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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Participants:

Eighteen maternity care providers, including 14 nurse/midwives, 2 physician assistants, and 2 physicians (ob/gyn specialists).


Results:

The HIV/AIDS epidemic has had numerous adverse effects and a few positive effects on maternity care providers in this setting. Adverse effects include reductions in the number of health care providers, increased workload, burnout, reduced availability of services in small health facilities when workers are absent due to attending HIV/AIDS training programs, difficulties with confidentiality and unwanted disclosure, and maternity care providers' fears of becoming HIV infected and the resulting stigma and discrimination. Positive effects include improved infection control procedures on maternity wards and enhanced maternity care provider knowledge and skills.


Conclusion:

A multifaceted package including policy, infrastructure, and training interventions is needed to support maternity care providers in these settings and ensure that they are able to perform their critical roles in maternal healthcare and prevention of HIV/AIDS transmission.



HIV/AIDS and maternity care in Kenya: how fears of stigma and discrimination affect uptake and provision of labor and delivery services.
Author: Turan, J. M.; Miller, S.; Bukusi, E. A.; Sande, J., and Cohen, C. R.
Source: AIDS Care. 2008 Sep; 20(8):938-45.
Abstract: Although policies and programs exist to promote safe motherhood in sub-Saharan Africa, maternal health has not improved and may be deteriorating in some countries. Part of the explanation may be the adverse effects of HIV/AIDS on maternity care. We conducted a study in Kisumu, Kenya to explore how fears related to HIV/AIDS affect women's uptake and health workers' provision of labor and delivery services. In-depth qualitative interviews with 17 maternity workers, 14 pregnant or postpartum women, four male partners and two traditional birth attendants; as well as structured observations of 22 births; were conducted at four health facilities. Participants reported that fears of HIV testing; fears of involuntary disclosure of HIV status to others, including spouses; and HIV/AIDS stigma are among the reasons that women avoid delivering in health facilities. Maternity workers now have to take into account the HIV status of the women they serve (as well as their own fears of becoming infected and stigmatized) but do not seem to be adequately prepared to handle issues related to consent, confidentiality and disclosure. Importantly, it appeared that women of unknown HIV status during labor and delivery were likely to be targets of stigma and discriminatory practices and that these women were not receiving needed counseling services. The findings suggest that increasing infection control precautions will not be enough to address the challenges faced by maternity care providers in caring for women in high-HIV-prevalence settings. Maternity workers need enhanced culturally sensitive training regarding consent, confidentiality and disclosure. Furthermore, this study points to the necessity of paying more attention to the care of women of unknown HIV-serostatus during labor and delivery. Such interventions may improve the quality of maternity care, increase utilization and contribute to overall improvements in maternal health, while also enhancing prevention of mother-to-child-transmission and HIV care.

Preventing mother-to-child transmission of HIV in Western Kenya: operational issues.
Author: Van't Hoog, A. H.; Mbori-Ngacha, D. A.; Marum, L. H.; Otieno, J. A.; Misore, A. O.; Nganga, L. W., and Decock, K. M.
Source: J Acquir Immune Defic Syndr. 2005 Nov 1; 40(3):344-9.
Abstract: Objectives:

To improve uptake in a program to prevent mother-to-child HIV transmission and describe lessons relevant for prevention of mother-to-child transmission programs in resource-poor settings.


Methods:

Implementation of a pilot project that evaluates approaches to increase program uptake at health facility level at New Nyanza Provincial General Hospital, a public hospital in western Kenya, an area with high HIV prevalence. Client flow was revised to integrate counseling, HIV testing, and dispensing of single-dose nevirapine into routine antenatal services. The number of facilities providing PMCT services was expanded to increase district-wide coverage. Main outcome measures were uptake of counseling, HIV testing, nevirapine, and estimated program impact.


Results:

Uptake of counseling and testing improved from 55 to 68% (P < 0.001), nevirapine uptake from 57% to 70% (P < 0.001), and estimated program impact from 15% to 23% (P = 0.03). Aggregate reports compare well with computer-entered data.


Conclusion:

Addressing institutional factors can improve uptake, but expected program impact remains low for several reasons, including relatively low efficacy of the intervention and missed opportunities in the labor room



Evaluation of TB and HIV services prior to introducing TB-HIV activities in two rural districts in western Kenya.
Author: Van't Hoog, A. H.; Onyango, J.; Agaya, J.; Akeche, G.; Odero, G.; Lodenyo, W. and Marston, B. J.
Source: Int J Tuberc Lung Dis. 2008 Mar; 12(3 Suppl 1):32-8.
Abstract: Setting:

Health facilities providing tuberculosis (TB) treatment in two districts in rural western Kenya with a high TB and human immunodeficiency virus (HIV) burden.


Objective:

To evaluate TB and HIV/acquired immune-deficiency syndrome (AIDS) services at the facilities and identify barriers to providing quality diagnostic HIV testing and counseling (DTC) and HIV treatment for TB patients in anticipation of the introduction of TB-HIV collaborative services.


Methods:

We performed a standard interview with health workers responsible for TB care, inspected the facilities and collected service delivery data. A self-administered questionnaire on training attended was given to all health workers. Results were shared with stakeholders and plans for implementation were developed.


Results:

Of the 59 facilities, 58 (98%) provided TB treatment, 19 (32%) offered sputum microscopy and 24 (41%) HIV testing. Most facilities (72%) advised HIV testing only if TB patients were suspected of having AIDS. Barriers identified included unaccommodating TB clinic schedules and lack of space, which was an obstacle to holding confidential discussions. The need to refer for HIV testing and/or HIV care was a perceived barrier to recommending these services. Activities implemented following the assessment aimed 1) to provide HIV testing and cotrimoxazole prophylaxis at all TB treatment clinics, 2) to increase availability of HIV treatment services, and 3) to address structural needs at each facility.


Conclusion:

This evaluation identified barriers to the implementation of HIV testing and care services within facilities providing TB treatment.



