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

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DATA IN CONTEXT: APPROACHES TO HIV SURVEILLANCENational estimates of HIV prevalence in Kenya are estimated using several approaches: 1) generalpopulation-based surveys with HIV testing and 2) annual sentinel surveillance among pregnantwomen attending antenatal clinics (ANCs). Population-based surveys are based on large,nationally representative samples of adult women and men, while ANC surveillance is based on asample of pregnant women attending ANCs considered to be a proxy for the general population.Due to high costs, population-based surveys with HIV testing are conducted, on average, every fiveyears in a country. Therefore, ANC surveillance which is conducted more regularly (every one totwo years) remains an important, cost-effective source of information to monitor HIV prevalencetrends in the population. ANC surveillance data are incorporated into the UNAIDS EPP/Spectrummodel and calibrated using data from population-based surveys to arrive at national estimates.According to the modelled estimates, national HIV prevalence among adults aged 15-49 years hasbeen decreasing from 6.1% in 2004, to 5.9% in 2005 and 5.1% in 2006.In contrast, Kenya’s two national populations based surveys with HIV testing suggest that HIVprevalence has remained relatively stable. Among adults aged 15-49 years in the 2003 KDHS, HIVprevalence was 6.7% and not significantly different from the HIV prevalence estimate of 7.4% in the2007 KAIS. The precise reasons for why trends in the modelled estimates are different from thepopulation-based survey estimates require further investigation though a number of factors mayhave played a contributing role. In the EPP/Spectrum model, ANC estimates were calibrated using2003 KDHS data on the female-to-male ratio of HIV prevalence and the rural/urban populationdistribution. However, the 2007 KAIS supports important shifts in both of these factors since 2003.In addition, ANC sites may not be representative of the general population. For example, ANCsurveillance has a disproportionately larger number of urban ANC sites compared to rural ANCsites; however, the majority of adults in Kenya are living in rural areas. Declining ANC prevalencemay therefore be more reflective of declining urban prevalence among pregnant women. Further, Itis also possible that trends in HIV prevalence among pregnant women attending ANCs differ insome ways from trends in the general population.3.12 GAPS AND UNMET NEEDS• Young women aged 15‐24 years remain especially vulnerable to HIV infection.Further research is needed to assess the factors that contribute to risk ofinfection in the younger population so that effective interventions targetingyouth may be developed and implemented.• Prevalence among rural populations, particularly rural men, increasedbetween 2003 and 2007. This shift in the HIV epidemic highlights the need forincreased services and programs to these regions.• People with no primary level education and those in the lowest wealth indexquintile have significantly higher HIV prevalence in 2007 than in 2003highlighting the vulnerability of this group. HIV programs should plan toadapt education and behaviour change strategies to reach these groups.KAIS 2007 64
HIV Testing chapter 44.1. Key findings• Overall, 33.9% of adults aged 15-64 years reported that they had been tested forHIV at least once in their lifetime.• Women were more likely to have ever been tested than men (40.7% vs. 24.9%,respectively).• Of respondents who had never been tested for HIV, 47.2% reported that theyhad not sought testing because of their self-perceived low risk for HIV.4.2. IntroductionHIV testing and counselling are critical measures in a comprehensive response to the HIV epidemic.HIV testing is only way to learn one’s HIV status and can provide appropriate linkages for HIVinfectedpersons to access life‐saving HIV care and treatment interventions. In addition, the post‐testcounselling session offers focused counselling for HIV prevention to help reduce behaviours whichmay lead to acquisition or transmission of HIV.The Government of Kenya has set a national goal to provide HIV testing to at least 80% of alladolescents and adults by 2010. To reach this goal, a thorough understanding of access to and use ofHIV testing is needed to scale up national HIV testing and counselling efforts.Since 2004, “opt‐out” HIV testing has been offered as part of the routine package for all pregnantwomen attending antenatal clinics (ANC). In this approach, women receive pre‐test counselling forHIV testing and can choose to “opt‐out” of testing should they not wish to get tested. This policychange, in line with the national Prevention of Mother‐to‐Child Transmission (PMTCT) guidelines, hasled to substantial increases in HIV testing among women. Further discussion of “opt‐out” HIV testingin the context of PMTCT services is provided in Chapter 8 of this report.In this chapter, we present coverage of HIV testing and counselling at the time of the survey andidentify disparities and barriers to testing. Appendix B.4 provides sample sizes and 95% confidenceintervals for estimates presented in this chapter. Throughout the chapter, the term significant indicatesa chi‐square p‐value less than 0.05; marginally significant indicates a p‐value between 0.05 and 0.10,inclusive; and not significant indicates a p‐value greater than 0.10.KAIS 2007 65
