Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author
|
|  Yüklə 5.84 Mb.
|
Document Number: 325578 Working with risk: Occupational safety issues among healthcare workers in Kenya. Author: Taegtmeyer M; Suckling RM; Nguku PM; Meredith C; Kibaru J Source: AIDS Care. 2008 Mar;20(3):304-310. Abstract: The objective of this study was to explore knowledge of, attitudes towards and practice of post-exposure prophylaxis (PEP) among healthcare workers (HCWs) in the Thika district, Kenya. We used site and population-based surveys, qualitative interviews and operational research with 650 staff at risk of needlestick injuries (NSIs). Research was conducted over a 5-year period in five phases: (1) a bio-safety assessment; (2) a staff survey: serum drawn for anonymous HIV testing; (3) interventions: biosafety measures, antiretrovirals for PEP and hepatitis B vaccine; (4) a repeat survey to assess uptake and acceptability of interventions; in-depth group and individual interviews were conducted; and (5) health system monitoring outside a research setting. The main outcome measures were bio-safety standards in clinical areas, knowledge, attitudes and practice as regards to PEP, HIV-sero-prevalence in healthcare workers, uptake of interventions, reasons for poor uptake elucidated and sustainability indicators. Results showed that HCWs had the same HIV sero-prevalence as the general population but were at risk from poor bio-safety. The incidence of NSIs was 0.97 per healthcare worker per year. Twenty-one percent had had an HIV test in the last year. After one year there was a significant drop in the number of NSIs (OR: 0.4; CI: 0.3-0.6; p less than 0.001) and a significant increase in the number of HCWs accessing HIV testing (OR: 1.55; CI: 1.2-2.1; p = 0.003). In comparison to uptake of hepatitis B vaccination (88% of those requiring vaccine) the uptake of PEP was low (4% of those who had NSIs). In-depth interviews revealed this was due to HCWs fear of HIV testing and their perception of NSIs as low risk. We concluded that Bio-safety remains the most significant intervention through reducing the number of NSIs. Post-exposure prophylaxis can be made readily available in a Kenyan district. However, where HIV testing remains stigmatised uptake will be limited*particularly in the initial phases of a programme. (author's) Language: English Keywords: KENYA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | KAP SURVEYS | EPIDEMIOLOGIC METHODS | OPERATIONS RESEARCH | FOCUS GROUPS | HEALTH PERSONNEL | OCCUPATIONAL HEALTH | SAFETY | NEEDLE PIERCING | ACCIDENTS AND INJURIES | HIV TESTING | HIV TRANSMISSION | PREVALENCE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | GEOGRAPHIC FACTORS | POPULATION | SURVEYS | SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | PROGRAM EVALUATION | PROGRAMS | ORGANIZATION AND ADMINISTRATION | DATA COLLECTION | DELIVERY OF HEALTH CARE | HEALTH | PUBLIC HEALTH | RISK BEHAVIOR | BEHAVIOR | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | HIV INFECTIONS | VIRAL DISEASES | DISEASES | MEASUREMENT Document Number: 325502 Reasons for unsatisfactory acceptance of antiretroviral treatment in the urban Kibera slum, Kenya. Author: Unge C; Johansson A; Zachariah R; Some D; Van Engelgem I Source: AIDS Care. 2008 Feb;20(2):146-149. Abstract: The aim of this study was to explore why patients in the urban Kibera slum, Nairobi, Kenya, offered free antiretroviral treatment (ART) at the Medecins Sans Frontiers (MSF) clinic, choose not to be treated despite signs of AIDS. Qualitative semi-structured interviews were conducted with 26 patients, 9 men and 17 women. Six main reasons emerged for not accepting ART: a) fear of taking medication on an empty stomach due to lack of food; b) fear that side-effects associated with ART would make one more ill; c) fear of disclosure and its possible negative repercussions; d) concern for continuity of treatment and care; e) conflicting information from religious leaders and community, and seeking alternative care (e.g. traditional medicine); f) illiteracy making patients unable to understand the information given by health workers. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | URBAN POPULATION | SLUMS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | FEAR | SIDE EFFECTS | SOCIAL DISCRIMINATION | RELIGIOUS ASPECTS | TRADITIONAL HEALTH PRACTICES | ILLITERACY | BELIEFS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SURVEYS | SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | URBANIZATION | URBAN POPULATION DISTRIBUTION | POPULATION DISTRIBUTION | GEOGRAPHIC FACTORS | HIV | BEHAVIOR | EMOTIONS | PSYCHOLOGICAL FACTORS | TREATMENT | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | SOCIAL PROBLEMS | SOCIOCULTURAL FACTORS | RELIGION | CULTURE | EDUCATIONAL STATUS | SOCIOECONOMIC STATUS | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS Document Number: 324765 HIV testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and HIV treatment. Author: Chersich MF; Luchters SM; Othigo MJ; Yard E; Mandaliya K Source: International Journal of STD and AIDS. 2008 Jan;19(1):42-46. Abstract: This study assessed the potential for HIV testing at child health clinics to increase knowledge of HIV status, and entry to infant feeding counselling and HIV treatment. At a