HIV incidence in western Kenya during scale-up of antiretroviral therapy and voluntary medical male circumcision: a population-based cohort analysis

Borgdorff, Martien W.; Kwaro, Daniel; Obor, David; Otieno, George; Kamire, Viviane; Odongo, Frederick; Owuor, Patrick Mbullo; Muthusi, Jacques; Mills, Lisa; Joseph, Rachael; Schmitz, Mary; Young, Peter W.; Zielinski-Gutiérrez, Emily; Cock, Kevin M. De

doi:10.1016/s2352-3018(18)30025-0

“…Inclusion criteria for the cohort study included: male gender at birth, report of a male sex partner in the previous six months, and participation in a parent study of HIV oral self‐testing (OST) conducted between March and June 2016 . AMKENI peer educators were asked to trace all 219 MSM who tested HIV‐1 seronegative in 2016 for retesting with Determine (Abbott, Laboratories, Abbott Park, Illinois, USA), followed by First Response (Premier Medical Corporation, Nadi Daman, India) according to Kenyan national guidelines .…”

Section: Methodsmentioning

confidence: 99%

PrEP interest and HIV‐1 incidence among MSM and transgender women in coastal Kenya

Kimani

¹

,

Elst

²

,

Chiro

³

et al. 2019

View full text Add to dashboard Cite

Introduction There is emerging data on HIV ‐1 incidence among MSM in sub‐Saharan Africa ( SSA ), but no known estimate of HIV ‐1 incidence among transgender women ( TGW ) in the region has yet been reported. We assessed HIV ‐1 incidence and pre‐exposure prophylaxis (Pr EP ) interest in men who have sex with men exclusively ( MSME ), men who have sex with men and women ( MSMW ) and TGW in coastal Kenya. Methods HIV ‐1‐seronegative individuals who had participated in an HIV testing study in 2016 were traced and retested in 2017 according to Kenyan guidelines. All participants were assigned male sex at birth and had male sex partners; additional data on gender identity and sexual orientation were obtained. We assessed the factors associated with HIV ‐1 acquisition using Poisson regression and calculated HIV ‐1 incidence in MSME , MSMW and TGW . Pr EP interest was assessed through focus group discussions to characterize subcategories’ perceived Pr EP needs. Results Of the 168 cohort participants, 42 were classified as MSME , 112 as MSMW and 14 as TGW . Overall, HIV ‐1 incidence was 5.1 (95% confidence interval ( CI ): 2.6 to 9.8) per 100 person‐years ( PY ): 4.5 (95% CI : 1.1 to 17.8] per 100 PY among MSME , 3.4 (95% CI : 1.3 to 9.1) per 100 PY among MSMW and 20.6 (95% CI : 6.6 to 63.8] per 100 PY among TGW . HIV ‐1 acquisition was associated with exclusive receptive anal intercourse ( aIRR 13.0, 95% CI 1.9 to 88.6), history of an STI in preceding six months ( aIRR 10.3, 95% CI 2.2 to 49.4) and separated/divorced marital status ( aIRR 8.2 (95%: 1.1 to 62.2). Almost all (98.8%) participants were interested in initiating Pr EP . MSME and TGW felt that Pr EP would lead to increases in condomless anal or group sex. Conclusions ...

show abstract

“…30,31 Within the HDSS the crude prevalence among adults 15-34 years old was 9% in 2016. 32 Data on HIV were collected by two programs implemented by the CDC Kenya Division of Global HIV/acquired immunodeficiency syndrome (AIDS) (DGHA) and the International Emerging Infections Program: Home-Based Counseling and Testing (HBCT) and Provider-Initiated HIV Testing and Counseling (PITC). Protocols established by the Ministry of Health for HIV testing and counseling were followed for both HBCT and PITC.…”

Section: Methodsmentioning

confidence: 99%

Water, Sanitation, and Hygiene Characteristics among HIV-Positive Households Participating in the Global Enteric Multicenter Study in Rural Western Kenya, 2008–2012

