James N. Kiarie is an associate professor in obstetrics and gynaecology the University of Nairobi, and a consultant obstetrician gynaecologist in Kenyatta National Hospital.  He is also an affiliate Associate Professor in Epidemiology and Global Health at the University of Washington. 

His work focuses on Health Professionals training, reproductive health, HIV and use of Information technologies in research and training.  Dr Kiarie is the director of the University of Nairobi Medical Education Program Initiative (MEPI) whose mission is to improve the health of Kenyans through medical education and research.  Prof Kiarie also directs the University of Nairobi HIV Fellowship Program that aims to support the Kenyan National HIV AIDS response by training program managers and leaders.   He is the Principal Investigator of a cohort study on HIV and Pregnancy Intention and the Nairobi Site Partners in Prevention PrEP trial.  

Prof Kiarie has extensive experience in Public health and training and has over 75 papers published in peer reviewed journals.


Prof. James N. Kiarie

James N. Kiarie is an associate professor in obstetrics and gynaecology the University of Nairobi, and a consultant obstetrician gynaecologist in Kenyatta National Hospital.  He is also an affiliate Associate Professor in Epidemiology and Global Health at the University of Washington. 

Associate Professor, Obstetrics and Gynaecology

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James N. Kiarie is an associate professor in obstetrics and gynaecology the University of Nairobi, and a consultant obstetrician gynaecologist in Kenyatta National Hospital.  He is also an affiliate Associate Professor in Epidemiology and Global Health at the University of Washington. 



Mackelprang, RD, Bosire R, Guthrie BL, Choi RY, Liu A, Gatuguta A, Rositch AF, Kiarie JN, Farquhar C.  2014.  High rates of relationship dissolution among heterosexual HIV-serodiscordant couples in Kenya., 2014 Jan. AIDS and behavior. 18(1):189-93. Abstract

HIV-1 serodiscordant couples may experience increased risks of relationship dissolution; however, longitudinal stability of these relationships is poorly understood. We determined rates and correlates of separation among 469 serodiscordant couples in Nairobi and found that 113 (24 %) separated during 2 years of follow-up. Couples with a female HIV-1 infected partner (F+M-) and no income were more likely to separate than M+F- couples without income (HR = 5.0; 95 % CI 1.1-25.0), and F+M- and M+F- couples with income (HR = 2.4; 95 % CI 1.3-4.5 and HR = 2.3; 95 % CI 1.2-4.8, respectively). High separation rates may be important for couple support services and for conducting discordant couple studies.

Osoti, AO, John-Stewart G, Kiarie J, Richardson B, John Kinuthia, James N Kiarie, Krakowiak D, Farquhar C.  2014.  Home visits during pregnancy enhance male partner HIV counselling and testing in Kenya: a randomized clinical trial., 2014 Jan 2. AIDS (London, England). 28(1):95-103. Abstract

HIV testing male partners of pregnant women may decrease HIV transmission to women and promote uptake of prevention of mother-to-child HIV transmission (PMTCT) interventions. However, it has been difficult to access male partners in antenatal care (ANC) clinics. We hypothesized that home visits to offer HIV testing to partners of women attending ANC would increase partner HIV testing.

Soh, J, Rositch AF, Koutsky L, Guthrie BL, Choi RY, Bosire RK, Gatuguta A, Smith JS, Kiarie J, Lohman-Payne B, Farquhar C.  2014.  Individual and partner risk factors associated with abnormal cervical cytology among women in HIV-discordant relationships., 2014 Apr. International journal of STD & AIDS. 25(5):315-24. Abstract

Individual and sexual partner characteristics may increase the risk of abnormal cervical cytology among women in human immunodeficiency virus (HIV)-discordant relationships. Papanicolaou smears were obtained in a prospective cohort of Kenyan HIV-discordant couples. Of 441 women, 283 (64%) were HIV-infected and 158 (36%) were HIV-uninfected with HIV-infected partners. Overall, 79 (18%) had low-grade and 25 (6%) high-grade cervical abnormalities. Male herpes simplex virus type 2 (HSV-2) seropositivity and lower couple socioeconomic status were associated with cervical abnormalities (p < 0.05). HIV-uninfected women with HIV-infected male sex partners (CD4 > 350 cells/µL) had the lowest prevalence of high-grade cervical lesions. HIV-infected women (CD4 > 350 cells/µL) and HIV-uninfected women with HIV-infected partners (CD4 ≤ 350 cells/µL) were at similar intermediate risk (p > 0.05), and HIV-infected women (CD4 ≤ 350 cells/µL) had significantly higher risk of high-grade cervical abnormalities (p = 0.05). Women in HIV-discordant relationships have high rates of cervical lesions and this may be influenced by couple-level factors, including HIV status and CD4 count of the infected partner.