provincial hospital in Mombasa, Kenya, HIV testing and counselling were offered to women bringing their child for immunization or acute care services. Most women said HIV testing should be offered in these clinics (472/493, 95.7%), with many citing the benefits of regular testing and entry to prevent mother-to-child transmission. Of 500 women, 416 (83.4%) received test results, 97.6% on the same day. After 50 participants, point-of-care testing replaced laboratory-based rapid testing. Uptake increased 2.6 times with point-of-care testing (95% confidence interval = 1.4-5.1; P = 0.003). Of 124 women who had not accessed HIV testing during pregnancy, 98 tested in the study (79.0%). Measured by uptake and attitudes, HIV testing in child health clinics is acceptable. This could optimize entry into HIV treatment, infant feeding counselling and family planning services. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | SURVEYS | MOTHERS | INFANT | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV TESTING | COUNSELING | CHILD HEALTH SERVICES | HIV INFECTIONS | TREATMENT | BREASTFEEDING | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | PARENTS | FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS | YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | DISEASE TRANSMISSION CONTROL | PREVENTION AND CONTROL | DISEASES | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | CLINIC ACTIVITIES | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | MATERNAL-CHILD HEALTH SERVICES | PRIMARY HEALTH CARE | VIRAL DISEASES | INFANT NUTRITION | NUTRITION Document Number: 324667 Reduced rates of HIV acquisition during unprotected sex by Kenyan female sex workers predating population declines in HIV prevalence. Author: Kimani J; Kaul R; Nagelkerke NJ; Luo M; MacDonald KS Source: AIDS. 2008 Jan 2;22(1):131-137. Abstract: Female sex workers (FSWs) form a core group at high risk of both sexual HIV acquisition and secondary transmission. The magnitude of these risks may vary by sexual risk taking, partner HIV prevalence, host immune factors and genital co-infections. We examined temporal trends in HIV prevalence and per-act incidence, adjusted for behavioral and other variables, in FSWs from Nairobi, Kenya. An open cohort of FSWs followed since 1985. Behavioral and clinical data were collected six monthly from 1985 to 2005, and sexually transmitted infection (STI) diagnostics and HIV serology performed. A Cox proportional hazards model with time-dependent covariables was used to estimate infection risk as a function of calendar time. HIV prevalence in new FSW enrollees peaked at 81% in 1986, and was consistently below 50% after 1997. Initially uninfected FSWs remained at high risk of acquiring HIV throughout the study period, but the rate of HIV acquisition during unprotected sex with a casual client declined by overfour-fold. This reduction correlated closely with decreases in gonorrhea prevalence, and predated reductions in the Kenyan HIV population prevalence by over a decade. The per-act rate of HIV acquisition in high-risk Nairobi FSWs fell dramatically between 1985 and 2005. This decline may represent the impact of improved STI prevention/therapy, immunogenetic shifts in at-risk women, or changes in the proportion of HIV exposures occurring with clients who had acute HIV infection. Declining HIV incidence in high-risk cohorts may predict and/or be causally related to future reductions in population prevalence. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | COHORT ANALYSIS | MATHEMATICAL MODEL | LONGITUDINAL STUDIES | SEX WORKERS | WOMEN IN DEVELOPMENT | HIV POSITIVE PERSONS | HIV INFECTIONS | SEX BEHAVIOR | RISK BEHAVIOR | PREVALENCE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | MODELS, THEORETICAL | STUDIES | BEHAVIOR | ECONOMIC DEVELOPMENT | ECONOMIC FACTORS | PERSONS LIVING WITH HIV/AIDS | VIRAL DISEASES | DISEASES | MEASUREMENT Document Number: 322747 Lessons learned in the conduct, validation, and interpretation of national population based HIV surveys. Author: Garcia Calleja JM; Marum LH; Carcamo CP; Kaetano L; Muttunga J Source: AIDS. 2005 May;19 Suppl 2:S9-S17. Abstract: In the past few years several countries have conducted national population-based HIV surveys. Survey methods, levels of participation bias from absence or refusal and lessons learned conducting such surveys are compared in four national population surveys: Mali, Kenya, Peru and Zambia. In Mali, Zambia, and Kenya, HIV testing of adult women and men was included in the national-level demographic and health surveys carried out regularly in these countries, whereas in Peru the national HIV survey targeted young people in 24 cities with populations over 50 000. The household response rate was above 90% in all countries, but some individuals were absent for interviews. HIV testing rates were between 70 and 79% of those eligible, with higher test rates for women. Three critical questions in this type of survey need to be answered: who did the surveys miss; how much it matters that they were missed; and what can be done to increase the participation of respondents so the coverage rates are adequate. The level of representativeness of the populations tested was adequate in each survey to provide a reliable national estimate of HIV prevalence that