Search

In countries with high human immunodeficiency virus (HIV) prevalence, up to 30% of pregnant women are living with HIV, with fetal exposure to both HIV and antiretroviral therapy during pregnancy. In addition, pregnant women without HIV but at high risk of HIV acquisition are increasingly receiving HIV preexposure antiretroviral prophylaxis (PrEP). Investments are being made to establish and follow cohorts of children to evaluate the long-term effects of in utero HIV and antiretroviral exposure. Agreement on a key set of definitions for relevant exposures and outcomes is important both for interpreting individual study results and for comparisons across cohorts. Harmonized definitions of in utero HIV and antiretroviral drug (maternal treatment or PrEP) exposure will also facilitate improved classification of these exposures in future observational studies and clinical trials. The proposed definitions offer a uniform approach to facilitate the consistent description and estimation of effects of HIV and antiretroviral exposures on key child health outcomes.

The 2014–2016 West Africa Ebola Virus Disease (EVD) Epidemic devastated Guinea’s health system and constituted a public health emergency of international concern. Following the crisis, Guinea invested in the establishment of basic health system reforms and crucial legal instruments for strengthening national health security in line with the WHO’s recommendations for ensuring better preparedness for (and, therefore, a response to) health emergencies. The investments included the scaling up of Integrated Disease Surveillance and Response; Joint External Evaluation of International Health Regulation capacities; National Action Plan for Health Security; Simulation Exercises; One Health platforms; creation of decentralised structures such as regional and prefectural Emergency Operation Centres; Risk assessment and hazard identification; Expanding human resources capacity; Early Warning Alert System and community preparedness. These investments were tested in the subsequent 2021 EVD outbreak and other epidemics. In this case, there was a timely declaration and response to the 2021 EVD epidemic, a lower-case burden and mortality rate, a shorter duration of the epidemic and a significant reduction in the cost of the response. Similarly, there was timely detection, response and containment of other epidemics including Lassa fever and Marburg virus disease. Findings suggest the utility of the preparedness activities for the early detection and efficient containment of outbreaks, which, therefore, underlines the need for all countries at risk of infectious disease epidemics to invest in similar reforms. Doing so promises to be not only cost-effective but also lifesaving.

Condom effectiveness is compromised by user errors. We set out to examine the rates of condom use and condom errors among sexually active persons living within a Health Demographic Surveillance this high HIV prevalence area in Western Kenya. We analyzed data from the second round of a longitudinal bio-behavioral survey that was conducted in Gem, Siaya County between November 2012 and February 2014.Logistic regression analysis was done to identify predictors of condom use among all sexually active persons and condom errors among participants reporting condom use in the past 3 months. Of 7815 persons interviewed minority (39%) reported having used male condoms with at least one sexual partner in the past 3 months of whom 459 (15%) reported condom errors. Majority of those reporting condom errors had experienced ‘incomplete use’ (i.e. (a combination of early removal, late application or both early removal and late application). Participants who had experienced condom errors were significantly more likely to be aged

Introduction: The aim of this study was to determine HIV risk perception, sexual satisfaction and condom use among recently-circumcised sexually-active males and their female partners from a traditionally noncircumcising Kenyan community. Methods: A longitudinal bio-behavioural survey using interviewer-administered structured questionnaires was conducted in Siaya County of Kenya between November 2012 and February 2014 among persons of both genders aged ≥13 years. Male respondents were characterized as ‘recently circumcised’ if they had been circumcised within the 2 years of the interview, ‘previously circumcised’ if prior to this and as ‘uncircumcised’. Sexual satisfaction was measured on a 3-point likert scale (‘satisfied’, ‘no opinion’, ‘dissatisfied’). Logistic regression analysis was carried out to compare self-reported characteristics of the survey respondents by their own (males) or their partners (females) circumcision status. Results: Of 3,285 men interviewed, 1,001 (30%) were circumcised, of whom 247 (25%) were recently circumcised. Of 4,171 women interviewed, 976 (24%) had primary partners who were circumcised of whom 151 (15%) had ‘recently circumcised’ primary partners. Recently circumcised males were more likely to be younger, single and unemployed; similarly, their female partners were more likely to be younger, single and have attained above primary education (P < 0.05). Most of (≥ 90%) all men and women believed that circumcised men are less likely to get HIV infection and felt that both reducing the number of sex partners, and condom use with a partner with unknown HIV status were still necessary despite male circumcision (MC) being available in their community. Majority of males and females (> 90%) were pleased with their own or their partners recent circumcision, sexual performance and condom use. Discussion and Conclusion: Messages to promote MC should incorporate information regarding preserved/enhanced sexual satisfaction, ease of condom use, and include women to promote MC, a onetime intervention, which is not associated with risk compensation.

