Last data update: May 13, 2024. (Total: 46773 publications since 2009)
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Query Trace: Muraguri N[original query] |
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Identifying risk factors for recent HIV infection in Kenya using a recent infection testing algorithm: Results from a nationally representative population-based survey
Kim AA , Parekh BS , Umuro M , Galgalo T , Bunnell R , Makokha E , Dobbs T , Murithi P , Muraguri N , De Cock KM , Mermin J . PLoS One 2016 11 (5) e0155498 INTRODUCTION: A recent infection testing algorithm (RITA) that can distinguish recent from long-standing HIV infection can be applied to nationally representative population-based surveys to characterize and identify risk factors for recent infection in a country. MATERIALS AND METHODS: We applied a RITA using the Limiting Antigen Avidity Enzyme Immunoassay (LAg) on stored HIV-positive samples from the 2007 Kenya AIDS Indicator Survey. The case definition for recent infection included testing recent on LAg and having no evidence of antiretroviral therapy use. Multivariate analysis was conducted to determine factors associated with recent and long-standing infection compared to HIV-uninfected persons. All estimates were weighted to adjust for sampling probability and nonresponse. RESULTS: Of 1,025 HIV-antibody-positive specimens, 64 (6.2%) met the case definition for recent infection and 961 (93.8%) met the case definition for long-standing infection. Compared to HIV-uninfected individuals, factors associated with higher adjusted odds of recent infection were living in Nairobi (adjusted odds ratio [AOR] 11.37; confidence interval [CI] 2.64-48.87) and Nyanza (AOR 4.55; CI 1.39-14.89) provinces compared to Western province; being widowed (AOR 8.04; CI 1.42-45.50) or currently married (AOR 6.42; CI 1.55-26.58) compared to being never married; having had ≥ 2 sexual partners in the last year (AOR 2.86; CI 1.51-5.41); not using a condom at last sex in the past year (AOR 1.61; CI 1.34-1.93); reporting a sexually transmitted infection (STI) diagnosis or symptoms of STI in the past year (AOR 1.97; CI 1.05-8.37); and being aged <30 years with: 1) HSV-2 infection (AOR 8.84; CI 2.62-29.85), 2) male genital ulcer disease (AOR 8.70; CI 2.36-32.08), or 3) lack of male circumcision (AOR 17.83; CI 2.19-144.90). Compared to HIV-uninfected persons, factors associated with higher adjusted odds of long-standing infection included living in Coast (AOR 1.55; CI 1.04-2.32) and Nyanza (AOR 2.33; CI 1.67-3.25) provinces compared to Western province; being separated/divorced (AOR 1.87; CI 1.16-3.01) or widowed (AOR 2.83; CI 1.78-4.45) compared to being never married; having ever used a condom (AOR 1.61; CI 1.34-1.93); and having a STI diagnosis or symptoms of STI in the past year (AOR 1.89; CI 1.20-2.97). Factors associated with lower adjusted odds of long-standing infection included using a condom at last sex in the past year (AOR 0.47; CI 0.36-0.61), having no HSV2-infection at aged <30 years (AOR 0.38; CI 0.20-0.75) or being an uncircumcised male aged <30 years (AOR 0.30; CI 0.15-0.61). CONCLUSION: We identified factors associated with increased risk of recent and longstanding HIV infection using a RITA applied to blood specimens collected in a nationally representative survey. Though some false-recent cases may have been present in our sample, the correlates of recent infection identified were epidemiologically and biologically plausible. These methods can be used as a model for other countries with similar epidemics to inform targeted combination prevention strategies aimed to drastically decrease new infections in the population. |
Lessons learned from respondent-driven sampling recruitment in Nairobi: experiences from the field
Okal J , Raymond HF , Tun W , Musyoki H , Dadabhai S , Broz D , Nyamu J , Kuria D , Muraguri N , Geibel S . BMC Res Notes 2016 9 (1) 158 BACKGROUND: Respondent-driven sampling (RDS) is used in a variety of settings to study hard-to-reach populations at risk for HIV and sexually transmitted infections. However, practices leading to successful recruitment among diverse populations in low-resource settings are seldom reported. We implemented the first, integrated, bio-behavioural surveillance survey among men who have sex with men, female sex workers and people who injected drugs in Nairobi, Kenya. METHODS: The survey period was June 2010 to March 2011, with a target sample size of 600 participants per key populations. Formative research was initially conducted to assess feasibility of the survey. Weekly monitoring reports of respondent characteristics and recruitment chain graphs from NetDraw illustrated patterns and helped to fill recruitment gaps. RESULTS: RDS worked well with men who have sex with men and female sex workers with recruitment initiating at a desirable pace that was maintained throughout the survey. Networks of people who injected drugs were well-integrated, but recruitment was slower than the men who have sex with men and female sex workers surveys. CONCLUSION: By closely monitoring RDS implementation and conducting formative research, RDS studies can effectively develop and adapt strategies to improve recruitment and improve adherence to the underlying RDS theory and assumptions. |
