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1. Suicidality and associated risk factors in outpatients attending a general medical facility in rural Kenya

Author

Ongeri, L, McCulloch, CE, Neylan, TC, Bukusi, E, Macfarlane, SB, Othieno, C, Ngugi, AK, and Meffert, SM

Subjects
Biomedical and Clinical Sciences, Health Services and Systems, Clinical Sciences, Health Sciences, Psychology, Suicide, Brain Disorders, Serious Mental Illness, Depression, Major Depressive Disorder, Behavioral and Social Science, Mental Illness, Post-Traumatic Stress Disorder (PTSD), Mental Health, Clinical Research, Anxiety Disorders, Prevention, Suicide Prevention, 2.3 Psychological, social and economic factors, Mental health, Good Health and Well Being, Adolescent, Adult, Cross-Sectional Studies, Depressive Disorder, Major, Female, Humans, Kenya, Male, Middle Aged, Odds Ratio, Outpatients, Prevalence, Risk Factors, Rural Population, Suicidal Ideation, Suicide, Attempted, Young Adult, Suicidal ideation, Posttraumatic stress disorder, Global mental health, Sub-Saharan Africa, Medical and Health Sciences, Psychology and Cognitive Sciences, Psychiatry, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundLow-and-Middle-Income-Countries (LMICs) account for 75% of global suicides. While primary care populations in high-income countries (HIC) typically have higher prevalence of suicidal behavior relative to general populations, few studies have explored suicidal behavior among general medical outpatients in LMICs. This study addresses the research gap by characterizing potential risk factors for suicidal ideation in a large general medical outpatient setting in rural Kenya.MethodsA cross-sectional study of adult general medical outpatients attending a rural sub-county hospital in Kaloleni, Kenya. Primary outcomes included major depressive disorder (MDD), posttraumatic stress disorder (PTSD) and suicidal behavior measured by the Mini International Neuropsychiatric Interview (MINI 5.0). We use binary logistic regression to model suicidality, mental disorders, intimate partner violence, and lifetime abuse.Results394 outpatients completed the assessment. The prevalence of SI over the past month was 20%. 18% of those with suicidal ideation over the past month also attempted suicide in the past month. Participants who met criteria for MDD (suicidality item removed) were 19 times [CI: 4.56, 79.05] more likely to report suicidal ideation compared to those without MDD (adjusted odds ratio 12.15 [CI: 2.66, 55.49]).LimitationsThis was a cross sectional study design with convenience sampling and hence vulnerable to selection and recall bias.ConclusionThe prevalence of SI and its strong association with actual suicide attempt in this population, make an urgent public health case for intervention. These data identify MDD as a highly significant correlate of SI.

Published
2018

6. The cost‐effectiveness of prophylaxis strategies for individuals with advanced HIV starting treatment in Africa

Author

Walker, Simon M., Cox, Edward, Revill, Paul, Musiime, Victor, Bwakura?Dangarembizi, Mutsa, Mallewa, Jane, Cheruiyot, Priscilla, Maitland, Kathryn, Ford, Nathan, Gibb, Diana M., Walker, A Sarah, Soares, Marta, Mugyenyi, P, Kityo, C, Musiime, V, Wavamunno, P, Nambi, E, Ocitti, P, Ndigendawani, M, Kabahenda, S, Kemigisa, M, Acen, J, Olebo, D, Mpamize, G, Amone, A, Okweny, D, Mbonye, A, Nambaziira, F, Rweyora, A, Kangah, M, Kabaswahili, V, Abach, J, Abongomera, G, Omongin, J, Aciro, I, Philliam, A, Arach, B, Ocung, E, Amone, G, Miles, P, Adong, C, Tumsuiime, C, Kidega, P, Otto, B, Apio, F, Baleeta, K, Mukuye, A, Abwola, M, Ssennono, F, Baliruno, D, Tuhirwe, S, Namisi, R, Kigongo, F, Kikyonkyo, D, Mushahara, F, Tusiime, J, Musiime, A, Nankya, A, Atwongyeire, D, Sirikye, S, Mula, S, Noowe, N, Lugemwa, A, Kasozi, M, Mwebe, S, Atwine, L, Senkindu, T, Natuhurira, T, Katemba, C, Ninsiima, E, Acaku, M, Kyomuhangi, J, Ankunda, R, Tukwasibwe, D, Ayesiga, L, Hakim, J, Nathoo, K, Bwakura?Dangarembizi, M, Reid, A, Chidziva, E, Mhute, T, Tinago, Gc, Bhiri, J, Mudzingwa, S, Phiri, M, Steamer, J, Nhema, R, Warambwa, C, Musoro, G, Mutsai, S, Nemasango, B, Moyo, C, Chitongo, S, Rashirai, K, Vhembo, S, Mlambo, B, Nkomani, S, Ndemera, B, Willard, M, Berejena, C, Musodza, Y, Matiza, P, Mudenge, B, Guti, V, Etyang, A, Agutu, C, Berkley, J, Maitland, K, Njuguna, P, Mwaringa, S, Etyang, T, Awuondo, K, Wale, S, Shangala, J, Kithunga, J, Mwarumba, S, Maitha, S Said, Mutai, R, Lewa, M Lozi, Mwambingu, G, Mwanzu, A, Kalama, C, Latham, H, Shikuku, J, Fondo, A, Njogu, A, Khadenge, C, Mwakisha, B, Siika, A, Wools?Kaloustian, K, Nyandiko, W, Cheruiyot, P, Sudoi, A, Wachira, S, Meli, B, Karoney, M, Nzioka, A, Tanui, M, Mokaya, M, Ekiru, W, Mboya, C, Mwimali, D, Mengich, C, Choge, J, Injera, W, Njenga, K, Cherutich, S, Orido, M Anyango, Lwande, G Omondi, Rutto, P, Mudogo, A, Kutto, I, Shali, A, Jaika, L, Jerotich, H, Pierre, M, Mallewa, J, Kaunda, S, Van Oosterhout, J, O'Hare, B, Heydermann, R, Gonzalez, C, Dzabala, N, Kelly, C, Denis, B, Selemani, G, Mipando, L Nyondo, Chirwa, E, Banda, P, Mvula, L, Msuku, H, Ziwoya, M, Manda, Y, Nicholas, S, Masesa, C, Mwalukomo, T, Makhaza, L, Sheha, I, Bwanali, J, Limbuni, M, Gibb, D, Thomason, M, Walker, As, Pett, S, Szubert, A, Griffiths, A, Wilkes, H, Rajapakse, C, Spyer, M, Prendergast, A, Klein, N, Rauchenberger, M, Van Looy, N, Little, E, Fairbrother, K, Cowan, F, Seeley, J, Bernays, S, Kawuma, R, Mupambireyi, Z, Kyomuhendo, F, Nakalanzi, S, Peshu, J, Ndaa, S, Chabuka, J, Mkandawire, N, Matandika, L, Kapuya, C, Weller, I, Malianga, E, Mwansambo, C, Miiro, F, Elyanu, P, Bukusi, E, Katabira, E, Mugurungi, O, Peto, T, Musoke, P, Matenga, J, Phiri, S, Lyall, H, Johnston, V, Fitzgerald, F, Post, F, Ssali, F, Arenas?Pinto, A, Turkova, A, and Bamford, A

