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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Language: English Keywords: AFRICA SOUTH OF THE SAHARA | KENYA | RESEARCH REPORT | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | ESTIMATION TECHNICS | HIV POSITIVE PERSONS | MALARIA | HIV INFECTIONS | COMPLICATIONS | FEVER | INCIDENCE | HUMAN GEOGRAPHY | DEVELOPING COUNTRIES | AFRICA | AFRICA, EASTERN | RESEARCH METHODOLOGY | MODELS, THEORETICAL | PERSONS LIVING WITH HIV/AIDS | VIRAL DISEASES | DISEASES | PARASITIC DISEASES | BODY TEMPERATURE | PHYSIOLOGY | BIOLOGY | MEASUREMENT | GEOGRAPHY | SOCIAL SCIENCES | SCIENCE | SOCIOCULTURAL FACTORS Document Number: 314802 Characteristics of HIV infected patients cared for at "academic model for the prevention and treatment of HIV / AIDS" clinics in western Kenya. Author: Diero LO; Shaffer D; Kimaiyo S; Siika AM; Rotich JK Source: East African Medical Journal. 2006 Aug;83(8):424-433. Abstract: With the new initiatives to treat large numbers of HIV infected individuals in sub-Saharan Africa, policy makers require accurate estimates of the numbers and characteristics of patients likely to seek treatment in these countries. The objective was to describe characteristics of adults receiving care in two Kenyan public HIV clinics. Design: Cross-sectional cohort analysis of data extracted from an electronic medical records system. Setting: Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) HIV clinics in Kenya's second national referral (urban) hospital and a nearby rural health center. Subjects: Adult patients presenting for care at HIV clinics. Main outcome measures: Gender and inter-clinic stratified comparisons of demographic, clinical, and treatment data. In the first nineteen months, 790 adults visited the urban clinic and 294 the rural clinic. Mean age was 36±9 (SD) years. Two-thirds were women; a quarter had spouses who had died of acquired immune deficiency syndrome (AIDS). HIV/AIDS behavioural risk factors (multiple sexual partners, rare condom use) and constitutional symptoms (fatigue, weight loss, cough, fever, chills) were common. Rural patients had more symptoms and less prior and current tuberculosis. Men more commonly presented with symptoms than women. The cohort CD4 count was low (223 ± 197mm3), with men having significantly lower CD4 count than women (185 ± 175 vs 242 ± 205 p = 0.0007). Eighteen percent had an infiltrate on chest radiograph. Five percent (most often men) had received prior antiretroviral drug therapy, (7% in urban and 1% in rural patients, p = 0.0006). Overall, 393 (36%) received antiretroviral drugs, 89% the combination of lamivudine, stavudine, and nevirapine. Half received prophylaxis for tuberculosis and Pneumocystis jirovecii. Men were sicker and more often received antiretroviral drugs. Patients presenting to two Kenyan HIV clinics were predominantly female, ill and naive to retroviral therapy with substantial differences by clinic site and gender. Behavioural risk factors for HIV/AIDS were common. A thorough understanding of clinical and behavioural characteristics can help target prevention and treatment strategies. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CLINICS | RISK BEHAVIOR | SEX BEHAVIOR | ANTIRETROVIRAL THERAPY | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES | HEALTH FACILITIES | DELIVERY OF HEALTH CARE | HEALTH | BEHAVIOR | HIV Document Number: 308129 Outcomes of HIV-infected orphaned and non-orphaned children on antiretroviral therapy in western Kenya. Author: Nyandiko WM; Ayaya S; Nabakwe E; Tenge C; Sidle JE Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2006 Dec 1;43(4):418-425. Abstract: The objectives were to determine outcome differences between orphaned and non-orphaned children receiving antiretroviral therapy (ART). Design: Retrospective review of prospectively recorded electronic data. Setting: Nine HIV clinics in western Kenya. Population: 279 children on ART enrolled between August 2002 and February 2005. Main Measures: Orphan status, CD4%, sex- and age-adjusted height (HAZ) and weight (WAZ) z scores, ART adherence, mortality. Median follow-up was 34 months. Cohort included 51% males and 54% orphans. At ART initiation (baseline), 71% of children had CDC clinical stage B or C disease. Median CD4% was 9% and increased dramatically the first 30 weeks of therapy, then leveled off. Parents and guardians reported perfect adherence at every visit