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Nyaboe E, Larsen A, Sila J, Kinuthia J, Owiti G, Abuna F, Kohler P, John-Stewart G, Pintye J. Contraceptive Method Mix and HIV Risk Behaviors Among Kenyan Adolescent Girls and Young Women Seeking Family Planning Services: Implications for Integrating HIV Prevention. FRONTIERS IN REPRODUCTIVE HEALTH 2021; 3:667413. [PMID: 36304017 PMCID: PMC9580727 DOI: 10.3389/frph.2021.667413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 06/22/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Understanding HIV risk behaviors among adolescent girls and young women (AGYW) seeking contraception could help inform integrating HIV prevention services within family planning (FP) clinics. Methods: From 10/2018 to 04/2019, we conducted a survey at 4 FP clinics in Kisumu, Kenya to evaluate risk behaviors among AGYW without HIV infection seeking contraception. All AGYW aged 15-24 were invited to participate following receipt of FP services. Adolescent girls and young women initiating or refilling contraception were included in this analysis. Long-acting reversible contraceptives (LARC) included intrauterine devices, implants, or injectables. Non-LARC methods included oral contraceptive pills (OCP) or condoms. We used an empiric risk score to assess HIV risk behaviors; HIV risk scores of ≥5 (corresponding to 5-15% HIV incidence) defined "high" HIV risk. Results: Overall, 555 AGYW seeking FP were included. Median age was 22 years [interquartile range (IQR) 20-23], median completed education was 12 years (IQR 10-12); 23% of AGYW had HIV risk scores of ≥5. The most frequent form of contraception was injectables (43%), followed by implants (39%). After adjustment for education, prior pregnancy, and marital status, LARC users more frequently engaged in transactional sex than non-LARC users [6 vs. 0%, adjusted prevalence ratio (PR) = 1.17, 95% CI 1.09-1.29, p < 0.001]; LARC use was not associated with HIV risk scores ≥5. Among LARC users, AGYW using injectables more frequently had condomless sex compared to AGYW using other LARC methods (85 vs. 75%, adjusted PR = 1.52, 95% CI 1.09-2.10, p = 0.012); injectable use was not associated with HIV risk scores ≥5. Conclusions: Adolescent girls and young women seeking contraception frequently had high HIV risk, emphasizing the importance of integrating HIV prevention within FP. Multipurpose technologies for contraception and HIV prevention could particularly benefit AGYW.
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Affiliation(s)
| | - Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Joseph Sila
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - George Owiti
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya
| | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Child, Family, and Population Health, University of Washington, Seattle, WA, United States
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jillian Pintye
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, United States
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Larsen A, Kinuthia J, Lagat H, Sila J, Abuna F, Kohler P, John-Stewart G, Pintye J. Depression and HIV risk behaviors among adolescent girls and young women seeking family planning services in Western Kenya. Int J STD AIDS 2020; 31:652-664. [PMID: 32538330 DOI: 10.1177/0956462420920423] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We assessed prevalence of human immunodeficiency virus (HIV) risk behaviors and depressive symptoms among adolescent girls and young women (AGYW) aged 15-24 years attending four public family planning clinics in Western Kenya from January to June 2019. Moderate-to-severe depression (MSD) was defined as a Center for Epidemiologic Studies Depression Scale (CESD-10) score ≥10. Among 487 AGYW, the median age was 22 years (interquartile range 20-23), and 59 (12%) AGYW reported MSD. MSD was more prevalent among AGYW without a current partner (p = 0.001) and associated with HIV risk factors including partner ≥10 years older, recent transactional sex, forced sex, intimate partner violence, and alcohol use (each p ≤ 0.005). Thirty-four percent of AGYW with MSD had a high HIV risk score corresponding to 5 to 15 incident HIV cases per 100 person-years. Overlapping high prevalence of depression and HIV risk among AGYW underscores the need for integrated mental health and HIV services in family planning clinics.
