research & publications

HIV RESEARCH

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  • 344 results found
  • 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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  • 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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  • 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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  • 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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  • Knowledge and attitude of women on the available PMTCT services at the antenatal clinic of the Coast Province General Hospital

    Background:

    Several high profile events of the last decade have served as catalysts for the now widely available prevention of mother-to-child transmission of HIV services. However, Kenya continues to face challenges in assuring that all women in need of PMTCT services receive the full package.


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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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  • A cross-sectional survey of prevalence and correlates of couple sexual concurrency among married couples in fishing communities along Lake Victoria in Kisumu, Kenya.

    Background:

    Sexual concurrency has been associated with HIV infection. Since HIV in sub-Saharan Africa is mostly spread within the context of heterosexual couples, it is necessary that intervention is focused on such couples. We sought to establish the correlates of couple sexual concurrency in Kisumu, Kenya.


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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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  • 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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  • Incident HSV-2 infections are common among HIV-1-discordant couples.

    Background:

    The synergy between herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus type 1 (HIV-1) is well known, but lack of knowledge about the epidemiology of HSV-2 acquisition in HIV-1-discordant couples hampers development of HSV-2 prevention interventions that could reduce HIV-1 transmission.


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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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  • Community perceptions of childbearing and use of safer conception strategies among HIV-discordant couples in Kisumu, Kenya.

    Background:

    Safer conception strategies (SCS) have the potential to decrease HIV transmission among HIV-discordant couples who desire children. Community perceptions of SCS may influence the scale-up and uptake of these services, but little is known about how communities will react to these strategies. Without community support for SCS, their success as an HIV prevention tool may be limited. The objective of this study is to characterize community perceptions of SCS for HIV-discordant couples in Kisumu, Kenya, to inform ongoing and future safer conception intervention studies in low-resource settings.


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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-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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  • 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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  • Disproportionate HIV and HSV-2 Prevalence and Incidence Among Women and Adolescent Girls in Western Kenya: Preparation for Female-Centered Prevention Trials

    Background:


    HIV and Herpes simplex virus type 2(HSV-2) disproportionately affect young women in sub-Saharan Africa. Recent success with a vaginal microbicide active against HIV and HSV-2 reinforces the need to establish high HIV/HSV-2 incidence female cohorts for urgent and important of female- centred prevention strategies

  • Understanding the HIV yield by HIV testing strategy for female sex workers in Kisumu County, Kenya

    Background:


    In Kenya, HIV prevalence among female sex workers (FSWs) is disproportionately high compared to the general population (29.3% vs 5.6%). Though HIV testing is a critical first step in the HIV care continuum, approximately half of all HIV-infected people in Kenya are unaware of their status. We seek to understand HIV testing outcomes among FSWs enrolled in the USAID- and PEPFAR-funded LINKAGES project in Kisumu County, Western Kenya

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  • Oral PrEP for HIV Prevention: Early Lessons from a PrEP Demonstration Project in Kenya

    Background: Clinical trials conducted among HIV serodiscordant heterosexual couples, men who have sex with men (MSM) and young women have shown that oral Pre-Exposure Prophylaxis (PrEP) is effective in preventing HIV-1 transmission when taken as prescribed. Feasibility studies reported high willingness to take PrEP. However, willingness may not always translate to actual uptake of PrEP and there is little data on effective delivery of oral PrEP in real world settings
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  • Galvanizing the Voices and Action of Religious Leaders for HIV Prevention Research

    Background:


    In July 2015, 27 Kenya Catholic Bishops called for polio vaccination boycott in

    the country. This was the second call for a boycott, with the first targeting a tetanus

    vaccination campaign for women. Religious leaders are a very influential group of opinions

    leaders in Kenya. International Network of Religious Leaders Living with or Personally

    Affected by HIV (INERELA+ Kenya) conducted a survey to assess knowledge, attitudes and

    practice of this group on vaccination, HIV vaccine research and other new prevention

    technologies to inform advocacy

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  • Assessment of Safer Conception Services for HIV-serodiscordant Couples in Kenyatta National Hospital

    Background:


    Discordant couples are an important source of new HIV infections among cohabitating couples in Africa. The HIV-uninfected partner is at increased risk of HIV infection if they have unprotected sex to achieve a pregnancy when the HIV-infected partner is not virally suppressed. The goal of this study is to describe the perceptions and experiences of safer conception services in Kenyatta National Hospital.

