research & publications

HIV RESEARCH

Results by County (Approx)
  • 80 results found
  • Financial Incentives to Increase Pediatric HIV Testing Pilot Study (FIT-Pilot) (FIT-Pilot)

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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

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

    Background:

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

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

    Introduction:

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


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

    Background:

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


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

    Background :

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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

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


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

    Background:

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


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

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

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

    Background :

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Background:

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


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

    Abstract

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


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

    BACKGROUND:

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

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

    BACKGROUND:

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


    METHODS:

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


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

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


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

    Abstract

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


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

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


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

    BACKGROUND:

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


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

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


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

    Abstract

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



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

    INTRODUCTION:

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


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

    BACKGROUND:

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


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

    BACKGROUND: 

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


    METHODS:

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


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

    BACKGROUND:

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


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

    OBJECTIVE:

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


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  • "They make money off of us": a phenomenological analysis of consumer perceptions of corruption in Kenya's HIV response system.

    BACKGROUND:

    Problems with misallocation and redirection of critical resources and benefits intended for PLHIV are not uncommon in Kenya. This study explores corruption in Kenya's HIV response system and the implications for health outcomes from the perspective of people living with HIV (PLHIV). Although they might not be directly responsible for health care fund management, PLHIV and their advocacy efforts have been central to the development of HIV system response and they have a vested interest in ensuring proper governance.

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  • Changes in Male Circumcision Prevalence and Risk Compensation in the Kisumu, Kenya Population 2008-2013.

    BACKGROUND:

    Three randomized controlled trials (RCT) showed that voluntary medical male circumcision (VMMC) reduces the risk of female to male HIV transmission by approximately 60%. However, data from communities where VMMC programs have been implemented are needed to assess changes in circumcision prevalence and whether men and women compensate for perceived reductions in risk by increasing their HIV risk behaviors.

  • "A Baby Was an Added Burden": Predictors and Consequences of Unintended Pregnancies for Female Sex Workers in Mombasa, Kenya: A Mixed-Methods Study.

    INTRODUCTION:

    Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya.


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  • Couple interdependence impacts HIV-related health behaviours among pregnant couples in southwestern Kenya: a qualitative analysis.

    INTRODUCTION:

    HIV infection is frequently transmitted within stable couple partnerships. In order to prevent HIV acquisition in HIV-negative couples, as well as improve coping in couples with an HIV-positive diagnosis, it has been suggested that interventions be aimed at strengthening couple relationships, in addition to addressing individual behaviours. However, little is known about factors that influence relationships to impact joint decision-making related to HIV.


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  • Alcohol Use and Associations With Biological Markers and Self-Reported Indicators of Unprotected Sex in Human Immunodeficiency Virus-Positive Female Sex Workers in Mombasa, Kenya.

    BACKGROUND:

    Studies of alcohol use and sexual behavior in African populations have primarily been cross-sectional, used nonvalidated measures of alcohol use, or relied on self-reported sexual risk endpoints. Few have focused on human immunodeficiency virus (HIV)-positive women.


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  • Understanding Barriers to Scaling Up HIV-Assisted Partner Services in Kenya.

    Assisted partner services (APS) are more effective than passive referral in identifying new cases of HIV in many settings. Understanding the barriers to the uptake of APS in sub-Saharan Africa is important before its scale up. In this qualitative study, we explored client, community, and healthcare worker barriers to APS within a cluster randomized trial of APS in Kenya.


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  • Outcomes of prevention of mother to child transmission of the human immunodeficiency virus-1 in rural Kenya--a cohort study.

    Success in prevention of mother-to-child transmission (PMTCT) raises the prospect of eliminating pediatric HIV infection. To achieve global elimination, however, strategies are needed to strengthen PMTCT interventions. This study aimed to determine PMTCT outcomes and identify challenges facing its successful implementation in a rural setting in Kenya.


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  • Identifying the Gaps: An Assessment of Nurses' Training, Competency, and Practice in HIV Care and Treatment in Kenya.

    Given the burden of HIV and the critical shortage of health workers in Kenya, in 2011 the National AIDS and STI Control Program recommended shifting HIV care and treatment tasks to nurses in settings without physicians and clinical officers in order to decentralize and scale-up HIV services. In September 2013, ICAP at Columbia University conducted a survey with nurses in four health facilities in eastern Kenya to assess preparedness for task shifting. Findings indicated gaps in nurses' training, perceived competency, and practice in HIV care and treatment. Further investment in nurse capacity building is needed to bridge the gaps and prepare more nurses to provide high-quality, comprehensive HIV care and treatment services to curb the epidemic in Kenya.


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  • Using Health Commodity Management Platform (HCMP) Improve Laboratory Commodity Reporting Rates in Kenya

    Background:

    Accurate quantification, timely reporting and requisition of HIV rapid test kits (RTKs) has been a perennial challenge for the health system in Kenya. We introduced an online reporting system for HIV RTKs in Nakuru County in October 2013 to streamline the reporting, requisition and monitor consumption of HIV RTKs We report here the process used in setting up this system and how data was collected and used to monitor stock levels.