Circulating and unique recombinant forms of HIV type 1 containing subsubtype A2.
Author: Visawapoka, U.; Tovanabutra, S.; Currier, J. R.; Cox, J. H.; Mason, C. J.; Wasunna, M.; Ponglikitmongkol, M.; Dowling, W. E.; Robb, M. L.; Birx, D. L., and McCutchan, F. E.
Source: AIDS Res Hum Retroviruses. 2006 Jul; 22(7):695-702.
Abstract: HIV-1 strains containing subsubtype A2 are relatively rare in the pandemic but have been repeatedly identified in Kenya, where candidate vaccines based in part on subtype A, but not A2 strains, may be evaluated. Among the most recent is CRF16_A2D, a circulating recombinant form (CRF) whose prototypes are complete or partial HIV-1 sequences from Kenya, Korea, and Argentina. Using samples from blood bank discards in Kenya and complete genome sequencing, this report further documents CRF16_A2D and related recombinants and identifies a second CRF, CRF21_A2D. The two A2-containing CRFs, and two recombinants related to CRF16_A2D, share common structural elements but appear to have been independently derived. Concerted selection may have influenced the emergence and spread of certain A2-containing strains in Kenya. The second complete subtype C sequence from Kenya is also reported here. Monitoring of A2-containing recombinants and subtype C strains, both relatively rare in Kenya, may be informative in the course of cohort development and evaluation of candidate vaccines.

Improving the education response to HIV and AIDS: Lessons of partner efforts in coordination, harmonisation, alignment, information sharing and monitoring in Jamaica, Kenya, Thailand and Zambia.
Author: Visser-Valfrey M; Brown, C. R.; . = Abagi O; Buabuttra T, and Nalwamba C.
Abstract: This report documents the findings of a study on the quality and effectiveness of collaboration among partners involved in the HIV and AIDS response in the education sector. The study was commissioned by the United Nations Joint Programme on HIV/AIDS (UNAIDS) Inter-Agency Task Team (IATT) on Education which brings together UNAIDS Cosponsors, bilateral agencies, private donors, and civil society organizations. The purpose of this study was to document how external partners coordinate and harmonise their efforts at the country level, to identify areas of overlap and significant gaps in country responses, and to formulate recommendations for improving synergy and alignment across IATT member agencies and other actors operating at the country level. The case studies were conducted between March and May 2007 in Jamaica, Kenya, Thailand and Zambia. These countries were selected to represent geographical, epidemiological and socio-economic diversity and because significant efforts have been undertaken insupport of education sector responses to HIV and AIDS in these settings. The study was carried out by an international consultant with the support of four local consultants. In each country, an IATT member agency hosted the study, while the IATT Secretariat, with the help of a working group of IATT members, undertook the overall supervision of the study. Data for the study were collected through a comprehensive documentation review and interviews with key stakeholders from the education sector and the overall HIV and AIDS response. To ensure maximum involvement of all parties, a draft country aide memoire was produced after the field work, circulated to those consulted and finalised based on the suggestions received. While every attempt was made to ensure that a wide selection of stakeholders was consulted, the findings are limited by the short duration of time in-country. The study is not a comprehensive mapping exercise of country-level activity. Rather the findings reflect country stakeholder perspectiveson engagements, progress and on-going challenges. (author's)

The impact of pre-exposure prophylaxis (PrEP) on HIV epidemics in Africa and India: a simulation study.
Author: Vissers, D. C.; Voeten, H. A.; Nagelkerke, N. J.; Habbema, J. D., and de Vlas, S. J.
Source: PLoS ONE. 2008; 3(5):e2077.
Abstract: Background:

Pre-exposure prophylaxis (PrEP) is a promising new HIV prevention method, especially for women. An urgent demand for implementation of PrEP is expected at the moment efficacy has been demonstrated in clinical trials. We explored the long-term impact of PrEP on HIV transmission in different HIV epidemics.


Methodology/principal findings:

We used a mathematical model that distinguishes the general population, sex workers and their clients. PrEP scenarios varying in effectiveness, coverage and target group were modeled in the epidemiological settings of Botswana, Nyanza Province in Kenya, and Southern India. We also studied the effect of condom addition or condom substitution during PrEP use. Main outcome was number of HIV infections averted over ten years of PrEP use. PrEP strategies with high effectiveness and high coverage can have a substantial impact in African settings. In Southern India, by contrast, the number of averted HIV infections in different PrEP scenarios would be much lower. The impact of PrEP may be strongly diminished or even reversed by behavioral disinhibition, especially in scenarios with low coverage and low effectiveness. However, additional condom use during low coverage and low effective PrEP doubled the amount of averted HIV infections.


Conclusions/significance:

The public health impact of PrEP can be substantial. However, this impact may be diminished, or even reversed, by changes in risk behavior. Implementation of PrEP strategies should therefore come on top of current condom campaigns, not as a substitution.



Regular partners may contribute more to HIV transmission than clients.
Author: Voeten, H. A.; Egesah, O. B.; Varkevisser, C. M., and Habbema, J. D. Female sex workers and unsafe sex in urban and rural Nyanza, Kenya:
Source: Trop Med Int Health. 2007 Feb; 12(2):174-82.
Abstract: Objectives:

To compare the sexual behaviour of female sex workers in urban and rural areas in Nyanza province in Kenya, and to compare their unsafe sex with clients and with regular partners.


Methods:

In a cross-sectional study among 64 sex workers (32/32 in urban/rural areas), sex workers kept a sexual diary for 14 days after being interviewed face-to-face.


Results:

Most sex workers were separated/divorced and had one or two regular partners, who were mostly married to someone else. Sex workers in Kisumu town were younger, had started sex work at an earlier age, and had more clients in the past 14 days than rural women (6.6 vs. 2.4). Both groups had an equal number of sex contacts with regular partners (4.7). With clients, condom use was fairly frequent (75%) but with regular partners, it was rather infrequent (<40%). For both urban and rural areas, the mean number of sex acts in which no condom was used was greater for regular partners (3.2 and 2.8 respectively) than for clients (1.9 and 1.0 respectively).


Conclusions:

Sex workers in urban and rural areas of Nyanza province practise more unsafe sex with regular partners than with clients. Interventions for sex workers should also focus on condom use in regular partnerships



Morbidity among HIV-1-infected mothers in Kenya: prevalence and correlates of illness during 2-year postpartum follow-up.
Author: Walson, J. L.; Brown, E. R.; Otieno, P. A.; Mbori-Ngacha, D. A.; Wariua, G.; Obimbo, E. M.; Bosire, R. K.; Farquhar, C.; Wamalwa, D., and John-Stewart, G. C.
Source: J Acquir Immune Defic Syndr. 2007 Oct 1; 46(2):208-15.
Abstract: Background:

Much of the burden of morbidity affecting women of childbearing age in sub-Saharan Africa occurs in the context of HIV-1 infection. Understanding patterns of illness and determinants of disease in HIV-1-infected mothers may guide effective interventions to improve maternal health in this setting.