Subjects
Cost benefit analysis, Practice guidelines (Medicine) -- Evaluation, HIV infection -- Diagnosis -- Care and treatment, Cost benefit analysis, Health
Abstract

: Introduction: Many HIV‐positive individuals in Africa have advanced disease when initiating antiretroviral therapy (ART) so have high risks of opportunistic infections and death. The REALITY trial found that an enhanced‐prophylaxis package including fluconazole reduced mortality by 27% in individuals starting ART with CD4 Methods: The REALITY trial enrolled from June 2013 to April 2015. A decision‐analytic model was developed to estimate the cost‐effectiveness of six management strategies in individuals initiating ART in the REALITY trial countries. Strategies included standard‐prophylaxis, enhanced‐prophylaxis, standard‐prophylaxis with fluconazole; and three CrAg testing strategies, the first stratifying individuals to enhanced‐prophylaxis (CrAg‐positive) or standard‐prophylaxis (CrAg‐negative), the second to enhanced‐prophylaxis (CrAg‐positive) or enhanced‐prophylaxis without fluconazole (CrAg‐negative) and the third to standard‐prophylaxis with fluconazole (CrAg‐positive) or without fluconazole (CrAg‐negative). The model estimated costs, life‐years and quality‐adjusted life‐years (QALY) over 48 weeks using three competing mortality risks: cryptococcal meningitis; tuberculosis, serious bacterial infection or other known cause; and unknown cause. Results: Enhanced‐prophylaxis was cost‐effective at cost‐effectiveness thresholds of US$300 and US$500 per QALY with an incremental cost‐effectiveness ratio (ICER) of US$157 per QALY in the CD4 Conclusions: The REALITY enhanced‐prophylaxis package in individuals with advanced HIV starting ART reduces morbidity and mortality, is practical to administer and is cost‐effective. Efforts should continue to ensure that components are accessed at lowest available prices., Introduction In low‐ and middle‐income settings, more than a third of HIV‐positive individuals starting antiretroviral therapy (ART) present with advanced disease (CD4 ≤ 200 cells/mm[sup.3]); over half of these have [...]

Published
2020
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7. SMS reminders did not improve PrEP adherence in a randomized controlled trial among young Kenyan women

Author

Haberer, J., Mugo, N., Bukusi, E., Pyra, M., Oware, K., Kiptinness, C., Thomas, K., Garrison, L., Musinguzi, N., Morrison, S., Anderson, P., Ngure, K., and Baeten, J.

Subjects
Patient compliance -- Management, Young women -- Drug therapy, Company business management, Health
Abstract

Background: Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV acquisition. However, adherence among young women has been challenging. SMS reminders have been shown to improve adherence to antiretroviral therapy in some contexts. We present results from a randomized controlled trial of SMS reminders to support PrEP adherence among young women in Kenya. Methods: The MPYA (Monitoring PrEP among Young Adult women) study involved 18 to 24-year-old women with high HIV risk. PrEP adherence was measured over 2 years with a real-time electronic monitor (Wisepill) and pharmacy refill; tenofovir-diphosphate (TFV-DP) levels were determined from dried blood spots for 15% of participants. Participants were randomized 1:1 to SMS reminders versus no reminders. Reminders were initially sent daily, although participants could opt for 'as needed' reminders (if they missed doses). The effect of SMS reminders on adherence was assessed by Poisson models adjusted for study site. Results: Of 348 women in the study, 173 were assigned daily SMS reminders; 9% opted for 'as needed' reminders. Participants were a median of 21 years old and two-thirds reported condomless sex in the month prior to enrollment. As shown in the figure, adherence decreased over time by both electronic monitoring and pharmacy refill. Correlation between electronically monitored adherence and TFV-DP levels was high ([R.sup.2] = 0.73). Among participants picking up PrEP, electronically monitored adherence was 26.9% over 24 months and did not differ by arm (27.0% with SMS; 26.7% without SMS; adjusted incidence rate ratio 1.07 [95% CI 0.86, 1.33], p = 0.55). No differences were seen between arms when assessing adherence for all participants regardless of PrEP refills, by pharmacy refill data, with only 12 months of follow-up, or by site. Conclusions: SMS reminders did not overcome adherence challenges among young Kenyan women taking PrEP over two years. Given the overall low adherence in the trial, additional interventions are needed to support PrEP use in this population., OA07.01 J. Haberer (1); N. Mugo (2); E. Bukusi (2); M. Pyra (3); K. Oware (2); C. Kiptinness (2); K. Thomas (4); L. Garrison (5); N. Musinguzi (6); S. Morrison [...]

Published
2021
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9. EVALUATING THE EFFECT OF WAYA COUPLE EDUCATION AND COUNSELING INTERVENTION ON QUALITY OF MARITAL RELATIONSHIP: A QUALITATIVE INQUIRY.

Author

Kwena, Z. A., Olugo, P. A., Turan, J. M., Baeten, J. M., Darbes, L. A., Oketch, B. A., Angawa, D. O., and Bukusi, E. A.

Subjects
HIV prevention, MARRIAGE, INTIMACY (Psychology), HUMAN sexuality, COUPLES therapy, INTERVIEWING, QUALITATIVE research, SAFE sex, SEX customs, INTERPERSONAL relations, COMMUNICATION, LONGITUDINAL method
Abstract

Objective: We evaluated married couples’ perspectives on the quality of their marital relationships after participating in a counselor-led couple education and counseling intervention aimed at improving the quality of marital relationships and reducing high HIV risk sexual behaviors. Design: This qualitative endline survey was part of a prospective study to assess the effect of a counselor-led couple education and counseling intervention on improving the quality of marital relationships. Settings: Fishing communities along Lake Victoria in Kisumu County, Kenya. Participants: We conducted dyad in-depth interviews with a sub-sample of six married couples three months following a 5-session Waya (local language word for paternal aunt) intervention Outcome measures: Perspectives on the effect of in a counselor-led couple education and counseling on quality of marital relationships.Results: The couples perceived that the intervention resulted in enhanced quality of their marital relationships. Specifically, the couples reported improved intimacy, joint financial planning, partner support, enhanced communication, conflict-solving abilities, and sexual behavior change. Couples also reported improved knowledge of sexual and reproductive health issues and services available to support safer sex practices. Conclusion: Married couples perceived the Waya intervention to have improved their marital relationships. Given the potential to reduce HIV transmission, there is a need to test this intervention with a rigorous trial design for efficacy. [ABSTRACT FROM AUTHOR]

