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

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The KEMRI Ethical Review Committee and the Institutional Review Board of the CDCapproved the 2007 KAIS protocol prior to survey implementation. All participants providedoral informed consent and had the choice to consent separately to the interview, blood draw,and blood specimen storage for future testing.. Oral consent was requested from the KEMRIEthical Review Committee and the Institutional Review Board of the CDC due to the highrate of illiteracy in some regions of the country and its potential to negatively impact surveyuptake. For minors aged 15‐17 years, parental consent and minor assent were both requiredfor participation. Data collectors signed the consent form for each of the components andindicated whether or not oral consent was provided. Data collectors informed all eligiblepersons that participation in the survey was strictly voluntary and that there would be noconsequences if a household or person refused participation. Every effort was made toidentify space in households that provided privacy during the interview.A.4 LABORATORY METHODSThe 2007 KAIS included several novel concepts and methods for maximising laboratorytesting in a national surveillance effort.Recruitment and trainingField and core laboratory staff were recruited from existing laboratory staff within NPHLSand from KEMRI laboratories. Training included the following components: a didacticoverview of the 2007 KAIS methodology; a detailed description of the roles and structure offield and core laboratory survey teams; a review of basic laboratory operations, includingcollection, handling, and transport of blood specimens and bio‐safety considerations; and areview of technical procedures, including specific assays, quality assurance, and generallogistics.Ensuring sufficient staff capacity was critical given the large volume of samples received perweek (on average 500 samples per week), the rapid turnover required to quantify CD4 cellswithin seven days of sample collection, and the need to report test results for an entirecluster within six weeks of sample collection.Laboratory field processThe laboratory field process consisted of three main components: sample collection at theparticipants’ home; preparation of samples at temporary field laboratories, which werelaboratory facilities within the cluster or hotel rooms designated for sample processing iflaboratory facilities were not available; and proper packing and documentation of samplesbefore transport to the central laboratory in Nairobi. The procedures for each of theseelements are summarised in the following sections.Sample collection. Trained, experienced laboratory technicians were responsible for thecollection of blood from the arm by venipuncture using an evacuated tube collection system.Five milliliters (ml) of blood were collected into a “red‐top” glass tube without anticoagulantfor HIV, HSV‐2, and syphilis testing. Immediately after the first 5 ml of blood was collected,KAIS 2007 286
an additional 2 ml of blood was collected into a special “green‐top” blood collection tube(Becton Dickinson [BD] Vacutainer CD4 Stabilization Blood Collection System) designed tostabilise CD4 cells for up to seven days. The 2007 KAIS was the first national survey toutilise these tubes for CD4 testing. To protect against potential loss of specimens in transit,DBS samples for HIV testing were prepared from all CD4 blood tubes at temporary fieldlaboratories at the end of each day.For participants who were willing to participate but refused the venous blood sample or forwhom venipuncture was not feasible, technicians collected finger‐prick DBS samples whichwere air‐dried overnight, separated by glassine paper, and stored at ambient temperature ingroups of 20 in sealable plastic bags (Zip‐loc) containing desiccant and a humidity indicatorcard.Processing blood samples in the field. At the end of each field day, laboratory techniciansbrought samples to a temporary field laboratory for processing. The red‐top tube used in the2007 KAIS allowed for complete separation of serum from the clotted red cells; however,each survey team was equipped with a manual centrifuge as a backup. Once separated fromthe clotted red cells, serum samples were transferred from the red‐top tube to threecryovials; the packed red cells (red blood cells/buffy coat blood clot) remained in the red‐toptube and were transported to the core laboratory. The CD4 tubes were kept at ambienttemperature at the field laboratory until transportation to the National HIV ReferenceLaboratory (NHRL), within the larger NPHLS system, in Nairobi.Labeling of blood samples in the field. A unique, bar‐coded, random identification number(IDNO) was assigned to each participant who consented to testing. At the time of samplecollection, labels containing the code were affixed to the household questionnaire, red‐topand green‐top tubes, DBS filter paper cards, cryovials and specimen tracking forms. Tocheck specimens in the field and at the NHRL, the location of each cryovial or DBS filterpaper card within a shipping container or bag was recorded on a specimen inventory form.Packing and transporting samples. The three cryovials containing serum were stored in adry shipper (‐80 o C). The red‐top tubes containing the blood clot were packaged in coldboxes for transportation. The green‐top tubes were transported at room temperature. Acontract courier service collected these samples and transported them overnight to theNHRL in Nairobi two to three times per week. The tubes containing the blood clot werestored at ‐80 o C at the NHRL for future testing, and the dried blood spots were stored at ‐20 oC. Because certain remote areas of North Eastern province could not be reached easily byroad transport, the 2007 KAIS laboratory logistics team coordinated with the EuropeanCommission Humanitarian Organization (ECHO) to provide room in a small airlineoperated by ECHO to transport dry shippers, cool boxes and other supplies between remoteareas in North Eastern province and the NPHLS in Nairobi. This service was provided freeof cost to survey implementers.Figure A3. Laboratory field process, 2007 KAIS.KAIS 2007 287
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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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Figure 13.3d Prevalence of syphilis
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Page 241 and 242: Household Characteristics andImpact
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Page 245 and 246: Figure 14.3d Household population,
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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 284 and 285: and treatment services and other he
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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