Methods:

We describe the incidence and cofactors of comorbidities affecting peripartum and postpartum HIV-1-infected women in Kenya. Women were evaluated by clinical examination and standardized questionnaires during pregnancy and for up to 2 years after delivery.


Results:

Five hundred thirty-five women were enrolled in the cohort (median CD4 count of 433 cells/mm) and accrued 7736 person-months of follow-up. During 1-year follow-up, the incidence of upper respiratory tract infections was 161 per 100 person-years, incidence of pneumonia was 33 per 100 person-years, incidence of tuberculosis (TB) was 11 per 100 person-years, and incidence of diarrhea was 63 per 100 person-years. Immunosuppression and HIV-1 RNA levels were predictive for pneumonia, oral thrush, and TB but not for diarrhea; CD4 counts <200 cells/mm(3) were associated with pneumonia (relative risk [RR] = 2.87, 95% confidence interval [CI]: 1.71 to 4.83), TB (RR = 7.14, 95% CI: 2.93 to 17.40) and thrush. The risk of diarrhea was significantly associated with crowding (RR = 1.86, 95% CI: 1.19 to 2.92) and breast-feeding (RR = 1.71, 95% CI: 1.19 to 2.44). Less than 10% of women reported hospitalization during 2-year follow-up; mortality risk in the cohort was 1.9% and 4.8% for 1 and 2 years, respectively.


Conclusions:

Mothers with HIV-1, although generally healthy, have substantial morbidity as a result of common infections, some of which are predicted by immune status or by socioeconomic factors. Enhanced attention to maternal health is increasingly important as HIV-1-infected mothers transition from programs targeting the prevention of mother-to-child transmission to HIV care clinics.



Albendazole treatment of HIV-1 and helminth co-infection: a randomized, double-blind, placebo-controlled trial.
Author: Walson, J. L.; Otieno, P. A.; Mbuchi, M.; Richardson, B. A.; Lohman-Payne, B.; Macharia, S. W.; Overbaugh, J.; Berkley, J.; Sanders, E. J.; Chung, M. H., and John-Stewart, G. C.
Source: AIDS. 2008 Aug 20; 22(13):1601-9.
Abstract: Objective:

Several co-infections have been shown to impact the progression of HIV-1 infection. We sought to determine if treatment of helminth co-infection in HIV-1-infected adults impacted markers of HIV-1 disease progression.


Design:

To date, there have been no randomized trials to examine the effects of soil-transmitted helminth eradication on markers of HIV-1 progression.


Methods:

A randomized, double-blind, placebo-controlled trial of albendazole (400 mg daily for 3 days) in antiretroviral-naive HIV-1-infected adults (CD4 cell count >200 cells/microl) with soil-transmitted helminth infection was conducted at 10 sites in Kenya (Clinical Trials.gov NCT00130910). CD4 and plasma HIV-1 RNA levels at 12 weeks following randomization were compared in the trial arms using linear regression, adjusting for baseline values.


Results:

Of 1551 HIV-1-infected individuals screened for helminth infection, 299 were helminth infected. Two hundred and thirty-four adults were enrolled and underwent randomization and 208 individuals were included in intent-to-treat analyses. Mean CD4 cell count was 557 cells/microl and mean plasma viral load was 4.75 log10 copies/ml at enrollment. Albendazole therapy resulted in significantly higher CD4 cell counts among individuals with Ascaris lumbricoides infection after 12 weeks of follow-up (+109 cells/microl; 95% confidence interval +38.9 to +179.0, P = 0.003) and a trend for 0.54 log10 lower HIV-1 RNA levels (P = 0.09). These effects were not seen with treatment of other species of soil-transmitted helminths.


Conclusion:

Treatment of A. lumbricoides with albendazole in HIV-1-coinfected adults resulted in significantly increased CD4 cell counts during 3-month follow-up. Given the high prevalence of A. lumbricoides infection worldwide, deworming may be an important potential strategy to delay HIV-1 progression.



Early response to highly active antiretroviral therapy in HIV-1-infected Kenyan children.
Author: Wamalwa, D. C.; Farquhar, C.; Obimbo, E. M.; Selig, S.; Mbori-Ngacha, D. A.; Richardson, B. A.; Overbaugh, J.; Emery, S.; Wariua, G.; Gichuhi, C.; Bosire, R., and John-Stewart, G.
Source: J Acquir Immune Defic Syndr. 2007 Jul 1; 45(3):311-7.
Abstract: Objectives:

To describe the early response to World Health Organization (WHO)-recommended nonnucleoside reverse transcriptase inhibitor (NNRTI)-based first-line highly active antiretroviral therapy (HAART) in HIV-1-infected Kenyan children unexposed to nevirapine. DESIGN: Observational prospective cohort.


Methods:

HIV-1 RNA level, CD4 lymphocyte count, weight for age z score, and height for age z score were measured before the initiation of HAART and every 3 to 6 months thereafter. Children received no nutritional supplements.


Results:

Sixty-seven HIV-1-infected children were followed for a median of 9 months between August 2004 and November 2005. Forty-seven (70%) used zidovudine, lamivudine (3TC), and an NNRTI (nevirapine or efavirenz), whereas 25% used stavudine (d4T), 3TC, and an NNRTI. Nevirapine was used as the NNRTI by 46 (69%) children, and individual antiretroviral drug formulations were used by 63 (94%), with only 4 (6%) using a fixed-dose combination of d4T, 3TC, and nevirapine (Triomune; Cipla, Mumbai, India). In 52 children, the median height for age z score and weight for age z score rose from -2.54 to -2.17 (P<0.001) and from -2.30 to -1.67 (P=0.001), respectively, after 6 months of HAART. Hospitalization rates were significantly reduced after 6 months of HAART (17% vs. 58%; P<0.001). The median absolute CD4 count increased from 326 to 536 cells/microL (P<0.001), the median CD4 lymphocyte percentage rose from 5.8% before treatment to 15.4% (P<0.001), and the median viral load fell from 5.9 to 2.2 log10 copies/mL after 6 months of HAART (P<0.001). Among 43 infants, 47% and 67% achieved viral suppression to less than 100 copies/mL and 400 copies/mL, respectively, after 6 months of HAART.


Conclusion:

Good early clinical and virologic response to NNRTI-based HAART was observed in HIV-1-infected Kenyan children with advanced HIV-1 disease.



