research & publications

SRH RESEARCH

Results by County (Approx)
  • 165 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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  • End-Users’ Product Preference Across Three Multipurpose Prevention Technology Delivery Forms: Baseline Results from Young Women in Kenya and South Africa

    Background:

    Multipurpose prevention technologies (MPTs) are biomedical interventions that provide protection from both sexually transmitted infections, such as HIV, and unintended pregnancy. A dual-purpose product that combines HIV and pregnancy prevention could offer advantages over single-indication products. In recent population-based surveys, 4 in 10 women in Kenya and 89% of women ages 18–24 in South Africa were current users of modern contraceptive methods. A contraceptive product that also confers protection against HIV could lead to greater coverage of prevention methods in these countries than a single-purpose HIV prevention method.


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  • ARVs to Prevent Breastmilk HIV:Viral and Immune Responses

    Background:

    Identifying new approaches for preventing breastmilk transmission of HIV-1 is an important research priority. To this end, clinical trials are underway to evaluate the efficacy of HAART (zidovudine, lamivudine, nevirapine) during late pregnancy/lactation versus zidovudine/nevirapine peripartum for prevention of breastmilk HIV-1 transmission. It is important to understand the mechanism of effect of these antiretroviral (ARV) strategies on prevention of breastmilk HIV-1 transmission.


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  • Persistently HIV-1 seronegative Nairobi sex workers are susceptible to in vitro infection

    Background:

    Several studies have reported on individuals that remain persistently seronegative despite repeated exposure to the HIV type 1 (HIV-1). These have included health care workers with accidental exposure (1), infants born to infected mothers (2-4), needle-sharing intravenous drug users (5), individuals engaged in unprotected sexual intercourse (6,7) and prostitutes (8,9). The risk for infection among these cohorts varied greatly, and T cell-mediated immunity, as measured by interleukin (IL)-2 production, lymphocyte proliferation in response to HIV-derived peptides or HIV-specific cytotoxic T lymphocytes, was thought to contribute to resistance in these cases (1-4,6,7,9,10). The proposed mechanism involved priming of T cell responses with low antigenic doses, and generation of cytokine-mediated T helper cell type 1 (Th1) immune responses, which upregulate cellular effector functions and downregulate T cell help for B cells .


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  • End-Users' Product Preference Across Three Multipurpose Prevention Technology Delivery Forms: Baseline Results from Young Women in Kenya and South Africa.

    Background:

    A multipurpose prevention technology (MPT) that combines HIV and pregnancy prevention is a promising women's health intervention, particularly for young women. However, little is known about the drivers of acceptability and product choice for MPTs in this population. This paper explores approval ratings and stated choice across three different MPT delivery forms among potential end-users.


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  • Successful increase in contraceptive uptake among Kenyan HIV-1-serodiscordant couples enrolled in an HIV-1 prevention trial.

    Background:

    Sub-Saharan Africa has the highest prevalence and incidence of HIV-1 infection in the world, and the region also has high fertility rates, with approximately 14 million pregnancies annually considered unintended. As an example, in Kenya, HIV-1 seroprevalence is 7.1%, 60% of HIV-1 infected adults are women, the total fertility rate is 4.7 births per woman, and it has been estimated that there is a 25% unmet need for family planning among married women.


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  • Increased Risk of HIV-1 Transmission in Pregnancy: A Prospective Study among African HIV-1 Serodiscordant Couples

    Background :

    Physiologic and behavioral changes during pregnancy may alter HIV-1 susceptibility and infectiousness. Prospective studies exploring pregnancy and HIV-1 acquisition risk in women have found inconsistent results. No study has explored the effect of pregnancy on HIV-1 transmission risk from HIV-1 infected women to male partners.


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  • A Prospective Study of Frequency and Correlates of Intimate Partner Violence among African Heterosexual HIV Serodiscordant Couples

    Background :

    Intimate partner violence (IPV) is common worldwide and is an important consideration in couples HIV voluntary counseling and testing (CVCT), especially for HIV serodiscordant couples (i.e., in which only one member is HIV infected).


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  • Social Exchange and Sexual Behavior in Young Women's Premarital Relationships in Kenya.

    Background:

    Although HIV incidence in sub-Saharan Africa has been in slow decline, the epidemic continues in the region, with an estimated 1.8 million people newly infected in 2009 alone (Joint United Nations Program on HIV/AIDS [UNAIDS], 2010). Importantly, young women are disproportionately affected (Gouws, Staneckib, Lyerla, & Ghys, 2008; UNAIDS, 2010). In Kenya, women ages 20–24 are four times more likely to be HIV positive (7.4%) than men of the same age group (1.9%) (National AIDS and STI Control Programme [NASCOP], 2009). Researchers and policymakers have paid increasing attention to the role of transactional sex, or the exchange of money and gifts (what we refer to as “transfers”) within non-marital relationships, as a key explanation for the gender difference in infection rates (Côté et al., 2004; Dunkle, Jewkes, Brown, Gray, McIntryre, & Harlow, 2004; Hope, 2007). 

  • Contraceptive method and pregnancy incidence among African women in HIV-1 serodiscordant partnerships

    Background :

    Effective contraception reduces unintended pregnancies and is a central strategy to reduce vertical HIV-1 transmission for HIV-1 infected women.


