Hiv testing and counselling for women attending child health clinics: An opportunity for entry to prevent mother-to-child transmission and hiv treatment. Author
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- Impact of HIV / AIDS on trends in major causes of death at a rural mission hospital in Kenya: Review of 4858 records. Author
- Commercial sex and HIV transmission in mature epidemics: a study of five African countries. Author
- Toll-like receptor expression and responsiveness are increased in viraemic HIV-1 infection. Author
- Feasibility, acceptability, effect and cost of integrating counseling and testing for HIV within family planning services in Kenya. Author
- HIV type 1 subtypes among STI patients in Nairobi: a genotypic study based on partial pol gene sequencing. Author
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- Longitudinal assessment of human immunodeficiency virus type 1 (HIV-1)-specific gamma interferon responses during the first year of life in HIV-1-infected infants. Author
- Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya. Author
- Challenges of a pandemic: HIV/AIDS-related problems affecting Kenyan widows. Author
- Anti-retroviral drug resistance-associated mutations among non-subtype B HIV-1-infected Kenyan children with treatment failure. Author
- Should voluntary counseling and testing counselors address alcohol use with clients Findings from an operations research study in Kenya. Author
- The link between HIV / AIDS and recent fertility patterns in Kenya. Author
Author: Lavreys, L.; Baeten, J. M.; Chohan, V.; McClelland, R. S.; Hassan, W. M.; Richardson, B. A.; Mandaliya, K.; Ndinya-Achola, J. O., and Overbaugh, J. Source: Clin Infect Dis. 2006 May 1; 42(9):1333-9. Abstract: Background: There is limited information on the natural history of human immunodeficiency virus type 1 (HIV-1) infection in Africa, especially from individuals with well-defined dates of infection. We used data from a prospective cohort study of female sex workers in Mombasa, Kenya, who were followed up monthly from before the date of HIV-1 infection. Methods: Antiretroviral-naive women who had a well-defined date of HIV-1 infection were included in this analysis. The effects of set point plasma viral load (measured 4-24 months after infection), early CD4+ cell count, and symptoms of acute HIV-1 infection on mortality were assessed using Cox proportional hazards analysis. Results: Among 218 women, the median duration of follow-up after HIV-1 infection was 4.6 years. Forty women died, and at 8.7 years (the time of the last death), the cumulative survival rate was 51% by Kaplan-Meier analysis. Higher set point viral load, lower early CD4+ cell count, and more-symptomatic acute HIV-1 illness each predicted death. In multivariate analysis, set point viral load (hazard ratio [HR], 2.28 per 1 log10 copies/mL increase; P=.001) and acute HIV-1 illness (HR, 1.14 per each additional symptom; P=.05) were independently associated with higher mortality. Conclusion: Among this group of African women, the survival rate was similar to that for HIV-1-infected individuals in industrialized nations before the introduction of combination antiretroviral therapy. Higher set point viral load and more-severe acute HIV-1 illness predicted faster progression to death. Early identification of individuals at risk for rapid disease progression may allow closer clinical monitoring, including timely initiation of antiretroviral treatment. Impact of HIV / AIDS on trends in major causes of death at a rural mission hospital in Kenya: Review of 4858 records. Author: Leblanc, P. A. Source: Annals of African Medicine. 2006; 5(3):142-148. Abstract: Acquired Immune Deficiency Syndrome (AIDS), caused by the human immunodeficiency virus (HIV), is a worldwide public health issue. Hospital death records can be used to study the impact of HIV in Africa. The explanation of mortality figures through hospital records identifies the evolution of the pandemic at that point. This study was framed with the objective, to describe trends in the leading causes of death from 1980 to 2000 at Kijabe Hospital; determining the proportion of deaths attributed to HIV/AIDS. Data were examined from death records stored in an ACCESS database at Kijabe Hospital. The numbers of deaths in categories of causes of death were used to determine trends in the most frequent causes of death over the time period. In the case of HIV/AIDS the frequency of this diagnosis as recorded on the death certificates was tracked. The study design was a retrospective review of the death records. Larger proportions of young people died in at Kijabe Hospital over the study period. HIV/AIDS became the leading cause of death for every year after 1991. These trends may help rural hospitals plan and allocate resources. The data in this study may influence local resource distribution and future programs in similar settings. (author's Commercial sex and HIV transmission in mature epidemics: a study of five African countries. Author: Leclerc, P. M. and Garenne, M. Source: Int J STD AIDS. 2008 Oct; 19(10):660-4. Abstract: The study compares