Development and Validation of a Novel Risk Calculator to Predict Sub-optimal HIV Outcomes Among Pregnant and Postpartum Women with HIV in Kenya.

No tool currently exists to predict the cumulative risk of suboptimal clinical outcomes among pregnant and postpartum women with HIV (PPWH). This study sought to develop and validate a parsimonious risk calculator capable of predicting disengagement from care and HIV treatment failure among PPWH. We created the risk calculator using data from 1,331 PPWH from Southwestern Kenya (Homabay, Migori, and Kisumu Counties) in the Mother Infant Visit Adherence and Treatment Engagement Trial.

Feasibility of smartphone-enabled asynchronous video directly observed therapy to improve viral suppression outcomes among HIV unsuppressed children and adolescents in Kenya.

Background: Video directly observed therapy (VDOT) has been used as an acceptable, cost-effective, client-centered intervention for tuberculosis management. VDOT targeting children (0-14 years) and adolescents (15-19 years) living with HIV (CALHIV) not achieving viral suppression (VS) [i.e.

Evaluation of risk stratification and problem management plus (PM+) for pregnant women with HIV in Kenya (Tatua study): Protocol paper.

Background: While many pregnant and postpartum women with HIV (PPWH) in the African Region successfully engage in HIV care, a substantial number still face significant barriers, including poor mental health and HIV stigma. These psychosocial barriers contribute to poor medication and clinic visit adherence, poor health outcomes, including unsuppressed viral load, and increased risk of perinatal transmission of HIV. To efficiently improve health outcomes within a resource-constrained health system, responsive and effective interventions are urgently needed to support women who are at the highest risk of sub-optimal outcomes.

Moving milk and shifting risk: A mixed methods assessment of food safety risks along informal dairy value chains in Kisumu, Kenya.

Animal sourced foods (ASF) are important for global food security and in mitigating the impact of undernutrition. Across Sub-Saharan Africa, demand and urbanization continue to increase, creating a greater divide between farm-level production and consumption. Food safety residues including antibiotics and aflatoxin residues often originate at the production site, and risk can shift as milk is transported.

Mental health and quality of life following breast cancer diagnosis in patients seen at a tertiary care hospital in Nairobi, Kenya: A qualitative study.

Mental health challenges are common following cancer diagnosis, negatively impacting treatment and quality of life for breast cancer (BC) patients. This pilot study provides an understanding of the impacts of BC diagnosis and care experiences on the mental health of patients seen at the Aga Khan University Hospital in Nairobi, Kenya. We conducted 40 in-depth interviews, including 10 women with newly diagnosed BC, 10 women with metastatic BC, 10 family members and 10 healthcare professionals.

Expanding Understanding of Urban Rift Valley Fever Risk and Associated Vector Ecology at Slaughterhouses in Kisumu, Kenya.

Rift Valley fever virus (RVFV) is an adaptable arbovirus that can be transmitted by a wide variety of arthropods. Widespread urban transmission of RVFV has not yet occurred, but peri-urban outbreaks of RVFV have recently been documented in East Africa. We previously reported low-level exposure in urban communities and highlighted the risk of introduction via live animal influx.

Optimizing HIV case identification: investigating client characteristics predictive of HIV positivity from provider-initiated testing (PITC) in central Kenya.

Background: Routine program data indicates positivity rates under 2% from HIV testing services (HTS) at sites supported by Centre for Health Solutions-Kenya in Central Kenya. Achieving the UNAIDS 95:95:95 goals requires continuous identification of people living with HIV in an environment of diminishing resources. We assessed non-clinical and clinical characteristics of persons who tested HIV-positive aimed at improving the process of HTS through Provider-Initiated HIV Testing & Counseling (PITC).

Cost of Home-Based Couples Human Immunodeficiency Virus Counseling and Testing and Human Immunodeficiency Virus Self-Testing During Pregnancy and Postpartum in Southwestern Kenya.

Objective: Home-based couples HIV testing and counseling and HIV self-testing (HIVST) for pregnant women can promote HIV status disclosure and male partner testing; however, cost data are lacking. We examined a home-based couples intervention (HBCI) and HIVST intervention costs per couple (unit cost) during pregnancy and postpartum in Kenya.

Methods: This randomized controlled trial is comparing HBCI and HIVST for couples among pregnant women attending antenatal care clinics in two counties in southwestern Kenya.