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

    Background:

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


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  • Sexual behavior of HIV-positive adults not accessing HIV treatment in Mombasa, Kenya: Defining their prevention needs

    Background :

    HIV spread continues at high rates from infected persons to their sexual partners. In 2009, an estimated 2.6 million new infections occurred globally. People living with HIV (PLHIV) receiving treatment are in contact with health workers and therefore exposed to prevention messages. By contrast, PLHIV not receiving ART often fall outside the ambit of prevention programs. There is little information on their sexual risk behaviors. This study in Mombasa Kenya therefore explored sexual behaviors of PLHIV not receiving any HIV treatment.


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  • Correlates of prevalent sexually transmitted infections among participants screened for an HIV incidence cohort study in Kisumu, Kenya

    Background :

    We determined the prevalence of four sexually transmitted infections and the demographic and behavioural correlates associated with having one or more sexually transmitted infections among participants in an HIV incidence cohort study in Kisumu, western Kenya.


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  • Correlates of prevalent sexually transmitted infections among participants screened for an HIV incidence cohort study in Kisumu, Kenya

    Background :

    We determined the prevalence of four sexually transmitted infections and the demographic and behavioural correlates associated with having one or more sexually transmitted infections among participants in an HIV incidence cohort study in Kisumu, western 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, multiple sexual partners,inconsistent or lack of condom use, the absence of male circumcision,and most recently, hormonal contraceptive use. 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.


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  • Cost-effectiveness of cervical cancer screening and preventative cryotherapy at an HIV treatment clinic in Kenya

    Background:

    Cancer is a growing cause of mortality worldwide, and cervical cancer is one of the leading causes of cancer death in sub-Saharan Africa (SSA). Although preventable if detected early, cervical cancer is one of the most prevalent cancers on the continent with 75,000 incident cases per year. In addition to the cancer burden, more than 10 million women are infected with HIV and are therefore at greater risk for cervical cancer and early mortality, making early detection and prevention critical for this already vulnerable population . 


    Reducing cervical cancer among HIV-infected women is a primary focus of the Pink Ribbon Red Ribbon Initiative, a joint public–private international program launched in 2011 supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) . The initiative promotes integrating cervical cancer screening and treatment into HIV treatment clinics in sub-Saharan Africa.


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  • Risk factors for postpartum depression in women living with HIV attending Prevention of Mother–to-Child Transmission (PMTCT) Clinic at Kenyatta National Hospital, Nairobi

    Background:

    Mothers with HIV face a range of psychosocial problems, including postpartum depression (PPD) (Vesga-Lopez, Blanco, Keyes, Olfson, Grant, & Hasin, 2008) which impacts HIV disease progression in the mother and has lasting impacts for child health (Hartley, Pretorius, Mohamed, Laughton, Madhi, Cotton & Seedat, 2010). Depression is a highly prevalent co-morbidity among HIV+ individuals (Owe-Larsson, Sall, Salamon, Allgulander, 2009). It is inversely correlated with self-esteem, infant health status, and years of formal education (Ross, Sawatphanit, Mizuno & Takeo, 2011). High prevalence of depressive symptoms amongst pregnant HIV+ women areassociated with increased risk of adverse pregnancy outcomes and poor quality of life (Kapetanovic, Dass-Brailsford, Nora & Talisman, 2014). Additionally, women with HIV experience lower levels of emotional support available to them (Bonacquisti, Geller, Aaron, 2014).

    Perinatal depression is reported to be as high as 30–50 % in South Africa (Chibanda et al., 2010; Hartley et al., 2011; Rochat, Tomlinson, Barnighausen, Newell, and Stein, 2011; Stewart et al., 2010). In Nyanza province of Kenya HIV prevalence is as high as 20.7% in antenatal care settings (Dillabaugh et al., 2012). Stigma is known as a substantial barrier in adhering to and accessing HIV/AIDS care. Furthermore stigma contributes to depressive symptomatology (Rao et al., 2012) compounding the negative impact on women living with HIV.


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  • Treatment interruption after 2-year antiretroviral treatment (ART) initiated during acute/early HIV in infancy: a randomized trial

    Background:

    Early antiretroviral treatment (ART) is recommended for HIV-infected infants based on significant benefits of early versus eligibility-deferred ART. Prior to widespread ART use, some HIV-infected untreated children had long-term non-progression (LTNP). It is plausible that some children who would be LTNP without therapy, as well as others who control virus following early ART, could benefit from treatment interruption (TI) after immune recovery. This approach could reduce ART toxicity or resistance and preserve ART regimens for later in life.The objective of this study was to compare outcomes in treatment interruption versus continued ART among early-treated infants.


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  • Achieving pregnancy safely: perspectives on timed vaginal insemination among HIV-serodiscordant couples and health-care providers in Kisumu, Kenya.

    Background:

    In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to antiretroviral therapy. Therefore, in these settings, timed unprotected intercourse without assurance of HIV viral suppression may pose unnecessary risks. Timed vaginal insemination, a simple and affordable intervention, can be considered an adjunct method and option of safer conception for HIV prevention with treatment of the HIV-infected partner and/or pre-exposure prophylaxis.


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  • Continuous quality improvement intervention for adolescent and young adult HIV testing services in Kenya improves HIV knowledge

    Background:

    Adolescents have the highest HIV incidence of any age group and are the only age group in which HIV-related mortality increased between 2005 and 2013. While substantial progress has been made in HIV testing and treatment for adult populations, there has been less programmatic focus on adolescents (aged 10–19 years) and young adults (aged 20–24 years). Eighty-three per cent of all adolescents living with HIV reside in sub-Saharan Africa (SSA), and yet just 9–13% of adolescent boys and girls in the region have tested for HIV in the past year.


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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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  • 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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