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Affiliation(s)
- Anna Larsen
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - John Kinuthia
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, Kenya.,Kenyatta National Hospital, Nairobi, Kenya
| | | | | | | | - Pamela Kohler
- Department of Global Health, University of Washington, Seattle, WA, USA.,Psychosocial and Community Health, University of Washington, Seattle, WA, USA
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA.,University of Washington, Department of Medicine, Seattle, WA, USA.,Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, WA, USA
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Sila J, Larsen AM, Kinuthia J, Owiti G, Abuna F, Kohler PK, John-Stewart G, Pintye J. High Awareness, Yet Low Uptake, of Pre-Exposure Prophylaxis Among Adolescent Girls and Young Women Within Family Planning Clinics in Kenya. AIDS Patient Care STDS 2020; 34:336-343. [PMID: 32757980 DOI: 10.1089/apc.2020.0037] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Adolescent girls and young women (AGYW) are a priority population for HIV prevention in high-burden settings. We evaluated psychosocial characteristics, behavioral risk factors for HIV, and pre-exposure prophylaxis (PrEP) awareness and uptake among AGYW seeking contraceptive services at four public sector family planning (FP) clinics offering integrated PrEP delivery in Kisumu, Kenya. From October 2018 to June 2019, we approached all AGYW (aged 15-24 years) seeking contraception to participate in a survey following receipt of FP services and PrEP screening. Overall, 470 AGYW were screened for PrEP at their FP visit by facility staff and subsequently enrolled in the survey. Median age was 22 years (interquartile range 20-23), 22% of AGYW were in school, and 55% were married. The most frequent forms of contraception were implants and injectables (41% each). Over a third of AGYW (36%) reported low social support, 13% had symptoms of moderate to severe depression, and 3% reported intimate partner violence. Three-quarters (75%) of AGYW reported recent condomless sex and 42% suspected that their primary partner had other sexual partners. Most AGYW (89%) had previously heard of PrEP; 76% had at least one PrEP eligibility criterion as per national guidelines; however, only 4% initiated PrEP at their current FP visit. PrEP initiators more frequently had high HIV risk perception than noninitiators (85% vs. 10%, p < 0.001). Low perceived HIV risk (76%) and pill burden (51%) were common reasons for declining PrEP among AGYW with HIV behavioral risk factors. PrEP counseling should be tailored to AGYW to guide appropriate PrEP decision-making in this important population.
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Affiliation(s)
| | - Anna M. Larsen
- Department of Epidemiology and University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Kenyatta National Hospital, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | | | - Pamela K. Kohler
- Department of Global Health, University of Washington, Seattle, Washington, USA
- University of Washington Child, Family, and Population Health, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Epidemiology and University of Washington, Seattle, Washington, USA
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Medicine, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, and University of Washington, Seattle, Washington, USA
| | - Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA
- Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, Washington, USA
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John Nutor J, Duodu PA, Agbadi P, Duah HO, Oladimeji KE, Gondwe KW. Predictors of high HIV+ prevalence in Mozambique: A complex samples logistic regression modeling and spatial mapping approaches. PLoS One 2020; 15:e0234034. [PMID: 32497145 PMCID: PMC7272061 DOI: 10.1371/journal.pone.0234034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 05/18/2020] [Indexed: 01/10/2023] Open
Abstract