Slyker, J, Farquhar C, Atkinson C, Ásbjörnsdóttir K, Roxby A, Drake A, Kiarie J, Wald A, Boeckh M, Richardson B, Odem-Davis K, John-Stewart G, Emery V.  2014.  Compartmentalized cytomegalovirus replication and transmission in the setting of maternal HIV-1 infection., 2014 Feb. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 58(4):564-72. Abstract

Cytomegalovirus (CMV) infection is associated with adverse outcomes in human immunodeficiency virus (HIV)-exposed infants. Determinants of vertical CMV transmission in the setting of maternal HIV-1 infection are not well-defined.

Masese, L, Baeten JM, Richardson BA, Bukusi E, John-Stewart G, Jaoko W, Shafi J, Kiarie J, McClelland SR.  2014.  Incident herpes simplex virus type 2 infection increases the risk of subsequent episodes of bacterial vaginosis., 2014 Apr 1. The Journal of infectious diseases. 209(7):1023-7. Abstract

Herpes simplex virus type 2 (HSV-2) infected women have a higher prevalence of bacterial vaginosis (BV) compared to HSV-2-seronegative women. To explore the temporal association between these conditions, we evaluated the frequency of BV episodes before and after HSV-2 acquisition in a prospective study of 406 HSV-2/HIV-1-seronegative Kenyan women, of whom 164 acquired HSV-2. Incident HSV-2 was associated with increased likelihood of BV (adjusted OR, 1.28; 95% CI, 1.05-1.56; P = .01). Our findings strengthen the evidence for a causal link between genital HSV-2 infection and disruption of the vaginal microbiota.

Heffron, R, Donnell D, Kiarie J, Rees H, Ngure K, Mugo N, Were E, Celum C, Baeten JM.  2014.  A prospective study of the effect of pregnancy on CD4 counts and plasma HIV-1 RNA concentrations of antiretroviral-naive HIV-1-infected women., 2014 Feb 1. Journal of acquired immune deficiency syndromes (1999). 65(2):231-6. Abstract

In HIV-1-infected women, CD4 count declines occur during pregnancy, which has been attributed to hemodilution. However, for women who have not initiated antiretroviral therapy, it is unclear if CD4 declines are sustained beyond pregnancy and accompanied by increased viral levels, which could indicate an effect of pregnancy on accelerating HIV-1 disease progression.

Murnane, PM, Heffron R, Ronald A, Bukusi EA, Donnell D, Mugo NR, Were E, Mujugira A, Kiarie J, Celum C, Baeten JM.  2014.  Pre-exposure prophylaxis for HIV-1 prevention does not diminish the pregnancy prevention effectiveness of hormonal contraception., 2014 Apr 30. AIDS (London, England). Abstract

For women at risk of HIV-1, effective contraception and effective HIV-1 prevention are global priorities.

Roxby, AC, Atkinson C, Asbjörnsdóttir K, Farquhar C, Kiarie JN, Drake AL, Wald A, Boeckh M, Richardson B, Emery V, John-Stewart G, Slyker JA.  2014.  Maternal valacyclovir and infant cytomegalovirus acquisition: a randomized controlled trial among HIV-infected women., 2014. PloS one. 9(2):e87855. Abstract

Studies in HIV-1-infected infants and HIV-1-exposed, uninfected infants link early cytomegalovirus (CMV) acquisition with growth delay and cognitive impairment. We investigated maternal valacyclovir to delay infant acquisition of CMV.

Day, S, Graham SM, Masese LN, Richardson BA, Kiarie JN, Jaoko W, Mandaliya K, Chohan V, Overbaugh J, Scott McClelland R.  2014.  A Prospective Cohort Study of the Effect of Depot Medroxyprogesterone Acetate on Detection of Plasma and Cervical HIV-1 in Women Initiating and Continuing Antiretroviral Therapy., 2014 Aug 1. Journal of acquired immune deficiency syndromes (1999). 66(4):452-6. Abstract

: Depot medroxyprogesterone acetate (DMPA) use among HIV-1-infected women may increase transmission by increasing plasma and genital HIV-1 RNA shedding. We investigated associations between DMPA use and HIV-1 RNA in plasma and cervical secretions. One hundred two women initiated antiretroviral therapy, contributing 925 follow-up visits over a median of 34 months. Compared with visits with no hormonal contraception exposure, DMPA exposure did not increase detection of plasma (adjusted odds ratio: 0.81, 95% confidence interval: 0.47 to 1.39) or cervical HIV-1 RNA (adjusted odds ratio: 1.41, 95% confidence interval: 0.54 to 3.67). Our results suggest that DMPA is unlikely to increase infectivity in HIV-positive women who are adherent to effective antiretroviral therapy.