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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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  • 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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  • HIV and STI Prevalence and Risk Factors Among Male Sex Workers and Other Men Who Have Sex With Men in Nairobi, Kenya

    Previous surveys of men who have sex with men (MSM) in Africa have not adequately profiled HIV status and risk factors by sex work status. MSM in Nairobi, Kenya, were recruited using respondent-driven sampling, completed a behavioral interview, and were tested for HIV and sexually transmitted infections. Overlapping recruitment among 273 male sex workers and 290 other MSM was common. Sex workers were more likely to report receptive anal sex with multiple partners (65.7% versus 18.0%, P < 0.001) and unprotected receptive anal intercourse (40.0% versus 22.8%, P = 0.005). Male sex workers were also more likely to be HIV infected (26.3% versus 12.2%, P = 0.007).


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  • Identification of preferential CD4+ T-cell targets for HIV infection in the cervix

    Abstract

    A better understanding of the cellular targets of HIV infection in the female genital tract may inform HIV prevention efforts. Proposed correlates of cellular susceptibility include the HIV co-receptor CCR5, peripheral homing integrins, and immune activation. We used a CCR5-tropic pseudovirus to quantify HIV entry into unstimulated endocervical CD4(+) T cells collected by cytobrush. Virus entry was threefold higher into cervix-derived CD4(+) T cells than blood, but was strongly correlated between these two compartments. Cervix-derived CD4(+) T cells expressing CD69, α(4)β(7), or α(4)β(1) were preferential HIV targets; this enhanced susceptibility was strongly correlated with increased CCR5 expression in α(4)β(7)(+) and CD69(+) CD4(+) T cells, and to a lesser extent in α(4)β(1)(+) CD4(+) T cells. Direct binding of gp140 to integrins was not observed, integrin inhibitors had no effect on virus entry, and pseudotypes with an env that preferentially binds α(4)β(7) still demonstrated enhanced entry into α(4)β(1)(+) cells. In summary, a rapid and sensitive HIV entry assay demonstrated enhanced susceptibility of activated endocervical CD4(+) T cells, and those expressing α(4)β(7) or α(4)β(1). This may relate to increased CCR5 expression by these cell subsets, but did not appear to be due to direct interaction of α(4)β(7) or α(4)β(1) with HIV envelope.

  • Ability and willingness to pay for voluntary medical male circumcision: a cross-sectional survey in Kisumu County, Kenya.

    Voluntary medical male circumcision is one of the most effective measures in preventing male acquisition of HIV during heterosexual intercourse. In Kenya, the voluntary medical male circumcision programme was launched in the year 2008 as part of a comprehensive national HIV prevention strategy. With the global challenge of funding HIV intervention programs, the sustainability of the programme beyond the donor periods need to be assessed. The purpose of this study was to determine the household ability and willingness to pay for voluntary medical male circumcision as an alternative method of funding the programme. The findings show that 62.2% of the households were "able" to pay for medical circumcision. However, 60.4% of them were not "willing" to pay for the service regardless of the cost. The findings indicate that ability to pay is not a significant predictor of willingness to pay for voluntary medical male circumcision within Kisumu County. Knowledge on the role of medical circumcision is a more important factor in determining willingness to pay for the service.


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  • High mortality in HIV-infected children diagnosed in hospital underscores need for faster diagnostic turnaround time in prevention of mother-to-child transmission of HIV (PMTCT) programs

    BACKGROUND:

    Despite expanded programs for prevention of mother-to-child HIV transmission (PMTCT), HIV-infected infants may not be diagnosed until they are ill. Comparing HIV prevalence and outcomes in infants diagnosed in PMTCT programs to those in hospital settings may improve pediatric HIV diagnosis strategies

  • Uptake and Acceptability of Oral HIV Self-Testing among Community Pharmacy Clients in Kenya: A Feasibility Study.

    BACKGROUND:

    While HIV testing and counselling is a key entry point for treatment as prevention, over half of HIV-infected adults in Kenya are unaware they are infected. Offering HIV self-testing (HST) at community pharmacies may enhance detection of undiagnosed infections. We assessed the feasibility of pharmacy-based HST in Coastal Kenya.


    METHODS:

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


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  • Incidence and correlates of tuberculosis IGRA conversion among HIV-infected postpartum women

    Abstract


    SETTING:

    Prevention of maternal-to-child transmission program at a tertiary care hospital in Nairobi, Kenya. The risk of acquiring Mycobacterium tuberculosis infection among peripartum human immunodeficiency virus (HIV) infected women is poorly defined.


