Research

Pioneering Research

We design and conduct a broad spectrum of health research. The team has pioneered research in the areas of HIV and STI, generating and using evidence to develop programmes and policies. Some of the ground-breaking work conducted by the PHDA, University of Manitoba, and its partners has had an impact on programme and policy in Kenya and other counties.

Some key contributions include:

  • The role of “conventional” STIs in enhancing and facilitating HIV infection. This led to the development of the pioneering syndromic approach to STI management which resulted in a 25-40 percent decrease in STIs in the general population. This approach has been successfully disseminated to countries such as Uganda, Cambodia, Thailand, and India.
  • Early identification and confirmation shows that there is indeed a heterosexually transmitted epidemic of HIV in Africa. This led to the understanding that focused prevention programmes for sex workers and their clients to reduce HIV transmission in these groups and the general community is critical. One of the significant findings was the identification of highly HIV-exposed female sex workers who are resistant to HIV infection and the subsequent understanding of acquired immunity to HIV.
  • The protective effect of male circumcision for HIV acquisition in men through a randomized controlled trial conducted in the Nyanza region of Kenya. This led to the scale-up of the national Voluntary Male Medical Circumcision programme in Kenya and other parts of Africa, prioritizing traditionally non-circumcising counties and communities.
  • The high risk and vulnerability of adolescent and young girls who are part of the social and sexual network at “hotspots” or places, where men congregate to find sexual partners. This has led to pilot projects with young sex workers in hotspots to reach a population that is normally left out of programming.
  • Development of a global code for ethical research in partnership with various partners under the TRUST project funded by the European Union. The code has been accepted and followed by several global institutions and universities.

PHDA’s recent focus areas for research are:

Relationship between violence, mental health, and risk of HIV infection
The biological determinant of HIV acquisition
Impact of introduction of new products like HIV self-testing
Understanding the HIV prevention landscape in Kenya

Some Research Projects

Tatu Pamoja Study

The research study aims to estimate the HIV incidence, retention, and assess the uptake and adherence to PrEP among at-risk Men who have sex with men (MSM) and Transgender people enrolled at the 3 partnering clinics in Kisumu, Nairobi, and Kilifi.

Maisha Fiti Study

The study aims to examine the associations between violence against women, mental health concerns, alcohol and drug use, biological changes to the immune system, and the risk of HIV infection.

TRANSFORM The Targeted Research Advancing Sexual Health for Men who have sex with Men

The study that started in 2017 and ended in 2018 aimed to assess if existing and emerging HIV prevention and care interventions were feasible, acceptable, and needed by Men who have sex with Men (MSM).

HIV Self-Testing Study

The study aims to evaluate the incremental benefit of the community-based implementation of HIV Self Testing (HIVST) strategies as a part of existing HIV and sexual health interventions with MSM in Kenya.

Human Papillomavirus (HPV)
Screening and vaccination study for Men who have Sex with Men

This study aims to produce a solid evidence base to inform ongoing challenges in proactive responses to HPV-related health needs of MSM. MSM are at high risk for anal HPV-related infections and cancers, especially among those living with HIV.

URCHOICE
A Cross-sectional Study of End-User Preferences for HIV Prevention Among MSM in Kenya

This study aims at understanding the knowledge and preferences of Kenyan Gay and Bi-sexual MSM (GBMSM) and transgender women regarding the use of oral PrEP.  

Heart of Stigma Project

The heart of stigma project aims to assess stigma and discrimination experienced by people living with HIV (PLHIV) and key populations (KP) in Kenya. It is a part of IAS’s global “Getting to the Heart of Stigma” project.

Evaluation of KP Programme in Kenya

The goal of this study is to assess the effectiveness of the Key Population Programme funded by the Global Fund (in the last three years) in reducing the new HIV infections, AIDS related mortality and self-reported stigma and discrimination related to HIV/AIDS among Key populations in Kenya by 2025.

Resources

Tatu Pamoja Study

The research study aims to estimate the HIV incidence, retention, and assess the uptake and adherence to PrEP among at-risk Men who have sex with men (MSM) and Transgender people enrolled at the 3 partnering clinics in Kisumu, Nairobi, and Kilifi.

Objectives

  • To determine the HIV incidence, retention, and the correlates of HIV acquisition among 800 MSM and Transgender people
  • To assess uptake and adherence to PrEP administered as per National AIDS and STI Control Programme (NASCOP) guidelines.
  • To determine the prevalence of acute HIV infection in participants reporting symptoms that are compatible with the acute retroviral syndrome at scheduled or interim visits.

Project Initiated 2019

This study commenced in October 2019 and is ongoing, despite challenges posed by the COVID-19 pandemic. PHDA is responsible for the Nairobi site and has enrolled 300 participants. The study ultimately hopes to also demonstrate that young MSM and Transgender people can be engaged and followed for 1 year at 3 counties, by 3 different research groups using standardized procedures.

