This study examined the relationship between knowledge of HIV transmission and prevention and HIV counselling and testing uptake among young people in Nigeria. The study is a quantitative research guided by one research question and one hypothesis. The target population comprised young people in Nigeria ages 15 to 24 years because the focus of this study was to identify the factors affecting HCT uptake among young people in this age cohort. The representative sample was obtained from the updated master sample frame of rural and urban zones developed by the National Population Commission in Nigeria. This master sample frame was a national survey that comprises all 36 states in Nigeria [2]. Probability sampling technique was used to obtain a sample of 10091 respondents (ages 15 to 24 years) for the study. The multistage cluster sampling was used to select suitable young people with known probability. Data were collected throughout Nigeria between September and December 2012 from 32,543 households (rural = 22,192; urban = 10,351) using structured and semi-structured questionnaires. The individual questionnaires asked about household characteristics, background characteristics of the respondents. Data were analyzed by inputing them into SPSS v21.0 for analysis [4] and then coded them for each participant. The data were summed using descriptive statistics. Frequencies and percentages; measures of central tendencies were used to answer the research question while nonparametric test such as chi-square was used to analyze non-normally distributed data at 0.5 level of significance. Results of data analysis indicated that the cognitive factors of knowledge of HIV prevention and knowledge of HIV transmission were statistically significant predictors of the likelihood of having HCT uptake. It was among others recommended that stakeholders, authorities, and providers of health services in Nigeria should strive to increase the rate of HCT uptake among young people ages 15 to 24 years.
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
Background: With the widespread use of highly active antiretroviral therapy, the epidemic of HIV has evolved into a chronic disease. HIV is extremely stigmatizing, resulting in highly emotionally charged responses to disclosure. World Health Organization (WHO) recommends that children should be informed of their HIV status at ages of 6 to 12 years and full disclosure at about 8 to 10 years. Disclosure process is much more difficult when the person being disclosed to is an adolescent. However, disclosure of HIV to a child should be an ongoing process that may last several years depending on the cognitive development of the child.
Methods: This study investigated the determinants of HIV status disclosure among HIV infected adolescents. A total of 209 HIV infected adolescents (10-19 years) who have been on treatment for at least six months, and are taking lifelong anti-retroviral therapy from Bondo County Hospital, Got Agulu and Uyawi Sub County Hospital in Bondo Sub County were enrolled. Simple random sampling was employed in selecting the adolescents. Data was collected using a structured questionnaire. Quantitative data was analysed using both descriptive and inferential statistics while statistical tests including Pearson Correlation analysis and multiple linear regression were used to test the hypotheses.
Results: Findings on the overall parental perceptions regarding risks and benefits of disclosure and disclosure of HIV status to adolescents show that 180 (86.12%) of the respondents had a negative attitude compared to 29 (13.88%) who held a positive attitude. 122 (58.37%) of the respondents believed that overall availability and quality of counselling was moderate. 10 (4.78%) of the respondents believed that the overall availability and quality of counselling was high. Quality services and perception of the parents have been found to be good predictors of disclosure of HIV status among the newly diagnosed adolescents in Bondo sub-County, p-value<0.05.
Conclusion and recommendation: This study identified quality of service and perception of the parents as the two factors determining the disclosure of HIV status. There is a correlation between the parental perceptions regarding risks and benefits of disclosure and the quality of counselling to parental disclosure of HIV status to adolescents. Therefore the study recommends deliberate efforts to ensure quality service delivery and age specific disclosure counselling to caregivers to equip them with adequate knowledge on disclosure.
This study examined the relationship between knowledge of HIV transmission and prevention and HIV counselling and testing uptake among young people in Nigeria. The study is a quantitative research guided by one research question and one hypothesis. The target population comprised young people in Nigeria ages 15 to 24 years because the focus of this study was to identify the factors affecting HCT uptake among young people in this age cohort. The representative sample was obtained from the updated master sample frame of rural and urban zones developed by the National Population Commission in Nigeria. This master sample frame was a national survey that comprises all 36 states in Nigeria [2]. Probability sampling technique was used to obtain a sample of 10091 respondents (ages 15 to 24 years) for the study. The multistage cluster sampling was used to select suitable young people with known probability. Data were collected throughout Nigeria between September and December 2012 from 32,543 households (rural = 22,192; urban = 10,351) using structured and semi-structured questionnaires. The individual questionnaires asked about household characteristics, background characteristics of the respondents. Data were analyzed by inputing them into SPSS v21.0 for analysis [4] and then coded them for each participant. The data were summed using descriptive statistics. Frequencies and percentages; measures of central tendencies were used to answer the research question while nonparametric test such as chi-square was used to analyze non-normally distributed data at 0.5 level of significance. Results of data analysis indicated that the cognitive factors of knowledge of HIV prevention and knowledge of HIV transmission were statistically significant predictors of the likelihood of having HCT uptake. It was among others recommended that stakeholders, authorities, and providers of health services in Nigeria should strive to increase the rate of HCT uptake among young people ages 15 to 24 years.
Over the past decade, Kenya has made tremendous efforts to enhance maternal and child health. Secure maternity policies such as free maternity care are one of the initiatives that have enhanced maternal and child health in all public health facilities. Despite these attempts, public health facilities for maternal and child health are still underused. This study employed a cross-sectional descriptive study design to identify determinants of free maternal health services by evaluating factors determining perceptions and health-seeking behavior of 384 pregnant mothers in Malava Sub-County, Kakamega County. The study used a mixed-method (quantitative and qualitative approaches). Questionnaires were administered to pregnant mothers selected for the study. The study employed a purposive sampling of research participants. Quantitative data were collected using the questionnaire administered by the research assistants whereas qualitative data were collected by the researcher through interview schedules. Quantitative data analysis was carried out using SPSS 23. However, qualitative data were analyzed through content analysis. Quantitative data representation was done in terms of frequency and percentages. Analysis of chi-square testing was used to assess the association between the variables of socio-economic and health facilities and the provision of free maternity facilities (p<0.05). The study established that the uptake of free maternal service by pregnant mothers was influenced by their level of primitivism and religious beliefs. In addition, this study found out that 53.8% and 77.7% of the pregnant mothers could not attend antenatal and post-natal care because government facilities were located far away from their residences and they also had less access to some information about free maternal health care. The results of this research would be disseminated to the hospital management team, Sub-Country health management team, County health management team, and other stakeholders, thereby demonstrating reasons for low uptake of free maternity services and helping to strategize for better service delivery. Based on the finding, the study recommends that to improve access to free maternal health care, the county government ought to place health services as close as possible to the community where people live. Secondly, there is a need to embrace the usage of the existing media network to sensitize pregnant mothers to the danger signs and the need to have decision-making powers over their safety. Lastly, hospital management ought to increase the awareness of free maternal health care and to include it among the community priorities during dialog days, action days, and other group discussions.
