HIV pre-exposure prophylaxis for female sex workers : ensuring women's family planning needs are not left behind

Introduction Female sex workers (FSWs) experience overlapping burdens of HIV, sexually transmitted infections and unintended pregnancy. Pre-exposure prophylaxis (PrEP) is highly efficacious for HIV prevention. It represents a promising strategy to reduce HIV acquisition risks among FSWs specifically given complex social and structural factors that challenge consistent condom use. However, the potential impact on unintended pregnancy has garnered little attention. We discuss the potential concerns and opportunities for PrEP to positively or negatively impact the sexual and reproductive health and rights (SRHR) of FSWs. Discussion FSWs have high unmet need for effective contraception and unintended pregnancy is common in low- and middle-income countries. Unintended pregnancy can have enduring health and social effects for FSWs, including consequences of unsafe abortion and financial impacts affecting subsequent risk-taking. It is possible that PrEP could negatively impact condom and other contraceptive use among FSWs due to condom substitution, normalization, external pressures or PrEP provision by single-focus services. There are limited empirical data available to assess the impact of PrEP on pregnancy rates in real-life settings. However, pregnancy rates are relatively high in PrEP trials and modelling suggests a potential two-fold increase in condomless sex among FSWs on PrEP, which, given low use of non-barrier contraceptive methods, would increase rates of unintended pregnancy. Opportunities for integrating family planning with PrEP and HIV services may circumvent these concerns and support improved SRHR. Synergies between PrEP and family planning could promote uptake and maintenance for both interventions. Integrating family planning into FSW-focused community-based HIV services is likely to be the most effective model for improving access to non-barrier contraception among FSWs. However, barriers to integration, such as provider skills and training and funding mechanisms, need to be addressed. Conclusions As PrEP is scaled up among FSWs, there is growing impetus to consider integrating family planning services with PrEP delivery in order to better meet the diverse SRHR needs of FSWs and to prevent unintended consequences. Programme monitoring combined with research can close data gaps and mobilize adequate resources to deliver comprehensive SRHR services respectful of all women's rights

Tanzania Joint Health Technical Review 2002:final report HIV/AIDS

\ud Tanzania has a HIV epidemic at an estimated range of approximately 12% of the adult population (15-49 years) being infected. The epidemic is still increasing and there are few signs that the epidemic will level off in the near future. Until 2000 the response to the epidemic was the responsibility of NACP, the National AIDS Control Programme, within the MoH. As the epidemic and the insight of the impact of the epidemic on society progressed the health approach changed to a multi-sectoral response – still led by the MoH. However, as in other countries with a significant HIV epidemic it was decided to move the response of the epidemic to the highest level of government. The multi-sectoral approach thus underwent a transformation from a strategy of the MoH to a strategy of GOT by placing the responsibility under the Prime Ministers’ Office. In this transition the TACAIDS was formed to provide the leadership of GOT’s fight on HIV/AIDS in 2001. TACAIDS is placed within the PM’s Office and has slowly started to become operational. In January 2002 the commissioners were appointed and the first meeting will take place in February. The NACP is undergoing a transformation from being the body for the national response of all sectors in society to be part of the response from the MoH. The new role of NACP is still being developed, but it has been decided that the NACP in the future will operate under the authority of the CMO in the MoH. The task within the health sector is huge since the health sector is the first to be impacted by the epidemic and many of the cost-effective preventive measures to combat the epidemic, such as STI treatment, and the care of an increasing number of people being sick and dying from HIV/AIDS, fall on this sector to be appropriately dealt with in partnership with civil society and other stakeholders. The timing of the mission is appropriate as far as HIV/AIDS is concerned. Great expectations are attached to TACAIDS to ensure leadership and the MoH can now concentrate on improving the provision of services in the health sector where it has a comparative advantage. At the same time new money are being made available from the donors in the basket fund for district health services and new resources are soon going to be available for HIV/AIDS activities: the Global Fund for AIDS, the HIPC money, and the TMAP – perhaps effective from 2003. The opportunity to consolidate the achievements in the health sector has never been greater. It is the objectives of the review to assess the performance of the health sector’s response to HIV/AIDS; main challenges regarding the consequences and combat of HIV/AIDS; and based on this recommend actions in the short and medium term. The scope of work includes a review the performance of the National Aids Control Programme \ud and the opportunities lying ahead for TACAIDS. Further the review on HIV/AIDS will assess constraints and opportunities within the health sector with regard to both preventive and care interventions including MTCT and HAART treatment. The response is assessed with regard to the capacity of the health care sector. In all these areas the following should be considered: Experience within Tanzania with a view to possible best practices and lessons learned. Cost implications should be considered, with a particular view to opportunity cost in areas where there would be a choice. Private sector possible contribution and specific problems The team, Adeline Kimambo, medical doctor and Anita Alban, health economist, hold international and national experience in the field of HIV/AIDS. The team carried out a review of \ud existing documentation, including policies and guidelines, and interviews were carried out with key people within MOH, PORALG, TACAIDS and civil society (NGOs for PLWHA). Further a field trip was undertaken to a district that is part of the health sector reform process. For the Health District Reform to succeed it needs an effective facilitated response from the MoH and cooperation from all stakeholders in the process – not least PRORALG. The report reflects this approach by reviewing and assessing both the new opportunities and obstacles of the MoH in the transition from a multi-sectoral response to a consolidated health sector response and the progress of the decentralisation process at district level. Further the team has made a strategic choice in focusing on the HIV/AIDS interventions that can make a significant difference if scaled up. In the time available for the team a choice also had to be made between assessing MTCT interventions and the introduction of anti-retroviral drugs into the care agenda. We chose the latter since it is the greatest investment challenge to the MoH.\u

