Goyette, MS, Wilson KS, Deya R, Masese LN, Shafi J, Richardson BA, Mandaliya K, Jaoko W, McClelland SR.  2017.  Brief Report: Association Between Menopause and Unprotected Sex in High-Risk HIV-Positive Women in Mombasa, Kenya., 2017 Apr 15. Journal of acquired immune deficiency syndromes (1999). 74(5):488-492. Abstract

Many HIV-positive women now live well beyond menopause. Postmenopausal women are no longer at risk for pregnancy, and some studies suggest that they may use condoms less often than premenopausal women. This study tests the hypothesis that, in HIV-positive women who report trading sex for cash or in-kind payment, unprotected sex is more common at postmenopausal visits compared with premenopausal visits.

Nordstrom, MPC, Westercamp N, Jaoko W, Okeyo T, Bailey RC.  2017.  Medical Male Circumcision Is Associated With Improvements in Pain During Intercourse and Sexual Satisfaction in Kenya., 2017 Apr. The journal of sexual medicine. 14(4):601-612. Abstract

Two cohort studies using data from randomized controlled trials in Africa offer the best evidence to date on the effects of voluntary medical male circumcision (VMMC) on male sexual function and satisfaction, suggesting no significant impairments in sexual function or satisfaction and some improvements in sexual function after male circumcision.

Ronen, K, Dingens AS, Graham SM, Jaoko W, Mandaliya K, McClelland SR, Overbaugh J.  2017.  Comprehensive Characterization of Humoral Correlates of Human Immunodeficiency Virus 1 Superinfection Acquisition in High-risk Kenyan Women., 2017 Apr. EBioMedicine. 18:216-224. Abstract

HIV-1 superinfection, in which an infected individual acquires a second HIV-1 infection from a different partner, is one of the only settings in which HIV acquisition occurs in the context of a pre-existing immune response to natural HIV infection. There is evidence that initial infection provides some protection from superinfection, particularly after 6months of initial infection, when development of broad immunity occurs. Comparison of the immune response of superinfected individuals at the time of superinfection acquisition to that of individuals who remain singly infected despite continued exposure can shed light on immune correlates of HIV acquisition to inform prophylactic vaccine design. We evaluated a panel of humoral immune responses in the largest published group of superinfected individuals (n=21), compared to a set of 3:1 matched singly infected controls from the same cohort. The immune functions studied included plasma neutralization, plasma and cervical antibody-dependent cellular cytotoxicity, and plasma IgG and IgA binding to a panel of 18 envelope antigens, including correlates of HIV acquisition in the RV144 vaccine trial, IgG binding to V1V2 and IgA binding to gp140. Association between each immune function and HIV superinfection was evaluated using conditional logistic regression. No significant associations were detected between any of the immune functions and superinfection acquisition. This study constitutes the most comprehensive and detailed characterization of multiple immune correlates of superinfection to date. The results suggest that immune responses not commonly measured in current HIV studies may be important in protection from HIV infection, and these or a more robust humoral response than that seen in naturally infected women may be needed for a protective vaccine.

Lokken, EM, Balkus JE, Kiarie J, Hughes JP, Jaoko W, Totten PA, McClelland SR, Manhart LE.  2017.  Recent bacterial vaginosis is associated with acquisition of Mycoplasma genitalium., 2017 May 03. American journal of epidemiology. Abstract

We assessed the association between recent bacterial vaginosis (BV) and incident Mycoplasma genitalium, a sexually transmitted bacterium associated with adverse female reproductive health outcomes. Female sex workers in Mombasa, Kenya completed a monthly sexual behavior interview and clinical examination. During February 2005-February 2006, vaginal fluid specimens collected from women every other month were tested for M. genitalium by nucleic acid amplification testing. Vaginal microbiota was assessed monthly and categorized by Nugent score (0-3 normal, 4-6 intermediate microbiota, 7-10 BV). A discrete time failure analysis for multiple events using logistic regression was used to estimate the odds of incident M. genitalium infection at follow-up visits in women with BV versus normal microbiota at the preceding visit. Among the 280 women, 54.3% were HIV positive. At baseline, 16.1% had prevalent M. genitalium infections and 40.4% had prevalent BV. There were 59 incident M. genitalium infections among 50 women for an incidence rate of 34.6 per 100 person-years. Following adjustment for age, HIV status, and time, prior BV was associated with a 3.5-fold increase in odds of incident M. genitalium (adjusted odds ratio = 3.49; 95% confidence interval: 1.86, 6.56). This strong association suggests that BV may enhance susceptibility to M. genitalium infection.


