Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author
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Methods: To describe the relationships between these parameters, we conducted a longitudinal cohort study involving 51 perinatally HIV-1 infected children aged between 1 and 13 years. HIV status was determined by ELISA and confirmed by western blot and PCR. Antibodies were quantified by limiting dilution ELISA, plasma HIV-1 RNA load by RT-PCR and CD4+ T-lymphocytes by FACSCount. Results: Asymptomatic and symptomatic disease had, respectively, a rise in median HIV-1 RNA load from 1,195 to 132,543 and from 42,962 to 1,109,281 copies/ml in children below 6 years.The increase in viral load was 10-fold higher for asymptomatic compared to other categories and 2-fold faster for children less than 6 years than those above. Similarly, symptomatic children below 6 years had initial median CD4+ T-lymphocyte counts of 647 (22) cells/µL, declining to 378 (20) while those above 6 years had initial values of below 335 (15) but which increased to 428 (17). Median viral load correlated significantly with median CD4+ T-lymphocyte percentage in children above 6 years (p=0.026) but not below. Conclusions: Viral load is lower in older than younger children and correlates significantly with percentage CD4+ T-lymphocytes. Survival by HIV-1 infected children requires a competent immune response early in infection to counter the rapidly replicating virus. Interventions aimed at boosting the naïve immune system may prolong survival in these children. AIDS in Kenya: background projections, impact, interventions. Source: Kenya Medical Research Institute, Kenya. Author: Kenya, Ministry of Health, National AIDS Control Programme; National Council for Population and Development. Abstract: The booklet provides information about the AIDS epidemic in Kenya in terms of background projections; impact; and interventions. Future projections of AIDS infection are given as well as the social and economic impacts of AIDS and what needs to be done to prevent the spread of AIDS. Language: English Assessment of utilisation of PMTCT services at Nyanza Provincial Hospital, Kenya. Source: WHO Regional Office for Africa, Library, Brazzaville, Congo Author: Moth, I.; Ayayo, A.; Kaseje, D. Abstract: The main objective of the study was to assess the utilisation of prevention of mother-to-child transmission (PMTCT) services among mothers registered for services at Nyanza Provincial Hospital in Kenya. A cross-sectional exploratory study was conducted, using both quantitative and qualitative approaches to collect primary and secondary data. The study population was 133 clients registered for PMTCT services. The study revealed that 52.4 of clients received PMTCT information at the health facility without prior knowledge about intervention, 96 waited for more than 90 minutes, and 89 took less than 10 minutes for post-test counselling. Knowledge of MTCT and PMTCT was inadequate even after counselling, as participants could not recall the information divulged during counselling. In addition, 80 of clients did not present for follow-up counselling irrespective of HIV status, and 95 did not disclose positive HIV status to spouses/relatives for fear of stigma, discrimination and violence. Inadequate counselling services delivered to clients affected service utilisation, in that significant dropout occurred at the stages of HIV result (31.5), enrollment (53.6), and delivery (80.7). Reasons for dropout included fear of positive HIV result, chronic illness, stigma and discrimination, unsupportive spouse and inability to pay for the services. Language: English Integrating HIV voluntary counselling and testing services into reproductive health settings. Source: United Nations Population Fund Author: Myaya, M. Abstract: This guide aims to provide sexual and reproductive health (SRH) programme planners, managers, and providers with the information necessary to integrate voluntary counselling and testing (VCT) for HIV/AIDS within their services. VCT has been shown to be an effective strategy to facilitate behaviour change for HIV prevention. It offers an entry point for early care and support for those infected with HIV and prevention of mother to child transmission. VCT also plays a role in reducing stigma and discrimination. The cost of establishing VCT services within existing SRH settings is lower than establishing them in freestanding sites. In particular, the guide considers integration within the context of family planning (FP) service provision. FP and VCT service provision have similar aims of reaching sexually active people and promoting safe and healthy sexuality, including the prevention of HIV, sexually transmitted infections (STIs), and unwanted pregnancy. FP settings offer specific opportunities for reaching women with VCT. (excerpt) Language: English Keywords: REPRODUCTIVE HEALTH SERVICES| HIV | DELIVERY HEALTH CARE | INTEGRATED | HEALTH PLANNING GUIDELINES Integrating STI and MCH / FP services. Author: Population Council. Africa Operations Research and Technical Assistance Project Source: Population Council, Africa Operations Research and Technical Assistance Project Abstract: This operations research brief summarizes research carried out under the Africa OR/TA Project 11 from 1995-1999 including situation analysis of programs to provide STI, HIV/AIDS services and MCH and FP services using an integrated approach and subsequent intervention studies to test ways of improving the existing approaches. Language: English Personal digital assistants for HIV treatment adherence, safer sex behavior support, and provider training in resource-constrained settings. Author: Kurth, A. E.; Curioso, W. H.; Ngugi, E.; McClelland, L.; Segura, P.; Cabello, R., and Berry, D. L. Source: AMIA Annu Symp Proc. 2007; 1018. Abstract: We developed a Web-based application delivered on PDAs (Colecta-PALM in Peru, Pambazuko-PALM in Kenya), to collect data from HIV patients and to facilitate HIV provider training. Colecta-PALM provides tailored feedback (behavioral messaging) based on risk assessment responses for HIV patients. Pambazuko-PALM collects patient risk assessment data, and delivers counseling protocol training and evaluation to nurses involved in HIV care SIECUS PEPFAR country profiles: focusing in on prevention and youth. Kenya. Abstract: The HIV/AIDS-prevalence rate nationally is 6.7%, with rates as high as 35% in some surveyed communities. That translates to 1.2 million Kenyan adults living with HIV/AIDS, and women ages 15-49 represent over half of those infected. The epidemic is generalized -- no longer confined to specific "high risk groups" but experienced by the people as whole. The primary mode of transmission is heterosexual intercourse, which accounts for 90% of new cases. In Kenya, as throughout Africa, poverty exacerbates the crisis by diminishing access to information, testing, treatment, and care on all levels. Poverty also constrains individuals' choices about sexual behavior and makes them more vulnerable to infection, especially those who are additionally marginalized or disempowered such as women and young people. For example, in one study in Kenya, 6.7% of sexually active women and 15.4% of sexually active men reported exchanging sex for money or other gifts in the year prior to the survey. In fact, the highest rates of transactional sex are among young people with 13.5% of young women ages 15-19 and 20.9% of young men ages 20-24 reporting having engaged in this practice High Mycoplasma genitalium organism burden is associated with shedding of HIV-1 DNA from the cervix. Author: Manhart, L. E.; Mostad, S. B.; Baeten, J. M.; Astete, S. G.; Mandaliya, K., and Totten, P. A. Source: J Infect Dis. 2008 Mar 1; 197(5):733-6. Abstract: 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 Epidemiology of human papillomavirus infection among fishermen along Lake Victoria Shore in the Kisumu District, Kenya. Author: Ng'ayo, M. O.; Bukusi, E.; Rowhani-Rahbar, A.; Koutsky, L. A.; Feng, Q.; Kwena, Z. A., and Holmes, K. K. Source: Sex Transm Infect. 2008 Feb; 84(1):62-6. Abstract: Objectives: The epidemiology of human papillomavirus (HPV) infection in men in Kenya is largely uncharacterized. We set out to determine the prevalence and determinants of HPV infection among sexually active fishermen along Lake Victoria in the Kisumu district of Kenya. Methods: Genital swabs were obtained from 250 consenting fishermen from 18 beaches and a detailed sociodemographic questionnaire was administered. HPV positivity was determined by polymerase chain reaction amplification and detected by dot blot hybridisation with generic HPV and beta-globin probes. HPV positive samples were genotyped using the Roche Linear array assay. Results: Overall, 144 (57.6%) fishermen had detectable HPV DNA, 106 (42.4%) were infected with oncogenic HPV types, with HPV-16 being the most frequent type (12.4%). Among HPV positive men, 105 (72.9%) were infected with more than one HPV type and 20 (13.9%) were infected with more than six different types. HIV seropositive men (PR 1.49, 95% CI 1.19 to 1.86) and those divorced or separated (PR 1.62, 95% CI 1.13 to 2.33) were more likely to be infected with HPV. HIV infection (PR 1.22, 95% CI 1.01 to 1.47) was the only factor independently associated with infection with multiple types of HPV. Conclusion: The prevalence of oncogenic HPV infection is high among this population and is associated with HIV serostatus and marital status. This community could benefit from enhanced sexually transmitted infection and HIV prevention interventions. Morbidity in the first year postpartum among HIV-infected women in Kenya. Author: Chersich MF; Luchters SM; Yard E; Othigo JM; Kley N Source: International Journal of Gynecology and Obstetrics. 