Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author


Determinants of Consistent Condom Use Vary by Partner Type among Young Men in Kisumu, Kenya: A Multi-level Data Analysis



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Determinants of Consistent Condom Use Vary by Partner Type among Young Men in Kisumu, Kenya: A Multi-level Data Analysis.
Author: Westercamp, N.; Mattson, C. L.; Madonia, M.; Moses, S.; Agot, K.; Ndinya-Achola, J. O.; Otieno, E.; Ouma, N., and Bailey, R. C.
Source: AIDS Behav. 2008 Sep 13.
Abstract: To evaluate whether determinants of consistent condom use vary by partner type among young sexually active Kenyan men, we conducted a cross-sectional assessment of lifetime sexual histories from a sub-sample of men enrolled in a clinical trial of male circumcision. 7913 partnerships of 1370 men were analyzed. 262 men (19%) reported never, 1018 (74%) sometimes and 92 (7%) always using a condom with their partners. Condoms were always used in 2672 (34%) of the total relationships-212 (70%) of the relationships with sex workers, 1643 (40%) of the casual and 817 (23%) of the regular/marital relationships. Factors influencing condom use varied significantly by partner type, suggesting that HIV prevention messages promoting condom use with higher-risk partners have achieved a moderate level of acceptance. However, in populations of young, single men in generalized epidemic settings, interventions should promote consistent condom use in all sexual encounters, independently of partner type and characteristics.

Renal disease in an antiretroviral-naive HIV-infected outpatient population in Western Kenya.
Author: Wools-Kaloustian, K.; Gupta, S. K.; Muloma, E.; Owino-Ong'or, W.; Sidle, J.; Aubrey, R. W.; Shen, J.; Kipruto, K.; Zwickl, B. E., and Goldman, M.
Source: Nephrol Dial Transplant. 2007 Aug; 22(8):2208-12.
Abstract: Background:

Several commonly used antiretrovirals (ARVs) require dose adjustments to prevent toxicities in the presence of renal insufficiency. Because no prospective studies of the prevalence or risk factors for kidney disease in stable outpatient human immunodeficiency virus (HIV)-infected indigenous African populations have been published to date, it is not known if already scarce resources should be allocated to detect renal dysfunction, in those without risk factors for kidney disease, prior to initiation of increasingly available antiretrovirals in developing countries.


Methods:

A cross-sectional study to determine the prevalence of and risk factors for renal disease in a cohort of medically stable, HIV-infected, antiretroviral-naive adults, without diabetes or hypertension, presenting to an HIV clinic in western Kenya.


Results:

Of 373 patients with complete data, renal insufficiency (CrCl <60 ml/min) was identified in 43 (11.5%) [18 (4.8%) had a CrCl <50 ml/min]. Despite high correlation coefficients between the three renal function estimating equations used, when compared to creatinine clearance as calculated by Cockcroft-Gault, lower rates of moderate to severe renal insufficiency were identified by the Modification of Diet in Renal Disease equations. Proteinuria, defined as a urine dipstick protein of equal to or greater than 1+, was detected in only 23 subjects (6.2%).


Conclusions:

Renal insufficiency is not uncommon, even in stable patients without diabetes or hypertension. Conversely, proteinuria was unexpectedly infrequent in this population. Utilizing resources to assess renal function prior to initiation of antiretrovirals in order to identify those likely to benefit from dosage adjustment is justified.



Viability and effectiveness of large-scale HIV treatment initiatives in sub-Saharan Africa: experience from western Kenya.
Author: Wools-Kaloustian, K.; Kimaiyo, S.; Diero, L.; Siika, A.; Sidle, J.; Yiannoutsos, C. T.; Musick, B.; Einterz, R.; Fife, K. H., and Tierney, W. M.
Source: AIDS. 2006 Jan 2; 20(1):41-8.
Abstract: Objectives:

To determine the clinical and immunological outcomes of a cohort of HIV-infected patients receiving antiretroviral therapy.


Design:

Retrospective study of prospectively collected data from consecutively enrolled adult HIV-infected patients in eight HIV clinics in western Kenya.


Methods:

CD4 cell counts, weight, mortality, loss to follow-up and adherence to antiretroviral therapy were collected for the 2059 HIV-positive non-pregnant adult patients treated with antiretroviral drugs between November 2001 and February 2005.