Background: With the widespread use of highly active antiretroviral therapy, the epidemic of HIV has evolved into a chronic disease. HIV is extremely stigmatizing, resulting in highly emotionally charged responses to disclosure. World Health Organization (WHO) recommends that children should be informed of their HIV status at ages of 6 to 12 years and full disclosure at about 8 to 10 years. Disclosure process is much more difficult when the person being disclosed to is an adolescent. However, disclosure of HIV to a child should be an ongoing process that may last several years depending on the cognitive development of the child.
Methods: This study investigated the determinants of HIV status disclosure among HIV infected adolescents. A total of 209 HIV infected adolescents (10-19 years) who have been on treatment for at least six months, and are taking lifelong anti-retroviral therapy from Bondo County Hospital, Got Agulu and Uyawi Sub County Hospital in Bondo Sub County were enrolled. Simple random sampling was employed in selecting the adolescents. Data was collected using a structured questionnaire. Quantitative data was analysed using both descriptive and inferential statistics while statistical tests including Pearson Correlation analysis and multiple linear regression were used to test the hypotheses.
Results: Findings on the overall parental perceptions regarding risks and benefits of disclosure and disclosure of HIV status to adolescents show that 180 (86.12%) of the respondents had a negative attitude compared to 29 (13.88%) who held a positive attitude. 122 (58.37%) of the respondents believed that overall availability and quality of counselling was moderate. 10 (4.78%) of the respondents believed that the overall availability and quality of counselling was high. Quality services and perception of the parents have been found to be good predictors of disclosure of HIV status among the newly diagnosed adolescents in Bondo sub-County, p-value<0.05.
Conclusion and recommendation: This study identified quality of service and perception of the parents as the two factors determining the disclosure of HIV status. There is a correlation between the parental perceptions regarding risks and benefits of disclosure and the quality of counselling to parental disclosure of HIV status to adolescents. Therefore the study recommends deliberate efforts to ensure quality service delivery and age specific disclosure counselling to caregivers to equip them with adequate knowledge on disclosure.
ABSTRACT- Background: Women of all races and ethnicities are at risk of cervical cancer. India, around 0.95 million new cases are detected yearly with high burden of 0.63 million. India bears about one fifth of the world’s burden of cervical cancer. Although fatality is high but cancers are largely preventable by effective screening programmes. Design: The present quasi-experimental study was conducted among female students studying in degree colleges from Feb. 2013 to Sept. 2013. Intervention: Educational intervention was conducted through sessions of participatory learning approach which included lectures using power-point, chalk and talk and question-answers method. Data was collected twice by administering predesigned questionnaire and conducting focus group discussion. Data Analysis: Data entered and analyzed using Epi Info 2000. To analyze qualitative information Atlas ti software was used. Paired t-test was used to measure the effect of intervention. Results: Total 149 students were the part of the study and successfully followed. Mean age of the participant was 18.5 years. Out of the 149 participants 4.1% had family history of the cancer. In the study it was observed that 18.8% had not ever heard about the cancer. In the post intervention test significant improvement was seen in all three parameters viz knowledge, attitude and practices. Conclusion: Continuing Educational interventions should be started at all level which highlights the importance of screening and prevention of cancer in women. Key-words- Cervical Cancer, Women, Perception Barriers, Effectiveness
Abstract—Sexual health (SH) and sexual behavior of young people have become a growing public concern. But few studies have been conducted to investigate the prevalence and psychosocial correlates of this phenomenon.
Purpose: To understand college students’ sexual knowledge (SK), sexual attitudes (SA), sexual desire (SD) and sexual behavior (SB).
Methods: A self-reported questionnaire survey on SK, SA, SD, and SB was conducted among 520 university students. Their demographic data, SK, SA, SD, and SB were assessed.
Results: A total of 500 students completed the questionnaire. The SKS total score had a mean of 23.05; 105 (21.0%) subjects had had premarital sex; 121 (24.2%) had a partner; 117 (23.4%) had a medical educational background. The results demonstrated an increased risk of premarital sex amongst males and subjects with the risk factors of smoking, drinking, having a partner, and having higher levels of SD and SK and more open SA.
Conclusions: This study provides support for the idea that university students lack SK (especially regarding contraception knowledge), even though the students had a medical educational background. Additionally, a considerable amount of them engaged in premarital SB. Our findings also suggest that university students need sex education, particularly in combining sexuality with their life, in relating to others maturely as a sexual individual, in employing contraception, and in preventing sexually transmitted diseases (STDs). Our study suggests that interventions aimed at expanding university students’ SK and other related skills are required.
Background: Incidence and prevalence of reproductive health difficulties have been shown to be higher among younger people. In Ghana, youthfriendly sexual and reproductive health services and facilities are very limited. The study aimed at examining the friendliness of sexual and reproductive health service delivery and utilization.
Methods: Across sectional design with both qualitative and quantitative methods was conducted to examine the friendliness and utilization of reproductive health services among youth in the Kwadaso Sub-Metro of Ashanti Region, Ghana. A multistage stratified sampling was used to enroll 170 youth (150 in-school and 20 out of school youth) aged 10 - 24years. Data analysis involved descriptive statistics using SPSS software version 20.
Results: Findings demonstrated that out of the 150 in-school youth sampled, 56% ever had a boyfriend or girlfriend, however, about one third(39.3%) did not recall the length of stay with partner, 58% have heard about sexual reproductive health services offered in the study area. A total of 55.8% of all categories of youth had used at least one or more reproductive health service before. Findings again revealed that 37.2% and 44% respectively of youth who had used sexual reproductive health considered the services received at a facility to be very friendly and friendly, yet, a few 18.6% indicated unfriendliness with services received at the facility.
Conclusion: An integrative and comprehensive approach is required to scale up youth utilization of sexual reproductive health services especially facility based. This requires baseline survey of youth users of reproductive health services and the quality of services offered.
Introduction: Uganda has an estimated 95,000 children living with HIV and only 68% are currently in HIV care. Reaching the fi rst 90 in the UNAIDS 90-90-90 strategy for children is still a far off goal considering the national prevalence of 0.5%. In this study, we set out to determine the coverage and yield from HIV testing using different approaches both at the facility and the community.
