KAIS 2007 1 - Kenya National AIDS & STI Control Programme ...

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and treatment services and other health issues, such as tuberculosis, blood donation history,and medical injections.Figure A.2. Data collection tools, KAIS 2007.HOUSEHOLD QUESTIONNAIRE• Household census• Parental survivorship• Household characteristics• Mosquito net use• Support to households for sick andrecently deceased adults, and OVCsINDIVIDUAL QUESTIONNAIRE• Socio‐demographic characteristics• HIV/STI knowledge and attitudes• Marriage and sexual partnerships• Fertility and family planning• Use of HIV prevention, care andtreatment servicesBLOOD DRAW• Venous blood:HIV, HSV‐2, syphilis testing; CD4for those with HIV• Dried blood spot:HIV testing onlyRESULTS FORM• Specific test results retrieved• Individual or couple counselling• Minors with or without parents• Referrals providedBlood draw. All eligible women and men were asked individually for their voluntaryconsent to provide a venous blood sample in the home for HIV, syphilis, and HSV‐2 testing,as well as CD4 cell quantification if seropositive for HIV. They also were asked to consent toextended storage of their samples for future, unspecified testing.Experienced technicians were responsible for the collection of blood from the arm byvenipuncture. Blood was collected into two separate tubes, one with anticoagulant fromwhich serum was obtained for HIV, HSV‐2, and syphilis testing and the other designed tostabilise CD4 cells for up to seven days after collection. For participants who were willing toparticipate but refused the venous blood sample, dried blood spot (DBS) samples from afinger prick were collected. DBS samples were also collected in cases in which thevenipuncture process was not feasible.Training. In July 2007, 204 skilled interviewers, laboratory technicians, laboratory scientistsand field supervisors were recruited and trained for two weeks in the procedures for thesurvey. Interviewers were trained to identify eligible households and individuals, conductinformed consent, educate participants about HIV, HSV‐2, and syphilis, use objectiveinterview techniques, and administer the household and individual questionnaires. Fieldlaboratory technicians and scientists were trained in preparing respondents for the blooddraw and in collection, processing, storage, and transportation of specimens to the centrallaboratory in Nairobi. Laboratory training emphasized ways to minimise risks in handlingbiological specimens. Laboratory technicians were trained to process and analyse specimensKAIS 2007 284
in the laboratory and to issue vouchers for participants to retrieve their test results. Thetraining involved didactic presentations, small group discussions and practical sessions,such as mock interviews and blood draws.Community mobilisation. On August 1, 2007, KAIS was officially launched in conjunctionwith a national television, radio, and print media campaign to educate, sensitise, andmobilise Kenyans about the survey and the importance of broad participation. Mobilisationefforts then shifted to interpersonal communications at the community and village levels toraise awareness of the survey as a major surveillance initiative by the Government of Kenya.This also served to prepare communities before survey teams arrived.District statistical officers and enumerators helped to locate sampled clusters and sampledhouseholds. As KNBS staff, these officers and enumerators were knowledgable about censusenumeration systems and had developed a rapport with community and village leadersthrough previous surveys. Teams of trained community mobilisers then visited the villageleaders to discuss the survey and when possible held community meetings to explain thepurpose and process of the survey and to answer questions in a public forum. Mobiliserscommunicated regularly with data collection teams and were able to convey estimated datesof data collection to the sampled households.Fieldwork. Each field team consisted of four interviewers, two laboratory technicians, onesupervisor and one driver. A total of 29 field teams conducted fieldwork over a period offour months from August to December 2007. Teams were given local languagequestionnaires in addition to instruments in Kiswahili and English to accommodaterespondents who were not conversant in the local languages. Completed questionnaires foreach cluster were packed and delivered to KNBS headquarters in Nairobii through securedcourier services for data processing.After obtaining consent from the head of the household, interviewers administered thehousehold questionnaire to the household heads. This was followed by interviews andblood draws among all eligible and consenting individuals in participating households.Participants received bilingual (English and Kiswahili) brochures on HIV, HSV‐2, syphilis,and tuberculosis, including information on the association between the diseases and thevalue of knowing one’s HIV status.Supervision. Data collection teams were routinely visited by teams of supervisorsrepresenting different KAIS collaborating institutions. These supervision teams travelledthroughout the country to meet with field teams, deliver survey supplies, perform qualitychecks on questionnaires, assess mobilisation efforts, and help address challenges to datacollection. Supervision reports were circulated to the 2007 KAIS TWG members and pendingissues in the field were resolved after discussion.A.3 HUMAN SUBJECTSKAIS 2007 285
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KAIS 2007 1
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P.O. Box: 9361 Code: 00202 Nairobi,
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KEMRIKNASPKNBSKshLLITNMCHmlμLMOMSM