HIV voluntary counseling and testing in Kenya.
Author: Wambugu S; Tegang, S. P.; . = Namwebya JH, and Obiero W.
Source: 2001-05. Analysis of data.
Abstract: Kenya has witnessed an unparalleled upsurge in voluntary and counseling (VCT) services since 2001. This increase was assisted by the USAID-funded IMPACT (Implementing AIDS Prevention and Care) Project, which is managed by Family Health International (FHI). IMPACT is a pioneer in VCT, and has helped establish 217 of Kenya's 687 VCT sites. This paper investigates trends in client utilization of VCT service between 2001 and 2005 within a sample of these IMPACT-supported sites. The analysis sought to establish sociodemographic and sexual behavior profiles of VCT clients and their HIV prevalence; correlate these client profiles with the service delivery model Chosen; ascertain how clients learned about VCT services and whether this information influenced them to seek and use other interventions; investigate links, if any, between types of referrals made and the sexual behavior profiles and serostatus of VCT clients; establish whether mass communication campaigns and the availability of antiretroviral therapy (ART) influenced clients to come to the sites. (excerpt)

HIV / AIDS and associated morbidity and mortality among hospitalised children in Kilifi, Kenya.
Author: Wamsele J and Kisenge, R.
Source: Tanzania Health Research Bulletin. 2006 May; 8(2):90-94.
Abstract: This study was carried to determine the frequency of HIV/AIDS and associated morbidity and mortality among children hospitalised in the paediatric ward at the Kilifi District Hospital, Kenya. All 7519 children admitted between January 2004 and June 2005 were eligible for the study. Testing for HIV antibodies was done using Determine and Unigold tests. Of the admitted children, 163 (2.2%) had clinical features of AIDS. Sixty (36.8%) of the HIV-positive children were below < 18 months and 103 (64.2%) were >/= 18 months old. There were 84 (51.5%) boys and 79 (49.5% girls). The median age was 2 years (range = 8 days to 11 years). The median duration of hospital stay for children with AIDS was 11 days (range 2 days to 6 weeks). The commonest causes of admission for children with HIV/AIDS were malnutrition (40.8%) and pulmonary tuberculosis (20.9%). Bacillus species were the most common isolates from the children blood samples with malnutrition. The inpatient mortality of 20.9% was observed among HIV positive children and malnutrition was a co-morbidity in 42.1% of those who died. In conclusion, this study revealed that the prevalence of paediatric HIV/AIDS in this area is high and appropriate interventions need to be taken to contain the worsening situation. (author's)

Audio computer-assisted self-interviewing (ACASI) may avert socially desirable responses about infant feeding in the context of HIV.
Author: Waruru, A. K.; Nduati, R., and Tylleskar, T.
Source: BMC Med Inform Decis Mak. 2005; 5:24.
Abstract: Background:

Understanding infant feeding practices in the context of HIV and factors that put mothers at risk of HIV infection is an important step towards prevention of mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing may not be a suitable way of ascertaining this information because respondents may report what is socially desirable. Audio computer-assisted self-interviewing (ACASI) is thought to increase privacy, reporting of sensitive issues and to eliminate socially desirable responses. We compared ACASI with FTF interviewing and explored its feasibility, usability, and acceptability in a PMTCT program in Kenya.


Methods:

A graphic user interface (GUI) was developed using Macromedia Authorware and questions and instructions recorded in local languages Kikuyu and Kiswahili. Eighty mothers enrolled in the PMTCT program were interviewed with each of the interviewing mode (ACASI and FTF) and responses obtained in FTF interviews and ACASI compared using McNemar's chi2 for paired proportions. A paired Student's t-test was used to compare means of age, marital-time and parity when measuring interview mode effect and two-sample Student's t-test to compare means for samples stratified by education level - determined during the exit interview. A Chi-Square (chi2test) was used to compare ability to use ACASI by education level.


Results:

Mean ages for intended time for breastfeeding as reported by ACASI were 11 months by ACASI and 19 months by FTF interviewing (p < 0.001). Introduction of complementary foods at
Conclusion:

ACASI seems to improve quality of information by increasing response to sensitive questions, decreasing socially desirable responses, and by preventing null responses and was suitable for collecting data in a setting where formal education is low.



Power brokering, empowering, and educating: the role of home-based care professionals in the reduction of HIV-related stigma in Kenya.
Author: Waterman, H.; Griffiths, J.; Gellard, L.; O'Keefe, C.; Olang, G.; Ayuyo, J.; Obwanda, E.; Ogwethe, V., and Ondiege, J.
Source: Qual Health Res. 2007 Oct; 17(8):1028-39.
Abstract: In this article the authors report on how home-based care (HBC) professionals reduce stigmatizing behavior in Kenya. This study was part of an action research project that evaluated the introduction of HBC. HBC professionals coordinate the delivery of HIV/AIDS services at a district level and educate community-based health workers in HBC. Understanding how HBC professionals reduce stigma is crucial to reduce, prevent, and treat HIV/AIDS. Fifty HBC professionals participated in 27 focus group interviews over 18 months. Stigma featured strongly when they discussed barriers to the introduction of HBC. Using sociological theory, the authors organized the data into five themes: Power broking and mobilization, Stigma as a social construction, Community and structural interventions, Educating and training people, and Historical context. The HBC professionals appear to operate at mostly individual and community levels in their efforts to challenge stigma, and in spite of the difficulties they appear to be having some impact.

Perceptions of children with HIV/AIDS from the USA and Kenya: self-concept and emotional indicators.
Author: Waweru, S. M.; Reynolds, A., and Buckner, E. B.
Source: Pediatr Nurs. 2008 Mar-2008 Apr 30; 34(2):117-24.
Abstract: Perceptions of children's self-concept and associated emotional indicators were assessed in two populations, United States and Kenya, in children living with HIV/AIDS. Assessment of the self-concept mode of the Roy Adaptation Model used both verbal and nonverbal strategies. The sample of children (N = 48), ages 7 to 12 years who were HIV-positive, was recruited from a family clinic that cares for children with chronic illness in the United States (n = 6) and an orphanage that provides for HIV-positive children in Kenya (n = 42). Self-concept was measured using a modification of Piers-Harris Self-Concept Scale. Emotional indicators were measured from Human Figure Drawings (HFD) described by Koppitz (1968). All U.S. children were found to have an average self-concept and one-third demonstrated significant emotional indicators. In Kenya, 93% of the participants had an average self-concept and half were found to have significant emotional indicators. HFD can be used with other screening tools to perform a psychosocial assessment and screening for referral. This study contributes to nursing science by introducing a model-based assessment with cross-cultural applicability.

