Family model of HIV care and treatment: a retrospective study in Kenya

<p>Abstract</p> <p>Background</p> <p>Nyanza Province, Kenya, had the highest HIV prevalence in the country at 14.9% in 2007, more than twice the national HIV prevalence of 7.1%. Only 16% of HIV-infected adults in the country accurately knew their HIV status. Targeted strategies to reach and test individuals are urgently needed to curb the HIV epidemic. The family unit is one important portal.</p> <p>Methods</p> <p>A family model of care was designed to build on the strengths of Kenyan families. Providers use a family information table (FIT) to guide index patients through the steps of identifying family members at HIV risk, address disclosure, facilitate family testing, and work to enrol HIV-positive members and to prevent new infections. Comprehensive family-centred clinical services are built around these steps. To assess the approach, a retrospective study of patients receiving HIV care between September 2007 and September 2009 at Lumumba Health Centre in Kisumu was conducted. A random sample of FITs was examined to assess family reach.</p> <p>Results</p> <p>Through the family model of care, for each index patient, approximately 2.5 family members at risk were identified and 1.6 family members were tested. The approach was instrumental in reaching children; 61% of family members identified and tested were children. The approach also led to identifying and enrolling a high proportion of HIV- positive partners among those tested: 71% and 89%, respectively.</p> <p>Conclusions</p> <p>The family model of care is a feasible approach to broaden HIV case detection and service reach. The approach can be adapted for the local context and should continue to utilize index patient linkages, FIT adaption, and innovative methods to package services for families in a manner that builds on family support and enhances patient care and prevention efforts. Further efforts are needed to increase family member engagement.</p

A psychosocial intervention to reduce gender-based violence and antepartum depressive symptoms in pregnant women in Kisumu County, Kenya: a quasi-experimental study

Introduction: Gender-based violence during pregnancy and its associated adverse health effects are disproportionately higher in developing countries like Kenya where screening for and management of gender-based violence is currently not part of routine antenatal care. This study assessed the effect of a psychosocial intervention on gender-based violence and antepartum depressive symptoms in pregnant women. Methods: This quasi-experimental study compared gender-based violence and antepartum depression scores of 288 pregnant women in the two arms; one exposed to a psychosocial intervention and another receiving usual antenatal care. We used analysis of covariance to estimate the intervention effect and Chi-square to test the equality of proportions. Results: The difference between the psychosocial intervention and the usual antenatal care group in the total intimate partner violence and physical violence scores was a significant, with small effect sizes of partial eta = 0.196 and 0.305 respectively. The two arms did not differ in terms of the proportion of women reporting other acts of gender-based violence by intimate and non-intimate partners post-intervention. The intervention group had significantly lower mean depression scores compared to the usual care group, post-intervention, with a medium effect size of 0.500. Conclusion: This intervention aimed at reduction of gender-based violence and improvement of mental health of pregnant women is promising. Primary health care facilities in resource-constrained settings can take advantage of local capacity to deliver focused non-specialized psychosocial support to pregnant women experiencing violence

The effects on tuberculosis treatment adherence from utilising community health workers: a comparison of selected rural and urban settings in Kenya.

INTRODUCTION: Community Health Workers (CHWs) have been utilised for various primary health care activities in different settings especially in developing countries. Usually when utilised in well defined terms, they have a positive impact. To support Kenya's policy on engagement of CHWs for tuberculosis (TB) control, there is need to demonstrate effects of utilising them. OBJECTIVES: This study assessed TB treatment adherence among patients who utilised CHWs in management of their illness in comparison to those who did not in urban and rural settings. METHODS: A retrospective cohort study was conducted in selected health facilities using standard clinical records for each TB patient registered for treatment between 2005 to 2011. Qualitative data was collected from CHWs and health care providers. RESULTS: The study assessed 2778 tuberculosis patients and among them 1499 (54%) utilized CHWs for their TB treatment. The urban setting in comparison with the rural setting contributed 70% of patients utilising the CHWs (p<0.001). Overall treatment adherence of the cohort was 79%. Categorizing by use of CHWs, adherence among patients who had utilized CHWs was 83% versus 68% among those that had not (p<0.001). In comparison between the rural and urban settings adherence was 76% and 81.5% (p<0.001) respectively and when categorized by use of CHWs it was 73% and 90% (p<0.001) for the rural and urban set ups respectively. Utilisation of CHWs remained significant in enhancing treatment adherence in the cohort with unadjusted and adjusted ORs; OR 2.25, (95% 1.86-2.73) p<0.001 and OR 1.98 (95% 1.51-2.5) p<0.001 respectively. It was most effective in the urban set-up, OR 2.65 (95% 2.02-3.48, p<0.001) in comparison to the rural set up, OR 0.74 (95% 0.56-0.97) p = 0.032. CONCLUSION: Utilisation of CHWs enhanced TB treatment adherence and the best effects were in the urban set-up

Treatment Adherence by potential risk factors, sorted by utilisation of CHWs.

<p>* All data are n(%).</p><p>CHW, Community Health Worker, PSP Pulmonary Smear Positive, PSN Pulmonary Smear Negative, EPTB Extrapulmonary TB.</p

The Effect of combining location and use of CHWS on treatment Adherence.

<p>CHW, Community Health Worker.</p

Framework of Study.

