To achieve global targets for universal treatment set forth by the Joint United Nations Programme on human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) (UNAIDS), viral load monitoring for HIV-infected persons receiving antiretroviral therapy (ART) must become the standard of care in low- and middle-income countries (LMIC) (1). CDC and other U.S. government agencies, as part of the President's Emergency Plan for AIDS Relief, are supporting multiple countries in sub-Saharan Africa to change from the use of CD4 cell counts for monitoring of clinical response to ART to the use of viral load monitoring, which is the standard of care in developed countries. Viral load monitoring is the preferred method for immunologic monitoring because it enables earlier and more accurate detection of treatment failure before immunologic decline. This report highlights the initial successes and challenges of viral load monitoring in seven countries that have chosen to scale up viral load testing as a national monitoring strategy for patients on ART in response to World Health Organization (WHO) recommendations. Countries initiating viral load scale-up in 2014 observed increases in coverage after scale-up, and countries initiating in 2015 are anticipating similar trends. However, in six of the seven countries, viral load testing coverage in 2015 remained below target levels. Inefficient specimen transport, need for training, delays in procurement and distribution, and limited financial resources to support scale-up hindered progress. Country commitment and effective partnerships are essential to address the financial, operational, technical, and policy challenges of the rising demand for viral load monitoring.

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Understanding how HIV is acquired can inform interventions to prevent infection. We constructed a risk profile of 10–24 year olds participating in the 2012 Kenya AIDS Indicator Survey and classified them as perinatally infected if their biological mother was infected with HIV or had died, or if their father was infected with HIV or had died (for those lacking mother’s data). The remaining were classified as sexually infected if they had sex, and the remaining as parenterally infected if they had a blood transfusion. Overall, 84 (1.6%) of the 5298 10–24 year olds tested HIV positive; 9 (11%) were aged 10–14 and 75 (89%) 15–24 years. Five (56%) 10–14 year olds met criteria for perinatal infection; 4 (44%) did not meet perinatal, sexual or parenteral transmission criteria and parental HIV status was not established. Of the 75 HIV-infected, 15 to 24 year olds, 5 (7%) met perinatal transmission, 63 (84%) sexual and 2 (3%) parenteral criteria; 5 (7%) were unclassified. Perinatal transmission likely accounted for 56% and sexual transmission for 84% of infections among 10–14 year olds and 15–24 year olds, respectively. Although our definitions may have introduced some uncertainty, and with the number of infected participants being small, our findings suggest that mixed modes of HIV transmission exist among adolescents and young people.

Background: Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya. Methods: Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 to March 3, 2015. Cause of death was abstracted from medical files and death notification forms. Cardiac blood was drawn and tested for HIV infection using the national HIV testing algorithm followed by viral load testing of HIV-positive samples. Results: Of 807 eligible cadavers, 610 (75.6%) had an HIV test result available. Cadavers from KNH had significantly higher HIV positivity at 23.2% (95% CI: 19.3 to 27.7) compared with City Mortuary at 12.6% (95% CI: 8.8 to 17.8), P < 0.001. HIV prevalence was significantly higher among women than men at both City (33.3% vs. 9.2%, P = 0.008) and KNH Mortuary (28.8% vs. 19.0%, P = 0.025). Half (53.3%) of HIV-infected cadavers had no diagnosis before death, and an additional 22.2% were only diagnosed during hospitalization leading to death. Although not statistically significant, 61.9% of males had no previous diagnosis compared with 45.8% of females (P = 0.144). Half (52.3%) of 44 cadavers at KNH with HIV diagnosis before death were on treatment, and 1 in 5 (22.7%) with a previous diagnosis had achieved viral suppression. Conclusions: HIV prevalence was high among deaths in Nairobi, especially among women, and previous diagnosis among cadavers was low. Establishing routine mortuary surveillance can contribute to monitoring HIV-associated deaths among cadavers sent to mortuaries.

