Detection of types of HPV among HIV-infected and HIV-uninfected Kenyan women undergoing cryotherapy or loop electrosurgical excision procedure

Objective: To assess the baseline types of HPV infection among HIV-positive and HIV-negative women in western Kenya undergoing cryotherapy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia. Methods: A prospective observational study was conducted of baseline HPV characteristics of women undergoing visual inspection with acetic acid (VIA) and cryotherapy or LEEP. After a positive VIA in HIV-positive and HIV-negative women, data on demographics, CD4 count, and use of antiretroviral therapy and a cervical swab were collected. HPV typing was performed using the Roche Linear Array. Results: Of 175 participants, 86 (49.1%) were HIV-positive and had a higher prevalence of low-risk HPV types (odds ratio [OR] 5.28, P=0.005) compared with HIV-negative women. The most common high-risk (HR)-HPV types in HIV-positive women were HPV 16 (13.9%) and HPV 18 (11.1%). HIV-positive women requiring LEEP were more likely to have HR-HPV types (OR 6.67, P=0.012) and to be infected with multiple HR-HPV types (OR 7.79, P=0.024) compared to those undergoing cryotherapy. Conclusion: HIV-positive women requiring LEEP versus cryotherapy had a higher prevalence of any HR-HPV type and multiple HR-HPV types. There were no such differences in HPV types identified among HIV-negative women

Microfinance, retention in care, and mortality among patients enrolled in HIV 2 Care in East Africa

Objective: To measure associations between participation in community-based microfinance groups, retention in HIV care, and death among people with HIV (PWH) in low-resource settings. Design and methods: We prospectively analyzed data from 3609 patients enrolled in an HIV care program in western Kenya. HIV patients who were eligible and chose to participate in a Group Integrated Savings for Health Empowerment (GISHE) microfinance group were matched 1 : 2 on age, sex, year of enrollment in HIV care, and location of initial HIV clinic visit to patients not participating in GISHE. Follow-up data were abstracted from medical records from January 2018 through February 2020. Logistic regression analysis examined associations between GISHE participation and two outcomes: retention in HIV care (i.e. >1 HIV care visit attended within 6 months prior to the end of follow-up) and death. Socioeconomic factors associated with HIV outcomes were included in adjusted models. Results: The study population was majority women (78.3%) with a median age of 37.4 years. Microfinance group participants were more likely to be retained in care relative to HIV patients not participating in a microfinance group [adjusted odds ratio (aOR) = 1.31, 95% confidence interval (CI) 1.01–1.71; P = 0.046]. Participation in group microfinance was associated with a reduced odds of death during the follow-up period (aOR = 0.57, 95% CI 0.28–1.09; P = 0.105). Conclusion: Participation in group-based microfinance appears to be associated with better HIV treatment outcomes. A randomized trial is needed to assess whether microfinance groups can improve clinical and socioeconomic outcomes among PWH in similar settings

Cryotherapy and LEEP are effective treatment for CIN lesions in HIV+ and HIV- women in western Kenya

Objectives: Cervical cancer is the third most common cancer worldwide and the most common cancer among Kenyan women, with an age-standardized incidence rate of 33.8% in 2018. Cervical intraepithelial neoplasia (CIN) caused by human papillomavirus (HPV) in HIV+ women is over twice as likely to progress in severity compared to HIV- women. Conflicting reports exist as to the efficacy of cryotherapy or loop electrosurgical excision procedure (LEEP) as treatment for CIN among HIV+ women. This study assesses the results of cryotherapy or LEEP for CIN among HIV+ compared to HIV- women in Western Kenya. Methods: One-hundred and twenty HIV+ (60 cryotherapy, 60 LEEP) and 120 HIV- (60 cryotherapy and 60 LEEP) women were intended to be enrolled after a positive visual inspection with acetic acid (VIA). However, only 86 HIV+ (39 cryotherapy, 47 LEEP) and 89 HIV- (46 cryotherapy, 43 LEEP) who had follow-up of 24 months were included in this analysis. Women were eligible for cryotherapy if the lesion covered low grade intraepithelial lesion (LSIL) on Pap smear or ≥ CINI on histology, LEEP failure was defined as high grade intraepithelial lesion (HSIL) on Pap smear or ≥ CIN 2 after treatment. Chi square and Fishers’ exact tests were used to compare the proportions. Results: There was no statistically significant difference in treatment failure rates between HIV+ and HIV- patients (10.1% v 19.8% p =0.09). Among patients who underwent cryotherapy, there was no statistically significant difference in treatment failure between HIV+ and HIV- women (18% v 4.4%, p = 0.073). No statistically significant difference in treatment failure was observed among HIV+ and HIV- women who underwent LEEP (16.3% v 21.3%, p = 0.599). No statistically significant difference in treatment failure was observed between all patients in the LEEP arm compared to those in the cryotherapy arm (10.6% v 18.9% p =0.141). Seventy-four percent of HIV+ women were on antiretroviral therapy (ART) during the study, and 91% had been on ART during or prior to the study. Mean CD4 count among HIV+ women was 580. Conclusions: In our experience, cryotherapy and LEEP are effective treatment for HIV+ and HIV- women if done for appropriate CIN lesions in low-resource settings

