Search

Orphans are at higher risk of HIV infection and several important HIV risk factors than non-orphans; however, this may be due to a combination of related social, psychological, and economic factors, as well as care environment, rather than orphan status alone. Understanding these complex relationships may aid policy makers in supporting evidence-based, cost-effective programming for this vulnerable population. This longitudinal study uses a causal effect model to examine, through decomposition, the relationship between care environment and HIV risk factors in orphaned and separated adolescents and youths (OSAY) in Uasin Gishu County, Kenya; considering resilience, social, peer, or family support, volunteering, or having one’s material needs met as potential mediators. We analysed survey responses from 1105 OSAY age 10–26 living in Charitable Children’s Institutions (CCI) (orphanages) and family-based care settings (FBS). Follow-up time was 7–36 months. Care in CCIs (vs. FBS) was associated with a decreased likelihood of engaging in forced, exchange, and consensual sex. Excess relative risks (ERR) attributable to the indirect pathway, mediation, or interaction were not significant in any model. Care environment was not statistically associated with differences in substance use. Our findings support the direct, unmediated, association between institutional care and HIV risk factors. [ABSTRACT FROM AUTHOR]

HIV/AIDS is known to have adverse effects on individual and family socio-economic status due to the loss of productive time and over-expenditure in treatment. However, empirical data on how HIV/AIDS affects households' socio-economic status are insufficient. We linked socio-economic data from a Health and Demographic Surveillance System (HDSS) that implements an HIV/AIDS Longitudinal bio-behavioural survey (LBBS) to understand the long-term impact of HIV/AIDS on households' socio-economic status between 2010 and 2018. We compared changes in socio-economic status between households headed by HIV-negative and -positive individuals. A logistic regression was used to assess factors that influence socio-economic status. The level of education and household size were not significant predictors of households' socio-economic status. Households headed by HIV-positive individuals could maintain their baseline socio-economic status (unadjusted RRR = 1.17, 95% CI: 1.01, 1.36) but improvement chances were reduced despite a non-significant association (unadjusted RRR = 0.98, 95% CI: 0.80, 1.20). While HIV/AIDS is known to disrupt economic growth, in this setting, being a male household head, old and widowed reduces chances of improved socio-economic status. The elderly people, widows and widowers are disadvantaged. Consequently, there is a need for special programmes, which seek to empower the identified vulnerable groups economically.. [ABSTRACT FROM AUTHOR]

HIV stigma is associated with delayed HIV disclosure and worse clinical outcomes for adolescents living with HIV (ALWH). Teachers critically influence school environments, but are understudied in terms of HIV stigma. We implemented a school-level, cluster-randomized trial to assess the impact of a one-day multi-media training on the knowledge, attitudes and beliefs (K/A/B) of school teachers in western Kenya. Teachers' K/A/B were evaluated at baseline and six months. Additionally, we assessed stigma with ALWH enrolled in the included schools to explore the impact of the training. Teachers (N = 311) and ALWH (N = 19) were enrolled from 10 primary and 10 secondary schools. The intervention and control groups did not significantly differ in overall stigma score (mean 1.83 vs. 1.84; adjusted difference, 0.18 [95% CI, −0.082 to 0.045]) at six months; however, we found a trend towards improvement in overall stigma score and a significant difference in the community discrimination sub-scale among secondary school teachers (mean 3.02 vs. 3.19; adjusted difference, −0.166 [95% CI, −0.310 to −0.022]). ALWH reported few experiences of discrimination, but emphasized keeping their HIV status secret (84%). The teacher-training reduced secondary school teacher perceptions of community-level stigma, but did not impact individual attitudes or beliefs.. [ABSTRACT FROM AUTHOR]

Reliable mortality data are important for evaluating the impact of health interventions. However, data on mortality patterns among populations living in urban informal settlements are limited. To examine the mortality patterns and trends in an urban informal settlement in Kibera, Nairobi, Kenya, Using data from a population-based surveillance platform we estimated overall and cause-specific mortality rates for all age groups using person-year-observation (pyo) denominators and using Poisson regression tested for trends in mortality rates over time. We compared associated mortality rates across groups using incidence rate ratios (IRR). Assignment of probable cause(s) of death was done using the InterVA-4 model. We registered 1134 deaths from 2009 to 2018, yielding a crude mortality rate of 4.4 (95% Confidence Interval [CI]4.2–4.7) per 1,000 pyo. Males had higher overall mortality rates than females (incidence rate ratio [IRR], 1.44; 95% CI, 1.28–1.62). The highest mortality rate was observed among children aged < 12 months (41.5 per 1,000 pyo; 95% CI 36.6–46.9). All-cause mortality rates among children < 12 months were higher than that of children aged 1–4 years (IRR, 8.5; 95% CI, 6.95–10.35). The overall mortality rate significantly declined over the period, from 6.7 per 1,000 pyo (95% CI, 5.7–7.8) in 2009 to 2.7 (95% CI, 2.0–3.4) per 1,000 pyo in 2018. The most common cause of death was acute respiratory infections (ARI)/pneumonia (18.1%). Among children < 5 years, the ARI/pneumonia deaths rate declined significantly over the study period (5.06 per 1,000 pyo in 2009 to 0.61 per 1,000 pyo in 2018; p = 0.004). Similarly, death due to pulmonary tuberculosis among persons 5 years and above significantly declined (0.98 per 1,000 pyo in 2009 to 0.25 per 1,000 pyo in 2018; p = 0.006). Overall and some cause-specific mortality rates declined over time, representing important public health successes among this population. [ABSTRACT FROM AUTHOR]

Emergency department-based HIV self-testing (ED-HIVST) could increase HIV-testing services to high-risk, under-reached populations. This study sought to understand the injury patient acceptability of ED-HIVST. Injury patients presenting to the Kenyatta National Hospital Accident and Emergency Department were enrolled from March to May 2021. Likert item data on HIVST assessing domains of general acceptability, personal acceptability, and acceptability to distribute to social and/or sexual networks were collected. Ordinal regression was performed yielding adjusted odds ratios (aOR) to identify characteristics associated with high HIVST acceptability across domains. Of 600 participants, 88.7% were male, and the median age was 29. Half reported having primary care providers (PCPs) and 86.2% reported prior HIV testing. For each Likert item, an average of 63.5% of the participants reported they 'Agree Completely' with positive statements about ED-HIVST in general, for themselves, and for others. In adjusted analysis for general acceptability, those <25 (aOR = 1.67, 95%CI:1.36–2.08) and with prior HIV testing (aOR = 1.68, 95%CI:1.27–2.21) had greater odds of agreeing completely. For personal acceptability, those with a PCP (aOR = 3.31, 95%CI:2.72–4.03) and prior HIV testing (aOR = 1.83, 95%CI:1.41–2.38) had greater odds of agreeing completely. For distribution acceptability, participants with a PCP (aOR = 2.42, 95%CI:2.01–2.92) and prior HIV testing (aOR = 1.79, 95%CI: 1.38–2.33) had greater odds of agreeing completely. ED-HIVST is perceived as highly acceptable, and young people with prior testing and PCPs had significantly greater favourability. These data provide a foundation for ED-HIVST programme development in Kenya. [ABSTRACT FROM AUTHOR]

Approximately 280 million people around the world suffer from depression, and the rates are higher among women than men. For women living in informal settlements in lower – and middle-income countries (LMICs) the prevalence and associated burden of depressive symptoms may be particularly high. The purpose of this paper was to explore factors associated with possible major depressive disorder (MDD) in a probability sample of women living in Mathare informal settlement in Nairobi, Kenya and to identify potential points for intervention and/or support. Quantitative surveys were conducted with 552 women aged 18–75. Possible MDD was measured using the Patient Health Questionnaire and regressed on individual, household/familial-, and community/interpersonal-level factors. Findings highlight the potential importance of factors such as physical health, economic stress, access to water and sanitation, household and family dynamics, and neighbourhood/village differences in possible MDD among women living in informal settlements. We identify potential points for research, intervention and policy including: providing appropriate tangible assistance or interventions to reduce economic stress/strain; expanding access to water and sanitation and, in doing so, reducing potential burdens to physical health; providing and expanding healthcare to include mental healthcare; and investigating family dynamics and bolstering support for families, particularly for those experiencing conflict. [ABSTRACT FROM AUTHOR]

