research & publications

SRH RESEARCH

Results by County (Approx)
  • 23 results found
  • 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.


    Read More

  • 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.


    Read More

  • 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.


    Read More

  • 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.


    Read More

  • 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.


    Read More

  • 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.


    Read More

  • 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.


    Read more

  • 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).


    Read more

  • 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.


    Read more


  • 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.


    Read more

  • 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.


    Read more

  • Uptake of cervical cancer screening among Female Sex Workers in Homabay, Migori and Kisii Counties of Western Kenya

    Background:

    Globally, cancer causes more deaths than HIV, Tuberculosis and Malaria combined. In women more than 30% of cancers are in the breast or cervix. Worldwide, 530,000 new cases of cervical cancer are identified each year, with 270,000 deaths. Approximately 85% of these deaths occur in Low / middle-income countries (WHO, 2013). This burden is predicted to rise further by 2030 if nothing is done. According to the Kenya network of cancer organizations, cervical cancer cases in Kenya are estimated at 25 per 100,000 and the numbers double in the event of a HIV co-infection. The network further reports that 60% of Kenyans affected by cancer are younger than 70 years old, with70-80% of cases diagnosed in late stages thus the high morbidity and mortality rates. The high mortalities are due to lack of awareness, inadequate diagnostic facilities, lack of treatment facilities, high cost of treatment and high poverty Index. Cryotherapy is however safe and results in cure rates of 80-90%, if administered in time. International Medical Corps working together in collaboration with Ministry of health runs a cervical cancer test and treat program for women of reproductive age in Kisii, Homabay and Migori counties. The program is aimed at early detection, treatment and cure of pre-cancerous lesions by screening using VIA (visual inspection with acetic acid) then treat pre-cancerous lesions using cryotherapy (freezing), as recommended by WHO for low income settings.


    Methodology:

    The programs installed seven cryotherapy machines in seven drop in centers (DiCEs) that prioritizes services for key populations (sex workers) who are at a greater risk of exposure, where they are screened and treated at a single visit. The sex workers were screened for cervical cancer during the quarterly visits using VIA and those found positive of VIA accorded treatment by freezing the cells using cryotherapy machines. Services were then recorded in the MOH tools and analysis of incidence done using excel.


    Results:

    From July 2014 to June 2016, the program screened 7215 female sex workers for cervical cancer out of which, 957 (13%) were VIA positive and 892 were treated using cryotherapy. 197 (20%) of the VIA positive women also tested positive for HIV and were linked to care and treatment. 28 had advanced cervical cancer lesions and were referred for further management.


    Conclusion:

    Increasing access to cervical cancer screening, early detection and treatment of VIA cells and improving demand of cervical cancer screening and treatment among FSW will go a long way into saving lives.



  • Uptake of cervical cancer screening among Female Sex Workers in Homabay, Migori and Kisii Counties of Western Kenya

    Background:

    Globally, cancer causes more deaths than HIV, Tuberculosis and Malaria combined. In women more than 30% of cancers are in the breast or cervix. Worldwide, 530,000 new cases of cervical cancer are identified each year, with 270,000 deaths. Approximately 85% of these deaths occur in Low / middle-income countries (WHO, 2013). This burden is predicted to rise further by 2030 if nothing is done. According to the Kenya network of cancer organizations, cervical cancer cases in Kenya are estimated at 25 per 100,000 and the numbers double in the event of a HIV co-infection. The network further reports that 60% of Kenyans affected by cancer are younger than 70 years old, with70-80% of cases diagnosed in late stages thus the high morbidity and mortality rates. The high mortalities are due to lack of awareness, inadequate diagnostic facilities, lack of treatment facilities, high cost of treatment and high poverty Index. Cryotherapy is however safe and results in cure rates of 80-90%, if administered in time. International Medical Corps working together in collaboration with Ministry of health runs a cervical cancer test and treat program for women of reproductive age in Kisii, Homabay and Migori counties. The program is aimed at early detection, treatment and cure of pre-cancerous lesions by screening using VIA (visual inspection with acetic acid) then treat pre-cancerous lesions using cryotherapy (freezing), as recommended by WHO for low income settings.


    Methodology:

    The programs installed seven cryotherapy machines in seven drop in centers (DiCEs) that prioritizes services for key populations (sex workers) who are at a greater risk of exposure, where they are screened and treated at a single visit. The sex workers were screened for cervical cancer during the quarterly visits using VIA and those found positive of VIA accorded treatment by freezing the cells using cryotherapy machines. Services were then recorded in the MOH tools and analysis of incidence done using excel.