the association between using the services of commercial sex workers and male HIV seroprevalence in five African countries: Ghana, Kenya, Lesotho, Malawi and Rwanda. The HIV seroprevalence among men who 'ever paid for sex' was compared with controls who 'never paid for sex'. Results were based on 12,929 eligible men, aged 15-59 years, interviewed in Demographic and Health Surveys. The odds ratio of HIV seroprevalence associated with ever paying for sex was 1.89 (95% confidence interval = 1.57-2.28), with only minor differences by country. The results were stable in multivariate analysis after controlling for available potential cofactors (data on non-sexual routes of transmission were not available). Given the relatively small proportion of men involved, the risk attributable to 'ever paying for sex' remained low: 7.1% in univariate analysis and 4.4% after adjustment, and it varied among countries (range 1.3-9.4%). These results match previous observations that commercial sex seems to play a minor role in the spread of HIV in mature epidemics. Toll-like receptor expression and responsiveness are increased in viraemic HIV-1 infection. Author: Lester, R. T.; Yao, X. D.; Ball, T. B.; McKinnon, L. R.; Kaul, R.; Wachihi, C.; Jaoko, W.; Plummer, F. A., and Rosenthal, K. L. Source: AIDS. 2008 Mar 30; 22(6):685-94. Abstract: Objectives: Toll-like receptors (TLR) are important in pathogen recognition and may play a role in HIV disease. We evaluated the effect of chronic untreated and treated HIV-1 infection on systemic TLR expression and TLR signalling. Methods: Two hundred HIV-infected and uninfected women from a Kenya cohort participated in the studies. TLR1 to TLR10 messenger RNA expression was determined by quantitative reverse transcriptase polymerase chain reaction in peripheral blood mononuclear cells (PBMC). TLR ligand responsiveness was determined in or using ex-vivo PBMC by cytokine production in culture supernatants. Results: Chronic, untreated HIV-1 infection was significantly associated with increased mRNA expression of TLR6, TLR7, and TLR8 and when analysis was limited to those with advanced disease (CD4 cell count < 200 cells/ml) TLR2, TLR3, and TLR4 were additionally elevated. TLR expression correlated with the plasma HIV-RNA load, which was significant for TLR6 and TLR7. In vitro HIV single-stranded RNA alone could enhance TLR mRNA expression. PBMC of HIV-infected subjects also demonstrated profoundly increased proinflammatory responsiveness to TLR ligands, suggesting sensitization of TLR signalling in HIV. Finally, viral suppression by HAART was associated with a normalization of TLR levels. Conclusion: Together, these data indicate that chronic viraemic HIV-1 is associated with increased TLR expression and responsiveness, which may perpetuate innate immune dysfunction and activation that underlies HIV pathogenesis, and thus reveal potential new targets for therapy. Feasibility, acceptability, effect and cost of integrating counseling and testing for HIV within family planning services in Kenya. Author: Liambila W; Kibaru J; Warren C; Gathitu M, and Mullick, S. Abstract: Integrating counseling and testing (CT) for HIV into family planning (FP) services potentially increases the range of services available for FP clients, many of whom are at risk of STIs including HIV in high prevalence settings. Systematic evidence about offering CT in FP settings has remained extremely limited, despite the widespread interest in this model of FP-HIV integration. FRONTIERS supported the Division of Reproductive Health (DRH) and the National AIDS and STI Control Program (NASCOP) of the Kenya Ministry of Health (MOH) to design, implement and compare two models of integrating CT for HIV within FP services in 23 health facilities in Nyeri and Thika Districts of Central Province, Kenya in terms of their feasibility, acceptability, cost and effect on the voluntary use of CT, as well as the quality of FP services. The study utilized a pre-post intervention design to obtain information from FP providers and their clients in 2006 to 2007. Data were collected through provider-client observations (554 at baseline and 530 at endline) and client exit interviews (552 at baseline and 530 at end line), pre and post intervention interviews and focus group discussions with health providers, and a health facility assessment of the readiness of facilities to offer HIV CT within FP services. Introduction and implementation involved: (a) holding sensitization meetings at national, provincial and district levels; (b) reviewing and developing training materials; (c) application of the Balanced Counseling Strategy (BCS) Plus approach; (d) modification of facility registers to record the required data; and (e) training of health providers. The MOH provided all required equipment and supplies, including HIV rapid test kits and FP commodities. Two models were pilot-tested. The "testing" model was implemented in Nyeri District, an area with relatively few VCT sites. In this model, FP clients were educated about HIV prevention generally, and CT in particular, and offered HIV CT during this