Introduction The burden of HIV infection in southern Africa is a public health concern with an increasing number of new infections. This study sought to investigate the predictors of HIV prevalence in Mozambique through a complex samples logistic regression and spatial mapping approach using nationally representative data. Methods We conducted a secondary data analysis using the 2015 Mozambique Demographic and Health Survey and AIDS Indicator Survey. The analysis performed in four stages while incorporating population survey sampling weights did the following: i) created a complex sample plan file in SPSS, ii) performed the weighted estimate of HIV prevalence, iii) performed complex sample chi-square test of independence, and then iv) performed complex sample logistic regression modeling. Results Out of 11,270 participants, 1,469 (13.0%) tested positive for HIV. The prevalence of HIV infection was higher in females (15.1%) than males (10.2%). We found that urban dwellers were more likely to be HIV-positive compared to rural dwellers (AOR: 1.70; CI: 1.27, 2.27). We observed provincial variations in HIV prevalence, with Maputo Cidade (17.4%), Maputo Provincia (22.6%), Gaza (25.2%) recording higher prevalence above the national estimate. Other independent predictors of HIV infection in Mozambique included age, education level, marital status, total lifetime sexual partners, and having had an STI in the last 12 months. Conclusions The study revealed associations between high-risk sexual behavior and HIV infection. Results from our spatial mapping approach can help health policy makers to better allocate resources for cost-effective HIV/AIDS interventions. Pre-Exposure Prophylaxis (PrEP) campaigns among high-risk groups should be pursued to lower the reservoir of HIV among high-risk groups.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, California, United States of America
- * E-mail:
| | | | - Pascal Agbadi
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | - Kelechi Elizabeth Oladimeji
- Department of Public Health, Faculty of Health Sciences, University of Fort Hare, Eastern Cape, South Africa
| | - Kaboni Whitney Gondwe
- College of Nursing, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, United States of America
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Pintye J, Rogers Z, Kinuthia J, Mugwanya KK, Abuna F, Lagat H, Sila J, Kemunto V, Baeten JM, John-Stewart G, Unger JA. Two-Way Short Message Service (SMS) Communication May Increase Pre-Exposure Prophylaxis Continuation and Adherence Among Pregnant and Postpartum Women in Kenya. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:55-67. [PMID: 32139420 PMCID: PMC7108943 DOI: 10.9745/ghsp-d-19-00347] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 02/05/2020] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We evaluated a 2-way short message service (SMS) communication platform to improve continuation of pre-exposure prophylaxis (PrEP) for HIV prevention among Kenyan women who initiated PrEP within routine maternal child health (MCH) and family planning clinics. METHODS We adapted an existing SMS platform (Mobile WACh [mWACh]) to send PrEP-tailored, theory-based SMS and allow clients to communicate with a remote nurse. Women who did not have HIV and who were initiating PrEP at 2 MCH/family planning clinics in Kisumu County, Kenya, from February to October 2018, were offered enrollment into the mWACh-PrEP program; SMS communication was free. We evaluated acceptability, satisfaction, and implementation metrics. In a pre/postevaluation, we compared PrEP continuation at 1-month postinitiation among women who initiated PrEP in the period before (n=166) versus after mWACh-PrEP implementation, adjusting for baseline differences. RESULTS Of the 334 women who were screened for enrollment into the mWACh-PrEP program; 193 (58%) were eligible and of those, 190 (98%) accepted enrollment. Reasons for ineligibility (n=141) included no phone access (29%) and shared SIM cards (25%). Median age was 25 years (interquartile range=22-30), and 91% were MCH clients. Compared to women who initiated PrEP in the month before mWACh-PrEP implementation, women who enrolled in mWACh-PrEP were more likely to return for their first PrEP follow-up visit (40% vs. 53%; adjusted risk ratio [aRR]=1.26; 95% confidence interval [CI]= 1.06, 1.50; P=.008) and more likely to continue PrEP (22% vs. 43%; aRR=1.75; 95% CI=1.21, 2.55; P=.003). Among those who returned, 99% reported successful receipt of SMS through the mWACh-PrEP system and 94% reported that mWACh-PrEP helped them understand PrEP better. Concerns about PrEP use, how it works, and side effects accounted for the majority (80%) of issues raised by participants using SMS. CONCLUSIONS Two-way SMS expanded support for PrEP and opportunities for dialogue beyond the clinic and enabled women to ask and receive answers in real time regarding PrEP, which facilitated its continued use.