Youth living with HIV in sub-Saharan Africa have poor HIV care outcomes. We determined the association of recent significant life-events with HIV antiretroviral treatment (ART) initiation and HIV viral suppression in youth aged 15–24 years living with HIV in rural Kenya and Uganda. This was a cross-sectional analysis of 995 youth enrolled in the SEARCH Youth study. At baseline, providers assessed recent (within 6 months) life-events, defined as changes in schooling/employment, residence, partnerships, sickness, incarceration status, family strife or death, and birth/pregnancy, self-reported alcohol use, being a parent, and HIV-status disclosure. We examined the frequencies of events and their association with ART status and HIV viral suppression (<400 copies/ul). Recent significant life-events were prevalent (57.7%). Having >2 significant life-events (aOR = 0.61, 95% CI:0.45-0.85) and consuming alcohol (aOR = 0.61, 95% CI:0.43-0.87) were associated with a lower odds of HIV viral suppression, while disclosure of HIV-status to partner (aOR = 2.39, 95% CI:1.6-3.5) or to family (aOR = 1.86, 95% CI:1.3-2.7), being a parent (aOR = 1.8, 95% CI:1.2-2.5), and being single (aOR = 1.6, 95% CI:1.3-2.1) had a higher odds. This suggest that two or more recent life-events and alcohol use are key barriers to ART initiation and achievement of viral suppression among youth living with HIV in rural East Africa. Trial registration: ClinicalTrials.gov identifier: NCT03848728.. [ABSTRACT FROM AUTHOR]

Adolescents and young adults (15–24 yrs.) have poorer HIV clinical outcomes than adults. Despite this, there is minimal data on individual-level factors such as self-efficacy towards antiretroviral adherence among perinatally infected adolescents living with HIV in sub-Saharan Africa. Our study examined the interaction between antiretroviral treatment adherence self-efficacy and other psychosocial factors among adolescents receiving care in Nairobi, Kenya. We enrolled perinatally infected Adolescent Living with HIV (ALWHIV) 16–19 yrs. who were accessing care routinely at the HIV clinic. We measured self-reported ART adherence (7-day recall) and defined optimal adherence as >95%, and conducted a regression analysis to identify independently associated factors. Mediation analysis explored interactions between the psychosocial variables. We enrolled 82 ALWHIV median age 17 (IQR 16,18) who had been on ART for a median age of 11 yrs. (IQR 7,13). Sixty-four per cent (52) of the ALWHIV reported optimal adherence of >95%, and 15% reported missing doses for three or more months. After controlling for the other covariates, self-esteem, high viral load and an adherence level > 95% were significantly associated with adherence self-efficacy. Self-esteem was significantly associated with adherence self-efficacy and social support (p < 0.001 and p = 0.001), respectively. The paramed test indicated that the association between self-efficacy and adherence was mediated by self-esteem with a total effect of OR 6.93 (bootstrap 95% CI 1.99–24.14). Adherence self-efficacy was also mediated by self-esteem in developing adherence behavior. Interventions focused on increasing adherence among ALWHIV should include self-esteem building components.Key words : Adolescents, Adherence self -efficacy, Transition , perinatal, [ABSTRACT FROM AUTHOR]

Several factors influence a victim's decision on whether or not to seek help after experiencing Intimate Partner Violence (IPV). This study used data from the Demographic and Health Surveys (DHS) for Kenya (2014) of ever married women (n = 5265). Majority of the women did not seek help after experiencing IPV (55.5%). Women justification for IPV decreased the odds of seeking help from informal services by 0.75 times and formal services by 0.58 times. Understanding cultural determinants of help seeking would contribute in the development of effective policies and programs for preventing and responding to IPV in Kenya and across the world. [ABSTRACT FROM AUTHOR]

Pediatric HIV remains a significant global concern, with 160,000 new infections annually. Accelerating Children's HIV/AIDS Treatment (ACT) provided a strategic response to the "treatment gap" for children. We examined whether activities under ACT increased testing and identification of youth living with HIV (YLWH). Family AIDS Care & Education Services implemented ACT across 130 health facilities in western Kenya between October 2015 and September 2016, providing: HIV-testing counselors and space; training on the Family Information Table (FIT) and chart audits; community outreach testing; and text message reminders for pregnant women. We analyzed the number of youths tested and identified with HIV over time and between intervention and control sites using interrupted time series analysis. We tested 268,312 youths (7,183 infants <18 months; 145,833 children 18 months to 9 years; and 115,296 adolescents 10–14 years). Mean monthly number tested per health facility increased from 2.8 to 7.2 (p < 0.0001) in infants, 44.8–142.0 (p < 0.0001) in children, and 30.1–123.3 (p < 0.0001) in adolescents. Mean monthly number identified with HIV per facility increased from 0.06 to 0.37 (p < 0.0001) in infants; 0.34–0.62 (p = 0.008) in children; and 0.17–0.26 (p = 0.04) in adolescents, resulting in 1,328 diagnoses. Among infants, FIT training was associated with increased HIV testing over time, incidence rate ratio (IRR) = 3.85 (95% confidence interval [CI] 2.16-6.84; p < 0.0001). Text messaging increased testing, IRR = 2.10 (95% CI 1.57-2.80; p < 0.0001) and identification of HIV in infants, IRR = 1.83 (95% CI 1.06-3.18; p = 0.0381) and older children, IRR = 2.25 (95% CI 1.62, 3.13; p < 0.0001). Chart audits increased testing over time among adolescents (IRR = 2.11; 95% CI 1.21-3.66; p = 0.0082). Outreach was associated with identification of adolescents with HIV, IRR = 1.58 (95% CI 1.22-2.06; p = 0.0005). In lower-income settings, targeted interventions effective at reaching YLWH can help optimize resource allocation to address gaps in testing and identification to further reduce HIV-related morbidity and mortality. [ABSTRACT FROM AUTHOR]

This study examined the factors affecting HIV testing among women during pregnancy while on ANC visits in Kenya, using the 2014 Kenya Demographic and Health Survey data. The sample included 3,747 (weighted N = 36,626) pregnant women who gave birth in last two years. Survey-weighted bivariate and multivariable analyses were performed. More than four-fifths (83.9%) of the participants reported that they had an HIV test during ANC visits in last two years. In the adjusted model, married (Adjusted Odds Ratio [aOR]:1.48, 95% Confidence Interval [95% CI]:1.06, 2.06, p < 0.001) than not in a union, having HIV counselling (aOR:1.89, 95% CI: 1.39, 2.56, p < 0.001), higher knowledge on HIV transmission (aOR:1.19, 95% CI: 1.05, 1.34, p = 0.006), increased the likelihood of testing for HIV. While women who were ≥20 years, living in other regions except Nyanza and Nairobi than people living in Coastal region, and who had higher HIV-related stigma (OR:0.83, 95%CI:0.73, 0.94, p = 0.004) had less chance of being tested. These findings have implications on the successful utilization of ANC services in resource limited regions. Culturally appropriate health education can influence cultural norms and enhance timely access of ANC services among women during pregnancy. [ABSTRACT FROM AUTHOR]

Adolescent pregnancy and associated neonatal mortality are major global health challenges. In low-income settings where 90% of the 21 million global adolescent pregnancies occur, half are unintended and a fifth experience unsafe abortion. In Kenya, Uganda, and Tanzania, the survival patterns of neonates born to adolescents are unclear. To assess survival patterns among neonates born to adolescents and the effect of pregnancy intentions and marital status on survival in Kenya, Uganda, and Tanzania. Cross-sectional data from demographic and health surveys in Kenya, Uganda, and Tanzania 2014–2016 were used. Kaplan-Meier estimates investigated patterns of neonatal survival among adolescent mothers, aged 15–19 years, compared to mothers aged 20–29 years. Cox proportional hazards regression determined the hazard ratios (HR) for the predictors of neonatal survival. About 50% of adolescent pregnancies were unintended and neonatal death rate was twice as high than older mothers (26.6 versus 12.0 deaths/1000 live births). The median survival time was two days for adolescent-born babies and four days among older mothers. The hazard of death for all adolescent-born neonates was about twofold that of 20–29 years-old-mothers, HR 1.80 (95% CI 1.22–2.63). Among married adolescents with unintended newborn pregnancies, the HR was 4-folds higher than corresponding older mothers, HR 4.08 (95% CI 1.62–10.31). Among married, primiparous adolescents with unintended pregnancies, the HR was six times higher than corresponding older mothers. Our findings reveal how unintended pregnancies and deaths of neonates born to adolescents contribute substantially to preventable neonatal deaths in East Africa. Full implementation of existing adolescent health policies and utilization of contraceptives should be ensured. Partnership with youths and novel efforts that address sociocultural norms to reduce adolescent pregnancies or marriage should be supported. Regulations requiring adolescents' obstetric care conducted by only skilled personnel should be introduced and implemented. [ABSTRACT FROM AUTHOR]

