Participation in methadone programs improves antiretroviral uptake and HIV viral suppression among people who inject drugs in Kenya.

BACKGROUND: HIV prevalence among people who inject drugs (PWID) in Kenya is estimated to be 18% compared to 4.5% in the general population. Studies from high-income countries have demonstrated that methadone use is associated with increased uptake of antiretroviral therapy (ART) and higher rates of viral suppression among PWID with HIV. However, it is unclear whether methadone use has the same effect among African PWID living with HIV. METHODS: We performed a cross-sectional study to evaluate associations between methadone program participation and ART uptake and viral suppression (HIV RNA viral load <1000 copies/ml) among PWID with HIV in Kenya. Participants were recruited from needle and syringe programs and methadone clinics, interviewed on site, and samples were obtained and assayed for HIV viral loads. Univariate and multiple logistic regression were used to determine associations. RESULTS: Among 679 participants, median age was 37 years, 48% were female, and 24% were in a methadone program. We observed higher proportions of ART use (96% vs. 87%, p = 0.001) and HIV viral suppression (78% vs. 65%, p = 0.012) among PWID on methadone compared to those not on methadone treatment. PWID who were not participating in a methadone program were 3-fold more likely to be off ART and approximately twice as likely to be viremic compared to those in methadone programs (adjusted odds ratio [aOR] = 3.35, 95% confidence interval [CI]: 1.35-8.35 and aOR = 1.90, 95% CI: 1.03-3.52, respectively). CONCLUSIONS: In this study, Kenyan PWID living with HIV participating in a methadone treatment program were more likely to be on ART and to have achieved viral suppression. Scale-up of methadone programs may have a positive impact on HIV epidemic control for this key population.

Assisted partner services for HIV in Kenya: a cluster randomised controlled trial.

BACKGROUND: Assisted partner services for index patients with HIV infections involves elicitation of information about sex partners and contacting them to ensure that they test for HIV and link to care. Assisted partner services are not widely available in Africa. We aimed to establish whether or not assisted partner services increase HIV testing, diagnoses, and linkage to care among sex partners of people with HIV infections in Kenya. METHODS: In this cluster randomised controlled trial, we recruited non-pregnant adults aged at least 18 years with newly or recently diagnosed HIV without a recent history of intimate partner violence who had not yet or had only recently linked to HIV care from 18 HIV testing services clinics in Kenya. Consenting sites in Kenya were randomly assigned (1:1) by the study statistician (restricted randomisation; balanced distribution in terms of county and proximity to a city) to immediate versus delayed assisted partner services. Primary outcomes were the number of partners tested for HIV, the number who tested HIV positive, and the number enrolled in HIV care, in those who were interviewed at 6 week follow-up. Participants within each cluster were masked to treatment allocation because participants within each cluster received the same intervention. This trial is registered with ClinicalTrials.gov, number NCT01616420. FINDINGS: Between Aug 12, 2013, and Aug 31, 2015, we randomly allocated 18 clusters to immediate and delayed HIV assisted partner services (nine in each group), enrolling 1305 participants: 625 (48%) in the immediate group and 680 (52%) in the delayed group. 6 weeks after enrolment of index patients, 392 (67%) of 586 partners had tested for HIV in the immediate group and 85 (13%) of 680 had tested in the delayed group (incidence rate ratio 4·8, 95% CI 3·7-6·4). 136 (23%) partners had new HIV diagnoses in the immediate group compared with 28 (4%) in the delayed group (5·0, 3·2-7·9) and 88 (15%) versus 19 (3%) were newly enrolled in care (4·4, 2·6-7·4). Assisted partner services did not increase intimate partner violence (one intimate partner violence event related to partner notification or study procedures occurred in each group). INTERPRETATION: Assisted partner services are safe and increase HIV testing and case-finding; implementation at the population level could enhance linkage to care and antiretroviral therapy initiation and substantially decrease HIV transmission. FUNDING: National Institutes of Health.

No Sex or Age Difference in Dead-Reckoning Ability among Tsimane Forager-Horticulturalists.

Sex differences in reproductive strategy and the sexual division of labor resulted in selection for and maintenance of sexual dimorphism across a wide range of characteristics, including body size, hormonal physiology, behavior, and perhaps spatial abilities. In laboratory tasks among undergraduates there is a general male advantage for navigational and mental-rotation tasks, whereas studies find female advantage for remembering item locations in complex arrays and the locations of plant foods. Adaptive explanations of sex differences in these spatial abilities have focused on patterns of differential mate search and routine participation in distinct subsistence behaviors. The few studies to date of spatial ability in nonindustrial populations practicing subsistence lifestyles, or across a wider age range, find inconsistent results. Here we examine sex- and age-based variation in one kind of spatial ability related to navigation, dead-reckoning, among Tsimane forager horticulturalists living in lowland Bolivia. Seventy-three participants (38 male) aged 6-82 years pointed a handheld global positioning system (GPS) unit toward the two nearest communities and the more distant market town. We find no evidence of sex differences in dead reckoning (p = 0.47), nor do we find any evidence of age-related decline in dead-reckoning accuracy (p = 0.28). Participants were significantly more accurate at pointing toward the market town than toward the two nearest villages despite its being significantly farther away than the two nearest communities. Although Tsimane do show sexual dimorphism in foraging tasks, Tsimane women have extensive daily and lifetime travel, and the local environment lacks directional cues that typically enhance male navigation. This study raises the possibility that greater similarity in mobility patterns because of overlapping subsistence strategies and activities may result in convergence of some male and female navigation abilities.