Partnerships

PHDA is working with the Kenya MSM Health and Research Consortium (MHRC) and the Kenya Medical Research Institute (KEMRI) with funding from the International AIDS Vaccine Initiative (IAVI).

Maisha Fiti Study

The study aims to examine the associations between violence against women, mental health concerns, alcohol and drug use, biological changes to the immune system, and the risk of HIV infection.

Objectives

The objective is to examine the association between HIV risk and factors that are generally studied separately i.e.

  • Biological factors (genital tract inflammation and immunological changes)
  • Behavioral factors (drug and alcohol use, mental health, HIV prevention, and treatment adherence)
  • Structural factors (poverty, violence)

Project Initiated 2018

Maisha Fiti is a two-phase study that commenced in 2018. The study is focused on 1,000 FSWs recruited from all seven PHDA managed SWOP clinics in Kenya. The findings at baseline show that the prevalence of alcohol use, substance use disorders and mental health disorders among female sex workers (FSWs) are both associated with HIV acquisition. The study has completed Phase 1 baseline and will enter phase 2 once the COVID-19 situation eases. With data from the first and second phases, interactions between biological, behavioral, and structural factors in HIV acquisition and adherence to ARVs will be understood. We also hope that the data will also inform the type and level of interventions that are needed to address some of the risk and vulnerability factors.

Partnerships

PHDA is partnering with the London School of Hygiene and Tropical Medicine (LSHTM) on this study funded by the Medical Research Council (MRC).

The Targeted Research Advancing Sexual Health for Men who have sex with Men (TRANSFORM)

The study that started in 2017 and ended in 2018 aimed to assess if existing and emerging HIV prevention and care interventions were feasible, acceptable, and needed by Men who have sex with Men (MSM).

Objectives

  • To estimate the size of MSM populations in Nairobi and Malindi and describe online and physical networking characteristics within these populations
  • To estimate the prevalence of HIV (including acute/early HIV), HBV, HCV, syphilis, genital, rectal, and pharyngeal Neisseria gonorrhoea/Chlamydia trachomatis infections.
  • To document the current continuum of HIV diagnosis, treatment initiation, and individual virologic suppression in this population.
  • To determine individual, community, structural enablers and deterrents to engagement

Project Initiated 2017, completed in 2018

617 MSM were enrolled during the implementation of the project. Results established that the continuum of HIV care for MSM and Transgender populations in Kenya is remarkably strong despite potential obstacles to HIV care. It also showed that HIV diagnosis represented the weakest link in the continuum of care for MSM in Nairobi and undiagnosed HIV accounted for over 80% of the total populations’ viral overload

Partnerships

The TRANSFORM project was conducted in Kenya and South Africa. PHDA partnered with Evidence for HIV prevention in Southern Africa (EHPSA), University of Manitoba (UoM), and the Kenya Institute of Medical Research (KEMRI), with funding from the Department for International Development.

HIV Self-Testing Study

The study aims to evaluate the incremental benefit of the community-based implementation of HIV Self Testing (HIVST) strategies as a part of existing HIV and sexual health interventions with MSM in Kenya

Objectives

  • Reducing the overall size of the undiagnosed MSM population and
  • Reducing time for linkage to prevention, treatment, and care following HIV testing

Project Initiated 2018

The HIVST study which commenced in November 2018 undertakes a programme science approach. The study which is being implemented in Mombasa, Kisumu, and Kiambu, uses a mixed-method approach to conduct this evaluation. A baseline and an end-line survey were conducted with 1200 MSM respondents sampled from physical and virtual sites. Qualitative longitudinal in-depth interviews were conducted with respondents at three-time points. Sexual network mapping was also conducted at baseline. The end-line data is being currently analyzed to answer some of the key research questions. The study also completed a costing sub-study to estimate the cost of integrating HIVST within HIV prevention programmes for MSM.

Partnerships

PHDA partners with the University of Manitoba, NASCOP, G10, Men Against AIDS Youth Group (MAAYGO), Kisumu, Mamboleo Peer Empowerment Group (MPEG), Kiambu, and HIV & AIDS People’s Alliance of Kenya (HAPA-Kenya) in implementing this project with funding from the Bill & Melinda Gates Foundation.

Download the HIV ST evidence brief (Click here)

Download a paper on  Kenyan Men Contextualizing HIV ST Technologies (Click here)

Human Papillomavirus (HPV) screening and vaccination study for Men who have Sex with Men

This study aims to produce a solid evidence base to inform ongoing challenges in proactive responses to HPV-related health needs of MSM. MSM are at high risk for anal HPV-related infections and cancers, especially among those living with HIV. Though HIV prevalence in Kenya continues to be high, homosexuality is criminalized while HPV-related prevention and treatment needs of men (including MSM) are largely ignored.

