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Tunnage J, Yates A, Nwoga C, Sing'oei V, Owuoth J, Polyak CS, Crowell TA. Hepatitis and tuberculosis testing are much less common than HIV testing among adults in Kisumu, Kenya: results from a cross-sectional assessment. BMC Public Health 2021; 21:1143. [PMID: 34130663 PMCID: PMC8204299 DOI: 10.1186/s12889-021-11164-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/24/2021] [Indexed: 12/17/2022] Open
Abstract
Background Kenya has a high burden of HIV, viral hepatitis, and tuberculosis. Screening is necessary for early diagnosis and treatment, which reduces morbidity and mortality across all three illnesses. We evaluated testing uptake for HIV, viral hepatitis, and tuberculosis in Kisumu, Kenya. Methods Cross-sectional data from adults aged 18–35 years who enrolled in a prospective HIV incidence cohort study from February 2017 to May 2018 were analyzed. A questionnaire was administered to each participant at screening for study eligibility to collect behavioral characteristics and to assess prior testing practices. Among participants without a history of previously-diagnosed HIV, multivariable robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for factors potentially associated with HIV testing in the 12 months prior to enrollment. A hierarchical model was used to test for differential access to testing due to spatial location. Results Of 671 participants, 52 (7.7%) were living with HIV, 308 (45.9%) were female, and the median age was 24 (interquartile range 21–28) years. Among 651 (97.0%) who had ever been tested for HIV, 400 (61.2%) reported HIV testing in the past 6 months, 129 (19.7%) in the past 6–12 months, and 125 (19.1%) more than one year prior to enrollment. Any prior testing for viral hepatitis was reported by 8 (1.2%) participants and for tuberculosis by 51 (7.6%). In unadjusted models, HIV testing in the past year was more common among females (PR 1.08 [95% CI 1.01, 1.17]) and participants with secondary education or higher (PR 1.10 [95% CI 1.02, 1.19]). In the multivariable model, only secondary education or higher was associated with recent HIV testing (adjusted PR 1.10 [95% CI 1.02, 1.20]). Hierarchical models showed no geographic differences in HIV testing across Kisumu subcounties. Conclusions Prior HIV testing was common among study participants and most had been tested within the past year but testing for tuberculosis and viral hepatitis was far less common. HIV testing gaps exist for males and those with lower levels of education. HIV testing infrastructure could be leveraged to increase access to testing for other endemic infectious diseases.
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Affiliation(s)
- Joshua Tunnage
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA
| | - Adam Yates
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Chiaka Nwoga
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Valentine Sing'oei
- HJF Medical Research International, Kisumu, Kenya.,Army Medical Research Directorate-Africa, Kisumu, Kenya
| | - John Owuoth
- HJF Medical Research International, Kisumu, Kenya.,Army Medical Research Directorate-Africa, Kisumu, Kenya
| | - Christina S Polyak
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA
| | - Trevor A Crowell
- U.S. Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD, USA. .,Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, USA.
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del Pino HE, Dacus JD, Harawa NT, McWells C. "Being downcast by society… adds to the stress levels and would explain why [we] smoke more.": Smoking among HIV-Positive Black Men Who Have Sex with Men. JOURNAL OF GAY & LESBIAN SOCIAL SERVICES 2020; 33:16-31. [PMID: 33642841 PMCID: PMC7909452 DOI: 10.1080/10538720.2020.1799473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Smoking causes more deaths among people living with HIV than HIV infection itself. Few smoking cessation interventions and studies of sexual minority communities have considered the lived experiences of Black men who have sex with men (BMSM) living with HIV. Before developing interventions for these men, we need to answer: How do experiences of discrimination and stigma influence their perceptions of smoking? This phenomenological study was led by a community-based organization. We conducted six focus groups with 53 BMSM living with HIV in Los Angeles. We used minority stress theory in the analysis and interpretation of the data. We identified two themes: (1) co-occurrence of race and sexual orientation stressors and smoking (e.g., "I feel like I'd be discriminated against sometimes because I'm gay and because I'm Black.") and (2) smoking as a reaction to HIV-positive status (e.g., "I know more people that started smoking after they found out they [had] HIV."). Participants smoked to cope with stressors around race, sexual orientation, and living with HIV. These findings challenge us to ensure that smoking cessation interventions address the personal and social concerns of BMSM living with HIV and help them identify healthier ways to cope with stressors.