Young, MR, Adera F, Mehta SD, Jaoko W, Adipo T, Badia J, Nordstrom SK, Irwin TE, Ongong'a D, Bailey RC.  2016.  Factors Associated with Preference for Early Infant Male Circumcision Among a Representative Sample of Parents in Homa Bay County, Western Kenya., 2016 Jan 18. AIDS and behavior. Abstract

Several countries scaling-up adult medical male circumcision (MMC) for HIV prevention intend to introduce early infant male circumcision (EIMC). To assess preference for EIMC in a community with a mature adult MMC program, we conducted a cross-sectional survey of a representative sample of mothers (n = 613) and fathers (n = 430) of baby boys ("index son") at 16 health facilities in western Kenya. Most (59 %) were for EIMC, generally. Just 29 % were for circumcising the index son. Pain and protection from HIV were the most frequently cited barrier and facilitator to EIMC, respectively. In multivariable logistic regression, ever talking with the partner about EIMC and positive serostatus were associated with preference for EIMC for the index son. Attitudes towards EIMC are favorable. Willingness to circumcise an infant son is modest. To facilitate EIMC uptake, education about EIMC pain management and encouraging discussion between parents about EIMC during pregnancy should be integrated into programs.

Njaanake, KH, Vennervald BJ, Simonsen PE, Madsen H, Mukoko DA, Kimani G, Jaoko WG, Estambale BB.  2016.  Schistosoma haematobium and soil-transmitted Helminths in Tana Delta District of Kenya: infection and morbidity patterns in primary schoolchildren from two isolated villages., 2016. BMC infectious diseases. 16:57. Abstract

Schistosomes and soil-transmitted helminths (STH) (hookworm, Trichuris trichiura and Ascaris lumbricoides) are widely distributed in developing countries where they infect over 230 million and 1.5 billion people, respectively. The parasites are frequently co-endemic and many individuals are co-infected with two or more of the species, but information on how the parasites interact in co-infected individuals is scarce. The present study assessed Schistosoma haematobium and STH infection and morbidity patterns among school children in a hyper-endemic focus in the Tana River delta of coastal Kenya.

Roxby, AC, Fredricks DN, Odem-Davis K, Ásbjörnsdóttir K, Masese L, Fiedler TL, De Rosa S, Jaoko W, Kiarie JN, Overbaugh J, McClelland SR.  2016.  Changes in Vaginal Microbiota and Immune Mediators in HIV-1-Seronegative Kenyan Women Initiating Depot Medroxyprogesterone Acetate., 2016 Apr 1. Journal of acquired immune deficiency syndromes (1999). 71(4):359-66. Abstractchanges_in_vaginal_microbiota_and_immune_mediators_in_hiv-1-seronegative_kenyan_women_initiating_depot_medroxyprogesterone_acetate.pdfPUBMED

Depot medroxyprogesterone acetate (DMPA) is associated with HIV acquisition. We studied changes in vaginal microbiota and inflammatory milieu after DMPA initiation.

Wilson, KS, Deya R, Yuhas K, Simoni J, Vander Stoep A, Shafi J, Jaoko W, Hughes JP, Richardson BA, McClelland SR.  2016.  A Prospective Cohort Study of Intimate Partner Violence and Unprotected Sex in HIV-Positive Female Sex Workers in Mombasa, Kenya., 2016 Apr 19. AIDS and behavior. Abstracta_prospective_cohort_study_of_intimate_partner_violence_and_unprotected_sex_in_hiv-positive_female_sex_workers_in_mombasa_kenya.pdfPUBMED

We conducted a prospective cohort study to test the hypothesis that intimate partner violence (IPV) is associated with unprotected sex in HIV-positive female sex workers in Mombasa, Kenya. Women completed monthly visits and quarterly examinations. Any IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the current or most recent emotional partner ('index partner'). Unprotected sex with any partner was measured by self-report and prostate specific antigen (PSA) test. Recent IPV was associated with significantly higher risk of unprotected sex (adjusted relative risk [aRR] 1.91, 95 % CI 1.32, 2.78, p = 0.001) and PSA (aRR 1.54, 95 % CI 1.17, 2.04, p = 0.002) after adjusting for age, alcohol use, and sexual violence by someone besides the index partner. Addressing IPV in comprehensive HIV programs for HIV-positive women in this key population is important to improve wellbeing and reduce risk of sexual transmission of HIV.