Factors Associated With Internet Use among Primary Care Patients in Makurdi, ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Socio-Economic Effect of HIV/AIDS on Orphans and Vulnerable Children in Nyami...paperpublications3
Since the first case of HIV/AIDS was reported in Kenya in 1984 the numbers of those infected have risen and many people have since died or are living with the HIV/AIDS since the epidemic started in 1980s in the drug injecting people and the homosexuals. These deaths have resulted in Orphans and Vulnerable Children (OVC). This was a descriptive cross-sectional study, with one of the objective of finding out the socio-economic effect of HIV/AIDS on Orphans and Vulnerable Children in Nyamira district. A sample of 384 people participated in the study. The people were through simple random selected from Bonyegwe sublocation of Nyamusi division. Semi-structured interview schedules were used in data collection from the households. To remove ambiguity, the research tools were pre-tested to both HIV/AIDS organizations and householders not in the sample population but with similar characteristics. The research tools were refined and used on the actual sample population. Text, graphs, figures and tables were used in data presentation. The study indicates that those people who had not attained any level of formal education were (17%). The study revealed that householders (40%) had higher proportion of secondary education as compared with members of HIV/AIDS organizations (37%). Most of the members of HIV/AIDS organizations (89%) indicated that farming is their main source of income and a cushion for food security as compared with householders (63%). The ministry of health should strengthen provision of PMTCT services at the ANC clinic so that we prevent more cases of orphans and vulnerable children. The study suggests that in future all mothers who test positive for HIV virus should be put on treatment in order to reduce defaulters at the same time reach sustainable coverage in the provision of HIV/AIDS services to the orphans and vulnerable children in the society.
ABSTRACT- Background: Women of all races and ethnicities are at risk of cervical cancer. India, around 0.95 million new cases are detected yearly with high burden of 0.63 million. India bears about one fifth of the world’s burden of cervical cancer. Although fatality is high but cancers are largely preventable by effective screening programmes. Design: The present quasi-experimental study was conducted among female students studying in degree colleges from Feb. 2013 to Sept. 2013. Intervention: Educational intervention was conducted through sessions of participatory learning approach which included lectures using power-point, chalk and talk and question-answers method. Data was collected twice by administering predesigned questionnaire and conducting focus group discussion. Data Analysis: Data entered and analyzed using Epi Info 2000. To analyze qualitative information Atlas ti software was used. Paired t-test was used to measure the effect of intervention. Results: Total 149 students were the part of the study and successfully followed. Mean age of the participant was 18.5 years. Out of the 149 participants 4.1% had family history of the cancer. In the study it was observed that 18.8% had not ever heard about the cancer. In the post intervention test significant improvement was seen in all three parameters viz knowledge, attitude and practices. Conclusion: Continuing Educational interventions should be started at all level which highlights the importance of screening and prevention of cancer in women. Key-words- Cervical Cancer, Women, Perception Barriers, Effectiveness
Abstract—Sexual health (SH) and sexual behavior of young people have become a growing public concern. But few studies have been conducted to investigate the prevalence and psychosocial correlates of this phenomenon.
Purpose: To understand college students’ sexual knowledge (SK), sexual attitudes (SA), sexual desire (SD) and sexual behavior (SB).
Methods: A self-reported questionnaire survey on SK, SA, SD, and SB was conducted among 520 university students. Their demographic data, SK, SA, SD, and SB were assessed.
Results: A total of 500 students completed the questionnaire. The SKS total score had a mean of 23.05; 105 (21.0%) subjects had had premarital sex; 121 (24.2%) had a partner; 117 (23.4%) had a medical educational background. The results demonstrated an increased risk of premarital sex amongst males and subjects with the risk factors of smoking, drinking, having a partner, and having higher levels of SD and SK and more open SA.
Conclusions: This study provides support for the idea that university students lack SK (especially regarding contraception knowledge), even though the students had a medical educational background. Additionally, a considerable amount of them engaged in premarital SB. Our findings also suggest that university students need sex education, particularly in combining sexuality with their life, in relating to others maturely as a sexual individual, in employing contraception, and in preventing sexually transmitted diseases (STDs). Our study suggests that interventions aimed at expanding university students’ SK and other related skills are required.
Background: Incidence and prevalence of reproductive health difficulties have been shown to be higher among younger people. In Ghana, youthfriendly sexual and reproductive health services and facilities are very limited. The study aimed at examining the friendliness of sexual and reproductive health service delivery and utilization.
Methods: Across sectional design with both qualitative and quantitative methods was conducted to examine the friendliness and utilization of reproductive health services among youth in the Kwadaso Sub-Metro of Ashanti Region, Ghana. A multistage stratified sampling was used to enroll 170 youth (150 in-school and 20 out of school youth) aged 10 - 24years. Data analysis involved descriptive statistics using SPSS software version 20.
Results: Findings demonstrated that out of the 150 in-school youth sampled, 56% ever had a boyfriend or girlfriend, however, about one third(39.3%) did not recall the length of stay with partner, 58% have heard about sexual reproductive health services offered in the study area. A total of 55.8% of all categories of youth had used at least one or more reproductive health service before. Findings again revealed that 37.2% and 44% respectively of youth who had used sexual reproductive health considered the services received at a facility to be very friendly and friendly, yet, a few 18.6% indicated unfriendliness with services received at the facility.
Conclusion: An integrative and comprehensive approach is required to scale up youth utilization of sexual reproductive health services especially facility based. This requires baseline survey of youth users of reproductive health services and the quality of services offered.
Introduction: Uganda has an estimated 95,000 children living with HIV and only 68% are currently in HIV care. Reaching the fi rst 90 in the UNAIDS 90-90-90 strategy for children is still a far off goal considering the national prevalence of 0.5%. In this study, we set out to determine the coverage and yield from HIV testing using different approaches both at the facility and the community.
