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Acquired Immunodeficiency Syndrome: HELP
Articles from Kenya
Based on 166 articles published since 2010

These are the 166 published articles about Acquired Immunodeficiency Syndrome that originated from Kenya during 2010-2020.
+ Citations + Abstracts
Pages: 1 · 2 · 3 · 4 · 5 · 6 · 7
1 Editorial Implementing quality improvement in tuberculosis programming: Lessons learned from the global HIV response. 2019

Ikeda, Daniel J / Basenero, Apollo / Murungu, Joseph / Jasmin, Margareth / Inimah, Maureen / Agins, Bruce D. ·HEALTHQUAL, Division of Global Epidemiology, Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA. · Ministry of Health and Social Services, Windhoek, Namibia. · HEALTHQUAL, Institute for Global Health Sciences, University of California, San Francisco, Harare, Zimbabwe. · National AIDS and STI Control Program, Nairobi, Kenya. · Institute for Implementation Science in Public Health, City University of New York, New York, NY, USA. ·J Clin Tuberc Other Mycobact Dis · Pubmed #31788558.

ABSTRACT: The quality of care and treatment for tuberculosis (TB) is a major barrier in global efforts to end TB as a global health emergency. Despite a growing recognition of the need to measure, assure, and improve quality of TB services, implementation of quality improvement (QI) activities remains limited. Applying principles of systems thinking, continuous measurement, and root cause analysis, QI represents a proven approach for identifying and addressing performance gaps in healthcare delivery, with demonstrated success in low- and middle-income settings in the areas of HIV/AIDS, maternal, newborn, and child health, and infection control, among others. Drawing from lessons learned in the development of QI programming as part of the global response to HIV, we review key enablers to implementation that may assist NTPs in turning aspirations of high-quality service delivery into action. Under the umbrella of a formal quality management (QM) program, NTPs' attention to planning and coordination, commitment to tracking key processes of care, investment in QI capacity building, and integration of TB QI activities within efforts to advance universal health coverage provide a framework to sustainably implement QI activities.

2 Editorial The HIV/AIDS pandemic will not end by the year 2030 in low and middle income countries. 2019

Bain, Luchuo Engelbert / Tarkang, Elvis Enowbeyang / Ebuenyi, Ikenna Desmond / Kamadjeu, Raoul. ·The Pan African Medical Journal, Nairobi, Kenya. · Athena Institute for Research on Innovation and Communication in Health and Life Sciences, Vrije Universiteit Amsterdam, The Netherlands. · School of Public Health, University of Health and Allied Sciences PMB 31 Ho, Ghana. · HIV/AIDS Prevention Research Network Cameroon PO Box 36 Kumba, Cameroon. ·Pan Afr Med J · Pubmed #31223359.

ABSTRACT: The recent Lancet Commission-International AIDS Society report: Advancing Global health and strengthening the HIV response in the Era of the Sustainable Development Goals; clearly highlights the fact that the world is NOT on track in ending the AIDS pandemic by 2030. Emphasis on massive and early diagnosis and placement on Combined Anti- Retroviral Therapy (cART) remain key cornerstones in reaching these goals. Effective viral load informed care remains very promising in reducing drug resistance, and improving outcomes in infected persons. The authors argue that the current funding trends, management paradigms, research agendas, data collection and information system models, as well as the overall appreciation of the evolution of the pandemic in low and middle- income countries, lead to a logical conclusion that this pandemic will not end, especially in these countries by 2030. Major action areas are proposed for policy makers and researchers for appreciation and action.

3 Editorial Editorial: Neuroscience in Africa. 2019

Patel, Nilesh B / Lakhdar-Ghazal, Nouria / Russell, Vivienne A. ·University of Nairobi, Nairobi, Kenya. · Mohammed V University, Rabat, Morocco. · University of Cape Town, University of KwaZulu-Natal, Cape Town, South Africa. ·Front Neuroanat · Pubmed #30837846.

ABSTRACT: -- No abstract --

4 Editorial Traversing the cascade: urgent research priorities for implementing the 'treat all' strategy for children and adolescents living with HIV in sub-Saharan Africa. 2018

Enane, Leslie A / Davies, Mary-Ann / Leroy, Valériane / Edmonds, Andrew / Apondi, Edith / Adedimeji, Adebola / Vreeman, Rachel C. ·Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA. · Center for Infectious Disease Epidemiology and Research, University of Cape Town, South Africa. · Inserm (French Institute of Health and Medical Research), UMR 1027, Université Toulouse 3, France. · Department of Epidemiology, University of North Carolina at Chapel Hill, NC, USA. · Moi Teaching and Referral Hospital, Eldoret, Kenya. · Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA. ·J Virus Erad · Pubmed #30515313.

ABSTRACT: Children and adolescents living with HIV (CALHIV) in sub-Saharan Africa experience significant morbidity and alarmingly high mortality rates due to critical gaps in the HIV care cascade, including late diagnosis and initiation of treatment, as well as poor retention in care and adherence to treatment. Interventions to strengthen the adult HIV care cascade may not be as effective in improving the cascade for CALHIV, for whom specific strategies are needed. Particular attention needs to be paid to the contexts of sub-Saharan Africa, where more than 85% of the world's CALHIV live. Implementing the 'treat all' strategy in sub-Saharan Africa requires dedicated efforts to address the unique diagnosis and care needs of CALHIV, in order to improve paediatric and adolescent outcomes, prevent viral resistance and reduce the number of new HIV infections. We consider the UNAIDS 90-90-90 targets from the perspective of infants, children and adolescents, and discuss the key challenges, knowledge gaps and urgent research priorities for CALHIV in implementation of the 'treat all' strategy in sub-Saharan Africa.

5 Review Assessing the feasibility of eHealth and mHealth: a systematic review and analysis of initiatives implemented in Kenya. 2017

Njoroge, Martin / Zurovac, Dejan / Ogara, Esther A A / Chuma, Jane / Kirigia, Doris. ·Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya. wnjoroge@kemri-wellcome.org. · Department of Public Health Research, KEMRI-Wellcome Trust Research Programme, PO BOX 43640-00100, Nairobi, Kenya. · Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, CCVTM, Oxford, OX3 7LJ, UK. · Center for Global Health and Development, Boston University School of Public Health, 85 East Concord Street, Boston, MA, 02118, USA. · Ministry of Health, Division of eHealth, Nairobi, Kenya. ·BMC Res Notes · Pubmed #28183341.