Ndase, P, Celum C, Campbell J, Bukusi E, Kiarie J, Katabira E, Mugo N, Tumwesigye E, Wangisi J, Were E, Brantley J, Donnell D, Baeten JM.  2014.  Successful discontinuation of the placebo arm and provision of an effective HIV prevention product after a positive interim efficacy result: the partners PrEP study experience., 2014 Jun 1. Journal of acquired immune deficiency syndromes (1999). 66(2):206-12. Abstract

Dissemination of research results to study participants and stakeholders and provision of proven effective products in the immediate post-trial period are core elements of the conduct of biomedical HIV prevention clinical trials. Few biomedical HIV prevention trials have demonstrated HIV protection with novel interventions, and thus, communication of positive trial results and provision of an effective product have not been tested in many situations.


Roxby, AC, Liu AY, Drake AL, Kiarie JN, Richardson B, Lohman-Payne BL, John-Stewart GC, Wald A, De Rosa S, Farquhar C.  2013.  Short communication: T cell activation in HIV-1/herpes simplex virus-2-coinfected Kenyan women receiving valacyclovir., 2013 Jan. AIDS research and human retroviruses. 29(1):94-8. Abstract

Herpes simplex virus-2 (HSV-2) suppression with acyclovir or valacyclovir reduces HIV-1 viral RNA levels; one hypothesis is that HSV-2 suppression reduces immune activation. We measured T cell immune activation markers among women participating in a randomized placebo-controlled trial of valacyclovir to reduce HIV-1 RNA levels among pregnant women. Although valacyclovir was associated with lower HIV-1 RNA levels, the distribution of both CD4(+) and CD8(+) CD38(+)HLA-DR(+) T cells was not different among women taking valacyclovir when compared to women taking placebo. Further study is needed to understand the mechanism of HIV-1 RNA reduction following herpes suppression among those coinfected with HIV-1 and HSV-2.

Kahn, TR, Desmond M, Rao D, Marx GE, Guthrie BL, Bosire R, Choi RY, Kiarie JN, Farquhar C.  2013.  Delayed initiation of antiretroviral therapy among HIV-discordant couples in Kenya., 2013. AIDS care. 25(3):265-72. Abstract

Timely initiation of antiretroviral therapy (ART) is particularly important for HIV-discordant couples because viral suppression greatly reduces the risk of transmission to the uninfected partner. To identify issues and concerns related to ART initiation among HIV-discordant couples, we recruited a subset of discordant couples participating in a longitudinal study in Nairobi to participate in in-depth interviews and focus group discussions about ART. Our results suggest that partners in HIV-discordant relationships discuss starting ART, yet most are not aware that ART can decrease the risk of HIV transmission. In addition, their concerns about ART initiation include side effects, sustaining an appropriate level of drug treatment, HIV/AIDS-related stigma, medical/biological issues, psychological barriers, misconceptions about the medications, the inconvenience of being on therapy, and lack of social support. Understanding and addressing these barriers to ART initiation among discordant couples is critical to advancing the HIV "treatment as prevention" agenda.

Heffron, R, Mugo N, Ngure K, Celum C, Donnell D, Were E, Rees H, Kiarie J, Baeten JM.  2013.  Hormonal contraceptive use and risk of HIV-1 disease progression., 2013 Jan 14. AIDS (London, England). 27(2):261-7. Abstract

For HIV-1-infected women, hormonal contraception prevents unintended pregnancy, excess maternal morbidity, and vertical HIV-1 transmission. Hormonal contraceptives are widely used but their effects on HIV-1 disease progression are unclear.

Kahle, EM, Hughes JP, Lingappa JR, John-Stewart G, Celum C, Nakku-Joloba E, Njuguna S, Mugo N, Bukusi E, Manongi R, Baeten JM.  2013.  An empiric risk scoring tool for identifying high-risk heterosexual HIV-1-serodiscordant couples for targeted HIV-1 prevention., 2013 Mar 1. Journal of acquired immune deficiency syndromes (1999). 62(3):339-47. Abstract

Heterosexual HIV-1-serodiscordant couples are increasingly recognized as an important source of new HIV-1 infections in sub-Saharan Africa. A simple risk assessment tool could be useful for identifying couples at highest risk for HIV-1 transmission.

