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Ambia J, Romero-Prieto JE, Kwaro D, Risher K, Khagayi S, Calvert C, Obor D, Tlhajoane M, Odongo F, Marston M, Slaymaker E, Rice B, Kabudula CW, Eaton JW, Reniers G. Comparison of programmatic data from antenatal clinics with population-based HIV prevalence estimates in the era of universal test and treat in western Kenya. PLoS One 2023; 18:e0287626. [PMID: 37363902 DOI: 10.1371/journal.pone.0287626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/12/2023] [Indexed: 06/28/2023] Open
Abstract
OBJECTIVE To compare HIV prevalence estimates from routine programme data in antenatal care (ANC) clinics in western Kenya with HIV prevalence estimates in a general population sample in the era of universal test and treat (UTT). METHODS The study was conducted in the area covered by the Siaya Health Demographic Surveillance System (Siaya HDSS) in western Kenya and used data from ANC clinics and the general population. ANC data (n = 1,724) were collected in 2018 from 13 clinics located within the HDSS. The general population was a random sample of women of reproductive age (15-49) who reside in the Siaya HDSS and participated in an HIV sero-prevalence survey in 2018 (n = 2,019). Total and age-specific HIV prevalence estimates were produced from both datasets and demographic decomposition methods were used to quantify the contribution of the differences in age distributions and age-specific HIV prevalence to the total HIV prevalence estimates. RESULTS Total HIV prevalence was 18.0% (95% CI 16.3-19.9%) in the ANC population compared with 18.4% (95% CI 16.8-20.2%) in the general population sample. At most ages, HIV prevalence was higher in the ANC population than in the general population. The age distribution of the ANC population was younger than that of the general population, and because HIV prevalence increases with age, this reduced the total HIV prevalence among ANC attendees relative to prevalence standardised to the general population age distribution. CONCLUSION In the era of UTT, total HIV prevalence among ANC attendees and the general population were comparable, but age-specific HIV prevalence was higher in the ANC population in most age groups. The expansion of treatment may have led to changes in both the fertility of women living with HIV and their use of ANC services, and our results lend support to the assertion that the relationship between ANC and general population HIV prevalence estimates are highly dynamic.
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Affiliation(s)
- Julie Ambia
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Julio E Romero-Prieto
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Daniel Kwaro
- Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya
| | - Kathryn Risher
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Sammy Khagayi
- Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya
| | - Clara Calvert
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David Obor
- Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya
| | - Malebogo Tlhajoane
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Fredrick Odongo
- Kenya Medical Research Institute - Center for Global Health Research, Kisumu, Kenya
| | - Milly Marston
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Emma Slaymaker
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Brian Rice
- MeSH Consortium, Department of Public Health Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chodziwadziwa Whiteson Kabudula
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Jeffrey W Eaton
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, United Kingdom
| | - Georges Reniers
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Ochieng BO, Khagayi S, Otieno M, Were JA, Nyothach EA, Hawi S, Kwaro D. The long-term impact of HIV/AIDS on socio-economic status: a comparative analysis of households headed by HIV-positive and HIV-negative individuals in Western Kenya. AIDS Care 2023:1-9. [PMID: 37217167 DOI: 10.1080/09540121.2023.2214863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/11/2023] [Indexed: 05/24/2023]
Abstract
HIV/AIDS is known to have adverse effects on individual and family socio-economic status due to the loss of productive time and over-expenditure in treatment. However, empirical data on how HIV/AIDS affects households' socio-economic status are insufficient. We linked socio-economic data from a Health and Demographic Surveillance System (HDSS) that implements an HIV/AIDS Longitudinal bio-behavioural survey (LBBS) to understand the long-term impact of HIV/AIDS on households' socio-economic status between 2010 and 2018. We compared changes in socio-economic status between households headed by HIV-negative and -positive individuals. A logistic regression was used to assess factors that influence socio-economic status. The level of education and household size were not significant predictors of households' socio-economic status. Households headed by HIV-positive individuals could maintain their baseline socio-economic status (unadjusted RRR = 1.17, 95% CI: 1.01, 1.36) but improvement chances were reduced despite a non-significant association (unadjusted RRR = 0.98, 95% CI: 0.80, 1.20). While HIV/AIDS is known to disrupt economic growth, in this setting, being a male household head, old and widowed reduces chances of improved socio-economic status. The elderly people, widows and widowers are disadvantaged. Consequently, there is a need for special programmes, which seek to empower the identified vulnerable groups economically. .
