Publications


2013

Masese L, McClelland RS, GWSKN-AJOLRBAKRGJF.  2013.  A pilot study of the feasibility of a vaginal washing cessation intervention among Kenyan female sex workers. Sex Transm Infect. 89(3):217-22.
Graham SM, Raboud J, MCRSJN-AMOBAMWJKJ.  2013.  Loss to Follow-Up as a Competing Risk in an Observational Study of HIV-1 Incidence. PLoS ONE. 8(3):e59480.abstract.pdf

2012

Ndinya-Achola JO, KA, McClelland RS, Gitau R, G W, J S, F K, L1 M, Lester R, Richardson BA, A. K.  2012.  A pilot study of the feasibility of a vaginal washing cessation intervention among Kenyan female sex workers.. document1.pdf
Backes DM, Bleeker MC, MCJHMGABRCN-AJOHHCJMSKJS, J SJS.  2012.  Male circumcision is associated with a lower prevalence of human papillomavirus-associated penile lesions among Kenyan men. Int J Cancer.:. 130(8):1888-97.abstaerctachola.pdf
Westercamp M, Agot KE, N-ABRCJ.  2012.  Circumcision preference among women and uncircumcised men prior to scale-up of male circumcision for HIV prevention in Kisumu, Kenya.. AIDS Care. . 24(2):157-66. AbstractWebsite

Following the endorsement by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) of male circumcision as an additional strategy to HIV prevention, initiatives to introduce safe, voluntary medical male circumcision (VMMC) services commenced in 2008 in several sub-Saharan African communities. Information regarding perceptions of circumcision as a method of HIV prevention, however, is largely limited to data collected before this important endorsement and the associated increase in the availability of VMMC services. To address this, we completed a community-based survey of male circumcision (MC) perceptions in the major non-circumcising community in Kenya, which is the current focus of VMMC programs in the country. Data was collected between November 2008 and April 2009, immediately before VMMC program scale-up commenced. Here we present results limited to women (n = 1088) and uncircumcised males (n = 460) to provide insight into factors contributing to the acceptability and preference for MC in those targeted by VMMC programs. Separate multivariable models examining preference for circumcision were defined for married men, unmarried men, and women. Belief in the protective effect of circumcision on HIV risk was strongly associated with preference for MC in all models. Other important factors included education, perceived improvement in sexual pleasure, and perceptions of impact on condom utilization. Identified barriers to circumcision were the belief that circumcision was not part of the local culture, the perception of a long healing period following the procedure, the lack of a specific impetus to seek out services, and the general fear of pain associated with becoming circumcised. A minority of participants expressed beliefs suggesting that behavioral risk compensation with increased MC prevalence and awareness is a possibility. This work describes the early impact of a large-scale VMMC program on beliefs and behaviors regarding MC and HIV risk. It is hoped that our findings may offer guidance into anticipating potential impacts that similar programs may observe in populations throughout Eastern Africa.

2011

Omosa-Manyonyi GS, Jaoko W, AOWMNNN-ABFOHSR, Oyaro M, Schmidt C PFFP.  2011.  Reasons for ineligibility in phase 1 and 2A HIV vaccine clinical trials at Kenya AIDS vaccine initiative (KAVI), Kenya.. PLoS One. . 6(1):e14580.abstract1.pdf
Masese LN, Graham SM, GPJN-AJOMRBAOMCRSRNW.  2011.  A prospective study of vaginal trichomoniasis and HIV-1 shedding in women on antiretroviral therapy.. BMC Infect Dis. 3(11):307.abstract1.pdf

2010

Smith JS, Moses S, HMGPCBAMN-AJOSPJMCJBRCKI.  2010.  Increased risk of HIV acquisition among Kenyan men with human papillomavirus infection. J Infect Dis. . 201(11):1677-85.
Mehta SD, Krieger JN, AMN-AJOPBRCKSC.  2010.  Circumcision and reduced risk of self-reported penile coital injuries: results from a randomized controlled trial in Kisumu, Kenya.. J Urol. . 184(1):203-9. Abstractcircumcision_and_reduced_risk_of_self-reported_penile_coital_injuries_results_from_a_randomized_controlled_trial_in_kisumu_kenya.pdfWebsite

PURPOSE:

Injuries to the penis during intercourse represent a hypothesized mechanism by which uncircumcised men are at increased risk for HIV. There are no published, systematically collected data regarding mild penile coital trauma to our knowledge. We identified risks of self-reported penile coital injuries in men 18 to 24 years old in a randomized trial of circumcision to prevent HIV in Kisumu, Kenya.

MATERIALS AND METHODS:

Each participant underwent standardized interview, medical history and physical examination at baseline, and 6, 12, 18 and 24 months after enrollment. Self-reported penile coital injuries were assessed at each visit, and were defined as penis feels sore during sex, penis gets scratches, cuts or abrasions during sex, and skin of the penis bleeds after sex. Generalized estimating equation analysis estimated odds ratios for penile coital injuries.