Neurological conditions and mental health problems are common in children in low- and middle-income countries, but the risk factors and downstream impact of these problems on children with neurological conditions are not reported. To determine the association of neurological conditions with behavioural and emotional problems in children, the prevalence and risk factors of behavioural and emotional problems, and long-term impact of these conditions. Data on multiple neurological conditions and mental health problems were available for 1,616 children (aged 6–9 years) from Kilifi, Kenya. Neurological conditions were diagnosed using standardised tools and clinical examination. Behavioural and emotional problems assessed using Child Behaviour Questionnaire for Parents. Long-term outcomes were obtained from census data of the Kilifi Health and Demographic Surveillance System. Logistic and linear regression were used to measure associations. Mental health problems were higher in those with any neurological condition compared to those without (24% vs. 12%, p < 0.001). Cognitive (odds ratio (OR) = 2.39; 95% CI: 1.59–3.59), motor (OR = 3.17; 95% CI: 1.72–5.82), hearing (OR = 2.07; 95% CI:1.12–3.83) impairments, and epilepsy (OR = 4.18; 95% CI: 2.69–6.48), were associated with mental health problems. Prevalence of any mental health problem was 15%, with externalizing problems more common than internalizing problems (21% vs. 17%, p = 0.004). Longitudinal follow-up indicated that the disorders affected an individual's future schooling (e.g. OR = 1.25; 95% CI: 0.14–1.46 following cognitive impairments), occupation (OR = 2.44; 95% CI: 1.09–5.44 following mental health problems), and access to household assets (OR = 2.78; 95% CI: 0.99–7.85 following epilepsy). Neurological conditions in school-aged children in Kilifi are associated with mental health problems, and both disorders have long-term consequences. Preventive and therapeutic measures for these conditions are needed to improve outcomes of these children. [ABSTRACT FROM AUTHOR]

Sexual prejudice toward men who have sex with men (MSM) is a pressing concern in sub-Saharan Africa (SSA). Given the high HIV infection risk among this population, sexual prejudice perpetuated by healthcare providers, affects access to and willingness of MSM to seek HIV care services. However, data on healthcare providers' attitudes towards MSM in SSA are limited, and there are no locally-adapted measures of sexual prejudice. We adapted a scale to measure sexual prejudice with a sample of 147 healthcare providers in western Kenya. Results from exploratory factor analysis revealed a single-factor structure. The scale demonstrated high internal consistency with Cronbach's α = 0.91. Healthcare providers who had prior interpersonal contact with MSM, had ever been trained on counselling MSM, and had higher knowledge about MSM health needs reported lower sexual prejudice scores, compared with peers who lacked these experiences (p < 0.001). In contrast, healthcare providers who had experienced secondary stigma (negative judgments from peers and community) for providing care to MSM reported higher scores of sexual prejudice scale (p < 0.001) compared with providers who had not experienced secondary stigma. The scale provides a contextualised tool to assess healthcare providers' attitudes toward MSM in Kenya and countries in SSA with similar cultural norms. [ABSTRACT FROM AUTHOR]

HIV stigma is a major barrier to HIV care and treatment among people living with HIV (PLWH). Evidence suggests that expansion in antiretroviral therapy (ART) may reduce stigma. However, there are limited longitudinal studies examining temporal trends in HIV stigma in sub-Saharan Africa in the Undetectable = Untransmittable (U = U) era. We longitudinally assessed temporal trends in self-reported experienced stigma and the association of experienced stigma with ART adherence and viral suppression among PLWH enrolled in the African Cohort Study (AFRICOS). AFRICOS is an ongoing cohort study enrolling PLWH in Uganda, Kenya, Tanzania, and Nigeria. As of 1 March 2020, 2937 PLWH enrolled in AFRICOS and had available data. In 2013, 22% of participants reported stigma at the enrollment visit and by 2018 the prevalence decreased to 1% overall and was below 2% for all countries. However, there was not a statistically significant change in stigma prevalence in our longitudinal models. In adjusted models, experiencing stigma was associated with a 0.67 decreased odds of ART Adherence (95% confidence interval (CI): 0.56–0.80) and a 0.64 decreased odds of viral suppression (95% CI: 0.73–0.99). HIV-associated stigma was associated with poor self-reported ART adherence and unsuppressed viral load. [ABSTRACT FROM AUTHOR]

This study examined outcomes associated with early sexual debut in five sub-Saharan African countries for males and females, separately. We employed Violence Against Children Surveys (VACS) from Kenya, Malawi, Nigeria, Tanzania, and Uganda, restricting samples to males and females age 18–24 years. Early sexual debut was defined as having one's first sexual intercourse before 15. Logistic, Ordinary Least Squares, and Poisson regressions were utilised to estimate associations between early sexual debut and outcomes across four ecological domains: individual, family, peer/partner, and community. Regressions were stratified by sex. The prevalence of early sexual debut ranged from 8.6% in Tanzania to 17.7% in Malawi. Males were more likely to report early sexual debut in Kenya (16.3%, compared to 6.7% for females; P < 0.001) and Uganda (15%, compared to 10.4% for females; P = 0.037). In Nigeria, 14.5% of females reported early sexual debut, compared to 5.4% of males (P < 0.001). Early sexual debut was associated with only one outcome in the individual and family domains, and was most consistently associated with outcomes in the peer/partner domain. Differences in these relationships for males and females suggest programs and policies working to reduce early sexual debut and promote healthy sexual relationships among young adolescents should thoughtfully consider framing messaging through a gendered lens. [ABSTRACT FROM AUTHOR]

The Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe (DREAMS) Initiative aims to reduce HIV infections among adolescent girls and young women (AGYW) in Africa. Oral pre-exposure prophylaxis (PrEP) is offered through DREAMS in Kenya to eligible AGYW in high burden counties including Kisumu and Homa Bay. This study examines PrEP persistence among AGYW in high burden community-based PrEP delivery settings. We evaluated PrEP persistence among AGYW in the DREAMS PrEP program in Kisumu and Homa Bay using survival analysis and programmatic PrEP refill data collected between March through December 2017. Among 1,259 AGYW who initiated PrEP during the study period, the median persistence time in the program was 56 days (95% CI: 49–58 days) and the proportion who persisted 3 months later was 37% (95% CI: 34-40%). Persistence varied by county (p < 0.001), age at PrEP initiation (p = 0.002), marital status (p = 0.008), transactional sex (p = 0.002), gender-based violence (GBV) experience (p = 0.009) and current school attendance (p = 0.001) at DREAMS enrollment. Persistence did not vary with orphan status, food insecurity, condom use, age at first sexual encounter or engagement in age-disparate sex at DREAMS enrollment. Targeted strategies are needed to improve AGYW retention in the PrEP program. [ABSTRACT FROM AUTHOR]

Wheelchair outcomes measures are useful to support evidence-based practice in wheelchair provision, especially in low- and middle-income countries (LMIC). The Wheelchair Interface Questionnaire (WIQ) was developed to provide a professional perspective on the quality of the interface between a wheelchair and its user. Studies conducted during the development of the WIQ indicated it has face validity and content validity. The objective of this field study was to conduct a subsequent investigation of the inter-rater reliability of the WIQ at a school for children with disabilities in Kenya. Eight practitioners with wheelchair experience from disparate cultural backgrounds participated in the study. They evaluated eight wheelchairs and the interface with their users. The interclass correlation coefficient (ICC) of the mean rating for the eight-item dataset was computed using SPSS. The ICC was found to be 0.911, indicating that the WIQ possesses inter-rater reliability. Common comment topics indicated that the qualitative data yielded by the WIQ is meaningful. Informal timing indicated that the WIQ is a brief measure. The WIQ is a reliable tool that can meet the need for a professional assessment of the wheelchair-user interface. The reliability of this questionnaire is important because the tool can be used to evaluate the interface between a wheelchair user and their wheelchair, strengthening evidence-based practice in wheelchair provision. Based on the score of a specific wheelchair interface, a rehabilitation professional could recommend more assessment, seating modification, or wheelchair replacement in order to maximize rehabilitation benefit for a client The WIQ could provide evidence-based information to support the need for wheelchair repair or replacement to funders. In large-scale studies involving many of the same wheelchair type in the same setting, the WIQ could be used to identify problems with the interface between that wheelchair type and its intended user population so that manufacturers can make responsive design changes. The WIQ could be used in a clinical setting over time to identify the most common wheelchair interface issues for that setting. [ABSTRACT FROM AUTHOR]

