RESUMEN
BACKGROUND: Co-morbidity with tuberculosis and HIV is a common cause of mortality in sub-Saharan Africa. In the second Kenya AIDS Indicator Survey, we collected data on knowledge and experience of HIV and tuberculosis, as well as on access to and coverage of relevant treatment services and antiretroviral therapy (ART) in Kenya. METHODS: A national, population-based household survey was conducted from October 2012 to February 2013. Information was collected through household questionnaires, and blood samples were taken for HIV, CD4 cell counts, and HIV viral load testing at a central laboratory. RESULTS: Overall, 13,720 persons aged 15-64 years participated; 96.7% [95% confidence interval (CI): 96.3 to 97.1] had heard of tuberculosis, of whom 2.0% (95% CI: 1.7 to 2.2) reported having prior tuberculosis. Among those with laboratory-confirmed HIV infection, 11.6% (95% CI: 8.9 to 14.3) reported prior tuberculosis. The prevalence of laboratory-confirmed HIV infection in persons reporting prior tuberculosis was 33.2% (95% CI: 26.2 to 40.2) compared to 5.1% (95% CI: 4.5 to 5.8) in persons without prior tuberculosis. Among those in care, coverage of ART for treatment-eligible persons was 100% for those with prior tuberculosis and 88.6% (95% CI: 81.6 to 95.7) for those without. Among all HIV-infected persons, ART coverage among treatment-eligible persons was 86.9% (95% CI: 74.2 to 99.5) for persons with prior tuberculosis and 58.3% (95% CI: 47.6 to 69.0) for those without. CONCLUSIONS: Morbidity from tuberculosis and HIV remain major health challenges in Kenya. Tuberculosis is an important entry point for HIV diagnosis and treatment. Lack of knowledge of HIV serostatus is an obstacle to access to HIV services and timely ART for prevention of HIV transmission and HIV-associated disease, including tuberculosis.
Asunto(s)
Infecciones por VIH/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Factores de Edad , Comorbilidad , Estudios Transversales , Escolaridad , Femenino , Infecciones por VIH/tratamiento farmacológico , Encuestas Epidemiológicas , Humanos , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Población Rural/estadística & datos numéricos , Factores Sexuales , Tuberculosis Pulmonar/tratamiento farmacológico , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
AIDS Indicator Surveys are standardized surveillance tools used by countries with generalized HIV epidemics to provide, in a timely fashion, indicators for effective monitoring of HIV. Such data should guide responses to the HIV epidemic, meet program reporting requirements, and ensure comparability of findings across countries and over time. Kenya has conducted 2 AIDS Indicator Surveys, in 2007 (KAIS 2007) and 2012-2013 (KAIS 2012). These nationally representative surveys have provided essential epidemiologic, sociodemographic, behavioral, and biologic data on HIV and related indicators to evaluate the national HIV response and inform policies for prevention and treatment of the disease. We present a summary of findings from KAIS 2007 and KAIS 2012 and the impact that these data have had on changing HIV policies and practice.
Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , Política de Salud , Encuestas Epidemiológicas , Vigilancia de la Población , Circuncisión Masculina/estadística & datos numéricos , Estudios Transversales , Femenino , Infecciones por VIH/prevención & control , Infecciones por VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Humanos , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Kenia/epidemiología , Masculino , Salud Pública , Conducta Sexual/estadística & datos numéricosRESUMEN
BACKGROUND: HIV testing and counseling (HTC) is essential for successful HIV prevention and treatment programs. The national target for HTC is 80% of the adult population in Kenya. Population-based data to measure progress towards this HTC target are needed to assess the country's changing needs for HIV prevention and treatment. METHODS: In 2012-2013, we conducted a national HIV survey among Kenyans aged 18 months to 64 years. Respondents aged 15-64 years were administered a questionnaire that collected information on demographics, HIV testing behavior, and self-reported HIV status. Blood samples were collected for HIV testing in a central laboratory. Participants were offered home-based testing and counseling to learn their HIV status in the home and point-of-care CD4 testing if they tested HIV-positive. RESULTS: Of 13,720 adults who were interviewed, 71.6% [95% confidence interval (CI): 70.2 to 73.1] had been tested for HIV. Among those, 56.1% (95% CI: 52.8 to 59.4) had been tested in the past year, 69.4% (95% CI: 68.0 to 70.8) had been tested more than once, and 37.2% (95% CI: 35.7 to 38.8) had been tested with a partner. Fifty-three percent (95% CI: 47.6 to 58.7) of HIV-infected persons were unaware of their infection. Overall 9874 (72.0%) of participants accepted home-based HIV testing and counseling; 4.1% (95% CI: 3.3 to 4.9) tested HIV-positive, and of those, 42.5% (95% CI 31.4 to 53.6) were in need of immediate treatment for their HIV infection but not receiving it. CONCLUSIONS: HIV testing rates have nearly reached the national target for HTC in Kenya. However, knowledge of HIV status among HIV-infected persons remains low. HTC needs to be expanded to reach more men and couples, and strategies are needed to increase repeat testing for persons at risk for HIV infection.
