Impact of HIV Self-Test Distribution to Male Partners of ANC Clients: Results of a Randomized Controlled Trial in Kenya.

BACKGROUND: In Kenya, HIV testing during first antenatal care (ANC) visit is a standard practice for pregnant women. Despite a policy promoting male partner testing in ANC, few male partners accompany their partners for HIV testing. We evaluated the impact of using oral HIV self-testing on HIV couples testing among ANC clients in Kenya and their male partners. METHODS: In a 3-arm randomized control study in eastern and central Kenya, consenting women attending the first ANC visit were randomized to receive: (1) standard-of-care and a standard information card; (2) an improved card stating the importance of male HIV testing; and (3) 2 oral HIV self-test kits and HIV testing information. Women completed a baseline and endline questionnaire, and consenting male partners were surveyed 3 months after enrolling female ANC clients. The primary outcome was HIV couples testing as reported by the female partners. RESULTS: We randomized 1410 women at their first ANC visit of which 1215 were successfully followed up. One thousand one hundred thirty-three male partners consented to the survey. In the self-testing study arm 3, 79.1% (334/422) of the women reported that their partner tested for HIV as part of a couple, compared with 27% (110/406) and 35.1% (136/387) in study arm 1 and study arm 2, respectively. More than 90% of male partners who used the oral HIV self-test kits reported that it was easy to take sample and read the test results. CONCLUSIONS: The study demonstrates that the ANC platform offers a unique opportunity to increase HIV couples testing among men using self-testing through distribution by their female partners.

Enhancing Maternal and Child Health using a Combined Mother & Child Health Booklet in Kenya.

Under Kenyan guidelines, HIV-exposed infants should be tested for HIV DNA at 6 weeks or at first clinical contact thereafter, as infants come for immunization. Following the introduction of early infant diagnoses programmes, however, many infants were not being tested and linked to care and treatment. We developed the Mother & Child Health Booklet to help relate mothers' obstetrical history to infants' healthcare providers to facilitate follow-up and timely management. The booklet contains information on the mother's pregnancy, delivery and postpartum course and her child's growth and development, immunization, nutrition and other data need to monitor the child to 5 years of age. It replaced three separate record clinical cards. In a 1 year pilot evaluation of the booklet in Nyanza province in 2007-08, the number of HIV DNA tests on infants increased by 34% from 9966 to 13 379. The booklet was subsequently distributed nationwide in 2009. Overall, the numbers of infants tested for HIV DNA rose from 27 000 in 2007 to 60 000 in 2012, which represents approximately 60% of the estimated HIV-exposed infants in Kenya. We believe that the booklet is an important strategy for identifying and treating infected infants and, thus, in progress toward Millennium Development Goal 4.

Client satisfaction determinants in four Kenyan slums.

PURPOSE: In Kenya, gaps exist in health service provision to slum residents, especially service availability and access to quality care. There is also little information on the health status of people living in slums other than in Nairobi. The purpose of this paper is to generate evidence for use in designing interventions to improve health services in four mid-sized slums in Embu, Nyeri and Thika, Kenya. DESIGN/METHODOLOGY/APPROACH: A cross-sectional survey of clients receiving services in health facilities was conducted in the targeted slums. Data were collected through face-to-face interviews. Factor scores were generated using the Rasch model; simple and multivariate logistic regression analyses were done using the R statistical software. FINDINGS: Overall, 81 per cent of the 203 participants reported being satisfied with health services. Most clients (89 per cent) reported that health facility staff greeted them warmly; 82 per cent said their consultation was private. The facility type, waiting time and client experience with service providers determined their satisfaction (p<0.05). PRACTICAL IMPLICATIONS: Healthcare managers can improve client satisfaction levels by understanding the client flow in their facilities and addressing causes of client dissatisfaction, such as long waiting times, while at the same time promoting facilitating factors. ORIGINALITY/VALUE: The authors use latent variable modelling to compute client satisfaction scores, which were dichotomised into two categories and fitted into a logistic regression model to identify factors that influence client satisfaction. Health facility clients in the four slums are satisfied with services and have confidence the providers will serve them in a friendly and professional manner that promotes respect and quality care. The paper recommend healthcare managers in similar settings carry out client flow analysis and institute remedial measures to address long waiting times. Qualitative studies are recommended to determine the reasons behind the high satisfaction levels reported in this study.

Case Study: A Rapid Rollout of Universal Maternal HAART Improves Outcomes among HIV-Positive Women and Their Infants in Kenya.

Globally, countries have made significant achievements in reducing rates of mother-to-child transmission (MTCT) of HIV. In Kenya, MTCT rates were most recently estimated at 8%, with 220,000 children under 15 years of age living with HIV. In 2013, the World Health Organization recommended highly active antiretroviral therapy (HAART) for all HIV-infected pregnant and lactating women. APHIAPLUSKAMILI supported rollout of a county-level, targeted, rapid scale-up of HAART in 152 high-volume facilities in Kenya. A review and comparison of data from these facilities in 2013 and 2014 revealed a significant increase in the proportion of women started on HAART and a reduction in MTCT.

Perceptions of child discipline and its contributions to child abuse in a low-income community in Nairobi, Kenya.

BACKGROUND: There is a fine line between child discipline and maltreatment. Perceptions of child discipline in three tribal groups living in an informal community in Kenya are reported. METHODS: Child disciplinary practices in the Kibera community of Nairobi were surveyed among three tribal groups (the Luo, Luyha and Nubi) to determine perceptions and modes of discipline and what was perceived as excessive. RESULTS: A random sample of 538 adults with children <18 years; 73% were mothers and 20% fathers. Overall, 98% had ever disciplined a child; 376 (70%) understood discipline to mean showing love and praising children when they do good but punishing wrong-doing, and 108 (20%) understood it to mean beating children whenever they do wrong. The majority said children should be disciplined by the mother (62%), father (47%) or whoever is around at the time of the offence (57%). It was deemed acceptable that teachers discipline children by 11% of the Luos, 23% of the Luhya and 34% of the Nubi. The most commonly used method was caning, used by 520 (97%), then pinching (40%), slapping (33%), pulling ears (20%) and denying food (19%). Sixty-three per cent of parents recognized that excessive punishment could cause fainting, and 64% that it could cause death. Factors reported as contributing to excessive discipline were domestic tension, poverty, stress and 'difficult children'. CONCLUSION: There were consistent patterns of child discipline in three tribal groups living in Nairobi. There was a high prevalence of excessive discipline in the form of physical abuse, and clinicians should be aware of the signs of excessive discipline and be prepared to act in the interests of the child's welfare.

Evaluation of a new serotyping kit for Streptococcus pneumoniae.

A new serotyping test kit (Streptococcus pneumoniae antisera "Seiken" set; Denka kit) was evaluated for 285 strains of Streptococcus pneumoniae in comparison with the standard capsular reaction (Quellung test). This new kit is based on the slide-agglutination method and is composed of eight pool sera, 40 group or type sera and 41 specific type sera. All serotyping results by using the Denka kit were completely identical to those obtained by using the conventional Quellung test. For types and groups, sensitivity and specificity were 100 and 100 %, respectively. For specific types, sensitivity and specificity were 100 and 100 %, respectively. The Denka kit is relatively rapid (mean test time, 5 min, versus 15 min by Quellung test), cheap (0.5 US$ per test, versus 1.4 US$ per Quellung test), easy to perform and does not require special equipment. The Denka kit may be useful for fieldworkers in developing countries involved in epidemiological surveys and vaccine development.