Contact investigation is recommended for close contacts of TB patients to identify undiagnosed cases of active and latent TB to initiate them on curative and preventive therapy respectively. Because contact invitation is conducted in Kenya, the value of TB contact investigation in childhood TB control is unknown. To compare the yield of contact investigation (intervention arm) to contact invitation (control arm) in contributing to childhood TB control, a cluster randomized trial was conducted in Kisumu County between 2014 and 2015 a period prior to the implementation of standardized contact investigation. This was done to compare TB cases diagnosed and children receiving IPT in the pre- intervention (2012-2013) and intervention (2014-2015) years, and in the intervention years using a minimum sample size of 15 per arm. Of 77 facilities identified for the study, 65 facilities were randomized to a contact screening strategy; a TB contact investigation strategy in isolation (n=4), in combination with health facility screening (n=19), or in combination with both enhanced facility screening and mobile units (n=31) with the remainder, (n=11) randomized to the standard approach i.e. TB contact invitation. Facilities distribution did not differ by category of services or patient type. In the pre-intervention and post-intervention years, TB number of TB cases diagnosed in children increased by 20 (75% from intervention arm). During the intervention years TB cases decreased by 17 (29% from intervention arm); the intervention arm contributed to 100% and 75% of the children put on IPT whose implementation had just begun. Contact investigation enhanced childhood TB control in comparison to routine approaches. Critical support ought to be availed to the TB screening cascade to facilitate contact investigation and IPT implementation as well as ingrain contact investigation within existing community health systems.

Setting Fifteen human immunodeficiency virus (HIV) clinics in Nyanza Region, Western Kenya. Objective To describe routine tuberculosis (TB) screening and diagnostic practices among newly enrolled people living with HIV (PLHIV) prior to the implementation of World Health Organization recommended TB intensified case finding. Design Retrospective chart abstraction of PLHIV aged ⩾7 years who were newly enrolled in HIV care in July and August 2009, and who had not received antiretroviral treatment in the preceding 2 years or been diagnosed with TB in the previous year. Factors associated with evidence of TB diagnostic evaluation among symptomatic PLHIV were assessed. Results Of 1020 patients included in the analysis, 995 (98%) were screened for TB at enrolment and 613 (62%) reported TB symptoms. Ninety-six (16%) patients with symptoms had evidence of referral for TB diagnostic evaluation, including patients at large clinics, those with advanced HIV disease and those reporting multiple TB symptoms. Among the 43 (45%) with documented evaluation results, 26 (60%) were diagnosed with TB. Conclusion Although most PLHIV were screened for TB, very few underwent an evaluation, and the proportion diagnosed with TB was very low. Efforts to improve TB screening should focus on standardizing the intensified case finding algorithm and linkage to, and adequate infrastructure for, TB diagnostic evaluation.

Background: Physical intimate partner violence (IPV) is an important risk factor for sexually transmitted infections, including HIV. We set out to determine the prevalence and correlates of IPV among youth aged 15 to 24 years – in a community with a high HIV prevalence – with a view to recommending strategies to address IPV. Methods: We analysed data from an HIV seroprevalence survey, which included participants aged 13 years and above and was conducted between November 2012 and December 2014 in Gem Subcounty, Siaya County, Western Kenya. Participants between 15 and 24 years old (youth) were described as “perpetrators of IPV” if they had done anything to physically hurt their sexual partners in the previous year and as “victims of IPV” if they had been physically hurt by a sexual partner in the same timeframe. Logistic regression was used to determine factors associated with being either a victim or perpetrator of IPV. Results: Of 1,957 participants included in the analysis, 142 (7%) were victims of IPV, and 77 (4%) were perpetrators of IPV. Victims were likely to be women (adjusted odds ratio [AOR] 7.9; 95% CI, 3.6 to 17.5), in a relationship or married (AOR 3.1; 95% CI, 1.8 to 5.4), and to have had multiple lifetime sexual partners. Victims of IPV were also more likely than not to have been subjected to sexual violence in the past (AOR 1.9; 95% CI, 1.0 to 3.4) or recently (AOR 3.9; 95% CI, 2.2 to 6.8). Perpetrators were likely to be men (AOR 2.1; 95% CI, 1.2 to 3.7), with 5 or more lifetime sexual partners (AOR 2.8; 95% CI, 1.3 to 6.3), and to have committed sexual violence recently (AOR 2.9; 95% CI, 1.1 to 7.7). Conclusion: There was a high prevalence of IPV among sexually active youth in this rural community. Study participants were recurrent victims or perpetrators and reported behaviours that put them at risk of HIV acquisition. Health programmes should screen for IPV victims and perpetrators using identified characteristics. Existing policies regarding gender-based violence should be enforced, and future research should focus on the impact of IPV prevention programmes.