ABSTRACT: BACKGROUND: The growth of Information and Communication Technology in Kenya has facilitated implementation of a large number of eHealth projects in a bid to cost-effectively address health and health system challenges. This systematic review aims to provide a situational analysis of eHealth initiatives being implemented in Kenya, including an assessment of the areas of focus and geographic distribution of the health projects. The search strategy involved peer and non-peer reviewed sources of relevant information relating to projects under implementation in Kenya. The projects were examined based on strategic area of implementation, health purpose and focus, geographic location, evaluation status and thematic area. RESULTS: A total of 114 citations comprising 69 eHealth projects fulfilled the inclusion criteria. The eHealth projects included 47 mHealth projects, 9 health information system projects, 8 eLearning projects and 5 telemedicine projects. In terms of projects geographical distribution, 24 were executed in Nairobi whilst 15 were designed to have a national coverage but only 3 were scaled up. In terms of health focus, 19 projects were mainly on primary care, 17 on HIV/AIDS and 11 on maternal and child health (MNCH). Only 8 projects were rigorously evaluated under randomized control trials. CONCLUSION: This review discovered that there is a myriad of eHealth projects being implemented in Kenya, mainly in the mHealth strategic area and focusing mostly on primary care and HIV/AIDs. Based on our analysis, most of the projects were rarely evaluated. In addition, few projects are implemented in marginalised areas and least urbanized counties with more health care needs, notwithstanding the fact that adoption of information and communication technology should aim to improve health equity (i.e. improve access to health care particularly in remote parts of the country in order to reduce geographical inequities) and contribute to overall health systems strengthening.

6 Review CD4+ T cell counts in initiation of antiretroviral therapy in HIV infected asymptomatic individuals; controversies and inconsistencies. 2015

Maina, E K / Bonney, E Y / Bukusi, E A / Sedegah, M / Lartey, M / Ampofo, W K. ·Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana; Centre for Microbiology Research, Kenya Medical Research Institute, Kenya. Electronic address: emaina02@yahoo.com. · Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Ghana. · Centre for Microbiology Research, Kenya Medical Research Institute, Kenya. · Malaria Program, Naval Medical Research Centre, USA. · Department of Medicine, School of Medicine & Dentistry, CHS, University of Ghana, Ghana. ·Immunol Lett · Pubmed #26475399.

ABSTRACT: The primary goal when devising strategies to define the start of therapy in HIV infected individuals is to avoid HIV disease progression and toxicity from antiretroviral therapy (ART). Intermediate goals includes, avoiding resistance by suppressing HIV replication, reducing transmission, limiting spread and diversity of HIV within the body and protecting the immune system from harm. The question of how early or late to start ART and achieve both primary and intermediate goals has dominated HIV research. The distinction between early and late treatment of HIV infection is currently a matter of CD4+ T cells count, a marker of immune status, rather than on viral load, a marker of virus replication. Discussions about respective benefits of early or delayed therapy, as well as the best CD4+ T cell threshold during the course of HIV infection at which ART is initiated remains inconclusive. Guidelines issued by various agencies, provide different initiation recommendations. This can be confusing for clinicians and policy-makers when determining the best time to initiate therapy. Optimizing ART initiation strategies are clearly complex and must be balanced between individual and broader public health needs. This review assesses available data that contributes to the debate on optimal time to initiate therapy in HIV-infected asymptomatic individuals. We also review reports on CD4+ T cell threshold to guide initiation of ART and finally discuss arguments for and against early or late initiation of ART.

7 Review Defeating AIDS--advancing global health. 2015

Piot, Peter / Abdool Karim, Salim S / Hecht, Robert / Legido-Quigley, Helena / Buse, Kent / Stover, John / Resch, Stephen / Ryckman, Theresa / Møgedal, Sigrun / Dybul, Mark / Goosby, Eric / Watts, Charlotte / Kilonzo, Nduku / McManus, Joanne / Sidibé, Michel / Anonymous4930834. ·London School of Hygiene & Tropical Medicine, London, UK. Electronic address: director@lshtm.ac.uk. · Centre for the AIDS Programme of Research in South Africa, Durban, South Africa. · Results for Development Institute, Washington, DC, USA. · London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore. · UNAIDS, Geneva, Switzerland. · Avenir Health, Glastonbury, CT, USA. · Harvard T H Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA. · Norwegian Knowledge Centre for the Health Services, Oslo, Norway. · Global Fund to Fight Aids, Tuberculosis and Malaria, Geneva, Switzerland. · Global Health Sciences, University of California, San Francisco, CA, USA. · London School of Hygiene & Tropical Medicine, London, UK. · National AIDS Control Council, Nairobi, Kenya. · independent, Oxford, UK. ·Lancet · Pubmed #26117719.

ABSTRACT: -- No abstract --

8 Review A Systematic Review of Nutritional Supplementation in HIV-Infected Children in Resource-Limited Settings. 2015

McHenry, Megan S / Dixit, Avika / Vreeman, Rachel C. ·Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA. · Department of Pediatrics, Children's Health Services Research, Indiana University School of Medicine, Indianapolis, IN, USA USAID-Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya rvreeman@iupui.edu. ·J Int Assoc Provid AIDS Care · Pubmed #24943654.

ABSTRACT: BACKGROUND: In resource-limited settings, malnutrition is the major cause of death in young children, but the precise benefits of nutritional supplementation for HIV-infected children are not well understood. METHODS: Two researchers reviewed studies conducted in low- or middle-income countries that involved macro- and micronutrient supplementation in HIV-infected individuals ≤18 years. RESULTS: Fifteen studies focused on micronutrients, including vitamin A, zinc, multivitamins, and multiple-micronutrient supplementation. The 8 macronutrient studies focused on ready-to-use foods (4 studies), spirulina, whey protein, general food rations, and F75 and F100 starter formulas. Vitamin A was associated with improved mortality rates, ranging from 28% to 63%. Multiple-micronutrient supplementations were not associated with improvement of measured health outcomes. Ready-to-use foods were associated with improvement in certain anthropometrics. CONCLUSION: Periodic vitamin A supplementation is associated with reduced mortality. Macronutrient supplementation is linked to improved anthropometrics. More research is needed to determine how nutritional supplementation benefits this particularly vulnerable population.

