research & publications

SRH RESEARCH

Results by County (Approx)
  • 144 results found
  • Healthcare-seeking behaviour of HIV-infected mothers and male partners in Nairobi, Kenya

    Background:

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


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  • Associations Between Fathers' and Sons' Sexual Risk in Rural Kenya: The Potential for Intergenerational Transmission.

    Background:

    Sub-Saharan Africa bears the burden of the highest rates of HIV in the world, accounting for approximately 70% of new HIV infections worldwide . Of these, approximately 30% occur among young people aged 15–24 years. In Sub-Saharan Africa, men are considered important drivers of the HIV epidemic, as heterosexual sex is the primary mode of HIV transmission, and patriarchal norms, present in many societies, increase men's power in sexual decision-making. For young males, such cultural norms can place reputational value on sexual activity, contributing to early sexual debut. The cultural and behavioral patterns that impact male youths' sexual risk are perpetuated in many ways, including parental influence. Parents may teach and shape beliefs and behaviors that promote sons' risky behavior. Fathers likely play an especially important role, as they are uniquely positioned to pass down masculine gender norms. Despite the relevance of examining fathers' influence on sons' sexual risk, little is known about this association, in part because fathers are generally under-represented in research on adolescent development [6]. Understanding how fathers' and sons' sexual beliefs and behaviors are related and how parenting might influence that relationship has the potential to inform strategies for decreasing adolescents' HIV risk.


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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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  • Optimizing linkage to care and initiation and retention on treatment of adolescents with newly diagnosed HIV infection

    Background:

    The 2014 WHO guidelines on adolescents and HIV recommend HIV testing and counseling (HTC) with linkage to prevention, treatment, and care for all adolescents in the settings of generalized epidemics. As the global community intensifies case finding among adolescents and youth, it becomes evident that there is an unmet need for efficient linkage to care and treatment among these populations. Most HTC and linkage to care and treatment services for adolescents and youth tend to replicate strategies designed for adults and frequently do not take into account the specific barriers faced by adolescents and youth, such as economic, legal, and social dependence; inadequate provider skills in caring for and communicating with adolescents and youth; and requirements for involvement of a guardian. There has been a paucity of data regarding targeted interventions to improve linkage to care among adolescents living with HIV in Sub-Saharan Africa.


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

    Background:

    HIV and cervical cancer are intersecting epidemics in many low-resource settings, yet there are few accurate estimates of the scope of this public health challenge. To understand disease prevalence and risk factors for cervical intraepithelial neoplasia 2 or greater (CIN2+), we conducted a cross-sectional study of women undergoing cervical cancer screening as part of routine HIV care in Kisumu, Kenya.


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

    Background :

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


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

    Background :

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


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

    Background :

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


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  • Prevalence, characteristics, and outcomes of HIV-positive women diagnosed with invasive cancer of the cervix in Kenya

    Background:

    Cancer of the cervix is a common malignancy and a leading cause of death in women worldwide. Approximately 500 000 new cases occur annually, 80% of which are reported among women in low-income countries. Although highly preventable, cervical cancer remains a major public health challenge in Sub-Saharan Africa, where the mortality to incidence ratio is up to 80%. Infection with HIV is associated with an increased incidence and recurrence of human papillomavirus (HPV) infection and HPV-associated cervical intraepithelial neoplasia (CIN). In addition, the majority of HIV-infected women reside in resource-limited settings, where access to cervical cancer screening is limited.

    The management of cervical cancer is a major challenge in Sub-Saharan Africa. In a survey of East, Central, and Southern African countries, surgical facilities for women with cervical cancer were available in only 46% of provincial hospitals, with only 21% of the hospitals having a gynecologist to perform the procedure. Only 22% of these countries had access to anticancer drugs, and the number of surgical oncologists and radiotherapists in tertiary hospitals was inadequate. Late presentation with advanced disease, incomplete or poor treatment, and high rates of loss to follow-up also contribute to the high mortality.