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KEY FINDINGS: HIV PREVENTION• Amo
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Among HIV‐uninfected women, 71.2%
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Men 5.4 26.3 1.9Total 7.1 35.1 1.8O
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Kenya is also committed to the “T
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Table 1.4 Distribution of sampled c
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1.7 SURVEY IMPLEMENTATIONTrainingIn
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Data processing included a number o
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Characteristic 2003 KDHS 2007 KAISQ
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Figure 1.11 Sampled clusters and el
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Table 1.11c Survey response rates b
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Population estimates reported in th
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2.4 HIV PREVALENCE AMONG YOUTHFigur
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Figure 2.6b HIV prevalence among ru
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2.7 HIV PREVALENCE BY PROVINCEFigur
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Figure 2.7c Estimated number of HIV
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2.9 HIV PREVALENCE BY EDUCATION LEV
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Figure 2.10b HIV prevalence among r
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2.11 HIV PREVALENCE BY TIME AWAY FR
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2.13 MALE CIRCUMCISION AND ASSOCIAT
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Figure 2.13c HIV prevalence among c
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Comparison of HIV Prevalence in the
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3.3 SEXFigure 3.3a HIV prevalence a
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Figure 3.4b. HIV prevalence among m
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3.7 PROVINCEFigure 3.7a HIV prevale
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2003 KDHS 1 2007 KAIS 2Marital stat
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3.10 WEALTH INDEXFigure 3.10a HIV p
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DATA IN CONTEXT: APPROACHES TO HIV
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Figure 4.3c Ever been tested for HI
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Figure 4.3e Ever been tested for HI
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Figure 4.3g Women aged 15-49 years
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Figure 4.4a Time since last HIV tes
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Figure 4.5a Reasons for not testing
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Increasing access to HIV testing wi
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4.7. Gaps and unmet needs• Two‐
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Figure 5.3b Self-reported HIV statu
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This section examines participants
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Figure 5.5a Knowledge of HIV status
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Figure 5.5c Percent of partnerships
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uninfected. A couple was considered
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Figure 5.6c Women and men aged 15-6
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Sexual Partners, Sexual DebutCircum
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Figure 6.3b. HIV prevalence among w
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Figure 6.3d. HIV prevalence among w
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Figure 6.3f. Men aged 15-64 years r
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In this section, “consistent cond
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Figure 6.4c. Marital or cohabiting
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Figure 6.5b. Young women and men ag
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Figure 6.5d. Young women and men ag
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Figure 6.6a. Male circumcision amon
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Figure 6.6d. HIV prevalence among m
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Knowledge, Attitudes and Beliefs ch
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Figure 7.3b. Most common source of
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Figure 7.3c Women and men aged 15-6
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Figure 7.3e Overall scores for 12 q
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Figure 7.3g Women and men aged 15-6
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Figure 7.3i Correct responses to se
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• If a female teacher has the AID
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7.5. Perceived risk of HIV infectio
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Figure 7.5c Reasons given for havin
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7.6. Attitudes toward women’s rol
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who had never been tested for HIV o
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8.2 INTRODUCTIONIn the absence of i
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8.3 ANTENATAL CLINIC ATTENDANCE, 20
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8.4 KNOWLEDGE OF MOTHER-TO-CHILD TR
