Data on the prevalence of human papillomavirus (HPV) types in cervical carcinoma in women with HIV are scarce but are essential to elucidate the influence of immunity on the carcinogenicity of different HPV types, and the potential impact of prophylactic HPV vaccines in populations with high HIV prevalence. We conducted a multicentre case-case study in Kenya and South Africa. During 2007-2009, frozen tissue biopsies from women with cervical carcinoma were tested for HPV DNA using GP51/61-PCR assay. One hundred and six HIV-positive (mean age 40.8 years) and 129 HIV-negative women (mean age 45.7) with squamous cell carcinoma were included. Among HIV-positive women, the mean CD4 count was 334 cells/lL and 48.1% were on combined antiretroviral therapy. HIV-positive women had many more multiple HPV infections (21.6% of HPV-positive carcinomas) compared with HIV-negative women (3.3%) (p < 0.001) and the proportion of multiple infections was inversely related to CD4 level. An excess of HPV18 of borderline statistical significance was found in HIV-positive compared with HIVnegative cases (Prevalence ratio (PR) 5 1.9, 95% confidence interval (CI): 1.0-3.7, adjusted for study centre, age and multiplicity of infection). HPV16 and/or 18 prevalence combined, however, was similar in HIV-positive (66.7%) and HIVnegative cases (69.1%) (PR 5 1.0, 95% CI: 0.9-1.2). No significant difference was found for other HPV types. Our data suggest that current prophylactic HPV vaccines against HPV16 and 18 may prevent similar proportions of cervical SCC in HIVpositive as in HIV-negative women provided that vaccine-related protection is sustained after HIV infection. Infection with high-risk (HR) human papillomavirus (HPV)is a necessary cause for invasive cervical carcinoma. Worldwide HPV16 and 18 are found in 57% and 16% of cervical carcinomas, respectively, according to the findings of a recent meta-analysis 1 and are targeted by the current prophylactic HPV vaccines for cervical carcinoma prevention. HIV-positive women are at increased risk for HPV infection and progression to cervical intraepithelial neoplasia grade 3 (CIN3). 2Linkage studies between HIV/AIDS and cancer registries have shown a 2-to 22-fold increased invasive cervical carcinoma incidence in HIV-positive women compared with the general female population from the same area, depending upon the life expectancy of HIV-positive women and the coverage and quality of cervical cancer screening in different countries. 3,4 HPV16 infection and HPV16-associated precancerous lesions were reported to be less dependent on a woman's immune status compared with other HR HPV types.5 Indeed, a meta-analysis of HPV prevalence in HIV-positive women worldwide showed a relative underrepresentation of HPV16 and overrepresentation of the other HR HPV types in HIVpositive compared with HIV-negative women with or without cervical abnormalities. 6 The lower prevalence of HPV16 in CIN2/3 (the endpoint lesions used in the evaluation of HPV vaccine efficacy) raised the fear that vaccination may preven...

In the last two decades, the use of short-acting methods of contraception has driven the increase of contraceptive use in Kenya. We assessed the factors associated with uptake of long-acting reversible contraception by women seeking family planning services in public health facilities in Kakamega County, Kenya. A mixed methods cross-sectional study through client exit surveys among 423 women seeking family planning services was done at 12 public health facilities in Kakamega County. Twelve in-depth interviews with health care providers from the study facilities further explored practices in provision of long-acting reversible contraception (LARC). Among women initiating contraceptive use, LARC method utilization was 20.6%. Women’s tertiary education level, Protestant Christian religion, age at first birth, and having no desire for more children were significantly associated with utilization of LARC. Structural factors including shortage of human resource, provider bias and lack of adequate skills on provision of services were identified as key barriers to uptake of long-acting reversible contraception services.

BackgroundSub-Saharan Africa bears the greatest burden of cervical cancer. Human papillomavirus (HPV) vaccination programmes to prevent the disease will need to reach vulnerable girls who may not be able access health and screening services in the future. We conducted formative research on facilitators and barriers to HPV vaccination and potential acceptability of a future HPV vaccination programme amongst girls living in hard-to-reach populations in Kenya.MethodsStakeholder interviews with Ministry of Health staff explored barriers to and support for the uptake of HPV vaccination. A situation assessment was conducted to assess community services in Maasai nomadic pastoralist communities in Kajiado County and in Korogocho informal settlement in Nairobi city, followed by focus group discussions (n=14) and semi-structured interviews (n=28) with health workers, parents, youth, and community and religious leaders. These covered marriage, knowledge of cervical cancer and HPV, factors that might inhibit or support HPV vaccine uptake and intention to accept HPV vaccine if a programme was in place.ResultsReported challenges to an HPV vaccination programme included school absenteeism and drop-out, early age of sex and marriage, lack of parental support, population mobility and distance from services. Despite little prior knowledge of cervical cancer and HPV, communities were interested in receiving HPV vaccination. Adequate social mobilisation and school-based vaccination, supplemented by out-reach activities, were considered important facilitating factors to achieve high coverage. There was some support for a campaign approach to vaccine delivery.ConclusionsGiven the high level of support for a vaccine against cervical cancer and the experience of reaching pastoralist and slum-dwellers for other immunizations, implementing an HPV vaccine programme should be feasible in such hard-to-reach communities. This may require additional delivery strategies in addition to the standard school-based delivery, with vaccine offered at multiple venues, potentially through a campaign approach.

Women living in Nairobi’s informal settlements face a higher risk of maternal death than those living elsewhere in the country, and have limited knowledge of actions they can take to improve their chances of survival during pregnancy and childbirth. As one strategy to reach this high risk group, Jhpiego has implemented young mothers’ clubs (YMCs). These clubs comprise mothers aged 18–30 who come together on a weekly basis to share experiences and solutions to their challenges while receiving health education from health facility staff and community health workers (CHWs). The aim of this study was to assess whether the YMC strategy could be used to improve participants’ knowledge of postpartum hemorrhage (PPH), positive behavior around childbirth, and family planning. Participants in nine YMCs (n = 193) across four informal settlements were interviewed to assess their knowledge of safe motherhood topics before and after a series of eight health education sessions. Data were analyzed with the McNemar test to determine significance of change in knowledge pre- and post-intervention. The largest improvements were observed in knowledge about what to include in a birth plan, with correct responses increasing from 32 to 73 % (p < 0.001), 58–93 % (p < 0.001), 36–66 % (p < 0.001), 58–85 % (p < 0.001), and 64–88 % (p < 0.001) for identifying a birth companion, budget, skilled birth attendant, emergency supplies, and place of birth, respectively. Less substantial improvements were observed in knowledge of danger signs of PPH (up 10 % from 77 %, p = 0.003). Although knowledge of actions to take in the event of bleeding after delivery did significantly improve, final knowledge scores remained low—knowledge to urinate increased from 14 to 28 % (p < 0.001) and to breastfeed from 12 to 24 % (p = 0.005). Even though the vast majority of respondents (84 %) knew before the intervention that a woman should space pregnancy by at least 2 years after delivery, there was an increase to 94 % after the sessions (p = 0.008). Overall, participants demonstrated significant improvements in knowledge of safe motherhood and family planning topics, suggesting that the materials and methods used were generally effective for improving knowledge among this high risk group.

Although the hormonal intrauterine system has limited availability in low- and middle-income countries, this highly effective long-acting reversible contraceptive method has the potential to be an important addition to the method mix. Introduction of the method in the public sector under “real-world” conditions in Kenya and Zambia shows promise to increase contraception use and continuation.