    Results:

    From July 2014 to June 2016, the program screened 7215 female sex workers for cervical cancer out of which, 957 (13%) were VIA positive and 892 were treated using cryotherapy. 197 (20%) of the VIA positive women also tested positive for HIV and were linked to care and treatment. 28 had advanced cervical cancer lesions and were referred for further management.


    Conclusion:

    Increasing access to cervical cancer screening, early detection and treatment of VIA cells and improving demand of cervical cancer screening and treatment among FSW will go a long way into saving lives.


  • Uptake of cervical cancer screening among Female Sex Workers in Homabay, Migori and Kisii Counties of Western Kenya

    Background:

    Globally, cancer causes more deaths than HIV, Tuberculosis and Malaria combined. In women more than 30% of cancers are in the breast or cervix. Worldwide, 530,000 new cases of cervical cancer are identified each year, with 270,000 deaths. Approximately 85% of these deaths occur in Low / middle-income countries (WHO, 2013). This burden is predicted to rise further by 2030 if nothing is done. According to the Kenya network of cancer organizations, cervical cancer cases in Kenya are estimated at 25 per 100,000 and the numbers double in the event of a HIV co-infection. The network further reports that 60% of Kenyans affected by cancer are younger than 70 years old, with70-80% of cases diagnosed in late stages thus the high morbidity and mortality rates. The high mortalities are due to lack of awareness, inadequate diagnostic facilities, lack of treatment facilities, high cost of treatment and high poverty Index. Cryotherapy is however safe and results in cure rates of 80-90%, if administered in time. International Medical Corps working together in collaboration with Ministry of health runs a cervical cancer test and treat program for women of reproductive age in Kisii, Homabay and Migori counties. The program is aimed at early detection, treatment and cure of pre-cancerous lesions by screening using VIA (visual inspection with acetic acid) then treat pre-cancerous lesions using cryotherapy (freezing), as recommended by WHO for low income settings.


    Methodology:

    The programs installed seven cryotherapy machines in seven drop in centers (DiCEs) that prioritizes services for key populations (sex workers) who are at a greater risk of exposure, where they are screened and treated at a single visit. The sex workers were screened for cervical cancer during the quarterly visits using VIA and those found positive of VIA accorded treatment by freezing the cells using cryotherapy machines. Services were then recorded in the MOH tools and analysis of incidence done using excel.


    Results:

    From July 2014 to June 2016, the program screened 7215 female sex workers for cervical cancer out of which, 957 (13%) were VIA positive and 892 were treated using cryotherapy. 197 (20%) of the VIA positive women also tested positive for HIV and were linked to care and treatment. 28 had advanced cervical cancer lesions and were referred for further management.


    Conclusion:

    Increasing access to cervical cancer screening, early detection and treatment of VIA cells and improving demand of cervical cancer screening and treatment among FSW will go a long way into saving lives.



  • Increased risk of genital ulcer disease in women during the first month after initiating antiretroviral therapy

    Introduction

    Genital ulcer disease (GUD) is common in HIV-1-infected women, and a small number of studies have suggested increased GUD risk after antiretroviral therapy (ART) initiation. To better define this risk, we monitored 134 women at ART initiation and monthly thereafter.
    Methods

    Women were evaluated monthly for genital ulcers. Syphilis serology was tested quarterly, and chancroid culture performed on ulcers that were felt to be clinically consistent with a diagnosis of chancroid. A logistic model with generalized estimating equations was used to analyze predictors of GUD from baseline until 6 months after ART initiation.
    Results

    During the study period, GUD occurred in 54 women (40.3%) at 85 visits (10.0%). GUD prevalence was 9.7% at baseline, increased to 16.7% at month 1 (adjusted odds ratio [aOR] 1.9 [1.0 – 3.6], p = 0.04), then decreased to 6.4% by month 6. History of GUD (aOR 3.8 [1.9 – 7.7], p < 0.001) and CD4 count <100 (aOR 1.8 [1.0 – 3.4, p = 0.06) were associated with increased risk of GUD after ART initiation.
    Discussion

    Women experience increased risk of GUD in the first month after ART initiation, particularly if they have low CD4 counts or a history of GUD.


