Last data update: May 20, 2024. (Total: 46824 publications since 2009)
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Query Trace: Musyoki H[original query] |
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The genomic epidemiology of SARS-CoV-2 variants of concern in Kenya (preprint)
Githinji G , Lambisia AW , Omah I , O'Toole A , Mohamed KS , de Laurent ZR , Makori TO , Mwanga M , Mburu MW , Morobe JM , Ong'era EM , Ndwiga L , Gathii K , Thiongo K , Omuoyo DWO , Chepkorir E , Musyoki J , Kingwara L , Matoke D , Oyola SO , Onyango C , Waitumbi J , Bulimo W , Khamadi S , Kiiru JNO , Kinyanjui S , Cotten M , Tsofa B , Ochola-Oyier I , Rambaut A , Nokes DJ , Bejon P , Agoti C . medRxiv 2022 27 The emergence and establishment of SARS-CoV-2 variants of concern presented a major global public health crisis across the world. There were six waves of SARSCoV-2 cases in Kenya that corresponded with the introduction and eventual dominance of the major SARS-COV-2 variants of concern, excepting the first 2 waves that were both wild-type virus. We estimate that more than 1000 SARS-CoV-2 introductions occurred in the two-year epidemic period (March 2020 - September 2022) and a total of 930 introductions were associated with variants of concern namely Beta (n=78), Alpha(n=108), Delta(n=239) and Omicron (n=505). A total of 29 introductions were associated with A.23.1 variant that circulated in high frequencies in Uganda and Rwanda. The actual number of introductions is likely to be higher than these conservative estimates due to limited genomic sequencing. Our data suggested that cryptic transmission was usually underway prior to the first real-time identification of a new variant, and that multiple introductions were responsible. Following emergence of each VOC and subsequent introduction, transmission patterns were associated with hotspots of transmission in Coast, Nairobi and Western Kenya and follows established land and air transport corridors. Understanding the introduction and dispersal of major circulating variants and identifying the sources of new introductions is important to inform public health control strategies within Kenya and the larger East-African region. Border control and case finding reactive to new variants is unlikely to be a successful control strategy. Copyright The copyright holder for this preprint is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license. |
Pre-exposure prophylaxis rollout in a national public sector program: the Kenyan case study
Masyuko S , Mukui I , Njathi O , Kimani M , Oluoch P , Wamicwe J , Mutegi J , Njogo S , Anyona M , Muchiri P , Maikweki L , Musyoki H , Bahati P , Kyongo J , Marwa T , Irungu E , Kiragu M , Kioko U , Ogando J , Were D , Bartilol K , Sirengo M , Mugo N , Baeten JM , Cherutich P . Sex Health 2018 15 (6) 578-586 Background: While advances have been made in HIV prevention and treatment, new HIV infections continue to occur. The introduction of pre-exposure prophylaxis (PrEP) as an additional HIV prevention option for those at high risk of HIV may change the landscape of the HIV epidemic, especially in sub-Saharan Africa, which bears the greatest HIV burden. Methods: This paper details Kenya's experience of PrEP rollout as a national public sector program. The process of a national rollout of PrEP guidance, partnerships, challenges, lessons learnt and progress related to national scale up of PrEP in Kenya, as of 2018, is described. National rollout of PrEP was strongly lead by the government, and work was executed through a multidisciplinary, multi-organisation dedicated team. This required reviewing available evidence, providing guidance to health providers, integration into existing logistic and health information systems, robust communication and community engagement. Mapping of the response showed that subnational levels had existing infrastructure but required targeted resources to catalyse PrEP provision. Rollout scenarios were developed and adopted, with prioritisation of 19 counties focusing on high incidence area and high potential PrEP users to maximise impact and minimise costs. Results: PrEP is now offered in over 900 facilities countrywide. There are currently over 14000 PrEP users 1 year after launching PrEP.Conclusions: Kenya becomes the first African country to rollout PrEP as a national program, in the public sector. This case study will provide guidance for low- and middle-income countries planning the rollout of PrEP in response to both generalised and concentrated epidemics. |