Asunto(s)
Recuento de Linfocito CD4/estadística & datos numéricos , Consejo/estadística & datos numéricos , Seropositividad para VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Adolescente , Adulto , Factores de Edad , Femenino , Seropositividad para VIH/terapia , Encuestas Epidemiológicas , Servicios de Atención de Salud a Domicilio , Humanos , Entrevistas como Asunto , Kenia , Masculino , Persona de Mediana Edad , Embarazo , Población Rural/estadística & datos numéricos , Factores Sexuales , Conducta Sexual , Factores Socioeconómicos , Encuestas y Cuestionarios , Población Urbana/estadística & datos numéricos , Adulto JovenRESUMEN
BACKGROUND: The Kenyan Ministry of Health initiated a voluntary medical male circumcision (VMMC) program in 2008. We used data from 2 nationally representative surveys to estimate trends in the number, demographic characteristics, and sexual behaviors of recently circumcised and uncircumcised HIV-uninfected men in Kenya. METHODS: We compared the proportion of circumcised men between the first and second Kenya AIDS Indicator Survey (KAIS 2007 and KAIS 2012) to assess the progress of Kenya's VMMC program. We calculated the number of uncircumcised HIV-uninfected men. We conducted descriptive analyses and used multivariable methods to identify the variables independently associated with HIV-uninfected uncircumcised men aged 15-64 years in the VMMC priority region of Nyanza. RESULTS: The proportion of men who reported being circumcised increased significantly from 85.0% in 2007 to 91.2% in 2012. The proportions of circumcised men increased in all regions, with the highest increases of 18.1 and 9.0 percentage points in the VMMC priority regions of Nyanza and Nairobi, respectively. Half (52.5%) of HIV-uninfected and uncircumcised men had never been married, and 84.6% were not using condoms at all times with their last sexual partner. CONCLUSIONS: VMMC prevalence has increased across Kenya demonstrating the success of the national program. Despite this accomplishment, the Nyanza region remains below the target to circumcise 80% of all eligible men aged 15-49 years between 2009 and 2013. As new cohorts of young men enter into adolescence, consistent focus is needed. To ensure sustainability of the VMMC program, financial resources and coordinated planning must continue.
Asunto(s)
Circuncisión Masculina/tendencias , Seropositividad para VIH/epidemiología , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Condones/estadística & datos numéricos , Estudios Transversales , Encuestas Epidemiológicas , Humanos , Kenia/epidemiología , Masculino , Estado Civil , Persona de Mediana Edad , Prevalencia , Conducta Sexual , Adulto JovenRESUMEN
BACKGROUND: Populations with higher risks for HIV exposure contribute to the HIV epidemic in Kenya. We present data from the second Kenya AIDS Indicator Survey to estimate the size and HIV prevalence of populations with high-risk characteristics. METHODS: The Kenya AIDS Indicator Survey 2012 was a national survey of Kenyans aged 18 months to 64 years which linked demographic and behavioral information with HIV results. Data were weighted to account for sampling probability. This analysis was restricted to adults aged 18 years and older. RESULTS: Of 5088 men and 6745 women, 0.1% [95% confidence interval (CI): 0.03 to 0.14] were persons who inject drugs (PWID). Among men, 0.6% (CI: 0.3 to 0.8) had ever had sex with other men, and 3.1% (CI: 2.4 to 3.7) were males who had ever engaged in transactional sex work (MTSW). Among women, 1.9% (CI: 1.3 to 2.5) had ever had anal sex, and 4.1% (CI: 3.5 to 4.8) were women who had ever engaged in transactional sex work (FTSW). Among men, 17.6% (CI: 15.7 to 19.6) had been male clients of transactional sex workers (TSW). HIV prevalence was 0% among men who have sex with men, 6.3% (CI: 0 to 18.1) among persons who injected drugs, 7.1% (CI: 4.8 to 9.4) among male clients of TSW, 7.6% (CI: 1.8 to 13.4) among MTSW, 12.1% (CI: 7.1 to 17.1) among FTSW, and 12.1% (CI: 5.0 to 19.2) among females who ever had engaged in anal sex. CONCLUSIONS: Population-based data on high-risk populations can be used to set realistic targets for HIV prevention, care, and treatment for these groups. These data should inform priorities for high-risk populations in the upcoming Kenyan strategic plan on HIV/AIDS.