Evaluation of Kenya's readiness to transition from sentinel surveillance to routine HIV testing for antenatal clinic-based HIV surveillance
Sirengo M , Rutherford GW , Otieno-Nyunya B , Kellogg TA , Kimanga D , Muraguri N , Umuro M , Mirjahangir J , Stein E , Ndisha M , Kim AA . BMC Infect Dis 2016 16 (1) 113 BACKGROUND: Sentinel surveillance for HIV among women attending antenatal clinics using unlinked anonymous testing is a cornerstone of HIV surveillance in sub-Saharan Africa. Increased use of routine antenatal HIV testing allows consideration of using these programmatic data rather than sentinel surveillance data for HIV surveillance. METHODS: To gauge Kenya's readiness to discontinue sentinel surveillance, we evaluated whether recommended World Health Organization standards were fulfilled by conducting data and administrative reviews of antenatal clinics that offered both routine testing and sentinel surveillance in 2010. RESULTS: The proportion of tests that were HIV-positive among women aged 15-49 years was 6.2 % (95 % confidence interval [CI] 4.6-7.7 %] in sentinel surveillance and 6.5 % (95 % CI 5.1-8.0 %) in routine testing. The agreement of HIV test results between sentinel surveillance and routine testing was 98.0 %, but 24.1 % of specimens that tested positive in sentinel surveillance were recorded as negative in routine testing. Data completeness was moderate, with HIV test results recorded for 87.8 % of women who received routine testing. CONCLUSIONS: Additional preparation is required before routine antenatal HIV testing data can supplant sentinel surveillance in Kenya. As the quality of program data has markedly improved since 2010 a repeat evaluation of the use of routine antenatal HIV testing data in lieu of ANC sentinel surveillance is recommended. |
Notes from the field: Ongoing cholera outbreak - Kenya, 2014-2016
George G , Rotich J , Kigen H , Catherine K , Waweru B , Boru W , Galgalo T , Githuku J , Obonyo M , Curran K , Narra R , Crowe SJ , O'Reilly CE , Macharia D , Montgomery J , Neatherlin J , De Cock KM , Lowther S , Gura Z , Langat D , Njeru I , Kioko J , Muraguri N . MMWR Morb Mortal Wkly Rep 2016 65 (3) 68-69 On January 6, 2015, a man aged 40 years was admitted to Kenyatta National Hospital in Nairobi, Kenya, with acute watery diarrhea. The patient was found to be infected with toxigenic Vibrio cholerae serogroup O1, serotype Inaba. A subsequent review of surveillance reports identified four patients in Nairobi County during the preceding month who met either of the Kenya Ministry of Health suspected cholera case definitions: 1) severe dehydration or death from acute watery diarrhea (more than four episodes in 12 hours) in a patient aged ≥5 years, or 2) acute watery diarrhea in a patient aged ≥2 years in an area where there was an outbreak of cholera. An outbreak investigation was immediately initiated. A confirmed cholera case was defined as isolation of V. cholerae O1 or O139 from the stool of a patient with suspected cholera or a suspected cholera case that was epidemiologically linked to a confirmed case. By January 15, 2016, a total of 11,033 suspected or confirmed cases had been reported from 22 of Kenya's 47 counties. The outbreak is ongoing. |
Kenyan MSM: no longer a hidden population
Sanders EJ , Jaffe H , Musyoki H , Muraguri N , Graham SM . AIDS 2015 29 Suppl 3 S195-9 In 2005, almost 25 years after the emergence of the HIV pandemic among MSM in the United States, the first substantial report of HIV and sexually transmitted infections (STIs) among a large group of MSM from Senegal was published in AIDS [1]. Although MSM received late recognition in the African HIV epidemic [2,3], Kenya was at the forefront in recognizing the vulnerabilities of this highly stigmatized population that feared legal authorities and had virtually no access to health services [4]. Numerous studies have since documented the elevated HIV/STI infection risks of African MSM, and donor responses have begun to focus on inclusion of MSM and their emerging organizations in HIV prevention and care programming in Africa [5]. Despite legal challenges and largely negative public debates [6], the Kenyan Ministry of Health and National AIDS and STI Control Programme has recognized that MSM are one of the