The STRiDE project sets out to support the development of effective dementia policy in middle-income countries (Brazil, India, Indonesia, Jamaica, Kenya, Mexico, and South Africa). As part of this it will generate new data about the prevalence of dementia for a subset of these countries. This study aims to identify the current estimates of dementia prevalence in these countries and where the gaps lie in the current literature. A systematic review was completed on 30th April 2019 across electronic databases, identifying dementia prevalence literature originating from any of the seven countries. Four hundred and twenty-nine records were identified following de-duplication; 28 studies met the inclusion criteria and were included in the systematic review. Pooled estimates of dementia prevalence ranged from 2% to 9% based on DSM-IV criteria; these figures were generally higher in studies using other diagnostic criteria (e.g. the 10/66 algorithm). Available prevalence data varied between countries. Only Brazil, Mexico and India had data derived from studies judged as having a low risk of bias. Irrespective of country, studies often were not explicit in detailing the representativeness of their sample, or whether there was non-response bias. Further transparent and externally valid dementia prevalence research is needed across the STRiDE countries. [ABSTRACT FROM AUTHOR]

Disclosure of HIV status to sexual partners in the context of prevention of mother-to-child transmission (PMTCT) may contribute to improved PMTCT outcomes. We administered a questionnaire to 200 women with HIV enrolled in a PMTCT study during pregnancy at 12 months after birth in Western Kenya between May-September 2017. Descriptive analysis of disclosure patterns and multivariate analysis of factors associated with male partner reactions is presented. Among 180 (90%) women who reported having a male partner, 95.5% reported disclosing their HIV status to that partner. The majority of women (82.8%) reported disclosure occurred within one year of their diagnosis, with 62.7% occurring within one week. The most common forms of disclosure were: self-disclosure (55.4%), during couple's HIV testing and counseling (CHTC) (31.5%), or at an antenatal care visit (7.7%). Most women (87.5%) reported that male partner reactions to their HIV status disclosure were positive. Those with negative reactions reported their partners were confused, annoyed, or threatened to leave, however there were no reports of intimate partner violence (IPV) or break ups. Disclosure via CHTC was associated with a positive male partner reaction compared to self-disclosure (adjusted OR (aOR) 20.2, 95% Confidence Interval (CI) 1.8–221.4). Those in concordant HIV status partnerships were more likely to have a positive reaction (aOR. 6.7, 95% CI 1.7–26.6). Women experiencing frequent verbal IPV were less likely to report a positive response (aOR 0.21, 95%CI 0.1–0.8). Most postpartum women with HIV in this cohort had disclosed to their male partners early after diagnosis and experienced a positive reaction. However, a minority had still not disclosed by 12 months after the birth and some experienced negative reactions to disclosure. The form of status disclosure and impact of intimate partner violence should be given greater attention within the context of PMTCT. [ABSTRACT FROM AUTHOR]

Purpose: In Kenya, the employment rate for persons with disabilities is about 1% compared to 73.8% for the general population, and the situation is even worse for persons with mental disabilities. Persons with mental disabilities are often regarded as "mad", and stand little or no chance of employment. We undertook an exploratory study with employers and potential employers to understand factors that hinder or facilitate their employment and to gain insight into employers' perceptions of mental disability. Materials and methods: We adopted a mixed method study design, including in-depth interviews (n = 10) and questionnaires (n = 158) with (potential) employers in Kenya to explore the barriers and facilitators of employment for persons with mental disabilities. Results: Out of the 158 employers who completed the questionnaire, only 15.4% had ever employed persons with mental disabilities. The perceptions that these persons are not productive and may be violent was associated with an unwillingness to employ them (OR: 10.11, 95%CI: 2.87–35.59 and OR: 3.6, 95%CI: 1.34–9.64, respectively). The possession of skills was the highest reported facilitator of employing persons with mental disabilities. Employers suggested that information about mental illness and the disclosure by prospective employees with mental disabilities are relevant for the provision of reasonable accommodation in the workplace. Conclusion: Possession of skills and disclosure by persons with mental disabilities could improve their employability. Information targeted at all actors including employers, employees, government, and policymakers is necessary for balancing employers and employees expectations. Disabled persons' organisations or mental disability programs that seek to improve the employment of persons with mental disabilities should incorporate methods that address employer expectations through dialogue to find mutual benefits. Employers require essential information about mental illness, and guidance and support in order to provide reasonable accommodation in the workplace for persons with mental disabilities. Disabled persons' organisations and inclusive employment programs should share the positive experiences of employers of persons with mental disabilities with employers who are unaware of the work abilities of persons with mental disabilities to stimulate adoption of inclusive practices. [ABSTRACT FROM AUTHOR]

Purpose: In Kenya, the employment rate for persons with disabilities is about 1% compared to 73.8% for the general population, and the situation is even worse for persons with mental disabilities. Persons with mental disabilities are often regarded as "mad", and stand little or no chance of employment. We undertook an exploratory study with employers and potential employers to understand factors that hinder or facilitate their employment and to gain insight into employers' perceptions of mental disability. Materials and methods: We adopted a mixed method study design, including in-depth interviews (n = 10) and questionnaires (n = 158) with (potential) employers in Kenya to explore the barriers and facilitators of employment for persons with mental disabilities. Results: Out of the 158 employers who completed the questionnaire, only 15.4% had ever employed persons with mental disabilities. The perceptions that these persons are not productive and may be violent was associated with an unwillingness to employ them (OR: 10.11, 95%CI: 2.87–35.59 and OR: 3.6, 95%CI: 1.34–9.64, respectively). The possession of skills was the highest reported facilitator of employing persons with mental disabilities. Employers suggested that information about mental illness and the disclosure by prospective employees with mental disabilities are relevant for the provision of reasonable accommodation in the workplace. Conclusion: Possession of skills and disclosure by persons with mental disabilities could improve their employability. Information targeted at all actors including employers, employees, government, and policymakers is necessary for balancing employers and employees expectations. Disabled persons' organisations or mental disability programs that seek to improve the employment of persons with mental disabilities should incorporate methods that address employer expectations through dialogue to find mutual benefits. Employers require essential information about mental illness, and guidance and support in order to provide reasonable accommodation in the workplace for persons with mental disabilities. Disabled persons' organisations and inclusive employment programs should share the positive experiences of employers of persons with mental disabilities with employers who are unaware of the work abilities of persons with mental disabilities to stimulate adoption of inclusive practices. [ABSTRACT FROM AUTHOR]

Measles is a highly infectious virus and one of the leading causes of childhood morbidity and mortality in areas with low immunization rates. Despite the introduction of the measles vaccine preventing about 20 million deaths between 2000 and 2016, there still is a low uptake of the vaccine, especially in low-income countries. Maternal HIV positive status is identified as one of the factors inhibiting the uptake of the measles vaccine in some settings. Using data from a Health and Demographic surveillance system (HDSS), and a Longitudinal Bio-behavioural Survey (LBBS), we assessed the effect of a mother's HIV status on a child's overall uptake of measles vaccine and timeliness in western Kenya. The findings did not show association between a mother's HIV status and a child's receipt of measles vaccine (OR = 0.84, 95% CI: 0.65, 1.08). However, higher socio-economic status (SES) was a positive factor for receipt of timely measles vaccine (OR = 1.34, 95% CI: 1.03, 1.75) for middle, (OR = 1.43, 95% CI: 1.10, 1.86) upper middle, and (OR = 1.51, 95% CI: 1.15, 1.98) higher quintiles as compared to the lower. Consequently, it is imperative to incorporate interventions that target low SES children and those that improve economic status. [ABSTRACT FROM AUTHOR]

There are currently no published estimates of mortality rates among street-connected young people in Kenya. In this short report, we estimate mortality rates among street-connected young people in an urban setting in Kenya and calculate standardized mortality ratios to assess excess mortality among street-connected young people compared to the general population of Kenyan adolescents. We collected data on deaths among street-connected young people aged 0–29 between 2010 and 2015. We calculated sex-stratified standardized mortality ratios for street-connected young people aged 0–19 and 20–29 from 2010 to 2015, using publicly available Kenya population data as reference. We found that between 2010 and 2015, there were 69 deaths among street-connected young people aged 0 to 29 years in 2013 was 1,248: 341 females (27%) and 907 males (73%). The standardized mortality ratios among street-connected females aged 0–19 and 20–29 years were 2.79 (95% CI 1.44–4.88) and 7.55 (95% CI 3.77–13.51), respectively; standardized mortality ratios among street-connected males aged 0–19 and 20–29 years were 0.71 (95% CI 0.32–1.35) and 5.48 (95% CI 3.86–7.55), respectively. In conclusion, we found that mortality among street-connected young people in an urban setting in Kenya is elevated compared to the general population of Kenyan young people. States should act urgently and take responsibility for protecting street-connected young people's human rights by scaling up programs to prevent morbidity and death associated with youth street involvement. [ABSTRACT FROM AUTHOR]