Initial outcomes of an emergency department rapid HIV testing program in western Kenya.
Author: Waxman, M. J.; Kimaiyo, S.; Ongaro, N.; Wools-Kaloustian, K. K.; Flanigan, T. P., and Carter, E. J.
Source: AIDS Patient Care STDS. 2007 Dec; 21(12):981-6.
Abstract: This paper reports the initial operational outcomes of an emergency department-based HIV testing program in a high-prevalence and resource-limited setting by describing (1) the number and percentage of patients approached, tested, and found to be HIV positive and (2) the linkage of care to the HIV clinic. A retrospective log and chart review of the initial 5 months (January 2006 to April 2006) of the HIV testing program was performed. Patients were selected for HIV testing by routine screening and by provider initiated referrals. Out of the 1371 patients who were approached for HIV testing, 1339 (97.7%) patients were tested for HIV. Three hundred twelve (22.7%) of the patients tested were HIV positive. Within a sample group of patients newly diagnosed with HIV in the department, 82% were compliant with their initial HIV clinic visit and 65% were compliant with a 1-month follow-up visit. The implementation of an emergency department-based HIV testing program in a high HIV prevalence and resource poor country is feasible with a high percentage of patients accepting HIV testing and a high percentage of positive patients presenting to follow-up care. Establishment of rapid HIV testing in emergency departments can identify significant numbers of HIV-positive patients who would otherwise remain undiagnosed and provides an education opportunity for those patients who are HIV negative.

Mapping of experiences of access to care, treatment and support - Kenya.
Author: Webi, E.
Abstract: Namibia, Kenya and Tanzania. The findings will contribute to advocacy for increased political support and resources to address gendered barriers to care, treatment and support. The project complements a mapping and database of civil society organizations (CSOs) providing treatment by the French consortium - SIDACTION. The research was carried out in Homabay (rural) and Kibera community (urban) involving women and men living with HIV and AIDS (13th December 2005 - 31st January 2006). Data was gathered through questionnaires and focus group discussions (FGDs). Women who participated in the focus group discussions were aged between 22 - 45 years old and in total 100 people took part in the project, including questionnaire respondents. The service providers in both sites were of varied age group (28-45 years) and both female and male service providers participated in the focus group discussions. Results from the mixed sex and service provider focus groups are presented here but the main emphasis is onthe results from the women only focus groups. (excerpt)

Treating curable sexually transmitted infections to prevent HIV in Africa: Still an effective control strategy?
Author: White, R. G.; . = Orroth KK; Glynn JR; Freeman EE, and Bakker R.
Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2008 Mar; 47(3):346-353.
Abstract: Evidence regarding the effectiveness of sexually transmitted infection (STI) treatment for HIV prevention in Africa is equivocal, leading some policy makers to question whether it should continue to be promoted for HIV control. We explore whether treating curable STIs remains a cost-effective HIV control strategy in Africa. The model STDSIM was fitted to the characteristics of 4 populations in East and West Africa. Over the simulated HIV epidemics, the population-attributable fractions (PAFs) of incident HIV attributable to STIs, the impact of syndromic STI management on HIV incidence, and the cost per HIV infection averted were evaluated and compared with an estimate of lifetime HIV treatment costs (US $3500). Throughout the HIV epidemics in all cities, the total PAF for all STIs remained high, with $50% of HIV transmission attributed to STIs. The PAF for herpes simplex virus type 2 increased during the epidemics, whereas the PAF for curable STIs and the relative impact of syndromic management decreased. The models showed that the absolute impact of syndromic management remains high in generalized epidemics, and it remained cost-saving in 3 of the 4 populations in which the cost per HIV infection averted ranged between US $321 and $1665. Curable STI interventions may remain cost-saving in populations with generalized HIV epidemics, particularly in populations with high-risk behaviors or low male circumcision rates. (author's)

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, and Sidle J.
Source: Nephrology Dialysis Transplantation. 2007; 22(8):2208-2212.
Abstract: Several commonly used antiretrovirals (ARVs) require dose adjustments to prevent toxicities in the presence of renal insufficiency. Because 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. 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. 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 threerenal 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%). 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. (author's)no prospective studies of the prevalence or risk factors for kidney disease in stable

Associations of sexual risk taking among Kenyan female sex workers after enrollment in an HIV-1 prevention trial.
Author: Yadav, G.; Saskin, R.; Ngugi, E.; Kimani, J.; Keli, F.; Fonck, K.; Macdonald, K. S.; Bwayo, J. J.; Temmerman, M.; Moses, S., and Kaul, R.
Source: J Acquir Immune Defic Syndr. 2005 Mar 1; 38(3):329-34.
Abstract: Background:

Female sex workers (FSWs) often lack the ability to negotiate safer sex and are at high risk for HIV-1 infection and sexually transmitted infections (STIs).


Methods:

Seronegative FSWs were enrolled in an STI/HIV-1 prevention trial in Nairobi, Kenya. Demographics and sexual risk taking were assessed every 3 months. Predictors of reduced risk taking were defined using multivariate logistic regression.


Results:

Four hundred sixty-six FSWs were enrolled and followed for just over 2 years each. A spectrum of sex work was apparent: FSWs working in night clubs were younger, charged more for sex, and used condoms more frequently; FSWs working from home were older, charged less, and used condoms the least; and those working in bars were intermediate. Increases in reported condom use were most significant and sustained for FSWs working from home and charging less for sex and were poorly maintained for bar-based FSWs. Self-reported lower condom use, higher client numbers, and alcohol use were associated with higher STI rates.


Conclusions:

Home-based FSWs and those charging less for sex used condoms the least at baseline but showed the greatest and most sustained improvements over time. Potential response heterogeneity in FSW subgroups should be considered in the design of HIV-1 prevention programs.



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.