key populations in need of urgent attention and have demonstrated their willingness to work with them [7]. | This relatively supportive environment set the stage for recruitment of MSM into a cohort study investigating the feasibility of HIV-1 vaccine research on the Kenyan coast [8]. The Key Populations Cohort studies at the Kenya Medical Research Institute–Wellcome Trust Research Program in Kilifi, now in existence for 10 years, have reported the much higher HIV-1 incidence among MSM who had exclusive sex with men than in MSM who had sex with men and women [9]. In addition, numerous operational research studies based in this cohort have informed HIV prevention and care programming for MSM in Kenya and beyond [10–13]. In the past few years, HIV research with MSM in Kenya has expanded to several major cities. In Nairobi, over 1000 male sex workers, most of them MSM, have been engaged in research and provided with HIV care and prevention services [14,15], whereas counselling services targeting MSM have also been provided by the Liverpool Voluntary Counselling and Testing Programme [16]. In Kisumu, a Centers for Diseases Control and Prevention-funded study of a combination prevention and care programme for up to 700 MSM started enrolment in 2015, and an additional 100 MSM will be targeted for enrolment into an HIV Prevention Trials Network study of the feasibility of engaging and retaining MSM in research at sites in South Africa, Malawi and Kenya. As a result of this increased activity, researchers in Kenya have formed an MSM health research consortium, with the aim of improving healthcare for MSM and sharing findings with the Ministry of Health. Increasingly, research with MSM is informed by the views and planned with the support of Kenyan lesbian, gay, bisexual, and transgender groups. In addition to tackling health challenges, these LGBT groups and their leaders aim to address human rights challenges. Clearly, MSM in Kenya are no longer a hidden population. |
Prevalence of HIV, sexually transmitted infections, and risk behaviours among female sex workers in Nairobi, Kenya: results of a respondent driven sampling study
Musyoki H , Kellogg TA , Geibel S , Muraguri N , Okal J , Tun W , Fisher Raymond H , Dadabhai S , Sheehy M , Kim AA . AIDS Behav 2015 19 Suppl 1 46-58 We conducted a respondent driven sampling survey to estimate HIV prevalence and risk behavior among female sex workers (FSWs) in Nairobi, Kenya. Women aged 18 years and older who reported selling sex to a man at least once in the past 3 months were eligible to participate. Consenting FSWs completed a behavioral questionnaire and were tested for HIV and sexually transmitted infections (STIs). Adjusted population-based prevalence and 95 % confidence intervals (CI) were estimated using RDS analysis tool. Factors significantly associated with HIV infection were assessed using log-binomial regression analysis. A total of 596 eligible participants were included in the analysis. Overall HIV prevalence was 29.5 % (95 % CI 24.7-34.9). Median age was 30 years (IQR 25-38 years); median duration of sex work was 12 years (IQR 8-17 years). The most frequent client-seeking venues were bars (76.6 %) and roadsides (29.3 %). The median number of clients per week was seven (IQR 4-18 clients). HIV testing was high with 86.6 % reported ever been tested for HIV and, of these, 63.1 % testing within the past 12 months. Of all women, 59.7 % perceived themselves at 'great risk' for HIV infection. Of HIV-positive women, 51.0 % were aware of their infection. In multivariable analysis, increasing age, inconsistent condom use with paying clients, and use of a male condom as a method of contraception were independently associated with unrecognized HIV infection. Prevalence among STIs was low, ranging from 0.9 % for syphilis, 1.1 % for gonorrhea, and 3.1 % for Chlamydia. The data suggest high prevalence of HIV among FSWs in Nairobi. Targeted and routine HIV and STI combination prevention strategies need to be scaled up or established to meet the needs of this population. |
HIV and STI prevalence and injection behaviors among people who inject drugs in Nairobi: results from a 2011 bio-behavioral study using respondent-driven sampling