Background: The increasing trends in cesarean delivery are globally acknowledged. However, in many low-resource countries, socioeconomic disparities have created a pattern of underuse and overuse among lower and higher socioeconomic groups. The impact of rising cesarean delivery rates on neonatal survival is also unclear. Objective: To examine cesarean delivery and its associated socioeconomic patterns and neonatal survival outcome in Kenya and Tanzania. Methods: We employed binary logistic regression to analyze cross-sectional demographic and health survey data on neonates born in health facilities in Kenya (2014) and Tanzania (2016). Results: Cesarean delivery rates ranged from 5% among uneducated, rural Tanzanian women to 26% among educated urban women in Kenya to 37.5% among managers in urban Tanzania. Overall findings indicated higher odds of cesarean delivery among mothers from richest households, adjusted odds ratio (aOR) 1.4 (95% CI 1.2–1.8), those insured, aOR 1.6 (95% CI 1.3–1.9), highly educated, aOR 1.6 (95% CI 1.2–2.0) and managers aOR 1.7 (95% CI 1.3–2.2), compared to middle class, no insurance, primary education and unemployed, respectively. Overall, compared to normal births and while adjusting for maternal risk factors, cesarean delivery was significantly associated with neonatal mortality in Kenya and Tanzania, overall aOR 1.7 (95% CI 1.2–2.7). However, statistical significance ceased when fetal risk factors and number of antenatal care visits were further controlled for, aOR 1.6 (95% CI 0.9–2.6). Conclusion: Disproportionate access to cesarean delivery has widened in Kenya and Tanzania. Higher risks of cesarean-related neonatal deaths exist. Medically indicated or not, the safety and/or choice of cesarean delivery is best addressed on individual basis at the health-facility level. However, policy initiatives to eliminate incentives, improve equitable access and accountability to reduce unnecessary cesarean deliveries through well-informed decisions are needed. Efforts to prevent unintended pregnancies among adolescents as well as training of health workers and continuous research to improve neonatal outcomes are vital. [ABSTRACT FROM AUTHOR]

People with HIV experience a high prevalence and burden of physical and psychological symptoms throughout their disease trajectory. These have important public and clinical health implications. We aimed to measure: the seven-day period prevalence of symptoms, the most burdensome symptoms, and determine if self-reported symptom burden is associated with treatment status, clinical stage and physical performance. We conducted a cross-sectional study among adult (aged at least 18 years) patients with HIV, attending HIV outpatient care in Kenya. Data was gathered through self-report using the Memorial Symptom Assessment Scale-Short Form (MSAS-SF), file extraction (sociodemographic data, treatment status, CD4 count, clinical stage) and through observation using the Karnofsky Performance Scale (KPS). Multivariable ordinal logistic regression assessed the association of symptom burden (MSAS-SF) controlling for demographic and clinical variables. Of the 475 participants approached, 400 (84.2%) participated. Ordinal logistic regression showed that being on HIV treatment was associated lower global distress index (in quartiles) (odds ratio.45, 95% CI.23 to.88; p = 0.019). Pain and symptom burden still persist in the era of antiretroviral therapy. Routine clinical practice should incorporate assessment and management of pain and symptoms irrespective of disease stage and treatment status in order to achieve the proposed fourth "90" in the UNAIDS 90-90-90 targets (that is good quality of life). [ABSTRACT FROM AUTHOR]

Social stigma related to women's reproductive decision-making negatively impacts the health of women. However, little is known about stigmatising attitudes and beliefs surrounding abortion and contraceptive use among adolescents. The aim of this study was to measure stigmatising attitudes and beliefs regarding abortion and contraceptive use among secondary school students in western Kenya. A self-reported classroom questionnaire-survey was administered in February 2017 to students at two suburban secondary schools in western Kenya. Two scales were used to measure the stigma surrounding abortion and contraceptive use – the Adolescent Stigmatizing Attitudes, Beliefs and Actions (ASABA) scale and the Contraceptive Use Stigma (CUS) scale. 1,369 students were eligible for the study; 1,207 (females = 618, males = 582) aged 13–21 years were included in the analysis. Descriptive statistics, Pearson's χ2 test, and the t-test were used to analyse the data. Binary logistic regression analysis was used to calculate odds ratios (OR) and 95% confidence intervals (CI). The students reported stigma associated with abortion (53.2%), and contraceptive use (54.4%). A larger proportion of male students reported abortion stigma (57.7%) and contraceptive use stigma (58.5%), compared to female students (49.0%, p =.003 and 50.6%, p =.007, respectively). Higher scores were displayed by younger rather than older age groups. No associations were identified between sexual debut and abortion stigma (p =.899) or contraceptive use stigma (p =.823). Abortion and contraceptive use are stigmatised by students in Kenya. The results can be used to combat abortion stigma and to increase contraceptive use among adolescents in Kenya. [ABSTRACT FROM AUTHOR]

While the overall incidence and prevalence of HIV/AIDS are declining in Africa, substance use-related HIV/AIDS is on the rise. The main objectives of this study were to elicit the types of commonly used substances and to examine the association between substance use and concurrent sexual relationships among slum dwellers in Kenya. Freelisting elicitation techniques were used to identify the most commonly used substances using 53 key informants. This was followed by a self-administered, structured questionnaire using a convenience sample of 506 participants. Findings from our freelisting analysis produced 27 substances that were used in the community. Analysis of the survey data shows that participants who reported using substances in the past three months were more likely to be involved in concurrent sexual relationships than those who did not (86.2% vs. 74.0%; p =.002). In the multivariable model, the odds of ever having concurrent sexual relationships were higher among participants who used any substance in the past three months (aOR 2.46; 95% CI 1.37–4.42, p <.01). The observed association between substance use and concurrent sexual relationships may be influenced by social and economic factors such as poverty and lack of opportunity among urban slum dwellers. [ABSTRACT FROM AUTHOR]

Poor retention in HIV care remains a major problem for Adolescents and Young Adults (AYA). A Standardized Patient (SP) clinical training intervention was developed to improve healthcare worker (HCW) "adolescent-friendly" competencies in Kenya. Professional actors were trained to portray HIV-infected AYA according to standardized scripts. HCWs completed a 2-day SP training that included didactic sessions, 7 video-recorded SP encounters, and group debriefing. AYA health experts rated HCWs by reviewing the video recordings. All HCWs (10/10) reported high satisfaction with the intervention and overall improvement in self-rated competency in caring for HIV-infected AYA. Cases were reported to be realistic and relevant by between 7 and 10 of 10 HCWs. The case on disclosure and adherence was rated as most challenging in communication and making medical decisions by HCWs. Areas identified by SPs for improvement by HCWs included allowing patients time to ask questions, and enabling SP to share sensitive information. The overall ICC by experts was low 0.27 (95% CI: −0.79 to 0.95), however, ICCs in assessment of HIV disclosure 0.78 (95% CI: 0.17–0.98), and sexual behavior 0.97 (95% CI: 0.89–0.99) were high. This intervention was acceptable for Kenyan HCWs and improved self-rated competency in caring for HIV-infected AYA. [ABSTRACT FROM AUTHOR]

We sought to understand whether women's empowerment and male partner engagement were associated with use of antenatal care (ANC). Women presenting for ANC in Nyanza province of Kenya between June 2015 and May 2016, were approached for participation. A total of 137 pregnant women and 96 male partners completed baseline assessments. Women's empowerment was measured using the modified Sexual Relationship Power Scale. ANC use measures included timing of the first ANC visit and number of visits. Male engagement was based on whether a husband reported accompanying his wife to one or more antenatal visits during the pregnancy. Multiple linear and logistic regression analyses were used to identify factors independently related to use and timing of ANC. Women with higher mean empowerment scores were likely to have more than one ANC visit in the index pregnancy [Adjusted Odds Ratio (AOR) = 2.8, 95% Confidence Interval (CI): 1.1–7.3], but empowerment was not associated with early ANC use. Women who were more empowered were less likely to have a husband who reported attending an ANC visit with his wife (AOR = 0.1, 95% CI: 0.03–0.8). Women's empowerment is important and may be related to ANC use and engagement of male partners in complex ways. [ABSTRACT FROM AUTHOR]

Men's relatively low rates of HIV testing has been termed the 'HIV blind spot' and recently declared by UNAIDS as a top priority. This study uses data from five nationally representative Demographic and Health Surveys in Kenya, Malawi, Mozambique, Zambia, and Zimbabwe to explore factors associated with men's lifetime HIV testing. Between 29.3% and 34.9% of men ages 15–49 in these countries had never tested for HIV and men who held accepting attitudes towards gender-based violence, who lacked HIV knowledge, and who held stigmatising views of HIV were more likely to report never testing for HIV. Findings are interpreted, including a discussion of the possible unintended consequences of current 90-90-90 targets on men's relatively low testing rates. The results point to possible intervention opportunities to increase HIV testing among men in high-HIV prevalence settings in Eastern and Southern Africa and emphasise the importance of changing men's perceptions related to stigma and gender norms. [ABSTRACT FROM AUTHOR]