Agricultural and Finance Intervention Increased Dietary Intake and Weight of Children Living in HIV-Affected Households in Western Kenya.

We tested whether a multisectoral household agricultural and finance intervention increased the dietary intake and improved the nutritional status of HIV-affected children. Two hospitals in rural Kenya were randomly assigned to be either the intervention or the control arm. The intervention comprised a human-powered water pump, microfinance loan for farm commodities, and training in sustainable farming practices and financial management. In each arm, 100 children (0-59 mo of age) were enrolled from households with HIV-infected adults 18-49 y old. Children were assessed beginning in April 2012 and every 3 mo for 1 y for dietary intake and anthropometry. Children in the intervention arm had a larger increase in weight (β: 0.025 kg/mo, P = 0.030), overall frequency of food consumption (β: 0.610 times · wk-1 · mo-1, P = 0.048), and intakes of staples (β: 0.222, P = 0.024), fruits and vegetables (β: 0.425, P = 0.005), meat (β: 0.074, P < 0.001), and fat (β: 0.057, P = 0.041). Livelihood interventions have potential to improve the nutrition of HIV-affected children. This trial was registered at clinicaltrials.gov as NCT01548599

Engaging Youth in Citizen-Led Advocacy and Accountability for Adolescent Sexual and Reproductive Health

The White Ribbon Alliance Kenya is an autonomous, locally registered nongovernmental organisation in Kenya with a vision to ensure that all women and girls realise their right to quality health and well-being. It is among 14 other national alliances affiliated with the White Ribbon Alliance Global Secretariat, based in Washington, DC. White Ribbon Alliance Kenya recognises that even though the Kenyan government has policies in place to improve adolescent sexual and reproductive health outcomes, proper implementation and commitment is still needed. Our advocacy and citizen-led accountability efforts are working towards educating youth on their sexual and reproductive health rights, obligations, and entitlements, and promoting public awareness and citizen engagement. The goal is to empower adolescents to demand high-quality sexual and reproductive health services through appropriate policy communication and advocacy channels

Viral suppression among children and their caregivers living with HIV in western Kenya