9 Clinical Trial Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. 2014

Grinsztejn, Beatriz / Hosseinipour, Mina C / Ribaudo, Heather J / Swindells, Susan / Eron, Joseph / Chen, Ying Q / Wang, Lei / Ou, San-San / Anderson, Maija / McCauley, Marybeth / Gamble, Theresa / Kumarasamy, Nagalingeshwaran / Hakim, James G / Kumwenda, Johnstone / Pilotto, Jose H S / Godbole, Sheela V / Chariyalertsak, Suwat / de Melo, Marineide Gonçalves / Mayer, Kenneth H / Eshleman, Susan H / Piwowar-Manning, Estelle / Makhema, Joseph / Mills, Lisa A / Panchia, Ravindre / Sanne, Ian / Gallant, Joel / Hoffman, Irving / Taha, Taha E / Nielsen-Saines, Karin / Celentano, David / Essex, Max / Havlir, Diane / Cohen, Myron S / Anonymous2560787. ·Instituto de Pesquisa Clinica Evandro Chagas, Fiocruz, Rio de Janeiro, Brazil. · University of North Carolina School of Medicine, Chapel Hill, NC, USA; UNC Project-Malawi, Lilongwe, Malawi. · Harvard School of Public Health, Boston, MA, USA. · University of Nebraska Medical Center, Omaha, NE, USA. · University of North Carolina School of Medicine, Chapel Hill, NC, USA. · Fred Hutchinson Cancer Research Center, Seattle, WA, USA. · FHI 360, Washington, DC, USA. · FHI 360, Durham, NC, USA. · Y R Gaitonade Center for AIDS Research and Education, Chennai, India. · University of Zimbabwe, Harare, Zimbabwe. · College of Medicine-Johns Hopkins Project, Lilongwe, Malawi. · Hospital Geral de Nova Iguacu and Laboratorio de AIDS e Imunologia Molecular-IOC/Fiocruz, Rio de Janeiro, Brazil. · National AIDS Research Institute (ICMR), Pune, India. · Research Institute for Health Sciences, Chiang Mai University, Chaing Mai, Thailand. · Hospital Nossa Senhora da Conceição, Porto Alegre RS, Brazil. · Fenway Institute, Boston, MA, USA. · Johns Hopkins University School of Medicine, Baltimore, MD, USA. · Botswana Harvard AIDS Institute, Gabarone, Botswana. · KEMRI-CDC, Kisumu, Kenya. · Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. · Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · David Geffen UCLA School of Medicine, Los Angeles, CA, USA. · University of California, San Francisco, CA, USA. · University of North Carolina School of Medicine, Chapel Hill, NC, USA. Electronic address: mscohen@med.unc.edu. ·Lancet Infect Dis · Pubmed #24602844.

ABSTRACT: BACKGROUND: Use of antiretroviral treatment for HIV-1 infection has decreased AIDS-related morbidity and mortality and prevents sexual transmission of HIV-1. However, the best time to initiate antiretroviral treatment to reduce progression of HIV-1 infection or non-AIDS clinical events is unknown. We reported previously that early antiretroviral treatment reduced HIV-1 transmission by 96%. We aimed to compare the effects of early and delayed initiation of antiretroviral treatment on clinical outcomes. METHODS: The HPTN 052 trial is a randomised controlled trial done at 13 sites in nine countries. We enrolled HIV-1-serodiscordant couples to the study and randomly allocated them to either early or delayed antiretroviral treatment by use of permuted block randomisation, stratified by site. Random assignment was unblinded. The HIV-1-infected member of every couple initiated antiretroviral treatment either on entry into the study (early treatment group) or after a decline in CD4 count or with onset of an AIDS-related illness (delayed treatment group). Primary events were AIDS clinical events (WHO stage 4 HIV-1 disease, tuberculosis, and severe bacterial infections) and the following serious medical conditions unrelated to AIDS: serious cardiovascular or vascular disease, serious liver disease, end-stage renal disease, new-onset diabetes mellitus, and non-AIDS malignant disease. Analysis was by intention-to-treat. This trial is registered with ClinicalTrials.gov, number NCT00074581. FINDINGS: 1763 people with HIV-1 infection and a serodiscordant partner were enrolled in the study; 886 were assigned early antiretroviral treatment and 877 to the delayed treatment group (two individuals were excluded from this group after randomisation). Median CD4 counts at randomisation were 442 (IQR 373-522) cells per μL in patients assigned to the early treatment group and 428 (357-522) cells per μL in those allocated delayed antiretroviral treatment. In the delayed group, antiretroviral treatment was initiated at a median CD4 count of 230 (IQR 197-249) cells per μL. Primary clinical events were reported in 57 individuals assigned to early treatment initiation versus 77 people allocated to delayed antiretroviral treatment (hazard ratio 0·73, 95% CI 0·52-1·03; p=0·074). New-onset AIDS events were recorded in 40 participants assigned to early antiretroviral treatment versus 61 allocated delayed initiation (0·64, 0·43-0·96; p=0·031), tuberculosis developed in 17 versus 34 patients, respectively (0·49, 0·28-0·89, p=0·018), and primary non-AIDS events were rare (12 in the early group vs nine with delayed treatment). In total, 498 primary and secondary outcomes occurred in the early treatment group (incidence 24·9 per 100 person-years, 95% CI 22·5-27·5) versus 585 in the delayed treatment group (29·2 per 100 person-years, 26·5-32·1; p=0·025). 26 people died, 11 who were allocated to early antiretroviral treatment and 15 who were assigned to the delayed treatment group. INTERPRETATION: Early initiation of antiretroviral treatment delayed the time to AIDS events and decreased the incidence of primary and secondary outcomes. The clinical benefits recorded, combined with the striking reduction in HIV-1 transmission risk previously reported, provides strong support for earlier initiation of antiretroviral treatment. FUNDING: US National Institute of Allergy and Infectious Diseases.

10 Article HIV infection, and overweight and hypertension: a cross-sectional study of HIV-infected adults in Western Kenya. 2020

Saito, Akiko / Karama, Mohamed / Kamiya, Yasuhiko. ·1School of Tropical Medicine & Global Health, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523 Japan. · grid.174567.6 · 0000 0000 8902 2273 · 2Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya. · grid.33058.3d · 0000 0001 0155 5938 ·Trop Med Health · Pubmed #32398924.