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Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington, USA. .,Department of Biobehavioral Nursing and Health Informatics, University of Washington, Seattle, WA, USA
| | - Zoe Rogers
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Kenneth K Mugwanya
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Felix Abuna
- Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Harison Lagat
- Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Joseph Sila
- Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Valarie Kemunto
- Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Jared M Baeten
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya.,Department of Epidemiology, University of Washington, Seattle, Washington, USA.,Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Jennifer A Unger
- Department of Global Health, University of Washington, Seattle, Washington, USA.,Department of Obstetrics/Gynecology, University of Washington, Seattle, Washington, USA
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James C, Harfouche M, Welton NJ, Turner KM, Abu-Raddad LJ, Gottlieb SL, Looker KJ. Herpes simplex virus: global infection prevalence and incidence estimates, 2016. Bull World Health Organ 2020; 98:315-329. [PMID: 32514197 PMCID: PMC7265941 DOI: 10.2471/blt.19.237149] [Citation(s) in RCA: 310] [Impact Index Per Article: 77.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 01/21/2020] [Accepted: 01/21/2020] [Indexed: 12/25/2022] Open
Abstract
Objective To generate global and regional estimates for the prevalence and incidence of herpes simplex virus (HSV) type 1 and type 2 infection for 2016. Methods To obtain data, we undertook a systematic review to identify studies up to August 2018. Adjustments were made to account for HSV test sensitivity and specificity. For each World Health Organization (WHO) region, we applied a constant incidence model to pooled prevalence by age and sex to estimate the prevalence and incidence of HSV types 1 and 2 infections. For HSV type 1, we apportioned infection by anatomical site using pooled estimates of the proportions that were oral and genital. Findings In 2016, an estimated 491.5 million people (95% uncertainty interval, UI: 430.4 million–610.6 million) were living with HSV type 2 infection, equivalent to 13.2% of the world’s population aged 15–49 years. An estimated 3752.0 million people (95% UI: 3555.5 million–3854.6 million) had HSV type 1 infection at any site, equivalent to a global prevalence of 66.6% in 0–49-year-olds. Differing patterns were observed by age, sex and geographical region, with HSV type 2 prevalence being highest among women and in the WHO African Region. Conclusion An estimated half a billion people had genital infection with HSV type 2 or type 1, and several billion had oral HSV type 1 infection. Millions of people may also be at higher risk of acquiring human immunodeficiency virus (HIV), particularly women in the WHO African Region who have the highest HSV type 2 prevalence and exposure to HIV.
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Affiliation(s)
- Charlotte James
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, England
| | | | - Nicky J Welton
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, England
| | | | | | - Sami L Gottlieb
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Katharine J Looker
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, England
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Brief Report: Integration of PrEP Services Into Routine Antenatal and Postnatal Care: Experiences From an Implementation Program in Western Kenya. J Acquir Immune Defic Syndr 2019; 79:590-595. [PMID: 30204720 DOI: 10.1097/qai.0000000000001850] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Programmatic approaches for delivering pre-exposure prophylaxis (PrEP) to pregnant and postpartum women in settings with high HIV burden are undefined. The PrEP Implementation for Young Women and Adolescents (PrIYA) Program developed approaches for delivering PrEP in maternal child health (MCH) clinics. METHODS Under the PrIYA Program, nurse-led teams worked with MCH staff at 16 public, faith-based, and private facilities in Kisumu, Kenya, to determine optimal clinic flow for PrEP integration into antenatal care (ANC) and postnatal care (PNC). A program-dedicated nurse facilitated integration. HIV-uninfected women were screened for behavioral risk factors; same-day PrEP was provided to interested and medically eligible women. PrEP and MCH services were evaluated using standardized flow mapping and time-and-motion surveys. RESULTS Clinics developed 2 approaches for integrating PrEP delivery within ANC/PNC: (1) co-delivery: ANC/PNC and PrEP services delivered by same MCH nurse or (2) sequential services: PrEP services after ANC/PNC by a PrEP-specialized nurse. Three clinics selected co-delivery and 13 sequential services, based on patient volume and space availability. Overall, 86 ANC/PNC visits were observed. Clients who initiated PrEP took a median of 18 minutes (interquartile range 15-26) for PrEP-related activities (risk assessment, PrEP counseling, creatinine testing, dispensation, and documentation) in addition to other routine ANC/PNC activities. For clients who declined PrEP, an additional 13 minutes (interquartile range 7-15) was spent on PrEP-related risk assessment and counseling. CONCLUSIONS PrEP delivery within MCH used co-delivery or sequential approaches. The moderate additional time burden for PrEP initiation in MCH would likely decline with community awareness and innovations such as group/peer counseling or expedited dispensing.
