STIs, HIV and AIDS: 2005 - 2008
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)
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
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)
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
HIV, hepatitis B and hepatitis C coinfection in Kenya.
Author: Harania RS; Karuru J; Nelson M; Stebbing J
Source: AIDS. 2008 Jun 19;22(10):1221-1222.
Abstract: There are few data regarding hepatitis and HIV coinfection in Africa. In 378 HIV seropositive individuals in Nairobi, 23 (6%) were hepatitis B virus (HBV) and HIV coinfected, four (1%) were hepatitis C virus (HCV) and HIV coinfected and one patient was infected with all three viruses. Coinfected individuals were more likely to be men and older; a lack of HBV vaccination was a risk factor for HIV/HBV coinfection (P = 0.001) and tenofovir containing regimens appeared most effective at reducing HBV viral load. (excerpt)
Keywords: KENYA | RESEARCH REPORT | CLINICAL RESEARCH | EPIDEMIOLOGIC METHODS | HIV POSITIVE PERSONS | HIV INFECTIONS | HEPATITIS | COMPLICATIONS | SEX FACTORS | AGE FACTORS | IMMUNIZATION | ANTIBIOTICS | PREVALENCE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | PERSONS LIVING WITH HIV/AIDS | VIRAL DISEASES | DISEASES | POPULATION CHARACTERISTICS | DEMOGRAPHIC FACTORS | POPULATION | PRIMARY HEALTH CARE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | DRUGS | TREATMENT | MEDICAL PROCEDURES | MEDICINE | MEASUREMENT
Document Number: 308638
HIV-neutralizing immunoglobulin A and HIV-specific proliferation are independently associated with reduced HIV acquisition in Kenyan sex workers.
Author: Hirbod T; Kaul R; Reichard C; Kimani J; Ngugi E
Source: AIDS. 2008 Mar 30;22(6):727-735.
Abstract: HIV-neutralizing immunoglobulin A (IgA) and HIV-specific cellular immunity have been described in highly exposed, persistently seronegative (HEPS) individuals, but well controlled studies have not been performed. We performed a prospective, nested case-control study to examine the association of genital IgA and systemic cellular immune responses with subsequent HIV acquisition in high-risk Kenyan female sex workers (FSWs). A randomized trial of monthly antibiotic prophylaxis to prevent sexually transmitted disease/HIV infection was performed from 1998 to 2002 in HIV-uninfected Kenyan FSWs. After the completion of trial, FSWs who had acquired HIV (cases) were matched 1 : 4 with persistently uninfected controls based on study arm, duration of HIV-seronegative follow-up, and time of cohort enrolment. Blinded investigators assayed the ability at enrolment of genital IgA to neutralize primary HIV isolates as well as systemic HIV-specific cellular IFNy-modified enzyme-linked immunospot and proliferativeresponses. The study cohort comprised 113 FSWs: 24 cases who acquired HIV and 89 matched controls. Genital HIV-neutralizing IgA was associated with reduced HIV acquisition (P = 0.003), as was HIV-specific proliferation (P = 0.002), and these associations were additive. HIV-specific IFNg production did not differ between case and control groups. In multivariable analysis, HIV-neutralizing IgA and HIV-specific proliferation each remained independently associated with lack of HIV acquisition. Genital herpes (HSV2) was associated with increased HIV risk and with reduced detection of HIV-neutralizing IgA. Genital HIV-neutralizing IgA and systemic HIV-specific proliferative responses, assayed by blinded investigators, were prospectively associated with HIV nonacquisition. The induction of these immune responses may be an important goal for HIV vaccines. (author's)
Keywords: KENYA | RESEARCH REPORT | PROSPECTIVE STUDIES | SEX WORKERS | HIV | BLOOD | LABORATORY PROCEDURES | EXPOSURE | AUTOIMMUNE RESPONSE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | STUDIES | RESEARCH METHODOLOGY | SEX BEHAVIOR | BEHAVIOR | HIV INFECTIONS | VIRAL DISEASES | DISEASES | HEMIC SYSTEM | PHYSIOLOGY | BIOLOGY | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | RISK FACTORS | ANTIBODIES | IMMUNOLOGIC FACTORS | IMMUNITY | IMMUNE SYSTEM
Document Number: 325533
Engendering health sector responses to sexual violence and HIV in Kenya: Results of a qualitative study.
