AIDS in Garissa County.

    Methodology: This research utilized a survey research design.

    Findings: Results revealed that people living with HIV and AIDS experienced stigmatization and discrimination. The people were stigmatized and discriminated in ways such as verbal abuse, they were perceived to die soon, being shunned by their families and friends, people avoiding physical contact with them and general fear from the public. Additionally, illiteracy, ignorance and poverty were the factors that promoted stigmatization and discrimination. Binary logistic regression results showed that gender was statistically associated with stigmatization and discrimination. The probability of stigmatization and discrimination increased. The multivariate logistic regression results showed that gender was not statistically associated with stigmatization and discrimination levels. Binary logistic regression results showed that the level of education, level of income, was negatively statistically associated with stigmatization and discrimination levels. The multivariate logistic regression results showed that the level of income was negatively statistically associated with stigmatization and discrimination levels. Binary logistic regression results showed that the likelihood of females spreading HIV, likelihood of unmarried people spreading HIV and likelihood of old people spreading HIV was statistically associated to levels of stigmatization and discrimination. A multivariate logistic regression results revealed that the likelihood of females spreading HIV and likelihood of old people spreading HIV is statistically associated to levels of stigmatization and discrimination. Binary logistic regression results showed that the knowledge level on whether HIV can be spread through a mosquito bite is statistically associated to levels of stigmatization and discrimination. The multivariate logistic regression results showed that the knowledge level on whether HIV can be spread through a mosquito bite is statistically associated to levels of stigmatization and discrimination.

    Unique contribution to theory, practice and policy: This study will benefit various groups of people. These include stakeholders in the management of stigma and discrimination of People Living with HIV and AIDS, Governmental and Non Governmental organizations (NGOs) and people living with HIV and AIDS. The study will also benefit academicians and other researchers.


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  • Everyone has a secret they keep close to their hearts’: challenges faced by adolescents living with HIV infection at the Kenyan coast

    Abstract

    Background

    The upsurge in the uptake of antiretroviral therapy (ART) has led to a significant increase in the survival of vertically acquired HIV infected children, many of whom are currently living into adolescence and early adulthood. However little if anything is known of the lived experiences and the challenges faced by HIV positive adolescents in the African context. We set out to investigate psychosocial challenges faced by HIV infected adolescents on the Kenyan coast.


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  • Trauma, Depression, and Resilience among Women Living with HIV/AIDS in Kenya

    Abstract

    Kenya has one of the world’s worst HIV and AIDS epidemics. In 2011, an estimated 1.6 million people were living with HIV and nearly 62,000 people died from AIDS-related illnesses including Korogocho, the worst slum area with 14% HIV prevalence. Even though awareness of HIV and AIDS in Kenya is high, many people living with the virus still face stigma and discrimination. Studies have shown that although people are aware of the basic facts about HIV and AIDS, many do not have the more in-depth knowledge that address issues of stigma. Especially social stigma of HIV to women is an urgent issue in Kenya. Especially women with HIV suffered from stigma and discrimination to break themselves down. Their severe depression and psychological trauma is the most significant cause of their deprived quality of life. Kenya women have been exposed to intense and ongoing trauma and depression since diagnosis of HIV/AIDS. Among 122 women living with HIV/AIDS in Korogocho, Kenya, we examined the prevalence and severity of pre traumatic experience (PET), impact of event (IES-R), depression (CES-D), internal stigma (ISS), and resilience (RS). Results revealed a high prevalence in emotional impact of event in women living with HIV/AIDS (86%); 65.3% reported severe depression after diagnosis of HIV/AIDS. As expected, depression was significantly correlated with both impact of event and internal stigma. Hierarchical regression analyses revealed the association between IES-R score and CES-D scores persisted even after controlling for relevant demographic variables. The most difficulties on living with HIV/AIDS were emotional distress, physical health, social relationship, and financial problems. Implications for improving the psychological functioning and resilience of women living with HIV/AIDS are discussed.

  • 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.

    METHODS:

    We conducted a cost-benefit analysis, measuring economic return on investment, of a task-shifted cognitive-behavioral therapy (CBT) intervention delivered by paraprofessionals to reduce alcohol use in a modeled cohort of 13,440 outpatients in Kenya. In our base-case, we estimated the costs and economic benefits from a societal perspective across a six-year time horizon, with a 3% annual discount rate. Costs included all costs associated with training and administering task-shifted CBT therapy. Benefits included the economic impact of lowered HIV incidence as well as the improvements in household and labor-force productivity. We conducted univariate and multivariate probabilistic sensitivity analyses to test the robustness of our results.

    RESULTS:

    Under the base case, total costs for CBT rollout was $554,000, the value of benefits were $628,000, and the benefit-to-cost ratio was 1.13. Sensitivity analyses showed that under most assumptions, the benefit-to-cost ratio remained above unity indicating that the intervention was cost-saving (i.e., had positive return on investment). The duration of the treatment effect most effected the results in sensitivity analyses.

    CONCLUSIONS:

    CBT can be effectively and economically task-shifted to paraprofessionals in Kenya. The intervention can generate not only reductions in morbidity and mortality, but also economic savings for the health system in the medium and long term. The findings have implications for other countries with generalized HIV epidemics, high prevalence of alcohol consumption, and shortages of mental health professionals.


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  • A Livelihood Intervention to Reduce the Stigma of HIV in Rural Kenya: Longitudinal Qualitative Study.

    Abstract

    The scale-up of effective treatment has partially reduced the stigma attached to HIV, but HIV still remains highly stigmatized throughout sub-Saharan Africa. Most studies of anti-HIV stigma interventions have employed psycho-educational strategies such as information provision, counseling, and testimonials, but these have had varying degrees of success. Theory suggests that livelihood interventions could potentially reduce stigma by weakening the instrumental and symbolic associations between HIV and premature morbidity, economic incapacity, and death, but this hypothesis has not been directly examined. We conducted a longitudinal qualitative study among 54 persons with HIV participating in a 12-month randomized controlled trial of a livelihood intervention in rural Kenya. Our study design permitted assessment of changes over time in the perspectives of treatment-arm participants (N = 45), as well as an understanding of the experiences of control arm participants (N = 9, interviewed only at follow-up). Initially, participants felt ashamed of their seropositivity and were socially isolated (internalized stigma). They also described how others in the community discriminated against them, labeled them as being "already dead," and deemed them useless and unworthy of social investment (perceived and enacted stigma). At follow-up, participants in the treatment arm described less stigma and voiced positive changes in confidence and self-esteem. Concurrently, they observed that other community members perceived them as active, economically productive, and contributing citizens. None of these changes were noted by participants in the control arm, who described ongoing and continued stigma. In summary, our findings suggest a theory of stigma reduction: livelihood interventions may reduce internalized stigma among persons with HIV and also, by targeting core drivers of negative attitudes toward persons with HIV, positively change attitudes toward persons with HIV held by others. Further research is needed to formally test these hypotheses, assess the extent to which these changes endure over the long term, and determine whether this class of interventions can be implemented at scale.


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