Tun W , Sheehy M , Broz D , Okal J , Muraguri N , Raymond HF , Musyoki H , Kim AA , Muthui M , Geibel S . AIDS Behav 2015 19 Suppl 1 24-35 There is a dearth of evidence on injection drug use and associated HIV infections in Kenya. To generate population-based estimates of characteristics and HIV/STI prevalence among people who inject drugs (PWID) in Nairobi, a cross-sectional study was conducted with 269 PWID using respondent-driven sampling. PWID were predominantly male (92.5 %). An estimated 67.3 % engaged in at least one risky injection practice in a typical month. HIV prevalence was 18.7 % (95 % CI 12.3-26.7), while STI prevalence was lower [syphilis: 1.7 % (95 % CI 0.2-6.0); gonorrhea: 1.5 % (95 % CI 0.1-4.9); and Chlamydia: 4.2 % (95 % CI 1.2-7.8)]. HIV infection was associated with being female (aOR, 3.5; p = 0.048), having first injected drugs 5 or more years ago (aOR, 4.3; p = 0.002), and ever having practiced receptive syringe sharing (aOR, 6.2; p = 0.001). Comprehensive harm reduction programs tailored toward PWID and their sex partners must be fully implemented as part of Kenya's national HIV prevention strategy. |
HIV and STI prevalence and risk factors among male sex workers and other men who have sex with men in Nairobi, Kenya
Muraguri N , Tun W , Okal J , Broz D , Raymond HF , Kellogg T , Dadabhai S , Musyoki H , Sheehy M , Kuria D , Kaiser R , Geibel S . J Acquir Immune Defic Syndr 2015 68 (1) 91-6 Previous surveys of men who have sex with men (MSM) in Africa have not adequately profiled HIV status and risk factors by sex work status. MSM in Nairobi, Kenya, were recruited using respondent-driven sampling, completed a behavioral interview, and were tested for HIV and sexually transmitted infections. Overlapping recruitment among 273 male sex workers and 290 other MSM was common. Sex workers were more likely to report receptive anal sex with multiple partners (65.7% versus 18.0%, P < 0.001) and unprotected receptive anal intercourse (40.0% versus 22.8%, P = 0.005). Male sex workers were also more likely to be HIV infected (26.3% versus 12.2%, P = 0.007). |
Pregnancy desire and dual method contraceptive use among people living with HIV attending clinical care in Kenya, Namibia and Tanzania
Antelman G , Medley A , Mbatia R , Pals S , Arthur G , Haberlen S , Ackers M , Elul B , Parent J , Rwebembera A , Wanjiku L , Muraguri N , Gweshe J , Mudhune S , Bachanas P . J Fam Plann Reprod Health Care 2015 41 (1) e1 AIM: To describe factors associated with pregnancy desire and dual method use among people living with HIV in clinical care in sub-Saharan Africa. DESIGN: Sexually active HIV-positive adults were enrolled in 18 HIV clinics in Kenya, Namibia and Tanzania. Demographic, clinical and reproductive health data were captured by interview and medical record abstraction. Correlates of desiring a pregnancy within the next 6 months, and dual method use [defined as consistent condom use together with a highly effective method of contraception (hormonal, intrauterine device (IUD), permanent)], among those not desiring pregnancy, were identified using logistic regression. RESULTS: Among 3375 participants (median age 37 years, 42% male, 64% on antiretroviral treatment), 565 (17%) desired a pregnancy within the next 6 months. Of those with no short-term fertility desire (n=2542), 686 (27%) reported dual method use, 250 (10%) highly effective contraceptive use only, 1332 (52%) condom use only, and 274 (11%) no protection. Respondents were more likely to desire a pregnancy if they were from Namibia and Tanzania, male, had a primary education, were married/cohabitating, and had fewer children. Factors associated with increased likelihood of dual method use included being female, being comfortable asking a partner to use a condom, and communication with a health care provider about family planning. Participants who perceived that their partner wanted a pregnancy were less likely to report dual method use. CONCLUSIONS: There was low dual method use and low use of highly effective contraception. Contraceptive protection was predominantly through condom-only use. These findings demonstrate the importance of integrating reproductive health services into routine HIV care. |
Mother-to-child transmission of HIV in Kenya: results from a nationally representative study
Sirengo M , Muthoni L , Kellogg TA , Kim AA , Katana A , Mwanyumba S , Kimanga DO , Maina WK , Muraguri N , Elly B , Rutherford GW . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S66-74 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. |
Kenya AIDS Indicator Surveys 2007 and 2012: implications for public health policies for HIV prevention and treatment
Maina WK , Kim AA , Rutherford GW , Harper M , K'Oyugi B O , Sharif S , Kichamu G , Muraguri NM , Akhwale W , De Cock KM . J Acquir Immune Defic Syndr 2014 66 Suppl 1 S130-7 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. |
Enumeration of sex workers in the central business district of Nairobi, Kenya