Factors Associated With Internet Use among Primary Care Patients in Makurdi, ...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Socio-Economic Effect of HIV/AIDS on Orphans and Vulnerable Children in Nyami...paperpublications3
Since the first case of HIV/AIDS was reported in Kenya in 1984 the numbers of those infected have risen and many people have since died or are living with the HIV/AIDS since the epidemic started in 1980s in the drug injecting people and the homosexuals. These deaths have resulted in Orphans and Vulnerable Children (OVC). This was a descriptive cross-sectional study, with one of the objective of finding out the socio-economic effect of HIV/AIDS on Orphans and Vulnerable Children in Nyamira district. A sample of 384 people participated in the study. The people were through simple random selected from Bonyegwe sublocation of Nyamusi division. Semi-structured interview schedules were used in data collection from the households. To remove ambiguity, the research tools were pre-tested to both HIV/AIDS organizations and householders not in the sample population but with similar characteristics. The research tools were refined and used on the actual sample population. Text, graphs, figures and tables were used in data presentation. The study indicates that those people who had not attained any level of formal education were (17%). The study revealed that householders (40%) had higher proportion of secondary education as compared with members of HIV/AIDS organizations (37%). Most of the members of HIV/AIDS organizations (89%) indicated that farming is their main source of income and a cushion for food security as compared with householders (63%). The ministry of health should strengthen provision of PMTCT services at the ANC clinic so that we prevent more cases of orphans and vulnerable children. The study suggests that in future all mothers who test positive for HIV virus should be put on treatment in order to reduce defaulters at the same time reach sustainable coverage in the provision of HIV/AIDS services to the orphans and vulnerable children in the society.
Ijsrp p8825 Caregiver factors influencing seeking of Early Infant Diagnosis (...Elizabeth kiilu
Caregiver factors influencing seeking of Early Infant Diagnosis (EID) of HIV services in selected hospitals in Nairobi County, Kenya:A qualitative Study
October 7, 2019
On October 7, 2019, the Harvard Global Health Institute will host a one-day symposium to explore what enabled this visionary program, and to showcase how it has transformed not just the worldwide HIV/AIDS response but global health delivery more broadly.
There are many lessons learned in PEPFAR’s story - from what it took to build a supply chain where there was none, to establishing the use of generic antiretroviral therapies (ARTs) and leveraging human capacity. This event convened the early architects of PEPFAR as well as experts and implementers currently leading the charge. We took a historically informed look at what it will take to stop global transmission, and shared tools useful for others hoping to move the needle on vexing problems in global health.
For more information, visit our website at https://petrieflom.law.harvard.edu/events/details/15-years-of-pepfar
Awareness, Approach and Practice of Youth towards preclusion of Sexually Tran...PUBLISHERJOURNAL
Awareness, Approach and Practice of Youth towards preclusion of Sexually Transmitted Infections at KIU-TH, Ishaka Bushenyi District
Ahura, Alex
Department of Nursing Science, Kampala International University, Uganda.
________________________________________
ABSTRACT
Sexually Transmitted Infections (STIs) remains a serious reproductive health problem globally. Despite this fact, youths recklessly involve in sexual activities which predisposes them to STIs which could rather be easily preventable. Therefore, the aim of this study was to evaluate the knowledge, attitude and practice of youths aged 19–24 towards prevention of STIs at KIU-TH in Ishaka Bushenyi district, Uganda. The study was a descriptive cross-sectional and quantitative methods were employed in data collection. Fifty respondents both male and female were selected using a convenient sampling method. Most respondents 30 (60%) were between 19 – 20 years, 30(60%) were students and 30(60%) were single. Knowledge towards prevention of STIs was good as majority 50(100%) understood the term STIs, 25(50%) knew HIV infection as an STIs, 50(100%) knew about transmission of STIs, 30(60%) had been sensitized and health educated about STIs prevention and majority knew condom use 30(60%) as one of the ways of preventing STIs. Attitudes were fair as majority 40(80%) believed that STIs can be dangerous and majority 40(80%) felt they could prevent STIs. Practice was poor as majority had 1-2 partners, 30(60%) and majority had their first partner at 15-17 years old 30(60%), majority of the respondents took alcohol 35(70%), majority 37(74%) reported teenage involvement in sexual relationship and 35(70%) reported alcohol as one of the most leading factors into sexual relationships, majority 33(66%) did not take precautions during sexual intercourse only 18(36%) used condoms. The study found out adequate knowledge towards STIs prevention and attitudes were fair but practices were poor.
Keywords: knowledge, attitude, practice, youth, sexually transmitted infections, Uganda
[[INOSR ES 11(2)108-121, 2023.Evaluation of Male partner participation in pre...PUBLISHERJOURNAL
Evaluation of Male partner participation in prevention of mother to child transmission of HIV/AIDs at Hoima Referral hospital
Sebwami Richard
School of Allied Health Sciences, Kampala International University Uganda.
________________________________________
ABSTRACT
The purpose of the study was to assess the knowledge and attitude, the level of male involvement and factors associated with male involvement in the prevention of mother-to-child transmission of HIV in Hoima municipality. This study was a descriptive cross section in which quantitative method of data collection was employed in collection of data from respondents. Questionnaires were distributed to participants to assess the knowledge and attitude, the level of male involvement and factors associated with male involvement in prevention of mother-to-child transmission of HIV (PMTCT) in Hoima municipality. Sample size of 200 participants were used, this included the Male partners who hard escorted their pregnant partners to the antenatal clinic aged between 20-50years.The predominant religion were Catholics 59% and seventh day Adventists. Regarding educational levels, majority of respondents had completed secondary level and above (61%) and the predominant ages were between 20-29 years. The study revealed that very few males partner were involved in the PMTCT program especially during HIV counseling and testing (HCT) because of being at old age group above 30years couples, couples not living together, high number of wife’s pregnancies four and above, having no knowledge on methods of MTCT, and husbands failure to discuss HCT with their wives. From the findings, majority of the respondents have ever had about the male involvement in the PMTCT but there was still low male involvement in PMTCT programs at antenatal clinics. There is a need to do an in-depth assessment of women’s experiences when tested HIV-positive in the presence of their partners at the ANC, as well as to develop strategies to improve male involvement. The study again recommends formative research on the use of incentives to promote male involvement in the PMTCT program and the government should train more of the health promoters and the Village Health Teams in order to reach even those that are deep in the village that are not having easy access to the health facility.
Keywords: HIV, Hoima municipality, Male partner, counseling
Achievements and Implications of HIV Prevention of Mother-toChild Transmissio...QUESTJOURNAL
Background: Mother-to-child transmission is the predominant route through which children contract HIV and can be controlled through Prevention of Mother-to-Child Transmission (PMTCT) programme. This paper presents programme activities on PMTCT conducted among women of reproductive age in Plateau State, Nigeria. Methods: This intervention was carried out among women of reproductive age in eight local government areas of Plateau state. Seven civil society organizations were engaged and provided with funding by Plateau State Agency for the Control of AIDS under the HIV/AIDS fund (HAF) II. A total of 7460 women of reproductive age are the estimated sample size for this intervention and the minimum prevention package intervention was used for this project activities. Data were documented using various monitoring and evaluation tools and DHIS2 while analysis was carried out using Microsoft Excel. Results: The total number of community dialogues/advocacy held was 85 and a total of 1,437 people participated. Seventeen income generation activities were carried out in this intervention and 131 people benefitted from it. A total of 87,028 pieces of condom were distributed with majority (88.5%) being distributed in 2014. Only a total of 5606 women were counseled tested and received result and 44 (0.8%) were tested positive. A total of 3275 women were referred for antenatal care during this programme and more than half (52.0%) were referred in 2014. Conclusion: This intervention has been helpful in reducing the burden of HIV and AIDS among women of reproductive age in Plateau State. However, the coverage of minimum prevention package intervention was low. More needs to be done in terms of coverage in future programmes and the intervention should also be extended to other local government areas.
