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

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Recruitment and training of results counsellors. Effective results counselling in KAISrequired that all counsellors be equipped with basic knowledge of the STIs covered in thesurvey and with appropriate counselling skills according to national voluntary counsellingand testing guidelines. The results coordinator in collaboration with the Provincial AIDS/STICoordinators (PASCOs) identified, recruited, and assisted in the training of the 2007 KAISresults counsellors. In September 2007, a total of 202 health workers attended a training onhow to return KAIS test results to participants. Counsellors and health workers, regardlessof their health care experience, attended the training to refresh their counselling skills, learnhow to return the 2007 KAIS test results to participants, and to refer them and their partnersfor further testing, care and treatment if necessary. The training covered the following topicareas:• Overview of HIV and CD4, HSV‐2, and syphilis• Protocol for returning HIV, CD4 count, HSV‐2, and syphilis results• Counselling and referral messages• Effective counselling skills• Documentation of information from persons who receive their test results• Confidentiality• SupervisionThe training also included role plays and other opportunities for building practicalexperience in results counselling.Documentation of results at laboratory. Upon completion of laboratory testing for a givencluster, the LIMS coordinator produced a laboratory results form through an automated,computer‐based process for each cluster, listing out the test results for all individuals whoprovided a blood specimen for testing. The form was populated with the province, district,and cluster names; dates of sample collection; study identification numbers for a cluster;positive, negative, or indeterminate results for HIV, syphilis, HSV‐2, and CD4 counts forHIV‐infected persons; and codes indicating the reason for any missing results (e.g.insufficient sample, rejection sample, DBS only). Forms were submitted for review by theNPHLS lab coordinator (see Figure A5.c). After reviewing the results and resolving anydiscrepancies, the laboratory coordinator delivered hard copy results forms to the NASCOPresults coordinator.Dispatching results to the field. Upon receiving results from NHRL, the NASCOP resultsteam logged in the cluster numbers with results and arranged for a courier service to pick‐upthe paper results and deliver to the selected health facilities. The courier service was giventhe mobile telephone numbers of results counsellors so they could communicate directly toarrange a secure drop off.Methods for returning test results to participants. Results counsellors were trained tofollow a standardized protocol for returning test results to participants. Counsellors wereprovided with counselling messages for each test result to guide them during thecounselling session and to ensure consistency in the quality of counselling. The 2007 KAISfollowed similar procedures for returning laboratory results that are followed in generalhealth care settings in Kenya, including abbreviated counselling on basic information onKAIS 2007 294
HIV and STI, an explanation of the meaning of test results, the importance of partner testing,counselling on risk reduction practices, and referrals for further care and treatment services.Procedures for returning test results to minors complied with Kenyan law, Ministry ofHealth policy guidelines and international standards of ethics and practice. Youth wereencouraged but not required to come with a parent or guardian to receive their test results.Test results were first returned to the minor and then, upon consent of the minor, sharedwith the accompanying parent or guardian.The following core elements for returning test results to participants were emphasizedduring specimen collection and counselling session for returning test results:Validity of KAIS test results and importance of further testing. In addition todelivering KAIS test results, results counsellors discussed the reliability of results withparticipants. Due to the time lapse between sample collection and returning test results,reported results reflected the participant’s infection status at the time of specimencollection. When giving test results to participants, results counsellors explained that theparticipant’s current status might be different based on the window period of HIVinfection and recent exposures. Participants with negative test results were advised toseek further testing if they had engaged in unsafe risk behaviour after sample collection.Relations between HIV, genital herpes, and syphilis. Counselling of respondentsemphasized the links between HIV and tuberculosis, and between HIV and genitalherpes and syphilis.Partner testing. Partner testing or couples testing is a main strategy of national testinginitiatives in Kenya. During specimen collection, respondents were encouraged to learntheir test results with their partner.Prevention of transmission to partners and children. Participants who received their testresults as individuals (instead of as a couple) were encouraged to disclose their testresults to their sexual partners. Participants were also offered free condoms when theyreceived their test results, except at mission hospitals which did not supply condoms.Additionally, results counsellors provided specific messages to both male and femaleparticipants on prevention of transmission of HSV‐2, syphilis and HIV to children.Referrals for follow‐up testing and counselling. Results counsellors providedappropriate referrals to infected persons for additional testing, counselling, care andtreatment services. All participants received brochures on HIV, TB, syphilis, and genitalherpes.Confidentiality. During sample collection, laboratory technicians explained the need forparticipants to keep their results vouchers safe to ensure confidentiality of test results. Aresults voucher served as the only basis for providing test results to the 2007 KAISrespondents. Results counsellors verified that the sex of the person who returned for theirtest result was the sex of the participant who received the results voucher by crosscheckingwith the sex indicated on the voucher. Results counsellors were trained toKAIS 2007 295
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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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Figure 13.4b Prevalence of syphilis
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13.6 GAPS AND UNMET NEEDS• Patien
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Household Characteristics andImpact
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Page 257 and 258: Figure 14.7b HIV-affected and HIV-u
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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 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 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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