Results:

Median duration of follow-up after initiation of antiretroviral therapy was 40 weeks (95% confidence interval, 38-43); 111 patients (5.4%) were documented as deceased and 505 (24.5%) were lost to follow-up. Among 1766 (86%) evaluated for adherence to their antiretroviral regimen, 78% reported perfect adherence at every visit. Although patients with and without perfect adherence gained weight, patients with less than perfect adherence gained 1.04 kg less weight than those reporting perfect adherence (P = 0.059). CD4 cell counts increased by a mean of 109 cells/microl during the first 6 weeks of therapy and increased more slowly thereafter, resulting in overall CD4 cell count increases of 160, 225 and 297 cells/microl at 12, 24, and 36 months respectively. At 1 year, a mean increase of 170 cells/microl was seen among patients reporting perfect adherence compared with 123 cells/microl among those reporting some missed doses (P < 0.001).


Conclusions:

Antiretroviral treatment of adult Kenyans in this cohort resulted in significant and persistent clinical and immunological benefit. These findings document the viability and effectiveness of large-scale HIV treatment initiatives in resource-limited settings.



Payment for antiretroviral drugs is associated with a higher rate of patients lost to follow-up than those offered free-of-charge therapy in Nairobi, Kenya.
Author: Zachariah, R.; Van Engelgem, I.; Massaquoi, M.; Kocholla, L.; Manzi, M.; Suleh, A.; Phillips, M., and Borgdorff, M.
Source: Trans R Soc Trop Med Hyg. 2008 Mar; 102(3):288-93.
Abstract: This retrospective analysis of routine programme data from Mbagathi District Hospital, Nairobi, Kenya shows the difference in rates of loss to follow-up between a cohort that paid 500 shillings/month (approximately US$7) for antiretroviral drugs (ART) and one that received medication free of charge. A total of 435 individuals (mean age 31.5 years, 65% female) was followed-up for 146 person-years: 265 were in the 'payment' cohort and 170 in the 'free' cohort. The incidence rate for loss to follow-up per 100 person-years was 47.2 and 20.5, respectively (adjusted hazard ratio 2.27, 95% CI 1.21-4.24, P=0.01). Overall risk reduction attributed to offering ART free of charge was 56.6% (95% CI 20.0-76.5). Five patients diluted their ART regimen to one tablet (instead of two tablets) twice daily in order to reduce the monthly cost of medication by half. All these patients were from the payment cohort. Payment for ART is associated with a significantly higher rate of loss to follow-up, as some patients might be unable to sustain payment over time. In resource-limited settings, ART should be offered free of charge in order to promote treatment compliance and prevent the emergence of drug resistance.

AIDS in Kenya: trends, interventions and impact. 7th edition.
Abstract: Over two decades since the first AIDS case was described in Kenya, HIV/AIDS still remains a huge problem for the country in its efforts for social and economic development. Responses to the pandemic have evolved over time as people became aware of this new disease, as they experienced illness and death among family members, and as services have developed to confront this epidemic. Initially many segments of society expressed denial of the disease. Early in the epidemic in Kenya political commitment was limited. While awareness of AIDS has been nearly universal for more than a decade, misconceptions still abound and many still have not dealt with this disease at a personal or community level. This 7th edition of AIDS in Kenya comes at a crossroads in response to the epidemic. In the last 5 years HIV-related health services have expanded dramatically; they include the widespread availability of testing and counselling, and treatment with antiretroviral drugs, both to prevent mother-to-child transmission and to improve health and prolong life for people with advanced HIV infection and AIDS. While HIV remains an incurable infection, Kenya has now entered an era in which there is new hope in treating and caring for people with AIDS. This hope also offers new, effective opportunities for preventing HIV infection, as people with HIV infection learn they are infected and learn how to better protect their loved ones. (ex

