1
|
Mutisya I, Muthoni E, Ondondo RO, Muthusi J, Omoto L, Pahe C, Katana A, Ngugi E, Masamaro K, Kingwara L, Dobbs T, Bronson M, Patel HK, Sewe N, Naitore D, De Cock K, Ngugi C, Nganga L. A national household survey on HIV prevalence and clinical cascade among children aged ≤15 years in Kenya (2018). PLoS One 2022; 17:e0277613. [PMID: 36417391 PMCID: PMC9683548 DOI: 10.1371/journal.pone.0277613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
We analyzed data from the 2018 Kenya Population-Based HIV Impact Assessment (KENPHIA), a cross-sectional, nationally representative survey, to estimate the burden and prevalence of pediatric HIV infection, identify associated factors, and describe the clinical cascade among children aged < 15 years in Kenya. Interviewers collected information from caregivers or guardians on child's demographics, HIV testing, and treatment history. Blood specimens were collected for HIV serology and if HIV-positive, the samples were tested for viral load and antiretrovirals (ARV). For participants <18 months TNA PCR is performed. We computed weighted proportions with 95% confidence intervals (CI), accounting for the complex survey design. We used bivariable and multivariable logistic regression to assess factors associated with HIV prevalence. Separate survey weights were developed for interview responses and for biomarker testing to account for the survey design and non-response. HIV burden was estimated by multiplying HIV prevalence by the national population projection by age for 2018. Of 9072 survey participants (< 15 years), 87% (7865) had blood drawn with valid HIV test results. KENPHIA identified 57 HIV-positive children, translating to an HIV prevalence of 0.7%, (95% CI: 0.4%-1.0%) and an estimated 138,900 (95% CI: 84,000-193,800) of HIV among children in Kenya. Specifically, children who were orphaned had about 2 times higher odds of HIV-infection compared to those not orphaned, adjusted Odds Ratio (aOR) 2.2 (95% CI:1.0-4.8). Additionally, children whose caregivers had no knowledge of their HIV status also had 2 times higher odds of HIV-infection compared to whose caregivers had knowledge of their HIV status, aOR 2.4 (95% CI: 1.1-5.4)". From the unconditional analysis; population level estimates, 78.9% of HIV-positive children had known HIV status (95% CI: 67.1%-90.2%), 73.6% (95% CI: 60.9%-86.2%) were receiving ART, and 49% (95% CI: 32.1%-66.7%) were virally suppressed. However, in the clinical cascade for HIV infected children, 92% (95% CI: 84.4%-100%) were receiving ART, and of these, 67.1% (95% CI: 45.1%-89.2%) were virally suppressed. The KENPHIA survey confirms a substantial HIV burden among children in Kenya, especially among orphans.
Collapse
Affiliation(s)
- Immaculate Mutisya
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
- * E-mail:
| | - Evelyn Muthoni
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Raphael O. Ondondo
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Jacques Muthusi
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Lennah Omoto
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Charlotte Pahe
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Evelyn Ngugi
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Kenneth Masamaro
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Leonard Kingwara
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Trudy Dobbs
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Megan Bronson
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Hetal K. Patel
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Nicholas Sewe
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Doris Naitore
- International Center for AIDS Care and Treatment Programs, Nairobi, Kenya
| | - Kevin De Cock
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Catherine Ngugi
- National AIDS & STI Control Programme, Ministry of Health, Nairobi, Kenya
| | - Lucy Nganga
- Division of Global HIV & TB, Center for Global Health, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya
| |
Collapse
|
2
|
Mantell J, Franks J, Zerbe A, Lamb MR, Reed DM, Omollo D, Lahuerta M, Naitore D, El-Sadr WM, Agot K. MPrEP+ study protocol: a prospective cohort study assessing the feasibility and acceptability of an HIV pre-exposure prophylaxis (PrEP) strategy for male clients of female sex workers in Kisumu, Kenya. BMJ Open 2022; 12:e064037. [PMID: 36332953 PMCID: PMC9639093 DOI: 10.1136/bmjopen-2022-064037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Male clients (MCs) are integral to sex work-driven HIV transmission dynamics as sexual partners of female sex worker (FSW). MCs contribute disproportionately to incident HIV globally and in sub-Saharan Africa, with 27% of new infections attributed to MCs of FSW and other partners of key populations. Gaps in coverage of HIV testing and prevention services for men, including MCs, are well-documented, yet research and innovative interventions to improve MC uptake of effective prevention services, including pre-exposure prophylaxis (PrEP), are scarce. METHODS AND ANALYSIS MPrEP+ is a cohort study designed to assess the feasibility and acceptability of a PrEP-focused HIV prevention strategy providing daily oral tenofovir/emtricitabine (TDF/FTC) in combination with three adherence self-management interventions: (1) use of a validated point-of-care urine drug-level assay with real-time feedback and tailored self-management counselling; (2) frequent HIV self-testing; and (3) weekly one-way text messaging. This package of interventions is being delivered to 120 MCs enrolled in the study in Kisumu, Kenya over a 6-month period. The primary outcome is PrEP adherence at 6 months as measured by PrEP drug levels. Bivariate and multivariable regression models will be used to identify predictors of PrEP adherence. We will also explore associations of sociodemographic characteristics and PrEP beliefs with PrEP adherence. ETHICS AND DISSEMINATION The study was approved by the Columbia University Irving Medical Center Institutional Review Board and the Maseno University Ethical Review Committee. Study enrolment was initiated in November 2021 with participant follow-up planned through August 2022. Study results will be submitted for publication in peer-reviewed journals. Summaries and infographics of study findings will be developed and distributed to MC, FSW and stakeholders working in HIV prevention and support for people who sell and buy sex, including Kenya's Ministry of Health. TRIAL REGISTRATION NUMBER NCT04898699; Registered on 24 May 2021.
