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The effective use of waste materials is one of the key drivers in ensuring sustainability within the construction industry. This paper investigates the viability and efficacy of sustainably incorporating a polylactic acid-type plastic (WP) as a 10 mm natural coarse aggregate (NA) replacement in geopolymer concrete. Two types of concrete (ordinary Portland cement—OPC and geopolymer) were produced for completeness using a concrete formulation ratio of 1:2:3. The ordinary concrete binder control was prepared using 100% OPC at a water/binder ratio of 0.55, while the geopolymer concrete control used an optimum alkaline activator/precursor—A/P ratio (0.5) and sodium silicate to sodium hydroxide—SS/SH volume ratio (1.2/0.8). Using the same binder quantity as the control, four concrete batches were developed by replacing 10 mm NA with WP at 30 and 70 wt% for ordinary and geopolymer concrete. The mechanical performance of the developed concrete was assessed according to their appropriate standards, while a microstructural investigation was employed after 28 days of curing to identify any morphological changes and hydrated phases. The results illustrate the viability of incorporating WP in geopolymer concrete production at up to 70 wt% replacement despite some negative impacts on concrete performance. From a mechanical perspective, geopolymer concrete indicated a 46.7–58.3% strength development superiority over ordinary concrete with or without WP. The sample composition and texture quantified using automated scanning electron microscopy indicated that adding WP reduced the presence of pores within the microstructure of both concrete types. However, this was detrimental to the ordinary concrete due to the low interfacial zone (ITZ) between calcium silicate hydrate (CSH) gel and WP, resulting in the formation of cracks. [ABSTRACT FROM AUTHOR]

Objective: The authors evaluated factors contributing to coronavirus disease 2019 (COVID‐19) vaccine hesitancy among pregnant and postpartum women to inform vaccine scale‐up strategies. Methods: This observational study utilized data from pregnant and postpartum women attending four public maternal child health (MCH) clinics in Western Kenya. From October 2020 to July 2022, nurses assessed COVID‐19 vaccine hesitancy, defined as reporting "unlikely" or "very unlikely" to the question, "If a vaccine for COVID‐19 were available today, what is the likelihood that you would get vaccinated?" Results: Among 1023 women (235 pregnant, 788 postpartum), 20% reported worsened MCH care during the pandemic and most (92%) perceived themselves or family members to be at risk for COVID‐19, yet 54% of women reported COVID‐19 vaccine hesitancy. Vaccine hesitancy was more frequent among women reporting worsened MCH care (P < 0.001) since the pandemic and those who did not trust the government as a source of COVID‐19 information (P = 0.016). Over the 2‐year period, willingness to receive the vaccine almost doubled (38% to 71%, P < 0.001). Conclusions: Our findings suggest that sustaining access to quality MCH services may decrease COVID‐19 vaccine hesitancy. Willingness to receive the vaccine doubled over the 2‐year period in our cohort, suggesting increased trust for use and acceptance in the unique context of the pregnancy/postpartum period. Synopsis: Among Kenyan pregnant and postpartum women, COVID‐19 vaccine hesitancy was high and less frequent among those reporting no change in healthcare quality during the pandemic. [ABSTRACT FROM AUTHOR]

Commercial sodium hydroxide (NaOH) and sodium silicate (SS) have remained two of the leading alkaline activators widely used in producing geopolymer concrete, despite some identified negatives regarding their availability and additional CO2 emissions relating to the overall manufacturing process. This study reports the viability of developing geopolymer concrete using a laboratory-synthesised silica fume (SF)-derived SS solution in combination with NaOH at a molarity of 10M as an alternative binary alkali-alkaline activator to Ground Granulated Blast Furnace slag (GGBS). The use of SF in the development of geoolymer activators will pave the way for the quality usage of other high-silica content by-products from nature, industry, and agriculture. In the currently reported proof of concept, four geopolymer concrete batches were produced using different alkaline activator/precursor-A/P ratios (0.5 and 0.9) and SS to NaOH-SS/SH volume ratios (0.8/1.2 and 1.2/0.8), to establish the impact on the engineering performance. Two controls were adopted for ordinary and geopolymer concrete mixes. The engineering performance was assessed using slump and compaction index (CI) tests, while the Unconfined Compressive Strength (UCS) and tensile splitting (TS) tests were measured at different curing ages in accordance with their appropriate standards. The results indicated a reduction in slump values as the A/P ratio decreased, while the CI values showed a reversal of the identified trend in slump. Consequently, mix GC2 attained the highest UCS strength gain (62.6 MPa), displaying the superiority of the alkali activation and polymerisation process over the CSH gel. Furthermore, the impact of A/P variation on the UCS was more pronounced than SS/SH due to its vital contribution to the overall geopolymerisation process. [ABSTRACT FROM AUTHOR]

The main thrust of this research was to establish any benefits of mellowing, and the optimal moisture content (OMC) for compacting mellowed sulphate-bearing clay soil undergoing the stabilization process. Two three-day mellowing regimes were carried out, prior to final compaction, at different initial moisture contents of 30% or 40% OMC. The unmellowed specimens were compacted immediately after mixing with the blended stabilizers. A blend of quicklime (L) with a sustainable by-product, silica fume (SF), at a 1:1 ratio (2%L–2%SF) was used. Linear expansion and unconfined compressive strength (UCS) tests were carried out to evaluate the benefits of mellowing. The test results suggested that the mellowed test specimens achieved better UCS and swelling properties compared to the unmellowed specimens. Mellowing at 1.2 OMC produced better strength performance than at 1.4 OMC, whereas mellowed specimens at 1.4 OMC showed better resistance to linear expansion compared to 1.2 OMC. The research findings suggested that optimal performance was achieved by mellowing at the higher initial moisture condition of 40% OMC and compacting the materials at the lower moisture condition of 1.2 OMC. [ABSTRACT FROM AUTHOR]

Introduction: Integrating pre‐exposure prophylaxis (PrEP) delivery for pregnant and postpartum women within maternal and child health (MCH) clinics is feasible and acceptable. It is unknown whether a risk‐guided model would facilitate appropriate PrEP use among MCH attendees better than universally offering PrEP. Methods: The PrEP Implementation for Mothers in Antenatal Care (PrIMA) study was a cluster randomized trial to assess two models for PrEP delivery among pregnant women seeking routine MCH care at 20 public clinics in Kenya between January 2018 and July 2019 (NCT03070600). In the Universal arm, all participants received PrEP counselling and self‐selected whether to initiate PrEP. In the Targeted arm, participants underwent an HIV risk assessment, including an objective risk‐scoring tool and an offer of HIV self‐tests for at‐home partner testing; those determined to be at high risk received a PrEP offer. Participants were followed through 9 months postpartum. Primary outcomes included incident HIV and appropriate PrEP use (defined as PrEP uptake among those at high risk and no PrEP uptake for those not at risk). Outcomes were compared using intention‐to‐treat analyses, adjusting for baseline HIV risk and marital status. Results: Among 4447 women enrolled, the median age was 24.0 years (interquartile range [IQR]: 20.9, 28.3), and most were married (84.8%). The median gestational age at enrolment was 24 weeks (IQR: 20, 30). Women in the Targeted arm were more likely to be at high risk for HIV acquisition at baseline (51.6% vs. 33.3%). During 4638 person‐years (p‐yr) of follow‐up, there were 16 maternal HIV infections with no difference in maternal HIV incidence between arms: 0.31/100 p‐yr (95% CI: 0.15, 0.65) Targeted and 0.38/100p‐yr (95% CI: 0.20, 0.73) Universal (adjusted relative risk [aRR]: 0.85 [CI: 0.28, 2.55]). There was no significant difference in the frequency of appropriate PrEP use between the arms (68.2% vs. 59.1% in Targeted vs. Universal, respectively) (aRR: 1.03 [CI: 0.96, 1.10]). Conclusions: Given comparable maternal HIV incidence and PrEP uptake in Universal and Targeted approaches, and the simplicity that universal PrEP offers, our findings suggest that universal PrEP counselling is optimal for integrating PrEP in MCH systems. [ABSTRACT FROM AUTHOR]

The role of gypsum level on the long-term strength and expansion of soil stabilised with different lime contents is not well understood. This research, therefore, studied the effect of varying gypsum concentrations of 0, 3, 6, and 9 wt% (equivalent to the sulfate contents of 0, 1.4, 2.8, and 4.2%, respectively) on the performance of sulfate soil stabilised with two lime levels (4 and 6 wt%). This was carried out to establish the threshold level of gypsum/lime (G/L) at which the increase in G/L ratio does not affect the performance of lime-stabilised sulfate soil. Both unconfined compressive strength (UCS) and expansion, along with the derivative thermogravimetric (DTG) analysis, were adopted to accomplish the present objective. Accordingly, the result indicated that the strength and expansion were proportional to the lime and sulfate content, of which a G/L ratio of 1.5 was the optimum case scenario for UCS, and at the same time, the worst-case scenario for expansion. This discovery is vital, as it is anticipated to serve as a benchmark for future research related to the design of effective binders for suppressing the sulfate-induced expansion in lime-stabilised gypseous soil. [ABSTRACT FROM AUTHOR]