The long-term impacts of orphanhood on education attainment and land inheritance among adults in rural Kenya.
Author: Yamano, T.
Abstract: The long-term economic impacts of the AIDS epidemic on orphans have been major concerns in countries hit by the epidemic. Responding to these concerns, previous studies have investigated the schooling of orphans. Yet, few studies have investigated the impacts of orphan status into adulthood. Therefore, this paper examines the education attainment and land inheritance of former orphans, who have lost at least one parent before reaching 15, by using a survey of 889 households in Kenya in 2004. In the survey, we have asked the ages of household members when they lost their parents, if they have suffered such a loss, and identified former orphans. Among individuals who started schooling before the Free Education Program introduced in 1974, we find about a one year lower educational attainment among former maternal orphans compared with former non-orphans. We do not find a similar difference in education attainment among the younger cohorts, who started schooling after 1974. Even the Cost-Sharing Scheme introduced in 1988 does not seem to lower the educational attainment of former orphans. On inherited land, we find no significant difference between households headed by former orphans and non-orphans. (author's)

Working-age adult mortality and primary school attendance in rural Kenya.
Author: Yamano T and Jayne, T. S.
Source: Economic Development and Cultural Change. 2005; 53:619-653.
Abstract: The article is organized as follows. We first identify potential pathways by which adult mortality may affect child school attendance and the timing of each pathway. Second, we estimate reinterview models to assess the degree to which sample attrition is a problem and use the inverse probabilities of being reinterviewed as weights to control for attrition in the subsequent analyses. Then, using household fixed effects to control for time-invariant unobservables, we estimate the impacts of adult mortality on child school attendance in rural Kenya after stratifying sampled households and their children by wealth and gender. Kenya is one of the most heavily HIV-infected countries in the world: 13.5% of adults ages 15-49 were estimated to be living with HIV in June 2000. (excerpt)

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 treatment and intrahousehold resource allocations: children's nutrition and schooling in Kenya.
Author: Zivin, J. G.; . = Thirumurthy H, and Goldstein M.
Abstract: The provision of life-saving antiretroviral (ARV) treatment has emerged as a key component of the global response to HIV/AIDS, but very little is known about the impact of this intervention on the welfare of children in the households of treated persons. We estimate the impact of ARV treatment on children's schooling and nutrition outcomes using longitudinal household survey data collected in collaboration with a treatment program in western Kenya. We find that children's weekly hours of school attendance increase by 20 to 35 percent within six months after treatment is initiated for the adult household member. For boys in treatment households, these increases closely follow their reduced market labor supply. Similarly, young children's short-term nutritional status-as measured by their weight-for-height Z-score-also improves dramatically. These results illustrate how the intrahousehold allocation of time and resources are altered in response to significant health improvements. Since the improvements in children's schooling and nutrition at these critical early ages will affect their socio-economic outcomes in adulthood, the widespread provision of ARV treatment is likely to generate significant long-run macroeconomic benefits. (author's)

Challenges of care-givers in a HIV endemic area of central Kenya: a gender based approach
Author: Kamau G., The People Daily Newspaper Ltd, Nairobi, Kenya.

Abstract: The HIV/AIDS scourge can be termed as one of the most serious human rights issues of this century to be tackled with a gender-sensitive approach. Constitutional and national protection of the rights of those infected and affected by the scourge is lacking in most parts of the country.
This paper presents the statistics of the disease in Nairobi Kenya where 50 HIV/AIDS caregivers and health workers were interviewed. The results indicate that women now constitute almost 60 percent of all infections with more than 200,000 women and girls infected. Most caregivers are women. They have to grapple with the challenges of raising those living with the scourge, an assignment that is tasking because they have little or no control over the family's income. They expose themselves to infection by living intimately with the infected .Thus; the real challenge is to make the disease a priority issue of the women's movement countrywide.

With all the resources to combat the scourge in the country, women leaders are needed at every level to unite and counter the spread of the virus.


Violence against them and exploitation through prostitution fuels the epidemic. Women, especially those in rural areas, fear losing their homes and being rejected by their families. There is need for a gendered response sensitive to the needs and multiple vulnerabilities of women and young girls with HIV/AIDS while recognizing and4lr.engthening their own agency.

It is imperative that prevention information, confidential counselling and testing, treatment for sexually transmitted diseases and comprehensive drug and anti-retroviral treatment be available to men and women equally.


Our findings show a need to adopt comprehensive gender-based programmes, rather than piecemeal prevention projects to address this epidemic adequately. Non-discrimination, legal protection and equal access to services are critical if gender-based approach is to be an effective strategy.
Keywords: HIV/AIOS|WOMEN RIGHTS | VULNERABILITY | EQUALITY | STRATEGY

Men who have sex with men (MSM) and HIV prevention and care in Kenya.
Source: Parkinson A., Liverpool VCT & Care Kenya
Abstract: Background & Objectives:

This presentation will examine the experiences of Liverpool VCT in providing prevention and care services to MSM in Kenya. As the only organization in East Africa actively undertaking this work, LVCT has insights and experience that other organizations may benefit from.


Findings/Lessons Learnt:

Specifically, this presentation will examine lessons learnt in the provision of prevention and care services for MSM in Kenya, as well as presenting national VCT data on MSM, prevalence rates and related challenges.


Conclusions/Recommendations:

The presentation will recommend increased access for MSM to VCT, care and RH services as well as creating targeted interventions that are acceptable to MSM.



Keywords: MSM | HIV | SEXUALITY | RH RIGHTS | ACCESS TO CARE

Expanding and Integrating the Deaf HIV/ AIDS/STI Programme towards Efficiency.
Author: Henderson K., Liverpool VCT & Care (LVCT) Kenya
Abstract: Background:

The Deaf community numbers approximately 650,000 out of about 32,000,000 people in Kenya. It is most concentrated in the urbane regions and also spread out in the rural areas in lesser but significant numbers. In the Deaf community, access to education and services is more limited and employment either is lower or reaps less per capita income than the rest of the population. With its own linguistic culture based in Kenyan Sign Language, this community faces stigma and poverty at a more alarming level than general.


As the mission of LVCT Kenya is to reduce the rate of HIV transmission in Kenya, the organization aims to:

  • Implement high quality voluntary counseling and testing (VCT) and care services throughout Kenya

  • Provide technical assistance and support to GoK and partners

  • Develop research- and evidence-based practice to inform policy

Since October 2003, LVCT has trained 12 Deaf counselours and mobilizers and established three Deaf VCT stand-alone sites in Kisumu, Mombasa, and Nairobi, reinforced by monthly mobile VCT clinics in surrounding regions. After counseling and testing, Deaf clients who test positive for HIV are referred to local clinics that provide care and ART therapy. The objectives of the programme are two-fold:



  • To increase provision and quality of VCT and care services for Deaf clientele

  • To increase provision and quality of VCT services for the adjacent hearing population

In 2005, a coordinator position held by a Deaf professional was also established to run the programme.