HIV remains a major health problem in sub-Saharan Africa, and innovations—such as HIV self-testing (HST)—that break down barriers to testing are required to move toward elimination. Four anonymous cross-sectional surveys were conducted assessing HST knowledge and attitudes among sports-based HIV prevention tournament attendees in Nairobi, Kenya. Results suggest HST may increase testing rates in this population. Participants expressed interest in using HST and were willing to use HST as a tool to motivate others. This poses a unique opportunity for a community intervention aimed to increase knowledge of HST, and to increase HIV testing rates using HST kits. [ABSTRACT FROM AUTHOR]

Background: Despite substantial progress in antiretroviral therapy (ART) scale up, some people living with HIV (PLHIV) continue to present with advanced HIV disease, contributing to ongoing HIV-related morbidity and mortality. Objective: We aimed to quantify population-level estimates of advanced HIV from three high HIV prevalence settings in Sub-Saharan Africa. Methods: Three cross-sectional surveys were conducted in (Ndhiwa (Kenya): September–November 2012), (Chiradzulu (Malawi): February–May 2013) and (Eshowe (South Africa): July–October 2013). Eligible individuals 15–59 years old who consented were interviewed at home followed by rapid HIV test and CD4 count test if tested HIV-positive. Advanced HIV was defined as CD4 < 200 cells/µl. We used logistic regression to identify patient characteristics associated with advanced HIV. Results: Among 18,991 (39.2% male) individuals, 4113 (21.7%) tested HIV-positive; 385/3957 (9.7% (95% Confidence Interval [CI]: 8.8–10.7)) had advanced HIV, ranging from 7.8% (95%CI 6.4–9.5) Chiradzulu (Malawi) to 11.8% (95%CI 9.8–14.2) Ndhiwa (Kenya). The proportion of PLHIV with advanced disease was higher among men 15.3% (95% CI 13.2–17.5) than women 7.5% (95%CI 6.6–8.6) p < 0.001. Overall, 62.7% of all individuals with advanced HIV were aware of their HIV status and 40.3% were currently on ART. Overall, 65.6% of individuals not on ART had not previously been diagnosed with HIV, while only 29.6% of those on ART had been on ART for ≥6 months. Individuals with advanced HIV disease were more likely to be men (adjusted Odds Ratio [aOR]; 2.1 (95%CI 1.7–2.6), and more likely not to be on ART (aOR; 1.7 (95%CI 1.3–2.1). Conclusion: In our study, about 1 in 10 PLHIV had advanced HIV with nearly 40% of them unaware of their HIV status. However, a substantial proportion of patients with advanced HIV were established on ART. Our findings suggest the need for a dual focus on alternative testing strategies to identify PLHIV earlier as well as improving ART retention. [ABSTRACT FROM AUTHOR]

HIV incidence and mortality are high among adolescents and young adults (AYA) in sub-Saharan Africa, but testing rates are low. Understanding how support people (SP), such as peers, partners, or parents, influence AYA may improve HIV testing uptake. AYA aged 14-24 seeking HIV testing at a referral hospital in Nairobi, Kenya completed a post-test survey assessing the role of SP. Among 1062 AYA, median age was 21. Overall, 12% reported their decision to test was influenced by a parent, 20% by a partner, and 22% by a peer. Young adults (20-24 years old) were more likely than adolescents (14-19 years old) to be influenced to test by partners (23% vs. 12%, p < .001), and less likely by parents (6.6% vs. 27%, p < .001), healthcare workers (11% vs. 16%, p < .05), or counselors (9.4% vs. 19%, p < .001). Half of AYA were accompanied for testing (9.9% with parent, 10% partner, 23% peer, 4.3% others, and 2.1% multiple types). Young adults were more likely than adolescents to present alone (58% vs. 32%, p < .001) or with a partner (12% vs. 6.7%, p < .05), and less likely with a parent (1.6% vs. 31%, p < .001). Similar proportions of adolescents and young adults came with a peer or in a group. Correlates of presenting with SP included: younger age (aRR = 1.55 [95%CI = 1.30-1.85]), female sex (aRR = 1.45 [95%CI = 1.21-1.73]), and school enrollment (aRR = 1.41 [95%CI = 1.05-1.88]). SP play an important role in AYAs' HIV testing and varies with age. Leveraging SP may promote uptake of HIV testing and subsequent linkage care for AYA. [ABSTRACT FROM AUTHOR]

The objective of the study was to establish the mother-baby pair characteristics that contribute to vertical transmission of HIV and elucidate on remediation. We assessed for factors increasing the odds of HIV transmission in children born to HIV-infected mothers in western Kenya. We used a retrospective study which reviewed routinely collected data of 1 028 mother-baby pairs enrolled in a prevention of mother-to-child transmission (PMTCT) programme in western Kenya from January to December 2015. We compared the transmission rates amongst mothers known to have a positive HIV status before conception (known positives/KPs) versus the transmission amongst those who were newly diagnosed during maternal and child health (MCH) clinic attendance (new positives/NPs). We compared the socio-demographic and clinical characteristics of the mothers using chi square and Kruskal-Wallis tests at 95% confidence interval (CI). We assessed for factors associated with the infants’ HIV status using a logistic regression model. The results revealed that 60% (622) of the mothers were KPs, and that KPs and NPs had mother-to-child transmission (MTCT) rates of 5.5% and 20.7% respectively. Close to 90% of the NP Mothers were at an early HIV clinical stage at enrolment and 40% were enrolled after delivery. The infants of NPs were enrolled at a mean age of 18.3 weeks compared to 6.6 weeks for the infants of the KPs. On adjusted multivariable analysis, child's age at enrolment (AOR = 1.05, 95%CI = 1.036-1.064) and mother's status at conception (AOR = 1.96, 95%CI = 1.042-3.664) were significantly associated with the infant's HIV status. None of the HIV infected infants had received nevirapine prophylaxis. Most of the mothers enrolling into the PMTCT programme have a known HIV-positive status, however, NPs are the largest contributors to continued MTCT. [ABSTRACT FROM AUTHOR]

Measuring mistreatment and quality of care during childbirth is important in promoting respectful maternity care. We describe these dimensions throughout the birthing process from admission, delivery and immediate postpartum care. We observed 677 client-provider interactions and conducted 13 facility assessments in Kenya. We used descriptive statistics and logistic regression model to illustrate how mistreatment and clinical process of care vary through the birthing process. During admission, the prevalence of verbal abuse was 18%, lack of informed consent 59%, and lack of privacy 67%. Women with higher parity were more likely to be verbally abused [AOR: 1.69; (95% CI 1.03,2.77)]. During delivery, low levels of verbal and physical abuse were observed, but lack of privacy and unhygienic practices were prevalent during delivery and postpartum (>65%). Women were less likely to be verbally abused [AOR: 0.88 (95% CI 0.78, 0.99)] or experience unhygienic practices, [AOR: 0.87 (95% CI 0.78, 0.97)] in better-equipped facilities. During admission, providers were observed creating rapport (52%), taking medical history (82%), conducting physical assessments (5%). Women’s likelihood to receive a physical assessment increased with higher infrastructural scores during admission [AOR: 2.52; (95% CI 2.03, 3.21)] and immediately postpartum [AOR 2.18; (95% CI 1.24, 3.82)]. Night-time deliveries were associated with lower likelihood of physical assessment and rapport creation [AOR; 0.58; (95% CI 0.41,0.86)]. The variability of mistreatment and clinical quality of maternity along the birthing process suggests health system drivers that influence provider behaviour and health facility environment should be considered for quality improvement and reduction of mistreatment. [ABSTRACT FROM AUTHOR]

The 90-90-90 strategy from the Joint United Nations Programme on HIV/AIDS (UNAIDS) to end the AIDS epidemic by 2020 includes, as its first goal, to have 90% of all people living with HIV to know their status. Achieving this goal will depend on effectively reaching high risk populations, which include mobile populations such as truck drivers. This study aimed to characterise a sample of 305 truck drivers recruited from 2 roadside wellness clinics in Kenya in terms of anticipated HIV stigma, self-efficacy, fatalism, gender equity, sensation seeking, and self-esteem, and then determine the association of these psychosocial characteristics with HIV testing behaviour. Greater general self-efficacy was associated with higher income and more years working as a truck driver. Greater fatalism was associated with non-Christian religion, being married, and having a lower income. Greater gender equity was associated with completing high school, being married, and having higher income. Greater sensation seeking was associated with lower income and fewer years employed as a truck driver. In multivariable logistic regression adjusted for demographic variables, anticipated HIV stigma was negatively associated with having ever tested for HIV (adjusted odds ratio [aOR] = 0.79; 95% confidence interval [CI] = 0.63-0.98; p = 0.034) and self-esteem was positively associated with testing (aOR = 1.06; 95% CI = 1.00-1.12; p = 0.038). Associations with HIV testing behaviour were not significant for self-efficacy, fatalism, gender equity, or sensation seeking. Public health interventions aiming to reduce anticipated stigma and increase self-esteem may potentially increase the uptake of HIV testing among truck drivers. Further research is needed to better understand the influence of these psychosocial characteristics on HIV testing. [ABSTRACT FROM AUTHOR]