for 75% of children. Adherence and orphan status were not significantly associated with CD4% response. Adjusted for baseline age, follow-up was significantly shorter among orphaned children (median 33 vs. 41 weeks, P = 0.096). One-year mortality was 7.1% for orphaned and 6.6% for non-orphaned children (P = 0.836). HAZ and WAZ were significantly below norm in both groups. With ART, HAZ remained stable, while WAZ tended to increase toward the norm, especially among non-orphans. Orphans showed identical weight gains as non-orphans the first 70 weeks after start of ART but experienced reductions afterwards. Good ART adherence is possible in western rural Kenya. ART for HIV-infected children produced substantial and sustainable CD4% improvement. Orphan status was not associated with worse short-term outcomes but may be a factor for long-term therapy response. ART alone may not be sufficient to reverse significant developmental lags in the HIV-positive pediatric population. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CHILD | ORPHANS AND VULNERABLE CHILDREN | HIV POSITIVE PERSONS | HIV | ANTIRETROVIRAL THERAPY | TREATMENT | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | STUDIES | RESEARCH METHODOLOGY | YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | FAMILY AND HOUSEHOLD Document Number: 309400 Maternal knowledge on mother-to-child transmission of HIV and breastmilk alternatives for HIV positive mothers in Homa Bay District Hospital, Kenya. Author: Omwega AM; Oguta TJ; Sehmi JK Source: East African Medical Journal. 2006 Nov;83(11):610-618. Abstract: Mother-to-Child Transmission (MTCT) of HIV is a relatively new concept in rural populations and despite the huge amount of work that has been done on the HIV/AIDS, there still remains a dearth of information in knowledge of mothers on this concept especially in areas related to appropriate feeding methods for infants born to mothers infected with the virus. The objectives were to determine maternal knowledge on MTCT of HIV in the rural setting and to examine viable breastmilk alternatives for mothers who would be HIV positive. The design used was a cross-sectional study, supported by an observational study. The setting was a rural district community and Homa-Bay District Hospital in South Western Kenya. The subjects for the study were one-hundred and twelve non-tested mothers having infants aged 0-12 months in the community and a sub-group (10%) of HIV positive mothers from the District Hospital. Maternal knowledge on MTCT of HIV was as low as 8.9% in the study area. The MTCT knowledge was found to influence the alternative feeding choice as mentioned by the non-tested mothers (p = 0.001; OR = l.41; 95%CI, 1.04-3.86). Those with high MTCT knowledge tended to be more receptive and considered feeding alternatives other than cowmilk like expressed breastmilk (p = 0.l 5), formula (p = 0.036; OR = 2.44; 95%CI, 1.66-6.04) and milk from milk bank (p = 0.0l5; OR = l.34; 95%CI, 1.13-5.50) than their counterparts with low MTCT knowledge. Cowmilk, formula and wet-nursing were the three feeding alternatives that were viable with varying socio-cultural, economic and/or nutritional constraints. Maternal MTCT knowledge influences the choice of alternative infant feeding option but not breastfeeding practices. Cowmilk is the most common, socio-culturally acceptable and accessible breastmilk alternative in this community. It is recommended that in order to improve MTCT knowledge, health education and nutrition counselling be intensified in PMTCT programmes, VCT centers and ANC clinics. Concurrently, effort should be made to increase the supply of cowmilk within the community so as to make it more readily available and affordable. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | WOMEN | INFANT | HIV INFECTIONS | MOTHER-TO-CHILD TRANSMISSION | KNOWLEDGE | HUMAN MILK | INFANT NUTRITION | SOCIOCULTURAL FACTORS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | VIRAL DISEASES | DISEASES | DEMOGRAPHIC FACTORS | POPULATION | YOUTH | AGE FACTORS | POPULATION CHARACTERISTICS | TRANSMISSION | INFECTIONS | LACTATION | MATERNAL PHYSIOLOGY | PHYSIOLOGY | BIOLOGY | NUTRITION | HEALTH Document Number: 319527 Initial strategy for antiretroviral-naive patients. Author: Abgrall S Source: Lancet. 