ABSTRACT: Background: Non-communicable diseases (NCDs) are increasing in Kenya, where HIV/AIDS remains a leading cause of death; however, few studies have investigated obesity and hypertension among adults with HIV infection. We conducted a cross-sectional study in Homa Bay, Western Kenya, during 2015 to determine the prevalence of overweight/obesity and hypertension among HIV-infected adults and to identify their risk factors. Results: Anthropometric measurements and a structured questionnaire were administered to adults with HIV infection receiving care at Mbita Sub-county Hospital. A total of 251 HIV-positive individuals were enrolled. More women were overweight (17.2%) and obese (3.6%) than underweight (8.3%). The prevalence of abdominal obesity was high in women (62.7%), especially those aged 30-39 years. The prevalence of hypertension was 9.8% and 11.8% in men and women, respectively. Male participants tended to develop hypertension at an early age. Multivariate analysis showed that female sex was significantly associated with abdominal obesity. Regarding clinical factors, we identified an association between overweight and a history of opportunistic infections, as well as between hypertension and World Health Organization clinical stage. Sixty percent of HIV-infected participants assumed that a very thin body size indicated HIV infection. Conclusions: The main findings of this study include a greater prevalence of overweight than underweight as well as a high prevalence of abdominal obesity among women. Social perception toward body size among people with HIV infection might remain problematic. Individuals living with HIV in Kenya should receive preventive intervention for overweight and abdominal obesity, with consideration of relevant social and cultural aspects.

11 Article Economic burden and mental health of primary caregivers of perinatally HIV infected adolescents from Kilifi, Kenya. 2020

Katana, Patrick V / Abubakar, Amina / Nyongesa, Moses K / Ssewanyana, Derrick / Mwangi, Paul / Newton, Charles R / Jemutai, Julie. ·Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box, Kilifi, PO Box 230-80108, Kenya. pkatana@kemri-wellcome.org. · Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya. pkatana@kemri-wellcome.org. · Clinical Research (Neurosciences), KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Box, Kilifi, PO Box 230-80108, Kenya. · Department of Public Health, Pwani University, Kilifi, Kenya. · Department of Psychiatry, University of Oxford, Oxford, UK. · Institute for Human Development, Aga Khan University, Nairobi, Kenya. · Child and Adolescent Studies, Utrecht University, Utrecht, Netherlands. · Health Economics Research Unit, KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), Kilifi, Kenya. ·BMC Public Health · Pubmed #32299411.

ABSTRACT: BACKGROUND: Eighty per cent of perinatally HIV infected (PHI) adolescents live in sub-Saharan Africa (sSA), a setting also characterized by huge economic disparities. Caregiving is crucial to the management of chronic illness such as HIV/AIDS, but the economic costs and mental disorders borne by caregivers of PHI adolescents often go unnoticed. In this study, we evaluated economic costs, coping strategies and association between economic cost and mental health functioning of caregivers of perinatally HIV infected adolescents in Kilifi, Kenya. METHODS: We used a cost of illness descriptive analysis approach to determine the economic burden and Patient Health Questionnaire (PHQ-9) to assess the caregivers' mental health. Cross-sectional data were collected from 121 primary caregivers of PHI adolescents in Kilifi using a structured cost questionnaire. Economic costs (direct and indirect costs) were measured from primary caregivers' perspective. We used descriptive statistics in reporting the results of this study. RESULTS: Average monthly direct and indirect costs per primary caregiver was Ksh 2784.51 (USD 27.85). Key drivers of direct costs were transportation (66.5%) and medications (13.8%). Total monthly costs represented 28.8% of the reported caregiver monthly earnings. Majority of the caregivers borrowed resources to cope with high economic burden. About 10.7% of primary caregivers reported depressive symptoms. Caregivers with positive depression screen (PHQ-9 score ≥ 10) had high average monthly direct and indirect costs. However, this was not statistically different compared to costs incurred by caregivers who screened negative for depressive symptoms. CONCLUSION: Our study indicates that HIV/AIDS is associated with a significant economic burden for caregivers of adolescents living with HIV. Results underscore the need for developing economic empowerment and social support programmes that reduce the economic burden of caring for perinatally infected adolescent. These efforts may improve the mental health and quality of life of caregivers of adolescents living with HIV.

12 Article Disclosure of Same-Sex Sexual Practices to Family and Healthcare Providers by Men Who Have Sex with Men and Transgender Women in Nigeria. 2020

Kokogho, Afoke / Amusu, Senate / Baral, Stefan D / Charurat, Manhattan E / Adebajo, Sylvia / Makanjuola, Olumide / Tonwe, Veronica / Storme, Casey / Michael, Nelson L / Robb, Merlin L / Ake, Julie A / Nowak, Rebecca G / Crowell, Trevor A / Anonymous27571195. ·U.S. Army Medical Research Directorate-Africa, Nairobi, Kenya. · HJF Medical Research International, Abuja, Nigeria. · Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. · Institute of Human Virology, University of Maryland, Baltimore, MD, USA. · Population Council Nigeria, Abuja, Nigeria. · The Initiative for Equal Rights, Lagos, Nigeria. · Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA. · U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. · Center for Infectious Disease Research, Walter Reed Army Institute of Research, Silver Spring, MD, USA. · Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, 20817, USA. tcrowell@hivresearch.org. · U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. tcrowell@hivresearch.org. ·Arch Sex Behav · Pubmed #32193812.

ABSTRACT: Disclosure of same-sex sexual practices by men who have sex with men (MSM) and transgender women (TGW) may facilitate appropriate healthcare engagement, including risk assessment for HIV and other sexually transmitted infections (STIs), and negotiation of condom use with partners. However, disclosure may also generate stigma. In these cross-sectional analyses, MSM and TGW were categorized based on self-report of disclosure to family members and healthcare providers (HCP) at enrollment into the TRUST/RV368 study of comprehensive HIV and STI care programs in Abuja and Lagos, Nigeria. Multivariable Poisson regression models with robust error variance were used to estimate relative risk of disclosure with 95% confidence intervals. Pearson's chi-squared test was used to compare condom use and stigma indicators by disclosure status. Of 2557 participants who answered baseline questions about disclosure, 384 (15.0%) had ever disclosed to a family member and 733 (28.7%) to HCP, including 192 (7.5%) who disclosed to both. Higher education, prevalent HIV infections, and residence in Lagos were each associated with increased likelihood of disclosure to family and HCP. Older participants were more likely to disclose to HCP but not family. Participants who made a disclosure to family or HCP were more likely to report condom use during anal sex as well as perceived and experienced stigma that included healthcare avoidance, blackmail, assault, and sexual violence as compared to participants who had not disclosed. Improved disclosure practices within safe spaces may enhance engagement of MSM and TGW in healthcare and HIV prevention services.