RESULTS:

From February 2002 to September 2005, 2,784 participants were randomized. At baseline 1,775 (64.4%) men reported any coital injury including 1,313 (47.6%) soreness, 1,328 (48.2%) scratches, abrasions or cuts and 461 (16.7%) bleeding. On multivariable analysis coital injury risk was lower for circumcised than for uncircumcised men with soreness (OR 0.71, 95% CI 0.64-0.80), scratches/abrasions/cuts (OR 0.52, 95% CI 0.46-0.59), bleeding (OR 0.62, 95% CI 0.51-0.75) and any coital injury (OR 0.61, 95% CI 0.54-0.68). Other significant risks included increasing age, multiple recent sex partners, HSV-2 seropositivity and genital ulcers (p <0.05). Condom use, cleaning the penis soon after intercourse and being married/cohabiting were protective (p <0.05, each).

CONCLUSIONS:

Self-reported penile coital injuries were common in these healthy young men. Circumcised

2009

2008

Ogutu, EO, Wankya BM, Shah MV, Ndinya-Achola JO.  2008.  Prevalence of spontaneous bacterial peritonitis at Kenyatta National Hospital.
O., PROFNDINYA-ACHOLAJ.  2008.  Krieger JN, Mehta SD, Bailey RC, Agot K, Ndinya-Achola JO, Parker C, Moses S.Adult Male Circumcision: Effects on Sexual Function and Sexual Satisfaction in Kisumu, Kenya.J Sex Med. 2008 Aug 28. [Epub ahead of print]. J Sex Med. 2008 Aug 28. [Epub ahead of print]. : IBIMA Publishing Abstractadult_male_circumcision_effects_on_sexual_function_and_sexual_satisfaction_in_kisumu_kenya.pdf

Introduction. Male circumcision is being promoted for HIV prevention in high-risk heterosexual populations. However, there is a concern that circumcision may impair sexual function. Aim. To assess adult male circumcision's effect on men's sexual function and pleasure. Methods. Participants in a controlled trial of circumcision to reduce HIV incidence in Kisumu, Kenya were uncircumcised, HIV negative, sexually active men, aged 18-24 years, with a hemoglobin >/=9.0 mmol/L. Exclusion criteria included foreskin covering less than half the glans, a condition that might unduly increase surgical risks, or a medical indication for circumcision. Participants were randomized 1:1 to either immediate circumcision or delayed circumcision after 2 years (control group). Detailed evaluations occurred at 1, 3, 6, 12, 18, and 24 months. Main Outcome Measures. (i) Sexual function between circumcised and uncircumcised men; and (ii) sexual satisfaction and pleasure over time following circumcision. Results. Between February 2002 and September 2005, 2,784 participants were randomized, including the 100 excluded from this analysis because they crossed over, were not circumcised within 30 days of randomization, did not complete baseline interviews, or were outside the age range. For the circumcision and control groups, respectively, rates of any reported sexual dysfunction decreased from 23.6% and 25.9% at baseline to 6.2% and 5.8% at month 24. Changes over time were not associated with circumcision status. Compared to before they were circumcised, 64.0% of circumcised men reported their penis was "much more sensitive," and 54.5% rated their ease of reaching orgasm as "much more" at month 24. Conclusions. Adult male circumcision was not associated with sexual dysfunction. Circumcised men reported increased penile sensitivity and enhanced ease of reaching orgasm. These data indicate that integration of male circumcision into programs to reduce HIV risk is unlikely to adversely effect male sexual function.

O., PROFNDINYA-ACHOLAJ.  2008.  McClelland RS, Richardson BA, Graham SM, Masese LN, Gitau R, Lavreys L, Mandaliya K, Jaoko W, Baeten JM, Ndinya-Achola JO.A prospective study of risk factors for bacterial vaginosis in HIV-1-seronegative African women.Sex Transm Dis. 2008 Jun;35(6):617-23. Sex Transm Dis. 2008 Jun;35(6):617-23.. : IBIMA Publishing Abstract
BACKGROUND: Bacterial vaginosis (BV) is common and has been associated with increased HIV-1 susceptibility. The objective of this study was to identify risk factors for BV in African women at high risk for acquiring HIV-1. METHODS: We conducted a prospective study among 151 HIV-1-seronegative Kenyan female sex workers. Nonpregnant women were eligible if they did not have symptoms of abnormal vaginal itching or discharge at the time of enrollment. At monthly follow-up, a vaginal examination and laboratory testing for genital tract infections were performed. Multivariate Andersen-Gill proportional hazards analysis was used to identify correlates of BV. RESULTS: Participants completed a median of 378 (interquartile range 350-412) days of follow-up. Compared with women reporting no vaginal washing, those who reported vaginal washing 1 to 14 [adjusted hazard ratio (aHR) 1.29, 95% confidence interval (CI) 0.88-1.89], 15 to 28 (aHR 1.60, 95% CI 0.98-2.61), and >28 times/wk (aHR 2.39, 95% CI 1.35-4.23) were at increased risk of BV. Higher BV incidence was also associated with the use of cloth for intravaginal cleansing (aHR 1.48, 95% CI 1.06-2.08) and with recent unprotected intercourse (aHR 1.75, 95% CI 1.47-2.08). Women using depot medroxyprogesterone acetate contraception were at lower risk for BV (aHR 0.59, 95% CI 0.48-0.73). CONCLUSIONS: Vaginal washing and unprotected intercourse were associated with increased risk of BV. These findings could help to inform the development of novel vaginal health approaches for HIV-1 risk reduction in women.

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