Published
2022

11. Disparities in Dolutegravir Uptake Affecting Females of Reproductive Age With HIV in Low- and Middle-Income Countries After Initial Concerns About Teratogenicity : An Observational Study

Author

Romo, M.L., Patel, R.C., Edwards, J.K., Humphrey, J.M., Musick, B.S., Bernard, C., Maina, M.W., Brazier, E., Castelnuovo, B., Penner, J., Wyka, K., Cardoso, S.W., Ly, P.S., Kunzekwenyika, C., Cortés, C.P., Panczak, R., Kelvin, E.A., Wools-Kaloustian, K.K., Nash, D., Khol, V., Zhang, F.J., Zhao, H.X., Han, N., Lee, M.P., Li, P.C.K., Lam, W., Wong, H.Y., Kumarasamy, N., Ezhilarasi, C., Pujari, S., Joshi, K., Gaikwad, S., Chitalikar, A., Merati, T.P., Wirawan, D.N., Yuliana, F., Yunihastuti, E., Imran, D., Widhani, A., Tanuma, J., Oka, S., Nishijima, T., Choi, J.Y., Na, S., Kim, J.M., Gani, Y.M., Rudi, N.B., Azwa, I., Kamarulzaman, A., Syed Omar, S.F., Ponnampalavanar, S., Ditangco, R., Pasayan, M.K., Mationg, M.L., Chan, Y.J., Ku, W.W., Ke, E., Wu, P.C., Ng, O.T., Lim, P.L., Lee, L.S., Yap, J.K., Avihingsanon, A., Gatechompol, S., Phanuphak, P., Phadungphon, C., Kiertiburanakul, S., Phuphuakrat, A., Chumla, L., Sanmeema, N., Chaiwarith, R., Sirisanthana, T., Praparattanapan, J., Nuket, K., Khuwuwan, S., Kantipong, P., Kambua, P., Nguyen, K.V., Bui, H.V., Nguyen, D.T.H., Nguyen, D.T., Do, C.D., Ngo, A.V., Nguyen, L.T., Sohn, A.H., Ross, J.L., Petersen, B., Law, M.G., Jiamsakul, A., Bijker, R., Rupasinghe, D., Cahn, P., Cesar, C., Fink, V., Sued, O., Dell'Isola, E., Perez, H., Valiente, J., Yamamoto, C., Grinsztejn, B., Veloso, V., Luz, P., de Boni, R., Wagner, S.C., Friedman, R., Moreira, R., Pinto, J., Ferreira, F., Maia, M., de Menezes Succi, R.C., Machado, D.M., de Fátima Barbosa Gouvêa, A., Wolff, M., Rodriguez, M.F., Allendes, G., Pape, J.W., Rouzier, V., Marcelin, A., Perodin, C., Luque, M.T., Padgett, D., Madero, J.S., Ramirez, B.C., Belaunzaran, P., Vega, Y.C., Gotuzzo Herencia, José Eduardo, Mejía Cordero, Fernando Alonso, Carriquiry, G., McGowan, C.C., Shepherd, B.E., Sterling, T., Jayathilake, K., Person, A.K., Rebeiro, P.F., Castilho, J., Duda, S.N., Maruri, F., Vansell, H., Jenkins, C., Kim, A., Lotspeich, S., Pélagie, N., Gateretse, P., Munezero, J., Nitereka, V., Niyongabo, T., Twizere, C., Bukuru, H., Nahimana, T., Baransaka, E., Barasukana, P., Kabanda, E., Manirakiza, M., Ndikumwenayo, F., Biziragusenyuka, J., Munezero, A.M.M., Nforniwe, D.N., Ajeh, R., Ngamani, M.L., Dzudie, A., Mbuh, A., Amadou, D., Yone, E.W.P., Kendowo, E., Akele, C., Clever, A., Kitetele, F., Lelo, P., Tabala, M., Ekembe, C., Kaba, D., Diafouka, M., Ekat, M.H., Nsonde, D.M., Mafoua, A., Christ, M.N., Igirimbabazi, J., Ayinkamiye, N., Uwineza, P., Ndamijimana, E., Habarurema, E., Nyiraneza, M.L., Nyiransabimana, M.L., Tuyisenge, L., Shyaka, C., Kankindi, C., Uwakijijwe, B., Ingabire, M.G., Ndumuhire, J., Nyirabahutu, M.G., Muyango, F., Bihibindi, J.C., Uwamahoro, O., Ndoli, Y., Nsanzimana, S., Mugwaneza, P., Remera, E., Umumararungu, E., Rwibasira, G.N., Habimana, D.S., Gasana, J., Kanyabwisha, F., Kubwimana, G., Muhoza, B., Munyaneza, A., Murenzi, G., Musabyimana, F., Umwiza, F., Ingabire, C., Tuyisenge, P., Butera, A.M., Kabahizi, J., Rurangwa, E., Feza, R., Mukashyaka, E., Benekigeri, C., Musaninyange, J., Adedimeji, A., Anastos, K., Dilorenzo, M., Murchison, L., Ross, J., Yotebieng, M., Addison, D., Jones, H., Kulkarni, S., Tymejczyk, O., Elul, B., Cai, X., Dong, A., Hoover, D., Kim, H.-Y., Li, C., Shi, Q., Lancaster, K., Kuniholm, M., Edmonds, A., Parcesepe, A., Edwards, J., Keiser, O., Kimmel, A., Diero, L., Ayaya, S., Sang, E., Bukusi, E., Mulwa, E., Nyanaro, G., Kasozi, C., Ssemakadde, M., Bwana, M.B., Muyindike, W., Byakwaga, H., Kanyesigye, M., Semeere, A., Matovu, J.M., Nalugoda, F., Wasswa, F.X., Kazyoba, P., Mayige, M., Lyamuya, R.E., Mayanga, F., Ngonyani, K., Lwali, J., Urassa, M., Nyaga, C., Machemba, R., Yiannoutsos, C., Vreeman, R., Syvertsen, J., Kantor, R., Martin, J., Wenger, M., Cohen, C., Kulzer, J., Maartens, G., Bolton, C., Wood, R., Sipambo, N., Tanser, F., Boulle, A., Fatti, G., Mbewe, S., Singh, E., Chimbetete, C., Technau, K., Eley, B., Muhairwe, J., Rafael, I., Fox, M.P., Prozesky, H., Anderegg, N., Ballif, M., Ostinelli, C.H.D., Egger, M., Fenner, L., Haas, A., Hossmann, S., Rohner, E., Riou, J., Skrivankova, V., Smith, L., Taghavi, K., von Groote, P., Wandeler, G., Zaniewski, E., Zürcher, K., Anderson, K., Cornell, M., Davies, M.-A., Iyun, V., Johnson, L., Kassanjee, R., Kehoe, K., Kubjane, M., Maxwell, N., Nyakato, P., Patten, G., Tlali, M., Tsondai, P., de Waal, R., and International epidemiology Databases to Evaluate AIDS (IeDEA)

