Detectable HIV Viral Load in Kenya: Data from a Population-Based Survey.

IntroductionAt the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV) transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicator Survey (KAIS 2012) provided a unique opportunity to evaluate the impact of antiretroviral therapy (ART) coverage on viremia and to examine the risks for failure to suppress viral replication. We report population-level HIV viral load suppression using data from KAIS 2012.MethodsBetween October 2012 to February 2013, KAIS 2012 surveyed household members, administered questionnaires and drew serum samples to test for HIV and, for those found to be infected with HIV, plasma viral load (PVL) was measured. Our principal outcome was unsuppressed HIV viremia, defined as a PVL ≥ 550 copies/mL. The exposure variables included current treatment with ART, prior history of an HIV diagnosis, and engagement in HIV care. All point estimates were adjusted to account for the KAIS 2012 cluster sampling design and survey non-response.ResultsOverall, 61·2% (95% CI: 56·4-66·1) of HIV-infected Kenyans aged 15-64 years had not achieved virological suppression. The base10 median (interquartile range [IQR]) and mean (95% CI) VL was 4,633 copies/mL (0-51,596) and 81,750 copies/mL (59,366-104,134), respectively. Among 266 persons taking ART, 26.1% (95% CI: 20.0-32.1) had detectable viremia. Non-ART use, younger age, and lack of awareness of HIV status were independently associated with significantly higher odds of detectable viral load. In multivariate analysis for the sub-sample of patients on ART, detectable viremia was independently associated with younger age and sub-optimal adherence to ART.DiscussionThis report adds to the limited data of nationally-representative surveys to report population- level virological suppression. We established heterogeneity across the ten administrative and HIV programmatic regions on levels of detectable viral load. Timely initiation of ART and retention in care are crucial for the elimination of transmission of HIV through sex, needle and syringe use or from mother to child. Further refinement of geospatial mapping of populations with highest risk of transmission is necessary

Working-age Adult Mortality and Primary Sschool Attendance in Rural Kenya

The rapid increase in adult mortality due to the AIDS epidemic in sub- Saharan Africa raises great concern about its impact on child welfare. This article estimates the impact of AIDS-related adult mortality on primary school attendance in rural Kenya using a panel of 1,266 households surveyed in 1997, 2000, and 2002. We find a strong correlation between working-age adult mortality and lagged HIV- prevalence rates at nearby sentinel survey sites. School attendance, especially for children in relatively poor households, is negatively correlated with lagged provincial HIV-prevalence rates. Children, especially girls in relatively poor households, are less likely to be in school directly prior to the death of an adult member than children in unafflicted households. By contrast, boys in relatively poor households are less likely to be in school after an adult death. The evidence indicates that rising adult mortality in rural Kenya is adversely affecting primary school attendance especially among the poor. However, these results measure only short-term impacts. Over the longer run, whether school attendance in afflicted household rebounds or deteriorates further is unknown.HIV/AIDS, Education, Kenya

Is the promise of methadone Kenya's solution to managing HIV and addiction? A mixed-method mathematical modelling and qualitative study.

BACKGROUND AND OBJECTIVES: Promoted globally as an evidence-based intervention in the prevention of HIV and treatment of heroin addiction among people who inject drugs (PWID), opioid substitution treatment (OST) can help control emerging HIV epidemics among PWID. With implementation in December 2014, Kenya is the third Sub-Saharan African country to have introduced OST. We combine dynamic mathematical modelling with qualitative sociological research to examine the 'promise of methadone' to Kenya. METHODS, SETTING AND PARTICIPANTS: We model the HIV prevention impact of OST in Nairobi, Kenya, at different levels of intervention coverage. We draw on thematic analyses of 109 qualitative interviews with PWID, and 43 with stakeholders, to chart their narratives of expectation in relation to the promise of methadone. RESULTS: The modelled impact of OST shows relatively slight reductions in HIV incidence (5-10%) and prevalence (2-4%) over 5 years at coverage levels (around 10%) anticipated in the planned roll-out of OST. However, there is a higher impact with increased coverage, with 40% coverage producing a 20% reduction in HIV incidence, even when accounting for relatively high sexual transmissions. Qualitative findings emphasise a culture of 'rationed expectation' in relation to access to care and a 'poverty of drug treatment opportunity'. In this context, the promise of methadone may be narrated as a symbol of hope-both for individuals and community-in relation to addiction recovery. CONCLUSIONS: Methadone offers HIV prevention potential, but there is a need to better model the effects of sexual HIV transmission in mediating the impact of OST among PWID in settings characterised by a combination of generalised and concentrated epidemics. We find that individual and community narratives of methadone as hope for recovery coexist with policy narratives positioning methadone primarily in relation to HIV prevention. Our analyses show the value of mixed methods approaches to investigating newly-introduced interventions

Spartan Daily, February 7, 1996

Volume 106, Issue 9https://scholarworks.sjsu.edu/spartandaily/8794/thumbnail.jp

Antiretroviral treatment uptake and attrition among HIV-positive patients with tuberculosis in Kibera, Kenya

Using data of human immunodeficiency virus-positive patients with tuberculosis from three primary care clinics in Kibera slums, Nairobi, Kenya, we report on the proportion that started antiretroviral treatment (ART) and attrition (deaths, lost to follow-up and stopped treatment) before and while on ART. Of 427 ART eligible patients, enrolled between January 2004 and December 2008, 70% started ART, 19% were lost to attrition and 11% had not initiated ART. Of those who started ART, 14% were lost to attrition, making a cumulative pre-ART and ART attrition of 33%. ART uptake among patients with TB was relatively good, but programme attrition was high and needs urgent addressing