    OBJECTIVE:

    To determine the incidence of and co-factors for interferon-gamma release assay (IGRA) conversion among postpartum HIV-infected women using T-SPOT.TB.


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  • Risk Factors for HIV Acquisition in a Prospective Nairobi-Based Female Sex Worker Cohort

    Abstract :

    With two million new HIV infections annually, ongoing investigations of risk factors for HIV acquisition is critical to guide ongoing HIV prevention efforts. We conducted a prospective cohort analysis of HIV uninfected female sex workers enrolled at an HIV prevention clinic in Nairobi (n = 1640). In the initially HIV uninfected cohort (70 %), we observed 34 HIV infections during 1514 person-years of follow-up, i.e. an annual incidence of 2.2 % (95 % CI 1.6-3.1 %). In multivariable Cox Proportional Hazard analysis, HIV acquisition was associated with a shorter baseline duration of sex work (aHR 0.76, 95 % CI 0.63-0.91), minimum charge/sex act (aHR 2.74, 0.82-9.15, for low vs. intermediate; aHR 5.70, 1.96-16.59, for high vs. intermediate), N. gonorrhoeae infection (aAHR 5.89, 95 % CI 2.03-17.08), sex with casual clients during menses (aHR 6.19, 95 % CI 2.58-14.84), Depo Provera use (aHR 5.12, 95 % CI 1.98-13.22), and estimated number of annual unprotected regular partner contacts (aHR 1.004, 95 % CI 1.001-1.006). Risk profiling based on baseline predictors suggested that substantial heterogeneity in HIV risk is evident, even within a key population. These data highlight several risk factors for HIV acquisition that could help to re-focus HIV prevention messages. 


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  • I Knew I Would Be Safer. Experiences of Kenyan HIV Serodiscordant Couples Soon After Pre-Exposure Prophylaxis (PrEP) Initiation.

    Pre-exposure prophylaxis (PrEP) for HIV-uninfected persons is highly efficacious for HIV prevention. Understanding how people at risk for HIV will use PrEP is important to inform PrEP scale-up and implementation. We used qualitative methods to gather insights into couples' early experiences with PrEP use within the Partners Demonstration Project, an open-label implementation study evaluating integrated delivery of PrEP and antiretroviral therapy (ART). PrEP is offered to HIV uninfected partners until the HIV-infected partner initiates and sustains ART use (i.e., PrEP as a "bridge" to ART initiation and viral suppression). From August 2013 to March 2014 we conducted 20 in-depth dyadic interviews (n = 40) with heterosexual HIV serodiscordant couples participating at the Thika, Kenya study site, exploring how couples make decisions about using PrEP for HIV prevention. We developed and applied deductive and inductive codes to identify key themes related to experiences of PrEP initiation and use of time-limited PrEP. Couples reported that PrEP offered them an additional strategy to reduce the risk of HIV transmission, meet their fertility desires, and cope with HIV serodiscordance. Remaining HIV negative at follow-up visits reinforced couples' decisions and motivated continued adherence to PrEP.


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  • The acceptability of male circumcision to reduce HIV infections in Nyanza Province, Kenya

    Compelling epidemiological evidence showing a significant association between lack of male circumcision and HIV infection has prompted calls for consideration of male circumcision interventions as a strategy for reducing HIV prevalence in highly affected areas where circumcision is little practiced and transmission is predominantly heterosexual. Little is known about whether male circumcision interventions would be acceptable or feasible in traditionally non-circumcisng areas of Africa. This study assesses the acceptability of male circumcision in the Luo, a large, traditionally non-circumcising ethnic group in western Kenya. Separate focused group discussions with adult Luo men and women and semi-structured interviews with clinicians were conducted in Nyanza Province, Kenya. The primary barriers to acceptance of male circumcision were cultural identification, fear of pain and excessive bleeding and cost. The main facilitators were association of male circumcision with better hygiene and reduced risk of infection. Both men and women were eager for promotion of genital hygiene and male circumcision, and they desired availability of circumcision clinical services in the Province's health facilities. Clinicians lacked the knowledge and resources to offer safe circumcision counselling and services. If results from this study are valid for other areas of sub-Saharan Africa, acceptability of male circumcision as a means to reduce STDs and HIV is higher than previously suspected. Further studies are needed in other regions to assess the feasibility of introducing acceptable male circumcision information and services to reduce HIV transmission.