Sulfate-induced expansion resulting from the formation of ettringite in sulfate-bearing soil stabilised with calcium-based stabilisers is a problematic issue with technical and economic implications. Thus, this research examines the viability of the co-addition of lime (L) and silica fume (S) at varying binder dosages (4, 6, and 10 wt%), with a view of establishing the optimum blend of L–S for suppressing the ettringite-induced expansion of artificially high sulfate-dosed soil (kaolinite-K and gypsum-G). To do so, a series of laboratory specimens, designed using different gypsum and lime concentrations, were investigated using unconfined compression strength (UCS), linear expansion, and derivative thermo-gravimetric analysis (DTG) as the main criteria for the examination. The research outcomes indicated that the increasing substitution of L with S induces a gradual reduction on the UCS and linear expansion at binder levels of 4 and 6 wt%, while its usage in a high binder level (10 wt%), can yield an expansion reduction, with no compromise on the UCS performance. Therefore, silica fume has the potential for restricting ettringite formation and suppressing the expansion, of which 3L7S is the optimum blending ratio for suppressing the expansion. [ABSTRACT FROM AUTHOR]

Introduction: The postpartum period can be challenging for women living with HIV. Understanding how the postpartum period impacts ART adherence and condomless sex could inform the development of comprehensive sexual and reproductive health and HIV services tailored to the needs of women living with HIV during this critical interval. Methods: In a longitudinal cohort study of HIV-seropositive Kenyan women, late ART refills and self-reported condomless sex were compared between the woman's pregnancy and the postpartum period. Analyses were conducted using generalized estimating equations and adjusted for alcohol use, depressive symptoms, intimate partner violence (IPV), and having a recent regular partner. Effect modification was explored for selected variables. Results and discussion: 151 women contributed visits. Late ART refills occurred at 7% (32/439) of pregnancy visits compared to 18% (178/1016) during the postpartum period (adjusted relative risk [aRR] 2.44, 95% confidence interval [CI] 1.62–3.67). This association differed by women's education level. Women with ≥8 years of education had late ART refills more during the postpartum period than pregnancy (aRR 3.00, 95%CI 1.95–4.62). In contrast, in women with <8 years of education, late ART refills occurred similarly during pregnancy and the postpartum period (aRR 0.88, 95%CI 0.18–4.35). Women reported condomless sex at 10% (60/600) of pregnancy visits compared to 7% (72/1081) of postpartum visits (aRR 0.76, 95%CI 0.45–1.27). This association differed by whether women had experienced recent IPV. Women without recent IPV had a significant decline in condomless sex from pregnancy to postpartum (aRR 0.53, 95%CI 0.30–0.95) while women with recent IPV had no significant change in condomless sex from pregnancy to postpartum (aRR 1.76, 95%CI 0.87–3.55). Conclusion: Improved support for ART adherence during the postpartum period and addressing IPV to limit condomless sex could improve HIV treatment and prevention outcomes for HIV-seropositive women as well as their infants and sexual partners. [ABSTRACT FROM AUTHOR]

Background: Pregnant and postpartum women living with HIV (WLWH) need support for HIV and maternal child health (MCH) care, which could be provided using short message service (SMS).Methods and Findings: We compared 2-way (interactive) and 1-way SMS messaging to no SMS in a 3-arm randomized trial in 6 MCH clinics in Kenya. Messages were developed using the Health Belief Model and Social Cognitive Theory; HIV messages were integrated into an existing MCH SMS platform. Intervention participants received visit reminders and prespecified weekly SMS on antiretroviral therapy (ART) adherence and MCH, tailored to their characteristics and timing. Two-way participants could message nurses as needed. Clinic attendance, viral load (VL), and infant HIV results were abstracted from program records. Primary outcomes were viral nonsuppression (VL ≥1,000 c/ml), on-time clinic attendance, loss to follow-up from clinical care, and infant HIV-free survival. Among 824 pregnant women randomized between November 2015 and May 2017, median age was 27 years, gestational age was 24.3 weeks, and time since initiation of ART was 1.0 year. During follow-up to 2 years postpartum, 9.8% of 3,150 VL assessments and 19.6% of women were ever nonsuppressed, with no significant difference in 1-way versus control (11.2% versus 9.6%, adjusted risk ratio (aRR) 1.02 [95% confidence interval (CI) 0.67 to 1.54], p = 0.94) or 2-way versus control (8.5% versus 9.6%, aRR 0.80 [95% CI 0.52 to 1.23], p = 0.31). Median ART adherence and incident ART resistance did not significantly differ by arm. Overall, 88.9% (95% CI 76.5 to 95.7) of visits were on time, with no significant differences between arms (88.2% in control versus 88.6% in 1-way and 88.8% in 2-way). Incidence of infant HIV or death was 3.01/100 person-years (py), with no significant difference between arms; risk of infant HIV infection was 0.94%. Time to postpartum contraception was significantly shorter in the 2-way arm than control. Study limitations include limited ability to detect improvement due to high viral suppression and visit attendance and imperfect synchronization of SMS reminders to clinic visits.Conclusions: Integrated HIV/MCH messaging did not improve HIV outcomes but was associated with improved initiation of postpartum contraception. In programs where most women are virally suppressed, targeted SMS informed by VL data may improve effectiveness. Rigorous evaluation remains important to optimize mobile health (mHealth) interventions.Trial Registration: ClinicalTrials.gov number NCT02400671. [ABSTRACT FROM AUTHOR]

Background: In 2020, 14% of diagnosed persons living with HIV (PLWH) in Kenya were not taking antiretroviral therapy (ART), and 19% of those on ART had unsuppressed viral loads. Long-acting antiretroviral therapy (LA-ART) may increase viral suppression by promoting ART uptake and adherence. We conducted key informant (KI) interviews with HIV experts in Kenya to identify product and delivery attributes related to the acceptability and feasibility of providing LA-ART to PLWH in Kenya. Methods: Interviews were conducted via Zoom on potential LA-ART options including intra-muscular (IM) injections, subcutaneous (SC) injections, implants, and LA oral pills. KI were asked to discuss the products they were most and least excited about, as well as barriers and facilitators to LA-ART roll-out. In addition, they were asked about potential delivery locations for LA-ART products such as homes, pharmacies, and clinics. Interviews were recorded and transcribed, and data were analyzed using a combination of inductive and deductive coding. Results: Twelve KI (5 women, 7 men) participated between December 2021 and February 2022. Overall, participants reported that LA-ART would be acceptable and preferable to PLWH because of fatigue with daily oral pills. They viewed IM injections and LA oral pills as the most exciting options to ease pill burden and improve adherence. KI felt that populations who could benefit most were adolescents in boarding schools and stigmatized populations such as sex workers. SC injections and implants were less favored, as they would require new training initiatives for patients or healthcare workers on administration. In addition, SC injections would require refrigeration and needle disposal after use. Some KI thought patients, especially men, might worry that IM injections and implants would impact fertility, given their role in family planning. Pharmacies were perceived by most KI as suboptimal delivery locations; however, given ongoing work in Kenya to include pharmacies in antiretroviral delivery, they recommended asking patients their views. Conclusion: There is interest and support for LA-ART in Kenya, especially IM injections and LA oral pills. Identifying patient preferences for modes and delivery locations and addressing misconceptions about specific products as they become available will be important before wide-scale implementation. [ABSTRACT FROM AUTHOR]

Background: During HIV retesting in antenatal and preexposure prophylaxis (PrEP) care, discrepant results occur, but guidelines are lacking.Methods: In a Kenyan trial implementing antenatal PrEP, if 1 test is reactive, a second is performed; if discrepant, both are repeated; if persistently discrepant, DNA polymerase chain reaction (PCR) is performed.Results: Among 4451 women, 23 265 HIV retesting sessions were performed; 14 (0.06%, 95% confidence interval, 0.03%-0.10%) had discrepant results among 10 individuals; in all 10 initial cases, PCR was negative.Conclusions: Discrepant rapid tests are an expected, rare, and important challenge for antenatal care HIV retesting, with and without PrEP.Clinical Trials Registration: NCT03070600. [ABSTRACT FROM AUTHOR]

In a pre-exposure prophylaxis program for Kenyan women, we detected tenofovir-diphosphate in 61% (125/201) of randomly selected dried blood spots collected at the first follow-up visit. Tenofovir-diphosphate was detected more frequently among women who had partners living with human immunodeficiency virus, who were not pregnant, and who were ≥24 years. [ABSTRACT FROM AUTHOR]

Background: Home-based human immunodeficiency virus (HIV) testing and education has increased HIV test uptake and access to health services among men. We studied how a home-based antenatal intervention influenced male partner utilization of clinic-based HIV and sexually transmitted infection (STI) services, linkage to HIV care and medical circumcision.Methods: We conducted a secondary analysis within a randomized controlled trial of pregnant women attending antenatal care in Kenya. Women and their male partners received either a home-based couple intervention or an invitation letter for clinic-based couple HIV testing. The home-based intervention included education on STI symptoms, STI and HIV treatment and male circumcision for HIV prevention. Male self-reported outcomes were compared using relative risks at 6 months postpartum.Results: Among 525 women, we reached 487 (93%) of their male partners; 247 men in the intervention arm and 240 men in the control arm. Men who received the intervention were more likely to report an STI consultation (n = 47 vs. 16; relative risk, 1.59; 95% confidence interval, 1.33-1.89). Among 23 men with newly diagnosed HIV, linkage to HIV care was reported by 4 of 15 in the intervention (3 men had missing linkage data) and 3 of 5 men in the control arms (relative risk, 0.66; 95% confidence interval, 0.34-1.29). Although the intervention identified 3 times more men with new HIV infection, the study lacked power to find significant differences in linkage to HIV care. Few eligible men sought medical circumcision (4 of 72 intervention and 2 of 88 control).Conclusions: Home-based couple education and testing increased STI consultations among male partners of pregnant women, but appeared insufficient to overcome the barriers involved in linkage to HIV care and medical circumcision. [ABSTRACT FROM AUTHOR]

