Prevalence and correlates of physical, sexual, and threatened violence among partners of people who inject drugs living with HIV in Kenya

Thesis (Master's)--University of Washington, 2022Background: People who inject drugs (PWID) have a higher HIV burden compared to the general adult population in Kenya. Violence among PWID is also common and associated with increased HIV risk and decreased HIV service uptake. Understanding the nature, distribution, and correlates of violence among PWID in Kenya may inform population-specific public health interventions and policy recommendations. Methods: Using a cross-sectional study, we identified the prevalence and correlates of different types of violence experienced by sexual and injecting partners of HIV-positive PWID in Kenya, who were contacted through assisted partner services. We used a Chi-squared test to estimate the risk of violence and conducted a pairwise comparison and two-sided Fisher’s exact test to identify the socio-demographic characteristics associated with violence. Using the Woolf test for homogeneity, we conducted a stratified analysis and tested for effect modification by gender and HIV status. Results: Among 3302 participants, 1439 (44%) had experienced some form of violence within the past one year. Physical violence was the most common form of violence experienced (35%; 95%CI 33.3%, 36.5%), followed by being threatened (23%; 21.5%, 24.4%), and sexual violence (7%; 95% CI 6.2%, 7.9%). Being male (Relative risk [RR]=1.22; 95% confidence interval [CI] 1.11, 1.33; p<0.001), living in coastal Kenya (RR=1.53; 95%CI 1.41, 1.66; p<0.001), having multiple sexual partners (vs. single) (RR=1.39; 95%CI 1.22, 1.6; p<0.001), being divorced/ separated or widowed (vs. single) (RR=1.24; 95%CI 1.13, 1.37; p<0.001), not having a stable place to live (RR=1.14; 95%CI 1.03, 1.27; p=0.019), being both a sexual and injecting partner (vs. sexual partner only) (RR=1.16; 95%CI 1.01, 1.33; p=0.041), being an active injection drug user not on methadone (vs. non-active injection drug users taking methadone) (RR=1.53; 95%CI 1.04, 2.25; p=0.018), and identifying as a man who has sex with men or man who have sex with both men and women (MSM/MSMW) (vs. man who has sex with women) (RR=1.36; 95%CI 1.21, 1.54; p<0.001) were associated with experiencing violence. The stratified analysis revealed that gender was an effect modifier on the association between partner characteristics (region, employment, partner type) and experiencing violence while HIV status was not. Conclusion: The study identified that the prevalence of violence among partners of PWID in Kenya differs for different genders and regions, and physical violence was the most frequent form of violence reported. There was strong evidence of an association between several partner characteristics and experiencing violence and it was modified by different Genders. This information will be useful to formulate and tailor effective public health interventions, and policy recommendations to increase HIV-related services among key populations in Kenya

Prevalence and correlates of violence among sexual and injecting partners of people who inject drugs living with HIV in Kenya: a cross-sectional study

Abstract Background In Kenya, violence is common among people who inject drugs (PWID) living with HIV and their sexual and injecting partners and may lead to decreased uptake of HIV services, increased HIV risk behaviors, and increased HIV transmission. Violence is defined as any physical harm, threatened harm, or forced sexual acts inflicted on a person in the past year. Understanding the nature of violence and its correlates among PWID and their partners will inform population-specific public health interventions and policy recommendations. Methods This is a cross-sectional study nested in a prospective cohort study conducted in eight public health centers, methadone clinics, and needle syringe programs in Nairobi, Kilifi, and Mombasa counties in Kenya. 3,302 sexual and/or injecting partners of PWID living with HIV were recruited through assisted partner services and participated in the study. Prevalence and correlates of violence were identified using the Wald test and negative binomial regression. Results Out of 3302 study participants, 1439 (44%) had experienced violence within the past year. Physical violence was the most common form of violence experienced (35%), followed by being threatened (23%) or subjected to sexual violence (7%). In an adjusted analysis, female participants reported higher experiences of sexual violence (prevalence ratio [PR] = 2.46; 95% confidence interval [CI] 1.62, 3.74; p < 0.001) compared to male participants. In adjusted analysis, coastal residents had a higher experience of overall violence (PR = 1.48; 95% CI 1.27, 1.72; p < 0.001) than those living in Nairobi. This regional effect was relatively stronger among the female respondents (p interaction = 0.025). Participants’ sex modified the association between region and experiencing violence after adjusting potential confounding factors. Conclusions The study reveals the prevalence of violence among PWID and identifies high-risk sub-groups, including women, specifically for sexual violence, and coastal residents. Tailored interventions addressing their unique needs are essential. A holistic approach that combines violence prevention and response, comprehensive harm reduction, healthcare access, and community support is crucial to address the complex issue of drug use and HIV burden among PWID in Kenya for improved health outcomes

Enhancing respiratory disease surveillance to detect COVID-19 in shelters for displaced persons, Thailand–Myanmar border, 2020–2021

We developed surveillance guidance for COVID-19 in 9 temporary camps for displaced persons along the Thailand-Myanmar border. Arrangements were made for testing of persons presenting with acute respiratory infection, influenza-like illness, or who met the Thailand national COVID-19 Person Under Investigation case definition. In addition, testing was performed for persons who had traveled outside of the camps in outbreak-affected areas or who departed Thailand as resettling refugees. During the first 18 months of surveillance, May 2020-October 2021, a total of 6,190 specimens were tested, and 15 outbreaks (i.e., >1 confirmed COVID-19 cases) were detected in 7 camps. Of those, 5 outbreaks were limited to a single case. Outbreaks during the Delta variant surge were particularly challenging to control. Adapting and implementing COVID-19 surveillance measures in the camp setting were successful in detecting COVID-19 outbreaks and preventing widespread disease during the initial phase of the pandemic in Thailand