Wilson, KS, Wanje G, Yuhas K, Simoni JM, Masese L, Vander Stoep A, Jaoko W, Hughes JP, Richardson BA, Scott McClelland R.  2016.  A Prospective Study of Intimate Partner Violence as a Risk Factor for Detectable Plasma Viral Load in HIV-Positive Women Engaged in Transactional Sex in Mombasa, Kenya., 2016 May 3. AIDS and behavior. Abstracta_prospective_study_of_intimate_partner_violence_as_a_risk_factor_for_detectable_plasma_viral_load_in_hiv-positive_women_engaged_in_transactional_sex_in_mombasa_kenya.pdfPUBMED

We conducted a prospective cohort study to evaluate intimate partner violence (IPV) as a risk factor for detectable plasma viral load in HIV-positive female sex workers (FSWs) on antiretroviral therapy (ART) in Kenya. IPV in the past year was defined as ≥1 act of physical, sexual, or emotional violence by the index partner (i.e. boyfriend/husband). The primary outcome was detectable viral load (≥180 copies/ml). In-depth interviews and focus groups were included to contextualize results. Analyses included 195 women (570 visits). Unexpectedly, IPV was associated with significantly lower risk of detectable viral load (adjusted relative risk 0.21, 95 % CI 0.05-0.84, p-value = 0.02). Qualitative findings revealed that women valued emotional and financial support from index partners, despite IPV. IPV was not a major barrier to ART adherence. The observed association between IPV and lower risk of detectable viral load in FSWs may be due to unmeasured personal and relationship factors, warranting further research.

Obiero, JA, Waititu KK, Mulei I, Omar FI, Jaoko W, Mwethera PG.  2016.  Baboon vaginal microbial flora., 2016 Jun. Journal of medical primatology. 45(3):147-55. Abstractbaboon_vaginal_microbial_flora.pdfPUBMED

Knowledge of the composition of vaginal microbial ecosystem is essential for understanding the etiology, prevention, and treatment of vaginal diseases. A baboon model has been used to provide detailed understanding of reproductive physiology and immunology applicable to women. However, little is known about the composition of its vaginal microbial ecosystem.


Su, R-C, Plesniarski A, Ao Z, Kimani J, Sivro A, Jaoko W, Plummer FA, Yao X, Ball TB.  2015.  Reducing IRF-1 to Levels Observed in HESN Subjects Limits HIV Replication, But Not the Extent of Host Immune Activation., 2015. Molecular therapy. Nucleic acids. 4:e259. Abstract

Cells from women who are epidemiologically deemed resistant to HIV infection exhibit a 40-60% reduction in endogenous IRF-1 (interferon regulatory factor-1), an essential regulator of host antiviral immunity and the early HIV replication. This study examined the functional consequences of reducing endogenous IRF-1 on HIV-1 replication and immune response to HIV in natural HIV target cells. IRF-1 knockdown was achieved in ex vivo CD4(+) T cells and monocytes with siRNA. IRF-1 level was assessed using flow cytometry, prior to infection with HIV-Bal, HIV-IIIB, or HIV-VSV-G. Transactivation of HIV long terminal repeats was assessed by p24 secretion (ELISA) and Gag expression (reverse transcription-polymerase chain reaction (RT-PCR)). The expression of IRF-1-regulated antiviral genes was quantitated with RT-PCR. A modest 20-40% reduction in endogenous IRF-1 was achieved in >87% of ex vivo-derived peripheral CD4(+) T cells and monocytes, resulted in >90% reduction in the transactivation of the HIV-1 genes (Gag, p24) and, hence, HIV replication. Curiously, these HIV-resistant women demonstrated normal immune responses, nor an increased susceptibility to other infection. Similarly, modest IRF-1 knockdown had limited impact on the magnitude of HIV-1-elicited activation of IRF-1-regulated host immunologic genes but resulted in lessened duration of these responses. These data suggest that early expression of HIV-1 genes requires a higher IRF-1 level, compared to the host antiviral genes. Together, these provide one key mechanism underlying the natural resistance against HIV infection and further suggest that modest IRF-1 reduction could effectively limit productive HIV infection yet remain sufficient to activate a robust but transient immune response.