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Pintye J, Drake AL, Begnel E, Kinuthia J, Abuna F, Lagat H, Dettinger J, Wagner AD, Thirumurthy H, Mugwanya K, Baeten JM, John-Stewart G. Acceptability and outcomes of distributing HIV self-tests for male partner testing in Kenyan maternal and child health and family planning clinics. AIDS 2019; 33:1369-1378. [PMID: 30932954 PMCID: PMC6546533 DOI: 10.1097/qad.0000000000002211] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Providing HIV self-tests to women for distribution to male partners may provide a unique opportunity to increase male partner and couples testing among women in HIV high-burden settings. METHODS Between November 2017 and June 2018, we offered self-tests for at-home couples or partner HIV testing to HIV-uninfected women seeking routine maternal and child health and family planning services at eight facilities in Kisumu, Kenya. Women accepting self-tests were offered at least two self-tests (OraQuick) to take to their partner(s) with instructions on use. HIV self-testing (HIVST) outcomes were evaluated using available programmatic data. RESULTS Overall, 3620 women were offered self-tests for at-home male partner HIV testing. The median age was 24 years (interquartile range 21-28) and 81% were in monogamous marriages. Overall, 1422 (39%) women reported having a partner of unknown HIV status, of whom 755 (53%) accepted self-tests. Among women with partners of unknown HIV status who declined self-tests (n = 667), 49% reported needing to consult their partner. Pregnant women were more likely to accept HIVST than nonpregnant women (prevalence ratio = 1.2, 95% confidence interval 1.0-1.4, P = 0.013). Self-testing outcomes were ascertained for 389 (44%) women who accepted self-tests. Among these women, 93% offered HIVSTs to their male partner; of these, 95% reported their male partners used the self-test and 99% used a self-test with their partner. CONCLUSION Among women attending routine maternal and child health and family planning services who had male partners of unknown HIV status, over half accepted self-tests for partner testing. Most women with outcomes ascertained reported that male partners accepted and used self-tests and that couples testing occurred.
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Affiliation(s)
- Jillian Pintye
- Department of Global Health, University of Washington, Seattle, Washington
| | - Alison L Drake
- Department of Global Health, University of Washington, Seattle, Washington
| | - Emily Begnel
- Department of Global Health, University of Washington, Seattle, Washington
| | - John Kinuthia
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Obstetrics/Gynecology, Kenyatta National Hospital, Nairobi, Kenya
| | - Felix Abuna
- University of Washington—Kenya, Nairobi, Kenya
| | | | - Julia Dettinger
- Department of Global Health, University of Washington, Seattle, Washington
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, Washington
| | - Harsha Thirumurthy
- Department of Medical Ethics and Health Policy, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth Mugwanya
- Department of Global Health, University of Washington, Seattle, Washington
| | - Jared M. Baeten
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Epidemiology, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
- Department of Pediatric, University of Washington, Seattle, Washington
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Viral and Host Characteristics of Recent and Established HIV-1 Infections in Kisumu based on a Multiassay Approach. Sci Rep 2016; 6:37964. [PMID: 27897226 PMCID: PMC5126579 DOI: 10.1038/srep37964] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022] Open
Abstract
Integrated approaches provide better understanding of HIV/AIDS epidemics. We optimised a multiassay algorithm (MAA) and assessed HIV incidence, correlates of recent infections, viral diversity, plus transmission clusters among participants screened for Kisumu Incidence Cohort Study (KICoS1) (2007–2009). We performed BED-CEIA, Limiting antigen (LAg) avidity, Biorad avidity, and viral load (VL) tests on HIV-positive samples. Genotypic analyses focused on HIV-1 pol gene. Correlates of testing recent by MAA were assessed using logistic regression model. Overall, 133 (12%, 95% CI: 10.2–14.1) participants were HIV-positive, of whom 11 tested recent by MAA (BED-CEIA OD-n < 0.8 + LAg avidity OD-n < 1.5 + VL > 1000 copies/mL), giving an incidence of 1.46% (95% CI: 0.58–2.35) per year. This MAA-based incidence was similar to longitudinal KICoS1 incidence. Correlates of testing recent included sexually transmitted infection (STI) treatment history (OR = 3.94, 95% CI: 1.03–15.07) and syphilis seropositivity (OR = 10.15, 95% CI: 1.51–68.22). Overall, HIV-1 subtype A (63%), D (15%), C (3%), G (1%) and recombinants (18%), two monophyletic dyads and intrinsic viral mutations (V81I, V81I/V, V108I/V and K101Q) were observed. Viral diversity mirrored known patterns in this region, while resistance mutations reflected likely non-exposure to antiretroviral drugs. Management of STIs may help address ongoing HIV transmission in this region.