Leveraging livestock movements to urban slaughterhouses for wide-spread Rift Valley fever virus surveillance in Western Kenya.

Rift Valley fever virus (RVFV) is an economically devastating, zoonotic arbovirus endemic across Africa with potential to cause severe disease in livestock and humans. Viral spread is primarily driven by movement of domestic ruminants and there is a high potential for transboundary spread. Despite influx of livestock to urban areas in response to the high demand for meat and animal products, RVFV has not been detected in any urban center.

County Health Leadership Practices and Readiness for Noncommunicable Disease Services in Kenya.

Background: Premature mortality from noncommunicable diseases (NCDs) is a contemporary development challenge. Low-income and lower-middle-income countries are disproportionately affected, with the poorest in society considered the most vulnerable. A paucity of literature exists on how leadership practices at the implementation level relate to ensuring readiness for NCD services.

Characteristics and Treatment Response of Patients with HIV Associated Kaposi's Sarcoma in Central Kenya.

Introduction: Kaposi's sarcoma (KS) is the most common HIV-associated malignancy in Sub Saharan Africa. In 2018, it was the 7th most common cancer and the 10th most common cause of cancer death in Kenya. This study aimed to describe the baseline and clinical characteristics and treatment response observed following combined antiretroviral treatment (ART) and chemotherapy in KS patients.

Factors Associated with Treatment Outcomes Among Children and Adolescents Living with HIV Receiving Antiretroviral Therapy in Central Kenya.

Expanded access to HIV treatment services has improved outcomes for children and adolescents living with HIV in Kenya. Minimal data are available on these outcomes. We describe temporal trends in outcomes for children and adolescents initiating antiretroviral therapy (ART) from 2004 to 2014 at sites supported by Centre for Health Solutions-Kenya, in central Kenya.

Effects of behavioural interventions on postpartum retention and adherence among women with HIV on lifelong ART: the results of a cluster randomized trial in Kenya (the MOTIVATE trial).

Introduction: Retention in HIV care and adherence to antiretroviral therapy (ART) during pregnancy and postpartum for women living with HIV (WLWH) are necessary to optimize health outcomes for women and infants. The objective of this study was to evaluate the impact of two evidenced-based behavioural interventions on postpartum adherence and retention in WLWH in Kenya.

Methods: The Mother-Infant Visit Adherence and Treatment Engagement (MOTIVATE) study was a cluster-randomized trial enrolling pregnant WLWH from December 2015 to August 2017.

Tenofovir Diphosphate in Dried Blood Spots in Pregnant and Postpartum Women With HIV in Kenya: A Novel Approach to Measuring Peripartum Adherence.

Background: Adherence to antiretroviral therapy (ART) among pregnant and postpartum women with HIV (PWLWH) is critical to promote maternal health and prevent HIV transmission. Tenofovir diphosphate (TFV-DP) in dried blood spots (DBS) is an objective assessment of cumulative ART adherence that has not been fully assessed in PWLWH.

Setting: Southwestern Kenya.

Experiences, perceptions and potential impact of community-based mentor mothers supporting pregnant and postpartum women with HIV in Kenya: a mixed-methods study.

Introduction: Community-based mentor mothers (cMMs) are women living with HIV who provide peer support to pregnant/postpartum women living with HIV (PWLWH) to enhance antiretroviral therapy (ART) adherence, retention in care and prevent perinatal transmission of HIV. The goal of this study was to explore the experiences, perceptions, mechanisms and health impact of cMMs on PWLWH in Kenya from the perspective of cMMs.

Methods: We conducted a prospective mixed-methods study in southwestern Kenya in 2015-2018.

Insecticide resistance status of indoor and outdoor resting malaria vectors in a highland and lowland site in Western Kenya.

Background: Long Lasting Insecticidal Nets (LLINs) and indoor residual spraying (IRS) represent powerful tools for controlling malaria vectors in sub-Saharan Africa. The success of these interventions relies on their capability to inhibit indoor feeding and resting of malaria mosquitoes. This study sought to understand the interaction of insecticide resistance with indoor and outdoor resting behavioral responses of malaria vectors from Western Kenya.

Time to HIV testing of sexual contacts identified by HIV-positive index clients in Siaya County, Kenya.