Roxby, AC, Matemo D, Drake AL, John Kinuthia, James N Kiarie, John-Stewart GC, Ongecha-Owuor F, Kiarie J, Farquhar C.  2013.  Pregnant women and disclosure to sexual partners after testing HIV-1-seropositive during antenatal care., 2013 Jan. AIDS patient care and STDs. 27(1):33-7.
Hubacher, D, Liku J, Kiarie J, Rakwar J, Muiruri P, Omwenga J, Chen P-L.  2013.  Effect of concurrent use of anti-retroviral therapy and levonorgestrel sub-dermal implant for contraception on CD4 counts: a prospective cohort study in Kenya., 2013. Journal of the International AIDS Society. 16:18448. Abstract

Simultaneous use of contraceptive hormones and anti-retroviral therapy (ART) may theoretically lessen the effectiveness of both. Women on ART need assurance that hormonal contraception is safe and effective. The sub-dermal implant is an ideal product to study: low and steady progestin release and no adherence uncertainties. We sought to determine if the medications' effectiveness is compromised.

Kiarie, E, Romero LF, Nyachoti CM.  2013.  The role of added feed enzymes in promoting gut health in swine and poultry., 2013 Jun. Nutrition research reviews. 26(1):71-88. Abstract

The value of added feed enzymes (FE) in promoting growth and efficiency of nutrient utilisation is well recognised in single-stomached animal production. However, the effects of FE on the microbiome of the gastrointestinal tract (GIT) are largely unrecognised. A critical role in host nutrition, health, performance and quality of the products produced is played by the intestinal microbiota. FE can make an impact on GIT microbial ecology by reducing undigested substrates and anti-nutritive factors and producing oligosaccharides in situ from dietary NSP with potential prebiotic effects. Investigations with molecular microbiology techniques have demonstrated FE-mediated responses on energy utilisation in broiler chickens that were associated with certain clusters of GIT bacteria. Furthermore, investigations using specific enteric pathogen challenge models have demonstrated the efficacy of FE in modulating gut health. Because FE probably change the substrate characteristics along the GIT, subsequent microbiota responses will vary according to the populations present at the time of administration and their reaction to such changes. Therefore, the microbiota responses to FE administration, rather than being absolute, are a continuum or a population of responses. However, recognition that FE can make an impact on the gut microbiota and thus gut health will probably stimulate development of FE capable of modulating gut microbiota to the benefit of host health under specific production conditions. The present review brings to light opportunities and challenges for the role of major FE (carbohydrases and phytase) on the gut health of poultry and swine species with a specific focus on the impact on GIT microbiota.

Muiru, AN, Guthrie BL, Bosire R, Merkel M, Liu AY, Choi RY, Lohman-Payne B, Gatuguta A, Mackelprang RD, Kiarie JN, Farquhar C.  2013.  Incident HSV-2 infections are common among HIV-1-discordant couples., 2013 Oct 1. The Journal of infectious diseases. 208(7):1093-101. Abstract

The synergy between herpes simplex virus type 2 (HSV-2) and human immunodeficiency virus type 1 (HIV-1) is well known, but lack of knowledge about the epidemiology of HSV-2 acquisition in HIV-1-discordant couples hampers development of HSV-2 prevention interventions that could reduce HIV-1 transmission.

Mose, F, Newman LP, Njunguna R, Tamooh H, John-Stewart G, Farquhar C, Kiarie J.  2013.  Biomarker evaluation of self-reported condom use among women in HIV-discordant couples., 2013 Jul. International journal of STD & AIDS. 24(7):537-40. Abstract

Self-reported condom use is a commonly collected statistic, yet its use in research studies may be inaccurate. We evaluated this statistic among women in HIV-discordant couples enrolled in a clinical trial in Nairobi, Kenya. Vaginal swabs were acquired from 125 women and tested for prostate-specific antigen (PSA), a biomarker for semen exposure, using an enzyme-linked immunosorbent assay. Ten (10%) of 98 women who reported 100% use of condoms in the previous month tested PSA positive. In a bivariate logistic regression analysis, among women who reported 100% condom use in the previous month, those with ≤8 years of school had significantly higher odds of testing PSA-positive (odds ratio [OR] = 8.39, 95% confidence interval [CI] 1.02-69.13) than women with more schooling. Our estimate may be conservative, as the ability to detect PSA may be limited to 24-48 hours after exposure. Less educated women may be a target group for counselling regarding reporting sexual behaviour in clinical trials.