2. engage in discussions about their personal HIV risk, risk behaviors,
and improve their autonomy to reduce their HIV risk. We sought to
increase HIV testing by improving HIVawareness, enhancing HIV
risk perception, and reducing high risk behavior among young
women in a rural region of Kenya through automated text messages.
MATERIALS AND METHODS
Study Design
This was a quasi-experimental study using text messages
to increase HIV testing. There were 2 technical colleges and 2
teachers' training colleges within the study cohort, and students
within these colleges are assigned by selection from the central
government. A coin toss was used to assign all participants at each
college to receive weekly HIV-related text messages (intervention
group) or no messages (control group). To minimize differences
in student characteristics, 1 technical college and 1 teacher training
college were assigned to each group. Because study participants
were boarding at their college, there was high potential for partic-
ipants to discuss the study with one another, which influenced the
decision to randomize institutions, rather than individuals and
avoid bias from cross-contamination.
Study Population
Participants were enrolled between September 2013 and
March 2014 from four 2-year colleges located in Kiambu County
in Central Kenya, a predominantly rural area. Eligible participants
were women ages 18 to 24 years, were HIVuninfected or unaware
of their HIV status, had not tested for HIV in the preceding
12 months, owned a mobile phone and had regular access to elec-
tricity to charge their mobile phone, and knew how to send and
receive text messages.
Study Procedures
The college administrative bodies granted permission to
conduct the study within the college compounds, suggested ap-
propriate times to contact students for study recruitment, and
designated areas to conduct study screening and enrollment pro-
cedures. Study staff approached potential participants, described
the study, and offered enrollment during the same day. At screen-
ing and enrollment, demographic and eligibility data were col-
lected via face-to-face standardized quantitative interviews in a
private area. Staff verified that each participant could read and
respond to SMS and provided training on SMS survey questions
and procedures, including instructions to delete the messages after
responding as a privacy measure. Participants selected a 4-digit
numeric password and a preferred time to receive the survey and
messages (for the intervention group) and completed a practice
survey on their phone.
Participants at colleges assigned to the intervention arm re-
ceived weekly messages on HIV and reproductive health-related
topics that were developed after interactive discussions with area
college students during formative community entry activities.
Convenience sampling was used to select students who were in-
vited to participate in informal discussions about concerns that
young people, particularly women, may have concerning sexu-
ality and HIV. A total of 4 sessions were held—2 with more
than 100 participants (men and women) at 2 colleges and 2
sessions with female participants only with up to 30 partici-
pants at 2 colleges. Six categories of topics (with 63 total
messages) were developed: pregnancy, contraceptives, sexually
transmitted infections, condoms, anal and oral sex, and HIV
risk (Table 1). Messages were not static and evolved throughout
the study to avoid repetition and maintain participant interest.
All messages ended with the statement “Get tested for HIV.”
Recipients had the option to send a return SMS requesting ad-
ditional messages on the same topic or access a menu enabling
exploration of the other topics. Each woman could request up to
3 additional messages per week.
All participants received monthly SMS surveys to col-
lect data on HIV testing and sexual behavior. SMS surveys were
automated to begin the day after enrollment and continue once
a month for 5 consecutive months. The survey comprised of nine
questions, including password verification, HIV testing, number
of new and recurrent sex partners, sexual frequency and condom
use, pregnancy and pregnancy intent, and perceived risk of HIV
during the past one month. Survey questions were resent if re-
sponses were not one of the designated codes. Participants were
not charged for their survey responses and on completion of the
survey, they were compensated with 50 KSH (~US $0.50).
SMS Survey Platform
An automated SMS system was developed for delivery, re-
ceipt, and recording of SMS surveys and weekly messages (mSurvey
Inc., Nairobi, Kenya), and the database was hosted on cloud-based
TABLE 1. Examples of Weekly HIV Sensitization Messages
Topic Example
Contraceptives Abstinence is the only 100% effective way to prevent pregnancy. The second best way is to use contraceptives.
Contraceptives are safe for use by young women. However, only condoms can reduce your risk of acquiring HIV.
Emergency contraceptive pills are for emergency use only. They do not protect against HIV and other STIs.
STIs Did you know that not all STIs (eg, HIV) have symptoms? Use a condom to prevent acquisition of STIs.
It is possible to have a sexually transmitted infection, for example, HIV and not have any symptoms.
You are at higher risk of getting HIV if you're infected with a STI.
Condoms You risk getting HIV if you have sex without a condom even if your partner removes his penis before ejaculation.
Did you know that you can get HIV infected the first time you have sex without a condom if your partner is infected?
There is some fluid released from the penis before ejaculation which contains HIV if the man is infected.
Pregnancy Protect yourself against HIV and unwanted pregnancy by using condoms correctly and consistently during sex.
Did you know that you are at increased risk of getting HIV when you are pregnant?
You can transmit some STIs to your baby if you are pregnant (eg, HIV, herpes, syphilis, and gonorrhea).
Anal and oral sex Did you know that there's a higher risk of getting HIV through anal sex than vaginal sex?
It is possible to become infected with HIV by giving or receiving oral sex. Use a condom during oral sex.
Use condoms during anal/vaginal sex if your partner's HIV infected or of unknown status or you may get HIV.
Your risk of getting HIV Did you know that women have a higher risk of acquiring HIV from men?
Young women 15–24 years old are four times at higher risk of being HIV infected than young men the same age.
Excessive alcohol use may cause you to have risky sexual behaviour thus increase your risk of getting HIV.
STI, sexually transmitted infections
Njuguna et al.
354 Sexually Transmitted Diseases • Volume 43, Number 6, June 2016
3. technology. SMS messages were sent out directly through the mo-
bile provider's network. Study staff accessed the SMS survey oper-
ational metrics online in real time to view participants' responses,
track survey completion, and weekly message responses.