Introduction: The World Health Organization, while recommending pre‐exposure prophylaxis (PrEP) for HIV‐negative pregnant and postpartum women in HIV high‐burden settings, advocates for continued safety evaluation of PrEP in this population. Methods: The PrEP Implementation in Young Women and Adolescents (PrIYA) program delivered PrEP to pregnant and postpartum women integrated within routine maternal and child health clinics (MCH) at 16 sites in Western Kenya. PrEP exposure and perinatal outcome data were collected among women obtaining postnatal services during programme evaluation. PrEP use was self‐reported and confirmed with clinical records. Perinatal outcomes including gestational age at birth, birthweight, congenital malformations and infant growth outcomes were abstracted from clinical records for mother‐infant pairs attending the six week visit. Associations between infant outcomes and maternal prenatal PrEP use were assessed using univariate and multivariate logistic and linear regression. Results: The PrIYA evaluation identified 1530 postpartum mother‐infant pairs with data on prenatal PrEP exposure: 206 with prenatal PrEP use, 1324 without. Median maternal age was 24 years in both groups. PrEP users (any reported PrEP use) were significantly more likely to report HIV risk factors such as: intimate partner violence, sexually transmitted infections and having a partner with positive or unknown HIV status. Most mothers initiated PrEP during the second trimester (n = 116, 57%) and used PrEP for more than one month (n = 110, 58%). The mean birthweight was 3.3 kg and gestational age at birth was 38.5 weeks in both groups. There were no major differences between PrEP exposed and unexposed infants in rates of preterm birth and low birthweight. There were no congenital malformations identified in the PrEP‐exposed group and five reported in the PrEP unexposed group. At six weeks postpartum, infants in both groups had similar growth. No differences in infant outcomes were found by duration PrEP exposure, trimester of PrEP initiation, a subset analysis of women 15 to 24 years old or in multivariate analyses. This analysis demonstrates that monitoring of infant outcomes is feasible within large‐scale programmatic implementation of PrEP among pregnant and postpartum populations. Conclusions: Pregnancy outcomes and early infant growth did not differ by PrEP exposure. [ABSTRACT FROM AUTHOR]

Background: Programmatic approaches for delivering pre-exposure prophylaxis (PrEP) to pregnant and postpartum women in settings with high HIV burden are undefined. The PrEP Implementation for Young Women and Adolescents (PrIYA) Program developed approaches for delivering PrEP in maternal child health (MCH) clinics. Methods: Under the PrIYA Program, nurse-led teams worked with MCH staff at 16 public, faith-based, and private facilities in Kisumu, Kenya, to determine optimal clinic flow for PrEP integration into antenatal care (ANC) and postnatal care (PNC). A program-dedicated nurse facilitated integration. HIV-uninfected women were screened for behavioral risk factors; same-day PrEP was provided to interested and medically eligible women. PrEP and MCH services were evaluated using standardized flow mapping and time-and-motion surveys. Results: Clinics developed 2 approaches for integrating PrEP delivery within ANC/PNC: (1) co-delivery: ANC/PNC and PrEP services delivered by same MCH nurse or (2) sequential services: PrEP services after ANC/PNC by a PrEP-specialized nurse. Three clinics selected co-delivery and 13 sequential services, based on patient volume and space availability. Overall, 86 ANC/PNC visits were observed. Clients who initiated PrEP took a median of 18 minutes (interquartile range 15-26) for PrEP-related activities (risk assessment, PrEP counseling, creatinine testing, dispensation, and documentation) in addition to other routine ANC/PNC activities. For clients who declined PrEP, an additional 13 minutes (interquartile range 7-15) was spent on PrEP-related risk assessment and counseling. Conclusions: PrEP delivery within MCH used co-delivery or sequential approaches. The moderate additional time burden for PrEP initiation in MCH would likely decline with community awareness and innovations such as group/peer counseling or expedited dispensing. [ABSTRACT FROM AUTHOR]

Highlights • Up to 25% RHA can be used as blends in sodium silicate free metakaolin geopolymer. • RHA improved the workability and the tensile strength of geopolymers. • RHA acted as setting retarder with effect not significant at up to 25% RHA. • RHA reduced brittleness and eliminated long term reduction in strength of samples. • RHA reduced voids and densified the matrix of hardened geopolymers. Abstract The objective of the present work is to study the effect of RHA on the performance of fresh and hardened metakaolin geopolymer pastes with focus on tensile strength and microstructure. The metakaolin was partially substituted by 12.5–50% RHA in the solid mixes and reacted with 10 M sodium hydroxide solution at ambient conditions of 20 ± 3 °C and 70 ± 5% relative humidity using a liquid/solid ratio of 0.95. Physical, chemical and mineralogical characteristics of raw materials were determined. Fresh geopolymer pastes were tested for consistency and setting. Hardened products at 7 and 28 days of curing underwent tensile strength measurements according to ASTM C 307-03 (2012). SEM/EDX and thermogravimetric analyses were done on samples at 28 days of curing. Geopolymer pastes in which MK was substituted with up to 25% RHA showed improvement in workability and tensile strength compared to the mixture of MK with no RHA as substitution. Microstructural observations and SEM/EDX analyses of hardened pastes suggested that, the presence of RHA affected Si/Al ratios of geopolymers, with consequences on their polycondensation reactions products. Enhancement of tensile strength resulted from the densification of the matrix and the reduction of the negative effect of drying shrinkage and associated micro-cracks. [ABSTRACT FROM AUTHOR]

Background: Few men are tested for syphilis or human immunodeficiency virus (HIV) during their partner's pregnancy, a high-risk period for HIV and syphilis transmission. Offering home-based rapid testing of syphilis to couples during pregnancy can support prevention efforts to reduce transmission of sexually transmitted diseases and adverse pregnancy outcomes.Methods: We assessed men's uptake of paired (separate tests, single blood draw) point-of-care syphilis and HIV tests within a randomized controlled trial of pregnant women who received clinic or home partner HIV testing. We evaluated acceptance of paired HIV-syphilis testing during pregnancy or at 6 months postpartum, and evaluated whether addition of syphilis testing affected the uptake of HIV testing among men.Results: Of 601 women, we were unable to meet 101 male partners, and 180 tested before syphilis tests were available. Paired syphilis and HIV testing was offered at home to 80 men during pregnancy and to 230 men postpartum. For syphilis, 93% of men agreed to test during pregnancy and 98% agreed postpartum. For paired syphilis and HIV testing, 91% of men tested for both during pregnancy and 96% tested postpartum. Before syphilis test introduction, 96% of men accepted HIV testing, compared with 95% of men who accepted HIV testing when paired testing was offered.Conclusions: Uptake of syphilis and HIV testing was high among male partners offered couple testing at home. Introducing syphilis testing did not adversely affect HIV testing among men. Point-of-care diagnostics outside facilities can increase testing of male partners who rarely accompany women to antenatal clinics. [ABSTRACT FROM AUTHOR]

The preference of clay-based materials for sustainable construction is well-established. The establishment of sustainability credentials of emergent construction materials is very subjective, and most available tools are not fully equipped to deal with individual material systems, such as composite cement- or lime-based cementitious systems, including clay-based blocks and bricks. The main problem emanates from the challenges of the audit of each aspect of the material processing, and especially the quantification of the most relevant inputs into the composite product. The variability in material ingredients, and lack of data for each aspect of the manufacturing processes involved creates major challenges. Incorporation of materials with long and complex recycling processes further exacerbate the challenge. These incorporations create problems in terms of accurate material trails and data for input in a robust Life Cycle Assessment (LCA) of individual products. This paper reports on a simplified approach towards full LCA of seven clay-based brick products developed in UK (4) and Spain (3), based on known material data and estimated energy inputs in the manufacturing processes. The UK-based bricks comprise of Lower Oxford Clay (LOC), stabilised using combinations of hydrated lime, Ground Granulated Blast-furnace Slag (GGBS) and Portland cement (PC). In order to test the robustness of the proposed approach, results on UK-based bricks are compared with a parallel LCA on clay-based product developed in Spain. Finally, the clay-based products are compared with a typical Portland cement-based concrete block and fired clay brick. In the LCA, boundary conditions include fixed transport, thus attempting to factor only the material ingredients, their known atmospheric emissions, and estimated energy inputs during processing. Results suggest that the most challenging aspect in the undertaking of LCA is the availability of reliable input data. Results also show that there are numerous parameters that can reliably and corroboratively facilitate the comparison of performance, besides carbon dioxide emissions. [ABSTRACT FROM AUTHOR]

Background: Availability of laboratory confirmation of sexually transmitted infections is increasing in low- and middle-income countries, but costs continue to limit their access. Chlamydia trachomatis (CT) is a sexually transmitted infection of significant clinical importance, particularly among women. This study aimed to develop a risk score to identify women with a higher likelihood of CT infection, who could then be prioritized for laboratory testing, in a population of Kenyan women planning pregnancies. Methods: Women with fertility intentions were included in this cross-sectional analysis. Logistic regression was used to estimate odds ratios for the association between demographic, medical, reproductive, and behavioral characteristics and the prevalence of CT infection. A risk score was developed and validated internally based on the regression coefficients in the final multivariable model. Results: The prevalence of CT was 7.4% (51 of 691). A risk score for predicting CT infection, with scores 0 to 6, was derived from participants' age, alcohol use, and presence of bacterial vaginosis. The prediction model yielded an area under the receiver operating curve of 0.78 (95% confidene interval [Cl], 0.72-0.84). A cutoff of =2 versus >2 identified 31.8% of women as higher risk with moderate sensitivity (70.6%; 95% Cl, 56.2-71.3) and specificity (71.3%; 95% Cl, 67.7-74.5). The bootstrap-corrected area under the receiver operating curve was 0.77 (95% Cl, 0.72-0.83). Conclusions: In similar populations of women planning pregnancies, this type of risk score could be useful for prioritizing women for laboratory testing and would capture most women with CT infections while performing more costly testing in less than half of the population. [ABSTRACT FROM AUTHOR]