Marson, KG, Tapia K, Kohler P, McGrath CJ, John-Stewart GC, Richardson BA, Njoroge JW, Kiarie JN, Sakr SR, Chung MH.  2013.  Male, mobile, and moneyed: loss to follow-up vs. transfer of care in an urban African antiretroviral treatment clinic., 2013. PloS one. 8(10):e78900. Abstract

The purpose of this study was to analyze characteristics, reasons for transferring, and reasons for discontinuing care among patients defined as lost to follow-up (LTFU) from an antiretroviral therapy (ART) clinic in Nairobi, Kenya.


Ndase, P, Celum C, Thomas K, Donnell D, Fife KH, Bukusi E, Delany-Moretlwe S, Baeten JM.  2012.  Outside sexual partnerships and risk of HIV acquisition for HIV uninfected partners in African HIV serodiscordant partnerships., 2012 Jan 1. Journal of acquired immune deficiency syndromes (1999). 59(1):65-71. Abstract

As African countries scale-up couples HIV testing, little is known about sexual behaviors and HIV risk for HIV-uninfected partners in known HIV-serodiscordant relationships.

Heffron, R, Donnell D, Rees H, Celum C, Mugo N, Were E, de Bruyn G, Nakku-Joloba E, Ngure K, Kiarie J, Coombs RW, Baeten JM.  2012.  Use of hormonal contraceptives and risk of HIV-1 transmission: a prospective cohort study., 2012 Jan. The Lancet infectious diseases. 12(1):19-26. Abstract

Hormonal contraceptives are used widely but their effects on HIV-1 risk are unclear. We aimed to assess the association between hormonal contraceptive use and risk of HIV-1 acquisition by women and HIV-1 transmission from HIV-1-infected women to their male partners.

Ngure, K, Heffron R, Mugo NR, Celum C, Cohen CR, Odoyo J, Rees H, Kiarie JN, Were E, Baeten JM.  2012.  Contraceptive method and pregnancy incidence among women in HIV-1-serodiscordant partnerships., 2012 Feb 20. AIDS (London, England). 26(4):513-8. Abstract

Effective contraception reduces unintended pregnancies and is a central strategy to reduce vertical HIV-1 transmission for HIV-1-infected women.

Drake, AL, Roxby AC, Ongecha-Owuor F, Kiarie J, John-Stewart G, Wald A, Richardson BA, Hitti J, Overbaugh J, Emery S, Farquhar C.  2012.  Valacyclovir suppressive therapy reduces plasma and breast milk HIV-1 RNA levels during pregnancy and postpartum: a randomized trial., 2012 Feb 1. The Journal of infectious diseases. 205(3):366-75. Abstract

The effect of herpes simplex virus type 2 (HSV-2) suppression on human immunodeficiency virus type 1 (HIV-1) RNA in the context of prevention of mother-to-child transmission (PMTCT) interventions is unknown.

Hughes, JP, Baeten JM, Lingappa JR, Magaret AS, Wald A, de Bruyn G, Kiarie J, Inambao M, Kilembe W, Farquhar C, Celum C.  2012.  Determinants of per-coital-act HIV-1 infectivity among African HIV-1-serodiscordant couples., 2012 Feb 1. The Journal of infectious diseases. 205(3):358-65. Abstract

Knowledge of factors that affect per-act infectivity of human immunodeficiency virus type 1 (HIV-1) is important for designing HIV-1 prevention interventions and for the mathematical modeling of the spread of HIV-1.

Slyker, JA, Chung MH, Lehman DA, Kiarie J, John Kinuthia, James N Kiarie, Holte S, Tapia K, Njiri F, Overbaugh J, John-Stewart G.  2012.  Incidence and correlates of HIV-1 RNA detection in the breast milk of women receiving HAART for the prevention of HIV-1 transmission., 2012. PloS one. 7(1):e29777. Abstract

The incidence and correlates of breast milk HIV-1 RNA detection were determined in intensively sampled women receiving highly active antiretroviral therapy (HAART) for the prevention of mother-to-child HIV-1 transmission.

Balkus, JE, Jaoko W, Mandaliya K, Richardson BA, Masese L, Gitau R, Kiarie J, Marrazzo J, Farquhar C, McClelland SR.  2012.  The posttrial effect of oral periodic presumptive treatment for vaginal infections on the incidence of bacterial vaginosis and Lactobacillus colonization., 2012 May. Sexually transmitted diseases. 39(5):361-5. Abstract

We previously demonstrated a decrease in bacterial vaginosis (BV) and an increase in Lactobacillus colonization among randomized controlled trial (RCT) participants who received monthly oral periodic presumptive treatment (PPT; 2 g metronidazole + 150 mg fluconazole). Posttrial data were analyzed to test the hypothesis that the treatment effect would persist after completion of 1 year of PPT.