13 Article Frequency and predictors of tenofovir-diphosphate detection among young Kenyan women in a real-world pre-exposure prophylaxis implementation program. 2020

Pintye, Jillian / Kinuthia, John / Abuna, Felix / Mugwanya, Kenneth / Lagat, Harison / Dettinger, Julia C / Odinga, Daniel / Sila, Joseph / Anderson, Peter L / John-Stewart, Grace / Baeten, Jared M / Anonymous2531141. ·Department of Global Health, University of Washington. · Department of Biobehavioral Nursing and Health Informatics, University of Washington. · Department of Research and Programs, Kenyatta National Hospital. · Department of Pharmaceutical Sciences, University of Colorado. · Department of Epidemiology, University of Washington. · Department of Medicine, University of Washington. · Department of Pediatrics, University of Washington. ·Clin Infect Dis · Pubmed #32109293.

ABSTRACT: In a pre-exposure prophylaxis program for Kenyan women, we detected tenofovir-diphosphate in 61% (125/201) of randomly selected dried blood spots collected at first follow-up visit (median time since initiation 5 weeks [IQR 4-18]). Tenofovir-diphosphate was detected more frequently among women who had HIV-positive partners, were not pregnant, and were ≥24 years.

14 Article Demand for self-tests: Evidence from a Becker-DeGroot-Marschak mechanism field experiment. 2020

Aylward, Patrick / Essendi, Hildah / Little, Kristen / Wilson, Nicholas. ·Population Services International, Washington, District of Columbia, USA. · Population Services International, Nairobi, Kenya. · Department of Economics, Reed College, Portland, Oregon, USA. ·Health Econ · Pubmed #31965689.

ABSTRACT: Self-tests offer one approach for reducing frictions underlying low demand for preventive health inputs, yet there is little evidence on demand for self-tests. We used the Becker-DeGroot-Marschak mechanism-an incentive-compatible approach-to elicit exact willingness to pay (WTP) for HIV self-tests in a field experiment with 822 participants at 66 health clinics/pharmacies in Kenya. Our analysis reveals substantial demand at low prices and highly elastic demand at a wide range of prices above this range. We find few participants with nonpositive WTP. We examine correlates of WTP and discuss policy and research implications of our findings.

15 Article Effects of social health insurance on access and utilization of obstetric health services: results from HIV+ pregnant women in Kenya. 2020

Were, Lawrence P O / Were, Edwin / Wamai, Richard / Hogan, Joseph / Galarraga, Omar. ·Department of Health Sciences, Boston University's College of Health and Rehabilitation Sciences: Sargent College, Boston, USA. werelpo@bu.edu. · School of Public Health, Brown University, Providence, RI, USA. werelpo@bu.edu. · Department of Reproductive Health, Moi University & AMPATH-Kenya, Eldoret, Kenya. · Department of Cultures, Societies and Global Studies, Northeastern University, Boston, MA, USA. · School of Public Health, Brown University, Providence, RI, USA. ·BMC Public Health · Pubmed #31959153.

ABSTRACT: BACKGROUND: Reducing maternal morbidity and mortality remains a top global health agenda especially in high HIV/AIDS endemic locations where there is increased likelihood of mother to child transmission (MTCT) of HIV. Social health insurance (SHI) has emerged as a viable option to improve population access to health services, while improving outcomes for disenfranchised populations, particularly HIV+ women. However, the effect of SHI on healthcare access for HIV+ persons in limited resource settings is yet to undergo rigorous empirical evaluation. This study analyzes the effect of health insurance on obstetric healthcare access including institutional delivery and skilled birth attendants for HIV+ pregnant women in Kenya. METHODS: We analyzed cross-sectional data from HIV+ pregnant women (ages 15-49 years) who had a delivery (full term, preterm, miscarriage) between 2008 and 2013 with their insurance enrollment status available in the electronic medical records database of a HIV healthcare system in Kenya. We estimated linear and logistic regression models and implemented matching and inverse probability weighting (IPW) to improve balance on observable individual characteristics. Additionally, we estimated heterogeneous effects stratified by HIV disease severity (CD4 < 350 as "Severe HIV disease", and CD4 > 350 otherwise). FINDINGS: Health Insurance enrollment is associated with improved obstetric health services utilization among HIV+ pregnant women in Kenya. Specifically, HIV+ pregnant women covered by NHIF have greater access to institutional delivery (12.5-percentage points difference) and skilled birth attendants (19-percentage points difference) compared to uninsured. Notably, the effect of NHIF on obstetric health service use is much greater for those who are sicker (CD4 < 350) - 20 percentage points difference. CONCLUSION: This study confirms conceptual and practical considerations around health insurance and healthcare access for HIV+ persons. Further, it helps to inform relevant policy development for health insurance and HIV financing and delivery in Kenya and in similar countries in sub-Saharan Africa in the universal health coverage (UHC) era.

16 Article "I Couldn't Afford to Resist": Condom Negotiations Between Male Sex Workers and Male Clients in Mombasa, Kenya. 2020

Valente, Pablo K / Mantell, Joanne E / Masvawure, Tsitsi B / Tocco, Jack Ume / Restar, Arjee J / Gichangi, Peter / Chabeda, Sophie Vusha / Lafort, Yves / Sandfort, Theo G. ·Brown School of Public Health, Brown University, Providence, RI, USA. · HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA. · HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 15, New York, NY, 10032, USA. jem57@cumc.columbia.edu. · Department of Sociology and Anthropology, College of the Holy Cross, Worcester, MA, USA. · International Centre for Reproductive Health-Kenya, Mombasa, Kenya. · International Centre for Reproductive Health-Ghent University, Ghent, Belgium. · Department of Anatomy, University of Nairobi, Nairobi, Kenya. ·AIDS Behav · Pubmed #31321637.