Background: Understanding sexual behaviors and vaginal practices of pregnant and breastfeeding women in sub-Saharan Africa is critical to inform HIV prevention strategies during these periods. Methods: HIV-uninfected women presenting for antenatal care in western Kenya were enrolled and followed through 36 weeks postpartum. Sexual behavior and vaginal practices were ascertained by structured questionnaires. Logistic regression was used to assess correlates of unprotected sex, vaginal washing, and vaginal drying. Results: Among 1252 women enrolled, 78.4% were married (of whom 15.1% were in polygamous unions), 1.4% had a known HIV-infected partner, and 33.6% had a partner of unknown HIV status. At enrollment, 58.5% reported sex in the past month (94.3% unprotected) and 4.5% reported forced sex. Odds of unprotected sex at enrollment was >11-fold higher in married than in unmarried women (P < 0.001) and lower among women who reported partners of unknown HIV status or HIV-infected compared with HIV-uninfected partners. Median time to postpartum resumption of sex was 7 weeks (interquartile range 4–12). Prevalence of unprotected sex in the past week increased from 6.6% to 60.0% between 2 and 36 weeks postpartum (P < 0.001). Vaginal washing was reported by 60.1% of women at enrollment and prevalence remained stable postpartum; vaginal drying was reported by 17.9% at enrollment and decreased to 6.1% at 36 weeks postpartum (P < 0.001). Vaginal washing and drying were associated with forced sex. Conclusions: High rates of unknown partner HIV status, polygamy, and less frequent condom use among pregnant/postpartum women underscore the need for female-controlled HIV prevention interventions. Vaginal washing and drying may present challenges to microbicide use. [ABSTRACT FROM AUTHOR]

Introduction: Male partner HIV testing has been recognized as an important component of prevention of mother-to-child HIV transmission. Scheduled home-based couple HIV testing may be an effective strategy to reach men. Methods: Women attending their first antenatal visit at Kisumu County Hospital in Kenya were randomized to home-based education and HIV testing within 2 weeks of enrollment (HOPE) or to written invitations for male partners to attend clinic (INVITE). Male partner HIV testing and maternal child health outcomes were compared at 6 months postpartum. Results: Of 1101 women screened, 620 were eligible and 601 were randomized to HOPE (n = 306) or INVITE (n = 295). At 6 months postpartum, male partners were more than twice as likely [relative risk (RR) = 2.10; 95% CI (CI): 1.81 to 2.42] to have been HIV tested in the HOPE arm [233 (87%)] compared with the INVITE arm [108 (39%)]. Couples in the HOPE arm [192 (77%)] were 3 times as likely (RR = 3.17; 95% CI: 2.53 to 3.98) to have been tested as a couple as the INVITE arm [62 (24%)] and women in the HOPE arm [217 (88%)] were also twice as likely (RR = 2.27; 95% CI: 1.93 to 2.67) to know their partner's HIV status as the INVITE arm [98 (39%)]. More serodiscordant couples were identified in the HOPE arm [33 (13%)] than in the INVITE arm [10 (4%)] (RR = 3.38; 95% CI: 1.70 to 6.71). Maternal child health outcomes of facility delivery, postpartum family planning, and exclusive breastfeeding did not vary by arm. Conclusions: Home-based HIV testing for pregnant couples resulted in higher uptake of male partner and couple testing, as well as higher rates of HIV status disclosure and identification of serodiscordant couples. However, the intervention did not result in higher uptake of maternal child health outcomes, because facility delivery and postpartum family planning were high in both arms, whereas exclusive breastfeeding was low. The HOPE intervention was successful at its primary aim to increase HIV testing and disclosure among pregnant couples and was able to find more serodiscordant couples compared with the invitation-only strategy. [ABSTRACT FROM AUTHOR]

Background: Childbirth at health facilities is an important strategy to reduce maternal morbidity and mortality, improve fetal outcomes, and reduce mother-to-child transmission of HIV. Although access to antenatal care in Kenya is high (>90%), less than half of births occur at health facilities. This analysis aims to assess correlates of facility delivery among recently pregnant HIV-infected women participating in a community-based survey, and to determine whether these correlates were unique when compared to HIV-uninfected women from the same region. Methods: Women residing in the Kenya Medical Research Institute/Centers for Disease Control and Prevention Health and Demographic Surveillance System, and who had delivered an infant in the previous year were visited at home in 2011. Consenting mothers answered a questionnaire assessing demographics, place of delivery, utilization of prevention of mother-to-child HIV transmission (PMTCT) services, and stigma indicators. Known HIV-positive women were purposively oversampled. Chi-square tests of proportions and multivariate logistic regression, stratified by HIV status, were performed to assess correlates of facility delivery. Results: Overall, 101 (46.8%) HIV-infected and 127 (39.9%) HIV-uninfected women delivered at health facilities. Among HIV-infected women, cost (42.8%), distance (18.8%) and fear of harsh treatment (15.2%) were primary disincentives for facility delivery; 2.9% noted fear of HIV testing was a disincentive. HIV-infected women who delivered at facilities had higher education (p = 0.04) and socioeconomic status (p < 0.005), initiated antenatal care (ANC) earlier (4.9 vs. 5.4 months, p = 0.016), were more likely to know partner's HIV status (p = 0.016), report satisfaction with delivery care (p = 0.001) and use antiretrovirals (87.1% vs. 77.4%, p = 0.063) compared to those with non-facility delivery. Stigma indicators were not associated with delivery location. Similar cofactors of facility delivery were noted among uninfected women. Conclusions: Utilization of facility delivery remains low in Kenya and poses a challenge to elimination of infant HIV and reduction of peripartum mortality. Cost, distance, and harsh treatment were cited as barriers and these need to be addressed programmatically. HIV-infected women with lower socioeconomic status and those who present late to ANC should be prioritized for interventions to increase facility delivery. Partner involvement may increase use of maternity services and could be enhanced by couples counseling. [ABSTRACT FROM AUTHOR]

• Development of MgO waste activated GGBS cementitious systems. • Optimal stabiliser dosage for MgO waste:GGBS binder in stabilising high sulphate soil. • Use of MgO-waste to address swelling caused by ettringite formation in soils. • Superior engineering performance credited to M-S-H gel formation. • Potential to improve environmental sustainability by the reuse of waste materials. Industrial and urban wastes have been generated over time due to urban development with severe environmental and health implications. This paper reports the valorisation of waste and industrial by-product (magnesium oxide waste – MG1 and Ground Granulated Blast furnace Slag – GGBS) to develop an alternative cementitious binder for suppressing swelling in high sulphate bearing soils due to the formation of a highly expansive crystalline hydrate (ettringite) upon treatment with Portland Cement – PC or lime. Cylinder test specimens were developed using three MG1:GGBS proportions by weight (10:90, 20:80 and 30:70) to stabilise a natural Gypsum marl soil (GM) containing high levels of sulphate at varying stabiliser dosages (6, 8 and 10 wt%), with PC as the control binder. UCS, Linear Expansion and SEM investigations were employed to assess the engineering suitability of the MG1:GGBS stabilised GM cylinder test specimen. Results suggest the viability of producing an alternative cementitious binder using up to 30 wt% MgO-waste to successfully activate GGBS at stabiliser dosages of 6–10 wt%. From a mechanical perspective, the MG1:GGBS stabilised GM soil was 1.5–3 times more than the control at 28 days moist curing age, while the resistance to linear expansion produced near-zero swellings (0.13%–0.2%) after 56 days, in comparison with the control of 3.2%. SEM micrographs showed a more compact structure with lesser voids and no morphology of ettringite. This new technology is expected to mitigate the environmental concerns of using PC and promote sustainable techniques of reusing industrial by-product materials for stabilising sulphate soils. [ABSTRACT FROM AUTHOR]

Stabilisation of sulphate-bearing soils with lime/cement-based binders has always been problematic, owing to excessive sulphate-induced expansion. This paper reports on investigations conducted on the consistency and compaction properties of Lower Oxford Clay (LOC), a sulphate-bearing soil that has been difficult to stabilise in the traditional manner using lime. In the investigations, LOC was stabilised both in the conventional manner using lime as the control, and also using a wide range of sustainable stabilisers incorporating industrial waste and by-product materials. The sustainable binders included wastepaper sludge ash (WSA) used on its own, as well as binary binders comprising WSA--lime, WSA--Portland cement (PC) and WSA--ground granulated blastfurnace slag. The results obtained showed that the blended stabilisers incorporating WSA were able to modify the soil by reducing the plasticity index, coupled with good compaction, strength and volume stability properties. The findings suggested that there are economic and environmental advantages of utilising WSA and similar industrial by-products in the modification and compaction of soils, including sulphate-bearing clay soils, as equal or at times superior alternatives to the traditional stabilisers of lime and/or PC. [ABSTRACT FROM AUTHOR]

Abstract: The main objective of this research was to investigate the effect of mellowing on the swelling properties of stabilized Lower Oxford Clay (LOC), a sulfate-bearing clay soil that has caused concern in the past due to expansion upon stabilization. Two stabilizers were used, quicklime and a more sustainable stabilizer — wastepaper sludge ash (WSA), an industrial by-product used on its own and in combination with either quicklime (CaO) or ground granulated blastfurnace slag (GGBS). Quicklime was used on its own as a control. Compacted cylinders of LOC stabilized with the various stabilizers were made either mellowed (compacted 3days after mixing with stabilizer) or unmellowed (compacted immediately after mixing with stabilizer). The linear expansion of the stabilized cylinders during moist curing and subsequent soaking was monitored for a total of 100days. The results obtained showed that the linear expansion of unmellowed stabilized LOC was significantly reduced, and thus in terms of swelling potential, mellowing was not beneficial in the LOC system investigated. The results observed also suggest that there are technological, economic as well as environmental advantages of utilizing WSA and similar industrial by-products, in the stabilization of sulfate-bearing and other clay soils, as an alternative to the traditional stabilizers of lime and/or Portland Cement. [ABSTRACT FROM AUTHOR]