Asunto(s)
Seropositividad para VIH/epidemiología , Homosexualidad Masculina/estadística & datos numéricos , Trabajo Sexual/estadística & datos numéricos , Adolescente , Adulto , Estudios Transversales , Femenino , Seropositividad para VIH/diagnóstico , Encuestas Epidemiológicas , Humanos , Entrevistas como Asunto , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores Sexuales , Conducta Sexual/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Cross-sectional population-based surveys are essential surveillance tools for tracking changes in HIV epidemics. In 2007, Kenya implemented the first AIDS Indicator Survey [Kenya AIDS Indicator Survey (KAIS) 2007)], a nationally representative, population-based survey that collected demographic and behavioral data and blood specimens from individuals aged 15-64 years. Kenya's second AIDS Indicator Survey (KAIS 2012) was conducted to monitor changes in the epidemic, evaluate HIV prevention, care, and treatment initiatives, and plan for an efficient and effective response to the HIV epidemic. METHODS: KAIS 2012 was a cross-sectional 2-stage cluster sampling design, household-based HIV serologic survey that collected information on households as well as demographic and behavioral data from Kenyans aged 18 months to 64 years. Participants also provided blood samples for HIV serology and other related tests at the National HIV Reference Laboratory. RESULTS: Among 9300 households sampled, 9189 (98.8%) were eligible for the survey. Of the eligible households, 8035 (87.4%) completed household-level questionnaires. Of 16,383 eligible individuals aged 15-64 years and emancipated minors aged less than 15 years in these households, 13,720 (83.7%) completed interviews; 11,626 (84.7%) of the interviewees provided a blood specimen. Of 6302 eligible children aged 18 months to 14 years, 4340 (68.9%) provided a blood specimen. Of the 2094 eligible children aged 10-14 years, 1661 (79.3%) completed interviews. CONCLUSIONS: KAIS 2012 provided representative data to inform a strategic response to the HIV epidemic in the country.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Seropositividad para VIH/epidemiología , Encuestas Epidemiológicas/métodos , Síndrome de Inmunodeficiencia Adquirida/inmunología , Adolescente , Adulto , Recuento de Linfocito CD4 , Niño , Preescolar , Consejo , Estudios Transversales , Femenino , Seropositividad para VIH/inmunología , Humanos , Lactante , Entrevistas como Asunto , Kenia/epidemiología , Masculino , Persona de Mediana Edad , Estudios Seroepidemiológicos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
BACKGROUND: Kenya has an estimated 13,000 new infant HIV infections that occur annually. We measured the burden of HIV infection among women of childbearing age and assessed access to and coverage of key prevention of mother-to-child transmission interventions. METHODS: The second Kenya AIDS Indicator Survey was a nationally representative 2-stage cluster sample of households. We analyzed data from women aged 15-54 years who had delivered a newborn within the preceding 5 years and from whom we obtained samples for HIV testing. RESULTS: Of 3310 women who had ≥1 live birth in the preceding 5 years, 2862 (86.5%) consented to HIV testing in the survey, and 171 (6.1%) were found to be infected. Ninety-five percent received prenatal care, 93.1% were screened for HIV during prenatal care, and of those screened, 97.8% received their test results. Seventy-six women were known to be infected in their last pregnancy. Of these, 54 (72.3%) received antepartum antiretroviral prophylaxis, and 51 (69.1%) received intrapartum prophylaxis; 56 (75.3%) reported their newborns received postpartum prophylaxis. Of the 76 children born to these mothers, 63 (82.5%) were tested for HIV at the first immunization visit or thereafter, and 8 (15.1%) were HIV infected. CONCLUSIONS: We found a substantial burden of HIV in Kenyan women of childbearing age and a cumulative 5-year mother-to-child transmission rate of 15%. Although screening has improved over the past 5 years, fewer than three-quarters of infected pregnant women are receiving antiretroviral prophylaxis. Universal antiretroviral therapy for HIV-infected pregnant women will be essential in achieving Kenyan's target to eliminate mother-to-child transmission to <5% by 2015.
