Introduction Identifying HIV‐positive individuals is increasingly recognized as one of the most important and most challenging of the UNAIDS 90‐90‐90 goals. Assisted partner notification services (aPNS) involves tracing and offering HIV testing to partners of HIV‐positive individuals, and is effective and safe when provided to newly diagnosed HIV‐positive patients. Voluntary aPNS is now part of the World Health Organization's guidelines for HIV prevention and care. However, uptake of aPNS is significantly lower among adults with established HIV infection already engaged in care compared to newly diagnosed individuals. We sought to describe barriers encountered and potential opportunities to providing aPNS to established patients living with HIV. Methods We conducted focus group discussions and in‐depth interviews at Nairobi's largest public HIV clinic in April to May 2016 to elucidate barriers to and opportunities for aPNS among established patients engaged in HIV care. Participants included HIV‐positive adults in care, their partners, and healthcare workers (HCWs). Qualitative data analysis took a grounded theory approach. Results Barriers to aPNS fell under three main categories. Fear of disclosure to partners included concerns over relationship repercussions, loss of trust, blame and violence. Stigma and discrimination were described in the healthcare setting, at church and in general society. Participants described difficulties approaching communication, including cultural barriers and differences in education. For almost every barrier a potential solution was also identified, and a barrier‐opportunity relationship emerged. Opportunities included using couples testing centres to aid in disclosure, focusing on the ambiguous introduction of the infection, and sensitization of HCWs and community leaders. Conclusions aPNS among established HIV patients is associated with different barriers and opportunities than aPNS among newly diagnosed patients, and HCWs should build their capacity to support aPNS in this population. There is a strong need for increased training and sensitization on the use of aPNS in different circumstances and for different clients, taking into consideration factors such as timing of partner notification, characteristics of the relationship and duration of knowledge discordance. The overall success of this intervention among populations living with HIV may rely on customization of services and key messages to meet the patients’ specific needs.

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Background: Hypertension is both public health and medical problem worldwide. Compliance to antihypertensive therapy is key in avoiding hypertension complications. The purpose of this study was to establish compliance to antihypertensive therapy and associated factors among adults’ hypertensive patients in Kilifi county Kenya.Methods: A facility-based cross-sectional was undertaken in four public health facilities in Kilifi County Kenya. Two hundred and thirteen hypertensive patients were recruited in the study. Data was collected using a pretested questionnaire and analyzed using Statistical package for social sciences (SPSS) version 23 software. Chi-square test was utilized in establishing the relations, while logistic regression was adopted to determine independent risk factors for compliance.Results: Compliance to antihypertensive therapy was recorded in 31 (14.6%) of the patients. A statistically significant association was established between compliance to antihypertensive therapy and patients knowledge (p<0.001); age (p=0.024); education (p=0.04); income (p=0.013); duration on treatment (p=0.005); cost (p=0.029); health care provider advice (p=0.009); consistency of therapy (p=0.002); medicines availability (p=0.021); and health facility distance (p=0.013). Independent risk factors for compliance to antihypertensive therapy were the duration on treatment of (OR=0.383; 95%CI 0.151-0.972); Knowledge on hypertension (OR=2.715; 95%CI 1.598-4.615); Health care worker follow-ups (OR=0.452; 95%CI 0.282-0.726); and cost of medication (OR=2.682; 95%CI 1.134-6.345).Conclusions: Anti-hypertensive therapy compliance among patients was low. This could be attributed to factors that are socio-demographic, patient, and health service-related in nature. Prompt public health interventions that are patient-community centred are necessary to improve compliance to antihypertensive therapy.

This is a descriptive cross-sectional study utilising quantitative and qualitative approaches targeting women of reproductive age (15–49 years old). The proportion of deliveries attended by skilled birth attendants (SBA) was at 41.4%. Factors influencing utilisation of SBAs in the study area were: age (χ2=8.65(df=2), p=0.013), religion (Odds Ratio (OR) 3.22, p=0.004), level of education (OR 2.43, p=0.05), partner’s occupation (OR 0.533, p=0.029), parity (OR 0.26, p=0.002), residence (OR 4.07, p<0.0001), type of housing (OR 0.502, p=0.010), house ownership (OR 0.39, p=0.001), number of house occupants (χ2=10.9(df=2), p=0.004), household monthly income (OR 1.73, p=0.018), antenatal clinic attendance (OR 5.6, p=0.025), facility for antenatal clinic attendance (OR 0.388, p=0.001), birth preparedness (OR 0.8, p=0.015), decision to attend antenatal clinics (χ2=7.59(df=2), p=0.022), decision on delivery place (χ2=10.424(df=2), p=0.005) and facility staff’s attitude (OR 5.18, p=0.014). Barriers to utilisation of SBAs included: training of traditional birth attendants (TBA), lack of co-ordinated referral systems, poor and unreliable means of transport, limited infrastructure, and limited number of SBAs. The study sought to find out about utilisation of SBAs in Kitui County, Kenya. The results indicate sociodemographic and economic factors significantly determine utilisation. Various barriers hindered utilisation of skilled birth attendants. In conclusion, ensuring skilled deliveries is only possible in health facility settings. At the same time, this is not practical unless the health facilities are renovated and equipped with supplies and service providers. As per the key informants, there are limited numbers of skilled birth attendants even in the hospitals, the health system lacks infrastructure (means of transport), supplies are limited, the terrain is rocky and there are few retired midwives in the community to offer these services. From the study area, none of the deliveries which took place at home were conducted by a SBA.

In developing countries, exclusive breastfeeding (EBF) remains the best and safest source of nutrition and a recommended method of prevention of mother-to-child transmission of HIV in combination with use of prophylactic anti-retrovirals. Other feeding options could be detrimental to the infant if the mother cannot afford the recommended replacement feeds and expose the infants to diarrhoeal diseases and malnutrition, which could lead to early mortality. Despite this evidence, EBF ranges from 3.2 to 13% in Kenya. The aim of this study was to identify knowledge, attitude and practice in adherence to EBF among 188 HIV-positive women with children aged 6-12 months in Nairobi, Kenya. This was a descriptive crosssectional study using quantitative and qualitative approaches. Participants were interviewed using semi-structured questionnaires. In addition, two focus group discussions were conducted and key informants from the health facility were also interviewed. The results showed that 69.1% of women EBF. The following factors influenced adherence to EBF positively: presence of main breadwinner (OR=3.44, P=0.003), food availability (P=<0.001), mastitis (P=0.002), knowledge of mother-to-child transmission of HIV (P=<0.001), being taught about EBF in antenatal and postnatal classes (OR=7.78, P=0.002), expressing breast milk (P=<0.001), disclosure of HIV status to husband (OR=2.46, P=0.007) and relative (OR=2.29, P=0.033). In conclusion, information sharing of mother-to-child transmission of HIV antenatally and postnatally should be strengthened in the health facilities. Additionally, mothers should also be taught how to express breast milk.