Tuberculosis illness is associated with uncertain outcomes, and has high prevalence among people living with HIV. The new World Health Organization’s End TB strategy specifies person-centred symptom management and psychosocial support alongside treatment within its pillars and components. There is a paucity of research to inform an effective care response in Kenya in terms of self-reported outcomes. We aimed to measure the three day period intensity of problems and concerns (physical, psychological, social and spiritual), and identify predictors of problems and concerns, among HIV patients attending outpatient care. We conducted a cross-sectional self-report quantitative study among adult (aged at least 18 years) patients with confirmed HIV diagnosis, and aware of their diagnosis and attending HIV outpatient care in Kenya. Multi-dimensional palliative care problems and concerns were collected using African Palliative Outcome Scale (APOS). Ordinal logistic regression assessed the association of multi-dimensional problems and concerns controlling for demographic variables (age, gender, education and wealth) and clinical variables (WHO clinical stage, HIV treatment status, TB treatment status, and CD4 count). We recruited N = 400 participants. N = 61 (15.64%) were on TB treatment. The items with worst score responses were help and advice to plan for the future (52.5%), ability to share feelings (46.25%), at peace (30.75%) pain (27%) and life worthwhile (18.75%). TB treatment status was associated with lower (worse) score for APOS total score (odds ratio.59, 95% CI.36 to.99; P = 0.046) and factor 3(existential and spiritual wellbeing:.55,.32 to.92; p = 0.023). Interestingly higher CD4 count was predictive of lower (worse) factor 3 outcomes (existential and spiritual wellbeing:.84, 95% CI 73 to.97; p = 0.014). This study informs the new WHO End TB policy with novel data on specific clinical needs. This calls for holistic symptom assessment, person-centred care and holistic management to respond positively to the End TB strategy. [ABSTRACT FROM AUTHOR]

We investigated features of major adherence lapses in antiretroviral therapy (ART) at public Emusanda Health Centre in rural Kakamega County, Kenya using medical records from 2008 to 2015 for all 306 eligible patients receiving ART. Data were modelled using survival analysis. Patients were more likely to lapse if they received stavudine (hazard ratio (HR) 2.54, 95% confidence interval (95%CI):1.44-4.47) or zidovudine (HR 1.64, 95%CI:1.02-2.63) relative to tenofovir. Each day a patient slept hungry per month increased risk of major adherence lapse by 3% (95%CI:0-7%). Isolated home visits by community health workers (CHWs) were more effective to assist patients to return to the health centre than isolated phone calls (HR 2.52, 95%CI:1.02-6.20). [ABSTRACT FROM AUTHOR]

The UNAIDS 90-90-90 target has prioritized achieving high rates of viral suppression. We identified factors associated with viral suppression among HIV-positive gay, bisexual, and other men who have sex with men (GBMSM) in Kisumu, Kenya. HIV-positive participants in the Anza Mapema study were offered antiretroviral therapy (ART) regardless of CD4 count. HIV viral load was assessed at baseline and after 6 and 12 months of follow-up. Viral suppression was defined as <1,000 copies/mL. Sociodemographic, sexual behaviors, and psychosocial characteristics were assessed via audio computer-assisted self interview. We used generalized estimating equations to estimate the associations between baseline and time-dependent predictors and viral suppression at 6 and 12 months. Seventy-five HIV-positive men were enrolled in the Anza Mapema study, of which 63 had at least one viral load measured during follow-up. Among 52 men with a viral load measure at month 6, 37 (71%) were on ART and virally suppressed. Among 59 men with a viral load measure at month 12, 37 (63%) were on ART and virally suppressed. In the final multivariable model, men who reported receptive or versatile sexual position during anal intercourse with a male partner had reduced odds of viral suppression (aOR = 0.20; 95% CI: 0.08-0.50). Greater levels of coping self-efficacy were associated with increased odds of viral suppression (aOR = 1.10; 95% CI: 1.03-1.16). Despite extensive initiation, retention, and adherence support, the rate of viral suppression in this population did not meet the UNAIDS 90-90-90 target (81% for individuals aware of their HIV status). Pervasive stigma against male-male sex, especially men who practice receptive anal sex, may underlie our findings, which highlight the need for advocacy and stigma reduction efforts. Because coping self-efficacy was a protective factor, efforts to promote resilience in addition to healthy sexual identity development may lead to improved care outcomes among GBMSM in this area. [ABSTRACT FROM AUTHOR]

Few studies have examined gender differences in sub-Saharan Africa, where HIV disproportionately affects women. Objectives of this cross-sectional study were to determine gender differences in HRQoL at the time of a positive HIV test, and whether factors associated with HRQoL differed between men and women. Adults testing HIV-positive were recruited from two clinics located in informal settlements. HRQoL was measured with the SF-12. Multiple linear regression was used to test whether there were gender differences in physical (PCS) and mental composite summary (MCS) scores. Separate models were built for men and women to examine factors associated with HRQoL. Between April 2013 and June 2015, 775 individuals from were recruited. The mean PCS score was higher in women (adjusted mean difference 2.49, 95% CI 0.54 to 4.44,p = 0.012). There was no significant gender difference in MCS scores. Similar factors were associated with better physical HRQoL in men and women: secondary education, younger age, higher CD4, and employment. Employment was the only factor associated with MCS in men, while less social support and low CD4 were associated with poorer MCS scores in women. Gender differences in factors related to HRQoL should be considered in broader policy and interventions to improve the HRQoL in those diagnosed with HIV. [ABSTRACT FROM AUTHOR]

Objectives: This study sought to investigate the incidence and factors associated with hospital-acquired malnutrition in children.Design: A hospital-based longitudinal survey carried out between December 2013 and February 2014.Setting: Aga Khan University Hospital, Nairobi, Kenya, a tertiary care hospital.Subjects: One hundred and seventy children who met the inclusion criteria were included in the study.Outcome measures: Anthropometry was done at admission and discharge. Incidence of hospital-acquired malnutrition was estimated from the total number of children showing a decrease in weight-for-height/length (WFH) or Body Mass Index (BMI) z-scores from the time of admission to discharge. Logistic regression analysis was performed to determine associations between selected variables and weight loss during hospitalisation.Results: Albeit a borderline level of significance, a decrease in calculated z-scores occurred in 60.6% (Confidence Interval (CI) 53.1-67.6%) of children during hospitalisation with a mean weight decrease of 0.5 kg (Standard Deviation (SD) ± 3.37, p = 0.055). Children ≤ 60 months of age demonstrated a mean decrease in weight-for-height/length z-score of 0.145 (SD ± 0.73, p = 0.042); and those > 60 months, a mean decrease in BMI z-score of 0.152 (SD ± 0.39, p = 0.004). The majority with weight loss had been admitted with a diagnosis of gastroenteritis (81.2%), gastritis (64.3%) and pneumonia (55.6%). Weight loss was associated with duration of admission: 3 - 5 days (Odds Ratio (OR) 2.43, CI 1.46-4.03), 5 - 7 days (OR 4.67, CI 1.34-16.24), and > 7 days (OR 2.75, CI 0.88-8.64); score test for trend of odds is OR 1.37 (95% CI 1.11-1.69, p = 0.003).Conclusion: This study found a high incidence of hospital-acquired malnutrition in children. The most affected were those with gastroenteritis, gastritis and pneumonia. Hospital-acquired malnutrition was associated with an increased duration of hospitalisation. [ABSTRACT FROM AUTHOR]