Community-Based HIV / AIDS Prevention Care and Support Project (COPHIA).
Source: Project No. 623-A-00-99-000045-00. Final report: July 1999 - June 2005.
Abstract: Prior to COPHIA's commencement, when discharged from a hospital most Kenyans with AIDS were cared for by family, friends or volunteers with limited nursing knowledge and skills, no professional backup, and very little understanding of the virus and its consequences. Fear of the disease and stigma aimed at those infected by household and community members and even healthcare workers, meant that many HIV-infected people received little or no care and were simply left to die. To address the overwhelming need for home-based care, USAID/Kenya awarded Pathfinder International a cooperative agreement to launch the Community-Based HIV/AIDS Care, Support, and Prevention (COPHIA) project in June 1999. COPHIA was designed to meet the entire spectrum of needs experienced by People Living With HIV/AIDS (PLWHA) and their families-physical, social, psychological, emotional, and spiritual-by providing comprehensive home-based care. And in doing so, COPHIA responded to the devastating toll the HIV/AIDS pandemic has taken on Kenyan families and communities, both in terms of human and development losses. Initially envisioned as a three-year, $2 million initiative, the program evolved into a $7.5 million, 6-year program, which continued beyond this project period with funding from other sources. (excerpt)

Corporate partners support vocational programs for orphans and vulnerable children in Kenya.
Source: Pathways. 2005 Jun; 5.
Abstract: The story of Laban Liboyi, a 20-year-old Kenyan youth, is like many others in his homeland, AIDS-ravaged Western Province of Kenya. Having lost first his father, then his mother, to AIDS by the age of 17, he became the sole support for his three little brothers and two sisters. Relatives and neighbors already burdened with the epidemic and too many dependents withdrew their support, and the chances of survival for Laban and his siblings grew slim. However, Laban’s experience diverges from the 650,000 orphans and vulnerable children (OVC) in Kenya whose support networks have been decimated by the AIDS epidemic. One day in July 2003, Laban met a community health worker at the market, who urged him to register with the Kabras Jua Kali Association (KJKA). Under an initiative led by Pathfinder International and Barclay’s Bank of Kenya, Ltd., KJKA runs a program for orphans and vulnerable children ages 15-21 years. The program trains them in vocational skills such as carpentry and tailoring, and links them to jobs and resources, such as micro credit groups. Laban soon enrolled. (excerpt)

Early infant diagnosis of HIV through dried blood spot testing: Pathfinder International / Kenya's Prevention of Mother to Child Transmission project.
Abstract: Without treatment, an infant infected with HIV in Africa has a 35 percent chance of dying by his first birthday and a 53 percent chance of dying before the age of two. But if the baby receives prophylactic antibiotics, such as cotrimoxazole, soon after birth and Antiretroviral Therapy (ART) as soon as is medically indicated, he has a good chance of surviving childhood and living a long, healthy life. The challenge in resource-limited settings is identifying HIV-infected infants and providing early access to this lifesaving medicine. Access to Antiretroviral (ARV) drugs has improved in Kenya in the last few years, spurred in large part by the introduction of the President's Emergency Plan for AIDS Relief. But until very recently, little could be done to diagnose infants' HIV status in their first year of life. (excerpt)

Evaluations of five programs for orphans and vulnerable children in Kenya and Tanzania.
Abstract: In sub-Saharan Africa, an estimated 12 million children 17 years of age or younger have lost one or both parents to AIDS. Many more children live with one or more chronically ill parent. Despite the recognition of the magnitude and negative consequences of this problem, there is little empirical evidence on "what works" to improve the well-being of children affected by HIV and AIDS. Governments, program managers, and service providers need strategic information on how to reach more orphans and vulnerable children (OVC) with services that improve their well-being. Information on effectiveness and costs of interventions for OVC can help donors, policymakers, and program managers make better informed decisions on the allocation of scarce resources. In an attempt to fill these knowledge gaps, MEASURE Evaluation with U.S. President's Emergency Plan for AIDS Relief funds from the U.S. Agency for International Development (USAID) will conduct evaluations of four programs for OVC in Kenya and Tanzania. There will also be a costing component of the study that will inform resource allocation and help estimate the costs of scaling up programs. (excerpt)

Financing framework: resource requirement for the Kenya National AIDS Strategic Plan (KNASP), 2005-2010.
Abstract: The following report provides a summary analysis of the resources required to achieve the broad objectives outlined in Kenya's National AIDS Strategic Plan (KNASP). The report specifically provides summary information on the key interventions as laid out in the KNASP (2005-2010) and the financial resources required for a credible response to the epidemic. The report also includes the best estimates on the current coverage of those interventions; the current assumptions about HIV/AIDS capacity required to scale up coverage; the best current estimates; and the current and projected HIV/AIDS resources. The data specific to Kenya were obtained using a combination of: 1) key informant interviews with representatives from government, US government agencies, UN institutions, and local universities; 2) a review of six existing HIV/AIDS budgets in Kenya; 3) review of international literature; and 4) various demographic and economic surveys conducted on HIV/AIDS interventions in Kenya. (excerpt)

