During recent years, Quality of Life (QoL) is a significant assessment factor in clinical trials and epidemiological researches due to the advent of Antiretroviral Therapy (ART), Human Immunodeficiency Virus (HIV) has become a manageable,chronic disease. With regards, more attention must be paid to the QoL of infected patients. Limited evidence exists on the impact of ART on QoL among HIV infected patients. Due to lacking of a systematic approach to summarizing the available evidence on the clinical determinants of People Who Live with HIV/AIDS (PWLHs’) QoL, this study aimed to analyze the impact of clinical determinants (ART experience, CD4 count < 200, co-morbidities, time diagnosis and accessibility to cares) on QoL among PWLHs’. This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). PubMed, Science Direct, Web of Science, and Cochrane electronic databases were searched in February 2017 to identify all past studies that discussed social and behavioral characteristics of QoL in PLWHA. To recognize effective factors on social and behavioral QoL, a meta-analysis was conducted. Polled Odds Ratios (ORs) were utilized at a 95% confidence level. Since sampling methods differed between articles in the systematic review, we evaluated pooled estimates using a random effect model. Metan, metareg, metacum, and metabias commands in STATA version 13.0 were applied to analyze the data. Our findings indicated that ART has a positive impact on QoL, with a pooled effect size at approximately 1.04 with a confidence interval between 0.42 to 1.66 which indicates this impact is not very considerable and may be relatively neutral. The pooled effect size for CD4 count on QoL was .29 (95%CI = .22–.35), indicating that there is a negative associate between CD4 count and QoL. The co-morbidity as a negative determinant for QoL among HIV/AIDS infected people. The pooled effect size implies on a relative neutral association, although the confidence interval is wide and ranges between 0.32 to 1.58. The pooled effect size is about 1.82 with confidence interval 1.27 to 2.37 which indicates a considerable positive association with lowest level of heterogeneity. The results illustrated that time diagnosing and availability to hospital services had significant relationship with a higher QoL and CD4 < 200 was associated with a lower QoL. In conclusion, policy makers should set an agenda setting to provide a suitable diagnostic and therapeutic facilities to early detecting and continues monitoring the health status of People Who Live with HIV/AIDS (PWLHs’).

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Clinical determinants associated with quality of life for people who live with HIV/AIDS: a Meta-analysis.

Although HIV/AIDS is a global epidemic the majority of people living with HIV/AIDS are in sub-Saharan Africa. It is a leading cause of death in that region and a serious public health problem with southern Africa being the most affected. Sub-Saharan Africa is the only part of the world where HIV prevalence and AIDS deaths are higher for women than for men. The gender dimension is therefore vital to understanding how HIV is spread: the concept facilitates an analysis of how men’s and women’s roles increase vulnerability to the disease. In every society males and females — who by nature are biologically different — are expected to behave in prescribed ways. In some cultures in southern Africa men are expected to have multiple partners while women are expected to be monogamous; the age of marriage is often lower for females than for males and men are expected to have younger sexual partners. Common law and customary laws reinforce these expectations. (excerpt)

Correcting gender inequalities is central to controlling HIV / AIDS [editorial]

Introduction dual contraception, the use of non-barrier contraceptive method in combination with condoms, is an effective strategy in the elimination of mother-to-child transmission (eMTCT) of human immunodeficiency virus (HIV) and the achievement of zero new HIV infections. Despite its effectiveness, dual contraception use among HIV-infected women in Kenya remains low. We identified factors associated with dual contraceptive uptake in Bungoma County, Kenya. Methods this was a facility-based cross-sectional study in eight hospitals in Bungoma County. We interviewed women using structured questionnaires. We calculated descriptive statistics about the womens' baseline characteristics, examined the association between dual contraceptive use and other factors by calculating Odds Ratios (OR) and 95% Confidence Intervals (CI) and performed logistic regression. Results we recruited 283 HIV-infected women.Among all enrolled women, 190 (67.1%) were aware of dual method and only 109 (38.5%) used dual contraception. The preferred dual pattern was male condom plus injectable contraceptive used by 53.2% of women (58/109). Among the 174 women who did not use dual contraception, 86 (49.4%) preferred using male condoms alone for contraception. Women were more likely to use dual contraception method if they were aware of dual contraception (AOR 12.2, 95% CI 4.7 - 31.7), used non-barrier contraceptives (AOR 9.8 95%; CI 4.5 - 21.3) and had disclosed their HIV status (AOR 7.1 95% CI 2.8 - 18.2) compared to those who did not. Conclusion dual contraceptive prevalence was low. Advocacy on dual contraception as an approach to preventing vertical transmission of HIV should be escalated in order to improve its uptake.