ABSTRACT: Male sex workers in Kenya face a disproportionate burden of HIV and often engage in condomless sex with their commercial partners, yet little is known about how condom negotiations between male sex workers and clients take place. We conducted semi-structured interviews with 25 male sex workers and 11 male clients of male sex workers in Mombasa, Kenya, to examine barriers and facilitators to condom use and how condom use negotiation takes place in these interactions. Participants reported positive attitudes toward condom use and perceived condom use to be a health-promoting behavior. Barriers to condom use included extra-payment for condomless sex, low perceived HIV/STI risk with some sexual partners, perceived reduced pleasure associated with using condoms, alcohol use, and violence against male sex workers by clients. Future interventions should address individual- and structural-level barriers to condom use to promote effective condom use negotiation between male sex workers and male clients.

17 Article Chain Peer Referral Approach for HIV Testing Among Adolescents in Kisumu County, Kenya. 2020

Ong'wen, Patricia / Samba, Benard O / Moghadassi, Michelle / Okoko, Nicollate / Bukusi, Elizabeth A / Cohen, Craig R / Wolf, Hilary T. ·Center for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. · Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA. · Department of Pediatrics, Georgetown University, 3800 Reservoir Road, NW, Washington, DC, 20007, USA. hilarywolf@gmail.com. ·AIDS Behav · Pubmed #31267295.

ABSTRACT: New HIV infections among adolescents continues to be a large public health burden in sub-Saharan Africa, with few adolescents accessing HIV testing and counseling (HTC) services. We evaluated the effect of a peer referral program among adolescents in Kisumu county, Kenya in accessing HTC. Female adolescents aged 15 to 19 years were recruited from three health clinics in Kisumu County. They, in turn, recruited their peers for HTC by handing out referral cards. Referrals would then recruit their peers and this peer-referral repeated for approximately 5 months. The 252 female index seeds showed a relatively higher-risk profile for HIV compared to the 792 referral participants. The referral system yielded an increased proportion of first-time adolescent testers from 13.1% among index seeds to 42.7% among the second wave of referrals. However, the peer referral system ultimately did not increase the absolute number of adolescents Queryaccessing HTC. Future strategies should consider these findings to better target those with undiagnosed HIV infection.

18 Article Risk factors for Burkitt lymphoma in East African children and minors: A case-control study in malaria-endemic regions in Uganda, Tanzania and Kenya. 2020

Peprah, Sally / Ogwang, Martin D / Kerchan, Patrick / Reynolds, Steven J / Tenge, Constance N / Were, Pamela A / Kuremu, Robert T / Wekesa, Walter N / Sumba, Peter O / Masalu, Nestory / Kawira, Esther / Magatti, Josiah / Kinyera, Tobias / Otim, Isaac / Legason, Ismail D / Nabalende, Hadijah / Dhudha, Herry / Ally, Hillary / Genga, Isaiah O / Mumia, Mediatrix / Ayers, Leona W / Pfeiffer, Ruth M / Biggar, Robert J / Bhatia, Kishor / Goedert, James J / Mbulaiteye, Sam M. ·Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD. · EMBLEM Study, St. Mary's Hospital Lacor, Gulu, Uganda. · African Field Epidemiology Network, Kampala, Uganda. · EMBLEM Study, Kuluva Hospital Kuluva, Arua, Uganda. · Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD. · EMBLEM Study, Moi University College of Health Sciences, Eldoret, Kenya. · EMBLEM Study, Academic Model Providing Access To Healthcare (AMPATH), Eldoret, Kenya. · Kenya Medical Research Institute, Kisumu, Kenya. · EMBLEM Study, Bugando Medical Center, Mwanza, Tanzania. · EMBLEM Study, Shirati Health and Educational Foundation, Shirati, Tanzania. · Department of Pathology, The Ohio State University, Columbus, OH. ·Int J Cancer · Pubmed #31054214.

ABSTRACT: Endemic Burkitt lymphoma (eBL) is the most common childhood cancer in sub-Saharan African countries, however, few epidemiologic studies have been undertaken and none attempted enrolling cases from multiple countries. We therefore conducted a population-based case-control study of eBL in children aged 0-15 years old in six regions in Northern Uganda, Northern Tanzania and Western Kenya, enrolling 862 suspected cases and 2,934 population controls (response rates 98.5-100%), and processing ~40,000 vials of samples using standardized protocols. Risk factor questionnaires were administered, and malaria period prevalence was measured using rapid diagnostic tests (RDTs). A total of 80.9% of the recruited cases were diagnosed as eBL; 61.4% confirmed by histology. Associations with eBL risk were computed using logistic regression models adjusted for relevant confounders. Associations common in at least two countries were emphasized. eBL risk was decreased with higher maternal income and paternal education and elevated with history of inpatient malaria treatment >12 months before enrollment. Reporting malaria-attributed fever up to 6 months before enrollment and malaria-RDT positivity at enrollment were associated with decreased eBL risk. Conversely, reporting exposure to mass malaria suppression programs (e.g., indoor residual insecticide) was associated with elevated risk. HIV seropositivity was associated with elevated eBL risk, but the relative impact was small. The study shows that it is feasible to conduct networked, multisite population-based studies of eBL in Africa. eBL was inversely associated with socioeconomic status, positively associated with inpatient malaria treatment 12 months ago and with living in areas targeted for malaria suppression, which support a role of malaria in eBL.

19 Article " 2020

Schenk, Katie D / Tun, Waimar / Sheehy, Meredith / Okal, Jerry / Kuffour, Emmanuel / Moono, Grimond / Mutale, Felix / Kyeremaa, Rita / Ngirabakunzi, Edson / Amanyeiwe, Ugochukwu / Leclerc-Madlala, Suzanne. ·Department of Global and Community Health, George Mason University, Fairfax, VA. · HIVCore/Population Council, New York City, NY, USA. · HIVCore/Population Council, Nairobi, Kenya. · HIVCore/Population Council, Accra, Ghana. · HIVCore/Population Council, Lusaka, Zambia. · Zambia Agency for Persons with Disabilities, Lusaka, Zambia. · Ghana Federation of Disability Organisations, Accra, Ghana. · National Union of Disabled Persons of Uganda, Kampala, Uganda. · USAID/Global Health Bureau, Washington, DC, USA. ·Disabil Rehabil · Pubmed #30282493.


