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Background Adolescence is a sensitive time for girls' sexual and reproductive health (SRH), as biological changes occur concurrently with heightening pressures for sexual activity. In western Kenya, adolescent girls are vulnerable to acquiring sexually transmitted infections (STIs), such as HIV and herpes simplex virus type 2 (HSV-2), and to becoming pregnant prior to reaching adulthood. This study examines associations between individual, household, and partner-related risk factors and the prevalence of sex, adolescent pregnancy, HIV, and HSV-2. Methods and findings We report baseline findings among 4,138 girls attending secondary school who were enrolled between 2017 and 2018 in the Cups or Cash for Girls (CCG) cluster randomized controlled trial in Siaya County, rural western Kenya. Laboratory confirmed biomarkers and survey data were utilized to assess the effects of girls' individual, household, and partner characteristics on the main outcome measures (adolescent reported sex, prior pregnancy, HIV, and HSV-2) through generalized linear model (GLM) analysis. Complete data were available for 3,998 girls (97%) with median age 17.1 years (interquartile range [IQR] 16.3 to 18.0 years); 17.2% were HSV-2 seropositive (n = 686) and 1.7% tested positive for HIV (n = 66). Sexual activity was reported by 27.3% girls (n = 1,090), of whom 12.2% had been pregnant (n = 133). After adjustment, orphanhood (adjusted risk ratio [aRR] 2.81, 95% confidence interval [CI] 1.18 to 6.71, p-value [p] = 0.020), low body mass index (BMI) (aRR 2.07; CI: 1.00 to 4.30, p = 0.051), and age (aRR 1.34, 1.18 to 1.53, p < 0.001) were all associated with HIV infection. Girls reporting light menstrual bleeding (aRR 2.42, 1.22 to 4.79, p = 0.012) for fewer than 3 days (aRR 2.81, 1.16 to 6.82, p = 0.023) were over twice as likely to have HIV. Early menarche (aRR 2.05, 1.33 to 3.17, p = 0.001) was associated with adolescent pregnancy and HSV-2-seropositive girls reported higher rates of pregnancy (aRR 1.62, CI: 1.16 to 2.27, p = 0.005). High BMI was associated with HSV-2 (aRR 1.24, 1.05 to 1.46, p = 0.010) and sexual activity (aRR 1.14, 1.02 to 1.28, p = 0.016). High levels of harassment were detected in the cohort (41.2%); being touched indecently conveyed the strongest association related to reported sexual activity (aRR 2.52, 2.26 to 2.81, p < 0.001). Study limitations include the cross-sectional design of the study, which informs on the SRH burdens found in this population but limits causal interpretation of associations, and the self-reported exposure ascertainment, which may have led to possible underreporting of risk factors, most notably prior sexual activity. Conclusions Our findings indicate that adolescent girls attending school in Kenya face frequent harassment for sex and are at high risk of pregnancy and HSV-2, with girls experiencing early menarche particularly vulnerable. Targeted interventions, such as earlier sexual education programs, are warranted to address their vulnerability to SRH harms. Trial registration ClinicalTrials.gov NCT03051789., Author(s): Garazi Zulaika 1,*, Elizabeth Nyothach 2, Anna Maria van Eijk 1, David Obor 2, Linda Mason 1, Duolao Wang 1, Tao Chen 1, Emily Kerubo 2, Valarie Opollo 2, [...]

Objective To evaluate mortality and morbidity among internally displaced persons (IDPs) who relocated in a demographic surveillance system (DSS) area in western Kenya following post-election violence. Methods In 2007, 204 000 individuals lived in the DSS area, where field workers visit households every 4 months to record migrations, births and deaths. We collected data on admissions among children < 5 years of age in the district hospital and developed special questionnaires to record information on IDPs. Mortality, migration and hospitalization rates among IDPs and regular DSS residents were compared, and verbal autopsies were performed for deaths. Findings Between December 2007 and May 2008, 16 428 IDPs migrated into the DSS, and over half of them stayed 6 months or longer. In 2008, IDPs aged 15-49 years died at higher rates than regular residents of the DSS (relative risk, RR: 1.34; 95% confidence interval, Ch 1.004-1.80). A greater percentage of deaths from human immunodeficiency virus (HIV) infection occurred among IDPs aged ≥ 5 years (53%) than among regular DSS residents (25-29%) (P< 0.001). Internally displaced children < 5 years of age did not die at higher rates than resident children but were hospitalized at higher rates (RR: 2.95; 95% Ch 2.44-3.58). Conclusion HIV-infected internally displaced adults in conflict-ridden parts of Africa are at increased risk of HIV- related death. Relief