Factors associated with uptake of dual contraception among HIV-infected women in Bungoma County, Kenya: a cross-sectional study.

Abstract Background Involving men and boys as both users and supporters of Family Planning (FP) is now considered essential for optimising maternal and child health outcomes. Evidence on how to engage men and boys to meet FP needs is therefore important. Objectives The main objective of this review was to assess the strength of evidence in the area and uncover the effective components and critical process‐ and system‐level characteristics of successful interventions. Search Methods We searched nine electronic databases, seven grey literature databases, organisational websites, and the reference lists of systematic reviews relating to FP. To identify process evaluations and qualitative papers associated with the included experimental studies, we used Connected Papers and hand searches of reference lists. Selection Criteria Experimental and quasi‐experimental studies of behavioural and service‐level interventions involving males aged 10 years or over in low‐ and middle‐income countries to increase uptake of FP methods were included in this review. Data Collection and Analysis Methodology was a causal chain analysis involving the development and testing of a logic model of intervention components based on stakeholder consultation and prior research. Qualitative and quantitative data relating to the evaluation studies and interventions were extracted based on the principles of ‘effectiveness‐plus’ reviews. Quantitative analysis was undertaken using r with robust variance estimation (RVE), meta‐analysis and meta‐regression. Qualitative analysis involved ‘best fit’ framework synthesis. Results We identified 8885 potentially relevant records and included 127 in the review. Fifty‐nine (46%) of these were randomised trials, the remainder were quasi‐experimental studies with a comparison group. Fifty‐four percent of the included studies were assessed as having a high risk of bias. A meta‐analysis of 72 studies (k = 265) showed that the included group of interventions had statistically significantly higher odds of improving contraceptive use when compared to comparison groups (odds ratio = 1.38, confidence interval = 1.21 to 1.57, prediction interval = 0.36 to 5.31, p < 0.0001), but there were substantial variations in the effect sizes of the studies (Q = 40,647, df = 264, p < 0.0001; I 2 = 98%) and 73% was within cluster/study. Multi‐variate meta‐regression revealed several significant intervention delivery characteristics that moderate contraceptive use. These included community‐based educational FP interventions, interventions delivered to women as well as men and interventions delivered by trained facilitators, professionals, or peers in community, home and community, or school settings. None of the eight identified intervention components or 33 combinations of components were significant moderators of effects on contraceptive use. Qualitative analysis highlighted some of the barriers and facilitators of effective models of FP that should be considered in future practice and research. Authors' Conclusions FP interventions that involve men and boys alongside women and girls are effective in improving uptake and use of contraceptives. The evidence suggests that policy should continue to promote the involvement of men and boys in FP in ways that also promote gender equality. Recommendations for research include the need for evaluations during conflict and disease outbreaks, and evaluation of gender transformative interventions which engage men and boys as contraceptive users and supporters in helping to achieve desired family size, fertility promotion, safe conception, as well as promoting equitable family planning decision‐making for women and girls.

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Involving men and boys in family planning: A systematic review of the effective components and characteristics of complex interventions in low‐ and middle‐income countries

HIV-1 sero-discordant couples are at risk of transmitting to each other HIV, HBV and HCV. This cross-sectional study evaluated the prevalence of HBV and HCV infection and associated risk factors among 270 heterosexual HIV sero-discordant couples. Serum samples and data from questionnaires at baseline were obtained from the Phase III randomized placebo-controlled trial of acyclovir for Herpes Simplex Virus-2 suppression to prevent HIV transmission among HIV sero-discordant couples site in Kisumu. The serum samples were analyzed for Hepatitis B surface antigen, antibodies to Hepatitis B core antigen and HCV IgG antibodies. The prevalence of HBV and HCV was not associated with age, gender, income, education, number of children or years lived together and use of contraception. Regardless of whether the participants were HIV positive or not, HCV and HBV prevalence rates were 4%, 5.6% respectively, and HBV/HCV co-infection rate was 0.2%. HCV prevalence was associated with the HIV-1 infection. Since the prevalence of HBV was high, HBV prevention measures should be encouraged among HIV-1 sero-discordant couples to reduce HBV transmission rates among couples. All HIV-1 positive patients should be tested for both HBV and HCV, since HIV positive patients are likely to have HBV or HCV co-infection. Afr J Health Sci . 2016; 29(1):54-67

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The prevalence of hepatitis B and C viruses among HIV sero discordant couples in Kisumu, Kenya