Drake, AL, Roxby AC, Kiarie J, Richardson BA, Wald A, John-Stewart G, Farquhar C.  2012.  Infant safety during and after maternal valacyclovir therapy in conjunction with antiretroviral HIV-1 prophylaxis in a randomized clinical trial., 2012. PloS one. 7(4):e34635. Abstract

Maternal administration of the acyclovir prodrug valacyclovir is compatible with pregnancy and breastfeeding. However, the safety profile of prolonged infant and maternal exposure to acyclovir in the context of antiretrovirals (ARVs) for prevention of mother-to-child HIV-1 transmission (PMTCT) has not been described.

Roxby, AC, Drake AL, Ongecha-Owuor F, Kiarie JN, Richardson B, Matemo DN, Overbaugh J, Emery S, John-Stewart GC, Wald A, Farquhar C.  2012.  Effects of valacyclovir on markers of disease progression in postpartum women co-infected with HIV-1 and herpes simplex virus-2., 2012. PloS one. 7(6):e38622. Abstract

Herpes simplex virus type 2 (HSV-2) suppression has been shown to reduce HIV-1 disease progression in non-pregnant women and men, but effects on pregnant and postpartum women have not been described.

Hubacher, D, Olawo A, Manduku C, Kiarie J, Chen P-L.  2012.  Preventing unintended pregnancy among young women in Kenya: prospective cohort study to offer contraceptive implants., 2012 Nov. Contraception. 86(5):511-7. Abstract

Subdermal contraceptive implants have low discontinuation rates but are underused among young women in Africa. This study aimed to isolate the role initial contraceptive method has on preventing unintended pregnancy.

Mullan, F, Frehywot S, Omaswa F, Sewankambo N, Talib Z, Chen C, Kiarie J, Kiguli-Malwadde E.  2012.  The Medical Education Partnership Initiative: PEPFAR's effort to boost health worker education to strengthen health systems., 2012 Jul. Health affairs (Project Hope). 31(7):1561-72. Abstract

The early success of the President's Emergency Plan for AIDS Relief (PEPFAR) in delivering antiretroviral medications in poor countries unmasked the reality that many lacked sufficient health workers to dispense the drugs effectively. The 2008 reauthorization of PEPFAR embraced this challenge and committed to supporting the education and training of thousands of new health workers. In 2010 the program, with financial support from the US National Institutes of Health and administrative support from the Health Resources and Services Administration, launched the Medical Education Partnership Initiative to fund thirteen African medical schools and a US university. The US university would serve as a coordinating center to improve the quantity, quality, and retention of the schools' graduates. The program was not limited to training in the delivery of services for patients with HIV/AIDS. Rather, it was based on the principle that investment in medical education and retention would lead to health system strengthening overall. Although results are limited at this stage, this article reviews the opportunities and challenges of the first year of this major transnational medical education initiative and considers directions for future efforts and reforms, national governmental roles, and the sustainability of the program over time.

Baeten, JM, Donnell D, Ndase P, Mugo NR, Campbell JD, Wangisi J, Tappero JW, Bukusi EA, Cohen CR, Katabira E, Ronald A, Tumwesigye E, Were E, Fife KH, Kiarie J, Farquhar C, John-Stewart G, Kakia A, Odoyo J, Mucunguzi A, Nakku-Joloba E, Twesigye R, Ngure K, Apaka C, Tamooh H, Gabona F, Mujugira A, Panteleeff D, Thomas KK, Kidoguchi L, Krows M, Revall J, Morrison S, Haugen H, Emmanuel-Ogier M, Ondrejcek L, Coombs RW, Frenkel L, Hendrix C, Bumpus NN, Bangsberg D, Haberer JE, Stevens WS, Lingappa JR, Celum C.  2012.  Antiretroviral prophylaxis for HIV prevention in heterosexual men and women., 2012 Aug 2. The New England journal of medicine. 367(5):399-410. Abstract

Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations.

Rositch, AF, Gatuguta A, Choi RY, Guthrie BL, Mackelprang RD, Bosire R, Manyara L, Kiarie JN, Smith JS, Farquhar C.  2012.  Knowledge and acceptability of pap smears, self-sampling and HPV vaccination among adult women in Kenya., 2012. PloS one. 7(7):e40766. Abstract

Our study aimed to assess adult women's knowledge of human papillomavirus (HPV) and cervical cancer, and characterize their attitudes towards potential screening and prevention strategies.