Gichuhi, S, Macharia E, Kabiru J, Zindamoyen AM'bongo, Rono H, Ollando E, Wanyonyi L, Wachira J, Munene R, Onyuma T, Jaoko WG, Sagoo MS, Weiss HA, Burton MJ.  2015.  Toluidine Blue 0.05% Vital Staining for the Diagnosis of Ocular Surface Squamous Neoplasia in Kenya., 2015 Nov. JAMA ophthalmology. 133(11):1314-21. Abstract

Clinical features are unreliable for distinguishing ocular surface squamous neoplasia (OSSN) from benign conjunctival lesions.

Wilson, KS, Deya R, Masese L, Simoni JM, Vander Stoep A, Shafi J, Jaoko W, Hughes JP, McClelland SR.  2015.  Prevalence and correlates of intimate partner violence in HIV-positive women engaged in transactional sex in Mombasa, Kenya., 2015 Oct 12. International journal of STD & AIDS. Abstract

SummaryWe evaluated the prevalence and correlates of intimate partner violence in the past year by a regular male partner in HIV-positive female sex workers in Mombasa, Kenya. This cross-sectional study included HIV-positive women ≥18 years old who reported engagement in transactional sex at the time of enrolment in the parent cohort. We asked 13 questions adapted from the World Health Organization survey on violence against women about physical, sexual, or emotional violence in the past year by the current or most recent emotional partner (index partner). We used standardised instruments to assess socio-demographic and behavioural characteristics as possible correlates of intimate partner violence. Associations between intimate partner violence and these correlates were evaluated using univariate and multivariate logistic regression. Overall, 286/357 women (80.4%) had an index partner, and 52/357 (14.6%, 95% confidence interval 10.9%-18.2%) reported intimate partner violence by that partner in the past year. In multivariate analysis, women with severe alcohol problems (adjusted odds ratio 4.39, 1.16-16.61) and those experiencing controlling behaviours by the index partner (adjusted odds ratio 4.98, 2.31-10.74) were significantly more likely to report recent intimate partner violence. Recent intimate partner violence was common in HIV-positive female sex workers. Interventions targeting risk factors for intimate partner violence, including alcohol problems and partner controlling behaviours, could help to reduce recurrent violence and negative health outcomes in this key population.

Golub, G, Herman-Roloff A, Hoffman S, Jaoko W, Bailey RC.  2015.  The Relationship Between Distance and Post-operative Visit Attendance Following Medical Male Circumcision in Nyanza Province, Kenya., 2015 Sep 30. AIDS and behavior. Abstract

To date, there is no research on voluntary medical male circumcision (VMMC) catchment areas or the relationship between distance to a VMMC facility and attendance at a post-operative follow-up visit. We analyzed data from a randomly selected subset of males self-seeking circumcision at one of 16 participating facilities in Nyanza Province, Kenya between 2008 and 2010. Among 1437 participants, 46.7 % attended follow-up. The median distance from residence to utilized facility was 2.98 km (IQR 1.31-5.38). Nearly all participants (98.8 %) lived within 5 km from a facility, however, 26.3 % visited a facility more than 5 km away. Stratified results demonstrated that among those utilizing fixed facilities, greater distance was associated with higher odds of follow-up non-attendance (OR5.01-10km vs. 0-1km = 1.71, 95 % CI 1.08, 2.70, p = 0.02; OR>10km vs. 0-1 km = 2.80, 95 % CI 1.26, 6.21, p = 0.01), adjusting for age and district of residence. We found 5 km marked the threshold distance beyond which follow-up attendance significantly dropped. These results demonstrate distance is an important predictor of attending follow-up, and this relationship appears to be modified by facility type.

Weis, JF, McClelland SR, Jaoko W, Mandaliya KN, Overbaugh J, Graham SM.  2015.  Short communication: Fc gamma receptors IIa and IIIa genetic polymorphisms do not predict HIV-1 disease progression in Kenyan women., 2015 Mar. AIDS research and human retroviruses. 31(3):288-92. Abstract

Genetic polymorphisms of the Fc gamma receptors (FcγR) IIa and IIIa have been implicated in the rate of HIV-1 disease progression, but results are inconsistent. We aimed to determine the association between these polymorphisms and disease progression in a cohort of HIV-1 seroconverters from Mombasa, Kenya. Neither FcγRIIa nor FcγRIIIa genotypes were predictive of set point viral load, viral load increase, CD4 decline, or HIV-1 disease progression (time to CD4 count <200 cells/mm(3), death, or treatment initiation). Our results suggest that FcγR polymorphisms might not be an important indicator of viral control and disease progression in this population.