Background Isoniazid Preventative Therapy (IPT) is recommended for children aged less than 5 years that have been in contact with an open case of TB and screen negative for TB to prevent the risk of TB progression. We examined IPT uptake among child household contacts of TB index cases within a TB case detection study in a high TB burden region. Methods A cross-sectional study involving all IPT eligible children drawn from a TB case detection study was done in Kisumu County, Kenya between 2014 and 2015. By linking a subset study database to the TB program IPT register, we described Child contacts as ‘initiated on IPT’ and TB index cases as ‘having child contacts initiated on IPT’ based on whether their names or their child contacts names respectively, were found in the IPT register. Logistic regression analysis was used to describe index and contact characteristics associated with IPT initiation Results Of 555 TB index cases into the study, 243 (44%) had a total of 337 IPT-eligible child household contacts. Forty-seven (19%) index cases that had child contacts initiated on IPT; they were more likely to have been diagnosed with smear positive TB compared to those who were diagnosed with smear negative TB (OR 5.1, 95% CI 1.1-23.2; p=0.03) and to reside in rural Kisumu compared to those in urban Kisumu (OR 3.3, 05% CI 1.6-6.8; p

Background: The delivery of public health policies may be in conflict with individualism. Objectives: To propose measures to ethically provide routine HIV testing services to persons visiting a funeral home. Research design: A document analysis of study documents and presentations made to an institutional review board. Participants and research context: Institutional review board members (both lay and professionals) and Study investigators attending an `open session' where study investigators were invited to elaborate on some study procedures. Ethical considerations: Identities of all parties were anonymized. Findings: Opt-out approaches to HIV testing, grief counseling, relational ethics, and a modular consenting process were proposed to safeguard clients' autonomy. The golden-rule approach and protective empowering were suggested to protect clientele beneficence. Discussion and conclusion: It is possible to ethically provide universal HIV testing and counseling services among grieving populations in this setting; elsewhere, this should be contextualized.

Background An optimal number of health workers, who are appropriately allocated across different occupations and geographical regions, are required to ensure population coverage of health interventions. Health worker shortages in HIV care provision are highest in areas that are worst hit by the HIV epidemic. Kenya is listed among countries that experience health worker shortages (

Funeral homes in health facilities are accessed by persons who may not visit other parts of the hospital to access HTC services. Between November 2014 and February 2015, all persons visiting the Jaramogi Oginga Odinga Teaching and Referral Hospital funeral home were offered HTC and grief counseling services and interviewed to determine the acceptability of HTC services at this location. This was done as they waited for various services. ‘Acceptability’ was defined as the proportion of those who felt people should receive HTC services at the funeral home. Qualitative data was manually coded and thematically analyzed. Of 609 persons interviewed, majority were aged 25-34 years (33%), female (54%), married (68%), of primary level education (39%), self-employed (49%) and were not related to the deceased (53%). Majority had come to collect/bring the body of the deceased (63%) and had undergone prior testing (91%). A minority (2%) who found HTC services unacceptable were aged 18-24 years (42%), single (50%), of tertiary level education (58%), came to collect/bring the bodies of their deceased (83%), had ever been tested (92%) and were self-employed (33%) or unemployed (33%). Respondents stated that this was because, “….the bereaved not in the right frame of mind” (76%) and “…the HTC service-providers were very conspicuous” (26%). Acceptability did not differ by age-group, gender or relationship to the deceased. Of the 569 (93%) who were tested, 42 (7%) were first-time testers; HIV prevalence was 3% and 5% respectively. Funeral homes provide acceptable avenues for increasing access to knowledge of HIV status which could have a substantial impact on the HIV epidemic.