2006 Dec 16;368(9553):2107-2109. Abstract: In today's Lancet, the CPCRA 058 FIRST trial is reported. Earlier this year, in The Lancet, the INITIO trial was reported. Both trials attempted to define the best antiretroviral strategy for drug-naive HIV-infected patients with moderate immunosuppression, assessed clinically and immunologically in FIRST and virologically in INITIO (table). The first question was: what is the best third drug (protease inhibitor or non-nucleoside reversetranscriptase inhibitor [NNRTI]) to add to two nucleoside reverse-transcriptase inhibitors (NRTI) in a two-class initial antiretroviral regimen? The second question was: is there a three-class (mainly four-drug) regimen more potent than the two-class and three-drug standard one? Changes in CD4 cell counts best predict clinical outcome in the short to mid term. Nevertheless, virological failure jeopardises further treatment efficacy with acquisition of resistance mutations and compromises long-term immunological and clinical outcome when prolonged. (excerpt) Language: English Keywords: DEVELOPING COUNTRIES | RECOMMENDATIONS | CLINICAL TRIALS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | AIDS PREVENTION | IMMUNITY, CELLULAR | ADMINISTRATION AND DOSAGE | CLINICAL RESEARCH | RESEARCH METHODOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES | HIV | BEHAVIOR | AIDS | IMMUNITY | IMMUNE SYSTEM | PHYSIOLOGY | BIOLOGY | DRUGS | TREATMENT | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH Document Number: 310956 The role of health care in the spread of HIV / AIDS in Africa: evidence from Kenya. Author: Deuchert E; Brody S Source: International Journal of STD and AIDS. 2006 Nov;17(11):749-752. Abstract: It is commonly asserted that the sub-Saharan African HIV/AIDS epidemic is predominantly due to heterosexual transmission. However, recent reexamination of the available evidence strongly suggests that unsafe health care is the more likely vector. The present report adds to the evidence for health-care transmission by showing that Kenyan women who received prophylactic tetanus toxoid injections during pregnancy are 1.89 times (95% confidence interval [CI]: 1.03--3.47) more likely to be HIV-1 seropositive than women who did not receive this vaccination. In contrast, recent sexual behaviour (condom use, number of partners) was not related to HIV status. The findings are unconfounded by reverse causality (all injections were purely prophylactic rather than for treatment of any HIV-related illnesses, and none of the women reported knowing that she was HIV seropositive). Focus on a specific injection may have improved participant recall. The results are consistent with health care being a very important vector for HIV in sub-Saharan Africa. It is recommended that there be a reallocation of resources to address healthcare transmission of HIV/AIDS. (author's) Language: English Keywords: AFRICA SOUTH OF THE SAHARA | KENYA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | HEALTH PERSONNEL | HIV TRANSMISSION | NEEDLE PIERCING | VACCINATION | QUALITY OF HEALTH CARE | SAFETY | AFRICA | DEVELOPING COUNTRIES | AFRICA, EASTERN | DEMOGRAPHIC SURVEYS | POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | POPULATION CHARACTERISTICS | DELIVERY OF HEALTH CARE | HEALTH | RISK BEHAVIOR | BEHAVIOR | IMMUNIZATION | PRIMARY HEALTH CARE | HEALTH SERVICES | HEALTH SERVICES EVALUATION | PROGRAM EVALUATION | PROGRAMS | ORGANIZATION AND ADMINISTRATION | PUBLIC HEALTH Document Number: 309321 Characteristics of HIV infected patients cared for at "academic model for the prevention and treatment of HIV / AIDS" clinics in western Kenya. Author: Diero LO; Shaffer D; Kimaiyo S; Siika AM; Rotich JK Source: East African Medical Journal. 2006 Aug;83(8):424-433. Abstract: With the new initiatives to treat large numbers of HIV infected individuals in sub-Saharan Africa, policy makers require accurate estimates of the numbers and characteristics of patients likely to seek treatment in these countries. The objective was to describe characteristics of adults receiving care in two Kenyan public HIV clinics. Design: Cross-sectional cohort analysis of data extracted from an electronic medical records system. Setting: Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) HIV clinics in Kenya's second national referral (urban) hospital and a nearby rural health center. Subjects: Adult patients presenting for care at HIV clinics. Main outcome measures: Gender and inter-clinic stratified comparisons of demographic, clinical, and treatment data. In the first nineteen months, 790 adults visited