<p>H/F Health Facility.</p

Effect of the Levonorgestrel Intrauterine Device on Genital HIV-1 RNA Shedding Among HIV-1–Infected Women Not Taking Antiretroviral Therapy in Nairobi, Kenya

The effect of the levonorgestrel-releasing intrauterine device (LNG-IUD) on genital HIV-1 RNA shedding and inflammation among 25 HIV-infected women was evaluated. Blood, endocervical, and cervicovaginal lavage samples were collected from HIV-infected women not taking antiretrovirals before LNG-IUD insertion and 1 month, 3 month, and 6 months thereafter. HIV-1 RNA was quantitated by real-time reverse transcriptase-polymerase chain reaction. Inflammatory markers were measured by enzyme immunoassay. Genital HIV-1 RNA shedding and inflammatory markers did not differ between LNG-IUD placement and month 6, with the exception of interleukin 1β that increased (0.42 log10; 95% confidence interval: 0.10 to 0.75). The LNG-IUD did not increase genital HIV-1 RNA shedding after 6 months of use

Associations Between Genital Tract Infections, Genital Tract Inflammation, and Cervical Cytobrush HIV-1 DNA in US Versus Kenyan Women

Cervical shedding of HIV-1 DNA may influence HIV-1 sexual transmission. HIV-1 DNA was detected in 250 (80%) of 316 and 207 (79%) of 259 cervical cytobrush specimens from 56 US and 80 Kenyan women, respectively. Plasma HIV-1 RNA concentration was associated with increased HIV-1 DNA shedding among US and Kenyan women. Kenyan women had higher cervicovaginal concentrations of proinflammatory interleukins (IL)-1β, IL-6, IL-8, and anti-inflammatory secretory leukocyte protease inhibitor compared with US women (all P &lt; 0.01). HIV-1 DNA shedding was associated with increased concentrations of IL-1β and IL-6 and lower secretory leukocyte protease inhibitor among US women but not Kenyan women

Interaction Between Lactobacilli, Bacterial Vaginosis-Associated Bacteria, and HIV Type 1 RNA and DNA Genital Shedding in U.S. and Kenyan Women

Bacterial vaginosis has been associated with genital HIV-1 shedding; however, the effect of specific vaginal bacterial species has not been assessed. We tested cervicovaginal lavage from HIV-1-seropositive women for common Lactobacillus species: L. crispatus, L. jensenii, and seven BV-associated species: BVAB1, BVAB2, BVAB3, Leptotrichia, Sneathia, Megasphaera, and Atopobium spp. using quantitative PCR. We used linear and Poisson regression to evaluate associations between vaginal bacteria and genital HIV-1 RNA and DNA. Specimens from 54 U.S. (310 visits) and 50 Kenyan women (137 visits) were evaluated. Controlling for plasma viral load, U.S. and Kenyan women had similar rates of HIV-1 RNA (19% of visits vs. 24%; IRR=0.95; 95% CI 0.61, 1.49) and DNA shedding (79% vs. 76%; IRR=0.90; 0.78, 1.05). At visits during antiretroviral therapy (ART), the likelihood of detection of HIV-1 RNA shedding was greater with BVAB3 (IRR=3.16; 95% CI 1.36, 7.32), Leptotrichia, or Sneathia (IRR=2.13; 1.02, 4.72), and less with L. jensenii (IRR=0.39; 0.18, 0.84). At visits without ART, only L. crispatus was associated with a lower likelihood of HIV-1 RNA detection (IRR=0.6; 0.40, 0.91). Vaginal Lactobacillus species were associated with lower risk of genital HIV-1 shedding, while the presence of certain BV-associated species may increase that risk

Interaction Between Lactobacilli, Bacterial Vaginosis-Associated Bacteria, and HIV Type 1 RNA and DNA Genital Shedding in U.S. and Kenyan Women

Bacterial vaginosis has been associated with genital HIV-1 shedding; however, the effect of specific vaginal bacterial species has not been assessed. We tested cervicovaginal lavage from HIV-1-seropositive women for common Lactobacillus species: L. crispatus, L. jensenii, and seven BV-associated species: BVAB1, BVAB2, BVAB3, Leptotrichia, Sneathia, Megasphaera, and Atopobium spp. using quantitative PCR. We used linear and Poisson regression to evaluate associations between vaginal bacteria and genital HIV-1 RNA and DNA. Specimens from 54 U.S. (310 visits) and 50 Kenyan women (137 visits) were evaluated. Controlling for plasma viral load, U.S. and Kenyan women had similar rates of HIV-1 RNA (19% of visits vs. 24%; IRR=0.95; 95% CI 0.61, 1.49) and DNA shedding (79% vs. 76%; IRR=0.90; 0.78, 1.05). At visits during antiretroviral therapy (ART), the likelihood of detection of HIV-1 RNA shedding was greater with BVAB3 (IRR=3.16; 95% CI 1.36, 7.32), Leptotrichia, or Sneathia (IRR=2.13; 1.02, 4.72), and less with L. jensenii (IRR=0.39; 0.18, 0.84). At visits without ART, only L. crispatus was associated with a lower likelihood of HIV-1 RNA detection (IRR=0.6; 0.40, 0.91). Vaginal Lactobacillus species were associated with lower risk of genital HIV-1 shedding, while the presence of certain BV-associated species may increase that risk