KAIS REPORT

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The Kenya AIDS Indicator Survey 2007. Nationally-representative HIV serosurvey~18,000 individuals from nearly 10,000 householdsIncludes older adults age 50-64Prevalence of HIV, HSV-2 and syphilisCoverage of HIV services. 4 Components of KAIS. Household QuestionnaireIndividual QuestionnaireBlood DrawReturn of Result.
KAIS REPORT

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1. KAIS REPORT

2. The Kenya AIDS Indicator Survey 2007 Nationally-representative HIV serosurvey ~18,000 individuals from nearly 10,000 households Includes older adults age 50-64 Prevalence of HIV, HSV-2 and syphilis Coverage of HIV services

3. 4 Components of KAIS Household Questionnaire Individual Questionnaire Blood Draw Return of Result

4. Differences from KDHS 2003 KAIS allows examination of older adults 50-64 years old comparisons of persons? perceived HIV status to actual HIV status HSV-2 Return of results CD4 counts measured KAIS-KDHS comparisons restricted to men and women 15-49

5. HIV PREVALENCE IN KENYA 2007

6. Roughly 1.4 million Kenyan adults are living with HIV Comparison of KAIS and KDH for 15-49. Comparison of KAIS and KDH for 15-49.

7. HIV peaks for younger women and older men, but remains an issue across age groups 15-34 y.o gender gap is greatest. And that there is still substantial infection among older adults. And 55+ for men have higher infections tyhan 15-24. Focus on interventions for young women and older men. Infections run the range of ages (not seculded to youth population). 15-34 y.o gender gap is greatest. And that there is still substantial infection among older adults. And 55+ for men have higher infections tyhan 15-24. Focus on interventions for young women and older men. Infections run the range of ages (not seculded to youth population).

8. Dramatic disparity in HIV prevalence across provinces Nairobi/nyanza/coast above national average of 7.4%; central/northeastern low; are there province trends that seem to ?explain? some of these differences; prevention resources directed to provincesNairobi/nyanza/coast above national average of 7.4%; central/northeastern low; are there province trends that seem to ?explain? some of these differences; prevention resources directed to provinces

9. Nyanza & RV are home to over 50% of all HIV infected persons in Kenya Importance of looking at estimated burden in order to understand directing resourcesImportance of looking at estimated burden in order to understand directing resources

10. Rural areas have witnessed an increase in HIV prevalence

11. From Prevalence to Prevention: Assessing Key Domains of Prevention Efforts in Kenya

12. Key Concerns of Current Prevention Efforts HIV testing Knowledge of HIV status and disclosure between partners Partner HIV discordance Male circumcision HIV awareness and knowledge Youth sexuality Older adults Note that these are not all the prevention areasNote that these are not all the prevention areas

13. HIV TESTING Prevention Relevance Increase accurate knowledge of status, and reduce transmission/acquisition risk Prevention Goal Increase the number of persons testing, particularly among those at higher risk of HIV transmission/acquisition

14. Testing has increased in recent years, especially among women Half of those ever testing tested in the past 12 months, and most testers returned for results. Around 5% did not return for the results. Testing in rural areas is on average 20 percentage points lower than testing in urban areas. Half of those ever testing tested in the past 12 months, and most testers returned for results. Around 5% did not return for the results. Testing in rural areas is on average 20 percentage points lower than testing in urban areas.

15. ?but we are far from the 2010 target of 80% universal CT coverage

16. Increased testing among women is likely a result of increased ANC testing Chart refers to testing during most recent birth. Small percent (30% prior to 2002, and 6% after 2003) tested at other sites.Chart refers to testing during most recent birth. Small percent (30% prior to 2002, and 6% after 2003) tested at other sites.

17. Testing rates show little difference across provinces . . . Point out NairobiPoint out Nairobi

18. . . . but should testing rates differ given HIV prevalence?

19. Testing: Summary Trend is improving, but long way to go from testing target ANC testing has increased among pregnant women Acceptability of home testing is high Testing among men and in rural areas lagging Gap in testing among older adults Testing gap in high prevalence provinces

20. Knowledge of HIV Status & Disclosure Prevention Relevance Knowledge of serostatus and proper disclosure to sexual partners can help reduce new infections Prevention Goals Increase knowledge of serostatus Increase disclosure between sexual partners

21. 82% of HIV+ adults do not know they are HIV infected [pwp][pwp]

22. Most people do not know their partners? status Never tested: 89% do not know partners? status Tested and believe themselves negative: 60% do not know partners? status Reported HIV positive: 36% do not know partners? status

23. Consistent condom use is low with partners of unknown HIV status Condom use with partners of known status is (9-26%). Discrepancy in condom use between HIV- men and women. Encourage condom use approaches for women. Boyfriend/girlfriend: 72-82%; Casual: 82-95%; Only 17-42% of people report always using condoms in these relationships. Condom use with partners of known status is (9-26%). Discrepancy in condom use between HIV- men and women. Encourage condom use approaches for women. Boyfriend/girlfriend: 72-82%; Casual: 82-95%; Only 17-42% of people report always using condoms in these relationships.