HIV / AIDS and sexually transmitted infection in Kenya. Behavioural surveillance survey 2002. Summary report.
Abstract: The government of Kenya through the National AIDS/STI Control Program (NASCOP) of the Ministry of Health in collaboration with Family Health International (FHI), the Centers for Disease Control and Prevention (CDC), and the Central Bureau of Statistics (CBS) conducted a national behavioural surveillance survey of HIV/AIDS and sexually transmitted infection in Kenya in late 2002 in order to understand the behaviour dynamics driving the HIV epidemic. The behavioural surveillance survey is a monitoring and evaluation tool to track trends in HIV/AIDS knowledge, attitudes and behaviour in populations at particular risk of HIV infection, such as youth, female sex workers and migrant men. It is envisaged that this survey will be repeated every two or three years to monitor trends and changes in HIV and sexually transmitted infection risky behaviour in the country. The populations selected to participate in the first round of the national behavioural surveillance survey were out-of-school youth, youth in school, female sex workers, women in low-income settings, matatu or mini-van drivers and their touts or helpers, bodaboda or bicycle taxi cyclists, policemen, and men in large worksites. Questionnaires were developed in both English and Kiswahili. They were administered to respondents in the selected groups by trained interviewers under close supervision of a team of supervisors. High standards of conducting the survey were adhered to in terms of a well-planned data collection strategy and a commitment to establish high-quality data systems. EpiData software was used for data entry and processing, and a statistical software package for social sciences was used for data analysis. (excerpt)

HIV and AIDS Planning Workshop report.
Abstract: This is a report of the first workshop ever held in Kenya for HIV-positive teachers, between 13th and 18th December 2004. It was organised by the Kenya Network of Positive Teachers (KENEPOTE) and the POLICY Project with support from USAID. The 60 HIV-positive teachers attending came from all Kenyan provinces. The top leadership of the Ministry of Education, Science and Technology (MOEST) and Kenya National Union of Teachers (KNUT) participated in the opening and closing ceremonies of the Workshop while the Director of the Teachers Service Commission/ AIDS Control Unit (TSC/ACU) attended throughout. USAID officer responsible for its HIV and AIDS programs in Kenya attended the closing ceremony. (excerpt

HIV notes from MEASURE DHS.
Abstract: The Kenya HIV Service Provision Assessment (SPA) survey, the first SPA to look at national HIV/AIDS health care delivery services, has just been published in Kenya. The 2004 KSPA includes a nationally representative sample of 440 health care facilities ranging from stand alone VCT sites to provincial and national referral hospitals. Survey results show a complex picture of uneven availability and quality but also provide clear evidence of PEPFAR funds at work. Almost 10 percent of Kenya health care facilities and just over 50 percent of its hospitals now provide antiretroviral treatment (ART). NGO and private for-profit facilities are more likely to offer ART than government-managed facilities. 24 percent of facilities offer some element of PMTCT. Only 13 percent offer the full PMTCT package with HIV counseling and testing, counseling on infant feeding and family planning, and ARV prophylaxis for the infant. Just 4 percent of facilities nationwide offer PMTCT+. (excerpt)

Hormonal Contraception and HIV: Science and Policy.
Source: Africa Regional Meeting, Nairobi 19-21 September 2005. Statement (final).
Abstract: The World Health Organization Headquarters Office and Regional Office for Africa, in partnership with the Reproductive Health and HIV Research Unit of the University of Witwatersrand in South Africa (a WHO Collaborating Centre), International Planned Parenthood Federation Africa Region and Family Health International (FHI), convened a meeting of 72 representatives from 17 francophone, lusophone and Anglophone sub-Saharan African countries on “Hormonal Contraception and HIV: Science and Policy”. The participants included policymakers and programme managers involved with family planning, sexual and reproductive health, and HIV/AIDS, women’s health advocates, people living with HIV and scientists and clinicians involved with family planning and HIV research. They were joined by 13 representatives from international donor and non-governmental organizations and agencies. The goal of the meeting was to promote evidence-based discussion and decision-making in response to new information on any potential association between hormonal contraceptive use and the acquisition of HIV. (excerpt)