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Maixenchs M, Anselmo R, Zielinski-Gutiérrez E, Odhiambo FO, Akello C, Ondire M, Zaidi SSH, Soofi SB, Bhutta ZA, Diarra K, Djitèye M, Dembélé R, Sow S, Minsoko PCA, Agnandji ST, Lell B, Ismail MR, Carrilho C, Ordi J, Menéndez C, Bassat Q, Munguambe K. Willingness to Know the Cause of Death and Hypothetical Acceptability of the Minimally Invasive Autopsy in Six Diverse African and Asian Settings: A Mixed Methods Socio-Behavioural Study. PLoS Med 2016; 13:e1002172. [PMID: 27875532 PMCID: PMC5119724 DOI: 10.1371/journal.pmed.1002172] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/11/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The minimally invasive autopsy (MIA) is being investigated as an alternative to complete diagnostic autopsies for cause of death (CoD) investigation. Before potential implementation of the MIA in settings where post-mortem procedures are unusual, a thorough assessment of its feasibility and acceptability is essential. METHODS AND FINDINGS We conducted a socio-behavioural study at the community level to understand local attitudes and perceptions related to death and the hypothetical feasibility and acceptability of conducting MIAs in six distinct settings in Gabon, Kenya, Mali, Mozambique, and Pakistan. A total of 504 interviews (135 key informants, 175 health providers [including formal health professionals and traditional or informal health providers], and 194 relatives of deceased people) were conducted. The constructs "willingness to know the CoD" and "hypothetical acceptability of MIAs" were quantified and analysed using the framework analysis approach to compare the occurrence of themes related to acceptability across participants. Overall, 75% (379/504) of the participants would be willing to know the CoD of a relative. The overall hypothetical acceptability of MIA on a relative was 73% (366/504). The idea of the MIA was acceptable because of its perceived simplicity and rapidity and particularly for not "mutilating" the body. Further, MIAs were believed to help prevent infectious diseases, address hereditary diseases, clarify the CoD, and avoid witchcraft accusations and conflicts within families. The main concerns regarding the procedure included the potential breach of confidentiality on the CoD, the misperception of organ removal, and the incompatibility with some religious beliefs. Formal health professionals were concerned about possible contradictions between the MIA findings and the clinical pre-mortem diagnoses. Acceptability of the MIA was equally high among Christian and Islamic communities. However, in the two predominantly Muslim countries, MIA acceptability was higher in Mali than in Pakistan. While the results of the study are encouraging for the potential use of the MIA for CoD investigation in low-income settings, they remain hypothetical, with a need for confirmation with real-life MIA implementation and in populations beyond Health and Demographic Surveillance System areas. CONCLUSIONS This study showed a high level of interest in knowing the CoD of a relative and a high hypothetical acceptability of MIAs as a tool for CoD investigation across six distinct settings. These findings anticipate potential barriers and facilitators, both at the health facility and community level, essential for local tailoring of recommendations for future MIA implementation.
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Affiliation(s)
- Maria Maixenchs
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Rui Anselmo
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
| | | | - Frank O. Odhiambo
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Clarah Akello
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - Maureen Ondire
- Kenya Medical Research Institute, Centre for Global Health Research, Kisumu, Kenya
| | - S. Shujaat H. Zaidi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Sajid Bashir Soofi
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A. Bhutta
- Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kounandji Diarra
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | - Mahamane Djitèye
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | | | - Samba Sow
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako, Mali
| | | | - Selidji Todagbe Agnandji
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Bertrand Lell
- Centre de Recherches Médicales de Lambaréné, Hôpital Albert Schweitzer, Lambaréné, Gabon
- Institut für Tropenmedizin, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Mamudo R. Ismail
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Carla Carrilho
- Department of Pathology, Maputo Central Hospital, Maputo, Mozambique
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Jaume Ordi
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Clara Menéndez
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Quique Bassat
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça, Maputo, Mozambique
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- * E-mail:
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11