complements other methods of HIV surveillance. Different lessons were learned from each survey. These population-based HIV seroprevalence surveys demonstrate that reliable and useful results can be obtained, although they require careful planning and increased financial and human resource investment to maximize responses at the household and individual level, which are key elements to validate survey results. This review was initiated through an international meeting on 'New strategies for HIV/ AIDS Surveillance in Resource-constrained Countries' held in Addis Ababa on 26--30 January 2004 to share and develop recommendations to guide future surveys. (author's) Language: English Keywords: MALI | KENYA | PERU | ZAMBIA | METHODOLOGICAL STUDIES | DEMOGRAPHIC AND HEALTH SURVEYS | EPIDEMIOLOGIC METHODS | HOUSEHOLDS | HIV INFECTIONS | PREVALENCE | DATA QUALITY | AFRICA, WESTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | AFRICA, EASTERN | SOUTH AMERICA, WESTERN | SOUTH AMERICA | LATIN AMERICA | AMERICAS | AFRICA, SOUTHERN | DEMOGRAPHIC SURVEYS | POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | RESEARCH METHODOLOGY | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS | VIRAL DISEASES | DISEASES | MEASUREMENT | DATA ANALYSIS Document Number: 306899 Prevention of mother-to-child transmission and voluntary counseling and testing programme data: What is their utility for HIV surveillance? Author: Hladik W; Masupu K; Roels T; Plipat T; Kaharuza F Source: AIDS. 2005 May;19 Suppl 2:S19-S24. Abstract: Antenatal clinic (ANC)-based surveillance through unlinked anonymous testing (UAT) for HIV without informed consent provides solid long-term trend data in resource-constrained countries with generalized epidemics. The rapid expansion of the prevention of mother-to-child transmission (PMTCT) and voluntary counseling and testing (VCT) programmes prompts the question regarding their utility for HIV surveillance and their potential to replace UAT-based ANC surveillance. Four presentations on the use of PMTCT or VCT data for HIV surveillance were presented at a recent international conference. The main findings are presented in this paper, and the operational and epidemiological aspects of using PMTCT or VCT data for surveillance are considered. VCT data in Uganda confirm the falling trend in HIV prevalence observed in ANC surveillance. Thailand, a country with nationwide PMTCT coverage and a very high acceptance of HIV testing, has replaced UAT data in favor of PMTCT data for surveillance. Studies from Botswana and Kenya showed that PMTCT-based HIV prevalences was similar, but the quality and availability of the PMTCT data varied. The strength of UAT lies in the absence of selection bias and the availability of individual data. Conversely, the quantity of VCT and PMTCT programme testing data often exceed those in UAT, but may be subject to bias due to self-selection or test refusal. When using VCT or PMTCT data for surveillance, investigators must consider these caveats, as well as their varying data quality, accessibility, and availability of individual records. (author's) Language: English Keywords: UGANDA | THAILAND | BOTSWANA | KENYA | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | MOTHERS | INFANT | MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | DATA QUALITY | BIAS | VOLUNTARY COUNSELING AND TESTING | ANTENATAL CARE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | ASIA, SOUTHEASTERN | ASIA | AFRICA, SOUTHERN | RESEARCH METHODOLOGY | PARENTS | FAMILY RELATIONSHIPS | FAMILY CHARACTERISTICS | FAMILY AND HOUSEHOLD | SOCIOCULTURAL FACTORS | YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | TRANSMISSION | INFECTIONS | DISEASES | HIV INFECTIONS | VIRAL DISEASES | DATA ANALYSIS | ERROR SOURCES | MEASUREMENT | HIV TESTING | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | MATERNAL HEALTH SERVICES | MATERNAL-CHILD HEALTH SERVICES | PRIMARY HEALTH CARE Document Number: 306900 Prevalence of HCV and HCV / HIV co-infection among in-patients at the Kenyatta National Hospital. Author: Karuru JW; Lule GN; Joshi M; Anzala O Source: East African Medical Journal. 2005 Apr;82(4):170-172. Abstract: The objective was to determine the prevalence of HCV and HCV/HIV co-infection among medical in-patients at the Kenyatta National Hospital. Design: Prospective cross-sectional descriptive study. Setting: Kenyatta National Hospital, a tertiary referral and teaching hospital, in-patient department Subjects: HIV/AIDS and HIV negative in-patients at KNH medical wards. Among 458 HIV/AIDS medical in-patients, the prevalence of HCV was 3.7% while in the 518 HIV negative patients, it was 4.4%. The prevalence of co-infection with HCV and HIV was 3.7%. The incidence of risk factors in persons with HCV and/ or HIV infection(s) was low. This study found the prevalence of HCV infection among medical in-patients to be similar in HIV positive and HIV negative group of patients. The co-infection rates were low, as were the risk factors for transmission of these infections. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | CLIENTS | HOSPITALS | HEPATITIS | HIV INFECTIONS | PREVALENCE | RISK FACTORS | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | HEALTH FACILITIES | DELIVERY OF HEALTH CARE | HEALTH | VIRAL DISEASES | DISEASES | |