Vulnerabilities at first sex and their association with lifetime gender-based violence and HIV prevalence among adolescent girls and young women engaged in sex work, transactional sex, and casual sex in Kenya
Becker ML , Bhattacharjee P , Blanchard JF , Cheuk E , Isac S , Musyoki HK , Gichangi P , Aral S , Pickles M , Sandstrom P , Ma H , Mishra S . J Acquir Immune Defic Syndr 2018 79 (3) 296-304 BACKGROUND: Adolescent girls and young women (AGYW) experience high rates of HIV early in their sexual life-course. We estimated the prevalence of HIV-associated vulnerabilities at first sex, and their association with lifetime gender-based violence (GBV) and HIV. METHODS: We conducted a cross-sectional bio-behavioural survey among AGYW (14-24 years) in Mombasa, Kenya in 2015. We compared the prevalence of first sex vulnerabilities across AGYW who self-identified as engaging in sex work (N=408), transactional sex (N=177) or casual sex (N=714); and used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes (GBV after first sex; HIV). RESULTS: The median age at first sex was 16 years (IQR 14 - 18). 43.6% received gifts or money at first sex; 41.2% and 11.2% experienced a coerced and forced first sex respectively. First sex vulnerabilities were generally more common among AGYW in sex work. GBV (prevalence 23.8%) and HIV (prevalence 5.6%) were associated with first sex before age 15 (GBV AOR 1.4, 95% CI 1.0-1.9; HIV AOR 1.9, 95% CI 1.1-1.3); before or within 1 year of menarche (GBV AOR 1.3, 95% CI 1.0-1.7; HIV AOR 2.1, 95% CI 1.3-3.6); and receipt of money (GBV AOR 1.9, 95% CI 1.4-2.5; HIV AOR 2.0, 95% CI 1.2-3.4). CONCLUSION: HIV-associated vulnerabilities begin at first sex and potentially mediate an AGYW's trajectory of risk. HIV prevention programmes should include structural interventions that reach AGYW early, and screening for a history of first sex vulnerabilities could help identify AGYW at risk of ongoing GBV and HIV.This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
The contributions and future direction of Program Science in HIV/STI prevention
Becker M , Mishra S , Aral S , Bhattacharjee P , Lorway R , Green K , Anthony J , Isac S , Emmanuel F , Musyoki H , Lazarus L , Thompson LH , Cheuk E , Blanchard JF . Emerg Themes Epidemiol 2018 15 7 Background: Program Science is an iterative, multi-phase research and program framework where programs drive the scientific inquiry, and both program and science are aligned towards a collective goal of improving population health. Discussion: To achieve this, Program Science involves the systematic application of theoretical and empirical knowledge to optimize the scale, quality and impact of public health programs. Program Science tools and approaches developed for strategic planning, program implementation, and program management and evaluation have been incorporated into HIV and sexually transmitted infection prevention programs in Kenya, Nigeria, India, and the United States. Conclusion: In this paper, we highlight key scientific contributions that emerged from the growing application of Program Science in the field of HIV and STI prevention, and conclude by proposing future directions for Program Science. |
Healthcare provider perspectives on managing sexually transmitted infections in HIV care settings in Kenya: A qualitative thematic analysis
Chesang K , Hornston S , Muhenje O , Saliku T , Mirjahangir J , Viitanen A , Musyoki H , Awuor C , Githuka G , Bock N . PLoS Med 2017 14 (12) e1002480 BACKGROUND: The burden of sexually transmitted infections (STIs) has been increasing in Kenya, as is the case elsewhere in sub-Saharan Africa, while measures for control and prevention are weak. The objectives of this study were to (1) describe healthcare provider (HCP) knowledge and practices, (2) explore HCP attitudes and beliefs, (3) identify structural and environmental factors affecting STI management, and (4) seek recommendations to improve the STI program in Kenya. METHODS AND FINDINGS: Using individual in-depth interviews (IDIs), data were obtained from 87 HCPs working in 21 high-volume comprehensive HIV care centers (CCCs) in 7 of Kenya's 8 