Despite risks of HIV transmission to infants born of the HIV positive women, contraceptive use is uncommon among women in HIV discordant partnerships. The aim of this study was to determine the factors associated with contraceptive use in a clinical trial cohort of HIV serodiscordant couples based in Thika and Eldoret, Kenya. Data were analyzed from 481 HIV discordant couples enrolled in the Partners in Prevention HSV/HIV Transmission Study at the Thika and Eldoret sites. The primary study outcome was self-reported use of contraception other than condoms. Using a marginal longitudinal logistic model based on generalized estimating equations (GEE) approach we assessed the association of various demographic and behavioral factors with contraceptive use. At baseline the prevalence of non barrier contraceptive use among HIV positive and negative women was 24.3% and 25.7%, respectively. At month 12 of follow-up, the prevalence of contraceptive use was 44.4% among the HIV positive and 26% among the HIV negative women while at month 24, the prevalence of contraceptive use was 38.6% among the HIV positive and 18.2% among the HIV negative women. HIV positive women were more likely to report using contraception than HIV negative women (odds ratio (OR) 1.61 95% confidence interval (CI) 1.04-2.47). Additionally, being married (OR 2.4, 95% CI 1.2-5.0), attending Thika site clinic (OR 6.1, 95% CI 4.2-9.0), and having two or more children (OR 1.9, 95% CI 1.3-2.8) were significantly associated with use of non barrier contraceptives. Future programs should focus on interventions to increase contraceptive use among HIV serodiscordant couples, with a special emphasis on HIV negative women, unmarried women and women with few children.

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Correlates of contraceptive use among HIV discordant couples in Kenya

With the increasing use of antiretroviral therapy (ART) in developing countries, little is known on the potential impact of large-scale ART use on sexual behavior. We used Herpes simplex virus type 2 (HSV-2) infection as a marker for sexual behavior to aid in assessing the association between ART related knowledge and beliefs and sexual behavior. This cross-sectional study analyzed secondary data collected in Kisumu’s general population. A total of 1,655 participants (749 men, 906 women) aged 15 to 49yrs were interviewed. Socio-demographic factors, prevalence of HSV-2 and ART related knowledge and beliefs and their association with HSV-2 infection were evaluated. Overall, the prevalence of HSV-2 was 53%, and significantly higher in females (65%) than males (38%), p 2 times odds of having HSV-2 (aOR: 2.02, 95% CI: 1.1 to 3.43) similar observations in females (aOR: 2.14, 95% CI: 1.34 to 3.40). Misinformation on ART capability may lead to increased HIV and sexually transmitted infection incidence if people think they are a cure for HIV. Targeted informative messages on ART to those at risk may aid in reducing the incidence of HSV-2.

	 

	Key words: Antiretroviral therapy, knowledge, beliefs, herpes simplex virus, general population, Kisumu, Kenya.

https://www.academicjournals.org/article/article1379665566_Njuguna et al.pdf

Herpes simplex virus type 2 seroprevalence, HIV and Antiretroviral therapy knowledge and beliefs in the general population in Kisumu, Kenya

Opportunistic infections (OIs) are the main cause of morbidity and mortality in patients with HIV-1 infection throughout the world, particularly among patients who have not had access to anti-retroviral therapy (ART) and other HIV care services. 1, 2, 3 Among patients taking ART, OIs can present when the immune system starts to recover aka immune reconstitution inflammatory syndrome (IRIS). 4, 5 Also, some patients do not have a sustained response to ART due to lack of adherence to medications, development of drug resistance, or suboptimal therapeutic regimens. 1 Therefore, OIs continue to cause substantial morbidity and mortality even after initiation of ART.

The World Health Organization (WHO) developed HIV clinical staging criteria based on OIs to standardize disease severity classification in the absence of virologic or immunologic measurements. 6, 7 Diagnosis of WHO stage 4 conditions remains important in the ART era in order to: 1) help determine timing of ART initiation, and 2) treat OIs to reduce morbidity and mortality. There are no published data from Kenya that quantify the burden of WHO stage 4 conditions that persist in the ART era and continue to negatively impact patient survival. We therefore set out to determine the prevalence and gender distribution of WHO stage 4 conditions among patients enrolled in a large peri-urban HIV clinic in western Kenya.

Frankline Onchiri

Papers

Correlates of contraceptive use among HIV discordant couples in Kenya

Herpes simplex virus type 2 seroprevalence, HIV and Antiretroviral therapy knowledge and beliefs in the general population in Kisumu, Kenya

World Health Organization's stage 4 conditions among adults accessing outpatient HIV care: a retrospective cohort study in Kisumu, Kenya.