An investigation was carried out to establish the physical, mechanical and durability characteristics of an unprocessed pulverised fuel ash (PFA) from a former landfill site at the Power Station Hill near Church Village, South Wales, United Kingdom. This was aimed at establishing the suitability of the ash in the construction of the Church Village Bypass (embankment and pavement) and also in concrete to be used in the construction of the proposed highway. Concrete made using binder blends using various levels of PFA as replacement to Portland cement (PC) were subjected to compressive strength tests to establish performance. The concrete was also subjected to sodium sulphate attack by soaking concrete specimens in sulphate solution to establish performance in a sulphatic environment. Strength development up to 365 days for the concrete made with PC–PFA blends as binders (PC–PFA concrete), and 180 days for the PC–PFA paste, is reported. The binary PC–PFA concrete did not show good early strength development, but tended to improve at longer curing periods. The low early strength observed means that PC–PFA concrete can be used for low to medium strength applications for example blinding, low-strength foundations, crash barriers, noise reduction barriers, cycle paths, footpaths and material for pipe bedding. [Copyright &y& Elsevier]

Abstract: An investigation was carried out to establish the physical, mechanical and chemical characteristics of an unprocessed pulverised fuel ash (PFA) from a former landfill site at the Power Station Hill near Church Village, South Wales, United Kingdom. This was aimed at establishing the suitability of the ash in road construction (embankment and pavement) and also in concrete to be used in the construction of a proposed highway. This paper reports on mortar blends made using the unprocessed PFA as cement replacement. The resistance of the mortar was tested by observing sulphate attack during soaking in a standard BS sodium sulphate solution, for soaking periods of up to 504days. Mortar cylinders of various mix designs were subjected to splitting tensile strength tests, after curing in water for up to 28days. Thermogravimetric and derivative thermogravimetric (TG/DTG) analyses were carried out on the unhydrated ingredients, in order to assess the degree of hydration and rate of, and portlandite formation in the cement paste after soaking in either water or sodium sulphate solution environment. The binary PC–PFA mortar shows good sulphate resistance under a sulphatic environment with the exception of one trial pit ash (Trail Pit No. 6). The tensile splitting strength decreases as the cement replacement increases. [Copyright &y& Elsevier]

This paper reviews one way in which colliery spoil can be utilized in low-strength concrete. Colliery Spoil (CS) (minestone), a by-product of coal mining, is abundant in most parts of the world. It has potential as a construction material but it has not been fully appreciated. This is partly because colliery spoil is not easy to utilize, due a number of drawbacks. The major problems identified in attempts to utilize CS in construction include excessive wear, expansive behaviour, leaching of heavy metals and even radioactivity. Thus, to date, the bulk of the CS utilization is limited to isolated cases of highway embankments, backfilling of mines, quarries and other surface tips, or in extreme cases subjected to marine and other disposal. This paper reports on the scope of technological benefits of utilizing colliery spoil (CS) in low to medium strength concrete. There has been intermittent pursuance of the benefits of utilizing colliery spoil in the United Kingdom. However, there is still no well-accepted and/or positive feedback on any colliery-based technology and/or construction material, apart from that relating its use for bulk fill. This research was triggered by proximity of large supplies of both CS and slag in South Wales, UK, as well as the authors' interest in advances in sustainable construction. Two fractions of colliery spoil were mixed in equal proportions and used for concrete where the binder was PC, or novel binders comprising of either Wastepaper Sludge Ash (WSA) or WSA combined in equal proportions with Ground Granulated Blastfurnace Slag (GGBS), themselves industrial wastes or by-product materials. Compressive strength of compacted cube specimens was monitored for a period of up to 56 days of curing. Results indicate that the performance of systems incorporating CS and WSA were of very poor workability, but the resultant strength was within the low to medium category usable for blinding concrete and or for use in bound granular fill or foundations. [ABSTRACT FROM AUTHOR]

In the present study, un-densified silica fume was reacted with a 10 M sodium hydroxide solution to produce the sodium silicate gel having a pH of 14. The calorimetry of the reaction was evaluated. The gel was dried to increase its density by almost 35%. Thereafter, the thermogravimetry of the gel was performed at temperatures up to 1000 °C. Except the loss in mass caused by the departure of physical and chemical water at temperatures below 200 °C, no other mass loss process was identified in the gel. The potential applications of the gel as high-temperature lubricants for automotive and metallurgical engineering and as alkaline activator in geopolymer binder were discussed. Since silica fume is a by-product material that do not require heating or grinding and can react with sodium hydroxide solution at ambient temperature, the results suggested potential for enhanced sustainability in the reduction of embodied energy for the production of the materials like high-temperature inorganic lubricant and alkaline activator for geopolymer binder. [ABSTRACT FROM AUTHOR]

We examined the association between serum aflatoxin B1‐lysine adduct (AFB1‐lys) levels in pregnant women and adverse pregnancy outcomes (low birthweight, miscarriage and stillbirth) through a nested matched case–control study of pregnant women enroled at ≤28 weeks' gestation in Mombasa, Kenya, from 2017 to 2019. Cases comprised women with an adverse birth outcome, defined as either delivery of a singleton infant weighing <2500 g, or a miscarriage, or a stillbirth, while controls were women who delivered a singleton live infant with a birthweight of ≥2500 g. Cases were matched to controls at a ratio of 1:2 based on maternal age at enrolment, gestational age at enrolment and study site. The primary exposure was serum AFB1‐lys. The study included 125 cases and 250 controls. The median gestation age when serum samples were collected was 23.0 weeks (interquartile range [IQR]: 18.1–26.0) and 23.5 (IQR: 18.1–26.5) among cases and controls, respectively. Of the 375 tested sera, 145 (38.7%) had detectable serum AFB1‐lys: 36.0% in cases and 40.0% in controls. AFB1‐lys adduct levels were not associated with adverse birth outcomes on multivariable analysis. Mid‐upper arm circumference was associated with a 6% lower odds of adverse birth outcome for every unit increase (p = 0.023). Two‐fifths of pregnant women had detectable levels of aflatoxin midway through pregnancy. However, we did not detect an association with adverse pregnancy outcomes, likely because of low serum AFB1‐lys levels and low power, restricting meaningful comparison. More research is needed to understand the public health risk of aflatoxin in pregnant women to unborn children. [ABSTRACT FROM AUTHOR]

Background: In 2020, healthcare providers were expected to provide care to individuals with coronavirus disease 2019 (COVID-19), putting them at risk of acquiring COVID-19. The possibility of acquiring poorly understood infectious diseases while providing care may have an impact on the mental health of providers. We conducted a study to explore the effects of COVID-19 on the mental health of healthcare providers. Methods: Between April and August 2021, we conducted in-depth interviews with 60 healthcare providers in the infectious disease unit (IDU) and other units of the hospital (non-IDU). The healthcare providers completed an online self-administered survey form with demographic data (age, sex, average income, and known contact with a COVID-19 patient). We used semi-structured interview guides to understand the healthcare providers' lived experiences of stress, anxiety, depression, and their associated factors. We transcribed the interviews verbatim and coded and analyzed the transcripts to derive thematic concepts related to mental health experiences. Results: The healthcare providers had a median age of 37 years [IQR 20.0–58.0], and 56.7% were female, 30.0% nurses, 18.3% medical doctors, and 11.7% laboratory technologists. The healthcare providers reported increased stress during the pandemic, attributed to the high demand for patient care, changes in social life, and fear of COVID-19 infection. They also reported experiences of anxiety and depression as a result of limited knowledge at the beginning of the pandemic and the perception that "COVID-19 resulted in death". Testing positive for COVID-19, high exposure to COVID-19 risks, and the death of patients and colleagues reportedly affected the healthcare providers' mental health. Additionally, the healthcare providers reported mental health support through debriefing meetings, peer-to-peer support, and psychological counseling, with privacy and confidentiality concerns. Conclusions: Healthcare providers faced mental health issues such as stress and anxiety while taking care of COVID-19 patients. An effective mental health response requires institutional practices that address context-specific challenges such as privacy and confidentiality. [ABSTRACT FROM AUTHOR]

This study investigates the feasibility of utilizing recycled plastic waste as a partial substitute for sand in concrete production. Reprocessing used plastic items or materials involves collecting, cleaning, shredding, and melting, resulting in reprocessed plastic particles. Incorporating these recycled plastic particles into concrete addresses environmental concerns related to plastic disposal and the growing scarcity and increasing cost of natural sand. To evaluate the sand replacement capacity of recycled plastic, four types of mixtures were created with varying levels of recycled plastic replacement (5%, 10%, 15%, and 20%). All mixtures maintained a water-to-binding ratio of 0.55 and were tested at 7, 28, and 56 days. The testing regimen encompassed determining the slump value, density, compressive strength, tensile strength, and resistance to freezing and thawing. The findings revealed that replacing sand in the concrete mix with recycled plastic enhanced workability, which was attributed to the hydrophobic nature of the plastic particles. However, both compressive and tensile strength exhibited a declining trend. Additionally, after undergoing multiple freezing and thawing cycles, the concrete mix exhibited poor durability properties and brittleness. These issues may arise due to factors such as incompatibility, non-uniformity, reduced cohesion, and the lower density of plastic particles. [ABSTRACT FROM AUTHOR]