Collapse
Affiliation(s)
- Joanne Mantell
- HIV Center for Clinical and Behavioral Studies, Gender, Sexuality and Health Area, New York State Psychiatric Institute, New York City, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA
| | - Julie Franks
- Mailman School of Public Health, ICAP at Columbia University, New York City, New York, USA
| | - Allison Zerbe
- Mailman School of Public Health, ICAP at Columbia University, New York City, New York, USA
| | - Matthew R Lamb
- Mailman School of Public Health, ICAP at Columbia University, New York City, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Domonique M Reed
- Mailman School of Public Health, ICAP at Columbia University, New York City, New York, USA
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York City, New York, USA
| | - Dan Omollo
- Impact Research And Development Organisation, Kisumu, Kenya
| | - Maria Lahuerta
- Mailman School of Public Health, ICAP at Columbia University, New York City, New York, USA
| | - Doris Naitore
- Mailman School of Public Health, ICAP at Columbia University, New York City, New York, USA
| | - Wafaa M El-Sadr
- Mailman School of Public Health, ICAP at Columbia University, New York City, New York, USA
| | - Kawango Agot
- Impact Research And Development Organisation, Kisumu, Kenya
| |
Collapse
|
3
|
Dougherty G, Akoth S, Hawken M, Leting I, Mutei R, Ngugi C, Naitore D, Tsiouris F, Wakoli A, Walker L, Rabkin M. Improving viral load utilisation to enhance care for Kenyan adolescents with HIV. BMJ Open Qual 2022; 11:bmjoq-2022-001900. [PMID: 35948387 PMCID: PMC9379533 DOI: 10.1136/bmjoq-2022-001900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/26/2022] [Indexed: 11/04/2022] Open
Abstract
Improving the use of viral load (VL) testing for adolescents and young people living with HIV (AYPLWH) is a priority for Kenya’s Ministry of Health (MOH). Despite expansion of VL testing coverage and rollout of national policies, guidelines and training, VL result utilisation for AYPLWH remains suboptimal, with inadequate adherence to national guidelines recommending everyone on antiretroviral therapy (ART) with unsuppressed viral load (UVL) (≥401 copies/mL) receive three enhanced adherence counselling (EAC) sessions and a repeat VL test within 3 months. In March 2019, ICAP at Columbia University partnered with the MOH to launch a Quality Improvement Collaborative (QIC) at 22 health facilities in the Eastern Province to optimise management of AYPLWH on ART with UVL. Over 17 months, facility QI teams tested interventions targeting client education, workflow modifications, commodity management, community engagement and improved documentation. The QIC led to marked improvement in the proportion of clients completing three EAC sessions and repeat VL testing. Median completion rate was 16% (n=479) at baseline (from March 2018 to February 2019) and rose to 73% (n=755) during the implementation period (from March 2019 to July 2020). In the final month (July 2020), rates rose to 90% (n=31). Another success was the increase in the proportion of clients whose VL was resuppressed on repeat testing, which improved from 34% (n=273) at baseline to 62% (n=710) during the implementation period and 77% (n=44) in the final month. The QIC also led to improvement in the proportion of AYPLWH on first-line ART whose regimens were switched within 2 months of recorded UVL results, which rose from 58% (n=48) at baseline to 94% (n=128) during the implementation period. In summary, the QIC helped facility teams to identify and prioritise local, contextually appropriate innovations which led to swift improvement in three critical indicators of VL utilisation.
Collapse
Affiliation(s)
- Gillian Dougherty
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | | | | | | | | | | | | | - Fatima Tsiouris
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | | | - Lauren Walker
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
| | - Miriam Rabkin
- ICAP at Columbia University, Mailman School of Public Health, New York, New York, USA
- Epidemiology, Columbia University Mailman School of Public Health, New York, New York, USA
| |
Collapse
|