Findings/Lessons Learnt:

  • Maintaining anonymity and confidentiality in Deaf community

  • Mobilization of rural Deaf communities requires more support, consistency, time, and creativity

  • Data on Deaf clientele is lacking

  • Limited Deaf involvement in professional development

  • Quality of care of Deaf PLWHA decreases after VCT service


Conclusions and Recommendations

  • Data collection of Deaf and physically challenged clientele needs to be incorporated in national data system

  • VCT & Care scale-up then must begin to reflect above data e.g. access ramps & lifts, sign language fluency and sensitivity training among care providers

  • Increase provision of Deaf counselors at rural stand alone sites near sizable Deaf communities and trim down over-reliance on costly mobile VCT activities


Keywords: DEAF, CULTURE, BARRIERS TO ACCESS, HIV/AIDS, SEXUAL HEALTH


The HIV Status and associated factors among clients attending the Egerton University VCT centre in 2006.
Author: Dr. Douglas Kamau Ngotho, Faculty Of Health Sciences, Egerton University, P.O Box 536.
Abstract: Summary:

The study covered the period between Jan 2nd and December 31st 2006. The essence was to assess the HIV status and other related data of the clients who were attended in that VCT centre that year. The details of all the clients were documented and analyzed appropriately.

The results, conclusions and recommendations were there from extracted.

Objectives:


  • To relate the demographic data to the HIV status

  • To assess the purpose of attendance

  • To assess the sexual practices

  • To make some recommendations based on findings


Measures:

Of the 846 clients who attended the number and the attendant percentage of those tested was documented. This was also done for those found to be seropositive. The demographic data of all the clients and the infected ones was analyzed and compared. The information on the services required and how the clients knew of their existence was documented and analyzed. Sexual history over the last twelve months and the use of the condom was analyzed as was couple discordance and the referral pattern.


Results:

Of the 846 clients who attended, 715(84.5%) were tested and 36(5.0%) found to be positive. Of these positive ones 25(69.4%) were females. The age-group most affected was 29-32 years. Although the students constituted 54.7% of the total population, they were the least affected. One the other hand the married monogamous were the most affected (36.1% of the seropositive). Plan for the future and the desire to know the serostatus were the key reasons for visiting the clinic. Information from a relative or friends was the key motivation for the visit. There was still a proposion of clients with multiple sexual partners yet condom use was mstill low. No couple discordance was noted and the referral was done appropriately.


Conclusion:

The seropositivity and its female to ratio are similar to the National one. The age group distribution seems to peak at 29-32 years, decline rapidly thereafter and then plateau at between 34 and 44 years before a final gentle drop. This pattern would be expected. The students and the professionals had the lowest infection rates. It is possible they could have been more sensitized but there was a reasonable number of students who had not had sex and many also with one sexual partner. Of the educated, those with secondary education had the highest infection rate.

One would have expected the primary education level. Besides, those without education had the lowest rate. However, those without a job had the highest rate. The married monogamous comprised about 40% of those infected. It might help to investigate this cohort. Most clients wanted to know their status with a future in mind. Of concern are those with multiple sexual partners and yet condom use is low. This should be an area for emphasis in awareness and practice.
Recommendations:


  • Vigilance in our Universities on data collection, analysis and dissemination.

  • Address the needs of the non-academic staff from whom the infected cases were highest.

  • Find out why married monogamous clients were most affected

  • Continue information dissemination as catalyst for VCT attendance.

  • Find out modes of enhancing condom use especially where multiple sexual partners are concerned



Effectiveness Of Non-Nucleoside Reverse Transcriptase Inhibitor-Containing Antiretroviral Therapy In Women Previously Exposed To A Single Dose Of Nevirapine: A Multi-Country Cohort Study.
Author: James Kiarie5, John Ongech5,Paul J Weidle1, Jeffrey Stringer2, Michelle S McConnell3, 4, Thanomsak Anekthananon6, Tavatchai Jariyasethpong7, Dara Potter2, Winnie Mutsotso8, Craig B Borkowf1, Omotayo Bolu4.
Source: Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, GA, US. University of Alabama at Birmingham Centre for Infectious Disease Research in Zambia, Lusaka. Thailand Ministry of Public Health--US CDC Collaboration, Nonthaburi, Thailand Global AIDS Program, NCHHSTP, CDC, Atlanta, GA, US. Kenyatta National Hospital/University of Nairobi, Nairobi, Kenya Department of Social and Preventive Medicine, Siriraj Hospital, Mahidol University, Bangkok, ThailandInfectious Diseases Unit, Rajavithi Hospital, Bangkok, Thailand. CDC-Kenya, Nairobi, Kenya


Abstract: Background:

Maternal-infant single-dose nevirapine (SDNVP) reduces perinatal HIV transmission, but induces viral resistance to non-nucleoside reverse transcriptase inhibitor (NNRTI) drugs in some women. Prior SDNVP exposure may compromise future maternal treatment with NNRTI-based antiretroviral therapy (ART).


Methods:

Between May ’05 and Jan ’07, we enrolled SDNVP-exposed and unexposed women starting NNRTI-based ART in a prospective cohort study in Zambia, Thailand, and Kenya. Women were frequency matched at entry by WHO stage and CD4 cell count (CD4). We compared treatment failure (viral load [VL] >400 copies/ml, not on NNRTI, died) between exposure groups at 6 months after ART initiation.


Results:

We studied 878 women (355 SDNVP-exposed, 523 unexposed). SDNVP-exposed women were younger (29 vs 33 yrs, p<0.001), had a higher median CD4 (160 vs 139 cells/mm3 p=0.007), and lower median VL (97,300 vs 142,000 copies/ml, p=0.02), but were of similar weight (51 vs 52 kg, p=0.4). At 6 months after ART initiation, 186 (21%) women had failed (76 had VL >400 copies/ml, 51 discontinued the study, 48 died, and 11 had been changed to a protease inhibitor). Women with exposure to SDNVP <6 months before NNRTI-based ART initiation, with baseline CD4 0-49 cells/mm3, or VL >100,000 copies/ml had poorer treatment responses (Table). Women exposed to SDNVP >12 months before NNRTI-based ART did as well as unexposed women.