    Kenya’s cervical cancer incidence is estimated at 29–200 per 100 000 women annually, with a 2- to 4-fold higher risk among HIV-infected women . Currently, the prevalence of HIV among women aged 18–49 years in Kenya is estimated at 8.9%. Without a functional national cancer registry, little is known about women diagnosed with cervical cancer in Kenya, including treatment access and outcomes. Treatment options for late-stage disease are severely limited because only 1 public facility, in the capital city of Nairobi, provides radiation therapy.

    Low-cost screening strategies have the potential to improve access to cervical cancer prevention for both HIV-infected and HIV-uninfected women in resource-limited settings. With increased access to screening, more HIV-infected women will be diagnosed with early-stage disease, potentially increasing their treatment options. The standard of care for the treatment of early-stage disease is generally surgical, ranging from cone biopsy for stage IA1 disease to radical hysterectomy with lymph node dissection for stage IB or IIA . Recently, treatment of stage IA1 disease using excisional techniques with close follow-up has been explored for women desiring fertility or seeking less radical surgery. Expanding access to treatment, especially in resource-limited settings, should also be considered as a justification for excisional treatment. Loop electrosurgical excision procedure (LEEP) can be safely performed by trained non-physician healthcare providers in this setting, and if offered as treatment for stage IA1 cancer, it could potentially increase access to treatment in settings where availability of inpatient surgery is limited.


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  • Men’s knowledge and attitudes about cervical cancer screening in Kenya

    Background:

    A number of studies have identified male involvement as an important factor affecting reproductive health outcomes, particularly in the areas of family planning, antenatal care, and HIV care. As access to cervical cancer screening programs improves in resource-poor settings, particularly through the integration of HIV and cervical cancer services, it is important to understand the role of male partner support in women’s utilization of screening and treatment.


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  • Accuracy of Visual Inspection with Acetic Acid to detect Cervical Cancer Precursors Among HIV-infected Women in Kenya

    Background:

    Visual Inspection with Acetic Acid (VIA) is becoming a more widely recommended and implemented screening tool for cervical cancer prevention programs in low-resource settings. Many of these settings have a high prevalence of HIV-infected women. We carried out a cross-sectional validation study to define the sensitivity, specificity and predictive values of VIA among HIV-infected women.


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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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  • Characteristics, medical management and outcomes of survivors of sexual gender-based violence, Nairobi, Kenya

    Background:

    Many countries in sub-Saharan Africa have experienced rapid development and urbanisation in recent years. This, along with internal instability and other factors, has led to sexual gender-based violence (SGBV) becoming a major problem. Addressing SGBV is important given its physical, psychological and social consequences. The consequences in terms of human immunodeficiency virus (HIV) infection, unwanted pregnancies and long-term psychological effects are not well described, especially in sub-Saharan African countries.

    Although there are no national data on the prevalence of SGBV in Kenya, 1400 cases of rape, estimated at only 11% of the actual number of rape cases, were reported during the post-election violence between December 2007 and March 2008.6 These estimates suggest that, as in several other sub-Saharan African countries, there is a need to provide adequate and effective prevention, care and protection strategies for SGBV in Kenya.

    Médecins Sans Frontières (MSF) has been offering care to survivors of SGBV in Eastern Nairobi, Kenya, since 2007. It is one of the few organisations in the country to offer a comprehensive package of care to such victims. The present study attempts to fill the knowledge gap and describe the care and support offered to SGBV survivors in a slum in Nairobi, Kenya, in 2011. Specific objectives were to describe amongst SGBV survivors: 1) individual demographic characteristics and episodes of sexual violence, 2) medical and psychological management, including medico-legal certification, and 3) HIV infection and pregnancy outcomes associated with the provision of care.


