Knowledge, attitudes and practices regarding HIV/AIDS and STIs among youths and key populations in informal settlements of Nairobi, Kenya.

Kenya is home to one of the worst HIV/AIDS epidemics, with higher prevalence rates in youths in urban slums. We conducted a cross-sectional mixed-methods study in Nairobi informal settlements. The aim was to investigate knowledge, attitudes and behaviours of this marginalized community, and to identify, with a bottom-up approach, the most appropriate interventions to increase the utilization of HIV/STIs services. Preliminary qualitative research was used to draw questionnaires, which assessed: STIs/HIV/AIDS knowledge, attitudes, and behaviours; access and barriers to STIs/HIV/AIDS services; perceived quality of services; the impact of COVID-19. One thousand and fifty-four respondents completed the questionnaire. 48.3% were youth in the community, 23% youth in school, 16.8% young mothers, 6.9% drug users and 5% people attending a technical-vocational training. We found unsatisfactory knowledge of STIs/HIV/AIDS transmission and prevention, and low condom use, mainly due to difficult access, poverty, and gender-based violence. We also found limited use of health services, and lack of trust due to poor attitude of the staff. COVID-19 has widened barriers to access to health services. To reach this population, it is necessary to implement educational interventions, facilitate access to free condoms, and train health centre staff to be more welcoming. Respondents found proximity strategies more efficient, including door-to-door testing and community outreach.

Acute Delta Hepatitis in Italy spanning three decades (1991-2019): Evidence for the effectiveness of the hepatitis B vaccination campaign.

Updated incidence data of acute Delta virus hepatitis (HDV) are lacking worldwide. Our aim was to evaluate incidence of and risk factors for acute HDV in Italy after the introduction of the compulsory vaccination against hepatitis B virus (HBV) in 1991. Data were obtained from the National Surveillance System of acute viral hepatitis (SEIEVA). Independent predictors of HDV were assessed by logistic-regression analysis. The incidence of acute HDV per 1-million population declined from 3.2 cases in 1987 to 0.04 in 2019, parallel to that of acute HBV per 100,000 from 10.0 to 0.39 cases during the same period. The median age of cases increased from 27 years in the decade 1991-1999 to 44 years in the decade 2010-2019 (p < .001). Over the same period, the male/female ratio decreased from 3.8 to 2.1, the proportion of coinfections increased from 55% to 75% (p = .003) and that of HBsAg positive acute hepatitis tested for by IgM anti-HDV linearly decreased from 50.1% to 34.1% (p < .001). People born abroad accounted for 24.6% of cases in 2004-2010 and 32.1% in 2011-2019. In the period 2010-2019, risky sexual behaviour (O.R. 4.2; 95%CI: 1.4-12.8) was the sole independent predictor of acute HDV; conversely intravenous drug use was no longer associated (O.R. 1.25; 95%CI: 0.15-10.22) with this. In conclusion, HBV vaccination was an effective measure to control acute HDV. Intravenous drug use is no longer an efficient mode of HDV spread. Testing for IgM-anti HDV is a grey area requiring alert. Acute HDV in foreigners should be monitored in the years to come.