Schilling

¹

,

Awuor

²

,

Rajasingham

³

et al. 2018

The American Journal of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Diarrheal illness, a common occurrence among people living with human immunodeficiency virus (PLHIV), is largely preventable through access to safe drinking water quality, sanitation, and hygiene (WASH) facilities. We examined WASH characteristics among households with and without HIV-positive residents enrolled in the Global Enteric Multicenter Study (GEMS) in rural Western Kenya. Using univariable logistic regression, we examined differences between HIV-positive and HIV-negative households in regard to WASH practices. Among HIV-positive households, we explored the relationship between the length of time knowing their HIV status and GEMS enrollment. No statistically significant differences were apparent in the WASH characteristics among HIV-positive and HIV-negative households. However, we found differences in the WASH characteristics among HIV-positive households who were aware of their HIV status ≥ 30 days before enrollment compared with HIV-positive households who found out their status < 30 days before enrollment or thereafter. Significantly more households aware of their HIV-positive status before enrollment reported treating their drinking water (odds ratio [OR] confidence interval [CI]: 2.34 [1.12, 4.86]) and using effective water treatment methods (OR [CI]: 9.6 [3.09, 29.86]), and had better drinking water storage practices. This suggests that within this region of Kenya, HIV programs are effective in promoting the importance of practicing positive WASH-related behaviors among PLHIV.

show abstract

“…[202][203][204][205][206] In a recent Kenyan study the reduction was 50%. 206 Criticisms of the RCT findings by MC opponents [176][177][178][179][188][189][190][191][192] were shown by scientists and public health authorities to contain fundamental flaws. 56,[207][208][209][210][211][212][213][214][215][216][217][218][219][220][221][222][223] The suggestion that, once circumcised, men would forego condom use was contradicted by a recent meta-analysis that found no difference in condom use for up to 2 years post-MC.…”

Section: In Heterosexual Menmentioning

confidence: 99%

“…VMMC has been very effective in lowering HIV infections in epidemic settings in sub‐Saharan Africa . In a recent Kenyan study the reduction was 50% . Criticisms of the RCT findings by MC opponents were shown by scientists and public health authorities to contain fundamental flaws .…”

Section: Physical Harmmentioning

confidence: 99%

See 1 more Smart Citation

Critical evaluation of arguments opposing male circumcision: A systematic review

Morris

¹

,

Moreton²,

Krieger

³

2019

J Evidence Based Medicine

View full text Add to dashboard Cite

Objective To systematically evaluate evidence against male circumcision (MC). Methods We searched PubMed, Google Scholar, EMBASE and Cochrane databases. Results Database searches retrieved 297 publications for inclusion. Bibliographies of these yielded 101 more. After evaluation we found: Claims that MC carries high risk were contradicted by low frequency of adverse events that were virtually all minor and easily treated with complete resolution. Claims that MC causes psychological harm were contradicted by studies finding no such harm. Claims that MC impairs sexual function and pleasure were contradicted by high‐quality studies finding no adverse effect. Claims disputing the medical benefits of MC were contradicted by a large body of high‐quality evidence indicating protection against a wide range of infections, dermatological conditions, and genital cancers in males and the female sexual partners of men. Risk‐benefit analyses reported that benefits exceed risks by 100‐200 to 1. To maximize benefits and minimize risks, the evidence supported early infant MC rather than arguments that the procedure should be delayed until males are old enough to decide for themselves. Claims that MC of minors is unethical were contradicted by balanced evaluations of ethical issues supporting the rights of children to be provided with low‐risk, high‐benefit interventions such as MC for better health. Expert evaluations of case‐law supported the legality of MC of minors. Other data demonstrated that early infant MC is cost‐saving to health systems. Conclusions Arguments opposing MC are supported mostly by low‐quality evidence and opinion, and are contradicted by strong scientific evidence.

show abstract

HIV incidence in western Kenya during scale-up of antiretroviral therapy and voluntary medical male circumcision: a population-based cohort analysis

Cited by 77 publications

References 19 publications

PrEP interest and HIV‐1 incidence among MSM and transgender women in coastal Kenya

PrEP interest and HIV‐1 incidence among MSM and transgender women in coastal Kenya

Water, Sanitation, and Hygiene Characteristics among HIV-Positive Households Participating in the Global Enteric Multicenter Study in Rural Western Kenya, 2008–2012

Critical evaluation of arguments opposing male circumcision: A systematic review

Contact Info

Product

Resources

About