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  • Benefits and constraints of intimate partnerships for HIV positive sex workers in Kibera, Kenya

    Background;

    Research on the intimate partnerships of female sex workers (FSWs) tends to focus on the risks associated with these relationships. This paper takes as its starting point that the situation of FSWs is better understood by including knowledge of the benefits of their intimate partnerships. Specifically, we employ the conceptual framework provided by emergent research examining intimacy as a complex fusion of affective and instrumental dimensions among sex workers. This perspective allows us to frame information about FSWs’ intimate partnerships within a behaviour-structural approach that is helpful for identifying how intimate partnerships can be a source of both benefit as well as increased risk to FSWs.


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  • “She mixes her business”: HIV transmission and acquisition risks among female migrants in western Kenya

    Background:

    Gender is fundamental to understanding migration processes, causes and consequences, and gender and economic inequalities are critical to understanding why the HIV epidemic disproportionately burdens younger, poorer women worldwide. Yet the convergence of these phenomena has been poorly characterized, and is largely absent from the literature on migration and HIV. The central concern of this paper is to shed light on the ways in which gendered migration processes shape the HIV risks faced by female migrants, which in turn helps to explain the persistence of HIV in high prevalence areas.


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

    Background :

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


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

    Background:

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


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  • “It is all about the fear of being discriminated [against]…the person suffering from HIV will not be accepted”: a qualitative study exploring the reasons for loss to follow-up among HIV-positive youth in Kisumu, Kenya

    Background

    Youth represent 40% of all new HIV infections in the world, 80% of which live in sub-Saharan Africa. Youth living with HIV (YLWH) are more likely to become lost to follow-up (LTFU) from care compared to all other age groups. This study explored the reasons for LTFU among YLWH in Kenya.


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  • HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya

    Background :

    The World Health Organization (WHO) recommends that HIV-infected women practice exclusive breastfeeding (EBF) for the first 6 months postpartum to reduce HIV transmission. The aim of this study was to determine the effects of HIV/AIDS knowledge and other psychosocial factors on EBF practice among pregnant and postpartum women in rural Nyanza, Kenya, an area with a high prevalence of HIV.


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  • Medical male circumcision and herpes simplex virus 2 acquisition: post trial surveillance in Kisumu, Kenya.

    Background:

    We estimated the 72-month efficacy of medical male circumcision (MMC) against herpes simplex virus 2 (HSV-2) incidence among men in the Kisumu MMC randomized trial.


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  • Parents' and teachers' views on sexual health education and screening for sexually transmitted infections among in-school adolescent girls in Kenya: a qualitative study.

    Background :

    To successfully develop and implement school-based sexual health interventions for adolescent girls, such as screening for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, it is important to understand parents’ and teachers’ attitudes towards sexual health education and acceptability of sexually transmitted infection (STI) screening interventions.


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

    Background:

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


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  • “Facing Our Fears,” using facilitated film viewings to engage communities in HIV research involving MSM in Kenya

    Background:

    Kenya is a generally homophobic country where homosexuality is criminalised and people who engage in same sex sexuality face stigma and discrimination. In 2013, we developed a 16 min documentary entitled “Facing Our Fears” that aimed at sharing information on how and why men who have sex with men (MSM) are involved in on-going KEMRI HIV prevention research, and associated community engagement. To consider the film’s usefulness as a communication tool, and its perceived security risks in case the film was publicly released, we conducted nine facilitated viewings with 122 individuals representing seven different stakeholder groups. The documentary was seen as a strong visual communication tool with potential to reduce stigma related to homosexuality, and facilitated film viewings were identified as platforms with potential to support open dialogue about HIV research involving MSM. Despite the potential, there were concerns over possible risks to LGBT communities and those working with them following public release. We opted—giving emphasis to the “do no harm” principle—to use the film only in facilitated settings where audience knowledge and attitudes can be carefully considered and discussed. The results highlight the importance of carefully assessing the range of possible impacts when using visuals in community engagement.


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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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  • What influences feeding decisions for HIV-exposed infants in rural Kenya?