Rositch, AF, Cherutich P, Brentlinger P, Kiarie JN, Nduati R, Farquhar C.  2012.  HIV infection and sexual partnerships and behaviour among adolescent girls in Nairobi, Kenya., 2012 Jul. International journal of STD & AIDS. 23(7):468-74. Abstract

Early sexual partnerships place young women in sub-Saharan Africa at high risk for HIV. Few studies have examined both individual- and partnership-level characteristics of sexual relationships among adolescent girls. A cross-sectional survey of sexual history and partnerships was conducted among 761 adolescent girls aged 15-19 years in Nairobi, Kenya. Rapid HIV testing was conducted and correlates of HIV infection were determined using multivariate logistic regression. The HIV prevalence was 7% and seropositive adolescents had a younger age at sexual debut (P < 0.01), more sexual partners in 12 months (P = 0.03), and were more likely to report transactional or non-consensual sex (P < 0.01). Girls who reported not knowing their partner's HIV status were 14 times as likely to be HIV-seropositive than girls who knew their partner's status (adjusted odds ratio: 14.2 [1.8, 109.3]). Public health messages to promote HIV testing and disclosure within partnerships could reduce sexual risk behaviours and HIV transmission among adolescents.

Choi, RY, Levinson P, Guthrie BL, Lohman-Payne B, Bosire R, Liu AY, Hirbod T, Kiarie J, Overbaugh J, John-Stewart G, Broliden K, Farquhar C.  2012.  Cervicovaginal HIV-1-neutralizing immunoglobulin A detected among HIV-1-exposed seronegative female partners in HIV-1-discordant couples., 2012 Nov 13. AIDS (London, England). 26(17):2155-63. Abstract

Cervicovaginal HIV-1-neutralizing immunoglobulin A (IgA) was associated with reduced HIV-1 acquisition in a cohort of commercial sex workers. We aimed to define the prevalence and correlates of HIV-1-neutralizing IgA from HIV-1-exposed seronegative (HESN) women in HIV-1-serodiscordant relationships.

Guthrie, BL, Lohman-Payne B, Liu AY, Bosire R, Nuvor SV, Choi RY, Mackelprang RD, Kiarie JN, De Rosa SC, Richardson BA, John-Stewart GC, Farquhar C.  2012.  HIV-1-specific enzyme-linked immunosorbent spot assay responses in HIV-1-exposed uninfected partners in discordant relationships compared to those in low-risk controls., 2012 Nov. Clinical and vaccine immunology : CVI. 19(11):1798-805. Abstract

A number of studies of highly exposed HIV-1-seronegative individuals (HESN) have found HIV-1-specific cellular responses. However, there is limited evidence that responses prevent infection or are linked to HIV-1 exposure. Peripheral blood mononuclear cells (PBMC) were isolated from HESN in HIV-1-discordant relationships and low-risk controls in Nairobi, Kenya. HIV-1-specific responses were detected using gamma interferon (IFN-γ) enzyme-linked immunosorbent spot (ELISpot) assays stimulated by peptide pools spanning the subtype A HIV-1 genome. The HIV-1 incidence in this HESN cohort was 1.5 per 100 person years. Positive ELISpot responses were found in 34 (10%) of 331 HESN and 14 (13%) of 107 low-risk controls (odds ratio [OR] = 0.76; P = 0.476). The median immunodominant response was 18.9 spot-forming units (SFU)/10(6) peripheral blood mononuclear cells (PBMC). Among HESN, increasing age (OR = 1.24 per 5 years; P = 0.026) and longer cohabitation with the HIV-1-infected partner (OR = 5.88 per 5 years; P = 0.003) were associated with responses. These factors were not associated with responses in controls. Other exposure indicators, including the partner's HIV-1 load (OR = 0.99 per log(10) copy/ml; P = 0.974) and CD4 count (OR = 1.09 per 100 cells/μl; P = 0.238), were not associated with responses in HESN. HIV-1-specific cellular responses may be less relevant to resistance to infection among HESN who are using risk reduction strategies that decrease their direct viral exposure.

Kavanaugh, BE, Odem-Davis K, Jaoko W, Estambale B, Kiarie JN, Masese LN, Deya R, Manhart LE, Graham SM, McClelland RS.  2012.  Prevalence and correlates of genital warts in Kenyan female sex workers., 2012 Nov. Sexually transmitted diseases. 39(11):902-5. Abstract

Our goal in the present study was to investigate the prevalence and correlates of genital warts in a population of female sex workers in Mombasa, Kenya. Because of the high prevalence of human immunodeficiency virus type 1 (HIV-1) in this population, we were particularly interested in the association between HIV-1 infection and genital warts.