Author: Kilonzo N; Taegtmeyer M; Molyneux C; Kibaru J; Kimonji V
Source: AIDS Care. 2008 Feb;20(2):188-190.
Abstract: In Kenya many people who have been affected by sexual violence turn to the health sector for clinical treatment and preventive therapies. This interface provides a vital opportunity to impact on
the dual epidemics of HIV and sexual violence. Despite this, the uptake of post-rape care services in health facilities as low and health care providers felt ill-prepared to deal with the consequences of sexual violence. A qualitative study was conducted to better understand the reasons for the low uptake of services and to establish perceptions of sexual violence in Kenya. Thirty-four key informants were interviewed and sixteen focus group discussions with women and men were held in three districts in Kenya. Blurred boundaries between forced and consensual sex emerged. Important implications for the delivery of HIV post exposure prophylaxis (PEP) after sexual violence include the need for gender-aware patient-centred training for health providers and for HIV PEP interventions to strengthen on-going HIV-prevention counselling efforts. Further research needs to determine the feasibility of on-going risk reduction measures in the context of PEP delivery. (author's)
Keywords: KENYA | RESEARCH REPORT | QUALITATIVE RESEARCH | INTERVIEWS | FOCUS GROUPS | SEXUAL ABUSE | RAPE | GENDER ISSUES | HIV | HEALTH PERSONNEL | HEALTH SERVICES | AWARENESS | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | DATA COLLECTION | CRIME | SOCIAL PROBLEMS | SOCIOCULTURAL FACTORS | HIV INFECTIONS | VIRAL DISEASES | DISEASES | DELIVERY OF HEALTH CARE | HEALTH | KNOWLEDGE
Document Number: 324185
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)
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
Provider characteristics among staff providing care to sexually transmitted infection self-medicating patients in retail pharmacies in Kibera Slum, Nairobi, Kenya.
Author: Kwena Z; Sharma A; Wamae N; Muga C; Bukusi E
Source: Sexually Transmitted Diseases. 2008 May;35(5):480-483.
Abstract: The objectives were to evaluate the characteristics of providers in management of STI self-medicating patients in retail pharmacies within the largest informal settlement in Kenya. We collected sociodemographic, training, and work history attributes among pharmacy staff from a convenience sample of 50 retail pharmacies in Kibera slum using a self-administered questionnaire. We gathered the required data in 8 weeks, collecting completed self-administered questionnaires within 7 to 14 days after distribution. Two data collectors subsequently presented at these pharmacies as mystery patients seeking care for symptoms of genital ulcer disease and gonorrhea and completed a structured observation form within 10 minutes of leaving the pharmacy. Approximately half the respondents were men aged less than 28 years. Over 90% had 12 years of formal education and an additional 3 years of medical professional training. Two thirds (66%) had been trained in Government institutions. About 65% reported that patients presented without prescriptions, and 45% noted that patients requested specific medicines but were open to advice. One-third (36%) of the patients used the pharmacy as their first point of care. Using mystery patients to evaluate syndromic management of gonorrhea and genital ulcer disease, only 10% offered appropriate treatment per the Kenya Ministry of Health STI syndromic management guidelines. Although the majority of the pharmacy staff in this informal settlement have some medical training and some experience, a very low proportion offered adequate treatment for 2 common STIs. (author's)
Keywords: KENYA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | QUESTIONNAIRES | PROVIDERS WITH CLIENTS | PHARMACIES | TRAINING PROGRAMS | SEXUALLY TRANSMITTED DISEASES | GONORRHEA | SIGNS AND SYMPTOMS | ANTIBIOTICS | ADMINISTRATION AND DOSAGE | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | RESEARCH METHODOLOGY | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | HEALTH FACILITIES | EDUCATION | REPRODUCTIVE TRACT INFECTIONS | INFECTIONS | DISEASES | DRUGS | TREATMENT | MEDICAL PROCEDURES | MEDICINE
Document Number: 326476
Associations of human leukocyte antigen DRB with resistance or susceptibility to HIV-1 infection in the Pumwani Sex Worker Cohort.