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  • Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial

    Male circumcision could provide substantial protection against acquisition of HIV-1 infection. Our aim was to determine whether male circumcision had a protective effect against HIV infection, and to assess safety and changes in sexual behaviour related to this intervention.


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  • The impact of an alcohol harm reduction intervention on interpersonal violence and engagement in sex work among female sex workers in Mombasa, Kenya: Results from a randomized controlled trial.

    AIMS: To evaluate whether an alcohol harm reduction intervention was associated with reduced interpersonal violence or engagement in sex work among female sex workers (FSWs) in Mombasa, Kenya. DESIGN: Randomized controlled trial. SETTING: HIV prevention drop-in centers in Mombasa, Kenya. PARTICIPANTS: 818 women 18 or older in Mombasa who visited HIV prevention drop-in centers, were moderate-risk drinkers and engaged in transactional sex in past six months (410 and 408 in intervention and control arms, respectively).


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  • Preferences for Daily or Intermittent Pre-exposure Prophylaxis Regimens and Ability to Anticipate Sex Among HIV Uninfected Members of Kenyan HIV Serodiscordant Couples

    Intermittent dosing for pre-exposure prophylaxis (PrEP) has been proposed as an alternative to daily PrEP to reduce cost and patient drug exposure and to improve adherence. One possible dosing regimen is pre-intercourse PrEP, which requires anticipating sex in advance. We examined preferences for daily versus pre-intercourse PrEP and ability to anticipate sex among 310 HIV uninfected members of HIV serodiscordant heterosexual couples in Thika, Kenya, with high HIV knowledge and experience with daily PrEP use in a clinical trial setting. Preferences were evenly split between daily PrEP (47.4 %) and pre-intercourse PrEP (50.7 %). Participants were more likely to prefer daily PrEP if they reported unprotected sex during the prior month (adjusted prevalence ratio [aPR] 1.48, 95 % CI 1.20–1.81) or <80 % adherence to study drug (aPR 1.50, 95 % CI 1.25–1.79), and were less likely to prefer daily PrEP if sex was usually planned, versus spontaneous (aPR 0.76, 95 % CI 0.61–0.96). A minority (24.2 %) reported anticipating sex >3 h in advance, with younger participants being less likely to do so (aPR 0.43, 95 % CI 0.23–0.83 for ages 18–29 vs. ≥40). Findings suggest that intermittent PrEP could be a popular option in this population, but that optimal adherence and sufficient drug levels might be challenging with a pre-intercourse regimen.


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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

    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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  • HIV-1 Prevention for HIV-1 Serodiscordant Couples

    A substantial proportion of HIV-1 infected individuals in sub-Saharan Africa are in stable relationships with HIV-1 uninfected partners, and HIV-1 serodiscordant couples thus represent an important target population for HIV-1 prevention. Couple-based HIV-1 testing and counseling facilitates identification of HIV-1 serodiscordant couples, counseling about risk reduction, and referrals to HIV-1 treatment, reproductive health services, and support services. Maximizing HIV-1 prevention for HIV-1 serodiscordant couples requires a combination of strategies, including counseling about condoms, sexual risk, fertility, contraception, and the clinical and prevention benefits of antiretroviral therapy (ART) for the HIV-1-infected partner; provision of clinical care and ART for the HIV-1-infected partner; antenatal care and services to prevent mother-to-child transmission for HIV-1-infected pregnant women; male circumcision for HIV-1-uninfected men; and, pending guidelines and demonstration projects, oral pre-exposure prophylaxis (PrEP) for HIV-1-uninfected partners.


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  • Risk factors for postpartum depression in women living with HIV attending prevention of mother-to-child transmission clinic at Kenyatta National Hospital, Nairobi

    Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) among women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale and HIV/AIDS Stigma Instrument - PLWHA (HASI - P). Forty-eight percent (N = 59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI [0.04-0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14-5.42], p = .02) were associated with the presence of elevated depressive symptoms. The presence of stigma implied more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132-78.79], p = .04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother-baby dyad.