24. Knowledge of Status & Disclosure: Summary Most HIV+ persons do not know they are infected. Most persons do not know the HIV status of their partners. Consistent condom use is low. Those who know they are HIV+ are more likely to know HIV status of partners.

25. HIV Discordance Prevention Relevance Long-term discordant couples are at higher risk of HIV transmission/acquisition due to frequency of sexual contact Prevention Goal Increase awareness of discordance between couples Promote safer sex practices among serodiscordant couples

26. Discordance in Kenya

27. Condom use with married/cohabitating partners is highest among positives who correctly reported their HIV status

28. Male Circumcision Prevention Relevance Research suggests that male circumcision is associated with substantially lower HIV acquisition for men. Prevention Goals Increase awareness of potential benefits of circumcision Promote voluntary circumcision among adult men Encourage parents to have male children circumcised

29. Circumcision is associated with lower individual HIV risk among men

30. HIV Knowledge & Attitudes Prevention Relevance Increased knowledge of HIV should help promote risk-reducing behaviors Reduced stigma will support secondary HIV prevention through care and treatment of infected individuals Prevention Goals Increase HIV knowledge in general public and high risk populations Decrease stigma of HIV throughout population

31. Radio is the most common source of HIV information

32. Knowledge Questions 9 questions on general acquisition/transmission ?Can people reduce their chance of getting the AIDS virus by using a condom every time they have sex?? ?If a woman has the virus that causes AIDS, does her sexual partner always have the AIDS virus, almost always, or only sometimes?? 3 questions on mother-to-child transmission pathways ?Can the virus that causes AIDS be transmitted? during pregnancy??

33. School education is associated with comprehensive HIV knowledge Of the 12 major questions 56% of men and women answered 9 or more correctly 40% answered 5-8 items correctly 4% answered fewer than 5 correctly Educational background was an important determinant of comprehensive HIV knowledge 19% of those with no primary education answered fewer than 5 items correctly, compared to 1% of those who completed primary school or beyond People tended to answer single questions correctly, but when combined they did not get all of them correctPeople tended to answer single questions correctly, but when combined they did not get all of them correct

34. Increase in PMTCT knowledge among women, 15-49

35. Comprehensive HIV knowledge is not associated with differences in prevalence Age 15-64, women on average are 8.7, men 5.6; but this excludes those who knew they were HIV+. Targets (denominator): excludes persons who self-reported HIV positive status Age 15-64, women on average are 8.7, men 5.6; but this excludes those who knew they were HIV+. Targets (denominator): excludes persons who self-reported HIV positive status

36. Attitudes Questions 70-90% agreed with the following individual statements ?I would buy fresh vegetables from a vendor who has HIV? ?I would not want the status of an HIV-positive family member to remain secret? ?I am willing to care for a relative with HIV at home? ?I believe an HIV-positive teacher should be allowed to continue teaching?

37. Among women there is an increase in accepting attitudes But overall still low. Could this be a factor of ANC testing? In 03, higher for men than women, but women catching up. But overall still low. Could this be a factor of ANC testing? In 03, higher for men than women, but women catching up.

38. Knowledge & Attitudes: Summary Radio is the most common means of reaching people with HIV information Comprehensive knowledge was low, especially among those with little formal education HIV knowledge alone is not associated with reduced HIV infection PMTCT knowledge is growing for women Stigma remains a challenge, but improvements are evident among women

39. Youth Sexuality (age 15-24) Prevention Relevance Delayed initiation and safer sex during early sexual development can help reduce HIV acquisition Prevention Goals Increase age of sexual initiation Increase condom use among youth

40. Marriage and early sexual initiation are associated with higher HIV prevalence among young women Among 25-34 year old males (additional info) as well, marriage increased HIV prevalence compared to single males.Among 25-34 year old males (additional info) as well, marriage increased HIV prevalence compared to single males.

41. Some declines in age of sexual initiation evidence Point out that there may be small differences in the way KAIS classified age of initiation versus our classification. There was a very slight decline in HIV prev for males 20-24 btwn 03-07. [point out marriage by the age] Very few Point out that there may be small differences in the way KAIS classified age of initiation versus our classification. There was a very slight decline in HIV prev for males 20-24 btwn 03-07. [point out marriage by the age] Very few

42. Youth Sexuality: Summary Marriage at young ages is strongly associated with HIV prevalence Some decline in proportion of men having sex by age 15 Few young women have sex with men 10 or more years older

43. Older Adults: A New Prevention Area (50-64 year olds)

44. HIV in Older Adults 85% of older adults have never tested for HIV 88% of older adults do not know the HIV status of their marital/cohabitating partners Condom use is very low Less than 2% report consistent condom use with marital/cohabitating partners

45. HIV in Older Adults (cont.) Older women have higher proportion of undiagnosed HIV infection HIV is almost 3 times higher among formerly married older adults (widowed, separated, divorced) than those currently married

46. Lessons Learned Know your status; know your partners? status Need for ?repeat? testing and disclosure Condom use remains low Re-evaluate common perceptions of ?high risk groups? Married couples Uncircumcised men Older adults need to be targeted as much as our focus on youth

47. Acknowledgements MOH-NASCOP NACC KNBS NPHLS NCAPD KEMRI PEPFAR through CDC & USAID UNAIDS/WHO All TWG Members


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