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.

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.