consultation by the FP provider. The "referral" model was implemented in Thika district, an area with good accessibility to VCT services. In this model, FP clients were educated about HIV CT, and those interested were instead referred to a specialized CT service, either within the same facility or to another CT service (at another health facility or a stand-alone VCT center). The study demonstrated that both models were feasible and acceptable to providers and to clients as means of integrating and linking HIV prevention counseling, condom promotion and counseling and testing with FP services, and are effective in increasing quality of care and service utilization. (excerpt) HIV type 1 subtypes among STI patients in Nairobi: a genotypic study based on partial pol gene sequencing. Author: Lihana, R. W.; Khamadi, S. A.; Kiptoo, M. K.; Kinyua, J. G.; Lagat, N.; Magoma, G. N.; Mwau, M. M.; Makokha, E. P.; Onyango, V.; Osman, S.; Okoth, F. A., and Songok, E. M. Source: AIDS Res Hum Retroviruses. 2006 Nov; 22(11):1172-7. Abstract: Circulating strains of human immunodeficiency virus (HIV) exhibit an extraordinary degree of genetic diversity and have been classified on the basis of relationships into distinct lineages called groups, types, subtypes, and subsubtypes. Sexually transmitted infections (STIs) are known to be a risk factor for HIV infection. To establish HIV-1 subtype diversity among STI patients in Nairobi, 140 samples were collected and partial pol gene sequencing done. From the analysis it was established that subtype A1 was the major subtype (64%) followed by D (17%), C (9%), G (1%), and recombinants AD (4%), AC (3%), CRF02()AG (1%), and CRF16()A2D (1%). These results suggest that the HIV-1 epidemic may be evolving toward more virulent and complex subtypes through transmission of complex recombinants due to viral mixing. Any use of ARVs may therefore require initial testing for de novo resistance before commencement of treatment and/or management. Longitudinal assessment of human immunodeficiency virus type 1 (HIV-1)-specific gamma interferon responses during the first year of life in HIV-1-infected infants. Author: Lohman, B. L.; Slyker, J. A.; Richardson, B. A.; Farquhar, C.; Mabuka, J. M.; Crudder, C.; Dong, T.; Obimbo, E.; Mbori-Ngacha, D.; Overbaugh, J.; Rowland-Jones, S., and John-Stewart, G. Source: J Virol. 2005 Jul; 79(13):8121-30. Abstract: Human immunodeficiency virus type 1 (HIV-1) infection results in different patterns of viral replication in pediatric compared to adult populations. The role of early HIV-1-specific responses in viral control has not been well defined, because most studies of HIV-1-infected infants have been retrospective or cross-sectional. We evaluated the association between HIV-1-specific gamma interferon (IFN-gamma) release from the cells of infants of 1 to 3 months of age and peak viral loads and mortality in the first year of life among 61 Kenyan HIV-1-infected infants. At 1 month, responses were detected in 7/12 (58%) and 6/21 (29%) of infants infected in utero and peripartum, respectively (P = 0.09), and in approximately 50% of infants thereafter. Peaks of HIV-specific spot-forming units (SFU) increased significantly with age in all infants, from 251/10(6) peripheral blood mononuclear cells (PBMC) at 1 month of age to 501/10(6) PBMC at 12 months of age (P = 0.03), although when limited to infants who survived to 1 year, the increase in peak HIV-specific SFU was no longer significant (P = 0.18). Over the first year of life, infants with IFN-gamma responses at 1 month had peak plasma viral loads, rates of decline of viral load, and mortality risk similar to those of infants who lacked responses at 1 month. The strength and breadth of IFN-gamma responses at 1 month were not significantly associated with viral containment or mortality. These results suggest that, in contrast to HIV-1-infected adults, in whom strong cytotoxic T lymphocyte responses in primary infection are associated with reductions in viremia, HIV-1-infected neonates generate HIV-1-specific CD8+-T-cell responses early in life that are not clearly associated with improved clinical outcomes. Impact of five years of peer-mediated interventions on sexual behavior and sexually transmitted infections among female sex workers in Mombasa, Kenya. Author: Luchters S; Chersich, M. F.; . = Rinyiru A; Barasa MS, and King'ola N. Source: BMC Public Health. 