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

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Red top (5 ml)Whole blood collectedDBS (alternative)Green top (2 ml)HouseholdSerum vial #1(0.5 ml)Serum vial #2(1.0 ml)Serum vial #3(1.5 ml)ClotDBS(25 μl)Field labDry shipper(-80 º C)Cool box(Padded with ice packs)Separate package(room temperature)TransitCentral laboratory processThe central laboratory in Nairobi was responsible for coordinating all laboratory logistics forthe survey including securing supplies for the field laboratory activities, receiving, archivingand processing samples, testing, coordinating with the quality assurance laboratory, anddispatching testing results to NASCOP.Receipt of specimens at central laboratory. An average of 500 samples from the eightprovinces were received at the NHRL each week and logged into a laboratory informationmanagement system (LIMS) using an automated barcode reader. The specimen barcodelabels were cross‐checked against the sample tracking form. Core laboratory staff checkedthe integrity of the samples and recorded this information in the LIMS (e.g. satisfactory,haemolysed, contaminated). Overall, 98.9% of whole blood samples and 99.8% of serumsamples collected in the 2007 KAIS were of adequate quality for testing. The three serumcryovials, which were marked for testing, quality assurance or long‐term storage weresorted and forwarded to the appropriate stations for testing or archiving.Specimen testing. The following section summarises the testing protocols followed at theNHRL and KEMRI quality assurance (QA) laboratories:HIV testing. Specimens were first tested at the NHRL according to the manufacturer’srecommendations using a fourth‐generation HIV enzyme linked immunoassay (EIA)(Vironostika HIV‐1/2 antigen/antibody) for screening and a third‐generation EIA (MurexHIV.1.2.O) for confirmation in a serial testing algorithm. The screening test wascompleted within 24 hours of logging‐in the specimen into the LIMS, and seropositivesamples were referred for immediate CD4 testing. The HIV confirmatory test wascompleted the same day or one day later. Samples showing discordant results weretested again with the two assays. Polymerase chain reaction (PCR) testing (Roche HIVKAIS 2007 288
DNA v1.5) was conducted at the KEMRI QA laboratory to resolve specimens with twosets of discordant results. For QA purposes, all seropositive and 5% of seronegativespecimens were transported to the KEMRI QA laboratory and re‐tested using the samealgorithm. Specimens with discordant results between the two laboratories were testedagain at the KEMRI QA laboratory with the same algorithm. Specimens that were stilldiscordant after re‐testing were resolved by PCR at the KEMRI QA laboratory.CD4 cell count. Stabilised whole blood specimens for CD4 testing were prepared in thetemporary field laboratory at the end of each day. Specimens were transported to theNHRL at room temperature (18°–22°C). Only samples found to be reactive for HIV usingthe serial HIV testing algorithm described earlier were eligible for a CD4 cell count.Single‐platform technology was used to determine both absolute and percentagelymphocyte subset values from each CD4 tube of blood using BD FACSCompsoftware and BD CaliBRITE reagents. CD4 and CD8 cells were enumerated to calculatethe CD4:CD8 ratio. For quality control of CD4 testing, internal controls with known CD4quantities were included with each run. When the system detected an error with thecontrol, results from the run were discarded, the specific error was rectified based on theerror code generated by the software, and CD4 testing was repeated. All CD4 testing andre‐testing was conducted at the NHRL.Syphilis. Testing was conducted using two laboratory tests. All serum specimens werescreened at the NHRL using a Treponema pallidum particle agglutination assay (TPPA)(Serodia‐TPPA, Fujirebio Diagnostics Inc.). All TPPA positive specimens were reviewedby a second laboratory staff member and then tested using the rapid plasma reagin(RPR) (Macrovu‐Vue RPR Card Test, BD USA) on undiluted (i.e. neat) serum. RPRresults also were reviewed and reported by a second laboratory staff member. TPPA wasused as an antibody‐screening test to identify previous exposure to syphilis antigens,whereas RPR served as a test for presence of reaginic antigens, an indicator of activeinfection. For quality control, all TPPA‐reactive specimens and 5% of nonreactivespecimens were re‐tested at the QA laboratory using the same TPPA/RPR algorithm.Specimens with discordant results between the two laboratories were reported asindeterminate.HSV‐2. All specimens were tested using Kalon HSV2 IgG ELISA based on gG‐2according to the manufacturer’s recommendations. All samples reactive with the firstEIA run were re‐tested using Kalon HSV2 IgG ELISA and read by a second reader. Forquality control, all reactive specimens, 5% of randomly‐selected nonreactive specimensand specimens in gray zones were re‐tested at the QA laboratory using the above EIAtest. Specimens with discordant results between the two laboratories were reported asindeterminate.Dried blood spots. The DBS samples prepared from the CD4 blood tubes at thetemporary field laboratories were stored in freezers at temperatures of ‐20 o C at theNHRL. These samples were tested for HIV if serum samples were lost in transit or ifrespondents did not consent to giving venous blood but were willing to give blood froma finger prick. Sera were eluted from 6‐mm discs punched from the DBS samples andwere tested following the manufacturer’s recommendations using a parallel testingKAIS 2007 289
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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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Figure 13.3f Prevalence of syphilis
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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 284 and 285: and treatment services and other he
Page 286 and 287: The KEMRI Ethical Review Committee
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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