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Affiliation(s)
| | - Jagadisa-devasri Dacus
- HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, Room 6602, New York, NY 10032
| | - Nina T. Harawa
- Department of Medicine—Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, 1100 Glendon Ave Suite 850, Los Angeles, CA 90024
- Psychiatry and Human Behaviors, Charles R. Drew University of Medicine and Science, 1731 E. 120th St., Building N, Los Angeles, CA 90059
| | - Charles McWells
- Los Angeles Centers for Alcohol and Substance Abuse (L.A. CADA), 11015 Bloomfield Ave., Santa Fe Springs, CA 90670
- Division of Community Engagement, Charles R. Drew University of Medicine and Science, Los Angeles, CA 90059
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Birdthistle I, Tanton C, Tomita A, de Graaf K, Schaffnit SB, Tanser F, Slaymaker E. Recent levels and trends in HIV incidence rates among adolescent girls and young women in ten high-prevalence African countries: a systematic review and meta-analysis. Lancet Glob Health 2019; 7:e1521-e1540. [PMID: 31607465 PMCID: PMC7025003 DOI: 10.1016/s2214-109x(19)30410-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 07/01/2019] [Accepted: 08/13/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The roll-out of antiretroviral therapy (ART) has changed contexts of HIV risk, but the influence on HIV incidence among young women is not clear. We aimed to summarise direct estimates of HIV incidence among adolescent girls and young women since ART and before large investments in targeted prevention for those in sub-Saharan Africa. METHODS We did a systematic review and meta-analysis. We searched MEDLINE, Embase, Web of Science, Global Health, and CINAHL for studies reporting HIV incidence data from serological samples collected among females aged 15-24 years in ten countries (Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe) that were selected for DREAMS investment in 2015. We only included articles published in English. Our main outcome was to summarise recent levels and trends in HIV incidence estimates collected between 2005 and 2015, published or received from study authors, by age and sex, and pooled by region. FINDINGS 51 studies were identified from nine of the ten DREAMS countries; no eligible studies from Lesotho were identified. Directly observed HIV incidence rates were lowest among females aged 13-19 years in Kumi, Uganda (0·38 cases per 100 person-years); and directly observed HIV incidence rates were highest in KwaZulu-Natal, South Africa (7·79 per 100 person-years among females aged 15-19 years, and 8·63 in those aged 20-24 years), among fishing communities in Uganda (12·40 per 100 person-years in females aged 15-19 years and 4·70 in those aged 20-24 years), and among female sex workers aged 18-24 years in South Africa (13·20 per 100 person-years) and Zimbabwe (10·80). In pooled rates from the general population studies, the greatest sex differentials were in the youngest age groups-ie, females aged 15-19 years compared with male peers in both southern African (pooled relative risk 5·94, 95% CI 3·39-10·44) and eastern African countries (3·22, 1·51-6·87), and not significantly different among those aged 25-29 years in either region. Incidence often peaked earlier (during teenage years) among high-risk groups compared with general populations. Since 2005, HIV incidence among adolescent girls and young women declined in Rakai (Uganda) and Manicaland (Zimbabwe), and also declined among female sex workers in Kenya, but not in the highest-risk communities in South Africa and Uganda. INTERPRETATION Few sources of direct estimates of HIV incidence exist in high-burden countries and trend analyses with disaggregated data for age and sex are rare but indicate recent declines among adolescent girls and young women. In some of the highest-risk settings, however, little evidence exists to suggest ART availability and other efforts slowed transmission by 2016. Despite wide geographical diversity in absolute levels of incidence in adolescent girls and young women, risk relative to males persisted in all settings, with the greatest sex differentials in the youngest age groups. To end new infections among the growing population of adolescents in sub-Saharan Africa, prevention programmes must address gender inequalities driving excessive risk among adolescent girls. FUNDING This work was conducted as part of a planning grant funded by the Bill & Melinda Gates Foundation.