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  • Improvement of Vaginal Health for Kenyan Women at Risk for Acquisition of Human Immunodeficiency Virus Type 1: Results of a Randomized Trial

    In Africa, the region most affected by the HIV-1 pandemic, the majority of new human immunodeficiency virus type 1 (HIV-1) infections occur in women [1]. Biological, behavioral, and socioeconomic factors all contribute to HIV-1 risk in women. Abstinence, mutual monogamy, and consistent use of condoms have been widely promoted for prevention of HIV-1 transmission but may be difficult for women to implement in some settings. Additional strategies are needed to reduce women's risk for acquisition of HIV-1. Disturbances of the normal vaginal flora may contribute substantially to the population-level risk of HIV-1 acquisition [2]. Bacterial vaginosis (BV), vaginal candidiasis, and infection with Trichomonas vaginalis are common in Africa [3], and multiple prospective studies have shown that each is associated with an increased risk for HIV-1 [4]. Additionally, normal vaginal flora, characterized by a predominance of Lactobacillus species, has been associated with reduced HIV-1 risk [5]. Vaginal infections can be challenging to treat successfully, and they frequently recur [6, 7]. Simple, safe, and inexpensive interventions that effectively reduce the rate of vaginal infections and promote colonization with normal vaginal flora could provide important female controlled, non-coitally dependent strategies for reducing HIV-1 risk in African women.


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  • "How I Wish This Thing Was Initiated 100 Years Ago!" Willingness to Take Daily Oral Pre-Exposure Prophylaxis among Men Who Have Sex with Men in Kenya.

    BACKGROUND:

    The MSM population in Kenya contributes to 15% of HIV incidence. This calls for innovative HIV prevention interventions. Pre-exposure prophylaxis (PrEP) has been efficacious in preventing HIV among MSM in trials. There is limited data on the willingness to take daily oral PrEP in sub-Sahara Africa. PrEP has not been approved for routine use in most countries globally. This study aimed to document the willingness to take PrEP and barriers to uptake and adherence to PrEP in Kenya. The findings will inform the design of a PrEP delivery program as part of the routine HIV combination prevention.


    METHODS:

    Eighty MSM were recruited in 2 Counties in December 2013. Quantitative data on sexual behaviour and willingness to take PrEP were collected using semi-structured interviews and analysed using SPSS. Qualitative data on knowledge of PrEP, motivators and barriers to uptake and adherence to PrEP were collected using in-depth interviews and FGDs and analysed using Nvivo. Analysis of data in willingness to take PrEP was conducted on the HIV negative participants (n = 55)


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  • When and why women might suspend PrEP use according to perceived seasons of risk: implications for PrEP-specific risk-reduction counselling.

    Oral pre-exposure prophylaxis (PrEP) using the antiretroviral drug emtricitabine/tenofovir disoproxil fumarate (Truvada) has been shown to dramatically reduce the risk of HIV acquisition for women at higher risk of infection if taken daily. Understanding when and why women would intentionally stop using an efficacious oral PrEP drug within the context of their 'normal' daily lives is essential for delivering effective PrEP risk-reduction counselling. As part of a larger study, we conducted 60 qualitative interviews with women at higher risk of HIV in Bondo, Kenya, and Pretoria, South Africa. Participants charted their sexual contacts over the previous six months, indicated whether they would have taken PrEP if available and discussed whether and why they would have suspended PrEP use. Nearly all participants said they would have used PrEP in the previous six months; half indicated they would have suspended PrEP use at some point. Participants' reasons for an extended break from PrEP were related to partnership dynamics (e.g., perceived low risk of a stable partner) and phases of life (e.g., trying to conceive). Life events (e.g., holidays and travel) could prompt shorter breaks in PrEP use. These circumstances may or may not correspond to actual contexts of lower risk, highlighting the importance of tailored PrEP risk-reduction counselling.


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  • Male Partner Participation in Antenatal Clinic Services is Associated With Improved HIV-Free Survival Among Infants in Nairobi, Kenya: A Prospective Cohort Study.

    OBJECTIVE: This prospective study investigated the relationship between male antenatal clinic (ANC) involvement and infant HIV-free survival.


    METHODS:

    From 2009 to 2013, HIV-infected pregnant women were enrolled from 6 ANCs in Nairobi, Kenya and followed with their infants until 6 weeks postpartum. Male partners were encouraged to attend antenatally through invitation letters. Men who failed to attend had questionnaires sent for self-completion postnatally. Multivariate regression was used to identify correlates of male attendance. The role of male involvement in infant outcomes of HIV infection, mortality, and HIV-free survival was examined.


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