Nationally representative surveys provide an opportunity to assess trends in recent human immunodeficiency virus (HIV) infection based on assays for recent HIV infection. We assessed HIV incidence in Kenya in 2018 and trends in recent HIV infection among adolescents and adults in Kenya using nationally representative household surveys conducted in 2007, 2012, and 2018. To assess trends, we defined a recent HIV infection testing algorithm (RITA) that classified as recently infected (<12 months) those HIV-positive participants that were recent on the HIV-1 limiting antigen (LAg)-avidity assay without evidence of antiretroviral use. We assessed factors associated with recent and long-term (≥12 months) HIV infection versus no infection using a multinomial logit model while accounting for complex survey design. Of 1,523 HIV-positive participants in 2018, 11 were classified as recent. Annual HIV incidence was 0.14% in 2018 [95% confidence interval (CI) 0.057–0.23], representing 35,900 (95% CI 16,300–55,600) new infections per year in Kenya among persons aged 15–64 years. The percentage of HIV infections that were determined to be recent was similar in 2007 and 2012 but fell significantly from 2012 to 2018 [adjusted odds ratio (aOR) = 0.31, p < .001]. Compared to no HIV infection, being aged 25–34 versus 35–64 years (aOR = 4.2, 95% CI 1.4–13), having more lifetime sex partners (aOR = 5.2, 95% CI 1.6–17 for 2–3 partners and aOR = 8.6, 95% CI 2.8–26 for ≥4 partners vs. 0–1 partners), and never having tested for HIV (aOR = 4.1, 95% CI 1.5–11) were independently associated with recent HIV infection. Although HIV remains a public health priority in Kenya, HIV incidence estimates and trends in recent HIV infection support a significant decrease in new HIV infections from 2012 to 2018, a period of rapid expansion in HIV diagnosis, prevention, and treatment.

BACKGROUND Understanding sexual risk among youth can inform the design of effective HIV prevention interventions. METHODS The 2012 Kenya AIDS Indicator Survey was a nationally representative population-based survey. We administered a questionnaire and collected blood samples for HIV testing. We examined factors associated with unsafe sex among unmarried youth aged 15-19 and 20-24 years. RESULTS Of 2,090 unmarried youth aged 15-19 years, 33.3% (95% confidence interval [CI] 30.6-36.1) had ever had sex. Among those, 66.0% (95% CI 61.3-70.7) had sex in the past year (sexually active), and of these, 38.7% (95% 33.4 – 44.0) reported unsafe sex. No differences were observed in unsafe sex by sex. Factors associated with increased adjusted odds of unsafe sex among youth aged 15-19 years were residence in Central province; having primary or lower education; sexual debut before age 15 years; ever receiving money, gifts or favours for sex (transactional sex); multiple sexual partners in the past year; and low self-perceived risk of HIV. Of the 1,079 unmarried youth aged 20-24 years, 77.2% (95% CI 74.2-80.2) had ever had sex. Of these, 73.1% (95% CI 69.8-76.3) were sexually active, and 24.1% (95% CI 18.1-30.1) of women and 31.9% (95% CI 26.4-37.5) of men reported unsafe sex in the past year. Factors associated with increased adjusted odds of unsafe sex among youth aged 20-24 years were primary or lower education, transactional sex and multiple partners in the past year. CONCLUSION Unsafe sex is common among Kenyan youth, especially those aged 15-19 years. HIV prevention efforts need to target youth, support educational progression and economic empowerment.

BACKGROUNDElimination of mother-to-child transmission of HIV is achievable through prevention of mother-to-child transmission (PMTCT) interventions. For HIV-positive mothers to access PMTCT services, they must be identified through HIV testing and counseling. We sought to measure the proportion of mothers with unknown HIV status and to determine associated factors. METHODSWe recruited into a cross-sectional study 400 mothers accompanying their infants for routine immunization at mother-child health clinic (MCH) at Machakos Hospital, Kenya, collected information on HIV testing from their antenatal records, and offered opt-out HIV testing to those with unknown HIV status. RESULTSOverall, 304 (76.0%) mothers had unknown status at MCH, of whom 25 (8.6%) tested HIV-positive. HIV positivity was three times higher among mothers who never tested during pregnancy/delivery versus those whose last negative HIV test was >3 months prior to study enrolment (18% versus 6%). Women living more than three kilometers away from the health facility had 2.7-fold greater odds of having unknown status compared to those who lived less than three kilometers (adjusted odds ratio [AOR] 2.7, 95% CI 1.3–5.6). Married women had 3.2-fold greater odds of having unknown status as compared to those who were single (AOR 3.2, 95% CI 1.4–7.0). Those with education had a tenfold reduction in odds of having unknown status compared to those with none (AOR 0.1, 95% CI 0.0–0.2). CONCLUSIONInterventions are needed to improve women’s ANC attendance, uptake of HIV testing, and disclosure of HIV status during pregnancy to achieve the elimination of MTCT.