2008 Jan;100(1):45-51. Abstract: The objective was to assess the effects of HIV infection on morbidity and the needs of infected women for services in the first year postpartum. A cross-sectional study with 500 women attending a child-health clinic in Mombasa, Kenya. Postpartum duration was a median of 3.3 months (interquartile range, 1.9-6.1 months). The 54 HIV-infected women had a lower income and less financial support than the uninfected women, and they were more likely to experience fever, dyspnea, and dysuria, and to have genital warts (odds ratio [OR], 9.6; 95% confidence interval [CI], 2.6-35.6; P less than 0.001), candidiasis (OR, 2.9; 95% CI, 1.2-6.8; P=0.012), and bacterial vaginosis (OR, 1.8; 95% CI, 0.95-3.3; P=0.066). Six (nearly 15%) of the HIV-infected women had low- or high-grade squamous intraepithelial lesions, and 21 (42%) had an unmet need for contraception. More than half of all women were anemic, and normocytic anemia was predominant among the HIV infected. Compared with uninfected women, morbidity was increased for HIV-infected women during the year following delivery. This period could be used to offer these, and all-women, family planning services, cervical cancer screening, and treatment for anemia and reproductive tract infections. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | POSTPARTUM WOMEN | PERSONS LIVING WITH HIV/AIDS | MORBIDITY | ANEMIA | POSTPARTUM PROGRAMS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | PUERPERIUM | REPRODUCTION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | FAMILY PLANNING PROGRAMS | FAMILY PLANNING Document Number: 323762 Confronting the "sugar daddy" stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Author: Luke N Abstract: Context: "Sugar daddy" relationships, which are characterized by large age and economic asymmetries between partners, are believed to be a major factor in the spread of HIV in Sub-Saharan Africa. Information is needed about sugar daddy partnerships-and about age and economic symmetries more generally-to determine how common they are and whether they are related to unsafe sexual behavior. Methods: The sample comprised 1,052 men and aged 21-45 who were surveyed in Kisumu, Kenya, in 2001. Data on these men and their 1,614 recent nonmarital partnerships were analyzed to calculate the prevalence of sugar daddies and sugar daddy relationships, as well as a range of age and economic disparities within nonmarital partnerships. Logistic regression models were constructed to assess relationships between condom use at last sexual intercourse and various measures of age and economic asymmetry. Results: The mean age difference between nonmarital sexual partners was 5.5 years, and 47% of men's female partners were adolescents. Fourteen percent of partnerships involved an age difference of at least 10 years, and 23% involved more than the mean amount of male-to-female material assistance. Men who reported at least one partnership with both these characteristics were defined as sugar daddies and made up 5% of the sample; sugar daddy relationships accounted for 4% of partnerships. Sugar daddy partnerships and the largest age and economic asymmetries were constructed were associated with decreased odds of condom use. Conclusions: Although sugar daddy relationships are not as pervasive as generally assumed, age and economic asymmetries in nonmarital partnerships are relatively common. All these types of asymmetries are associated with nonuse of condoms. Increasing women's power within asymmetric sexual relationships could improve their ability to negotiate safer sexual behaviors, such as condom use. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | SAMPLING STUDIES | SUGAR DADDIES | SEXUAL PARTNERS | URBAN POPULATION | PREVALENCE | CONDOM USE | AGE FACTORS | PARTNER COMMUNICATION | POWER | SAFER SEX | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY | SEX BEHAVIOR | BEHAVIOR | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | MEASUREMENT | RISK REDUCTION BEHAVIOR | INTERPERSONAL RELATIONS | POLITICAL FACTORS Document Number: 280874 Human papillomavirus detection by penile site in young men from Kenya. Author: Smith JS; Moses S; Hudgens MG; Agot K; Franceschi S Abstract: Limited data are available on whether sampling from the penile shaft or urethra increases detection of penile HPV infection in men beyond that found in the glans and coronal sulcus. Within a randomized clinical trial, a validation study of penile sampling was conducted in Kisumu, Kenya. Young men (18-24 years) were invited to provide penile exfoliated cells using prewetted Dacron swabs to determine the best site for HPV detection. beta-Globin gene PCR and HPV DNA type GP5+/6+ PCR status were ascertained from 3 anatomical sites. A total of 98 young HIV-seronegative, uncircumcised men participated. Penile HPV prevalence varied by anatomical site: 50% in penile exfoliated cells from the glans, coronal sulcus, and inner foreskin tissue; 43% in the shaft and external foreskin tissue; and 18% in the urethra (P less than 0.0001). For each anatomical site, over 87% of samples were beta-globin positive. Beyond that found in the glans/coronal sulcus, urethral sampling resulted in no increase in HPV positivity andshaft sampling resulted in an additional 7.3% of overall HPV positivity. The prevalence of high-risk HPV positivity varied by anatomical site: 39% in glans/coronal sulcus, 31% in shaft, and 13% in the urethra (P less than 0.0001). HPV 16 was the most common type identified. Penile HPV prevalence was approximately 50% among young men in Kisumu, Kenya. Urethral sampling for HPV detection in men added no sensitivity for HPV detection over that found from sampling the glans/coronal sulcus and penile shaft. These data will help inform studies on HPV transmission dynamics, and