Subjects
Adult, medicine.medical_specialty, Prevention, policy, and public health, Adolescent, Pyridones, Reproductive age, HIV Infections, Choice Behavior, Article, Piperazines, chemistry.chemical_compound, Acquired immunodeficiency syndrome (AIDS), Pregnancy, Epidemiology, Oxazines, Internal Medicine, Medicine, Humans, Maternal Health Services, Cumulative incidence, HIV Integrase Inhibitors, 610 Medicine & health, Developing Countries, Health equity, business.industry, HIV, Contraceptives, General Medicine, Middle Aged, medicine.disease, Antiretroviral therapy, Regimen, Pharmaceutical Preparations, chemistry, Dolutegravir, Observational study, Female, Age groups, Safety, business, Heterocyclic Compounds, 3-Ring, 360 Social problems & social services, Demography, Cohort study
Abstract

BACKGROUND The transition to dolutegravir-containing antiretroviral therapy (ART) in low- and middle-income countries (LMICs) was complicated by an initial safety signal in May 2018 suggesting that exposure to dolutegravir at conception was possibly associated with infant neural tube defects. On the basis of additional evidence, in July 2019, the World Health Organization recommended dolutegravir for all adults and adolescents living with HIV. OBJECTIVE To describe dolutegravir uptake and disparities by sex and age group in LMICs. DESIGN Observational cohort study. SETTING 87 sites that began using dolutegravir in 11 LMICs in the Asia-Pacific; Caribbean, Central and South America network for HIV epidemiology (CCASAnet); and sub-Saharan African regions of the International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. PATIENTS 134��672 patients aged 16 years or older who received HIV care from January 2017 through March 2020. MEASUREMENTS Sex, age group, and dolutegravir uptake (that is, newly initiating ART with dolutegravir or switching to dolutegravir from another regimen). RESULTS Differences in dolutegravir uptake among females of reproductive age (16 to 49 years) emerged after the safety signal. By the end of follow-up, the cumulative incidence of dolutegravir uptake among females 16 to 49 years old was 29.4% (95% CI, 29.0% to 29.7%) compared with 57.7% (CI, 57.2% to 58.3%) among males 16 to 49 years old. This disparity was greater in countries that began implementing dolutegravir before the safety signal and initially had highly restrictive policies versus countries with a later rollout. Dolutegravir uptake was similar among females and males aged 50 years or older. LIMITATION Follow-up was limited to 6 to 8 months after international guidelines recommended expanding access to dolutegravir. CONCLUSION Substantial disparities in dolutegravir uptake affecting females of reproductive age through early 2020 are documented. Although this disparity was anticipated because of country-level restrictions on access, the results highlight its extent and initial persistence. PRIMARY FUNDING SOURCE National Institutes of Health.

Published
2021
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12. 'I just decided to stop:' understanding PrEP discontinuation among individuals initiating PrEP in HIV care centers in Kenya and its implications for a public health approach to prevention

Author

Dollah, A., Ongolly, F., Ngure, K., Odoyo, J., Irungu, E., Mugwanya, K., Morton, J., Bukusi, E., Mugo, N., Beaten, J., and O'Malley, G.

Subjects
Patient compliance -- Analysis, HIV patients -- Beliefs, opinions and attitudes -- Drug therapy, Public health administration, Company business management, Health
Abstract

Background: Although PrEP discontinuation rates in clinical trials and demonstration projects have been well characterized, little is known about it in routine public health settings. Understanding discontinuation decisions in non-study settings is important for calibrating expectations of PrEP persistence in national programs and strengthening public health approaches to HIV prevention. Methods: In-depth interviews were conducted with 47 individuals who initiated PrEP at 25 different HIV comprehensive care centers (CCCs) in Central and Western Kenya, whose clinic record indicated had not returned for scheduled refills. We explored decisions around initiation, discontinuation, and restarting PrEP. An inductive, thematic, content-analytic approach was used to analyze the data. Results: Clients initiated PrEP because they had one or more sexual partners who were either HIV positive or of unknown status. Many discontinued PrEP when their perceived risk decreased (i.e. because those relationships ended, because they were living apart from a primary partner, or when a known HIV positive partner became virally suppressed). These participants expressed willingness to re-start PrEP if their partnership situation changed. Others reported discontinuation due to side effects (dizziness, nausea, weight gain) or found daily pill-taking too burdensome, and preferred condoms for prevention purposes. Some participants (mostly women) discontinued PrEP due to their partner's insistence and wished for additional PrEP education and counselling to foster partner support. Though relatively few participants identified facility level factors as primary reasons for discontinuing PrEP, many described stigma-related discomfort with accessing PrEP at CCCs, inconvenient clinic location and/or operating hours, long wait times, and short refill dates as barriers. Most individuals reported multiple reasons for deciding to discontinue PrEP and did not inform health facilities of their decision to stop. Conclusions: Clients make intentional decisions to discontinue PrEP as they weigh different prevention options and navigate fluid and sometimes challenging relationships. Many clients will decide to discontinue PrEP when perceiving themselves to be at reduced risk and PrEP counseling approaches must include provisions for addressing 'seasonal risk.' PrEP will not be the right prevention method for everyone. However, expanding PrEP access points and increasing sex-positive messaging may facilitate PrEP being a better option for many., OA07.02 A. Dollah (1); F. Ongolly (2); K. Ngure (3); J. Odoyo (1); E. Irungu (2); K. Mugwanya (4); J. Morton (4); E. Bukusi (1); N. Mugo (2); J. Beaten [...]

Published
2021
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15. Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women

Author

Baeten, J. M., Donnell, D., Ndase, P., Mugo, N. R., Campbell, J. D., Wangisi, J., Tappero, J. W., Bukusi, E. A., Cohen, C. R., Katabira, E., Ronald, A., Tumwesigye, E., Were, E., Fife, K. H., Kiarie, J., Farquhar, C., John-Stewart, G., Kakia, A., Odoyo, J., Mucunguzi, A., Nakku-Joloba, E., Twesigye, R., Ngure, K., Apaka, C., Tamooh, H., Gabona, F., Mujugira, A., Panteleeff, D., Thomas, K. K., Kidoguchi, L., Krows, M., Revall, J., Morrison, S., Haugen, H., Emmanuel-Ogier, M., Ondrejcek, L., Coombs, R. W., Frenkel, L., Hendrix, C., Bumpus, N. N., Bangsberg, D., Haberer, J. E., Stevens, W. S., Lingappa, J. R., and Celum, C.

