Mother-baby dyads enrolled in PMTCT care in western Kenya: characteristics and implications for ART programmes.

The objective of the study was to establish the mother-baby pair characteristics that contribute to vertical transmission of HIV and elucidate on remediation. We assessed for factors increasing the odds of HIV transmission in children born to HIV-infected mothers in western Kenya. We used a retrospective study which reviewed routinely collected data of 1 028 mother-baby pairs enrolled in a prevention of mother-to-child transmission (PMTCT) programme in western Kenya from January to December 2015. We compared the transmission rates amongst mothers known to have a positive HIV status before conception (known positives/KPs) versus the transmission amongst those who were newly diagnosed during maternal and child health (MCH) clinic attendance (new positives/NPs). We compared the socio-demographic and clinical characteristics of the mothers using chi square and Kruskal-Wallis tests at 95% confidence interval (CI). We assessed for factors associated with the infants' HIV status using a logistic regression model. The results revealed that 60% (622) of the mothers were KPs, and that KPs and NPs had mother-to-child transmission (MTCT) rates of 5.5% and 20.7% respectively. Close to 90% of the NP Mothers were at an early HIV clinical stage at enrolment and 40% were enrolled after delivery. The infants of NPs were enrolled at a mean age of 18.3 weeks compared to 6.6 weeks for the infants of the KPs. On adjusted multivariable analysis, child's age at enrolment (AOR = 1.05, 95%CI = 1.036-1.064) and mother's status at conception (AOR = 1.96, 95%CI = 1.042-3.664) were significantly associated with the infant's HIV status. None of the HIV infected infants had received nevirapine prophylaxis. Most of the mothers enrolling into the PMTCT programme have a known HIV-positive status, however, NPs are the largest contributors to continued MTCT.

Effect of cognitive behaviour therapy on depressive symptoms among HIV-infected outpatients in Kenya

Timely diagnosis and treatment of depression among persons living with HIV (PLWH) in sub-Saharan Africa which is home to about 70% of global HIV infection is disproportionately low. In Kenya, the effect of cognitive behaviour therapy (CBT) for depression has scarcely been established through a study. Hence, we conducted an experimental study to test the effectiveness of CBT for depression among PLWH attending outpatient clinics in western Kenya. The intervention was a 2-hour weekly group-CBT conducted for 6 successive weeks. Out of 53 participants recruited, 26 were randomly assigned to CBT and 27 to control arms of the study. Data were collected using Patient Health Questionnaire (PHQ-9). Depression symptom was diagnosed for a score of >5 and reported functional impairment in the past 2 weeks. At baseline, the difference in median PHQ scores for CBT and control groups was not statistically significant (p= .644, 95%CI). At month-2, a significantly higher proportion of participants in the CBT condition had a reduction in depressive symptoms (a drop of 5.8 points) compared to those in the control arm who had a drop of 1.9 points (p= .001, 95% CI). We assessed the effect of CBT on depression and found a statistically significant result, Z= -3.276, p <.001, with a relatively large effect size (r= .5). The treatment effect of CBT was evidently sustained at 2 months post-treatment. We therefore recommend a larger randomised controlled trial to evaluate the effectiveness of CBT for long term treatment gains in similar settings (AU)

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Systematic cultural adaptation of cognitive-behavioral therapy to reduce alcohol use among HIV-infected outpatients in western Kenya.

Two-thirds of those with HIV worldwide live in sub-Saharan Africa. Alcohol use is associated with the HIV epidemic through risky sex and suboptimal ARV adherence. In western Kenya, hazardous drinking was reported by HIV (53%) and general medicine (68%) outpatients. Cognitive behavioral treatment (CBT) has demonstrated strong efficacy to reduce alcohol use. This article reports on a systematic cultural adaptation and pilot feasibility study of group paraprofessional-delivered CBT to reduce alcohol use among HIV-infected outpatients in Eldoret, Kenya. Following adaptation and counselor training, five pilot groups were run (n = 27). Overall attendance was 77%. Percent days abstinent from alcohol (PDA) before session 1 was 52-100% (women) and 21-36% (men), and by session 6 was 96-100% (women) and 89-100% (men). PDA effect sizes (Cohen's d) between first and last CBT session were 2.32 (women) and 2.64 (men). Participants reported treatment satisfaction. Results indicate feasibility, acceptability and preliminary efficacy for CBT in Kenya.