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Affiliation(s)
| | - Sammy Khagayi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Moses Otieno
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Joyce Akinyi Were
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | | | - Sarah Hawi
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
| | - Daniel Kwaro
- Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
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Yelverton V, Hair NL, Ghosh SH, Mfinanga SG, Ngadaya E, Baumgartner JN, Ostermann J, Vasudevan L. Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania. Vaccine 2022; 40:5483-5493. [PMID: 35961796 PMCID: PMC9954535 DOI: 10.1016/j.vaccine.2022.07.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/16/2022] [Accepted: 07/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Timely vaccination maximizes efficacy for preventing infectious diseases. In the absence of national vaccination registries, representative sample survey data hold vital information on vaccination coverage and timeliness. This study characterizes vaccination coverage and timeliness in Tanzania and provides an analytic template to inform contextually relevant interventions and evaluate immunization programs. METHODS Cross-sectional data on 6,092 children under age 3 from the 2015-16 Tanzania Demographic and Health Survey were used to examine coverage and timeliness for 14 vaccine doses recommended in the first year of life. The Kaplan-Meier method was used to model time to vaccination. Cox proportional hazard models were used to examine factors associated with timely vaccination. RESULTS Substantial rural-urban disparities in vaccination coverage and timeliness were observed for all vaccines. Across 14 recommended doses, documented coverage ranged from 52 % to 79 %. Median vaccination delays lasted up to 35 days; gaps were larger among rural than urban children and for later doses in vaccine series. Among rural children, median delays exceeded 35 days for the 3rd doses of the polio, pentavalent, and pneumococcal vaccines. Median delays among urban children were < 21 days for all doses. Among rural and urban children, lower maternal education and delivery at home were associated with increased risk of delayed vaccination. In rural settings, less household wealth and greater distance to a health facility were also associated with increased risk of delayed vaccination. DISCUSSION This study highlights persistent gaps in uptake and timeliness of childhood vaccinations in Tanzania and substantial rural-urban disparities. While the results provide an informative situation assessment and outline strategies for identifying unvaccinated children, a national electronic registry is critical for comprehensive assessments of the performance of vaccination programs. The timeliness measure employed in this study-the amount of time children are un- or undervaccinated-may serve as a sensitive performance metric for these programs.
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Affiliation(s)
- Valerie Yelverton
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Nicole L Hair
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Suvomita Happy Ghosh
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA
| | - Sayoki Godfrey Mfinanga
- Muhimbili Research Centre, National Institute for Medical Research, P.O. Box 65001, Dar-es-Salaam, Tanzania; Muhimbili University of Health and Allied Sciences, United Nations Rd, Dar es Salaam, Tanzania; The Nelson Mandela African Institution of Science and Technology (NM-AIST), Nelson Mandela Rd, Arusha, Tanzania; Alliance for Africa Research and Innovation (A4A), Dar es Salaam, Tanzania
| | - Esther Ngadaya
- Muhimbili Research Centre, National Institute for Medical Research, P.O. Box 65001, Dar-es-Salaam, Tanzania
| | - Joy Noel Baumgartner
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; School of Social Work, University of North Carolina at Chapel Hill, Tate-Turner-Kuralt Building, 325 Pittsboro St, CB #3550, Chapel Hill, NC 27599, USA
| | - Jan Ostermann
- Department of Health Services Policy & Management, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA; Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; South Carolina SmartState Center for Healthcare Quality, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Lavanya Vasudevan
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC 27710, USA; Department of Family Medicine and Community Health, 2200 W. Main Street, Suite 600, School of Medicine, Duke University, Durham, NC 27710, USA.
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OUP accepted manuscript. Trans R Soc Trop Med Hyg 2022; 116:686-693. [DOI: 10.1093/trstmh/trac013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 07/17/2021] [Accepted: 02/13/2022] [Indexed: 11/13/2022] Open
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Adamu AA, Essoh TA, Adeyanju GC, Jalo RI, Saleh Y, Aplogan A, Wiysonge CS. Drivers of hesitancy towards recommended childhood vaccines in African settings: a scoping review of literature from Kenya, Malawi and Ethiopia. Expert Rev Vaccines 2021; 20:611-621. [PMID: 33682587 DOI: 10.1080/14760584.2021.1899819] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is a dearth of literature on vaccine hesitancy in Africa. In this study, we aimed to explore the drivers of hesitancy toward recommended childhood vaccines in Kenya, Malawi, and Ethiopia. METHODS A scoping review methodology was used as this evidence synthesis approach is suitable for mapping existing literature and identifying knowledge gaps. For this study, we systematically searched four electronic databases for published and unpublished literature from the three African countries. The methodological framework that was used is in line with Arksey and O'Malley's recommendations as modified by Levac. RESULTS A total of 23 publications met the inclusion criteria and were included in the study. Majority of the studies were published after 2012. In these three African countries, hesitancy toward recommended childhood vaccines is driven by a mix of caregiver-related factors, health systems-related factors as well as the influence of community context. CONCLUSION This study demonstrated that vaccine hesitancy in Kenya, Malawi, and Ethiopia is a complex phenomenon that is driven by multiple interrelated and interconnected factors.
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Affiliation(s)
- Abdu A Adamu
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Téné-Alima Essoh
- Agence De Médecine Préventive (AMP) Afrique - Preventive Medicine Agency Africa, Abidjan, Cote d'Ivoire
| | - Gbadebo Collins Adeyanju
- Psychology and Infectious Diseases Lab, Department of Media and Communication Science, Faculty of Philosophy, University of Erfurt, Erfurt, Germany.,Centre for Empirical Research in Economics and Behavioural Science (CEREB), University of ErfurtErfurt, Germany
| | - Rabiu I Jalo
- Department of Community Medicine, Faculty of Clinical Sciences, College of Health Science, Bayero University Kano, Kano State, Nigeria.,Department of Community Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - Yusuf Saleh
- Department of Community Medicine, Aminu Kano Teaching Hospital, Kano State, Nigeria
| | - Aristide Aplogan
- Agence De Médecine Préventive (AMP) Afrique - Preventive Medicine Agency Africa, Abidjan, Cote d'Ivoire
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
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