efforts should extend to IDPs who have relocated outside IDP camps, particularly if afflicted with HIV infection or other chronic conditions. Objectif Decrire le passage a l'echelle superieure d'un programme decentralise de traitement du VlH delivre au travers du systeme de soins de sante primaires au KwaZulu-Natal rural, Afrique du Sud, et evaluer les tendances des caracteristiques de ligne de base et les resultats sur la population etudiee. Methodes Le programme a commence la distribution d'une therapie antiretrovirale (TAR) en octobre 2004. Les informations concernant l'ensemble des patients entamant un traitement TAR ont ete recueillies dans une base de donnees informatisee et le suivi de leur etat a ete actualise chaque mois. Tous les patients adultes (≥ 16 ans) ayant commence laTAR entre octobre 2004 et septembre 2008 ont ete inclus et stratifies en groupes de 6 mois. Les caracteristiques cliniques et sociodemographiques ont ete comparees entre les groupes. Les taux de retention sous traitement et de mortalite, ainsi que les nombres de perdus pour le suivi et les resultats virologiques ont ete evalues 12 mois apres le debut de la TAR. Resultats Au total 5 719 patients ayant initie un traitement TAR ont ete inclus (67,9 % de femmes). Le nombre moyen de lymphocytes CD4+ a la ligne de base etait de 116 cellules/µL (intervalle interquartile, IQR: 53-173). Une augmentation de la proportion de femmes ayant entame un traitement TAR alors qu'elles etaient enceintes a ete notee, mais aucun changement n'a ete observe dans le temps pour les autres caracteristiques a la ligne de base. Le taux global de retention sous traitement a 12 mois etait de 84,0 % (intervalle de confiance a 95 %, IC: 82,6-85,3); 10,9 % sont decedes (10 a 95 %: 9,8-12,0); 3.7 % ont ete perdus pour le suivi (IC a 95 %: 3,0-4,4). La mortalite a ete plus elevee durant les 3 premiers mois qui ont suivi le debut de TAR : 30,1 deces pour 100 personnes-ans (IC a 95 %: 26,3-34,5). A 12 mois, 23,0 % presentaient une charge virale detectable (≥25 copies/mi) (IC a 95 %: 19,5-25,5). Conclusion Les resultats n'ont pas ete affectes par la rapide expansion . de ce programme de traitement du VIH decentralise. Les taux relativement eleves de charge virale detectable mettent en evidence la necessite de futurs efforts a mettre en place pour ameliorer la qualite des services. Objetivos Describir la ampliacion de un programa descentralizado de tratamiento del VIH a traves del sistema sanitario de atencion primaria en zonas rurales de KwaZulu-Natal, Sudafrica, y evaluar las tendencias de las caracteristicas iniciales y los resultados de la poblacion en estudio. Metodos El programa comenzo con la administracion de un tratamiento antirretroviral (ARV) en octubre de 2004. La informacion de todos los pacientes que comenzaron el tratamiento ARV se recopilo en la base de datos del programa y el seguimiento se actualizo mensualmente. Todos los pacientes adultos (≥ 16 anos) que iniciaron el tratamiento ARV entre octubre de 2004 y septiembre de 2008 se incluyeron y estratificaron en grupos de seis meses. Se compararon las caracteristicas clinicas y sociodemograficas intergrupales. A los 12 meses del inicio del tratamiento ARV se evaluo la continuidad asistencial, la perdida para el seguimiento y los resultados virologicos. Resultados Se incluyo a un total de 5719 adultos que habian iniciado el tratamiento ARV, de los que el 67,9% eran mujeres. EI recuento medio inicial de linfocitos CD4 fue de 116 celulas/pl (ampiitud intercuartil, AIC: 53-173). EI porcentaje de mujeres que iniciaron el tratamiento ARV durante el embarazo aumento, si bien no se produjo ningun cambio en otras caracteristicas iniciales a lo largo del tiempo. La continuidad asistencial general a los 12 meses fue del 84,0% (intervalo de confianza dei 95%, Cl: 82; 6--85,3); el 10,9% fallecio (Cl del 95%: 9; 8-12,0); el 3,7% se perdio para el seguimiento (Cl del 95%: 3,0-4,4). La mortalidad fue mas elevada en los primeros tres meses posteriores al inicio del tratamiento ARV: 30,1 fallecimientos por cada 100 anos-personas (CI del 95%: 26,3--34,5). EI 23,0% tenia una carga viral detectable a los 12 meses (≥ 25 replicas/mi)(CI del 95%: 19,5-25,5). Conclusion Los resultados no se vieron afectados por la rapida expansion de este programa descentralizado de tratamiento del VIH. Los indices relativamente altos de la carga virica detectable ponen en evidencia la necesidad de dedicar un mayor esfuerzo en la mejora de la calidad de los servicios., Introduction Following the contentious presidential elections held in Kenya on 27 December 2007, violence and civil unrest erupted throughout the country and lasted for several months. During that time, over [...]