There are no studies on time to test since notification among identified sexual contacts of HIV-positive index clients using program data in Siaya County and Kenya. We sought to understand time to HIV testing by contact characteristics after identification to inform targeted testing interventions. We retrospectively analyzed data from adult (aged ≥18 years) sexual contacts identified by HIV-positive index clients from 117 health facilities in Siaya County (June 2017-August 2018).

Factors associated with 36-month loss to follow-up and mortality outcomes among HIV-infected adults on antiretroviral therapy in Central Kenya.

Background: The scale-up of HIV treatment programs has resulted in a reduction in HIV-related morbidity and mortality. However, retention of patients in these programs remains a challenge in sub-Saharan Africa. Understanding factors associated with loss to follow-up (LTFU) and mortality outcomes is therefore important to inform targeted program interventions.

Neonatal, infant, and child mortality among women exposed to intimate partner violence in East Africa: a multi-country analysis.

Background: Most neonatal, infant, and child deaths occur in low- and middle-income countries (LMICs), where incidence of intimate partner violence (IPV) is highest in the world. Despite these facts, research regarding whether the two are associated is limited. The main objective was to examine associations between IPV amongst East African women and risk of death among their neonates, infants, and children, as well as related variables.

Effects of Depression, Stigma and Intimate Partner Violence on Postpartum Women's Adherence and Engagement in HIV Care in Kenya.

We explored the association between HIV-related stigma and experiences of intimate partner violence (IPV) and depression with viral load suppression, and medication and visit adherence in postpartum women receiving lifelong antiretroviral therapy (ART) (N = 200). We administered a cross-sectional survey to 200 women with HIV at 12 months postpartum who were enrolled in the MOTIVATE trial. The MOTIVATE study is a cluster-randomized trial evaluating the impact of community mentor mothers and text messaging on PMTCT outcomes in southwestern Kenya.

Is sexual autonomy a protective factor for neonatal, child, and infant mortality? A multi-country analysis.

Background: Sexual autonomy empowers women to set boundaries, take control of their bodies, prevent sexually transmitted diseases and avoid unplanned pregnancy. A woman's ability to negotiate safer sex is crucial for her survival and that of her child. Sexual autonomy among East African women is vital to the elimination of the deaths of neonates, infants, and children.

The Prevalence of Intimate Partner Violence, Associated Risk Factors, and Other Moderating Effects: Findings From the Kenya National Health Demographic Survey.

Intimate partner violence (IPV) is not only a fundamental violation of human rights but also a major public health problem. IPV is the most predominant form of violence committed by men against women. Therefore, our study sought to determine the prevalence of IPV and other moderating factors associated with IPV among these women.

Maximizing adherence and retention for women living with HIV and their infants in Kenya (MOTIVATE! study): study protocol for a randomized controlled trial.

Background: Successful completion and retention throughout the multi-step cascade of prevention of mother-to-child HIV transmission (PMTCT) remains difficult to achieve. The Mother and Infant Visit Adherence and Treatment Engagement study aims to evaluate the effect of mobile text messaging, community-based mentor mothers (cMMs), or both on increasing antiretroviral therapy (ART) adherence, retention in HIV care, maternal viral load suppression, and mother-to-child HIV transmission for mother-infant pairs receiving lifelong ART.

Methods/design: This study is a cluster randomized, 2 × 2 factorial, controlled trial.

Association between stage at diagnosis and knowledge on cervical cancer among patients in a Kenyan tertiary hospital: a cross-sectional study.

Introduction: In Kenya, cervical cancer is the second most common cancer among women; almost half of all women with invasive cervical cancer are diagnosed at a late stage. Few women are aware of the symptoms and risk factors of cervical cancer and that its precursor lesions are detectable through screening thus most women seek treatment when the cancer is at an advanced stage. The study explored the influence of cervical cancer awareness on stage at diagnosis in patients attending Kenyatta National Hospital.

Factors associated with mother to child transmission of HIV despite overall low transmission rates in HIV-exposed infants in rural Kenya.

Despite the availability of efficacious prevention of mother-to-child transmission (PMTCT) interventions and improved access to preventive services in many developing countries, vertical HIV transmission persists. A matched case-control study of HIV-exposed infants between January and June 2012 was conducted at 20 clinics in Kenya. Cases were HIV-infected infants and controls were exposed, uninfected infants.