Statistical Analysis
The study sample size of 600 was designed to have 80%
power to detect a 20% increase in reported HIV testing between
the participants in the 2 study groups. Descriptive statistics were
used to summarize participant characteristics and survey re-
sponses. χ2
statistics were used to describe differences in sexual
behavior between study arms. Our primary analytic method was
an intent-to-treat analysis using Cox proportional hazards regres-
sion to compare the time elapsed from enrollment to the first
reported HIV test between participants in the 2 study arms. Cumu-
lative probability curves with a log rank test were used to de-
scribe the proportion of women testing by arm. Because of our
quasi-experimental design that did not individually randomize
women, we also conducted a multivariate analysis with adjustment
for covariates determined a priori—age, number of sex partners,
and condom use with all sex acts—due to their known associa-
tions with HIV testing behaviors.15–17
Additional demographic,
behavioral, and medical characteristics were considered as po-
tential confounders and included in final models if they substan-
tially changed the hazard ratio (by ≥10%). In separate statistical
models, generalized estimating equations were used to determine
associations between HIV testing and sexual behaviour on a per
visit basis and whether women who were consistently sexually ac-
tive reported more instances of testing. Less than 10% of the data
were missing from each data variable, and thus we excluded miss-
ing data from the analysis, rather than using imputation methods
or other methods for missing data. Data were analyzed using
STATA version 13.1 (College Station, TX).
Regulatory
The Kenyatta National Hospital Ethics Review Committee
approved the study protocol, and all participants provided writ-
ten informed consent. This study is registered with clinicaltrials.
gov (NCT02527135).
RESULTS
Participant Characteristics
A total of 1039 women were screened for the study: 600
were enrolled into the study, 421 were ineligible due to having
tested for HIV within the previous 12 months, and 10 were eligible
but did not enroll (Fig. 1). Half (300) were from the colleges
allocated to control arm, and 300 were from colleges allocated
to intervention arm. The median age of participants was 21 years
(interquartile range, 20–22; Table 2) with similar age distribution
between the 2 groups. Most women were unmarried (93%), had
engaged in vaginal and/or anal sex at least once in their lifetime
(64% in control arm and 79% in intervention arm), had never
tested for HIV (72.62%), and approximately half were in their first
year of college (55.59%). The majority of the participants had
been sexually active in the past month (62.69% in intervention
arm and 57.71% in control arm), and nearly half of these women
reported having new sexual partners (40% in intervention arm
FIGURE 1. Consort diagram of study design.
Health Text Messages on HIV Testing
Sexually Transmitted Diseases • Volume 43, Number 6, June 2016 355
4. and 45.35% in control arm) and using condoms for all sexual en-
counters in the previous month (Table 2).
Monthly Survey and Weekly Message Response Rates
There was no substantial difference in survey response rates
between the 2 arms. Of 3600 monthly surveys sent out over
6 months, 3272 received a response (90.89%), and 3136 (87.11%)
were fully completed. Four hundred thirty-four (72.33%) participants
completed all the survey questions sent to them, whereas 5 (<1%)
participants did not respond to any questions throughout the study
period. Of the 166 participants without complete survey data,
114 (68.67%) completed 3 or more surveys, whereas 17 (10.24%)
responded to at least 1 question from 3 or more surveys (Fig. 2).
TABLE 2. Baseline Characteristics of Study Participants Collected by Interview and SMS Survey
Baseline Characteristics Collected by Interview
Control Arm
(N = 300)
Intervention Arm
(N = 300) P
Age overall (median, IQR) 21 (20–22) 20 (19–22) 0.33
18–20 y (n, %) 131 (46) 154 (54)
21–24 y (n, %) 169 (53.60) 146 (46.40)
Married or cohabiting (n, %) 12 (6.12) 15 (6.25) 0.96
Year of college (median, IQR) 1 (1–2) 1 (1–2) 0.27
Average monthly income in USD (median, IQR) 16.4 (10.9–32.8) 10.9 (5.5–30.6) 0.01
Drinks alcohol (n, %) 40 (13.33) 45 (15) 0.38
1–3 drinks per week (n, %) 26 (65) 25 (56.56)
≥4 drinks per week (n, %) 14 (35) 20 (44.44)
Ever tested for HIV (n, %) 81 (27) 83 (27.67) 0.59
Ever sexually active (n, %) 192 (64) 237 (79) <0.001
Age at sexual debut (median, IQR) 19 (17–20) 19 (18–20)
No of lifetime partners (median, IQR) 1 (1–2) 1 (1–2)
No of partners last 12 months (median, IQR) 1 (1–2) 1 (1–2)
Baseline characteristics collected by SMS survey
Tested for HIV previous month (n, %) 17/300 (5.66) 24/272 (8.82) 0.15
Gotten pregnant previous month (n, %) 11/293 (3.75) 14/266 (5.26) 0.39
Pregnancy unintentional (n, %) 9/11 (81.81) 12/14 (85.71)
HIV risk perception (n, %) 0.21
No or low risk 239/292 (81.85) 204/262 (77.86)
Medium or high risk 53/292 (18.15) 58/262 (22.14)
Sexually active previous month (n, %)* 172/298 (57.71) 168/268 (62.69) 0.22
Among sexually active, frequency of new sex partners in previous month (n, %) 78/172 (45.35) 68/170 (40)
Among sexually active, number of sex partners in previous month (median, IQR) 1 (0–1) 1 (0–1)
Among sexually active, frequency of using a condom always in previous month (n, %) 81/172 (47.09) 99/168 (58.93)
*Missing data not shown.
IQR, interquartile range.
FIGURE 2. SMS survey completion rates by study month.
Njuguna et al.
356 Sexually Transmitted Diseases • Volume 43, Number 6, June 2016
5. Of 7200 weekly messages sent out to intervention arm par-
ticipants, 7078 (98.31%) were delivered to the participants'
phones. Of these, 63.07% of participants reengaged once for more
information, 59.06% reengaged twice, and 55.51% reengaged
3 times.
HIV Testing
A total of 356 women reported testing at least once for
HIV in the 6 months of study follow-up: 201 (67%) in the inter-
vention arm and 155 (51%) in the control arm (log rank,
P < 0.0001), indicating a 57% increase in reported HIV testing
by the intervention arm compared with the control arm (95% con-
fidence interval [95% CI], 28–92%) (Table 3). Adjusting for age,
condom use, and number of sex partners or ever having a sex part-
ner did not substantially change the point estimate (adjusted
harzard ratio (HR), 1.54; 95% CI; 1.25–1.90). The median time
to first HIV test was 12 weeks for women in the intervention
arm and 20 weeks for women in the control arm (Fig. 3).