Author: Lacap PA; Huntington JD; Luo M; Nagelkerke NJ; Bielawny T
Abstract: A group of commercial sex workers in the Pumwani Sex Worker Cohort, established in 1985 in Nairobi, Kenya, remain HIV-1 uninfected despite heavy exposure to HIV-1 through active sex work. Previous studies showed that this resistance is associated with a strong CD4+ T-cell response, which suggested that human leukocyte antigen class II antigens are important in resistance/susceptibility to HIV-1 infection. DRB1 is the most polymorphic locus among class II genes and forms haplotypes with DRB3, DRB4 and DRB5. The aim of this study is to investigate the role of DRB alleles/haplotypes on resistance/susceptibility to HIV-1 infection. In total, 1090 women enrolled in the Pumwani cohort were genotyped for DRB1, DRB3, DRB4 and DRB5 using a high-resolution sequence-based method. Allele/ haplotype frequencies were compared between HIV-positive women and women who have remained HIV negative for more than 3 years despite frequent exposure. Human leukocyte antigen DRB genes were amplified, sequenced and genotyped using a two-step sequence-based method. Allele/haplotype frequencies were determined using PyPop32-0.6.0. Statistical analysis was conducted using SPSS 11.0 for Windows. Three DRB1 alleles were associated with resistance: DRB1 010101 (P = 0.016; odd ratio (OR): 2.55; 95% confidence interval (CI): 1.16-5.61), DRB1 010201 (P = 0.019; OR: 1.86; 95% CI: 1.10-3.15), and DRB1 1102 (P = 0.025; OR: 1.72; 95% CI: 1.07-2.78). DRB1 030201 (P = 0.038; OR: 0.48; 95% CI: 0.23-0.98), DRB1 070101 (P = 0.035; OR: 0.54; 95% CI: 0.30-0.97), DRB1 1503 (P = 0.0004; OR: 0.34; 95% CI: 0.19-0.64), and DRB5 010101 (P = 0.001; OR: 0.37; 95% CI: 0.20-0.67) were associated with susceptibility. The haplotype DRB1 1102-DRB3 020201 was associated with HIV-1 resistance (P = 0.041; OR: 1.68; 95% CI: 1.02-2.78), whereas the haplotypes DRB1 070101-DRB4 01010101 (P = 0.041; OR: 0.52; 95% CI: 0.28-0.98) and DRB1 1503-DRB5 01010101 (P = 0.0002; OR: 0.30; 95% CI: 0.15-0.58) were associated with susceptibility. These associations with resistance/susceptibility to HIV-1 were independent of previously reported alleles HLA-DRB1 01 and HLA-A 2301. Our findings indicate that human leukocyte antigen DRB-specific CD4+ T-cell responses are an important factor in resistance/susceptibility to HIV-1 infection. (author's)
Keywords: KENYA | RESEARCH REPORT | GENETIC TECHNICS | SEX WORKERS | WOMEN | PERSONS LIVING WITH HIV/AIDS | IMMUNITY, NATURAL | LABORATORY PROCEDURES | DEVELOPING COUNTRIES | AFRICA, EASTERN | AFRICA, SUB SAHARAN | AFRICA | LABORATORY EXAMINATIONS AND DIAGNOSES | EXAMINATIONS AND DIAGNOSES | MEDICAL PROCEDURES | MEDICINE | HEALTH SERVICES | DELIVERY OF HEALTH CARE | HEALTH | SEX BEHAVIOR | BEHAVIOR | DEMOGRAPHIC FACTORS | POPULATION | HIV INFECTIONS | VIRAL DISEASES | DISEASES | IMMUNITY | IMMUNE SYSTEM | PHYSIOLOGY | BIOLOGY