20 Article Burden of anemia and its association with HAART in HIV infected children in Ethiopia: a systematic review and meta-analysis. 2019

Wagnew, Fasil / Eshetie, Setegn / Alebel, Animut / Tesema, Cheru / Kibret, Getiye Dejenu / Gebrie, Alemu / Dessie, Getenet / Abajobir, Amanuel Alemu. ·College of Health Science, Debre Markos University, Debre Markos, Ethiopia. fasilw.n@gmail.com. · College of Health Science, University of Gondar, Gondar, Ethiopia. · College of Health Science, Debre Markos University, Debre Markos, Ethiopia. · Faculity of health, University of Technology Sidney, Sidney, Australia. · College of Health Sciences, Bahirdar University, Bahirdar, Ethiopia. · Faculty of Medicine, The University of Queensland, Brisbane, Australia. · African Population and Health Research Center, Maternal and Child Wellbeing Unit, Nairobi, Kenya. ·BMC Infect Dis · Pubmed #31801471.

ABSTRACT: BACKGROUND: Anemia is a common problem in HIV (human immunodeficiency virus) infected patients, and is associated with decreased functional capacity and quality of life. Ethiopia is one of the countries which has expanded highly active antiretroviral treatment (HAART) over the past years. The effect of HAART on anemia among HIV remains inconsistent and inconclusive, particularly in children. This study thus aimed to synthesize the prevalence of anemia among HIV infected Ethiopian children and its association with HAART initiation. METHODS: MEDLINE/PubMed, EMBASE, PsycINFO, Web of Science and Google scholar were used to identify 12 eligible studies reporting an association between anemia and HIV using a priori set criteria. PRISMA guideline was used to systematically review and meta-analysis these studies. Details of sample size, magnitude of effect sizes, including odds ratio (OR) and standard errors were extracted. Random-effects model was used to calculate the pooled estimates using STATA/SE version-14. I RESULTS: In Ethiopia, the overall prevalence of anemia in HIV infected children was 22.3% (95% CI: 18.5-26.0%). The OR of anemia-HIV/AIDS comorbidity was 0.4 (95% CI, 0.2-0.5) in HAART initiated children as compared to non-initiated counterparts. Meta-bias and funnel plot detected no publication bias. CONCLUSION: On aggregate, anemia is a common comorbidity in pediatric HIV patients. HAART was significantly associated with a reduced anemia-HIV/AIDS comorbidity. Prompt start of HAART might help decreasing the prevalence of anemia and its subsequent complications.

21 Article A randomized clinical trial of mobile phone motivational interviewing for alcohol use problems in Kenya. 2019

Harder, Valerie S / Musau, Abednego M / Musyimi, Christine W / Ndetei, David M / Mutiso, Victoria N. ·Departments of Pediatrics and Psychiatry, University of Vermont, Burlington, VT, USA. · Africa Mental Health Foundation, Nairobi, Kenya. · Department of Psychiatry, University of Nairobi, Nairobi, Kenya. ·Addiction · Pubmed #31782966.

ABSTRACT: AIM: To test the effectiveness of a motivational interviewing (MI) intervention using the mobile phone among adults with alcohol use problems. DESIGN: A randomized clinical trial of mobile MI and standard in-person MI with 1- and 6-month follow-up, including a 1-month waitlist control followed by mobile MI. SETTING: A primary health center in rural Kenya. PARTICIPANTS: Three hundred adults screening positive for alcohol use problems were randomized and received immediate mobile MI (n = 89), in-person MI (n = 65) or delayed mobile MI (n = 76) for waiting-list controls 1 month after no treatment, with 70 unable to be reached for intervention. INTERVENTION AND COMPARATOR: One MI session was provided either immediately by mobile phone, in-person at the health center or delayed by 1 month and then provided by mobile phone. MEASUREMENTS: Alcohol use problems were repeatedly assessed using the Alcohol Use Disorder Identification Test (AUDIT) and the shorter AUDIT-C. The primary outcome was difference in alcohol score 1 month after no intervention for waiting-list control versus 1 month after MI for mobile MI. The secondary outcomes were difference in alcohol score for in-person MI versus mobile MI one and 6 months after MI. FINDINGS: For our primary outcome, average AUDIT-C scores were nearly three points higher (difference = 2.88, 95% confidence interval = 2.11, 3.66) for waiting-list controls after 1 month of no intervention versus mobile MI 1 month after intervention. Results for secondary outcomes supported the null hypothesis of no difference between in-person and mobile MI at 1 month (Bayes factor = 0.22), but were inconclusive at 6 months (Bayes factor = 0.41). CONCLUSION: Mobile phone-based motivational interviewing may be an effective treatment for alcohol use problems among adults visiting primary care in Kenya. Providing mobile motivational interviewing may help clinicians in rural areas to reach patients needing treatment for alcohol use problems.

22 Article Prevalence and correlates of depressive symptoms among adults living with HIV in rural Kilifi, Kenya. 2019

Nyongesa, Moses K / Mwangi, Paul / Wanjala, Stanley W / Mutua, Agnes M / Newton, Charles R J C / Abubakar, Amina. ·Centre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya. Mkachama@kemri-wellcome.org. · Centre for Geographic Medicine Research-Coast, KEMRI, Box 230, Kilifi, Kenya. · Department of Social Sciences, Pwani University, Kilifi, Kenya. · Department of Public Health, Pwani University, Kilifi, Kenya. · Department of Psychiatry, University of Oxford, Oxford, UK. · Institute for Human Development, Aga Khan University, Nairobi, Kenya. ·BMC Psychiatry · Pubmed #31675938.

ABSTRACT: BACKGROUND: Published research on depression among people living with HIV/AIDS (PLWHA) from Africa is increasing, but data from Kenya remains scarce. This cross-sectional study measured the prevalence and correlates of depressive symptoms among PLWHA in rural Kilifi, on the Kenyan coast. METHODS: Between February and April 2018, we consecutively recruited and interviewed 450 adults living with HIV and on combination antiretroviral therapy (cART). Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9), with a positive depression screen defined as PHQ-9 score ≥ 10. Measures of psychosocial, health, and treatment characteristics were also administered. RESULTS: The overall prevalence of depressive symptoms was 13.8% (95% Confidence Interval (95%CI): 10.9, 17.3). Multivariable logistic regression analysis identified current comorbid chronic illness (adjusted Odds Ratio (aOR) 5.72, 95% CI: 2.28, 14.34; p < 0.001), cART regimen (aOR 6.93, 95%CI: 2.34, 20.49; p < 0.001), perceived HIV-related stigma (aOR 1.10, 95%CI: 1.05, 1.14, p < 0.001) and difficulties accessing HIV care and treatment services (aOR 2.37, 95%CI: 1.14, 4.91; p = 0.02) as correlates of depressive symptoms. CONCLUSION: The prevalence of depressive symptoms among adults living with HIV on the Kenyan coast is high. Those at high risk for elevated depressive symptoms (e.g., with comorbid chronic illnesses, on second-line cART, experiencing perceived HIV-stigma or with problems accessing HIV care) may benefit from early identification, treatment or referral, which requires integration of mental health programmes into HIV primary care.