Kimani J , McKinnon LR , Wachihi C , Kusimba J , Gakii G , Birir S , Muthui M , Kariri A , Muriuki FK , Muraguri N , Musyoki H , Ball TB , Kaul R , Gelmon L . PLoS One 2013 8 (1) e54354 Accurate program planning for populations most at risk for HIV/STI acquisition requires knowledge of the size and location where these populations can best be reached. To obtain this information for sex workers operating at 137 hotspots in the central business district (CBD) in Nairobi, Kenya, we utilized a combined mapping and capture-recapture enumeration exercise. The majority of identified hotspots in this study were bars. Based on this exercise, we estimate that 6,904 male and female sex workers (95% confidence intervals, 6690 and 7118) were working nightly in the Nairobi CBD in April 2009. Wide ranges of captures per spot were obtained, suggesting that relatively few hot spots (18%) contain a relatively high proportion of the area's sex workers (65%). We provide geographic data including relatively short distances from hotspots to our dedicated sex worker outreach program in the CBD (mean<1 km), and clustering of hotspots within a relatively small area. Given the size covered and areas where sex work is likely taking place in Nairobi, the estimate is several times lower than what would be obtained if the entire metropolitan area was enumerated. These results have important practical and policy implications for enhancing HIV/STI prevention efforts. |
Integrated HIV testing, malaria, and diarrhea prevention campaign in Kenya: modeled health impact and cost-effectiveness
Kahn JG , Muraguri N , Harris B , Lugada E , Clasen T , Grabowsky M , Mermin J , Shariff S . PLoS One 2012 7 (2) e31316 BACKGROUND: Efficiently delivered interventions to reduce HIV, malaria, and diarrhea are essential to accelerating global health efforts. A 2008 community integrated prevention campaign in Western Province, Kenya, reached 47,000 individuals over 7 days, providing HIV testing and counseling, water filters, insecticide-treated bed nets, condoms, and for HIV-infected individuals cotrimoxazole prophylaxis and referral for ongoing care. We modeled the potential cost-effectiveness of a scaled-up integrated prevention campaign. METHODS: We estimated averted deaths and disability-adjusted life years (DALYs) based on published data on baseline mortality and morbidity and on the protective effect of interventions, including antiretroviral therapy. We incorporate a previously estimated scaled-up campaign cost. We used published costs of medical care to estimate savings from averted illness (for all three diseases) and the added costs of initiating treatment earlier in the course of HIV disease. RESULTS: Per 1000 participants, projected reductions in cases of diarrhea, malaria, and HIV infection avert an estimated 16.3 deaths, 359 DALYs and $85,113 in medical care costs. Earlier care for HIV-infected persons adds an estimated 82 DALYs averted (to a total of 442), at a cost of $37,097 (reducing total averted costs to $48,015). Accounting for the estimated campaign cost of $32,000, the campaign saves an estimated $16,015 per 1000 participants. In multivariate sensitivity analyses, 83% of simulations result in net savings, and 93% in a cost per DALY averted of less than $20. DISCUSSION: A mass, rapidly implemented campaign for HIV testing, safe water, and malaria control appears economically attractive. |
Voluntary medical male circumcision: translating research into the rapid expansion of services in Kenya, 2008-2011
Mwandi Z , Murphy A , Reed J , Chesang K , Njeuhmeli E , Agot K , Llewellyn E , Kirui C , Serrem K , Abuya I , Loolpapit M , Mbayaki R , Kiriro N , Cherutich P , Muraguri N , Motoku J , Kioko J , Knight N , Bock N . PLoS Med 2011 8 (11) e1001130 Since the World Health Organization and the Joint United Nations Programme on HIV/AIDS recommended implementation of medical male circumcision (MC) as part of HIV prevention in areas with low MC and high HIV prevalence rates in 2007, the government of Kenya has developed a strategy to circumcise 80% of uncircumcised men within five years. To facilitate the quick translation of research to practice, a national MC task force was formed in 2007, a medical MC policy was implemented in early 2008, and Nyanza Province, the region with the highest HIV burden and low rates of circumcision, was prioritized for services under the direction of a provincial voluntary medical male circumcision (VMMC) task force. The government's early and continuous engagement with community leaders/elders, politicians, youth, and women's groups has led to the rapid endorsement and acceptance of VMMC. In addition, several innovative approaches have helped to optimize VMMC scale-up. Since October 2008, the Kenyan VMMC program has circumcised approximately 290,000 men, mainly in Nyanza Province, an accomplishment made possible through a combination of governmental leadership, a documented implementation strategy, and the adoption of appropriate and innovative approaches. Kenya's success provides a model for others planning VMMC scale-up programs. |
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