    Background:

    Infant feeding in the context of human immunodeficiency virus (HIV) poses unique challenges to mothers and healthcare workers in balancing the perceived risks of HIV transmission and nutritional requirements. We aimed to describe the decision-making processes around infant feeding at a rural HIV clinic in Kenya.


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

    Background:

    To more effectively control HIV epidemics, correlates of HIV infection need to be better understood, and prevention strategies adapted to account for risk patterns linked to particular settings or situations. Several factors have been associated with HIV infection in sub-Saharan Africa, including extramarital sex,1,2 multiple sexual partners,3–6 inconsistent or lack of condom use,7–10 the absence of male circumcision,11–13 and most recently, hormonal contraceptive use.14–16 Physiological factors, such as having a sexually transmitted infection (STI), particularly ulcerative genital diseases such as herpes simplex virus type 2 (HSV-2), have also been found to increase infectiousness and susceptibility to HIV infection via a variety of biological mechanisms.

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

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


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  • “At our age, we would like to do things the way we want:” A qualitative study of adolescent HIV testing services in Kenya

    Background:

    HIV testing is the first step in linking HIV-positive adolescents to care and preventing new infections.However, the majority of adolescents are unaware of their HIV status . In Kenya, which represents 7% of all adolescent HIV infections globally, 49% of adolescents aged 15–19 years report ever testing for HIV, which is well below the target of 90%.Low uptake of HIV testing represents a missed opportunity for linkage to HIV care and prevention. Achieving new United Nations targets to ‘End Adolescent AIDS’ by 2020 will require improved understanding of how to engage adolescents in HIV testing and follow-up services.

    Recent studies have documented several individual, social, and systems-level barriers and facilitators to HIV testing and linkage to care among adolescents in Africa.Adolescents fear HIV stigma, have inaccurate risk perception, and distrust HCWs. Adolescent uncertainty around how they might have acquired HIV, either sexually or perinatally, can strain relationships with family and sexual partners, further deterring testing. In contrast, desire to know status, prior testing experience, discussing testing with family, and availability of ‘youth friendly services’ (e.g., flexible hours and separate waiting areas) may facilitate testing.Among HIV-positive adolescents, service quality, coordination between testing and care services, and psycho social support may increase linkage to care .Poor coping after a positive result and nondisclosure of status to parents and peers may negatively impact linkage.

    Despite growing awareness of these barriers and facilitators to HIV testing, we are unaware of studies that have explored the adolescent testing experience from multiple perspectives. Social relationships play a critical role in adolescents’ beliefs and behaviors, as they navigate both increased autonomy and ongoing vulnerability .Interactions with parents, HCWs, and peers may have a particularly powerful impact on adolescent HIV testing and linkage to follow-up services. To address this gap in knowledge and guide program improvements, our study aimed to characterize the adolescent HIV testing experience and explain how critical relationships influence adolescent HIV testing and linkage to care or repeat testing. We triangulated perspectives from adolescents, caregivers, and healthcare workers directly involved in adolescent testing.


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  • Contraceptive vaginal ring experiences among women and men in Kisumu, Kenya: A qualitative study.

    Background:

    Future HIV prevention options for women will likely include Antiretroviral (ARV)-based intravaginal rings. Valuable insights may be gained by examining user experiences with a similar licensed technology, a contraceptive ring, especially in settings where this technology may not be currently available.


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  • Determinants of Sexual and Reproductive Health among Street Adolescents in Dagoretti District. Rosemary Kamanu, Moses Mwangi, Prof. Zipporah Nganga, James Muttunga.

    Background: Adolescents make up 80% of the world population and despite being the hardest hit by sexual and reproductive health challenges their sexual and reproductive health (SRH) needs are largely unmet. The challenges are more intense among certain groups, including street adolescents based on social, cultural and  biological factors. 


    Methods: A descriptive cross sectional study was carried out in Dagoretti district of Nairobi to determine the sexual and reproductive health behaviour risk factors among street adolescents. Data was collected through interviews from 195 adolescents and 10 key informants.   