USAID's Implementing AIDS Prevention and Care (IMPACT) project.
Source: Kenya final report, September 1999 - September 2007.
Abstract: The project design included activities to support the HIV/AIDS program at the national level. It involved mobilizing private and parastatal businesses to initiate HIV interventions; supporting nongovernmental organizations (NGOs) and other networks to expand coverage; improving blood safety; strengthening sero-surveillance and behavioral surveillance; and supporting prevention and care initiatives. In 2000, with USAID's Leadership and Investing in Fighting an Epidemic (LIFE) Initiative, FHI expanded IMPACT/Kenya's geographic coverage from five to ten community sites in the three provinces and broadened its focus to include activities linking prevention, care, and psychosocial support. In 2003, IMPACT/Kenya adapted to address priorities put forth by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). As a result, IMPACT increased its focus on care and treatment and linked it to the prevention, care, and support program. Likewise, the communication response evolved from purely a preventionprogram to include treatment and support messages and prevention in the care setting. Nairobi was also added as a priority region. (excerpt)

Estimating expenditures on general health and HIV / AIDS care.
Source: Kenya National Health Accounts 2002:
Abstract: The government of Kenya (GoK) faces the dilemma of combating a growing burden of disease, regulating quality, and improving equity in health care distribution within the context of declining public financing that is forcing rationalization of health service delivery. To help resolve the dilemma, Kenyan policymakers need a comprehensive understanding of the organization and financing of the country’s health care system, including the expenditures on health care made by donors, public sector entities, and the private sector, particularly households. One tool that the government is using to understand health care expenditures is National Health Accounts (NHA), an internationally accepted framework for tracking the expenditures from their sources to their end uses. (excerpt
Kenya Network of HIV-Positive Teachers (KENEPOTE).
Abstract: Teachers interact with many people as they perform their many and varied roles, in classrooms and at school, as teachers, counsellors, role models and parents. They are also leaders in the church and the community, holding responsible positions, and are held in high esteem. Their countrywide distribution enables them to effectively advocate behaviour change since HIV and AIDS is a behavioural disease. "A teacher can save more lives than a doctor". KENEPOTE is a network of HIV-positive teachers founded in September 2003 by two HIV-positive teachers (Elsa Ouko, now retired, and living in Kitale, and Margaret Wambete, a teacher at Sosiani Primary School in Eldoret Municipality) after attending the International Conference on Sexually Transmitted Diseases and AIDS in Sub-Saharan Africa (ICASA) in Nairobi. The idea of the network had been muted earlier by a number of teachers both in the work place and others who had retired or forced to retire because of their HIV status. Some of these teachers have dedicated their time to running Community Based Organizations (CBOs) for people living with HIV and AIDS (PLWHAs); and providing support for orphans and vulnerable children (OVCs). (excerpt)

Kenyan national guidelines on nutrition and HIV / AIDS.
Abstract: People infected with HIV are at greater risk of malnutrition than those who are not infected. HIV and opportunistic infections interfere with the desire and ability to eat thus reducing dietary intake; causing mal-absorption of nutrients; increasing energy demand thus increasing nutrient requirements; and causing abnormal use of protein. Limited food security and inadequate knowledge of good nutrition in regions of Kenya where HIV is prevalent, makes the situation worse. The fundamental nutritional concerns for HIV-infected people include: the availability of a balanced diet on a continuous basis; factors that negatively impact food intake and utilization; drug/nutrient interactions; and interventions to help cope with nutrition-related, chronic conditions such as diabetes mellitus. HIV infection and associated malnutrition progressively weaken the immune system, lowering quality of life and odds for survival, thus infected persons and caregivers need clear, concise information on nutritional careand support. Nutritional care, as an adjunctive intervention to ART viral treatment, will enhance rehabilitation, optimize antiretroviral therapy, and enhance adherence to ART. The purpose of these Guidelines is to: Provide simple and practical ways to assess the nutritional status of HIV-infected clients and assess the risk of malnutrition; Assist service providers to identify locally-appropriate, sustainable ways of increasing dietary intake by those who are infected with HIV; and Mainstream nutrition interventions into the national HIV/AIDS response. (excerpt)


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