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Factors Associated with Acceptability of HIV Self-Testing Among Health Care Workers in Kenya

aids AND BEHAVIOR 2014年第4期18卷 S405-S414页

作者： Kalibala, Samuel Tun, Waimar Cherutich, Peter Nganga, Anne Oweya, Erick Oluoch, Patricia Populat Council HIV & AIDS Program Washington DC 20008 USA Minist Hlth Natl AIDS & STD Control Program NASCOP Nairobi Kenya Ctr Dis Control & Prevent Nairobi Kenya

Health care workers (HCWs) in sub-Saharan Africa are at a high risk of HIV infection from both sexual and occupational exposures. However, many do not seek HIV testing. This paper examines the acceptability of an unsupervised facility-based HIV self-testing (HIV-ST) intervention among HCWs and their partners and factors associated with uptake of HIVST among HCWs. HCWs in seven large Kenyan hospitals were invited to participate in pre-HIVST information sessions during which they were offered HIVST kits to take home for self-testing. A post-intervention survey was conducted among 765 HCWs. Forty-one percent attended the information session;of those, 89 % took the HIVST kits and of those, 85 % self-tested. Thirty-four percent of surveyed HCWs used the HIVST to test themselves. Of those who took the HIVST kit and had partners, 73 % gave the kit to their partner and 86 % of them indicated their partner self-tested. Factors positively associated with use of the HIVST on self were being female, being single, and being a HCW from Homa Bay Hospital (located in a high HIV prevalence area). HIVST is acceptable to HCWs and their partners. However, strategies are needed to increase HCWs attendance at pre-implementation information sessions.

关键词： HIV self-test Health care workers HIV testing

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Risk Factors for HIV Acquisition in a Prospective Nairobi-Based Female Sex Worker Cohort

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aids AND BEHAVIOR 2015年第12期19卷 2204-2213页

作者： McKinnon, Lyle R. Izulla, Preston Nagelkerke, Nico Munyao, Julius Wanjiru, Tabitha Shaw, Souradet Y. Gichuki, Richard Kariuki, Cecilia Muriuki, Festus Musyoki, Helgar Gakii, Gloria Gelmon, Lawrence Kaul, Rupert Kimani, Joshua Univ Nairobi Dept Med Microbiol Nairobi Kenya Univ Toronto Dept Med Toronto ON Canada Univ KwaZulu Natal Nelson R Mandela Sch Med Ctr AIDS Programme Res South Africa CAPRISA ZA-4013 Durban South Africa United Arab Emirates Univ Community Med Al Ain U Arab Emirates Univ Manitoba Dept Med Microbiol Winnipeg MB Canada Minist Publ Hlth & Sanitat Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Univ Manitoba Dept Community Hlth Sci Winnipeg MB R3T 2N2 Canada Univ Toronto Univ Hlth Network Div Infect Dis Toronto ON Canada

With two million new HIV infections annually, ongoing investigations of risk factors for HIV acquisition is critical to guide ongoing HIV prevention efforts. We conducted a prospective cohort analysis of HIV uninfected female sex workers enrolled at an HIV prevention clinic in Nairobi (n = 1640). In the initially HIV uninfected cohort (70 %), we observed 34 HIV infections during 1514 person-years of follow-up, i.e. an annual incidence of 2.2 % (95 % CI 1.6-3.1 %). In multivariable Cox Proportional Hazard analysis, HIV acquisition was associated with a shorter baseline duration of sex work (aHR 0.76, 95 % CI 0.63-0.91), minimum charge/sex act (aHR 2.74, 0.82-9.15, for low vs. intermediate;aHR 5.70, 1.96-16.59, for high vs. intermediate), N. gonorrhoeae infection (aAHR 5.89, 95 % CI 2.03-17.08), sex with casual clients during menses (aHR 6.19, 95 % CI 2.58-14.84), Depo Provera use (aHR 5.12, 95 % CI 1.98-13.22), and estimated number of annual unprotected regular partner contacts (aHR 1.004, 95 % CI 1.001-1.006). Risk profiling based on baseline predictors suggested that substantial heterogeneity in HIV risk is evident, even within a key population. These data highlight several risk factors for HIV acquisition that could help to re-focus HIV prevention messages.