    Methodology: The Sub-County medical laboratory technologists (SCMLTs were trained on the online commodity reporting and requisition platform, the report submission process and individual tracking of the reports. This was a day-to-day training and mentorship provided by the project laboratory technical officers to ensure timely and accurate submission of reports. After the launch of the system data on reporting rates, stock levels, commodity consumption, timeliness and accuracy of reporting was collected from October 2013 to May 2015.


    Results

    Prior to the launch of the platform, the average reporting rate was 66%. The reporting rate in October 2013, when the online platform was launched, was 83%. Within a year of introduction, commodity reporting rates improved to 100%.


    Conclusion:

    The new system allows real-time visualization of data by the supply side upon entry by the consumer. This has led to improved reporting rates, timely redistribution of kits to facilities that are facing stock outs, better monitoring of kit consumption by administrators as well as monitoring of the number of people tested across the region.



  • Use of data for decision making for epidemic Control

    Background

    Due to the difference in the data management practices between the MOH and implementing partners including the thoroughness of scrutiny and querying of reports by the later, there have been discordance between partner and MOH data in the District health information systems DHIS. More often than not the MOH has disowned data presented by partners as it seems better than what is in the DHIS.


    Objective System strengthening for informed decision making in HIV programming through District Health Information Systems data accuracy.


    Methods

    EGPAF working with the MOH introduced a monthly DHIS data concordance meeting to harmonize discrepancies witnessed between the two systems. EGPAF Monitoring &Evaluation team together with County health records department developed the DHIS concordance data review schedule to be implemented monthly. Seven indicators were initially tracked per facility a cross the supported sub-counties. This was later on scaled up to all the indicators in MOH 731, 711 & 717. At the end of the month and according to the prepared schedule, the sub-county Health Records Information Officer was invited to come with the original copies of the three reports. This was followed by , a meeting between the supporting M&E officer and the HRIO to compare indicators in the two systems and make corrections on the discrepancies identified in real time.


    Findings

    Since January 2016 to date, there has been increased concordance in the data with over 99% of the indicators achieving 100% concordance. There has also been increased ownership of data and enhanced relationships between the M&E departments between partners in the county due to increased contact time between them

    .

    Conclusion: There is need to embrace DHIS concordance meetings among county health partners for ownership and concordance of their data systems for informed decision making. This has demonstrated promising results and can be emulated by the rest of Counties faced with similar challenges.


    Implication: The cost of the intervention is one day per diem and transport reimbursement for the HRIOs from far flung sub-counties and only lunch allowance for the ones within the headquarters. This totals to Kshs 30,000 for the four supported sub-counties.


  • Innovations in commodity management coordination and decision-making at national and county level through use of DHIS2

    Background:

    The flow of information is critical to the effective management of health commodity supply chains. Within NASCOP, the presence of multiple vertical commodity information systems resulted in duplication and lack of full pipeline visibility. Variances in patient numbers across service and commodity data have also been identified. To address these weaknesses, various NASCOP programs - ART, lab, nutrition - decided to integrate commodity reporting into one national system, DHIS2, based on previous successful use in family planning and malaria programs.


    Objectives: To enable NASCOP team harmonize commodity data into one platform to allow for greater visibility at national and county level; facilitate decision-making and timely sharing of strategic information with stakeholders.


    Methods:

    A core team comprising NASCOP, other programs, KEMSA, HIS unit, UoN and implementing partners was constituted in 2015. Several consensus meetings were held to clarify requirements, develop a plan of action and undertake a proof of concept to ascertain the viability of incorporating NASCOP's decentralized hierarchy structure for commodity reporting into DHIS2. Development work was initiated involving the design and upload of commodity reporting tools, development of national and county dashboards, incorporation of data validation rules to enhance data quality, supply chain indicators for performance analysis and automation of facility ordering to inform resupply. The system was pre-tested in 3 counties (Tharaka-Nithi, Nakuru and Kiambu) by staff drawn from national and county levels.


    Results:

    The pilot counties were able to visualize their full list of facilities providing HIV services. Input facility data was immediately visible at facility, sub-county, county and national levels, enabling generation of reports on patient and test numbers, and stock status. Disparities in facility mapping between counties and the national program were rectified through the hierarchy implementation in DHIS2. With service and commodity data available in DHIS, county health management teams found it easier to triangulate data; and make commodity management decisions e.g. need for commodity redistribution, creation of additional central and satellite sites. The use of a common platform provided an opportunity for a team approach to commodity management coordination at county level, incorporating health records information officers, CASCOs, laboratory, nutrition and pharmacy coordinators.


    Conclusions, recommendations and implications:

    Integration of HIV reporting in DHIS2 will standardize and improve commodity information management, increase visibility of commodity information and enhance use of data for decision-making at all levels for HIV commodity security and improved patient outcomes. This new system is going to help counties to manage their commodities in line with decentralization of HIV commodity management and devolution of health services; enabling closer collaboration between the national and county levels. Strengthening the link between KEMSA systems and DHIS2 is required for visibility of upstream and downstream stocks to minimize disruption in commodity supply. With increased visibility of information such as service and workload data, opportunities for further decentralization of HIV services can be identified.