Objectives

  • Produce new health services knowledge, including knowledge on HPV vaccination acceptability.
  • Generate social scientific insights related to experience of illness and the role stigma plays in the late presentation of HPV-related diseases.
  • Contribute new evidence towards enabling a community-based programme that can effectively confront a health crisis and respond to the global health alarm over emerging cancer epidemics in African contexts who are the hardest hit with respect to the HIV epidemic.

Project Initiated 2021

The study based in Nairobi started in June 2021 and will continue for four years. It will focus on men who have sex with men.

Partnerships

PHDA is partnering with the University of Manitoba on this project with funding support from Centre on Health Insurance Reforms (CHIR)

URCHOICE: A Cross-sectional Study of End-User Preferences for HIV Prevention Among Men Who Have Sex with Men in Kenya

This study aims at understanding the knowledge and preferences of Kenyan Gay and Bi-sexual MSM (GBMSM) and transgender women regarding the use of oral PrEP.  URCHOICE is a one-year multisite study targeting MSM on the preferred options for taking oral PrEP. 

Objectives

The study intends to determine the preferences of men who have sex with men (MSM) towards reduce their risk of acquiring HIV in Kenya i.e.  their use of condoms, daily oral pre-exposure prophylaxis (PrEP), or use of prolonged acting PrEP.

Project Initiated 2021

The one-year study began in May 2021. It intends to target 150 GBMSM at each site and 500 across all three sites. The interview data was used to assess discrete choices between possible prevention options, reasons for different choices, and potential challenges in promoting the various PrEP options, through focus group discussions.
The study saw participation from 146 out of the 150 enrolled members for the information sessions and 98 out of the 140 enrolled participants for the interviews.

Partnerships

PHDA partners with the University of Illinois, Chicago, with funding from Merck, Sharp and Dohme.

Heart of stigma project

The heart of stigma project aims to assess stigma and discrimination experienced by people living with HIV (PLHIV) and key populations (KP) in Kenya. It is a part of IAS’s global “Getting to the Heart of Stigma” project.

Objectives

  • Contextualise, triangulate, interrogate, validate, and enhance the evidence base in HIV-related stigma
  • Assess demand and supply side of the stigma equation, changes in stigma and discrimination in health care personnel and changes in perceptions and experience of the health care system from those populations who may be victims of stigma and discrimination
  • Review current legal and policy situations and examine how stigma is addressed in governmental agencies such as the police, other uniformed services, the legal system, schools and universities, etc. who interact with stigmatised populations.

Project Initiated 2021

This study which began in March 2021 will be conducted through a) review of stigma literature in Kenya, b) interviews with policy makers, health care workers and members of the PLHIV and KP communities. The study has already produced some preliminary findings, which were reported at the National Maisha Conference in May, organised by the National AIDS Commission (NACC). 

The findings are as below

  • There aren’t enough interventions in Kenya that could provide an empirical measurement of success, so it is not possible to identify “critical success factors”.
  • Most literature and qualitative interviewees expressed their preference for service seeking options and community led initiatives wherein lay health care workers, and peer educators would provide support and help with navigating the system.
  • The success in reducing stigma is largely based on the government support provided for the programmes and other supportive policies which act as a deterrent, allowing interventions to take place.

Some factors that impede include:

  • Low investment of resources in Interventions addressing stigma.
  • Slow implementation of laws and policies.
  • Subtle forms of discrimination which are difficult to identify and hence challenging to intervene.

Partnerships

PHDA is partnering with HOYMAS on this project with funding support from the International AIDS Society (IAS).

Evaluation of Key Population Programme in Kenya

The goal of this study is to assess the effectiveness of the Key Population Programme funded by the Global Fund (in the last three years) in reducing the new HIV infections by 75%, AIDS related mortality by 25% and self-reported stigma and discrimination related to HIV/AIDS by 50% among Female Sex Workers (FSW), Men who have Sex with Men (MSM) and People Who Inject Drugs (PWID) in Kenya by 2025.

Objectives

  • Examine, appraise, and evaluate the comprehensiveness of prevention programmes for Female Sex Workers (FSWs), Men who have sex with men (MSM) and People who inject drugs (PWIDs).
  • Determine the literacy levels on human rights related to HIV and other barriers concerning access to health services and justice among Key Population.
  • Assess prevalence of gender-based violence and effectiveness of response mechanism among Key Population.
  • Appraise the extent to which the Global Fund programme has enhanced the capacity of the Key Population Networks in implementing KP programmes.

Project Initiated 2021

The study started in June 2021. The study population includes 46,425 FSW, 24,879 MSM, and 15,420 PWID who received comprehensive HIV prevention, treatment, care and support services from January 2018 to June 2020 across 20 counties in Kenya.

Partnerships

PHDA is partnering with The Circle of Concerned African Women Theologians, Kenya (CCAWT) and the Mathematical Consultation Research (MCR) for this study with funding support from The Global Fund through the Kenya Red cross Society.