    Results: The study established that despite moderately high SRH knowledge among 79% of the participants, 55% of them were involved in high risk sexual behaviour. Majority of the children had sex by the age of 10-15  years (41.9%) with older partners and did not use condoms (74.4%). In the multivariate model, the following  factors were found to be predictive of risky sexual behaviour, male gender (pv=0.006), age in years (pv=0.037),  attendance to HIV testing (pv=0.011), parents/guardians as a source of SRH information and combination of  number of drugs used (pv=0.001).   


    Conclusion: This study recommends enactment of a comprehensive ASRH policy aimed at providing accurate, age-appropriate and comprehensive sexual and reproductive health education for all adolescents with specific focus on early adolescence (10yrs to 14yrs) and the male gender. It further recommends for the strengthening of parental involvement in peer education, integration of SRH and sensitization in drugs and substances of abuse and improvement of health centres as education and service provision centres on ASRH. Further studies are  recommended to understand the gap between knowledge and practice as well as the need to disaggregate data on street children by cohorts to ensure appropriate programming for the different groups of children in contact with the streets. 


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  • Prevalence of sexually transmitted infections including HIV in street-connected adolescents in western Kenya

    PURPOSE:

    The objectives of this study were to characterise the sexual health of street-connected adolescents in Eldoret, Kenya, analyse gender disparity of risks, estimate the prevalence of sexually transmitted infections (STIs), and identify factors associated with STIs.


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  • Changing knowledge, attitudes, and behaviors regarding cervical cancer screening: The effects of an educational intervention in rural Kenya

    OBJECTIVE:

    Cervical cancer screening uptake may be influenced by inadequate knowledge in resource-limited settings. This randomized trial evaluated a health talk's impact on cervical cancer knowledge, attitudes, and screening rates in rural Kenya.


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  • Costs of integrating cervical cancer screening at an HIV clinic in Kenya.

    OBJECTIVE: To estimate the societal-level costs of integrating cervical cancer screening into HIV clinics in Nairobi, Kenya.


    METHODS: A cross-sectional micro-costing study was performed at Coptic Hope Center for Infectious Diseases and Kenyatta National Hospital, Kenya, between July 1 and October 31, 2014. To estimate direct medical, non-medical, and indirect costs associated with screening, a time-and-motion study was performed, and semi-structured interviews were conducted with women aged at least 18 years attending the clinic for screening during the study period and with clinic staff who had experience relevant to cervical cancer screening.


    RESULTS: There were 148 patients and 23 clinic staff who participated in interviews. Visual inspection with acetic acid was associated with the lowest estimated marginal per-screening costs ($3.30), followed by careHPV ($18.28), Papanicolaou ($24.59), and Hybrid Capture 2 screening ($31.15). Laboratory expenses were the main cost drivers for Papanicolaou and Hybrid Capture 2 testing ($11.61 and $16.41, respectively). Overhead and patient transportation affected the costs of all methods. Indirect costs were cheaper for single-visit screening methods ($0.43 per screening) than two-visit screening methods ($2.88 per screening).


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  • The Impact of Sex Work Interruption on Blood-Derived T Cells in Sex Workers from Nairobi, Kenya.

    BACKGROUND: Unprotected sexual intercourse exposes the female genital tract (FGT) to semen-derived antigens, which leads to a proinflammatory response. Studies have shown that this postcoital inflammatory response can lead to recruitment of activated T cells to the FGT, thereby increasing risk of HIV infection.


    OBJECTIVE: The purpose of this study was to evaluate the impact of sex work on activation and memory phenotypes of peripheral T cells among female sex workers (FSW) from Nairobi, Kenya.