the urban clinic and 294 the rural clinic. Mean age was 36±9 (SD) years. Two-thirds were women; a quarter had spouses who had died of acquired immune deficiency syndrome (AIDS). HIV/AIDS behavioural risk factors (multiple sexual partners, rare condom use) and constitutional symptoms (fatigue, weight loss, cough, fever, chills) were common. Rural patients had more symptoms and less prior and current tuberculosis. Men more commonly presented with symptoms than women. The cohort CD4 count was low (223 ± 197mm3), with men having significantly lower CD4 count than women (185 ± 175 vs 242 ± 205 p = 0.0007). Eighteen percent had an infiltrate on chest radiograph. Five percent (most often men) had received prior antiretroviral drug therapy, (7% in urban and 1% in rural patients, p = 0.0006). Overall, 393 (36%) received antiretroviral drugs, 89% the combination of lamivudine, stavudine, and nevirapine. Half received prophylaxis for tuberculosis and Pneumocystis jirovecii. Men were sicker and more often received antiretroviral drugs. Patients presenting to two Kenyan HIV clinics were predominantly female, ill and naive to retroviral therapy with substantial differences by clinic site and gender. Behavioural risk factors for HIV/AIDS were common. A thorough understanding of clinical and behavioural characteristics can help target prevention and treatment strategies. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CLINICS | RISK BEHAVIOR | SEX BEHAVIOR | ANTIRETROVIRAL THERAPY | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | HIV INFECTIONS | VIRAL DISEASES | DISEASES | HEALTH FACILITIES | DELIVERY OF HEALTH CARE | HEALTH | BEHAVIOR | HIV Document Number: 308129 Absorptive capacity and disbursements by the Global Fund to Fight AIDS, Tuberculosis and Malaria: analysis of grant implementation. Author: Lu C; Michaud CM; Khan K; Murray CJ Source: Lancet. 2006 Aug 5;368(9534):483-488. Abstract: The Global Fund to Fight AIDS, Tuberculosis and Malaria was launched in 2002 to attract and rapidly disburse money to fight these diseases. However, some commentators believe that poor countries cannot effectively use such resources to increase delivery of their health programmes--referred to as a lack of absorptive capacity. We aimed to investigate the major determinants of grant implementation in developing countries. With information available publicly on the Global Fund's website, we did random-effects analysis to investigate the effect of grant characteristics, types of primary recipient and local fund agent, and country attributes on disbursements that were made between 2003 and 2005 (phase one of Global Fund payments). To check the robustness of findings, regression results from alternative estimation methods and model specifications were also tested. Grant characteristics--such as size of commitment, lag time between signature and first disbursement, and funding round--had significant effects on grant implementation. Enhanced political stability was associated with high use of grants. Low-income countries, and those with less-developed health systems for a given level of income, were more likely to have a higher rate of grant implementation than nations with higher incomes or more-developed health systems. The higher rate of grant implementation seen in countries with low income and low health-spending lends support to proponents of major increases in health assistance for the poorest countries and argues that focusing resources on low-income nations, particularly those with political stability, will not create difficulties of absorptive capacity. Our analysis was restricted to grant implementation, which is one part of the issue of absorptive capacity. In the future, assessment of the effect of Global Fund grants on intervention coverage will be vital. (author's) Language: English Keywords: DEVELOPING COUNTRIES | RESEARCH REPORT | EVALUATION | NONGOVERNMENTAL ORGANIZATIONS | LOW INCOME POPULATION | AIDS | TUBERCULOSIS | MALARIA | PREVENTION AND CONTROL | GRANTS | DELIVERY OF HEALTH CARE | PROGRAM EFFECTIVENESS | ORGANIZATIONS | POLITICAL FACTORS | SOCIOCULTURAL FACTORS | SOCIAL CLASS | SOCIOECONOMIC STATUS | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | INFECTIONS | PARASITIC DISEASES | FINANCIAL ACTIVITIES | HEALTH | PROGRAM EVALUATION | PROGRAMS | ORGANIZATION AND ADMINISTRATION Document Number: 306303 Sexual abstinence, contraception, and condom use by young African women: a secondary analysis of survey data. Author: Cleland J; Ali MM Source: Lancet. 