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The analysis in this section consid
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Figure 8.5b Women aged 15-49 years
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• Incorrect communication or unde
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8.8 CURRENTLY PREGNANT WOMEN: HIV T
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Among currently pregnant women, 7.1
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Among pregnant, HIV‐uninfected wo
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Figure 8.11b Desire for a child in
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8.12 CONTRACEPTIVE USEThe next figu
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Figure 8.12c Contraceptive use* amo
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Blood and Injection Safety chapter
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D ATA IN C ONTEXT: N ATIONAL B LOOD
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Figure 9.3a Source of blood donatio
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Figure 9.3b Source of blood donatio
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Figure 9.3d Source of blood donatio
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9.4 Blood transfusionsAlthough the
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10080Injec tionsPillsNo preferenceW
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HIV prevalence among adults who rep
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9.6 Gaps and unmet needs• HIV pre
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The Ministry of Medical Services re
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10.3 COTRIMOXAZOLE PROPHYLAXIS FOR
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Coverage also varied significantly
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10.4 ARV ELIGIBILITY, COVERAGE AND
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ARV coverage was estimated by takin
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Figure 10.4b ARV coverage among HIV
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DATA IN CONTEXTEstimates of HIV-inf
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10.5 GAPS AND UNMET NEEDS• The es
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debilitating illness leading to hos
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Among HIV‐infected adults (83.6%
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Figure 11.3d HIV-infected adults ag
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Figure 11.4b HIV-infected adults ag
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Figure 11.4d HIV-infected adults ag
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DATA IN CONTEXTHIV Basic Care Packa
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Figure 11.5b HIV-infected adults ag
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Figure 11.6b Percent of HIV-infecte
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11.8 GAPS AND UNMET NEEDS• Counse
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12.3 HSV-2 prevalenceHSV‐2 preval
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807071.0WomenMen64.3HSV-2 Prevalenc
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Figure 12.3d HSV-2 prevalence among
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Figure 12.4b HSV-2 prevalence among
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Figure 12.5a HIV prevalence by HSV-
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Figure 12.6b Condom use during last
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12.7 Gaps and unmet needs• Increa
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also at substantially elevated risk
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Figure 13.3b Prevalence of syphilis
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Page 235 and 236: Figure 13.3f Prevalence of syphilis
Page 237 and 238: Figure 13.4b Prevalence of syphilis
Page 239 and 240: 13.6 GAPS AND UNMET NEEDS• Patien
Page 241 and 242: Household Characteristics andImpact
Page 243 and 244: Figure 14.3a Sex of head of househo
Page 245 and 246: Figure 14.3d Household population,
Page 247 and 248: 14.5 PREVALENCE OF HIV-AFFECTED HOU
Page 249 and 250: Figure 14.5c HIV-affected household
Page 251 and 252: social and economic conditions of h
Page 253 and 254: households used chemical disinfecta
Page 255 and 256: 14.7 HOUSEHOLD OWNERSHIP OF MOSQUIT
Page 257 and 258: Figure 14.7b HIV-affected and HIV-u
Page 259 and 260: Table 14.7b Source of bednets among
Page 261 and 262: Overall, 52.3% percent of children
Page 263 and 264: 14.9 CARE AND SUPPORT FOR ORPHANS A
Page 265 and 266: For consistency with other populati
Page 267: Returning Test Results15.1 KEY FIND
Page 270 and 271: Figure 15.3b. Participants aged 15-
Page 272 and 273: Figure 15.3d. Participants aged 15-
Page 274 and 275: Figure 15.3f. Participants aged 15-
Page 276 and 277: 15.4 RETURNING TO RECEIVE TEST RESU
Page 278 and 279: Figure 15.5 Women aged 15-64 years
Page 280 and 281: Methods of the 2007 KAISThis Append
Page 282 and 283: ClustersHouseholdsProvince Rural Ur
Page 286 and 287: The KEMRI Ethical Review Committee
Page 288 and 289: Red top (5 ml)Whole blood collected
Page 290 and 291: algorithm using two HIV EIAs (Viron
Page 292 and 293: Figure A5.a. Structure and flow of
Page 294 and 295: Recruitment and training of results
Page 296 and 297: observe confidentiality of particip
Page 298 and 299: Documentation. Results counsellors
Page 300 and 301: Normalisation of weightsNormalised
Page 302 and 303: This report presents the results of
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