on the efficacy of HPV prophylactic vaccines on penile HPV carri Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL TRIALS | MEN | HPV | PREVALENCE | TRANSMISSION | GENITALIA, MALE | RISK FACTORS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | CLINICAL RESEARCH | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | VIRAL DISEASES | DISEASES | MEASUREMENT | INFECTIONS | GENITALIA | UROGENITAL SYSTEM | PHYSIOLOGY | BIOLOGY Document Number: 321672 High Mycoplasma genitalium organism burden is associated with shedding of HIV-1 DNA from the cervix. Author: Manhart, L. E.; Mostad, S. B.; Baeten, J. M.; Astete, S. G.; Mandaliya, K., and Totten, P. A. Source: J Infect Dis. 2008 Mar 1; 197(5):733-6. Abstract: 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 Epidemiology of human papillomavirus infection among fishermen along Lake Victoria Shore in the Kisumu District, Kenya. Author: Ng'ayo, M. O.; Bukusi, E.; Rowhani-Rahbar, A.; Koutsky, L. A.; Feng, Q.; Kwena, Z. A., and Holmes, K. K. Source: Sex Transm Infect. 2008 Feb; 84(1):62-6. Abstract: Objectives: The epidemiology of human papillomavirus (HPV) infection in men in Kenya is largely uncharacterized. We set out to determine the prevalence and determinants of HPV infection among sexually active fishermen along Lake Victoria in the Kisumu district of Kenya. Methods: Genital swabs were obtained from 250 consenting fishermen from 18 beaches and a detailed sociodemographic questionnaire was administered. HPV positivity was determined by polymerase chain reaction amplification and detected by dot blot hybridisation with generic HPV and beta-globin probes. HPV positive samples were genotyped using the Roche Linear array assay. Results: Overall, 144 (57.6%) fishermen had detectable HPV DNA, 106 (42.4%) were infected with oncogenic HPV types, with HPV-16 being the most frequent type (12.4%). Among HPV positive men, 105 (72.9%) were infected with more than one HPV type and 20 (13.9%) were infected with more than six different types. HIV seropositive men (PR 1.49, 95% CI 1.19 to 1.86) and those divorced or separated (PR 1.62, 95% CI 1.13 to 2.33) were more likely to be infected with HPV. HIV infection (PR 1.22, 95% CI 1.01 to 1.47) was the only factor independently associated with infection with multiple types of HPV. Conclusion: The prevalence of oncogenic HPV infection is high among this population and is associated with HIV serostatus and marital status. This community could benefit from enhanced sexually transmitted infection and HIV prevention interventions. HIV / AIDS and home-based health care. International Journal for Equity in Health. Author: Opiyo, P. A.; . = Yamano T, and Jayne TS. Source: 2008 Mar 18; 7:8. Abstract: This paper highlights the socio-economic impacts of HIV/AIDS on women. It argues that the socio-cultural beliefs that value the male and female lives differently lead to differential access to health care services. The position of women is exacerbated by their low financial base especially in the rural community where their main source of livelihood, agricultural production does not pay much. But even their active involvement in agricultural production or any other income ventures is hindered when they have to give care to the sick and bedridden friends and relatives. This in itself is a threat to household food security. The paper proposes that gender sensitive policies and programming of intervention at community level would lessen the burden on women who bear the brunt of AIDS as caregivers and livelihood generators at household level. Improvement of medical facilities and quality of services at local dispensaries is seen as feasible since they are in the rural areas. Other interventions shouldtarget freeing women's and girls' time for education and involvement in income generating ventures. Two separate data sets from Western Kenya, one being quantitative and another qualitative data have been used. (author's) Equity, empowerment and choice: from theory to practice in public health. Author: Ratna, J. and Rifkin, S. Source: J Health Psychol. 2007 May; 12(3):517-30. Abstract: The purpose of this article is to illustrate how a framework that links equity and empowerment to improved health outcomes for those who live in poverty can be a useful tool for planning and managing health programmes. Using the work of Amartya Sen, Susan Rifkin has developed a framework described in the acronym CHOICE. The article applies the framework to two case studies from Kenya seeking to reduce the disease burdens of malaria and HIV/AIDS. The article examines how the process of pursuing equity and empowerment either supports the positive health outcomes identified as objectives and/or strengthens these outcomes. A prospective study assessing the effects of introducing the female condom in a sex worker population in Mombasa, Kenya. Author: Thomsen, S. C.; Ombidi, W.; Toroitich-Ruto, C.; Wong, E. L.; Tucker, H. O.; Homan, R.; Kingola, N., and Luchters, S. Source: Sex Transm Infect. 2006 Oct; 82(5):397-402. Abstract: Objective: To assess the impact and costs of adding female condoms to a male condom promotion and distribution peer education programme for sex workers in Mombasa, Kenya. |