    SUBJECTS: Thirty FSW were recruited from the Pumwani Sex Workers Cohort, 10 in each of the following groups: HIV-exposed seronegative (at least 7 years in active sex work), HIV positive, and New Negative (HIV negative, less than 3 years in active sex work). Blood was obtained at three different phases (active sex work, abstinence from sex work-sex break, and following resumption of sex work). Peripheral blood mononuclear cells were isolated and stained for phenotypic markers (CD3, CD4, CD8, and CD161), memory phenotype markers (CD45RA and CCR7), activation markers (CD69, HLA-DR, and CD95), and the HIV coreceptor (CCR5). T-cell populations were compared between groups.


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  • Characteristics of women screened for a contraceptive intravaginal ring study in Kisumu, Kenya, 2014.

    BACKGROUND:

    HIV antiretroviral-based intravaginal rings with and without co-formulated contraception hold promise for increasing HIV prevention options for women. Acceptance of and ability to correctly and consistently use this technology may create challenges for future ring-based microbicide trials in settings where this technology has not been introduced. We examined baseline factors associated with enrolling in a contraceptive intravaginal ring study in Kisumu, Kenya and describe notional acceptability (willingness to switch to a contraceptive ring based solely on information received about it).


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  • Higher HPV16 and HPV18 Penile Viral Loads Are Associated With Decreased Human Papillomavirus Clearance in Uncircumcised Kenyan Men.

    BACKGROUND:

    Whether higher penile human papillomavirus (HPV) viral load is associated with a lower rate of HPV clearance remains unknown.

    OBJECTIVES: We examined the association between penile HPV16 and HPV18 viral load and subsequent HPV clearance in uncircumcised Kenyan men.

    STUDY DESIGN: Participants were human immunodeficiency virus (HIV)-seronegative, sexually active, 18- to 24-year-old men randomized to the control arm of a male circumcision trial in Kisumu, Kenya. Men provided exfoliated penile cells from two anatomical sites (glans/coronal sulcus and shaft) every 6 months for 2 years. GP5+/6+ polymerase chain reaction was used to identify 44 HPV-DNA types. Human papillomavirus viral load testing was conducted using a LightCyler real-time polymerase chain reaction assay; viral load was classified as high (>250 copies/scrape) or low (≤250 copies/scrape), for nonquantifiable values. The Kaplan-Meier method and Cox regression modeling were used to examine the association between HPV viral load and HPV clearance.


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  • Male partner circumcision associated with lower Trichomonas vaginalis incidence among pregnant and postpartum Kenyan women: a prospective cohort study.

    OBJECTIVE:

    Trichomonas vaginalis is the world's most common curable STI and has implications for reproductive health in women. We determined incidence and correlates of T. vaginalis in an HIV-uninfected peripartum cohort.


    METHODS:

    Women participating in a prospective study of peripartum HIV acquisition in Western Kenya were enrolled during pregnancy and followed until 9 months post partum. T. vaginalis was assessed every 1-3 months using wet mount microscopy. Correlates of incident T. vaginalis were determined using Cox proportional hazards models.


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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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  • Use of visual inspection with acetic acid, Pap smear, or high-risk human papillomavirus testing in women living with HIV/AIDS for posttreatment cervical cancer screening: same tests, different priorities.

    OBJECTIVES:

    Few studies have addressed optimal follow-up for HIV-infected women after cervical treatment. This study aimed to compare performance of three available tests to detect posttreatment cervical disease in HIV-infected women in Kenya.


    DESIGN: This is a prospective cohort study.


    METHODS: At least 6 months following cryotherapy, 517 HIV-infected women were evaluated concurrently with visual inspection with acetic acid (VIA), papanicolaou (Pap) smear, and high-risk human papillomavirus (HR-HPV) testing. Women positive by any test (≥low-grade squamous intraepithelial lesion for Pap) were scheduled for colposcopy and biopsy. Among 248 with histological confirmation [and 174 assumed to be truly negative for cervical intraepithelial neoplasia (CIN)2+ after testing negative by all three tests], the ability of each test alone, or in combination, to detect CIN2+ was calculated to determine their utility in posttreatment follow-up.