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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%
Page 14 and 15: Men 5.4 26.3 1.9Total 7.1 35.1 1.8O
Page 17 and 18: Kenya is also committed to the “T
Page 19 and 20: Table 1.4 Distribution of sampled c
Page 22 and 23: 1.7 SURVEY IMPLEMENTATIONTrainingIn
Page 24 and 25: Data processing included a number o
Page 26 and 27: Characteristic 2003 KDHS 2007 KAISQ
Page 28 and 29: Figure 1.11 Sampled clusters and el
Page 30 and 31: Table 1.11c Survey response rates b
Page 32 and 33: Population estimates reported in th
Page 34 and 35: 2.4 HIV PREVALENCE AMONG YOUTHFigur
Page 36 and 37: Figure 2.6b HIV prevalence among ru
Page 38 and 39: 2.7 HIV PREVALENCE BY PROVINCEFigur
Page 40 and 41: Figure 2.7c Estimated number of HIV
Page 42 and 43: 2.9 HIV PREVALENCE BY EDUCATION LEV
Page 44 and 45: Figure 2.10b HIV prevalence among r
Page 46 and 47: 2.11 HIV PREVALENCE BY TIME AWAY FR
Page 48 and 49: 2.13 MALE CIRCUMCISION AND ASSOCIAT
Page 50 and 51: Figure 2.13c HIV prevalence among c
Page 52 and 53: Comparison of HIV Prevalence in the
Page 54 and 55: 3.3 SEXFigure 3.3a HIV prevalence a
Page 56 and 57: Figure 3.4b. HIV prevalence among m
Page 58 and 59: 3.7 PROVINCEFigure 3.7a HIV prevale
Page 60 and 61: 2003 KDHS 1 2007 KAIS 2Marital stat
Page 62 and 63: 3.10 WEALTH INDEXFigure 3.10a HIV p
Page 68 and 69: Figure 4.3c Ever been tested for HI
Page 70 and 71: Figure 4.3e Ever been tested for HI
Page 72 and 73: Figure 4.3g Women aged 15-49 years
Page 74 and 75: Figure 4.4a Time since last HIV tes
Page 76 and 77: Figure 4.5a Reasons for not testing
Page 78 and 79: Increasing access to HIV testing wi
Page 80 and 81: 4.7. Gaps and unmet needs• Two‐
Page 84 and 85: Figure 5.3b Self-reported HIV statu
Page 86 and 87: This section examines participants
Page 88 and 89: Figure 5.5a Knowledge of HIV status
Page 90 and 91: Figure 5.5c Percent of partnerships
Page 92 and 93: uninfected. A couple was considered
Page 94 and 95: Figure 5.6c Women and men aged 15-6
Page 96 and 97: Sexual Partners, Sexual DebutCircum
Page 98 and 99: Figure 6.3b. HIV prevalence among w
Page 100 and 101: Figure 6.3d. HIV prevalence among w
Page 102 and 103: Figure 6.3f. Men aged 15-64 years r
Page 104 and 105: In this section, “consistent cond
Page 106 and 107: Figure 6.4c. Marital or cohabiting
Page 108 and 109: Figure 6.5b. Young women and men ag
Page 110 and 111: Figure 6.5d. Young women and men ag
Page 112 and 113: 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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Figure 14.3a Sex of head of househo
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Figure 14.3d Household population,
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14.5 PREVALENCE OF HIV-AFFECTED HOU
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Figure 14.5c HIV-affected household
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social and economic conditions of h
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households used chemical disinfecta
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14.7 HOUSEHOLD OWNERSHIP OF MOSQUIT
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Figure 14.7b HIV-affected and HIV-u
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Table 14.7b Source of bednets among
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Overall, 52.3% percent of children
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14.9 CARE AND SUPPORT FOR ORPHANS A
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For consistency with other populati
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Returning Test Results15.1 KEY FIND
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Figure 15.3b. Participants aged 15-
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Figure 15.3d. Participants aged 15-
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Figure 15.3f. Participants aged 15-
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15.4 RETURNING TO RECEIVE TEST RESU
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Figure 15.5 Women aged 15-64 years
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Methods of the 2007 KAISThis Append
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ClustersHouseholdsProvince Rural Ur
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and treatment services and other he
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The KEMRI Ethical Review Committee
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Red top (5 ml)Whole blood collected
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algorithm using two HIV EIAs (Viron
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Figure A5.a. Structure and flow of
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Recruitment and training of results
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observe confidentiality of particip
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Documentation. Results counsellors
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Normalisation of weightsNormalised
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This report presents the results of
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