2008 Apr 29; 8:143. Abstract: Since 2000, peer-mediated interventions among female sex workers (FSW) in Mombasa Kenya have promoted behavioural change through improving knowledge, attitudes and awareness of HIV serostatus, and aimed to prevent HIV and other sexually transmitted infection (STI) by facilitating early STI treatment. Impact of these interventions was evaluated among those who attended peer education and at the FSW population level. A pre-intervention survey in 2000, recruited 503 FSW using snowball sampling. Thereafter, peer educators provided STI/HIV education, condoms, and facilitated HIV testing, treatment and care services. In 2005, data were collected using identical survey methods, allowing comparison with historical controls, and between FSW who had or had not received peer interventions. Over five years, sex work became predominately a full-time activity, with increased mean sexual partners (2.8 versus 4.9/week; P less than 0.001). Consistent condom use with clients increased from 28.8% (145/503) to 70.4% (356/506; P less than 0.001) as well as the likelihood of refusing clients who were unwilling to use condoms (OR=4.9, 95%CI=3.7-6.6). In 2005, FSW who received peer interventions (28.7%, 145/506), had more consistent condom use with clients compared with unexposed FSW (86.2% versus 64.0%; AOR=3.6, 95%CI=2.1-6.1). These differences were larger among FSW with greater peer-intervention exposure. HIV prevalence was 25% (17/69) in FSW attending greater than or equal to 4 peer-education sessions, compared with 34% (25/73) in those attending 1-3 sessions (P=0.21). Overall HIV prevalence was 30.6 (151/493) in 2000 and 33.3% (166/498) in 2005 (P=0.36). Peer-mediated interventions were associated with an increase in protected sex. Though peer-mediated interventions remain important, higher coverage is needed and more efficacious interventions to reduce overall vulnerability and risk. (author's) Challenges of a pandemic: HIV/AIDS-related problems affecting Kenyan widows. Author: Luginaah, I.; Elkins, D.; Maticka-Tyndale, E.; Landry, T., and Mathui, M. Source: Soc Sci Med. 2005 Mar; 60(6):1219-28. Abstract: The paper reports the findings of a qualitative study using focus group discussions and in-depth interviews about the challenges faced by widows as they confront the direct and indirect impacts of HIV/AIDS in Nyanza, Kenya. Two focus groups were conducted with widows from two community-based organizations. This was followed by in-depth interviews with four members and two leaders from each of the community-based organizations. The contents were analysed using grounded theory. The findings reveal several challenges encountered by widows in their struggles with the direct and indirect impacts of HIV/AIDS. Widows who know or do not know their HIV status are conscious about the possibility of contracting or transmitting the virus. Wife inheritance (a Luo custom), emerged as an outstanding issue for the widows in the context of HIV/AIDS transmission. The widows employ various strategies to resist being inherited. Widows in the current epidemic navigate issues of sexuality in various ways, such as insisting their partners use condoms or permanently abstaining from sexual intercourse. Anti-retroviral drug resistance-associated mutations among non-subtype B HIV-1-infected Kenyan children with treatment failure. Author: Lwembe, R.; Ochieng, W.; Panikulam, A.; Mongoina, C. O.; Palakudy, T.; Koizumi, Y.; Kageyama, S.; Yamamoto, N.; Shioda, T.; Musoke, R.; Owens, M.; Songok, E. M.; Okoth, F. A., and Ichimura, H. Source: J Med Virol. 2007 Jul; 79(7):865-72. Abstract: Recently increased availability of anti-retroviral therapy (ART) has mitigated HIV-1/AIDS prognoses especially in resource poor settings. The emergence of ART resistance-associated mutations from non-suppressive ART has been implicated as a major cause of ART failure. Reverse transcriptase inhibitor (RTI)-resistance mutations among 12 non-subtype B HIV-1-infected children with treatment failure were evaluated by genotypically analyzing HIV-1 strains isolated from plasma obtained between 2001 and 2004. A region of pol-RT gene was amplified and at least five clones per sample were analyzed. Phylogenetic analysis revealed HIV-1 subtype A1 (n = 7), subtype C (n = 1), subtype D (n = 3), and CRF02_AG (n = 1). Before treatment, 4 of 12 (33.3%) children had primary RTI-resistance mutations, K103N (n = 3, ages 5-7 years) and Y181C (n = 1, age 1 year). In one child, K103N was found as a minor population (1/5 clones) before treatment and became major (7/7 clones) 8 months after RTI treatment. In 7 of 12 children, M184V appeared with one thymidine-analogue-associated mutation (TAM) as the first mutation, while the remaining 5 children had only TAMs appearing either individually (n = 2), or as TAMs 1 (M41L, L210W, and T215Y) and 2 (D67N, K70R, and K219Q/E/R) appearing together (n = 3). These results suggest that "vertically transmitted" primary RTI-resistance mutations, K103N and Y181C, can persist over the years even in the absence of drug pressure and impact RTI treatment negatively, and that appearing patterns of RTI-resistance mutations among non-subtype B HIV-1-infected children could possibly be different from those reported in subtype B-infected children. Should voluntary counseling and testing counselors address alcohol use with clients? Findings from an operations research study in Kenya. Author: Mackenzie C and Kiraju, K. Abstract: With more than 800 VCT centers spread all over Kenya (NASCOP 2006), VCT services are now an important entry point for HIV prevention, treatment, and care. During pre-test counseling, clients are given information on modes of HIV transmission and triggers of risky behavior. Thus, the VCT setting offers an optimal venue for discussing alcohol as a factor in HIV transmission and for helping clients