A geopolymer is an inorganic amorphous cementitious material, emerging as an alternative sustainable binder for greener concrete production over Ordinary Portland Cement (OPC). Geopolymer concrete production promotes waste reuse since the applicable precursor materials include agricultural and industrial waste that requires disposal, helping to reduce waste in landfills and ensuring sustainable environmental protection. This study investigates the development of an environmentally friendly sodium silicate alternative (SSA) derived from pumice powder (PP) in place of a commercial Na2SiO3 solution at a 10 M concentration. Six concrete batches were produced at alkaline/precursor (A/P) ratios of 0.1, 0.2, 0.3, 0.4, and 0.5. The geopolymer mix AF4, with an A/P ratio of 0.4, became the optimum geopolymer concrete design; however, it recorded lower compressive, tensile splitting, and flexural strengths, respectively, against the control OPC concrete. The geopolymer formulations, however, obtained 28-day-hardened concrete densities comparable to the control concrete. The 28-day compressive strength of the OPC concrete was 29.4 MPa, higher than the 18.8 MPa recorded for AF4. However, the 56-day strength of AF4 improved to 22.4 MPa, an around 19% increase compared to the 30.8 MPa achieved by the control mix on day 56, having experienced only a 5% strength increase. The low mechanical performances of the geopolymer formulation could be attributed to extra water added to the original geopolymer design to improve the workability of the geopolymer mix. Therefore, the SSA alkaline solution using PP showed some potential for developing geopolymer concrete for low-strength construction applications. [ABSTRACT FROM AUTHOR]

Background: Women living with HIV (WLWH) face unique reproductive health (RH) barriers which increase their risks of unmet need for contraception, contraceptive failure, unintended pregnancy, and pregnancy-related morbidity and mortality and may prevent them from achieving their reproductive goals. Patient-centered counseling interventions that support health care workers (HCWs) in providing high-quality RH counseling, tailored to the needs of WLWH, may improve reproductive health outcomes. Methods and design: We are conducting a non-blinded cluster randomized controlled trial (cRCT) of a digital health intervention for WLWH (clinicaltrials.gov #NCT05285670). We will enroll 3,300 WLWH seeking care in 10 HIV care and treatment centers in Nairobi and Western Kenya. WLWH at intervention sites receive the Mobile WACh Empower intervention, a tablet-based RH decision-support counseling tool administered at baseline and SMS support during two years of follow-up. WLWH at control sites receive the standard of care FP counseling. The decision-support tool is a logic-based tool for family planning (FP) counseling that uses branching logic to guide RH questions based on participants' reproductive life plans, tailoring counseling based on the responses. Follow-up SMSs are based in the Information-Motivation-Behavioral (IMB) Skills model of behavioral change and are tailored to participant characteristics and reproductive needs through separate SMS "tracks". Follow-up visits are scheduled quarterly for 2 years to assess plans for pregnancy, pregnancy prevention, and contraceptive use. The primary outcome, FP discontinuation, will be compared using an intent-to-treat analysis. We will also assess the unmet need for FP, dual method use, viral load suppression at conception and unintended pregnancy. Discussion: The Mobile WACh Empower intervention is innovative as it combines a patient-centered counseling tool to support initial reproductive life decisions with longitudinal SMS for continued RH support and may help provide RH care within the context of provision of HIV care. [ABSTRACT FROM AUTHOR]

We sought to understand influences on PrEP uptake among Kenyan adolescent girls and young women (AGYW) whose decision on PrEP use was misaligned with their risk for HIV acquisition. In-depth interviews were conducted with 47 Kenyan HIV-negative AGYW aged 15–24 years who were offered PrEP during routine maternal and child health and family planning services. AGYW were sampled from two groups (1) declined PrEP and had ≥1 sexual partner(s) of unknown HIV status and (2) initiated PrEP and reported having one HIV-negative partner. AGYW with HIV-negative partners initiated PrEP due to known or suspected infidelity. AGYW with partners of unknown HIV status recognized PrEP as a helpful HIV prevention tool, yet worried about partner reactions and prioritized avoiding uncomfortable or unsafe situations over PrEP. Among pregnant AGYW, the responsibility of motherhood and providing a future for one's family, through staying healthy and remaining HIV-free, was a strong PrEP use motivator. Among AGYW who desired future motherhood, fears that PrEP could negatively impact fertility or reduce contraceptive effectiveness led to declining PrEP. Peers positively influenced PrEP decision-making, especially personally knowing a PrEP user. Strategies are needed to enhance messaging and delivery approaches that are tailored to AGYW, including peer-led strategies. [ABSTRACT FROM AUTHOR]

Some data gaps will be addressed in an ongoing cluster randomized trial evaluating PrEP delivery approaches in antenatal care (ANC) visits [10] (PrEP Implementation for Mothers in Antenatal Care (PrIMA, NCT03070600)). ANC, antenatal care; PrEP, pre-exposure prophylaxis; PrIMA, PrEP Implementation for Mothers in Antenatal Care. Perinatal outcomes following maternal pre-exposure prophylaxis (PrEP) use during pregnancy: results from a large PrEP implementation program in Kenya. [Extracted from the article]

Background: Identifying predictors of preterm birth (PTB) in high-burden regions is important as PTB is the leading cause of global child mortality.Methods: This analysis was nested in a longitudinal study of human immunodeficiency virus (HIV) incidence in Kenya. HIV-seronegative women enrolled in pregnancy had nucleic acid amplification tests (chlamydia and gonorrhea), rapid plasma reagin (syphilis), wet mount microscopy (Trichomonas and yeast), and Gram stain (bacterial vaginosis); sexually transmitted infection (STI) treatment was provided. PTB predictors were determined using log-binomial regression.Results: Among 1244 mothers of liveborn infants, median gestational age at enrollment was 26 weeks (IQR, 22-31), and at delivery was 39.1 weeks (IQR, 37.1-40.9). PTB occurred in 302 women (24.3%). Chlamydia was associated with a 1.59-fold (P = .006), gonorrhea a 1.62-fold (P = .04), and incident HIV a 2.08-fold (P = .02) increased PTB prevalence. Vaginal discharge and cervical inflammation were associated with PTB, as were age ≤21 (prevalence ratio [PR] = 1.39, P = .001) and any STI (PR = 1.47, P = .001). Associations with chlamydia and incident HIV remained in multivariable models.Conclusions: STIs and incident HIV in pregnancy predicted PTB despite treatment, suggesting the need for earlier treatment and interventions to decrease genital inflammation. [ABSTRACT FROM AUTHOR]

In sub-Saharan Africa little is known about how often women use pregnancy self-tests or characteristics of these women despite evidence that pregnancy self-testing is associated with early antenatal care (ANC) initiation. Understanding the characteristics of women who use pregnancy self-tests can facilitate more targeted efforts to improve pregnancy testing experiences and entry into the ANC pathway. We conducted a cross-sectional survey among pregnant women enrolling in a pre-exposure prophylaxis (PrEP) implementation study to determine the prevalence and factors associated with pregnancy self-testing among women in western Kenya. Overall, in our study population, 17% of women obtained a pregnancy self-test from a pharmacy. Pregnancy test use was higher among employed women, women with secondary and college-level educated partners, and women who spent 30 minutes or less traveling to the maternal and child health (MCH) clinic. The most reported reasons for non-use of pregnancy self-tests included not thinking it was necessary, lack of knowledge, and money to pay for the test. Future research should focus on understanding the knowledge and attitudes of women toward pregnancy self-testing as well as developing community-based models to improve access to pregnancy testing and ANC. [ABSTRACT FROM AUTHOR]

Background: Differentiated service delivery (DSD) approaches decrease frequency of clinic visits for individuals who are stable on antiretroviral therapy. It is unclear how to optimize DSD models for postpartum women living with HIV (pWLH). We evaluated longitudinal HIV viral load (VL) and cofactors, and modelled DSD eligibility with virologic failure (VF) among PWLH in prevention of mother-to-child transmission programs. Methods: This analysis used programmatic data from participants in the Mobile WAChX trial (NCT02400671). Women were assessed for DSD eligibility using the World Health Organization criteria among general people living with HIV (receiving antiretroviral therapy for ≥6 months and having at least 1 suppressed VL [<1000 copies/mL] within the past 6 months). Longitudinal VL patterns were summarized using group-based trajectory modelling. VF was defined as having a subsequent VL $1000 copies/mL after being assessed as DSD-eligible. Predictors of VF were determined using log-binomial models among DSD-eligible PWLH. Results: Among 761 women with 3359 VL results (median 5 VL per woman), a 3-trajectory model optimally summarized longitudinal VL, with most (80.8%) women having sustained low probability of unsuppressed VL. Among women who met DSD criteria at 6 months postpartum, most (83.8%) maintained viral suppression until 24 months. Residence in Western Kenya, depression, reported interpersonal abuse, unintended pregnancy, nevirapine-based antiretroviral therapy, low-level viremia (VL 200-1000 copies/mL), and drug resistance were associated with VF among DSD-eligible PWLH. Conclusions: Most postpartum women maintained viral suppression from early postpartum to 24 months and may be suitable for DSD referral. Women with depression, drug resistance, and detectable VL need enhanced services. [ABSTRACT FROM AUTHOR]