regions. Transcript coding was performed through an inductive and iterative process, and the data were analyzed using NVivo 10.0. Overall, HCPs were knowledgeable about STIs, saw STIs as a priority, reported high STI co-infection amongst people living with HIV (PLHIV), and believed STIs in PLHIV facilitate HIV transmission. Most used the syndromic approach for STI management. Condoms and counseling were available in most of the clinics. HCPs believed that having an STI increased stigma in the community, that there was STI antimicrobial drug resistance, and that STIs were not prioritized by the authorities. HCPs had positive attitudes toward managing STIs, but were uncomfortable discussing sexual issues with patients in general, and profoundly for anal sex. The main barriers to the management of STIs reported were low commitment by higher levels of management, few recent STI-focused trainings, high stigma and low community participation, and STI drug stock-outs. Solutions recommended by HCPs included formulation of new STI policies that would increase access, availability, and quality of STI services; integrated STI/HIV management; improved STI training; increased supervision; standardized reporting; and community involvement in STI prevention. The key limitations of our study were that (1) participant experience and how much of their workload was devoted to managing STIs was not considered, (2) some responses may have been subject to recall and social desirability bias, and (3) patients or clients of STI services were not interviewed, and therefore their inputs were not obtained. While considering these limitations, the number and variety of facilities sampled, the mix of staff cadres interviewed, the use of a standardized instrument, and the consistency of responses add strength to our findings. CONCLUSIONS: This study showed that HCPs understood the challenges of, and solutions for, improving the management of STIs in Kenya. Commitment by higher management, training in the management of STIs, measures for reducing stigma, and introducing new policies of STI management should be considered by health authorities in Kenya. |
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. |
Estimating the prevalence and predictors of incorrect condom use among sexually active adults in Kenya: results from a nationally representative survey
Grasso MA , Schwarcz S , Galbraith JS , Musyoki H , Kambona C , Kellogg TA . Sex Transm Dis 2016 43 (2) 87-93 BACKGROUND: Condom use continues to be an important primary prevention tool to reduce the acquisition and transmission of HIV and other sexually transmitted infections. However, incorrect use of condoms can reduce their effectiveness. METHODS: Using data from a 2012 nationally representative cross-sectional household survey conducted in Kenya, we analyzed a subpopulation of sexually active adults and estimated the percent that used condoms incorrectly during sex, and the type of condom errors. We used multivariable logistic regression to determine variables to be independently associated with incorrect condom use. RESULTS: Among 13,720 adolescents and adults, 8014 were sexually active in the previous 3 months (60.3%; 95% confidence interval [CI], 59.0-61.7). Among those who used a condom with a sex partner, 20% (95% CI, 17.4-22.6) experienced at least one instance of incorrect condom use in the previous 3 months. Of incorrect condom users, condom breakage or leakage was the most common error (52%; 95% CI, 44.5-59.6). Factors found to be associated with incorrect condom use were multiple sexual partnerships in the past 12 months (2 partners: adjusted odds ratio [aOR], 1.5; 95% CI, 1.0-2.0; P = 0.03; ≥3: aOR, 2.3; 95% CI, 1.5-3.5; P < 0.01) and reporting symptoms of a sexually transmitted infection (aOR, 2.8; 95% CI, 1.8-4.3; P < 0.01). CONCLUSIONS: Incorrect condom use is frequent among sexually active Kenyans and this may translate into substantial HIV transmission. Further understanding of the dynamics of condom use and misuse, in the broader context of other prevention strategies, will aid program planners in the delivery of appropriate interventions aimed at limiting such errors. |
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). |
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. |
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