关键词： HIV/aids Female sex workers Prospective cohort HIV acquisition Co-factors of transmission Risk profile

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Awareness and attitudes towards HIV/aids among residents of Kandy, Sri Lanka

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aids CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF aids/HIV 2015年第3期27卷 387-391页

作者： Navaratna, Samidi Kanda, Koji Dharmaratne, Samath D. Tennakoon, Sampath Jayasinghe, Ananda Jayasekara, Niroshan Nagano, Katsutoshi Obayashi, Yoshihide Arai, Asuna Tamashiro, Hiko Univ Peradeniya Fac Med Dept Community Med Peradeniya Sri Lanka Hokkaido Univ Grad Sch Med Dept Global Hlth & Epidemiol Sapporo Hokkaido Japan Natl STD AIDS Control Programme Colombo Sri Lanka

Currently, interventions for HIV/aids control in Sri Lanka are only carried out among the most-at-risk populations. This study was conducted to identify the level of awareness and stigma-related attitudes among the general population of Sri Lanka. A cross-sectional study was carried out among 869 residents of 18-64 years of age in Kandy, Sri Lanka. A self-administered questionnaire was utilised to obtain information about stigma, discrimination and HIV/aids-related knowledge. Chi-square test and multivariate analysis were applied to find possible associations between HIV-related variables and socio-demographic indicators. Response rate was 82.0%. Overall, 93.5% of the participants have heard of HIV/aids but the knowledge on HIV/aids was low with an average score of 51.7%, no statistically significant difference between genders (p = 0.352). Only 58.1% were aware that a condom was an effective tool for its prevention. There were many misconceptions related to epidemiology of HIV/aids. The participants showed more positive attitudes towards HIV/aids and people living with HIV/aids (PLHIV) for all questionnaire items except for those listed under shame and blame. Positive attitudes towards PLHIV were observed to be greater among those with a better HIV/aids-related knowledge score. There was no significant association between the attitudes towards PLHIV and socio-demographic characteristics such as ethnicity and religion. There is a greater need of making attempts towards educating the public regarding HIV/aids to eliminate misconceptions prevalent in the society. Stigma-related attitudes are mainly due to shame and blame associated with the disease. As the attitudes towards PLHIV were more positive among those with a better HIV/aids-related knowledge score, targeted HIV/aids-related health education interventions maybe recommended in this regard.

关键词： general population attitudes: stigma Sri Lanka awareness

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Transformation of HIV from pandemic to low-endemic levels: a public health approach to combination prevention

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LANCET 2014年第9939期384卷 272-279页

作者： Jones, Alexandra Cremin, Ide Abdullah, Fareed Idoko, John Cherutich, Peter Kilonzo, Nduku Rees, Helen Hallett, Timothy O'Reilly, Kevin Koechlin, Florence Schwartlander, Bernhard de Zalduondo, Barbara Kim, Susan Jay, Jonathan Huh, Jacqueline Piot, Peter Dybul, Mark Georgetown Univ Ctr Law ONeill Inst Natl & Global Hlth Law Washington DC USA Univ London Imperial Coll Sci Technol & Med Sch Publ Hlth London England SANAC Pretoria South Africa Natl Agcy Control AIDS Abuja Nigeria Natl AIDS STD Control Programme NASCOP Nairobi Kenya Liverpool Voluntary Counselling & Testing Care & Nairobi Kenya Univ Witwatersrand Wits Reprod Hlth & HIV Inst ZA-2050 Johannesburg South Africa WHO Dept HIV AIDS CH-1211 Geneva Switzerland UNAIDS Dept Evidence Strategy & Results Geneva Switzerland UNAIDS Off Deputy Execut Director Programme Geneva Switzerland London Sch Hyg & Trop Med Directors Off London WC1 England Global Fund Fight AIDS TB & Malaria Geneva Switzerland

Large declines in HIV incidence have been reported since 2001, and scientific advances in HIV prevention provide strong hope to reduce incidence further. Now is the time to replace the quest for so-called silver bullets with a public health approach to combination prevention that understands that risk is not evenly distributed and that effective interventions can vary by risk profile. Different countries have different microepidemics, with very different levels of transmission and risk groups, changing over time. Therefore, focus should be on high-transmission geographies, people at highest risk for HIV, and the package of interventions that are most likely to have the largest effect in each different microepidemic. Building on the backbone of behaviour change, condom use, and medical male circumcision, as well as expanded use of antiretroviral drugs for infected people and pre-exposure prophylaxis for uninfected people at high risk of infection, it is now possible to consider the prospect of what would be one of the most remarkable achievements in the history of public health: reduction of HIV transmission from a pandemic to low-level endemicity.