Overall, there were 884 monthly SMS surveys in which
participants reported HIV testing during the past month, 542
reports by intervention arm participants and 342 reports by con-
trol arm participants. Of the 356 participants who reported test-
ing for HIV at least once during study follow-up, 106 (17.66%)
women reported testing only once during study follow-up, 102
(17%) tested twice, and 148 (24.67%) tested 3 or more times.
Sexual Behaviour and HIV Testing
Among 3228 answered survey questions about sexual be-
havior, sexual partners were reported 2043 times (63%). Women
reporting a current sex partner were 1.42 times as likely to report
testing for HIV during the previous month (95% CI, 1.15–1.76)
compared with those without a partner. However, there was no
association between HIV testing at each visit and having a new
sex partner, condom use, or HIV risk perception during the previ-
ous month (Table 4).
DISCUSSION
In this quasi-experimental study, women receiving weekly
text messages tested for HIV in significantly higher numbers
than women who did not receive weekly messages. Approximately
TABLE 3. Comparison of HIV Testing Incidence by Study Arm and Other Demographic and Behavioral Factors
N Testing at
Least Once
Person-Years
Contributed
Incidence of
HIV Testing*
HR
(95% CI) P
Adjusted†
HR
(95% CI) P
Study arm
Intervention 201 64.66 310.84 1.57 (1.28, 1.92) <0.001 1.54 (1.25, 1.90) <0.001
Control 155 78.75 196.83 1.00 1.00
Age, y
18–20 172 66.05 260.40 0.92 (0.75–1.13) 0.43
≥21 184 77.35 237.85 1
Married/cohabiting
Yes 15 6.95 215.95 0.82 (0.49–1.38 0.46
No 246 98.16 250.61 1
Ever tested for HIV
Yes 255 39.54 252.92 1.01 (0.81–1.26) 0.93
No 100 103.87 245.49 1
Presence of sex partnerships
and condom use
No sex partner 106 51.82 204.54 1
Had sex partner(s) and inconsistent
condom use
92 36.82 249.87 1.21 (0.92–1.58) 0.17
Had sex partner(s) with consistent
condom use
142 47.87 296.64 1.47 (1.15–1.88) 0.002
Ever had sex
Yes 256 103.62 247.05 0.99 (0.79–1.25) 0.95
No 100 39.79 251.34 1
Alcohol use
Yes 62 25.07 247.27 0.99 (0.78–1.30) 0.10
No 293 118.18 247.92 1
Income
≤US $15 per month 175 74.87 233.73 1.14 (0.93–1.39) 0.22
>US $15 per month 181 68.53 264.09 1
*per 100 person years.
†
Adjusted for, age, presence of sex partnerships and condom use.
FIGURE 3. Cumulative probability curve of HIV testing by
study arm.
Health Text Messages on HIV Testing
Sexually Transmitted Diseases • Volume 43, Number 6, June 2016 357
6. half of the participants receiving intervention messages tested
within 12 weeks of the intervention, a rate that is almost twice as
fast as those participants not receiving intervention messages.
Human immunodeficiency virus testing and counseling
is the gateway to HIV prevention and care yet there remains a
wide HIV testing gap, especially for young women. In this study,
71.50% of participants had ever had sex in their lifetime, a rate
that was higher than the country average of 66.10%.4
Of all sexu-
ally experienced women in this study, only 30.61% had ever
tested for HIV at study enrollment. Human immunodeficiency
virus testing remains critical for the identification of new infec-
tions, linkage to HIV care and as a widely accepted prevention
intervention. Human immunodeficiency virus testing and counsel-
ing is a free service in Kenya and is widely available and yet
many young women engage in condomless sex without testing
and with limited perception of risk of HIV, pregnancy and other
consequences. Kenyan women predominantly report having their
first HIV test at antenatal care clinics and more than half of all
HIV infected women learning their status during pregnancy.4
In-
terventions targeting young women at the onset of sexual activity
have reduced numbers of sex partnerships, improved condom
use, and increased HIV testing.18 In our study, women who re-
ported a sex partner were more likely to test for HIV, highlighting
women's awareness of HIV risk and the importance of increasing
young women's access to HIV prevention and testing interventions
early in their sexual and reproductive lives when they are often
most vulnerable.
Given the high response rates elicited within our cohort,
our study demonstrated a high degree of feasibility for programs
to send SMS messages and conduct health behavior surveys
via SMS particularly among young college women. The Kenyan
school curriculum includes HIV/AIDS education with teachers
being the primary means to disseminate information for the
students. A recent review of the implementation of the HIV/
AIDS education policy revealed various shortcomings, including
an absence of a plan to implement the behavior change compo-
nent to prevent HIV acquisition among young people.19
This
SMS study used a suite of tailored messages to provide targeted
information to college women and encourage them to test for
HIV. A personalized SMS school-based education intervention
program is a feasible option to increase awareness of HIV risk,
improve HIV testing, and reduce risky behavior among young
women before sexual debut or early in their sexual lives. In this
study, one quarter of women reported testing for HIV 3 or more
times, more frequent than the recommended national guidelines.
Thus, routine SMS messages may also have a role to play in
increasing repeat HIV testing with future studies potentially re-
quiring follow-up for less than 6 months for optimal testing fre-
quency among young women.
In our data set, we were unable to account for underlying
differences in the student body at each college or the frequency
of additional testing interventions at the colleges. However,
adjusting for baseline characteristics in analyses did not alter
the results. Data were not collected about other ongoing testing
interventions, such as mobile testing campaigns, within the col-
leges where the study was conducted but all 4 colleges were
government-affiliated institutions with similar curricula and prac-
tices. In these settings, the content and timing of government or
school-sponsored HIV testing campaigns is standardized and
would be expected to influence testing rates among students sim-
ilarly across colleges. There were several instances of server out-
ages and variations in mobile network availability causing delays
in message delivery to recipients. These were transient and rela-
tively few, however, with negligible impact on the study. In addi-
tion, there may be some inaccuracy in participant's reports about
their testing and sexual behavior although the use of SMS pro-
vides an anonymous means of self-expression and dialogue and
is expected to minimize social desirability bias.20
Our study inter-
vention was a multipronged approach involving text messages to
improve HIVawareness, improve risk perception, and prompt par-
ticipants to test for HIV. As such, it is difficult to determine the
exact mechanism by which the intervention was successful in
achieving the primary study aim of improved HIV testing. Future
text message studies of HIV testing should consider exploring
the exact mechanism of action involved in attaining study objec-
tives. Finally, our study investigated the effect of HIV awareness
text messages on HIV testing only within the 6 months of study
follow-up. We did not evaluate poststudy effects of the text mes-
sages on HIV testing when participants were no longer receiv-
ing messages. These implications should be considered by future
SMS intervention studies.