Background : The former Nyanza Province of Kenya bore the brunt of HIV‑driven tuberculosis (TB); 62% of the 19,152 cases in 2010 were HIV co‑infected. The use of laypersons to improve TB case fnding in community settings has shown rewarding results in other countries. We have no documented Kenyan experience in health facility settings. We evaluated the beneft of using laypersons to support TB screening and referrals at the former Nyanza Province of kenya province’s largest regional referral facility. Methods : In 2010, fve high school graduates were trained on symptomatic recognition of TB suspects and assisted sputum production by the region’s District’s TB and Leprosy Coordinator. They then identifed and referred TB suspects (from hospital patients and visitors) at waiting‑areas and wards to clinicians and documented their TB screening and referral outcomes. We describe results from one waiting‑area with complete documentation between January and December 2011. Results : Of the 217 TB suspects identifed, majority were male (55%); their median age was 36 (range 1–70) years. 11% (23) were aged

Background : Postexposure prophylaxis (PEP) with antiretroviral therapy (ART) and vaccination against hepatitis B virus (HBV) aides in preventing human immunodefciency virus (HIV) infection and HBV, respectively, from accidental or occupational exposure. We assessed compliance to guidelines for HIV and HBV prevention after occupational exposure among hospital staff at a referral Kenyan hospital. Methods : We reviewed PEP registers for hospital staff reporting an occupational injury at a referral hospital in Western Kenya between January 2011 and December 2012. Proportions were used to summarize number of participants receiving the recommended services, Kaplan–Meier curves were used to describe time to ART initiation, and Chi‑square statistics was used to describe the association between participant characteristics and PEP completion rates. P < 0.05 was considered statistically signifcant. Results : Majority of documented hospital staff ( n = 52) were health workers (63%) and students (27%) and had high HIV risk exposures (97%). All had timely PEP initiation with 50% completing PEP. Completion rates did not vary by gender ( P = 0.78), exposure type ( P = 1.0), or department of exposure ( P = 0.75). Retesting for HIV and negativity rates at months 1.5, 3, and 6 were 96%, 25%, and 17% and 100%, 100%, and 100%, respectively. At the time of exposure, 17% (9) of staff were HBV vaccinated and HBV status of sources was unknown; no intervention was provided for HBV prevention. Conclusions : Low rates of completion and follow‑up negate intended benefts of PEP. Efforts should be directed to enforce universal precaution practices and completion of PEP. Low rates of HBV testing and vaccination illustrate the need for support for the implementation of HBV prevention guidelines. Keywords : Hepatitis B, human immunodefciency virus/AIDS, workplace injuries

This retrospective cohort analysis was conducted to describe the association between adherence to clinic appointments and mortality, one year after enrollment into HIV care. We examined appointment-adherence for newly enrolled patients between January 2011 and December 2012 at a regional referral hospital in western Kenya. The outcomes of interest were patient default, risk factors for repeat default, and year-one risk of death. Of 582 enrolled patients, 258 (44%) were defaulters. GEE revealed that once having been defaulters, patients were significantly more likely to repeatedly default (OR 1.4; 95% CI 1.12-1.77), especially the unemployed (OR 1.43; 95% CI 1.07-1.91), smokers (OR 2.22; 95% CI 1.31-3.76), and those with no known disclosure (OR 2.17; 95% CI 1.42-3.3). Nineteen patients (3%) died during the follow-up period. Cox proportional hazards revealed that the risk of death was significantly higher among defaulters (HR 3.12; 95% CI 1.2-8.0) and increased proportionally to the rate of patient default; HR was 4.05 (95% CI1.38-11.81) and 4.98 (95% CI 1.45-17.09) for a cumulative of 4-60 and ≥60 days elapsed between all scheduled and actual clinic appointment dates, respectively. Risk factors for repeat default suggest a need to deliver targeted adherence programs.

Background: Females in low and middle income countries (LMICs) have difficulty coping with menstrual needs, but few studies have examined the social or health implications of these needs. Methods: Responses from 3418 menstruating females aged 13–29 years were extracted from an HIV and behavioral risks cross-sectional survey conducted in rural western Kenya. We examined sanitary products used, provision of products from sexual partners or from transactional sex, and demographic and sexual exposures. Results: Overall, 75% of females reported using commercial pads and 25% used traditional materials such as cloth or items like paper or tissue, with 10% of girls

Occupational health surveillance data are vital to effective intervention. Limited information is available on the magnitude of occupational injuries among laboratory personnel in Kenya.