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Maximising the effect of combination HIV prevention through prioritisation of the people and places in greatest need: a modelling study

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LANCET 2014年第9939期384卷 249-256页

作者： Anderson, Sarah-Jane Cherutich, Peter Kilonzo, Nduku Cremin, Ide Fecht, Daniela Kimanga, Davies Harper, Malayah Masha, Ruth Laibon Ngongo, Prince Bahati Maina, William Dybul, Mark Hallett, Timothy B. Univ London Imperial Coll Sci Technol & Med Dept Infect Dis Epidemiol London W2 1PG England Univ London Imperial Coll Sci Technol & Med MRC PHE Ctr Environm & Hlth SAHSU London W2 1PG England Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Liverpool VCT Care & Treatment Nairobi Kenya UNAIDS Nairobi Kenya IAVI Nairobi Kenya Global Fund Fight AIDS TB & Malaria Geneva Switzerland

Background Epidemiological data show substantial variation in the risk of HIV infection between communities within African countries. We hypothesised that focusing appropriate interventions on geographies and key populations at high risk of HIV infection could improve the effect of investments in the HIV response. Methods With use of Kenya as a case study, we developed a mathematical model that described the spatiotemporal evolution of the HIV epidemic and that incorporated the demographic, behavioural, and programmatic differences across subnational units. Modelled interventions (male circumcision, behaviour change communication, early antiretoviral therapy, and pre-exposure prophylaxis) could be provided to different population groups according to their risk behaviours or their location. For a given national budget, we compared the effect of a uniform intervention strategy, in which the same complement of interventions is provided across the country, with a focused strategy that tailors the set of interventions and amount of resources allocated to the local epidemiological conditions. Findings A uniformly distributed combination of HIV prevention interventions could reduce the total number of new HIV infections by 40% during a 15-year period. With no additional spending, this effect could be increased by 14% during the 15 years-almost 100 000 extra infections, and result in 33% fewer new HIV infections occurring every year by the end of the period if the focused approach is used to tailor resource allocation to reflect patterns in local epidemiology. The cumulative difference in new infections during the 15-year projection period depends on total budget and costs of interventions, and could be as great as 150 000 (a cumulative difference as great as 22%) under different assumptions about the unit costs of intervention. Interpretation The focused approach achieves greater effect than the uniform approach despite exactly the same investment. Through prioritisation o

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Collaborative Effort for a Centralized Worldwide Tuberculosis Relational Sequencing Data Platform

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CLINICAL INFECTIOUS DISEASES 2015年第SUPPL_3期61卷 S141-S146页

作者： Starks, Angela M. Aviles, Enrique Cirillo, Daniela M. Denkinger, Claudia M. Dolinger, David L. Emerson, Claudia Gallarda, Jim Hanna, Debra Kim, Peter S. Liwski, Richard Miotto, Paolo Schito, Marco Zignol, Matteo Ctr Dis Control & Prevent Div TB Eliminat Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA 30329 USA Crit Path Inst Tucson AZ USA Ist Sci San Raffaele Ist Ricovero & Cura Carattere Sci I-20132 Milan Italy Fdn Innovat New Diagnost Geneva Switzerland St Michaels Hosp Li Ka Shing Knowledge Inst Ctr Eth Social & Cultural Risk Toronto ON M5B 1W8 Canada Bill & Melinda Gates Fdn Seattle WA USA NIAID Div AIDS NIH Bethesda MD 20892 USA WHO TB Monitoring & Evaluat Global TB Programme CH-1211 Geneva Switzerland

Continued progress in addressing challenges associated with detection and management of tuberculosis requires new diagnostic tools. These tools must be able to provide rapid and accurate information for detecting resistance to guide selection of the treatment regimen for each patient. To achieve this goal, globally representative genotypic, phenotypic, and clinical data are needed in a standardized and curated data platform. A global partnership of academic institutions, public health agencies, and nongovernmental organizations has been established to develop a tuberculosis relational sequencing data platform (ReSeqTB) that seeks to increase understanding of the genetic basis of resistance by correlating molecular data with results from drug susceptibility testing and, optimally, associated patient outcomes. These data will inform development of new diagnostics, facilitate clinical decision making, and improve surveillance for drug resistance. ReSeqTB offers an opportunity for collaboration to achieve improved patient outcomes and to advance efforts to prevent and control this devastating disease.