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McLellan-Lemal E, Gust DA, Gvetadze R, Furtado M, Otieno FO, Desai M, Zeh C, Samandari T, Nyagol B, Makanga EM. Characteristics of women screened for a contraceptive intravaginal ring study in Kisumu, Kenya, 2014. RESEARCH JOURNAL OF WOMEN'S HEALTH 2016; 3:1. [PMID: 27441094 PMCID: PMC4946642 DOI: 10.7243/2054-9865-3-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 06/30/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND HIV antiretroviral-based intravaginal rings with and without co-formulated contraception hold promise for increasing HIV prevention options for women. Acceptance of and ability to correctly and consistently use this technology may create challenges for future ring-based microbicide trials in settings where this technology has not been introduced. We examined baseline factors associated with enrolling in a contraceptive intravaginal ring study in Kisumu, Kenya and describe notional acceptability (willingness to switch to a contraceptive ring based solely on information received about it). METHODS Demographic, psychosocial, and behavioral eligibility screening of women 18-34 years was undertaken. Testing for pregnancy, HIV, and other sexually transmitted infections (STIs) was also conducted. We compared enrollment status across groups of categorical predictors using prevalence ratios (PR) and 95% confidence interval (CI) estimates obtained from a log-binomial regression model. RESULTS Out of 692 women pre-screened April to November 2014, 463 completed screening, and 302 women were enrolled. Approximately 97% of pre-screened women were willing to switch from their current contraceptive method to use the intravaginal ring exclusively for the 6-month intervention period. Pregnancy, HIV, and STI prevalence were 1.7%, 14.5%, and 70.4% respectively for the 463 women screened. Women 18-24 (PR=1.47, CI 1.15-1.88) were more likely to be enrolled than those 30-34 years of age, as were married/cohabitating women (PR=1.62, CI 1.22-2.16) compared to those separated, divorced, or widowed. In adjusted analyses, sexual debut at less than 17 years of age, one lifetime sexual partner, abnormal vaginal bleeding in the past 12 months, condomless vaginal or anal sex in the past 3 months, and not having a sexual partner of unknown HIV status in the past 3 months were predictive of enrollment. CONCLUSION High notional acceptability suggests feasibility for contraceptive intravaginal ring use. Factors associated with ring use initiation and 6-month use will need to be assessed.
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Affiliation(s)
- Eleanor McLellan-Lemal
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Deborah A. Gust
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Roman Gvetadze
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Melissa Furtado
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
- Engility Corporation, Atlanta, GA, USA
| | | | - Mitesh Desai
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
| | - Clement Zeh
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Kisumu, Kenya
| | - Taraz Samandari
- Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, Georgia
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12
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Ly KN, Kim AA, Umuro M, Drobenuic J, Williamson JM, Montgomery JM, Fields BS, Teshale EH. Prevalence of Hepatitis B Virus Infection in Kenya, 2007. Am J Trop Med Hyg 2016; 95:348-53. [PMID: 27273644 DOI: 10.4269/ajtmh.16-0059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/28/2016] [Indexed: 12/15/2022] Open
Abstract
Current estimates put the prevalence of hepatitis B virus (HBV) infection in Kenya at 5-8%. We determined the HBV infection prevalence in the human immunodeficiency virus (HIV)-negative Kenyan adult and adolescent population based on samples collected from a national survey. We analyzed data from HIV-negative participants in the 2007 Kenya AIDS Indicator Survey to estimate the HBV infection prevalence. We defined past or present HBV infection as presence of total hepatitis B core antibody (HBcAb), and chronic HBV infection (CHBI) as presence of both total HBcAb and hepatitis B surface antigen (HBsAg). We calculated crude and adjusted odds of HBV infection by demographic characteristics and risk factors using logistic regression analyses. Of 1,091 participants aged 15-64 years, approximately 31.5% (95% confidence interval [CI] = 28.0-35.3%) had exposure to HBV, corresponding to approximately 6.1 million (CI = 5.4-6.8 million) with past or present HBV infection. The estimated prevalence of CHBI was 2.1% (95% CI = 1.4-3.1%), corresponding to approximately 398,000 (CI = 261,000-602,000) with CHBI. CHBI is a major public health problem in Kenya, affecting approximately 400,000 persons. Knowing the HBV infection prevalence at baseline is important for planning and public health policy decision making and for monitoring the impact of viral hepatitis prevention programs.
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Affiliation(s)
- Kathleen N Ly
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Andrea A Kim
- Division of Global HIV/AIDS, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mamo Umuro
- National Public Health Laboratory Services, Ministry of Health, Nairobi, Kenya
| | - Jan Drobenuic
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - John M Williamson
- Division of Parasitic Diseases and Malaria, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joel M Montgomery
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Barry S Fields
- Division of Global Health Protection, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Eyasu H Teshale
- Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, Georgia
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