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  • Impact of periodic presumptive treatment for bacterial vaginosis on the vaginal microbiome among women participating in the Preventing Vaginal Infections trial.

    BACKGROUND:

    Evidence suggests specific vaginal bacteria that are associated with bacterial vaginosis (BV) may increase risk of adverse health outcomes in women. Among women participating in a randomized trial, we assessed the effect of periodic presumptive treatment (PPT) on detection and concentrations of select vaginal bacteria.


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  • HIV-1-Neutralizing IgA Detected in Genital Secretions of Highly HIV-1-Exposed Seronegative Women on Oral Preexposure Prophylaxis.

    Although nonhuman primate studies have shown that simian immunodeficiency virus/simian-human immunodeficiency virus (SIV/SHIV) exposure during preexposure prophylaxis (PrEP) with oral tenofovir can induce SIV immunity without productive infection, this has not been documented in humans. We evaluated cervicovaginal IgA in Partners PrEP Study participants using a subtype C primary isolate and found that women on PrEP had IgA with higher average human immunodeficiency virus type 1 (HIV-1)-neutralizing magnitude than women on placebo (33% versus 7%; P = 0.008).

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  • "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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  • Analysis of the Prevalence of HTLV-1 Proviral DNA in Cervical Smears and Carcinomas from HIV Positive and Negative Kenyan Women.

    The oncogenic retrovirus human T-cell lymphotropic virus type 1 (HTLV-1) is endemic in some countries although its prevalence and relationship with other sexually transmitted infections in Sub-Saharan Africa is largely unknown. A novel endpoint PCR method was used to analyse the prevalence of HTLV-1 proviral DNA in genomic DNA extracted from liquid based cytology (LBC) cervical smears and invasive cervical carcinomas (ICCs) obtained from human immunodeficiency virus-positive (HIV+ve) and HIV-negative (HIV-ve) Kenyan women.

  • Performance of p16INK4a ELISA as a primary cervical cancer screening test among a large cohort of HIV-infected women in western Kenya: a 2-year cross-sectional study.

    OBJECTIVE:

    A biomarker with increased specificity for cervical dysplasia compared with human papillomavirus (HPV) testing would be an attractive option for cervical cancer screening among HIV-infected women in resource-limited settings. p16(INK4a) has been explored as a biomarker for screening in general populations.


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  • Semen Bacterial Concentrations and HIV-1 RNA Shedding among HIV-1-Seropositive Kenyan Men.

    INTRODUCTION:

    HIV-1 is transmitted through semen from men to their sexual partners. Genital infections can increase HIV-1 RNA shedding in semen, but shedding also occurs in the absence of typical pathogens. We hypothesized that higher bacterial concentrations in semen would be associated with higher HIV-1 RNA levels.

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  • Associations Between Vaginal Infections and Potential High-risk and High-risk Human Papillomavirus Genotypes in Female Sex Workers in Western Kenya.

    PURPOSE:

    Infection with and persistence of high-risk human papillomavirus (HR HPV) are the strongest risk factors for cervical cancer. Little is known about the prevalence and role of concurrent sexually transmitted infections (STIs) found in HPV-infected female sex workers (FSW) in Africa. This study purports to test our a priori hypotheses that STIs are associated with genotypes pertaining to the α-group species 9. The objectives were to determine the prevalence of bacterial vaginosis (BV), Trichomonas vaginalis, and Candida spp in FSW, the association between these STIs and the prevalence of any potential HR and HR HPV genotypes in FSWs.


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  • HIV/AIDS and contraceptive use: Factors associated with contraceptive use among sexually-active HIV-positive women in Kenya.

    OBJECTIVES:

    With increased availability of anti-retroviral therapy and improved survival for people living with HIV, more HIV-positive women are leading full reproductive lives. However, HIV-positive women have special contraceptive needs/concerns. This paper examines the individual and community-level HIV/AIDS factors associated with contraceptive use and compares predictors of contraceptive uptake between HIV-positive and HIV-negative women in Kenya.


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