关键词： Mycobacterium tuberculosis drug resistance database

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Alcohol use and its association with HIV risk behaviors among a cohort of patients attending HIV clinical care in Tanzania, Kenya, and Namibia

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aids CARE-PSYCHOLOGICAL AND SOCIO-MEDICAL ASPECTS OF aids/HIV 2014年第10期26卷 1288-1297页

作者： Medley, Amy Seth, Puja Pathak, Sonal Howard, Andrea A. DeLuca, Nickolas Matiko, Eva Mwinyi, Abubakari Katuta, Frieda Sheriff, Mushin Makyao, Neema Wanjiku, Lucy Ngare, Carol Bachanas, Pamela US Ctr Dis Control & Prevent Div Global HIV AIDS Atlanta GA 30333 USA ICF Int Atlanta GA USA Columbia Univ Int Ctr AIDS Care & Treatment Programs ICAP New York NY USA US Ctr Dis Control & Prevent Dar Es Salaam Tanzania Columbia Univ Int Ctr AIDS Care & Treatment Programs ICAP Dar Es Salaam Tanzania Minist Hlth & Social Serv Windhoek Namibia Columbia Univ Int Ctr AIDS Care & Treatment Programs ICAP Nairobi Kenya Minist Hlth & Social Welf Dar Es Salaam Tanzania US Ctr Dis Control & Prevent Nairobi Kenya Natl AIDS STD Control Programme NASCOP Nairobi Kenya

This article describes the frequency of alcohol use among HIV-positive patients attending clinical care in sub-Saharan Africa and explores the association between alcohol use, medication adherence, and sexual risk behavior. Data from 3538 patients attending an HIV clinic in Kenya, Tanzania, or Namibia were captured through interview and medical record abstraction. Participants were categorized into three drinking categories: nondrinkers, nonharmful drinkers, and harmful/likely dependent drinkers. A proportional odds model was used to identify correlates associated with categories of alcohol use. Overall, 20% of participants reported alcohol use in the past 6 months;15% were categorized as nonharmful drinkers and 5% as harmful/likely dependent drinkers. Participants who reported missing a dose of their HIV medications [adjusted odds ratio (AOR): 2.04, 95% confidence interval (CI): 1.67, 2.49];inconsistent condom use (AOR: 1.49, 95% CI: 1.23, 1.79);exchanging sex for food, money, gifts, or a place to stay (AOR: 1.57, 95% CI: 1.06, 2.32);and having a sexually transmitted infection symptom (AOR: 1.40, 95% CI: 1.10, 1.77) were more likely to be categorized in the higher risk drinking categories. This research highlights the need to integrate alcohol screening and counseling into the adherence and risk reduction counseling offered to HIV-positive patients as part of their routine care. Moreover, given the numerous intersections between alcohol and HIV, policies that focus on reducing alcohol consumption and alcohol-related risk behavior should be integrated into HIV prevention, care, and treatment strategies.

关键词： alcohol use HIV/aids HIV risk behavior sub-Saharan Africa

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Economics of monitoring antiretroviral therapy

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LANCET INFECTIOUS DISEASES 2013年第7期13卷 560-561页

作者： Mermin, Jonathan Granich, Reuben Ctr Dis Control & Prevent Div HIV AIDS Prevent Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA 30333 USA United Nations Programme HIV AIDS Sci Act Div Geneva Switzerland

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Exploring the use of mobile phone technology for the enhancement of the prevention of mother-to-child transmission of HIV program in Nyanza, Kenya: a qualitative study

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BMC PUBLIC HEALTH 2013年第1期13卷 1-9页

作者： Jennings, Larissa Ong'ech, John Simiyu, Rogers Sirengo, Martin Kassaye, Seble Elizabeth Glaser Pediat AIDS Fdn Res Unit Washington DC 20036 USA Johns Hopkins Bloomberg Sch Publ Hlth Dept Int Hlth Social & Behav Intervent Baltimore MD 21205 USA Elizabeth Glaser Pediat AIDS Fdn Nairobi Kenya Univ Nairobi Kenyatta Natl Hosp Nairobi Kenya Minist Hlth Natl AIDS STD Control Programme Nairobi Kenya Georgetown Univ Div Infect Dis Dept Med Washington DC 20007 USA