23 Article Who are the missing men? Characterising men who never tested for HIV from population-based surveys in six sub-Saharan African countries. 2019

Quinn, Caitlin / Kadengye, Damazo T / Johnson, Cheryl C / Baggaley, Rachel / Dalal, Shona. ·Department of HIV/AIDS, World Health Organization, Geneva, Switzerland. · African Population and Health Research Center, Nairobi, Kenya. ·J Int AIDS Soc · Pubmed #31631576.

ABSTRACT: INTRODUCTION: We sought to characterize men who had never tested for HIV, understand factors associated with not testing, and measure survey HIV test uptake among never testers. We analysed nationally representative Demographic and Health Surveys of six African countries from 2013 to 2016: Ethiopia, Malawi, Zimbabwe, Rwanda, Lesotho and Zambia. METHODS: Eligible men were household residents or overnight visitors aged 15 to 59 years. We analysed questionnaire responses on HIV testing, known behavioural risk factors, and corresponding HIV laboratory results. We used survey-weighted logistic regression to identify factors associated with never testing for HIV. RESULTS: Approximately double the proportion of men had never tested for HIV compared to women (Malawi: 30% vs. 17%, p < 0.0001; Zimbabwe: 35% vs. 19%, p < 0.0001; Lesotho: 34% vs. 15%, p < 0.0001; Zambia: 36% vs. 20%, p < 0.0001); although, less of a differential existed in Ethiopia (54% vs. 56%, p = 0.12) and Rwanda (19% vs. 14%, p < 0.0001). When offered a test during the survey, 85% to 99% of sexually active men who reported never previously testing, accepted testing. HIV positivity ranged from <0.05% to 14% for never tested men. After adjusting for age, factors associated with never having tested for HIV were never being married (aOR range: 1.46 to 10.39), not having children (aOR: 1.36 to 3.59) and lower education (less than primary education aOR: 2.77 to 5.59). CONCLUSIONS: Although higher proportions of men than women had never tested for HIV, 85% to 99% of men did accept a test when offered. Finding opportunities to offer HIV testing to single men without children, older men who have never tested, and those disadvantaged with less schooling and employment, alongside other facility and community-based services, will be important in identifying those living with undiagnosed HIV and improving men's health.

24 Article Aging in the Context of HIV/AIDS: Spaces for Renegotiation and Recomposition of Mutual Solidarity in Burkina Faso. 2019

Ouedraogo, Ramatou / Attané, Anne / Gyasi, Razak M. ·African Population and Health Research Center (APHRC), Nairobi, Kenya. · Institut de Recherche pour le Developpement (IRD)/LPED, Marseille, France. ·J Int Assoc Provid AIDS Care · Pubmed #31615300.

ABSTRACT: PURPOSE: The HIV-infected older people in sub-Saharan Africa are inevitably vulnerable to chronic health-related conditions, yet the needed social support for these people is mostly inadequate. Drawing on the anthropology of disease and health paradigms, this study explores the recomposition of multidimensional and multidirectional nature of mutual familial support for older people living with or affected by HIV/AIDS in Burkina Faso. METHODS: We conducted multiple in-depth interviews among 147 individuals recruited from nonprofit organizations in Ouagadougou, Bobo-Dioulasso, Ouahigouya, and Yako through 2 projects funded by the National Agency for AIDS Research. Thematic and narrative analytical frameworks were used to analyze the data. RESULTS: We found that older people suffered serious socioeconomic and psychological challenges associated with HIV/AIDS. Older people were particularly vulnerable to the double burden of HIV/AIDS and caregiving responsibility for family members infected with the disease. However, the infected older people who received adequate treatment and familial support regained sociocultural positions as agents for cultural transition and material/emotional resources. CONCLUSIONS: Although HIV/AIDS potentially renegotiated the nature, intensity, and direction of familial support for vulnerable older people, the extrafamily solidarity seems an integral part of the great cycle of reciprocity and intrafamily mutual support. Health and policy interventions targeted at strengthening the interpersonal relationships and support for HIV/AIDS-infected and HIV/AIDS-affected older people are needed to improve their independence and well-being.

25 Article Validation of an HIV/AIDS Stigma Measure for Children Living with HIV and Their Families. 2019

Vreeman, Rachel Christine / Scanlon, Michael Lawrence / Tu, Wanzhu / Slaven, James / McAteer, Carole / Aluoch, Josephine / Ayaya, Samuel / Nyandiko, Winstone Mokaya. ·Department of Health Systems Design and Global Health, Icahn School of Medicine at Mount Sinai, NY, USA. · Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya. · Department of Child Health and Paediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya. · John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, MA, USA. · Department of Biostatistics, Indiana University School of Medicine, Indianapolis, IN, USA. ·J Int Assoc Provid AIDS Care · Pubmed #31581890.

ABSTRACT: BACKGROUND: There are few validated tools to measure stigma, particularly among children living with HIV and their families. METHODS: This study was nested within a larger study that followed 240 child-caregiver dyads (children aged 10-15 years) at 8 clinics in western Kenya. The stigma instrument was administered to all child-caregiver dyads at 2 time points 6 months apart. The primary end point was to construct validity assessed by comparison to criterion constructs using generalized estimating equation models. RESULTS: Mean age of child participants was 12.3 years and 52% were female. Generally, caregivers reported experiencing higher levels of HIV stigma compared to their children. Children (9%) and caregivers (14%) reported that HIV stigma made them feel stressed, anxious, and depressed. Child and caregiver stigma items showed high construct validity by emotional and behavioral outcomes. CONCLUSIONS: The stigma instrument showed high validity when compared to emotional and behavioral outcomes.