2006 Nov 18;368(9549):1788-1793. Abstract: Drug therapy for people with AIDS is a humanitarian priority but prevention of HIV infection remains essential. Focusing on young single African women, we aimed to assess trends in a set of behaviours -- sexual abstinence, contraceptive use, and condom use -- that are known to affect the rates of HIV transmission. We did a secondary analysis of public-access data sets in 18 African countries (132 800 women), and calculated changes in a set of behavioural indicators over time. We standardised these trends from nationally representative surveys to adjust for within-country changes in age, education, and type of residential location. Between about 1993 and 2001, the percentage of women reporting no sexual experience changed little. During the same period, the percentage of sexually experienced women who reported no sexual intercourse in the previous 3 months (secondary abstinence) rose significantly in seven of 18 countries and the median for all 18 countries increased from 43.8% to 49.2%. Use of condoms for pregnancy prevention rose significantly in 13 of 18 countries and the median proportion increased from 5.3% to 18.8%. The median rate of annual increase of condom use was 1.41 percentage points (95% CI 1.12-2.25). In the 13 countries with available data, condom use at most recent coitus rose from a median of 19.3% to 28.4%. Over half (58.5%) of condom users were motivated, at least in part, by a wish to avoid pregnancy. Condom promotion campaigns in sub-Saharan Africa have affected the behaviour of young single women; the pace of change has matched the rise in contraceptive use by married couples in developing countries over recent decades. Thus continuing efforts to promote condom use with emphasis on pregnancy prevention are justified. (author's) Language: English Keywords: AFRICA | RESEARCH REPORT | DATA ANALYSIS | WOMEN | SEX BEHAVIOR | ABSTINENCE, BE FAITHFUL, CONDOM USE | CONDOM USE | CONTRACEPTIVE USAGE | CONDOM | PROMOTION | CAMPAIGNS | HIV PREVENTION | PREGNANCY | PREVENTION AND CONTROL | DEVELOPING COUNTRIES | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | BEHAVIOR | RISK REDUCTION BEHAVIOR | CONTRACEPTION | FAMILY PLANNING | BARRIER METHODS | CONTRACEPTIVE METHODS | MARKETING | ECONOMIC FACTORS | COMMUNICATION PROGRAMS | COMMUNICATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | REPRODUCTION Document Number: 309666 The role of health care in the spread of HIV / AIDS in Africa: evidence from Kenya. Author: Deuchert E; Brody S Source: International Journal of STD and AIDS. 2006 Nov;17(11):749-752. Abstract: It is commonly asserted that the sub-Saharan African HIV/AIDS epidemic is predominantly due to heterosexual transmission. However, recent reexamination of the available evidence strongly suggests that unsafe health care is the more likely vector. The present report adds to the evidence for health-care transmission by showing that Kenyan women who received prophylactic tetanus toxoid injections during pregnancy are 1.89 times (95% confidence interval [CI]: 1.03--3.47) more likely to be HIV-1 seropositive than women who did not receive this vaccination. In contrast, recent sexual behaviour (condom use, number of partners) was not related to HIV status. The findings are unconfounded by reverse causality (all injections were purely prophylactic rather than for treatment of any HIV-related illnesses, and none of the women reported knowing that she was HIV seropositive). Focus on a specific injection may have improved participant recall. The results are consistent with health care being a very important vector for HIV in sub-Saharan Africa. It is recommended that there be a reallocation of resources to address healthcare transmission of HIV/AIDS. (author's) Language: English Keywords: AFRICA SOUTH OF THE SAHARA | KENYA | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | HEALTH PERSONNEL | HIV TRANSMISSION | NEEDLE PIERCING | VACCINATION | QUALITY OF HEALTH CARE | SAFETY | AFRICA | DEVELOPING COUNTRIES | AFRICA, EASTERN | DEMOGRAPHIC SURVEYS | POPULATION DYNAMICS | DEMOGRAPHIC FACTORS | POPULATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | POPULATION CHARACTERISTICS | DELIVERY OF HEALTH CARE | HEALTH | RISK BEHAVIOR | BEHAVIOR | IMMUNIZATION | PRIMARY HEALTH CARE | HEALTH SERVICES | HEALTH SERVICES EVALUATION | PROGRAM EVALUATION | PROGRAMS | ORGANIZATION AND ADMINISTRATION | PUBLIC HEALTH Document Number: 309321 Male circumcision for HIV prevention: Research implications for policy and programming WHO / UNAIDS technical consultation 6 -- 8 March 2007 conclusions and recommendations (excerpts). Source: Reproductive Health Matters. 