Background: Oral pre-exposure prophylaxis (PrEP) and male partner HIV self-testing (HIVST) is being scaled up within antenatal clinics. Few data are available on how co-distribution influences acceptance of both interventions. Methods: We used data from the PrEP Implementation of Mothers in Antenatal Care (NCT03070600) trial in Kenya. Women included in this analysis were determined to be at high risk of HIV and offered oral PrEP and partner HIVST. Characteristics were compared between women who chose: (1) PrEP and HIVST, (2) HIVST-alone, (3) PrEP-alone, or (4) declined both (reference), excluding women who had partners known to be living with HIV. Results: Among 911 women, median age was 24 years, 87.3% were married, 43.9% perceived themselves to be at high risk of HIV and 13.0% had history of intimate partner violence (IPV). Overall, 68.9% accepted HIVST and 18.4% accepted PrEP, with 54.7% accepting HIVST-alone, 4.2% PrEP-alone, and 14.3% both HIVST and PrEP. Of women accepting HIVST, partner HIV testing increased from 20% to 82% and awareness of partner HIV status increased from 4.7% to 82.0% between pregnancy and 9 months postpartum (P < 0.001). Compared with women who accepted neither, choosing: (1) HIVST-alone was associated with being married, higher level of education, and residing with partner; (2) PrEP-alone was associated with lower social support, IPV, not residing with partner, longer time living with partner, and suspicion of other partners; and (3) PrEP and HIVST was associated with being married, IPV, and suspicion that partner had other partners. Conclusions: Understanding factors associated with accepting HIVST and PrEP can inform HIV prevention programs for pregnant women. Clinical Trial Number: NCT03070600. [ABSTRACT FROM AUTHOR]

Introduction: Adverse birth outcomes particularly preterm births and congenital anomalies, are the leading causes of infant mortality globally, and the burden is highest in developing countries. We set out to determine the frequency of adverse birth outcomes and the risk factors associated with such outcomes in a cohort of pregnant women in Kenya. Methods: From October 2017 to July 2019, pregnant women < 28 weeks gestation were enrolled and followed up until delivery in three hospitals in coastal Kenya. Newborns were examined at delivery. Among women with birth outcome data, we assessed the frequency of congenital anomalies defined as gastroschisis, umbilical hernia, limb abnormalities and Trisomy 21, and adverse birth outcomes, defined as either stillbirth, miscarriage, preterm birth, small for gestational age, or microcephaly. We used log-binomial regression to identify maternal characteristics associated with the presence of at least one adverse outcome. Results: Among the 2312 women enrolled, 1916 (82.9%) had birth outcome data. Overall, 402/1916 (20.9%; 95% confidence interval (CI): 19.1–22.8) pregnancies had adverse birth outcomes. Specifically, 66/1916 (3.4%; 95% CI: 2.7–4.4) were stillbirths, 34/1916 (1.8%; 95% CI: 1.2–2.4) were miscarriages and 23/1816 (1.2%; 95% CI: 0.8–1.9) had congenital anomalies. Among the participants with anthropometric measurements data, 142/1200 (11.8%; 95% CI: 10.1 − 13.8) were small for gestational age and among the participants with ultrasound records, 143/1711 (8.4%; 95% CI: 7.1–9.8) were preterm. Febrile illnesses in current pregnancy (adjusted risk ratio (aRR): 1.7; 95% CI: 1.1–2.8), a history of poor birth outcomes in prior pregnancy (aRR: 1.8; 95% CI: 1.3–2.4) and high blood pressure in pregnancy (aRR: 3.9, 95% CI: (1.7–9.2) were independently associated with adverse birth outcomes in a model that included age, education, human immunodeficiency virus status and high blood pressure at enrolment. Conclusion: We found similar rates of overall adverse birth outcomes, congenital anomalies, and small for gestational age but higher rates of stillbirths and lower rates of prematurity compared to the rates that have been reported in the sub-Saharan Africa region. However, the rates of adverse birth outcomes in this study were comparable to other studies conducted in Kenya. Febrile illnesses during the current pregnancy, previous history of poor birth outcomes and high blood pressure in pregnancy are predictive of an increased risk of adverse birth outcomes. [ABSTRACT FROM AUTHOR]

Chlamydia and gonorrhea infections during pregnancy contribute to adverse pregnancy outcomes. In this study among HIV-negative pregnant women in Kenya, predictors of these infections were young age, being unmarried, and short partnerships. Background: Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections in pregnancy contribute to adverse perinatal outcomes. We identified predictors of CT and/or NG infection among pregnant Kenyan women. Methods: Women without HIV were enrolled at 2 antenatal clinics in Western Kenya. Both CT and NG were assessed using endocervical samples for nucleic acid amplification tests. Poisson regression models were used to evaluate potential CT/NG risk factors. Classification and regression trees were generated to evaluate the joint effects of predictors. Results: Overall, 1276 women had both CT and NG assessments. Women enrolled at a median of 26 weeks' gestation (interquartile range, 22–31 weeks), median age was 22 years (interquartile range, 19–27 years), and 78% were married. In total, 98 (7.7%) tested positive for CT/NG: 70 (5.5%) for CT and 32 (2.5%) for NG, 4 of whom (0.3%) had coinfections. Two-thirds (66%) of CT/NG cases were asymptomatic and would have been missed with only syndromic management. Risk factors of CT/NG included age <22 years, crowded living conditions, being unmarried, being in partnerships for <1 year, abnormal vaginal discharge, sexually transmitted infection history, and Trichomonas vaginalis diagnosis (P < 0.1). Classification and regression tree analyses identified unmarried women <22 years in relationships for <1 year as 6.1 times more likely to have CT/NG compared with women without these characteristics (26% vs. 6%, adjusted prevalence ratio = 6.1, 95% confidence interval = 3.55–10.39, P < 0.001). Conclusions: Chlamydia trachomatis / Neisseria gonorrhoeae was frequently asymptomatic and common among young unmarried women in newer partnerships in this cohort. Integrating CT/NG testing into routine antenatal care may be beneficial, especially for young women in Kenya. [ABSTRACT FROM AUTHOR]

Background Human immunodeficiency virus (HIV)–exposed uninfected (HEU) infants in endemic settings are at high risk of tuberculosis (TB). For infants, progression from primary Mycobacterium tuberculosis (Mtb) infection to TB disease can be rapid. We assessed whether isoniazid (INH) prevents primary Mtb infection. Methods We conducted a randomized nonblinded controlled trial enrolling HEU infants 6 weeks of age without known TB exposure in Kenya. Participants were randomized (1:1) to 12 months of daily INH (10 mg/kg) vs no INH. Primary endpoint was Mtb infection at end of 12 months, assessed by interferon-γ release assay (QuantiFERON-TB Gold Plus) and/or tuberculin skin test (TST, added 6 months after first participant exit). Results Between 15 August 2016 and 6 June 2018, 416 infants were screened, with 300 (72%) randomized to INH or no INH (150 per arm); 2 were excluded due to HIV infection. Among 298 randomized HEU infants, 12-month retention was 96.3% (287/298), and 88.9% (265/298) had primary outcome data. Mtb infection prevalence at 12-month follow-up was 10.6% (28/265); 7.6% (10/132) in the INH arm and 13.5% (18/133) in the no INH arm (7.0 vs 13.4 per 100 person-years; hazard ratio, 0.53 [95% confidence interval {CI},.24–1.14]; P  = .11]), and driven primarily by TST positivity (8.6% [8/93] in INH and 18.1% [17/94] in no INH; relative risk, 0.48 [95% CI,.22–1.05]; P  = .07). Frequency of severe adverse events was similar between arms (INH, 14.0% [21/150] vs no INH, 10.7% [16/150]; P  = .38), with no INH-related adverse events. Conclusions Further studies evaluating TB preventive therapy to prevent or delay primary Mtb infection in HEU and other high-risk infants are warranted. Clinical Trials Registration NCT02613169. [ABSTRACT FROM AUTHOR]

Study Question: Is bacterial vaginosis (BV) associated with fecundability?Summary Answer: Women with BV may be at increased risk for sub-fecundity.What Is Known Already: While BV has been associated with poor IVF outcomes, the association between vaginal microbiota disruption and non-medically assisted conception has not been thoroughly explored.Study Design, Size, Duration: Kenyan women with fertility intent were enrolled in prospective cohort that included monthly preconception visits with vaginal fluid specimen collection and pregnancy testing. Four hundred fifty-eight women attempting pregnancy for ≤3 menstrual cycles at enrollment were eligible for this fecundability analysis.Participants/materials, Setting, Methods: At monthly preconception visits, participants reported the first day of last menstrual period and sexual behavior, underwent pregnancy testing and provided vaginal specimens. Discrete time proportional probabilities models were used to estimate fecundability ratios (FRs) and 95% CI in menstrual cycles with and without BV (Nugent score ≥ 7) at the visit prior to each pregnancy test. We also assessed the association between persistent BV (BV at two consecutive visits) and fecundability.Main Results and the Role Of Chance: Participants contributed 1376 menstrual cycles; 18.5% (n = 255) resulted in pregnancy. After adjusting for age, frequency of condomless sex and study site, BV at the visit prior to pregnancy testing was associated with a 17% lower fecundability (adjusted FR (aFR) 0.83, 95% CI 0.6-1.1). Persistent BV was associated with a 43% reduction in fecundability compared to cycles characterized by optimal vaginal health (aFR 0.57, 95% CI 0.4-0.8).Limitations, Reasons For Caution: Detection of vaginal microbiota disruption using Gram stain and a point-of-care test for elevated sialidase identified a non-optimal vaginal environment, but these non-specific methods may miss important relationships that could be identified by characterizing individual vaginal bacteria and bacterial communities using molecular methods. In addition, results may be subject to residual confounding by condomless sex as this was reported for the prior month rather than for the fertile window during each cycle.Wider Implications Of the Findings: Given the high global prevalence of BV and infertility, an association between BV and reduced fecundability could have important implications for a large number of women who wish to conceive. Multi-omics approaches to studying the vaginal microbiota may provide key insights into this association and identify potential targets for intervention.Study Funding/competing Interest(s): This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-R.S.M.). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were made possible using REDCap electronic data capture tools hosted at the University of Washington's Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for consulting from Lupin Pharmaceuticals. L.E.M. receives research funding, paid to the University of Washington, from Hologic Corporation, and has received honoraria for service on scientific advisory boards from Hologic and Nabriva Therapeutics.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]