  2015.  A 15-year study of the impact of community antiretroviral therapy coverage on HIV incidence in Kenyan female sex workers., 2015 Nov. AIDS (London, England). 29(17):2279-86. AbstractWebsite

To test the hypothesis that increasing community antiretroviral therapy (ART) coverage would be associated with lower HIV incidence in female sex workers (FSWs) in Mombasa District, Kenya.


Schmidt C, Jaoko W, O-MKMNKBBLGGPJA, Chomba E, Kilembe W NNSCLCADSFPEMJGP.  2014.  Long-term follow-up of study participants from prophylactic HIV vaccine clinical trials in Africa. Human Vaccines & Immunotherapy. 10(3):714-23.
Masese L, Baeten JM, RBABJ-SJSKMCRSEGWJ.  2014.  Incident herpes simplex virus type 2 infection increases the risk of subsequent episodes of bacterial vaginosis.. Journal of Infectious Diseases. 209(7):1023-7.
Lehman DA, Ronen K, BCABJMJ-LJMRBAMCRSOZWK.  2014.  Systemic cytokine levels show limited correlation with risk of HIV-1 acquisition. Journal of Acquired Immune Deficiency Syndrome . 66(2):135-9.
Njuguna I, Reilly M, JGAM-OL-PHJ-SWCGE.  2014.  Infant Neutropenia Associated with Breastfeeding During Maternal Antiretroviral Treatment for Prevention of Mother-to-Child Transmission of HIV. Retrovirology: Research and Treatment. 32(44):5801-8.
of the Broutet N, Fruth U, DGSLRPSTIVTCCH 201.  2014.  Vaccines against sexually transmitted infections: the way forward. Vaccine. 32(14):1630-7.
Phipps W, Saracino M, SHMLJMWCMCRSSWK.  2014.  Oral HHV-8 replication among women in Mombasa, Kenya. Journal of Medical Virology. 86(10):1759-65.
Njaanake KH, Simonsen PE, VBJMDARCMGJWGEBBK &.  2014.  Urinary cytokines in Schistosoma haematobium-infected schoolchildren from Tana Delta District of Kenya. BMC Infectious Diseases . 14: 501
Sivapalasingam S, McClelland RS, RACCMGMMJAP, Shafi J, Masese L FAMEJKAEMW &.  2014.  An Effective Intervention to reduce intravaginal practices among HIV-1 uninfected Kenyan women.. AIDS Research and Human Retroviruses . 30(11)::1046-57.
Jespers V, Crucitti T, MVMMNGFD-MVHJRMK, van de Buve A WVBSGJ &.  2014.  Prevalence and correlates of bacterial vaginosis in different sub-populations of women in sub-Saharan Africa: a cross-sectional study. PloS One . 9(10): e109670
Weis JF, McClelland RS, JMKNOGSMWJ &.  2014.  Fc Gamma Receptors IIa and IIIa Genetic polymorphisms do not predict HIV-1 disease progression in Kenyan women. . AIDS Res Hum Retroviruses (in print).
Graham SM, Raboud J, JMMCRSBAMWK &.  2014.  Changes in sexual risk behavior in the mombasa cohort: 1993-2007. PLoS One. 9(11):e113543.


Wakasiaka S, Smith DJ, HTDMJAPFHWO &.  2013.  Health-care providers’ perceptions of intravaginal rings or HIV prevention in Nairobi, Kenya. Women’s Health. 7(3):144-50.
Obiero JA, Kunyera R, WKKMFIOLJMPGIKW &.  2013.  A comparative study of Smugel and KY Jelly vaginal lubricating gels. Journal of Reproduction & Contraception. 24(2):76-87.
Forthal DN, Landucci G, CRBASMCJBOBRW.  2013.  Antibody-dependent cell-mediated virus inhibition (ADCVI) antibody activity does not correlate with risk of HIV-1 superinfection. Journal of Acquired Immune Deficiency Syndrome. 63(1):31-3.
Masese L, Baeten JM, RBADKBJ-SJMCRSREEG.  2013.  Incidence and correlates of Chlamydia trachomatis infection in a high-risk cohort of Kenyan women.. Sexually Transmitted Diseases. 40(3):221-5.

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