INTRODUCTION: Despite the central role of caregivers in managing HIV treatment for children living with HIV, viral suppression within caregiver-child dyads in which both members are living with HIV is not well described. METHODS: We conducted a retrospective analysis of children living with HIV <15 years of age and their caregivers living with HIV attending HIV clinics affiliated with the Academic Model Providing Access to Healthcare (AMPATH) in Kenya between 2015 and 2017. To be included in the analysis, children and caregivers must have had ≥1 viral load (VL) during the study period while receiving antiretroviral therapy (ART) for ≥6 months, and the date of the caregiver's VL must have occurred ±90 days from the date of the child's VL. The characteristics of children, caregivers and dyads were descriptively summarized. Multivariable logistic regression was used to estimate the odds of viral non-suppression (≥ 1000 copies/mL) in children, adjusting for caregiver and child characteristics. RESULTS: Of 7667 children who received care at AMPATH during the study period, 1698 were linked to a caregiver living with HIV and included as caregiver-child dyads. For caregivers, 94% were mothers, median age at ART initiation 32.8 years, median CD4 count at ART initiation 164 cells/mm3 and 23% were not virally suppressed. For children, 52% were female, median age at ART initiation 4.2 years, median CD4 values at ART initiation were 15% (age < 5 years) and 396 cells/mm3 (age ≥ 5 years), and 38% were not virally suppressed. In the multivariable model, children were found more likely to not be virally suppressed if their caregivers were not suppressed compared to children with suppressed caregivers (aOR = 2.40, 95% CI: 1.86 to 3.10). Other characteristics associated with child viral non-suppression included caregiver ART regimen change prior to the VL, caregiver receipt of a non-NNRTI-based regimen at the time of the VL, younger child age at ART initiation and child tuberculosis treatment at the time of the VL. CONCLUSIONS: Children were at higher risk of viral non-suppression if their caregivers were not virally suppressed compared to children with suppressed caregivers. A child's viral suppression status should be closely monitored if his or her caregiver is not suppressed

Delivery of Youth Friendly Services in Kenya: Towards A Targeted Approach

The Adolescent Reproductive Health and Development Policy respond to the concerns of youths and bring their reproductive health issues into the development limelight as a whole. This policy has been pivotal in championing reproductive health issues of the youths and this has paved way to the development of the Plan of Action to strengthen commitment, partnership, networking and collaboration as well as resource mobilization efforts among stakeholders. In the delivery of Youth Friendly Services, the minimum conditions set by the Ministry of Health should be met in order to call it ‘youth friendly’. These minimum conditions include: affordability and accessibility, safe and basic range of services, privacy and confidentiality, provider competence and attitude, reliability and sustainability and an inbuilt monitoring and evaluation system. Key words: Youth Friendly Services (YFS), targeted approach, integrated approac

Tuberculosis and HIV/AIDS co-infection Rate among Tuberculosis patients in Sokoto TB Centre, North Western Nigeria

Background: The resurgence of TB infection after many decades of decline has been reported in recent times, and has been attributed to the high rate of HIV infection. The paucity of information on the prevalence of tuberculosis and HIV/AIDS co-infection in Sokoto has motivated this study. Methodology: The study was a cross-sectional descriptive study to determine the occurrence of tuberculosis and HIV/AIDS co-infection among ninety samples positive for sputum acid fast bacilli (AFB) attending DOTS point centre in Sokoto. The patients were counseled and consented patients were tested for presence of HIV antibodies using HIV 1/2 Determine®, Unigold® and Stat-Pak® rapid test kits in a serial algorithm. Results: The prevalence of HIV co-infection among TB patients obtained from this study was 5.6% (2.2% female and 3.3% male), the female to male ratio of TB patients was 1:2.9, while the ratio of co-infection of HIV among TB patients for female to male was 1:1.5. 100% of co-infected patients were married and 80.4% of co-infected patients were illiterates while 58.9% of them were business men and the remaining19.6% were farmers and unemployed. No co-infection was found among patients that were civil servants and the socio-demographic factors indicates a no statistical significant differences (p-value &gt; 0.05).The result also revealed co-infection occurred in age range of 21-40 years only, with age group 31 – 40 years having the highest prevalence of co-infection. Conclusion: We conclude from this study that the occurrance of HIV/AIDS among tuberculosis patients is high 5(5.6%) and does not correlates with the increase in HIV prevalence for Sokoto state in recent times