Background: Discontinuation of daily oral pre-exposure prophylaxis (PrEP) is frequent among adolescent girls and young women (AGYW) in African settings. We explored factors influencing early PrEP discontinuation and persistence among Kenyan AGYW who accepted PrEP within a programmatic setting. Methods: We conducted in-depth interviews with AGYW (aged 15-24 years) who accepted PrEP from 4 maternal child health (MCH) and family planning (FP) clinics. AGYW were identified by nurses at routine clinic visits and purposively sampled based on 4 categories: (1) accepted PrEP pills, but never initiated PrEP use (eg, never swallowed PrEP pills), (2) discontinued PrEP <1 month after initiation, (3) discontinued PrEP within 1-3 months, and (4) persisted with PrEP use >3 months. Informed by the Stages of Change Model, thematic analysis characterized key influences on PrEP discontinuation/persistence. Results: We conducted 93 in-depth interviews with AGYW who accepted pills. Median age was 22 years, 71% were married; 89% were from MCH, and 11% were from FP clinics. Early PrEP use was positively influenced by encouragement from close confidants and effective concealment of PrEP pill-taking when necessary to avoid stigma or negative reactions from partners. Pregnancy helped conceal PrEP use because pill-taking is normalized during pregnancy, but concealment became more difficult postpartum. AGYW found keeping up with daily PrEP pill-taking challenging, and many noted only episodic periods of the HIV risk. Frequently testing HIV-negative reassured AGYW that PrEP was working and motivated persistence. Discussion: As PrEP programs scale-up in MCH/FP, it is increasingly important to enhance protection-effective PrEP use through approaches tailored to AGYW, with special considerations during pregnancy and postpartum. [ABSTRACT FROM AUTHOR]

Background Pregnancy and human immunodeficiency virus (HIV) may influence tuberculosis infection detection using interferon (IFN)-γ release assay (QFT-Plus; Qiagen) and tuberculin skin test (TST). Methods Participants in Western Kenya underwent QFT-Plus and TST in pregnancy, 6 weeks postpartum (6wkPP) and 12 months postpartum (12moPP). Results 400 participants (200 with HIV [WHIV], 200 HIV-negative) enrolled during pregnancy (median 28 weeks' gestation [interquartile range, 24–30]). QFT-Plus positivity prevalence was higher than TST in pregnancy (32.5% vs 11.6%) and through 12moPP (6wkPP, 30.9% for QFT-Plus vs 18.0% for TST; 12moPP, 29.5% vs 17.1%; all P <.001), driven primarily by QFT-Plus–positive/TST-negative discordance among HIV-negative women. Tuberculosis infection test conversion incidence was 28.4/100 person-years (PY) and higher in WHIV than HIV-negative women (35.5 vs 20.9/100 PY; hazard ratio, 1.73 [95% confidence interval, 1.04–2.88]), mostly owing to early postpartum TST conversion among WHIV. Among QFT-Plus–positive participants in pregnancy, Mycobacterium tuberculosis   (Mtb) –specific IFN-γ responses were dynamic through 12moPP and lower among WHIV than HIV-negative women with tuberculosis infection at all time points. Conclusions QFT-Plus had higher diagnostic yield than TST in peripartum women. Peripartum QFT-Plus positivity was stable and less influenced by HIV than TST. Mtb –specific IFN-γ responses were dynamic and lower among WHIV. Tuberculosis infection test conversion incidence was high between pregnancy and early postpartum, potentially owing to postpartum immune recovery. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is Mycoplasma genitalium -infection associated with reduced fecundability? SUMMARY ANSWER Preconception M. genitalium -infection was associated with 27% lower fecundability though confidence intervals were wide, and the association between M. genitalium and fecundability may be dependent on concurrent bacterial vaginosis (BV). WHAT IS KNOWN ALREADY M. genitalium has been associated with cervicitis, pelvic inflammatory disease, infertility, and preterm birth, but the extent to which M. genitalium is causally related to adverse reproductive sequelae in women is debated. STUDY DESIGN, SIZE, DURATION Kenyan women enrolled in a prospective preconception cohort provided vaginal fluid specimens and underwent monthly pregnancy testing. Stored samples from 407 women who had been trying to conceive for ≤6 months were tested for M. genitalium using a nucleic acid amplification test. PARTICIPANTS/MATERIALS, SETTING, METHODS Data on first day of last menstrual period, sexual behavior, pregnancy status, and vaginal specimens were collected at monthly preconception visits. The association between M. genitalium detected at the visit prior to each pregnancy test and fecundability was estimated using discrete time proportional probabilities models. Secondary analyses explored the influence of concurrent BV on the association between M. genitalium and fecundability. MAIN RESULTS AND THE ROLE OF CHANCE The 407 participants experienced 1220 menstrual cycles and 213 pregnancies. The prevalence of M. genitalium at enrollment was 7.7%. After adjustment for age, frequency of condomless sex in the last 4 weeks, and study site, M. genitalium was associated with a 27% lower fecundability, but confidence intervals were wide (adjusted fecundability ratio (aFR) 0.73, 95% CI 0.44, 1.23). In secondary analyses, when compared to cycles without M. genitalium or BV at the visit prior, women with both M. genitalium and BV at the visit prior had a 51% lower fecundability (aFR = 0.49, 95% CI 0.22, 1.09) whereas there was no association of M. genitalium alone (aFR = 0.98 (95% CI 0.54, 1.76)), and a smaller reduction in fecundability for women with BV only (aFR = 0.80 (95% CI 0.60, 1.07)). LIMITATIONS, REASONS FOR CAUTION Results should be interpreted cautiously given the relatively low prevalence of M. genitalium and wide confidence intervals. WIDER IMPLICATIONS OF THE FINDINGS In this cohort of Kenyan women trying to conceive, the association between M. genitalium and fecundability was influenced by concurrent BV status, suggesting there may be a synergistic effect of M. genitalium and BV on fecundability. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a National Institutes of Health grant (NICHD R01 HD087346-RSM). R.S.M. received additional support for mentoring (NICHD K24 HD88229). E.M.L. was supported by pre- and post-doctoral fellowships (NIAID T32 AI07140, NICHD F32 HD100202). Data collection and management were completed using REDCap electronic data capture tools hosted at the University of Washington's Institute of Translational Health Science supported by grants from NCATS/NIH (UL1 TR002319). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. R.S.M. receives research funding, paid to the University of Washington, from Hologic Corporation and consulting fees from Lupin Pharmaceuticals. L.E.M. receives research funding and material for research studies, paid to the University of Washington, from Hologic Corporation and Nabriva Therapeutics, travel support from Hologic, and consulting fees from Health Advances. E.M.L.'s contributions to this study primarily occurred while affiliated with the University of Washington; at the time of submission, E.M.L. was an employee of and holds stock or stock grants for AbbVie, Inc. The other authors have no conflicts of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Background: Prevention of mother-to-child HIV transmission (PMTCT) programs usually test pregnant women for HIV without involving their partners. Non-disclosure of maternal HIV status to male partners may deter utilization of PMTCT interventions since partners play a pivotal role in decision-making within the home including access to and utilization of health services.Methods: Mothers attending routine 6-week and 9-month infant immunizations were enrolled at 141 maternal and child health (MCH) clinics across Kenya from June-December 2013. The current analysis was restricted to mothers with known HIV status who had a current partner. Multivariate logistic regression models adjusted for marital status, relationship length and partner attendance at antenatal care (ANC) were used to determine correlates of HIV non-disclosure among HIV-uninfected and HIV-infected mothers, separately, and to evaluate the relationship of non-disclosure with uptake of PMTCT interventions. All analyses accounted for facility-level clustering, RESULTS: Overall, 2522 mothers (86% of total study population) met inclusion criteria, 420 (17%) were HIV-infected. Non-disclosure of HIV results to partners was higher among HIV-infected than HIV-uninfected women (13% versus 3% respectively, p < 0.001). HIV-uninfected mothers were more likely to not disclose their HIV status to male partners if they were unmarried (adjusted odds ratio [aOR] = 3.79, 95% CI: 1.56-9.19, p = 0.004), had low (≤KSH 5000) income (aOR = 1.85, 95% CI: 1.00-3.14, p = 0.050), experienced intimate partner violence (aOR = 3.65, 95% CI: 1.84-7.21, p < 0.001) and if their partner did not attend ANC (aOR = 4.12, 95% CI: 1.89-8.95, p < 0.001). Among HIV-infected women, non-disclosure to male partners was less likely if women had salaried employment (aOR = 0.42, 95%CI: 0.18-0.96, p = 0.039) and each increasing year of relationship length was associated with decreased likelihood of non-disclosure (aOR = 0.90, 95% CI: 0.82-0.98, p = 0.015 for each year increase). HIV-infected women who did not disclose their HIV status to partners were less likely to uptake CD4 testing (aOR = 0.32, 95% CI: 0.15-0.69, p = 0.004), to use antiretrovirals (ARVs) during labor (OR = 0.38, 95% CI 0.15-0.97, p = 0.042), or give their infants ARVs (OR = 0.08, 95% CI 0.02-0.31, p < 0.001).Conclusion: HIV-infected women were less likely to disclose their status to partners than HIV-uninfected women. Non-disclosure was associated with lower use of PMTCT services. Facilitating maternal disclosure to male partners may enhance PMTCT uptake. [ABSTRACT FROM AUTHOR]