Published
2012

16. Acyclovir and Transmission of HIV-1 from Persons Infected with HIV-1 and HSV-2

Author

Celum, C., Wald, A., Lingappa, J. R., Magaret, A. S., Wang, R. S., Mugo, N., Mujugira, A., Baeten, J. M., Mullins, J. I., Hughes, J. P., Bukusi, E. A., Cohen, C. R., Katabira, E., Ronald, A., Kiarie, J., Farquhar, C., Stewart, G. J., Makhema, J., Essex, M., Were, E., Fife, K. H., de Bruyn, G., Gray, G. E., McIntyre, J. A., Manongi, R., Kapiga, S., Coetzee, D., Allen, S., Inambao, M., Kayitenkore, K., Karita, E., Kanweka, W., Delany, S., Rees, H., Vwalika, B., Stevens, W., Campbell, M. S., Thomas, K. K., Coombs, R. W., Morrow, R., Whittington, W. L.H., McElrath, M. J., Barnes, L., Ridzon, R., and Corey, L.

Published
2010
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17. Global temporal changes in the proportion of children with advanced disease at the start of combination antiretroviral therapy in an era of changing criteria for treatment initiation

Author

Panayidou K., Davies M. -A., Anderegg N., Egger M., Fatti G., Vinikoor M., Sawry S., Ehmer J., Eley B., Phiri S., Technau K. -G. u. N., Chimbetete C., Rabie H., Boulle A., Tanser F., Wood R., Wools-Kaloustian K., Vreeman R., Oyaro P., Ayaya S., Nakigozi G., Musick B., Yiannoutsos C., Amorissani-Folquet M., Takassi E., Sylla M., Renner L., Malateste K., Desmonde S., Leroy V., Kurniati N., Hansudewechakul R., Nguyen L. V., Ly P. S., Truong K. H., Kariminia A., Sohn A. H., Edmonds A., Yumo H. A., Dusingize J. C., Yotebieng M., Judd A., Rojo P., Smit C., Grabar S., Warszwarski J., Chene G., Raban D., Patel K., Seage G. R., Van Dyke R. B., Oleske J., Williams P. L., Abzug M. J., Succi R., Machado D. M., Pinto J., Rouzier V., Luque M., Mejia F., Khol V., Tucker J., Kumarasamy N., Saghayam S., Chandrasekaran E., Wati D. K., Vedaswari D., Malino I. Y., Muktiarti D., Fong S. M., Lim M., Daut F., Nik Yusoff N. K., Mohamad P., Mohamed T. J., Drawis M. R., Nallusamy R., Chan K. C., Sudjaritruk T., Sirisanthana V., Aurpibul L., Oberdorfer P., Denjanta S., Watanaporn S., Kongphonoi A., Lumbiganon P., Kosalaraksa P., Tharnprisan P., Udomphanit T., Jourdain G., Puthanakit T., Anugulruengkitt S., Phadungphon C., Chokephaibulkit K., Lapphra K., Phongsamart W., Sricharoenchai S., Du Q. T., Nguyen C. H., Do V. C., Ha T. M., An V. T., Khu D. T. K., Pham A. N., Nguyen L. T., Le O. N., Ross J. L., Sethaputra C., Law M. G., Cahn P., Cesar C., Fink V., Sued O., Dell'isola E., Perez H., Valiente J., Yamamoto C., Grinsztejn B., Veloso V., Luz P., de Boni R., Wagner S. C., Friedman R., Moreira R., Ferreira F., Maia M., de Menezes Succi R. C., Barbosa Gouv E A A. F. a. T., Wolff M., Cortes C., Rodriguez M. F., Allendes G., Pape J. W., Marcelin A., Perodin C., Luque M. T., Padgett D., Madero J. S., Ramirez B. C., Belaunzaran P., Vega Y. C., Gotuzzo E., Carriquiry G., McGowan C. C., Shepherd B. E., Sterling T., Jayathilake K., Person A. K., Rebeiro P. F., Giganti M., Castilho J., Duda S. N., Maruri F., Vansell H., P E Lagie N., Gateretse P., Munezero J., Nitereka V., Niyongabo T., Twizere C., Bukuru H., Nahimana T., Biziragusenyuka J., Manyundo R. S., Atsu K., Mbuh T., Ajeh R., Benwi M., Dzudie A., Mbuh A., Ngamani M. L., Nkome V., Amadou D., Ngassam E., Pefura Yone E. W., Ewanoge A. N., Fuhngwa N., Moki C., Akele C., Kitetele F., Lelo P., Tabala M., Okitolonda E. W., Wenzi L., Diafouka M., Ekat M. H., Nsonde D. M., Mafou A., Ntarambirwa F., Tuyishimire Y., Hakizimana T., Ayinkamiye J., Mukantwali S., Kayitesi H., Uwamahoro O., Habumuremyi V., Mukamana J., Kubwimana G., Mugenzi P., Muhoza B., Munyaneza A., Ndahiro E., Nyiransabimana D., D'Amour Sinayobye J., Sugira V., Benekigeri C., Mbaraga G., Adedimeji A., Anastos K., Dilorenzo M., Murchison L., Ross J., Addison D., Baker M., Brazier E., Jones H., Kelvin E., Kulkarni S., Nash D., Tymejczyk O., Elul B., Cai X., Hoover D., Kim H. -Y., Li C., Shi Q., Lancaster K., Kuniholm M., Parcesepe A., Duda S., Kimmel A., McNairy M., Diero L., Plus A. M. P. A. T. H., Bukusi E., Ssali J., Nalugoda F., Somi G. R., Lyamuya R. E., Ngonyani K., Lugina E., Urassa M., Michael D., Zannou M. D., Poda A., Sarfo F. S., Messou E., Chenal H., Minga K. A., Bissagnene E., Tanon A., Seydi M., Patassi A. A., Koumakpai-Adeothy S. A., Renner L. A., N'gbeche S. M., Bosse C. A., Kouakou K., Folquet M. A., Eboua F. c. O. T., Traore F. D., Dabis F. c. O., Arrive E., Balestre E., Becquet R., Bernard C., Arikawa S. C., Doring A., Jaquet A., Rabourdin E., Tiendrebeogo T., Jesson J., Ekouevi D. K., Azani J. -C., Coffi E P., Gnepa G., Kouadio C. G. K., Tchounga B., Maartens G., Lettow M. V., Muhairwe J., Jores A., Kamenova K., Fox M. P., Prozesky H., Zangerle R., Touloumi G., Warszawski J., Meyer L., Krause M. M., Ghosn J., Leport C., Wittkop L., Reiss P., Wit F., Prins M., Bucher H., Gibb D., Fatkenheuer G., Del Amo J., Obel N., Thorne C., Mocroft A., Kirk O., Stephan C., Perez-Hoyos S., Hamouda O., Bartmeyer B., Chkhartishvili N., Noguera-Julian A., Antinori A., D'Arminio Monforte A., Brockmeyer N., Prieto L., Conejo P. R., Soriano-Arandes