Factors associated with enrollment into differentiated service delivery model among adults with HIV in Kenya.

INTRODUCTION: Differentiated service delivery (DSD) such as multimonth dispensing (MMD) aims to provide client-centered HIV services, while reducing the workload within health facilities. We assessed individual and facility factors associated with receiving more than three MMD and switching from ≥3MMD back to <3MMD in Kenya. METHODS: We conducted a retrospective cohort study of clients eligible for DSD between July 2017 and December 2019. A random sample of clients eligible for DSD was selected from 32 randomly selected facilities located in Nairobi, Kisii, and Migori counties. We used a multilevel Poisson regression model to assess the factors associated with receiving ≥3MMD, and with switching from ≥3MMD back to <3MMD. RESULTS: A total of 3501 clients eligible for ≥3MMD were included in our analysis: 1808 (51.6%) were receiving care in Nairobi County and the remaining 1693 (48.4%) in Kisii and Migori counties. Overall, 65% of clients were enrolled in ≥3MMD at the time of entry into the cohort. In the multivariable model, younger age (20-24; 25-29; 30-34 vs. 50 or more years) and switching ART regimen was significantly associated with a lower likelihood of ≥3MMD uptake. Factors associated with a higher likelihood of enrollment in ≥3MMD included receiving DTG vs. EFV-based ART regimen (aRR: 1.10; 95% confidence interval: 1.05-1.15). CONCLUSION: Client-level characteristics are associated with being on ≥3MMD and the likelihood of switching from ≥3MMD to <3MMD. Monitoring DSD enrollment across different populations is critical to successfully implementing these models continually.

Grappling with the issue of homosexuality: perceptions, attitudes, and beliefs among high school students in Kenya.

While the past decade has seen an improvement in attitudes toward homosexuality, negative attitudes are still prevalent in many parts of the world. In general, increased levels of education tend to be predictive of relatively positive attitudes toward homosexuality. However, in most sub-Saharan countries, it is still believed that people are born heterosexual and that nonheterosexuals are social deviants who should be prosecuted. One such country is Kenya, where homosexuality is illegal and attracts a fine or jail term. The purpose of this study was to examine high school students' perceptions of homosexuality in Kenya. The participants included 1,250 high school students who completed a questionnaire on perceptions of homosexuality. The results showed that 41% claimed homosexuality is practiced in schools and 61% believed homosexuality is practiced mostly in single-sex boarding schools. Consistently, 52% believed sexual starvation to be the main cause of homosexuality. Also, 95% believed homosexuality is abnormal, 60% believed students who engage in homosexuality will not change to heterosexuality after school, 64% believed prayers can stop homosexuality, and 86% believed counseling can change students' sexual orientation. The consequences for homosexuality included punishment (66%), suspension from school (61%), and expulsion from school (49%). Significant gender and grade differences were found. The implications of the study findings are discussed.