LEEP more effective than cryotherapy as effective treatment for CIN lesions in women living with HIV and without HIV in western Kenya

Objectives: Cervical intraepithelial neoplasia (CIN) in women with HIV (WHIV) is over twice as likely to progress in severity than in women without HIV. This study assessed the results of cryotherapy or LEEP for CIN among WHIV compared to women without HIV in Western Kenya. Methods: A total of 120 WHIV (60 cryotherapies, 60 LEEP) and 120 women without HIV (60 cryotherapies and 60 LEEP) were intended to be enrolled after a positive visual inspection with acetic acid (VIA). However, only 86 WHIV (39 cryotherapies, 47 LEEP) and 89 women without HIV (46 cryotherapies, 43 LEEP) who had follow-ups within 24 months were included in this analysis. Women were eligible for cryotherapy if the lesion covered b75% of the transformation zone, did not extend into the endocervical canal, and was not N CIN 2 on histology. Women ineligible for cryotherapy underwent colposcopy/ biopsy, and those with confirmed CIN 2/3 underwent LEEP. Women had a follow-up every 6 months with VIA, Pap smear, or colposcopy/ biopsy. Cryotherapy failure was defined as N low-grade intraepithelial lesion (LSIL) on Pap smear or N CIN 1 on histology. LEEP failure was defined as a high-grade intraepithelial lesion (HSIL) on Pap smear or N CIN 2 by histology after treatment. χ2 and Fisher\u27s exact tests were used to compare the proportions. Results: There was a significant difference in treatment failure rates between WHIV and women without HIV (15.12% vs 5.62%, P = 0.04). The population average odds of treatment failure were higher in HIVpositive subjects compared to HIV-negative subjects (OR: 4.39, 95% CI: 1.23–15.64). There was a significant difference in treatment failure rates between WHIV compared to women without HIV who underwent cryotherapy (18.00% v 2.20%, P = 0.021). Among patients who underwent LEEP, no difference was observed in the treatment failure rates between WHIV and women without HIV (12.80% vs 9.30%, P = 0.74). There was no association between treatments and these covariates: married (OR: 3.55, 95% CI: 0.4–31.29), widowed (OR: 2.8, 95% CI: 0.19–40.97), secondary education (OR: 1.50, 95% CI: 0.42–5.39), college/university education (OR: 1.75, 95% CI: 0.25–12), unemployment (OR: 2.30, 95% CI: 0.39–13.18), age group 31–40 (OR: 0.91, 95% CI: 0.26–3.17) and aged 41+ (OR: 0.36, 95% CI: 0.08–1.74). For the patients in the LEEP arm of treatment, there was no association between these covariates and treatment failure: age at first sexual encounter (OR: 1.15, 95% CI: 0.91–1.45), condom use in the last 6 months (OR: 0.91, 95% CI: 0.56–1.49), HIV status (OR: 3.97, 95% CI: 0.66–23.96), self-employed (OR 0.63, 95% CI: 0.07–6.08), secondary education (OR 3.89, 95% CI: 0.42–30.54) and married (OR: 0.32, 95% CI: 0.01–7.87). Conclusions: In our experience, LEEP is a more effective treatment for WHIV compared to women without HIV for CIN in Western Keny