2007 May;15(29):11-14. Abstract: A number of observational studies indicate that circumcised men have lower levels of HIV infection than uncircumcised men. On 13 December 2006, the US National Institutes of Health announced that two trials assessing the impact of male circumcision on HIV risk would be stopped on the recommendation of the Data Safety and Monitoring Board. The trials being carried out in Kisumu, Kenya, and Rakai District, Uganda revealed at least a 53% and 51% reduction in risk of acquiring HIV infection, respectively. These results support findings published in 2005 from the South Africa Orange Farm Intervention Trial, sponsored by the French National Agency for Research on AIDS, which demonstrated at least a 60% reduction in HIV infection among men who were circumcised. WHO and UNAIDS convened an international consultation to review the results of the three randomised controlled trials and other evidence on male circumcision and HIV prevention, to discuss the policy and programme implications, and to make recommendations regarding public health issues. This document summarizes the principal conclusions and recommendations of the meeting. The international consultation was attended by experts representing a wide range of stakeholders, including government representatives, researchers, civil society representatives, gender experts, human rights and women's health advocates, young people, funding agencies and implementing partners. (excerpt) Language: English Keywords: KENYA | UGANDA | RESEARCH REPORT | TECHNICAL ASSISTANCE | MEN | MALE CIRCUMCISION | HIV PREVENTION | RECOMMENDATIONS | PROGRAM EVALUATION | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | DEVELOPING COUNTRIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | DEMOGRAPHIC FACTORS | POPULATION | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | HIV INFECTIONS | VIRAL DISEASES | DISEASES Document Number: 316691 Male circumcision for HIV prevention: The research evidence and some critical responses. Source: Reproductive Health Matters. 2007 May;15(29):9-10. Abstract: Three randomised clinical trials, in South Africa, Uganda and Kenya, have shown a substantial reduction in female-to-male transmission of HIV to men who had been circumcised as compared to men who had not, during a follow-up period of up to 24 months. The question of what to do with this evidence is currently being debated around the world. WHO and UNAIDS took the lead by developing technical, policy and programmatic guidance following a series of consultations with a range of stakeholders in the field, using the research evidence as the basis. Consensus on many aspects of this matter is far from being achieved, however. Many questions and different points of view are emerging - clinical, public health, sociological, anthropological and cultural; in relation to priority setting in HIV prevention and delivery of health services; and in relation to sexuality, ethics, gender and rights. On 28 March 2007, WHO and UNAIDS published a set of conclusions and recommendations regarding the research implications for HIV policy and programming. The introduction and excerpts from these follow below. They are, in turn, followed by a roundtable of nine papers which contain a range of critical thinking and analysis of these issues. Male circumcision is generating debate across the globe. This can only be a good thing, as it is a complex matter and far more than a straightforward public health intervention. We hope these papers will help to inform that debate. (author's) Language: English Keywords: KENYA | SOUTH AFRICA | UGANDA | RESEARCH REPORT | CLINICAL TRIALS | MEN | MALE CIRCUMCISION | GENDER ISSUES | SEXUALITY | SAFER SEX | HIV TRANSMISSION | HEALTH POLICY | HIV PREVENTION | PROGRAM EVALUATION | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | AFRICA, SOUTHERN | CLINICAL RESEARCH | RESEARCH METHODOLOGY | DEMOGRAPHIC FACTORS | POPULATION | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | SOCIOCULTURAL FACTORS | PERSONALITY | PSYCHOLOGICAL FACTORS | BEHAVIOR | SEX BEHAVIOR | HIV INFECTIONS | VIRAL DISEASES | DISEASES | POLICY | POLITICAL FACTORS | PROGRAMS | ORGANIZATION AND ADMINISTRATION Document Number: 316690 Putting on a brave face: the experiences of women living with HIV and AIDS in informal settlements of Nairobi, Kenya. Author: Amuyunzu-Nyamongo M; Okeng'o L; Wagura A; Mwenzwa E Source: AIDS Care. 2007 Feb;19 Suppl 1:S25-S34. Abstract: This paper examines two key dimensions of HIV and AIDS in sub-Saharan Africa, namely poverty and gender, within the particular context of informal settlements. The study, conducted in five informal settlements of Nairobi, Kenya explored the challenges facing women living with HIV and AIDS (WLWA) in informal settlements in Nairobi in terms of the specific risk environments of informal settlements, the support they receive and their perceptions of their future. The data were gathered through an interviewer-based questionnaire administered to 390 WLWA and 20 key informant interviews with Kenya Network of Women with AIDS (KENWA) project personnel. The results show that for WLWA in informal settlements, poverty and poor living conditions combine to increase the risk environment for HIV infection and other opportunistic infections and that the WLWA then face HIV- and AIDS-related problems that are exacerbated by poverty and by the poor living environments. In response, the WLWA had devised coping strategies that were largely centred on survival, including commercial sex work and the sale of illicit liquor, thus increasing their susceptibility to re-infections. Insecurity in informal settlements curtailed their participation in income generating activities (IGAs) and increased their risk of rape and HIV reinfection. Recognising the disadvantaged position of communities in informal settlements, the non-governmental organizations (NGOs), community-based organizations (CBOs) and faith-based organizations (FBOs) provide a range of services including HIV and AIDS information and therapy. Paradoxically, living in urban informal settlements was found to increase WLWA's access to HIV and AIDS prevention and treatment services through NGOs and social networks that are not found in more established residential areas. The sustainability of these services is, however, questioned, given the lack of local resources, weak state support and high donor dependency. We suggest that the economic and tenure insecurity found among WLWA demands in response consistent support through comprehensive, sustainable HIV and AIDS services complemented by social networks and community sensitisation against stigma and discrimination. Fundamentally, the upgrading of informal settlements would address the wider risk environments that exacerbate the poor health of the WLWA who line in them. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | KAP SURVEYS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | SLUMS | ORGANIZATIONS | HIV INFECTIONS | PSYCHOLOGICAL FACTORS | PSYCHOSOCIAL FACTORS | POVERTY | GENDER ISSUES | QUALITY OF LIFE | RISK BEHAVIOR | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | SURVEYS | SAMPLING STUDIES | STUDIES | RESEARCH METHODOLOGY | VIRAL DISEASES | DISEASES | ECONOMIC DEVELOPMENT | ECONOMIC FACTORS | URBANIZATION | URBAN POPULATION DISTRIBUTION | POPULATION DISTRIBUTION | GEOGRAPHIC FACTORS | POPULATION | POLITICAL FACTORS | SOCIOCULTURAL FACTORS | BEHAVIOR | SOCIOECONOMIC FACTORS | SOCIAL WELFARE Document Number: 308461 Clinical screening for HIV in a health centre setting in urban Kenya: An entry point for voluntary counselling, HIV testing and early diagnosis of Author: Arendt V; Mossong J; Zachariah R; Inwani C; Farah B Source: Tropical Doctor. 2007 Jan;37(1):45-47. Abstract: A study was conducted among patients attending a public health centre in Nairobi, Kenya in order to (a) verify the prevalence of HIV, (b) identify clinical risk factors associated with HIV and (c) determine clinical markers for clinical screening of HIV infection at the health centre level. Of 304 individuals involved in the study, 107 (35%) were HIV positive. A clinical screening algorithm based on four clinical markers, namely oral thrush, past or present TB, past or present herpes zoster and prurigo would pick out 61 (57%) of the 107 HIV-positive individuals. In a resource-poor setting, introducing a clinical screening algorithm for HIV at the health centre level could provide an opportunity for targeting voluntary counselling and HIV testing, and early access to a range of prevention and care interventions. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | PREVALENCE | URBAN AREAS | CLIENTS | VOLUNTARY COUNSELING AND TESTING | HIV TESTING | HIV INFECTIONS | EXAMINATIONS AND DIAGNOSES | SCREENING | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | MEASUREMENT | RESEARCH METHODOLOGY | GEOGRAPHIC FACTORS | POPULATION | PROGRAM ACTIVITIES | PROGRAMS | ORGANIZATION AND ADMINISTRATION | LABORATORY EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | VIRAL DISEASES | DISEASES Document Number: 316511 Relationship between markers of HIV-1 disease progression and serum beta-carotene concentrations in Kenyan women. Author: Baeten JM; McClelland RS; Wener MH; Bankson DD; Lavreys L Source: International Journal of STD and AIDS. 2007 Mar;18(3):202-206. Abstract: Observational studies have suggested that low serum ß-carotene concentrations may influence HIV-1 disease progression. However, randomized trials have not demonstrated beneficial effects of ß-carotene supplementation. To understand this discrepancy, we conducted a cross-sectional study among 400 HIV-1-seropositive women in Mombasa, Kenya, to correlate serum ß-carotene concentrations with several measures of HIV-1 disease severity. ß-Carotene concentrations were significantly associated with biologic markers of HIV-1 disease progression (CD4 count, HIV-1 plasma viral load, serum C-reactive protein [CRP] concentration, and serum albumin level). In multivariate analysis, ß-carotene concentrations below the median were associated with elevated CRP (>10 mg/l, adjusted odds ratio [aOR] 3.32, 95% confidence interval [CI] 1.99-5.53, P < 0.001) and higher HIV-1 plasma viral load (for each log10 copies/mL increase, aOR 1.38, 95% CI 1.01-1.88, P = 0.04). In the context of negative findings from randomized trials of ß-carotene supplementation in HIV-1-seropositive individuals, these results suggest that low ß-carotene concentrations primarily reflect more active HIV-1 infection rather than a deficiency amenable to intervention. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | CLINICAL TRIALS | CROSS SECTIONAL ANALYSIS | HIV POSITIVE PERSONS | WOMEN | SOCIOECONOMIC STATUS | VITAMIN A | DEFICIENCY DISEASES | NUTRITION INDEXES | FOOD SUPPLEMENTATION | IMMUNITY, CELLULAR | AFRICA, EASTERN | AFRICA SOUTH OF THE SAHARA | AFRICA | DEVELOPING COUNTRIES | CLINICAL RESEARCH | RESEARCH METHODOLOGY | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | DEMOGRAPHIC FACTORS | POPULATION | SOCIOECONOMIC FACTORS | ECONOMIC FACTORS | VITAMINS AND MINERALS | PHYSIOLOGY | BIOLOGY | NUTRITION DISORDERS | NUTRITION | HEALTH | NUTRITION PROGRAMS | PRIMARY HEALTH CARE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | IMMUNITY | IMMUNE SYSTEM Document Number: 315856 High uptake of postpartum hormonal contraception among HIV-1-seropositive women in Kenya. Author: Balkus J; Bosire R; John-Stewart G; Mbori-Ngacha D Source: Sexually Transmitted Diseases. 2007 Jan;34(1):25-29. Abstract: The objectives of this study were to determine patterns of contraceptive utilization among sexually active HIV-1-seropositive women postpartum and to identify correlates of hormonal contraception uptake. The goal of this study was to improve delivery of family planning services to HIV-1-infected women in resource-limited settings. HIV-1-infected pregnant women were followed prospectively in a perinatal HIV-1 transmission study. Participants were referred to local clinics for contraceptive counseling and management. Among 319 HIV-1-infected women, median time to sexual activity postpartum was 2 months and 231 (72%) women used hormonal contraception for at least 2 months during follow-up, initiating use at approximately 3 months postpartum (range, 1-11 months). Overall, 101 (44%) used DMPA, 71 (31%) oral contraception, and 59 (25%) switched methods during follow-up. Partner notification, infant mortality, and condom use were similar between those using and not using contraception. Using existing the healthcare infrastructure, it is possible to achieve high levels of postpartum hormonal contraceptive utilization among HIV-1-seropositive women. (author's) Language: English Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | KAP SURVEYS | CONTRACEPTIVE PREVALENCE SURVEYS | POSTPARTUM WOMEN | WOMEN IN DEVELOPMENT | HIV POSITIVE PERSONS | POSTPARTUM | CONTRACEPTIVE USAGE | TIME FACTORS | DEPO-PROVERA | ORAL CONTRACEPTIVES | CONTRACEPTIVE METHOD SWITCHING | |