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Affiliation(s)
- Isolde Birdthistle
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
| | - Clare Tanton
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Tomita
- Centre for Rural Health, School of Nursing and Public Health, and KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Kristen de Graaf
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Susan B Schaffnit
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Frank Tanser
- Africa Health Research Institute, Africa Centre Building, Mtubatuba, South Africa
| | - Emma Slaymaker
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Omoro T, Gray SC, Otieno G, Mbeda C, Phillips-Howard PA, Hayes T, Otieno F, Gust DA. Teen pregnancy in rural western Kenya: a public health issue. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2017. [DOI: 10.1080/02673843.2017.1402794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Tereza Omoro
- HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Simone C. Gray
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - George Otieno
- HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | - Calvin Mbeda
- HIV Research Branch, Kenya Medical Research Institute, Kisumu, Kenya
| | | | | | | | - Deborah A. Gust
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Viral and Host Characteristics of Recent and Established HIV-1 Infections in Kisumu based on a Multiassay Approach. Sci Rep 2016; 6:37964. [PMID: 27897226 PMCID: PMC5126579 DOI: 10.1038/srep37964] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 10/26/2016] [Indexed: 11/29/2022] Open
Abstract
Integrated approaches provide better understanding of HIV/AIDS epidemics. We optimised a multiassay algorithm (MAA) and assessed HIV incidence, correlates of recent infections, viral diversity, plus transmission clusters among participants screened for Kisumu Incidence Cohort Study (KICoS1) (2007–2009). We performed BED-CEIA, Limiting antigen (LAg) avidity, Biorad avidity, and viral load (VL) tests on HIV-positive samples. Genotypic analyses focused on HIV-1 pol gene. Correlates of testing recent by MAA were assessed using logistic regression model. Overall, 133 (12%, 95% CI: 10.2–14.1) participants were HIV-positive, of whom 11 tested recent by MAA (BED-CEIA OD-n < 0.8 + LAg avidity OD-n < 1.5 + VL > 1000 copies/mL), giving an incidence of 1.46% (95% CI: 0.58–2.35) per year. This MAA-based incidence was similar to longitudinal KICoS1 incidence. Correlates of testing recent included sexually transmitted infection (STI) treatment history (OR = 3.94, 95% CI: 1.03–15.07) and syphilis seropositivity (OR = 10.15, 95% CI: 1.51–68.22). Overall, HIV-1 subtype A (63%), D (15%), C (3%), G (1%) and recombinants (18%), two monophyletic dyads and intrinsic viral mutations (V81I, V81I/V, V108I/V and K101Q) were observed. Viral diversity mirrored known patterns in this region, while resistance mutations reflected likely non-exposure to antiretroviral drugs. Management of STIs may help address ongoing HIV transmission in this region.