    Read More

  • Prospective Study of Vaginal Bacterial Flora and Other Risk Factors for Vulvovaginal Candidiasis

    Background. It has been suggested that vaginal colonization with lactobacilli may reduce the risk of vulvovaginal candidiasis (VVC), but supporting data are limited. Our objective was to determine the relationship between vaginal bacterial flora and VVC.

    Methods. We conducted a prospective cohort analysis that involved 151 Kenyan sex workers. At monthly follow‐up visits, VVC was defined as the presence of yeast buds, pseudohyphae, or both on a wet preparation (including potassium hydroxide preparation) of vaginal secretions. Generalized estimating equations were used to identify correlates of VVC.

    Results. Participants returned for a median of 12 visits (interquartile range, 11–12 visits). VVC was identified at 162 visits, including 26 involving symptomatic VVC. Bacterial vaginosis was associated with fewer episodes of VVC (adjusted odds ratio [aOR], 0.29 [95% confidence interval {CI}, 0.16–0.50]). After excluding women with concurrent bacterial vaginosis, another possible cause of vaginal symptoms, the likelihood of symptomatic VVC was higher among those who had had yeast identified on wet preparation of vaginal secretions during the past 60 days (aOR, 4.06 [95% CI, 1.12–14.74]) and those with concurrent vaginal Lactobacillus colonization (aOR, 3.75 [95% CI, 1.30–10.83]).

    Conclusions. Contrary to the commonly posited hypothesis that vaginal Lactobacillus colonization has a protective effect, we found that such colonization was associated with a nearly 4‐fold increase in the likelihood of symptomatic VVC


    Read More

  • High Mycoplasma genitalium Organism Burden Is Associated with Shedding of HIV-1 DNA from the Cervix

    We assessed the relationship between infection with Mycoplasma genitalium, an emerging sexually transmitted pathogen, and cervical shedding of human immunodeficiency virus (HIV)–1 DNA among 303 HIV-1–positive Kenyan women. HIV-1 shedding was detected by qualitative polymerase chain reaction (PCR) in 154 women (51%); M. genitalium was detected by qualitative PCR in 52 (17%), and organism burden was determined by quantitative PCR. Women with high M. genitalium organism burdens (more than the median of 3195 genomes/mL) were 3-fold more likely to shed HIV-1 DNA than were M. genitalium–negative women (adjusted OR, 2.9
    [95% confidence interval, 1.1–7.6]), yet this did not appear to be mediated by traditional measures of cervical inflammation (elevated polymorphonuclear leukocyte count).

    Download
  • Trichomonas vaginalis Infection: Can We Afford to Do Nothing?

    For more than a century following its initial description in 1836, Trichomonas vaginalis was considered to be either a harmless vaginal colonizer or simply a minor nuisance [1]. This view may have been sustained by the observation that women with trichomoniasis vaginalis were usually either asymptomatic or had only mild symptoms

    Download
  • Compliance to chemotherapy treatment among patients with breast cancer at moi teaching and referral hospital

    To determine compliance of chemotherapy regiment among patients with breast cancer

  • Urethral infection in a workplace population of East African men: evaluation of strategies for screening and management.

    Transport workers (n = 504) in Mombasa, Kenya, were screened for urethral infection by history, clinical examination, and laboratory testing of urethral swabs and first-catch urine specimens. The prevalence of Neisseria gonorrhea was 3.4%, Chlamydia trachomatis, 3.6%, and Trichomonas vaginalis, 6.0%; more than two-thirds of infections were asymptomatic. A complaint of urethral discharge, dysuria, or both was twice as sensitive as the sign of discharge on physical examination (34.5% vs. 15.5%) in identifying infection. A positive leukocyte esterase dipstick (LED) test on urine predicted infection with a sensitivity of 95.0% and a specificity of 59.3% in symptomatic men and with a sensitivity of 55.3% and a specificity of 82.8% in asymptomatic men. Demographic and behavioral factors were not independent predictors of infection. In resource-poor settings with high prevalence’s of urethral infection, an effective screening and management strategy would be to treat symptomatic men, as well as asymptomatic men with a positive LED test, for all three infections

    Download
  • Resistance Pattern Of Isolates From Bacterial vaginosis In Female Sex Workers In Nairobi, Kenya

    SWOP clinicsMillicent Ogutu Dept.of Medical Microbiology, University of Nairobi