formulate a risk-reduction plan. Because both HIV and alcohol abuse are stigmatized, VCT centers can offer a supportive atmosphere to bring up risk behaviors that are otherwise uncomfortable to discuss, and can offer appropriate referrals. In order to document whether there is an unmet need for alcohol counseling among VCT clients in Kenya, focus group discussions and exit interviews were conducted in a variety of VCT service delivery points. This research is part of a larger operations research project being implemented by the Horizons Program, Liverpool VCT and Care, and the Steadman Group. Its goal is to provide information on the alcohol and substance use counseling needs of clients seeking HIV services, and provide guidance on how substance use can be effectively integrated into HIV counseling and testing. (excerpt) The link between HIV / AIDS and recent fertility patterns in Kenya. Author: Magadi M and Agwanda, A. Abstract: The relationship between fertility and the HIV/AIDS epidemic is not well understood. Although existing studies elsewhere generally point to the epidemic resulting in fertility reduction, earlier evidence from the Kenya Demographic and Health Survey 2003 (Central Bureau of Statistics [CBS], Kenya Ministry of Health [MOH] & ORC Macro, 2004), hereafter referred to as KDHS, showed interesting patterns, with regions most adversely affected with the HIV/AIDS epidemic showing the clearest sign of a reversal trend in fertility decline. HIV/AIDS may influence fertility through one or more behavioral and/or biological proximate fertility determinants. In this study, we explore: (i) the regional variations in the link between HIV/AIDS and fertility; (ii) possible mechanisms through which HIV/AIDS may influence fertility; and (iii) the effect of individual and contextual community-level HIV/AIDS factors on fertility. The study is based on secondary analysis of the 2003 KDHS data, which provides a unique opportunity to explore the impact of the HIV/AIDS epidemic on the affected populations, being the fourth survey in the international DHS program to include HIV testing, and the first to anonymously link the HIV results with key behavioral, social, and demographic factors at individual and household level. Multilevel models are used to examine the effect of individual and contextual community-level HIV/AIDS factors on fertility. The modeling is carried out in stages, starting with the key variables relating to HIV/AIDS, before introducing various proximate fertility determinants in successive stages, to explore possible mechanisms through which HIV/AIDS may influence fertility. The study corroborates findings of earlier studies on the fertility inhibiting effect of HIV/AIDS among infected women. HIV/AIDS infected women have 40 percent lower odds of having had a recent birth than their uninfected counterparts of similar background characteristics and child mortality experience. After taking into account proximate determinants of fertility relating to sexual exposure, breastfeeding duration, and fetal loss, the odds for HIV/AIDS infected women are 33 percent lower, suggesting that the effect of HIV/AIDS on fertility is partly through these proximate determinants. However, there is no evidence of a significant association between community level HIV/AIDS prevalence and fertility when the background socio-cultural and demographic factors are controlled for. The results suggest that although recent trends in sexual exposure factors (e.g. rising age at first sex and age at first marriage and a decline in the proportion of women in union) might be expected to sustain a declining trend in fertility, trends in some of the proximate determinants, including reduced duration of breastfeeding and increased child mortality coupled with reduced desire to stop childbearing may have contributed to the stalled fertility decline in Kenya. Whilst HIV/AIDS may have influenced the recent changes in sexual exposure factors, it is also likelythat it has contributed to increasing infant and child mortality and reduced duration of breastfeeding, which are partly responsible for the stall in fertility decline. The regional patterns show that the most notable increase in fertility and the greatest decline in contraceptive prevalence were observed in Nyanza province, the region with the highest HIV/AIDS prevalence. The regional patterns of the other proximate determinants with respect to sexual exposure factors, infant/child mortality and duration of breastfeeding all show unfavorable patterns for the region. For instance, Nyanza has consistently recorded the lowest age at first sex, the lowest age at first marriage, and the highest infant and child mortality in Kenya across years. The recent trends in Nyanza have not been encouraging either: it witnessed the least overall rise in age at first sex and first marriage during the 1993-2003 period; and recorded among the greatest declines in the duration of breastfeeding. These patterns are likely to have contributed to the observed reversal of fertility decline in the region. 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