Background: Community-based mobile phone programs can complement gaps in clinical services for prevention of mother-to-child transmission (PMTCT) of HIV in areas with poor infrastructure and personnel shortages. However, community and health worker perceptions on optimal mobile phone communication for PMTCT are underexplored. This study examined what specific content and forms of mobile communication are acceptable to support PMTCT. Methods: Qualitative methods using focus groups and in-depth interviews were conducted in two district hospitals in Nyanza Province, Kenya. A total of 45 participants were purposefully selected, including HIV-positive women enrolled in PMTCT, their male partners, community health workers, and nurses. Semi-structured discussion guides were used to elicit participants' current mobile phone uses for PMTCT and their perceived benefits and challenges. We also examined participants' views on platform design and gender-tailored short message service (SMS) messages designed to improve PMTCT communication and male involvement. Results: Most participants had access to a mobile phone and prior experience receiving and sending SMS, although phone sharing was common among couples. Mobile phones were used for several health-related purposes, primarily as voice calls rather than texts. The perceived benefits of mobile phones for PMTCT included linking with health workers, protecting confidentiality, and receiving information and reminders. Men and women considered the gender-tailored SMS as a catalyst for improving PMTCT male involvement and couples' communication. However, informative messaging relayed safely to the intended recipient was critical. In addition, health workers emphasized the continual need for in-person counseling coupled with, rather than replaced by, mobile phone reinforcement. For all participants, integrated and neutral text messaging provided antenatally and postnatally was most preferred, although not all topics or text formats w

关键词： Mobile phone mHealth Short message service SMS HIV Prevention of mother-to-child transmission PMTCT Male involvement

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Facility-level intervention to improve attendance and adherence among patients on anti-retroviral treatment in Kenya-a quasi-experimental study using time series analysis

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BMC HEALTH SERVICES RESEARCH 2013年第1期13卷 1-10页

作者： Boruett, Patrick Kagai, Dorine Njogo, Susan Nguhiu, Peter Awuor, Christine Gitau, Lillian Chalker, John Ross-Degnan, Dennis Wahlstrom, Rolf Tomson, Goran Management Sci Hlth Nairobi Kenya Natl AIDS & STI Control Programme NASCOP Nairobi Kenya Management Sci Hlth Arlington VA USA Harvard Univ Sch Med Boston MA USA Harvard Pilgrim Hlth Care Inst Boston MA USA Karolinska Inst Div Global Hlth IHCAR Stockholm Sweden Karolinska Inst MMC Stockholm Sweden

Background: Achieving high rates of adherence to antiretroviral therapy (ART) in resource-poor settings comprises serious, but different, challenges in both the first months of treatment and during the life-long maintenance phase. We measured the impact of a health system-oriented, facility-based intervention to improve clinic attendance and patient adherence. Methods: This was a quasi-experimental, longitudinal, controlled intervention study using interrupted time series analysis. The intervention consisted of (1) using a clinic appointment diary to track patient attendance and monitor monthly performance;(2) changing the mode of asking for self-reported adherence;(3) training staff on adherence concepts, intervention methods, and use of monitoring data;(4) conducting visits to support facility teams with the implementation. We conducted the study in 12 rural district hospitals (6 intervention, 6 control) in Kenya and randomly selected 1894 adult patients over 18 years of age in two cohorts: experienced patients on treatment for at least one year, and newly treated patients initiating ART during the study. Outcome measures were: attending the clinic on or before the date of a scheduled appointment, attending within 3 days of a scheduled appointment, reporting perfect adherence, and experiencing a gap in medication supply of more than 14 days. Results: Among experienced patients, the percentage attending the clinic on or before a scheduled appointment increased in both level (average total increase immediately after intervention) (+5.7%;95% CI = 2.1, 9.3) and trend (increase per month) (+1.0% per month;95% CI = 0.6, 1.5) following the intervention, as did the level and trend of those keeping appointments within three days (+4.2%;95% CI = 1.6, 6.7;and +0.8% per month;95% CI = 0.6, 1.1, respectively). The relative difference between the intervention and control groups based on the monthly difference in visit rates increased significantly in both level (+6.5;95% CI = 1

关键词： Appointment-keeping Medication gaps Self-reported adherence Indicators Monitoring performance

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