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Ssetaala A, Nakiyingi-Miiro J, Asiimwe S, Nanvubya A, Mpendo J, Asiki G, Nielsen L, Kiwanuka N, Seeley J, Kamali A, Kaleebu P. Recruitment and retention of women in fishing communities in HIV prevention research. Pan Afr Med J 2015; 21:104. [PMID: 26379811 PMCID: PMC4554809 DOI: 10.11604/pamj.2015.21.104.4962] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 05/21/2015] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Women in fishing communities in Uganda are more at risk and have higher rates of HIV infection. Socio-cultural gender norms, limited access to health information and services, economic disempowerment, sexual abuse and their biological susceptibility make women more at risk of infection. There is need to design interventions that cater for women's vulnerability. We explore factors affecting recruitment and retention of women from fishing communities in HIV prevention research. METHODS An HIV incidence cohort screened 2074 volunteers (1057 men and 1017 women) aged 13-49 years from 5 fishing communities along Lake Victoria using demographic, medical history, risk behaviour assessment questionnaires.1000 HIV negative high risk volunteers were enrolled and followed every 6 months for 18 months. Factors associated with completion of study visits among women were analyzed using multivariable logistic regression. RESULTS Women constituted 1,017(49%) of those screened, and 449(45%) of those enrolled with a median (IQR) age of 27 (22-33) years. Main reasons for non-enrolment were HIV infection (33.9%) and reported low risk behaviour (37.5%). A total of 382 (74%) women and 332 (69%) men completed all follow up visits. Older women (>24 yrs) and those unemployed, who had lived in the community for 5 years or more, were more likely to complete all study visits. CONCLUSION Women had better retention rates than men at 18 months. Strategies for recruiting and retaining younger women and those who have stayed for less than 5 years need to be developed for improved retention of women in fishing communities in HIV prevention and research Programs.
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Affiliation(s)
| | | | - Stephen Asiimwe
- University of Georgia, Athens, GA, USA ; Kabwohe Clinical Reserach Center(KCRC), Kabwohe, Uganda
| | | | | | | | - Leslie Nielsen
- International AIDS Vaccine Initiative (IAVI), New York, USA
| | - Noah Kiwanuka
- UVRI-IAVI HIV Vaccine Program, Entebbe, Uganda ; Makerere College of Health Sciences, School of Public Health, Makerere, Kampala, Uganda
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Gumbe A, McLellan-Lemal E, Gust DA, Pals SL, Gray KM, Ndivo R, Chen RT, Mills LA, Thomas TK. Correlates of prevalent HIV infection among adults and adolescents in the Kisumu incidence cohort study, Kisumu, Kenya. Int J STD AIDS 2014; 26:929-40. [PMID: 25505039 DOI: 10.1177/0956462414563625] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 11/06/2014] [Indexed: 01/09/2023]
Abstract
We estimated HIV prevalence and identified correlates of HIV infection among 1106 men and women aged 16-34 years residing in Kisumu, Kenya. Demographic, sexual, and other behavioural data were collected using audio computer-assisted self-interview in conjunction with a medical examination, real-time parallel rapid HIV testing, and laboratory testing for pregnancy, gonorrhoea, chlamydia, syphilis, and herpes simplex virus type 2. Multivariate logistic regression was used to identify variables associated with prevalent HIV infection by gender. Overall HIV prevalence was 12.1%. HIV prevalence among women (17.1%) was approximately two-and-one-half times the prevalence among men (6.6%). Odds of HIV infection in men increased with age (aOR associated with one-year increase in age = 1.21, CI = 1.07-1.35) and were greater among those who were uncircumcised (aOR = 4.42, CI = 1.41-13.89) and those who had an herpes simplex virus type 2-positive (aOR = 3.13, CI = 1.12-8.73) test result. Odds of prevalent HIV infection among women also increased with age (aOR associated with one-year increase in age = 1.16, CI = 1.04-1.29). Women who tested herpes simplex virus type 2 positive had more than three times the odds (aOR = 3.85, CI = 1.38-10.46) of prevalent HIV infection compared with those who tested herpes simplex virus type 2 negative. Tailored sexual health interventions and programs may help mitigate HIV age and gender disparities.
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Affiliation(s)
- Anne Gumbe
- Kenya Medical Research Institute, Kisumu, Kenya
| | - Eleanor McLellan-Lemal
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Deborah A Gust
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Sherri L Pals
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Kristen Mahle Gray
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | | | - Robert T Chen
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA, USA
| | - Lisa A Mills
- Centers for Disease Control and Prevention, HIV-Research Branch, Kisumu, Kenya
| | - Timothy K Thomas
- Centers for Disease Control and Prevention, HIV-Research Branch, Kisumu, Kenya
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