Asunto(s)
Seropositividad para VIH/epidemiología , Seropositividad para VIH/transmisión , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Transmisión Vertical de Enfermedad Infecciosa/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Antirretrovirales/uso terapéutico , Estudios Transversales , Femenino , Seropositividad para VIH/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Recién Nacido , Kenia/epidemiología , Nacimiento Vivo , Persona de Mediana Edad , Atención Perinatal/estadística & datos numéricos , Embarazo , Trimestres del Embarazo , Atención Prenatal/estadística & datos numéricos , Prevalencia , Adulto JovenRESUMEN
BACKGROUND: Increasing access to care and treatment for HIV-infected persons is a goal in Kenya's response to the HIV epidemic. Using data from the second Kenya AIDS Indicator Survey (KAIS 2012), we describe coverage of services received among adults and adolescents who were enrolled in HIV care. METHODS: KAIS 2012 was a population-based survey that collected information from persons aged 15-64 years that included self-reported HIV status, and for persons reporting HIV infection, use of HIV care and antiretroviral therapy (ART). Blood specimens were collected and tested for HIV. HIV-positive specimens were tested for CD4 counts and viral load. RESULTS: Among 363 persons who reported HIV infection, 93.4% [95% confidence interval (CI): 87.2 to 99.6] had ever received HIV care. Among those receiving HIV care, 96.3% (95% CI: 94.1 to 98.4) were using cotrimoxazole prophylaxis, and 74.6% (95% CI: 69.0 to 80.2) were receiving ART. A lower proportion of persons in care and not on ART reported using cotrimoxazole (89.5%, 95% CI: 82.5 to 96.5 compared with 98.6%, 95% CI: 97.1 to 100) and had a CD4 count measurement done (72.9%, 95% CI: 64.0 to 81.9 compared with 90.0%, 95% CI: 82.8 to 97.3) than persons in care and on ART, respectively. Among persons in care and not on ART, 23.2% (95% CI: 6.8 to 39.7) had CD4 counts ≤350 cells per microliter. Viral suppression was observed in 75.3% (95% CI: 68.7 to 81.9) of persons on ART. CONCLUSIONS: Linkage and retention in care are high among persons with known HIV infection. However, improvements in care for the pre-ART population are needed. Viral suppression rates were comparable to developed settings.
Asunto(s)
Antiinfecciosos/uso terapéutico , Antirretrovirales/uso terapéutico , Infecciones por VIH/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/uso terapéutico , Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Adolescente , Adulto , Factores de Edad , Recuento de Linfocito CD4 , Estudios Transversales , Escolaridad , Femenino , Infecciones por VIH/inmunología , Encuestas Epidemiológicas , Humanos , Kenia , Masculino , Estado Civil , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores Sexuales , Adulto JovenRESUMEN
OBJECTIVE: To assess the level of public support for tobacco control policies and to discuss how these findings could be used to influence the legislative process in the passing of tobacco control law in the country. METHODS: A cross-sectional study conducted in Kenya between March and May 2007 on a random sample of 2021 (991 men and 1030 women) respondents aged 18 years and above. Interviews were done using a structured questionnaire by a research consultancy firm with long-standing experience in public polling. RESULTS: The majority of respondents supported tobacco control policies as proposed by WHO Framework Convention on Tobacco Control. For example, 95% of the respondents supported smoking restrictions in all enclosed public places and workplaces, 94% supported visible health warnings on tobacco product packages, 83% supported a ban on advertisements of cigarettes and tobacco products and 69% supported a ban on sponsorship of events by tobacco companies. However, 60% perceived that there was very little commitment by legislators to tobacco control. CONCLUSIONS: There was overwhelming public support for tobacco control policies and a general view that government was not doing enough in implementing policies to protect the public from tobacco harm. This public opinion poll was used as an advocacy tool to generate support among legislators for national tobacco control law.
Asunto(s)
Actitud Frente a la Salud , Política de Salud/legislación & jurisprudencia , Mercadotecnía/legislación & jurisprudencia , Opinión Pública , Cese del Hábito de Fumar , Fumar/legislación & jurisprudencia , Industria del Tabaco/legislación & jurisprudencia , Adolescente , Adulto , Estudios Transversales , Etiquetado de Medicamentos , Femenino , Regulación Gubernamental , Humanos , Entrevistas como Asunto , Kenia , Masculino , Persona de Mediana Edad , Percepción , Política para Fumadores , Encuestas y Cuestionarios , Productos de Tabaco , Contaminación por Humo de Tabaco/legislación & jurisprudencia , Tabaquismo/prevención & control , Lugar de Trabajo , Adulto JovenRESUMEN
Noncommunicable diseases (NCDs) are the leading cause of mortality worldwide. However, these diseases have not been adequately addressed by health systems, especially in low-resource countries. Similarly, there is no equitable allocation of global resources for health commensurate with the burden of diseases occasioned by NCDs. This has resulted in poor access to care for women, girls, and other vulnerable groups affected by NCDs. Owing to their position in most societies, women lack control over resources and, hence, cannot afford quality care to treat NCDs. Women also face sociocultural, geographic, and economic barriers to access to care. They are less recognized and catered for in terms of accessibility, comprehensiveness, and responsiveness of healthcare systems. Considering that NCDs affect women more than the general population, tackling them as part of an integrated program for women's health will improve the coverage of the most vulnerable groups. This paper describes how NCD prevention and control could be integrated into maternal and child health programs to improve access to NCD services. It presents the effectiveness, benefits, and challenges of this approach when applied at the primary healthcare level.