A., Battegay M., Kouyos R., Mussini C., Tookey P., Casabona J., Miro J. M., Castagna A., Konopnick D., Goetghebuer T., Sonnerborg A., Torti C., Sabin C., Teira R., Garrido M., Haerry D., de Wit S., Costagliola D., Raben D., Barger D., Schwimmer C., Termote M., Campbell M., Frederiksen C. M., Friis-Moller N., Kjaer J., Brandt R. S., Berenguer J., Bohlius J., Bouteloup V., Cozzi-Lepri A., Dorrucci M., Dunn D., Furrer H., Guiguet M., Lambotte O., Lodi S., Matheron S., Miro J. M. ª., Monge S., Nakagawa F., Paredes R., Phillips A., Puoti M., Rohner E., Schomaker M., Sterne J., Thiebaut R., van der Valk M., Hazra R., Heckman B., O'gara E., Siminski S., Panayidou, K, Davies, M, Anderegg, N, Egger, M, Fatti, G, Vinikoor, M, Sawry, S, Ehmer, J, Eley, B, Phiri, S, Technau, K, Chimbetete, C, Rabie, H, Boulle, A, Tanser, F, Wood, R, Wools-Kaloustian, K, Vreeman, R, Oyaro, P, Ayaya, S, Nakigozi, G, Musick, B, Yiannoutsos, C, Amorissani-Folquet, M, Takassi, E, Sylla, M, Renner, L, Malateste, K, Desmonde, S, Leroy, V, Kurniati, N, Hansudewechakul, R, Nguyen, L, Ly, P, Truong, K, Kariminia, A, Sohn, A, Edmonds, A, Yumo, H, Dusingize, J, Yotebieng, M, Judd, A, Rojo, P, Smit, C, Grabar, S, Warszwarski, J, Chene, G, Raban, D, Patel, K, Seage, G, Van Dyke, R, Oleske, J, Williams, P, Abzug, M, Succi, R, Machado, D, Pinto, J, Rouzier, V, Luque, M, Mejia, F, Khol, V, Tucker, J, Kumarasamy, N, Saghayam, S, Chandrasekaran, E, Wati, D, Vedaswari, D, Malino, I, Muktiarti, D, Fong, S, Lim, M, Daut, F, Nik Yusoff, N, Mohamad, P, Mohamed, T, Drawis, M, Nallusamy, R, Chan, K, Sudjaritruk, T, Sirisanthana, V, Aurpibul, L, Oberdorfer, P, Denjanta, S, Watanaporn, S, Kongphonoi, A, Lumbiganon, P, Kosalaraksa, P, Tharnprisan, P, Udomphanit, T, Jourdain, G, Puthanakit, T, Anugulruengkitt, S, Phadungphon, C, Chokephaibulkit, K, Lapphra, K, Phongsamart, W, Sricharoenchai, S, Du, Q, Nguyen, C, Do, V, Ha, T, An, V, Khu, D, Pham, A, Le, O, Ross, J, Sethaputra, C, Law, M, Cahn, P, Cesar, C, Fink, V, Sued, O, Dell'Isola, E, Perez, H, Valiente, J, Yamamoto, C, Grinsztejn, B, Veloso, V, Luz, P, de Boni, R, Wagner, S, Friedman, R, Moreira, R, Ferreira, F, Maia, M, de Menezes Succi, R, Barbosa Gouv E A, A, Wolff, M, Cortes, C, Rodriguez, M, Allendes, G, Pape, J, Marcelin, A, Perodin, C, Padgett, D, Madero, J, Ramirez, B, Belaunzaran, P, Vega, Y, Gotuzzo, E, Carriquiry, G, Mcgowan, C, Shepherd, B, Sterling, T, Jayathilake, K, Person, A, Rebeiro, P, Giganti, M, Castilho, J, Duda, S, Maruri, F, Vansell, H, P E Lagie, N, Gateretse, P, Munezero, J, Nitereka, V, Niyongabo, T, Twizere, C, Bukuru, H, Nahimana, T, Biziragusenyuka, J, Manyundo, R, Atsu, K, Mbuh, T, Ajeh, R, Benwi, M, Dzudie, A, Mbuh, A, Ngamani, M, Nkome, V, Amadou, D, Ngassam, E, Pefura Yone, E, Ewanoge, A, Fuhngwa, N, Moki, C, Akele, C, Kitetele, F, Lelo, P, Tabala, M, Okitolonda, E, Wenzi, L, Diafouka, M, Ekat, M, Nsonde, D, Mafou, A, Ntarambirwa, F, Tuyishimire, Y, Hakizimana, T, Ayinkamiye, J, Mukantwali, S, Kayitesi, H, Uwamahoro, O, Habumuremyi, V, Mukamana, J, Kubwimana, G, Mugenzi, P, Muhoza, B, Munyaneza, A, Ndahiro, E, Nyiransabimana, D, D'Amour Sinayobye, J, Sugira, V, Benekigeri, C, Mbaraga, G, Adedimeji, A, Anastos, K, Dilorenzo, M, Murchison, L, Addison, D, Baker, M, Brazier, E, Jones, H, Kelvin, E, Kulkarni, S, Nash, D, Tymejczyk, O, Elul, B, Cai, X, Hoover, D, Kim, H, Li, C, Shi, Q, Lancaster, K, Kuniholm, M, Parcesepe, A, Kimmel, A, Mcnairy, M, Diero, L, Plus, A, Bukusi, E, Ssali, J, Nalugoda, F, Somi, G, Lyamuya, R, Ngonyani, K, Lugina, E, Urassa, M, Michael, D, Zannou, M, Poda, A, Sarfo, F, Messou, E, Chenal, H, Minga, K, Bissagnene, E, Tanon, A, Seydi, M, Patassi, A, Koumakpai-Adeothy, S, N'Gbeche, S, Bosse, C, Kouakou, K, Folquet, M, Eboua, F, Traore, F, Dabis, F, Arrive, E, Balestre, E, Becquet, R, Bernard, C, Arikawa, S, Doring, A, Jaquet, A, Rabourdin, E, Tiendrebeogo, T, Jesson, J, Ekouevi, D, Azani, J, Coffi E, P, Gnepa, G, Kouadio, C, Tchounga, B, Maartens, G, Lettow, M, Muhairwe, J, Jores, A, Kamenova, K, Fox, M, Prozesky, H, Zangerle, R, Touloumi, G, Warszawski, J, Meyer, L, Krause, M, Ghosn, J, Leport, C, Wittkop, L, Reiss, P, Wit, F, Prins, M, Bucher, H, Gibb, D, Fatkenheuer, G, Del Amo, J, Obel, N, Thorne, C, Mocroft, A, Kirk, O, Stephan, C, Perez-Hoyos, S, Hamouda, O, Bartmeyer, B, Chkhartishvili, N, Noguera-Julian, A, Antinori, A, D'Arminio Monforte, A, Brockmeyer, N, Prieto, L, Conejo, P, Soriano-Arandes, A, Battegay, M, Kouyos, R, Mussini, C, Tookey, P, Casabona, J, Miro, J, Castagna, A, Konopnick, D, Goetghebuer, T, Sonnerborg, A, Torti, C, Sabin, C, Teira, R, Garrido, M, Haerry, D, de Wit, S, Costagliola, D, Raben, D, Barger, D, Schwimmer, C, Termote, M, Campbell, M, Frederiksen, C, Friis-Moller, N, Kjaer, J, Brandt, R, Berenguer, J, Bohlius, J, Bouteloup, V, Cozzi-Lepri, A, Dorrucci, M, Dunn, D, Furrer, H, Guiguet, M, Lambotte, O, Lodi, S, Matheron, S, Monge, S, Nakagawa, F, Paredes, R, Phillips, A, Puoti, M, Rohner, E, Schomaker, M, Sterne, J, Thiebaut, R, van der Valk, M, Hazra, R, Heckman, B, O'Gara, E, and Siminski, S