We examined associations between respondent characteristics and Human Immunodeficiency Virus (HIV) “disclosure status and intentions” of People Living with HIV (PLHIV) at next sexual encounter using multinomial logistic regression in rural western Kenya, with three outcomes of interest were “having disclosed”, “not disclosed but intending to disclose” and “not disclosed and not intending to disclose”. We analyzed data from a sero-behavioral survey in Gem, Siaya County, 2011–2012 selecting respondents aged ≥15 years in monogamous unions. Of 379 respondents interviewed, 84% had disclosed, 6% had not disclosed but intended to disclose while 10% had not disclosed and did not intend to disclose. Persons who had “not disclosed and intended to disclose” did not differ from those who “had disclosed”. The odds for “not disclosing and not intending to disclose” vs. “having disclosed” was 5.38 times greater for persons who had ever used condoms relative to those who had not. Eight percent of the “not disclosed and not intending disclose” intended to use condoms at next sexual encounter. Couples HTC should promote condom use, legislation as regards “reasonable time to disclose HIV status” should be interpreted, and the conflicting roles of the health workers of protecting confidentiality of PLHIV and concurrently preventing HIV transmission should be clarified.

Objective To assess the performance of symptom-based screening for tuberculosis (TB), alone and with chest radiography among people living with HIV (PLHIV), including pregnant women, in Western Kenya. Design Prospective cohort study Methods PLHIV from 15 randomly-selected HIV clinics were screened with three clinical algorithms [World Health Organization (WHO), Ministry of Health (MOH), and “Improving Diagnosis of TB in HIV-infected persons” (ID-TB/HIV) study], underwent chest radiography (unless pregnant), and provided two or more sputum specimens for smear microscopy, liquid culture, and Xpert MTB/RIF. Performance of clinical screening was compared to laboratory results, controlling for the complex design of the survey. Results Overall, 738 (85.6%) of 862 PLHIV enrolled were included in the analysis. Estimated TB prevalence was 11.2% (95% CI, 9.9–12.7). Sensitivity of the three screening algorithms was similar [WHO, 74.1% (95% CI, 64.1–82.2); MOH, 77.5% (95% CI, 68.6–84.5); and ID-TB/HIV, 72.5% (95% CI, 60.9–81.7)]. Sensitivity of the WHO algorithm was significantly lower among HIV-infected pregnant women [28.2% (95% CI, 14.9–46.7)] compared to non-pregnant women [78.3% (95% CI, 67.3–86.4)] and men [77.2% (95% CI, 68.3–84.2)]. Chest radiography increased WHO algorithm sensitivity and negative predictive value to 90.9% (95% CI, 86.4–93.9) and 96.1% (95% CI, 94.4–97.3), respectively, among asymptomatic men and non-pregnant women. Conclusions Clinical screening missed approximately 25% of laboratory-confirmed TB cases among all PLHIV and more than 70% among HIV-infected pregnant women. National HIV programs should evaluate the feasibility of laboratory-based screening for TB, such as a single Xpert MTB/RIF test for all PLHIV, especially pregnant women, at enrollment in HIV services.

Background Diagnosis followed by effective treatment of tuberculosis (TB) reduces transmission and saves lives in persons living with HIV (PLHIV). Sputum smear microscopy is widely used for diagnosis, despite limited sensitivity in PLHIV. Evidence is needed to determine the optimal diagnostic approach for these patients. Methods From May 2011 through June 2012, we recruited PLHIV from 15 HIV treatment centers in western Kenya. We collected up to three sputum specimens for Ziehl-Neelsen (ZN) and fluorescence microscopy (FM), GeneXpert MTB/RIF (Xpert), and culture, regardless of symptoms. We calculated the incremental yield of each test, stratifying results by CD4 cell count and specimen type; data were analyzed to account for complex sampling. Results From 778 enrolled patients, we identified 88 (11.3%) laboratory-confirmed TB cases. Of the 74 cases who submitted 2 specimens for microscopy and Xpert testing, ZN microscopy identified 25 (33.6%); Xpert identified those plus an additional 18 (incremental yield = 24.4%). Xpert testing of spot specimens identified 48 (57.0%) of 84 cases; whereas Xpert testing of morning specimens identified 50 (66.0%) of 76 cases. Two Xpert tests detected 22/24 (92.0%) TB cases with CD4 counts

Hospitals’ safety climates have been correlated with incidents of exposure to blood and body fluids.