We conducted a randomized controlled trial among 305 truck drivers from two North Star Alliance roadside wellness clinics in Kenya to see if offering HIV testing choices would increase HIV testing uptake. Participants were randomized to be offered (1) a provider-administered rapid blood (finger-prick) HIV test (i.e., standard of care [SOC]) or (2) a Choice between SOC or a self-administered oral rapid HIV test with provider supervision in the clinic. Participants in the Choice arm who refused HIV testing in the clinic were offered a test kit for home use with phone-based posttest counseling. We compared HIV test uptake using the Mantel Haenszel odds ratio (OR) adjusting for clinic. Those in the Choice arm had higher odds of HIV test uptake than those in the SOC arm (OR = 1.5), but the difference was not statistically significant (p = 0.189). When adding the option to take an HIV test kit for home use, the Choice arm had significantly greater odds of testing uptake (OR = 2.8,p = 0.002). Of those in the Choice arm who tested, 26.9% selected the SOC test, 64.6% chose supervised self-testing in the clinic, and 8.5% took a test kit for home use. Participants varied in the HIV test they selected when given choices. Importantly, when participants who refused HIV testing in the clinic were offered a test kit for home use, an additional 8.5% tested. Offering truck drivers a variety of HIV testing choices may increase HIV testing uptake in this key population. [ABSTRACT FROM PUBLISHER]

The objective of this study was to understand and estimate the complex relationships in the continuum of care for maternal health to provide information to improve maternal and newborn health outcomes. Women (n = 4,082) aged 15–49 years in the 2008/2009 Kenya Demographic and Health Survey data were used to explore the complex relationships in the continuum of care for maternal health (i.e., before, during, and after delivery) using structural equation modeling. Results showed that the use of antenatal care was significantly positively related to the use of delivery care (β = 0.06; adjusted odds ratio [AOR] = 1.06; 95% confidence interval [CI]: 1.02–1.10) but not postnatal care, while delivery care was associated with postnatal care (β = 0.68; AOR = 1.97; 95% CI: 1.75–2.22). Socioeconomic status was significantly related to all elements in the continuum of care for maternal health; barriers to delivery of care and personal characteristics were only associated with the use of delivery care (β = 0.34; AOR = 1.40; 95% CI: 1.30–1.52) and postnatal care (β = 0.03; AOR = 1.03; 95% CI: 1.01–1.05), respectively. The three periods of maternal health care were related to each other. Developing a referral system of continuity of care is critical in the Sustainable Development Goals era. [ABSTRACT FROM PUBLISHER]

Objective: We analyze whether adverse childhood experiences predict weekly alcohol consumption patterns of Kenyan mothers and their partners. Method: Randomly selected respondents (n = 1,976) were asked about adverse childhood experiences and alcohol consumption patterns for themselves and their partners. Fixed effect models were used to determine odds of reporting weekly alcohol consumption and the number of beverages typically consumed, controlling for wealth, age, education, and partner alcohol consumption. Results: Cumulative adverse childhood experiences predicted higher odds of weekly alcohol consumption of the respondent and her partner. Childhood exposure to physical abuse, emotional neglect, and mental illness in the household significantly increased odds of weekly alcohol consumption by the respondent. More drinks consumed per typical session were higher among respondents with more cumulative adversities. Physical and emotional abuse significantly predicted number of drinks typically consumed by the respondent. Conclusions: To our knowledge, this is the first study to explore and find associations between adverse childhood experiences and alcohol consumption in Kenya. Consistent with high-income settings, exposure to childhood adversities predicted greater alcohol consumption among Kenyan women. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine whether gait cycle characteristics are associated with running economy in elite Kenyan runners. Fifteen elite Kenyan male runners completed two constant-speed running sets on a treadmill (12 km ·h−1and 20 km ·h−1).VO2and respiratory exchange ratio values were measured to calculate steady-state oxygen and energy cost of running. Gait cycle characteristics and ground contact forces were measured at each speed. Oxygen cost of running at different velocities was 192.2 ± 14.7 ml· kg−1· km−1at 12 km· h−1and 184.8 ± 9.9 ml· kg−1· km−1at 20 km· h−1, which corresponded to a caloric cost of running of 0.94 ± 0.07 kcal ·kg−1·km−1and 0.93 ± 0.07 kcal· kg−1· km−1. We found no significant correlations between oxygen and energy cost of running and biomechanical variables and ground reaction forces at either 12 or 20 km· h−1. However, ground contact times were ~10.0% shorter (very large effect) than in previously published literature in elite runners at similar speeds, alongside an 8.9% lower oxygen cost (very large effect). These results provide evidence to hypothesise that the short ground contact times may contribute to the exceptional running economy of Kenyan runners. [ABSTRACT FROM AUTHOR]

The relationship between muscle co-activation and energy cost of transport and risk of injury (initial loading rate and joint stiffness) has not been jointly studied. Fourteen elite Kenyan male runners were tested at two speeds (12 and 20 km · h−1), where oxygen consumption, kinematic, kinetic and electromyography were recorded. Electromyography of seven lower limb muscles was recorded. Pre-activation and ground contact of agonist:antagonist co-activation was determined. All muscles displayed higher activity during pre-activation exceptrectus femoris(RF). Conversely, no differences were found during ground contact except for higherbiceps femoris(BF) at 20 km · h−1. Knee stiffness was correlated to RF–BF co-activation during both pre-activation and ground contact at both running speeds. However, energy cost of transport was only positively correlated to the above-mentioned muscle pairs at 20 km · h−1(r = 0620,P = 0.032;r = 0.682,P = 0.015, respectively). These findings emphasise the influence of neuromuscular control and performance and its support to musculoskeletal system to optimise function and modulate risk of injury. Further, neuromuscular activity during terminal swing is also important and necessary to execute and maintain performance. [ABSTRACT FROM AUTHOR]

Single motherhood exposes women to poorer socioeconomic and health outcomes, which may also negatively impact child outcomes. The Demographic and Health Surveys of 1989, 1993, 1998, 2003, and 2009 were used to investigate trends over time and factors associated with single motherhood in Kenya. Urban residence, older age, and poorer economic status were associated with single motherhood over time. Women with more than one child, and those with children under 15 years living at home were less likely to be single mothers. As women become single mothers at different stages, targeted and supportive strategies are required to mitigate associated risks. [ABSTRACT FROM AUTHOR]

HIV treatment is life-long, yet many patients travel or migrate for their livelihoods, risking treatment interruption. We examine timely reengagement in care among patients who transferred-out or were lost-to-follow-up (LTFU) from a rural HIV facility. We conducted a cohort study among 369 adult patients on antiretroviral therapy between November 2011 and November 2013 on Mfangano Island, Kenya. Patients who transferred or were LTFU (i.e., missed a scheduled appointment by ≥90 days) were traced to determine if they reengaged or accessed care at another clinic. We report cumulative incidence and time to reengagement using Cox proportional hazards models adjusted for patient demographic and clinical characteristics. Among 369 patients at the clinic, 23(6%) requested an official transfer and 78(21%) were LTFU. Among official transfers, cumulative incidence of linkage to their destination facility was 91% at three months (95%CI (confidence intervals) 69–98%). Among LTFU, cumulative incidence of reengagement in care at the original or a new clinic was 14% at three months (95%CI 7–23%) and 60% at six months (95%CI 48–69%). In the adjusted Cox model, patients who left with an official transfer reengaged in care six times faster than those who did not (adjusted hazard ratio 6.2, 95%CI 3.4–11.0). Patients who left an island-based HIV clinic in Kenya with an official transfer letter reengaged in care faster than those who were LTFU, although many in both groups had treatment gaps long enough to risk viral rebound. Better coordination of transfers between clinics, such as assisting patients with navigating the process or improving inter-clinic communication surrounding transfers, may reduce delays in treatment during transfer and improve overall clinical outcomes. [ABSTRACT FROM AUTHOR]

A cross-sectional study was conducted to assess the extent of unstructured HIV treatment interruptions (TIs) and investigate the effects of socioeconomic, socio-demographic, HIV treatment-related and clinical factors on the magnitude and rate of the same among adult patients at a Kenyan regional referral center. Four hundred and twenty-one adult patients actively receiving antiretroviral therapy at Nyeri County Referral Hospital since 2003 were randomly selected to complete a health survey questionnaire. Electronic records were used to obtain their HIV treatment utilization history. The marginal effects of selected determinants on prevalence and rate of TI were assessed by fitting multiple Poisson log-linear regression models. In total, 392 patients participated in the study. HIV TI was prevalent with 64.5% having had at least one TI of 3 months or more during treatment. The risk of TI was significantly higher in those longer on treatment (prevalence ratio = 1.2, 95% confidence interval [CI] 1.12-1.28). Greater risk of TI was also associated with lower income (prevalence rate ratio [PRR] = 0.9, 95% CI 0.83-1.00), low medication adherence (PRR = 0.3, 95% CI 0.13-0.72), inconsistent treatment engagement (PRR = 0.4, 95% CI 0.19-0.75) and, contrarily, fewer adverse drug reactions (PRR = 0.9, 95% CI 0.90-0.97). Unstructured HIV TIs appear to be fairly common at the study site. The results suggest that efforts to minimize HIV TI could benefit from treatment-continuity monitoring strategies that target the high-risk sub-samples identified. [ABSTRACT FROM AUTHOR]