Subjects
0301 basic medicine, Male, sub-Saharan Africa, Databases, Factual, CD4 cell count, HIV Infections, Global Health, Cohort Studies, 0302 clinical medicine, Central and South America, Advanced disease, Medicine, 030212 general & internal medicine, Prospective Studies, Cd4 cell count, skin and connective tissue diseases, Child, Research Articles, humanities, 3. Good health, Europe, Infectious Diseases, Child, Preschool, Income, Drug Therapy, Combination, Female, advanced HIV disease, antiretroviral therapy, Asia, Caribbean, North America, WHO guidelines, Adolescent, Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Drug Administration Schedule, Follow-Up Studies, Humans, Poverty, World Health Organization, Research Article, medicine.medical_specialty, education, 610 Medicine & health, 03 medical and health sciences, Acquired immunodeficiency syndrome (AIDS), 360 Social problems & social services, Intensive care medicine, business.industry, Public Health, Environmental and Occupational Health, medicine.disease, 030112 virology, Antiretroviral therapy, Who guidelines, sense organs, business, sub‐Saharan Africa
Abstract

Introduction: The CD4 cell count and percent at initiation of combination antiretroviral therapy (cART) are measures of advanced HIV disease and thus are important indicators of programme performance for children living with HIV. In particular, World Health Organization (WHO) 2017 guidelines on advanced HIV disease noted that >80% of children aged 40% of children in low- and middle-income countries started cART with severe immunodeficiency compared to

Published
2018

20. Voluntary medical male circumcision: Safety and satisfacion at Migori County Hospital

Author

Kosgei, T., Mburu, M., Mwaniki, P., and Bukusi, E.

Abstract

Background: The World Health Organization (WHO) recommended Voluntary Medical Male Circumcision (VMMC) as an HIV prevention option for men based on evidence showing a reduction in HIV acquisition of 50% to 60%. Based in this evidence, the rapid expansion of VMMC in sub Saharan Africa has raised concerns on the capacity of VMMC programs to provide sustainable high quality and safe VMMC services.Objective: To determine the rates and correlates of adverse events following VMMC among clients attending Migori County Hospital.Design: Descriptive cross sectional study Setting: Migori County Referral Hospital, Kenya.Subjects: Between November and December 2015, 138 men receiving VMMC services at Migori County hospital were interviewed during their follow up visits within 7 days following the procedure. We systematically sampled every third participant attending their follow up visit. Face to face interviews were conducted to obtain data on demographics and levels of satisfaction, and physical examination to determine any adverse events after circumcision. Fishers exact was used to test for correlates of adverse events among participants.Results: The mean age of participants was 22 years, Standard Deviation (SD) ±5) .About two-thirds (63.8%) had reached secondary level education, 26(18.8%) tertiary level, 23(16.7%) primary level and only 1(0.7%) had no education. The majority 100(72.5%) reported being aware of possible adverse events following male circumcision and almost all 135 (97.8%) participants reported having adhered to wound care instructions. The rate of mild and moderate adverse events was 58.7% and 2.9%, respectively. There was no severe adverse event reported. Bathing and not changing underpants was associated with adverse events. The Majority 137 (99.3%) of participants were highly satisfied with the circumcision procedure and the post-operative care services they received.Conclusion: These results imply that VMMC in this setting can be delivered safely and effectively with high client satisfaction.

Published
2019

26. Association between use of the progestin Depot Medroxyprogesterone Acetate and Cervicovaginal Lavage Proinflammatory Cytokines among HIV-1 and HSV-2 co-infected African women: a case control study

Author

Edwin Walong, Walter Jaoko, Christopher Gontier, and Bukusi E

Subjects
0303 health sciences, biology, medicine.drug_class, business.industry, medicine.medical_treatment, High vaginal swab, Asymptomatic, 3. Good health, Proinflammatory cytokine, 03 medical and health sciences, Interleukin 10, 0302 clinical medicine, Cytokine, Immunology, medicine, biology.protein, Medroxyprogesterone acetate, 030212 general & internal medicine, medicine.symptom, Interleukin 6, business, Progestin, 030304 developmental biology, medicine.drug
Abstract