Strategies targeting young women for HIV prevention and
reproductive and sexual health messaging, especially those that
reach women before their first pregnancy, are imperative. SMS
are a low-cost health intervention that can be leveraged to increase
the frequency of HIV testing among a geographically diverse pop-
ulation. The SMS strategy that delivers messages to young women
attending college without disrupting their normal routines has
the potential to spark conversation between women within their
social networks and could potentially have an effect beyond the
individual.21
Kenya has a high rate of mobile phone use, and
SMS is near ubiquitous among young people. The use of SMS
TABLE 4. Association of HIV Testing With Longitudinal Sexual Behavior and HIV Risk Perception
No. of Visits With
HIV Test (n, %) OR 95% CI P
Adjusted OR
(95% CI)* P
Sex partner(s) during study 1.15–1.76
Yes 244 (11.97) 1.42 0.001 1.37 (1.11–1.69) 0.003
No 109 (9.2)
New sex partner(s) during study (N = 441)
Yes 113 (11.69) 1.05 0.84–1.33 0.66 1.04 (0.83–1.31) 0.72
No 126 (11.79)
Condom use during study (N = 436)
Yes 142 (12.08) 1.25 0.98–1.59 0.07 1.21 (0.96–1.54) 0.11
No 92 (11.12)
HIV risk perception during study (N = 584)
High or medium risk 73 (12.25) 1.17 0.92–1.48 0.19 1.10 (0.87–1.39) 0.44
Low or no risk 264 (10.39)
* Adjusted for age, arm, study month.
Njuguna et al.
358 Sexually Transmitted Diseases • Volume 43, Number 6, June 2016
7. messaging strategies in Kenya to increase HIV testing among
college students is scalable, and the current network capabilities
offer a large opportunity to reach intended targets.
REFERENCES
1. UNAIDS. Fact Sheet 2014: Global Statitistics. 2014; http://www.
unaids.org/sites/default/files/en/media/unaids/contentassets/documents/
factsheet/2014/20140716_FactSheet_en.pdf. Accessed 06 Aug2015.
2. UNAIDS. The Gap Report. 2014; http://www.unaids.org/sites/default/
files/media_asset/UNAIDS_Gap_report_en.pdf. Accessed 10 May2015.
3. Abdool Karim Q, Abdool Karim SS, Frohlich JA, et al. Effectiveness
and safety of tenofovir gel, an antiretroviral microbicide, for the pre-
vention of HIV infection in women. Science 2010; 329:1168–1174.
4. NASCOP. Kenya AIDS Indicator Survey 2012: Final report. Ministry
of Health; 2014.
5. Kenya Demographic and Health Survey 2014- Key Indicators. Kenya
National Bureau of Statistics (KNBS) and ICF Macro 2014.
6. Rosenstock IM. Why people use health services. Milbank Mem Fund
Q 1966; 44(Suppl 3):94–127.
7. Quarterly Sector Statistics Report: Second quater of the financial
year 2014/2015 (Oct–Dec 2014). Communitcations Authority of
Kenya; 2014.
8. Quarterly Sector Statistics erport: fourth quarter of the financial year
2013/14 (Apr–Jun 2014) Communications Authority of Kenya; 2014.
9. Lester RT, Ritvo P, Mills EJ, et al. Effects of a mobile phone short
message service on antiretroviral treatment adherence in Kenya
(WelTel Kenya1): a randomised trial. The Lancet 376:1838–1845.
10. Finocchario-Kessler S, Gautney BJ, Khamadi S, et al. If you text
them, they will come: using the HIV infant tracking system to im-
prove early infant diagnosis quality and retention in Kenya. AIDS
(London, England) 2014; 28:S313–S321.
11. Mbabazi WB, Tabu CW, Chemirmir C, et al. Innovations in communi-
cation technologies for measles supplemental immunization activities:
lessons from Kenya measles vaccination campaign, November 2012.
Health Policy Plan 2015; 30:638–644.
12. Odeny TA, Bailey RC, Bukusi EA, et al. Text messaging to improve
attendance at post-operative clinic visits after adult male circumcision
for HIV prevention: a randomized controlled trial. PLoS One 2012;
7:e43832.
13. Vahdat HL, L'Engle KL, Plourde KF, et al. There are some questions
you may not ask in a clinic: providing contraception information to
young people in Kenya using SMS. Int J Gynaecol Obstet 2013; 123
(Suppl 1):e2–e6.
14. Angela Crandall AO, L Mutuku, J Colaço. Mobile Phone Usage at the
Kenyan Base of the Pyramid. 2012; https://blogs.worldbank.org/ic4d/
files/ic4d/mobile_phone_usage_kenyan_base_pyramid.pdf.
15. Samet JH, Winter MR, Grant L, et al. Factors associated with HIV test-
ing among sexually active adolescents: A Massachusetts survey. Pedi-
atrics 1997; 100(3 Pt 1):371–377.
16. Houston S, Archibald CP, Strike C, et al. Factors associated with HIV
testing among Canadians: Results of a population-based survey. Int J
STD AIDS 1998; 9:341–346.
17. MacPhail C, Pettifor A, Moyo W, et al. Factors associated with HIV
testing among sexually active South African youth aged 15–24 years.
AIDS Care 2009; 21:456–467.
18. Melanie Croce-Galis KH, Jill Gay. Scaling up evidence-informed
HIV prevention for adolescent girls and young women. Health policy
project 1994; 4.
19. Education Sector Policy on HIVand AIDS. In: Ministry of Education
SaT, ed. Second ed: Government of Kenya; 2013.
20. Malbon K, Romo D. Is it ok 2 txt? Reaching out to adolescents about
sexual and reproductive health. Postgrad Med J 2013; 89:534–539.
21. Cornelius JB, St. Lawrence JS, Howard JC, et al. Adolescents' percep-
tions of a mobile cell phone text messaging-enhanced intervention and
development of a mobile cell phone-based HIV prevention interven-
tion. J Spec Pediatr Nurs 2012; 17:61–69.
Health Text Messages on HIV Testing
Sexually Transmitted Diseases • Volume 43, Number 6, June 2016 359