Baseline covariates

N

Multivariate odds ratio for treatment failure at 6 months adjusted for age

CI95

Time since SDNVP exposure (months)

Unexposed

<6

7-12


>12

523

115


67

173


1.0

1.86


1.61

0.90

1.12-3.09

0.87-2.98

0.56-1.45


Country

Thailand

Zambia


Kenya

217

509


152

1.0

2.00


1.47

1.23-3.23

0.81-2.65


CD4

(cells/mm3)



>200

50-199


0-49

255

479


144

1.0

1.42


3.21

0.91-2.21

1.88-5.49


VL

(copies/ml)



<10,000

10,000-99,999

>100,000

Missing


114

296


462

6


1.0

1.86


2.25

.

0.95-3.62

1.17-4.29



WHO Stage

I/II

III


IV

416

358


104

1.0

1.42


1.65

0.95-2.10

0.96-2.84

In a secondary analysis including only those still on NNRTI-based ART at 6 months, we found similar results.


Conclusions:

A high proportion (79%) of women in this cohort responded to 6 months of NNRTI-based ART whether previously exposed to SDNVP or not. These data do suggest an increased risk of treatment failure among women with recent SDNVP exposure, but not with SDNVP exposure >12 months before initiation of NNRTI-based ART.


Recommendations:

Treatment with ART or perinatal HIV prevention strategies other than SDNVP should be considered for pregnant women who are likely to initiate ART within 1 year after delivery.



Revised (2008 version) National Guidelines for Prevention of Mother-to-Child Transmission of HIV infection in Kenya: What is new?

Author: Dr. Boaz Otieno-Nyunya, Moi University School of Medicine, P.O. Box 30003, Eldoret Tel: 0722-263752, 0733-703214. Email: akinyijael@yahoo.com
Author: Background:

Mother-to-child transmission (MTCT) is the most important source of HIV infection in children. Most PMTCT programs in Kenya have relied on a single dose nevirapine SDNVP) as the main prophylactic regime for (PMTCT), the simplest regimen for settings where resources are constrained. WHO more recently recommended newer and more efficacious regimens based on the available scientific evidence and progmmatic experience. The revised(2008 version) National Guidelines for Prevention of Mother-to-Child Transmission of HIV Infections in Kenya have incorporated these recommendation.


Objectives:

  • Review the magnitude and trends of mother –to-child transmission in Kenya.

  • Outline the components of the new national guidelines of PMTCT.

  • Identify new issues and strategies in the PMTCT based on current evidence and programmatic experience.

  • Discuss service, research and pragmatic implications of the new recommendations.

  • Results:

  • The new guidelines consist of the following ten chapters:

  • Background

  • Antenatal care and prevention of MTCT of HIV

  • Intrapartum care

  • Use of ARVs in pregnancy in treatment and prevention of mother-to-child transmission of HIV infection.

  • Immediate post natal and neonatal care.

  • Late post natal care and family planning

  • HIV diagnosis in children

  • Feeding infants and young children born to HIV infected mothers

  • Care and follow up of children of HIV infected mothers

  • Monitoring and evaluation pf the PMTCT services.


Key Recommendations In The Revised Guidelines:

  • All HIV pregnant women in the need of treatment should receive ART

  • First line regimen for pregnant women in need of treatment is AZT+3TC +NVP

  • In women for whom ART is not indicated, AZT should be given from 28 weeks of pregnancy plus SDNVP and 3TC at the onset of labour with a 7 day tail of AZT plus 3TC to reduce the risk of NVP resistance; and the infant SDNVP soon after birth plus AZT for 7 days.

  • Alternative prophylactic regimens include AZT from 28 weeks plus SDNVP for women and SDNVP and 7 days AZT for infant.

  • Infants born HIV-positive women who had not received any ARVs should be given SDNVP at birth plus AZT for 4 weeks.

  • In programs (such as AMPATH) triple drug prophylaxis has been used since 2003. Experience gained shows that this is a feasible and effective option. Interruption in MTCT of less than 5% has been achieved using this regimen AZT+3TC +NLF/RJV (kaletra)


Conclusion:

Achieving global as well as local targets of PMTCT is feasible if we can increase access to integrated and comprehensive programmes for preventing HIV infection in infants and young children. The 4 pronged PMTCT approach must be adopted with focus on all the four prongs.



Development Of A Human Vaginal Spermicide And Microbicide (Unipron) To Prevent Pregnancy And Transmission Of HIV/AIDS (Safety Studies).
Author: Obiero, J.A., Mburu, N., Mwaura, B., Waititu, K., Mulei, I., Farah, I., Mwethera, P.G
Source: Institute of Primate Research, P.O. Box 24481, Karen, Nairobi. Kenya
Abstract: Summary:

Identification and characterization of bacterial species before and after UniPron administration, toxicity effect of UniPron on vaginal mucosa and body organs (liver and kidney).


Objectives:

To characterize the normal vaginal microbial flora during follicular, luteal and menstrual stages in the baboon.



  • To determine the effect of UniPron on normal vaginal microbial flora in the baboon.

  • To evaluate the effect of UniPron on the vaginal epithelium.

  • Determine the effect of UniPron on liver and kidney functions.


Measures:

Investigation of safety of UniPron using a baboon model.

RESULTS:

Lactobacilli, the predominant bacteria in the normal vagina of humans was not affected by administration of UniPron. There were no visible lesions/irritation on vagina mucosa and liver and kidney function tests were normal.



Conclusion:

UniPron did not cause any negative side effects and therefore safe to use in the baboon model.


Recommendations:

These studies can be extended to humans.



Effects Of HIV/AIDS On Maternity Care Providers On Labor & Delivery Wards In Kisumu, Kenya.
Author: Janet M. Turan, *Elizabeth A. Bukusi, Craig R. Cohen, John Sande, Suellen Miller
Source: Center for Microbiology Research, KEMRI, Box 19464, Post Code 00202, Nairobi
Honorary  Lecturer,Department of Obstetrics and Gynecology,University of Nairobi, email: ebukusi@csrtkenya.org
Abstract: Objective:

To explore the impact of HIV/AIDS on maternity care providers (MCPs) in labor and delivery in a high HIV prevalence setting in sub-Saharan Africa.


Design:

Qualitative one-on-one in-depth interviews and observations of care provision.


Setting:

Four health facilities providing labor and delivery services (a provincial hospital, a district hospital, a health center, and a small private maternity hospital) in Kisumu, Nyanza Province, Kenya.




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