BackgroundUse of the progestin contraceptive Depot Medroxyprogesterone Acetate (DMPA) by HIV 1 infected women is associated with increased female to male transmission of HIV. Mucosal innate immune activation has been proposed as a likely mechanism. To establish the effect of DMPA upon mucosal immune activation, this study sought to evaluate the concentrations of 5 proinflammatory and the regulatory cytokine IL 10 in cervicovaginal lavage fluid.MethodsThis was a case control study, 70 participants were recruited, comprising of 35 asymptomatic ART naïve HIV positive women on DMPA recruited as cases and 35 age matched asymptomatic ART naive HIV positive women not on contraceptives recruited as controls. Peripheral blood CD4 and total lymphocyte counts, High vaginal swab microscopy, endocervical smears and cervical cytology were performed for each participant. Concentrations of six proinflammatory cytokines were measured on cervicovaginal lavage by multiplex cytometric bead array.ResultsThe mean age of cases was 26.8 years and 30 years for controls. Total lymphocyte counts and CD4 cell counts were significantly higher among cases (p=0.02 and 0.004 respectively). HSV 2 prevalence as determined by ELISA was higher (p=0.034 among cases. The concentrations of the cytokines IL 1β, IL 6, IL 8, IL 12p70 and TNF α were lower among cases, with IL 1β being statistically significant (p=0.046). Concentrations of IL 10 was higher among cases (p=0.022). On multivariate analysis, reduction in IL 1β and IL 8 were associated with the duration of DMPA use (p=0.015 and 0.041 respectively). Inclusion of HSV 2 into the multivariate models showed elevation of all cytokines measured (p=ConclusionDMPA use is associated with reduction of proinflammatory cytokines and elevation of the regulatory cytokine IL 10. This may explain increased female to male transmission of HIV infection by modulation of male genital tract mucosa in the absence of increased HIV 1 genital shedding.

Published
2016

27. Complication of radiotherapy in the management

Author

Macharia, HC, Cheserem, EJ, Bukusi, E, and Muchiri, L

Subjects
Cervical, Cancer, Screening, Pap smear, Liquid-based cytology, Colposcopy biopsy histology, Sensitivity, Specificity, Predictive value
Abstract

Background: Cervical cancer is one of the most common female malignancies worldwide. Since the introduction of conventional Papanicolaou smear mortality from cervical cancer has reduced considerably. Despite its success, it has a sensitivity of only 51% and false negative rate of 5-10%. Approved Liquid Based Cytology (LBC) products by FDA claim a 65% increased detection rate of High Grade Squamous Intraepithelial Lesions (HGSIL) compared with conventional smears, as well as decreased unsatisfactory sample rates. Evidence shows that Liquid Based Preparation is more sensitive and accurate for the detection of both squamous and glandular lesions of the cervix. Studies of the accuracy of liquid based preparations reports sensitivity of 61-66% and specificity of 82-91%.Objective: To compare the performance of conventional Pap smear cytology, liquid based cytology and colposcopy clinical impression with colposcopic biopsy as the gold standard among women eligible for colposcopy in Kenyatta National Hospital, Kenya.Methods: This was a hospital-based comparative cross-sectional study. Convenient sampling over a period of 4 months was used to recruit clients referred to colposcopy clinic with abnormal Pap smear results.Results: A total of 73 patients referred with abnormal Pap smears were recruited into the study. The mean age of the patients was 38 years (SD ±10). About 45% of the patients interviewed did not have knowledge of Pap smear testing. Both the results of referral Pap smear and repeat pap smear were predominantly Low Grade Squamous Intraepithelial Lesions (LGSIL) or HGSIL. With biopsy results being the gold standard, Liquid Based Cytology (LBC) had a higher specificity of 75% when compared with conventional pap smears’ 11%.Conclusion: Even though colposcopy clinical impression has the highest agreement with colposcopy biopsy it’s a diagnostic and not a screening test, hence LBC showed better performance as a screening test compared to conventional Pap smear. In general, there was good agreement for cytological results of repeat CPAP and LBC. We therefore recommend that for patients referred with abnormal Pap smears requiring a repeat Pap smear, liquid based cytology is used due to its higher specificity compared to conventional Pap smear.Key words: Cervical, Cancer, Screening, Pap smear, Liquid-based cytology, Colposcopy biopsy histology, Sensitivity, Specificity, Predictive value

Published
2016

28. Social Networks and Decision Making for Clandestine Unsafe Abortions: Evidence from Kenya

Author

Osur, J, Orago, A, Mwanzo, I, and Bukusi, E

Subjects
abortion decisions, social influence, health seeking behavior
Abstract

Little is known about the role of social networks in promoting clandestine abortions. This study investigated the role social networks play in decision making for and facilitation of clandestine abortions. It was a mixed method study in which 320 women treated for complications of unsafe abortions were interviewed in a cross sectional survey to determine their consultation with social networks and how this ended up in clandestine abortions. Information obtained was supplemented with information from focus group discussions, case studies and key informant interviews. It was found that 95% of women consulted their social networks as part of decision making before aborting clandestinely and unsafely. The man responsible for pregnancy, friend of same sex and woman’s mother were the most consulted at 64%, 32% and 23% respectively. 92% of advice was for the woman to abort. The man responsible for pregnancy and the woman’s mother were the most influential advisors (p˂0.05). Intermediaries linked the woman to clandestine and unsafe abortion and included agents and previous clients of clandestine abortion providers and the woman’s friends and relatives. Decision making and seeking for clandestine abortion were therefore found to be shared responsibilities. It is recommended that programs for reducing unsafe abortions be designed with this fact in mind. Keywords: abortion decisions, social influence, health seeking behavior

Published
2015

29. Use of personal digital assistants for data collection in a multi-site AIDS stigma study in rural south Nyanza, Kenya

Author

Onono, M. A., Carraher, N., Cohen, R. C., Bukusi, E. A., and Janet Turan

Subjects
Rural Population, Acquired Immunodeficiency Syndrome, Stereotyping, Cost-Benefit Analysis, Data Collection, Kenya, Interviews as Topic, Pregnancy, Computers, Handheld, Humans, Female, Health Systems, Rural Health Services, Pregnancy Complications, Infectious, Computer Security
Abstract

Objectives: To describe the development, cost effectiveness and implementation of a PDA based electronic system to collect, verify and manage data from a multi-site study on HIV/AIDS stigma and pregnancy in a rural, resource-poor area. Methods: We worked within a large prevention of mother-to-child- transmission (PMTCT) program in nine rural health facilities to implement a PDA-based data collection system and to study the feasibility of its use in a multisite HIV research study in rural Kenya. The PDAs were programmed for collecting screening and eligibility data, and responses to structured interviews on HIV/AIDS stigma and violence in three local languages. Results: Between November 2007 and December 2008, nine PDAs were used by Clinic and Community Health Assistants to enrol 1,270 participants on to the PMTCT program. Successes included: capacity-building of interviewers, low cost of implementation, quick turnaround time of data entry with good data quality, and convenience. Conclusion: Our study demonstrated the feasibility of utilizing PDAs for data collection in a multi-site observational study on HIV/AIDS stigma conducted in remote rural health facilities in Kenya. However, appropriate and frequent data backup protocols need to be established and paper forms are still needed as backup tools in resource-poor settings.Keywords: Personal Digital Assistants, Developing countries, multisite studies, feasibility, cost effectivenessAfrican Health Sciences 2011; 11(3): 464 - 473

Published
2011

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