Murnane, PM, Hughes JP, Celum C, Lingappa JR, Mugo N, Farquhar C, Kiarie J, Wald A, Baeten JM.  2012.  Using plasma viral load to guide antiretroviral therapy initiation to prevent HIV-1 transmission., 2012. PloS one. 7(11):e51192. Abstract

Current WHO guidelines recommend antiretroviral therapy (ART) initiation at CD4 counts ≤350 cells/µL. Increasing this threshold has been proposed, with a primary goal of reducing HIV-1 infectiousness. Because the quantity of HIV-1 in plasma is the primary predictor of HIV-1 transmission, consideration of plasma viral load in ART initiation guidelines is warranted.

Koigi-Kamau, R, Leting PK, Kiarie JN.  2012.  Perceptions and practices of vaginal birth after Caesarean section among privately practicing obstetricians in Kenya. Abstract

To determine perceptions, preferences and practices of vaginal birth after Caesarean. DESIGN: Cross-sectional descriptive study. SETTING: Private clinics of obstetricians in five major towns of Kenya. SUBJECTS: Obstetricians in private practice. MAIN OUTCOME MEASURES: Practice and experiences in trial of labour (TOL); need for, and application of, selection criteria in TOL; perceptions on outcomes of TOL and patient preference; perception on trends of vaginal birth after Caesarean (VBAC) and need for policy on TOL. RESULTS: Nearly all respondents (98.4%) believed in the need for, and application of, selection criteria for allowing TOL. However, only 23% believed in routine screening with radiological pelvimetry, while 63.2% believed in routine foetal weight estimation. All obstetricians (100%) have ever managed TOL in private practice, and 74% had managed at least one case in the last six months. Despite lack of tangible selection criteria, 83.1% think that most women prefer TOL while 95.1% discourage it if perceived as inappropriate. Failure rate of TOL was perceived to be more than 50% by 35.2% of the respondents. A majority of the respondents (about 75%) would prefer TOL on themselves or their spouses. Those who perceived that there was a falling trend of VBAC were 58%, citing increased demand by mothers (45.7%), obstetricians' convenience (40.0%) and fear of litigation (26.8%) as the reasons for this observation. A fluid policy of "TOL whenever it is deemed as appropriate" was preferred by 88.7%. CONCLUSION: The perception of obstetricians is that desire for VBAC predominates over elective repeat Caesarean. However, consensus on appropriate selection criteria is lacking, which leaves the obstetrician in a management dilemma. Hence, there is need to study outcomes of both ERC and TOL in order to come out with objective policy guidelines on management of one previous Caesarean in pregnancy.

Balkus, JE, Jaoko W, Mandaliya K, Richardson BA, Masese L, Gitau R, Kiarie J, Marrazzo J, Farquhar C, McClelland SR.  2012.  The post-trial effect of oral periodic presumptive treatment for vaginal infections on the incidence of bacterial vaginosis and Lactobacillus colonization. Abstract

We previously demonstrated a decrease in bacterial vaginosis (BV) and an increase in Lactobacillus colonization among randomized controlled trial (RCT) participants who received monthly oral periodic presumptive treatment (PPT) [2g metronidazole + 150mg fluconazole]. Post-trial data were analyzed to test the hypothesis that the treatment effect would persist following completion of one year of PPT. Methods Data were obtained from women who completed all 12 RCT visits and attended ≥1 post-trial visit within 120 days following completion of the RCT. We used Andersen-Gill proportional hazards models to estimate the post-trial effect of the intervention on the incidence of BV by Gram stain and detection of Lactobacillus species by culture. Results The analysis included 165 subjects (83 active and 82 placebo). The post-trial incidence of BV was 260 per 100 person-years in the intervention arm versus 358 per 100 person-years in the placebo arm (hazard ratio [HR]=0.76; 95% confidence interval [CI]: 0.51–1.12). The post-trial incidence of Lactobacillus colonization was 180 per 100 person-years in the intervention arm versus 127 per 100 person-years in the placebo arm (HR=1.42; 95% CI: 0.85–2.71). Conclusions Despite a decrease in BV and an increase in Lactobacillus colonization during the RCT, the effect of PPT was not sustained at the same level following cessation of the intervention. New interventions that reduce BV recurrence and promote Lactobacillus colonization without the need for ongoing treatment are needed.

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