Working-Age Adult Mortality and Primary School Attendance in Rural Kenya

The rapid increase in adult mortality due to the AIDS epidemic in sub-Saharan Africa raises great concern about potential intergenerational effects on children. This article estimates the impact of AIDS-related adult mortality on primary school attendance in rural Kenya using a panel of 1,266 households surveyed in 1997, 2000, and 2002. The paper distinguishes between effects on boys’ and girls’ education to understand potential gender differences resulting from adult mortality. We also estimate how adult mortality affects child schooling before as well as after the death occurs. The paper also estimates the importance of households’ initial asset levels in influencing the relationship between adult mortality and child school attendance. We find that all of these distinctions are important when estimating the magnitude of the effects of adult mortality on child school attendance. The probability that girls in initially poor households will remain in school prior to the death of a working age adult in the household drops from roughly 88% to 55%. Boys in relatively poor households are less likely than girls to be in school after an adult death. By contrast, we find no clear effects on girls’ or boys’ education among relatively non-poor households, either before or after the timing of adult mortality in the household. We find a strong correlation between working-age adult mortality in our data and lagged HIV-prevalence rates at nearby sentinel survey sites. The evidence indicates that rising AIDS-related adult mortality in rural Kenya is adversely affecting primary school attendance among the poor. However, these results measure only short-term impacts. Over the longer run, whether school attendance in afflicted household rebounds or deteriorates further is unknown.HIV/AIDS, Kenya, Education, Health Economics and Policy, Labor and Human Capital, O12, O15, J10, Q12,

ADHERENCE TO TREATMENT GUIDELINES FOR THE PREVENTION OF MOTHER-TO-CHILD HIV TRANSMISSION IN KENYA

Access to the most effective treatments is not universal and treatment coverage for the prevention of mother-to-child transmission (PMTCT) is still low in many countries, including Kenya (WHO, 2010a). To improve uptake of PMTCT to reduce perinatal HIV transmission the World Health Organization (WHO) issued new treatment guidelines for use among pregnant HIV+ women in 2010 (WHO, 2010b). In the same year, Kenya's National AIDS and STI Control Programme (NASCOP) established revised guidelines for PMTCT. Despite expanded treatment guidelines it is unclear if women meeting the minimum requirements for treatment and ARV prophylaxis during pregnancy and postpartum follow-up are receiving treatment according to WHO and NASCOP recommendations. This study will examine the antenatal treatment regimens of HIV-infected women reporting to four hospitals in Kenya for Early Infant Diagnosis (EID) of HIV services. It will assess the extent to which PMTCT regimens of these HIV+ mothers reflect the revised PMTCT treatment guidelines, and if children born to mothers on less efficacious treatment regimes have higher HIV positivity rates

HIV/AIDS and contraceptive method choice : demographic and socio-economic correlates of contraceptive method choice among HIV-positive women practising family planning in Kenya

Introduction: As the generalized HIV epidemic in specific settings of sub-Saharan Africa continues to evolve, there is need for evidence-based response to address emerging challenges, which include enabling the large number of women living with HIV make informed choices to achieve their reproductive goals. Objectives: This paper seeks to (i) examine the effect of HIV/AIDS on contraceptive method choice among women using contraceptives in Kenya; and (ii) identify correlates of contraceptive method choice among HIV-positive women practising family planning. Material and Methods: We apply multinomial Logistic regression models to a sample of 3190 sexually-active women of reproductive age using contraceptives from the 2003 and 2008 Kenya Demographic and Health Surveys to examine the effect of HIV/AIDS on contraceptive method choice. The analysis of correlates of method choice among HIV-positive women is based on a sample of 255 HIV-positive women using contraceptives and involves bivariate cross-tabulations with Chi-Square tests. Result: Overall association between HIV status and contraceptive method choice is consistent with expected patterns, with women who are HIV-positive being more than twice as likely to use condoms rather than hormonal contraceptives, compared to their counterparts of similar characteristics who are HIV-negative (p<0.05). Among women infected with HIV, those who were previously tested for HIV were more likely to use condoms and less likely to use hormonal methods (p<0.05) than those who had never been tested. The higher use of condoms by HIV-positive women is only evident among those who had previously been tested for HIV. Significant correlates of contraceptive method choice among HIV-positive women include parity, marital status, age group, education and ethnicity. Overall trends suggest a notable shift from use of hormonal methods to condoms by HIV-positive women, but predominant use of hormonal methods (60%) and low use of condoms (23%) by HIV-positive young women aged 15-24 practising family planning is of potential concern. Conclusion: The findings have important implications for family planning policies/programs targeting young women living with HIV and underscore the need to intensify efforts towards improved HIV testing coverage to enable HIV-positive women make informed reproductive choices

Female-initiated prevention: Integrating female condoms into HIV risk-reduction activities in Kenya

The Female Condom (FC) is the only female-initiated prevention product on the market today that provides simultaneous protection against STIs, including HIV, and unintended pregnancy. Despite this unique dual protection benefit, the female condom remains limited in supply, not easily or widely available, and under utilized in many settings. Improvements in female condom programming are essential to achieve increased uptake and public health impact, as well as to pave the way for future women's HIV prevention products, such as microbicides. The Population Council's Female-Initiated Prevention Methods (FIPM) project, conducted in partnership with Liverpool VCT, Care & Treatment (LVCT), aimed to stimulate action and generate evidence around FC access through innovative program experimentation