Anthony Waruru

Centers for Disease Control and Prevention, Nairobi, Kenya · Surveillance and Epidemiology

Understanding infant feeding practices in the context of HIV and factors that put mothers at risk of HIV infection is an important step towards prevention of mother to child transmission of HIV (PMTCT). Face-to-face (FTF) interviewing may not be a suitable way of ascertaining this information because respondents may report what is socially desirabl...

Background: In a spatially well-known and dispersed HIV epidemic, identifying geographic clusters with significantly higher HIV-prevalence is important for focusing interventions for people living with HIV (PLHIV). Methods: We used Kulldorff spatial-scan Poisson model to identify clusters with high numbers of HIV-infected persons 15-64 years old...

Introduction Using spatial–temporal analyses to understand coverage and trends in elimination of mother-to-child transmission of HIV (e-MTCT) efforts may be helpful in ensuring timely services are delivered to the right place. We present spatial–temporal analysis of seven years of HIV early infant diagnosis (EID) data collected from 12 districts in...

Background A universal health care identifier (UHID) facilitates the development of longitudinal medical records in health care settings where follow up and tracking of persons across health care sectors are needed. HIV case-based surveillance (CBS) entails longitudinal follow up of HIV cases from diagnosis, linkage to care and treatment, and is re...

Routine HIV viral load (VL) monitoring is the standard of care for persons receiving antiretroviral therapy (ART) in developed countries. Although the World Health Organization recommends annual VL monitoring of patients on ART, recognizing difficulties in conducting routine VL testing, the WHO continues to recommend targeted VL testing to confirm...

Background Sub-Saharan Africa region bears the highest chronic hepatitis B virus (HBV) infection burden worldwide. National estimates of HBV burden are necessary for a viral hepatitis program planning. This study estimated the national prevalence of HBV infection in Kenya among people aged 15–64 years. Methods Of 27,745 participants age 15–64 year...

Introduction: Using peripheral oxygen saturation (SpO2) measurement is a cost-effective and reliable approach to assess the need for oxygen supplementation in patients admitted with coronavirus disease 2019 (COVID-19). Patients who have a SpO2 level of <95% are considered hypoxic and, per COVID-19 management guidelines, should receive oxygen supple...

Identifying persons who have newly acquired HIV infections is critical for characterizing the HIV epidemic direction. We analyzed pooled data from nationally representative Population-Based HIV Impact Assessment surveys conducted across 14 countries in Africa for recent infection risk factors. We included adults 15-49 years of age who had sex durin...

Background Understanding the magnitude and causes of mortality at national and sub-national levels for countries is critical in facilitating evidence-based prioritization of public health response. We provide comparable cause of death data from Kisumu County, a high HIV and malaria-endemic county in Kenya, and compared them with Kenya and low-and-m...

Background. Chlamydia trachomatis is a common a sexually transmitted infections (STI). Asymptomatic Chlamydia is undetectable because it is asymptomatic. In Kenyan women ages 18 to 49, the disease is poorly understood. Methods. This cross-sectional study was conducted at Kisumu County Referral Hospital, Kenya. 385 women consented and completed the...

Background For assessing the HIV epidemic in Kenya, a series of independent HIV indicator household-based surveys of similar design can be used to investigate the trends in key indicators relevant to HIV prevention and control and to describe geographic and sociodemographic disparities, assess the impact of interventions, and develop strategies. We...

Abstract Background and setting About 20% of persons living with HIV aged 15–64 years did not know their HIV status in Kenya, by 2018. Kenya adopted HIV self-testing (HIVST) to help close this gap. We examined the sociodemographic characteristics and outcomes of self-reported users of HIVST as our primary outcome. Methods We used data from a 2018 p...

Background Lack of dependable morbidity and mortality data complicates efforts to measure the demographic or population-level impact of the global HIV/AIDS epidemic. Mortuary-based mortality surveillance can address gaps in vital statistics in low-resource settings by improving accuracy of measuring HIV-associated mortality and indicators of access...

Background In resource-limited settings, underlying causes of death (UCOD) often are not ascertained systematically, leading to unreliable mortality statistics. We reviewed medical charts to establish UCOD for decedents at two high volume mortuaries in Kisumu County, Kenya, and compared ascertained UCOD to those notified to the civil registry. Met...

Background: Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya. Methods: We abstracted routinely collected clinical and sociode...

Background: Estimating cause-related mortality among the dead is not common, yet for clinical and public health purposes, a lot can be learnt from the dead. HIV/AIDS accounted for the third most frequent cause of deaths in Kenya; 39.7 deaths per 100,000 population in 2019. OraQuick® has previously been validated on oral fluid and implemented as a...

Background For assessing the HIV epidemic in Kenya, a series of independent HIV indicator household-based surveys of similar design can be used to assess trends in key indicators relevant to HIV prevention and control and to describe geographic and sociodemographic disparities, assess the impact of interventions, and develop strategies. We develope...

Background Accurate data on HIV-related mortality are necessary to evaluate the impact of HIV interventions. In low- and middle-income countries (LMIC), mortality data obtained through civil registration are often of poor quality. Though not commonly conducted, mortuary surveillance is a potential complementary source of data on HIV-associated mort...

Background: The UNAIDS 90-90-90 Fast-Track targets provide a framework for assessing coverage of HIV testing services (HTS) and awareness of HIV status – the “first 90.” In Kenya, the bulk of HIV testing targets are aligned to the five highest HIV-burden counties. However, we do not know if most of the new HIV diagnoses are in these five highest-bu...

Background The cause of death (COD) statement is a vital statistic that refers to the disease(s) and process(es) that lead to death. Obtaining accurate COD is valuable for mortality prevention priorities. The statements are formulated using International Classification of Diseases and related health problems, version 10 (ICD-10) system. However, ph...

Introduction High antiretroviral therapy (ART) coverage and high rates of viral load suppression (VLS) should reduce transmission of HIV, and ultimately, HIV incidence and the number of new HIV diagnoses out of the number tested (HIV positivity). We used 3 years of HIV program data in Kenya to assess whether trends in the number of new HIV diagnose...

Objective: To compare alternative methods of adjusting self-reported knowledge of HIV-positive status and antiretroviral (ARV) therapy use based on undetectable viral load (UVL) and ARV detection in blood. Design: Post hoc analysis of nationally representative household survey to compare alternative biomarker-based adjustments to population HIV...

Objective To compare alternative methods of adjusting self-reported knowledge of HIV-positive status and antiretroviral (ARV) therapy use based on undetectable viral load (UVL) and ARV detection in blood. Design Post hoc analysis of nationally-representative household survey to compare alternative biomarker-based adjustments to population HIV indi...

Background: Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya. Methods: Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 t...

Understanding the characteristics of individuals who are newly diagnosed with HIV is critical to controlling the HIV epidemic. Characterizing this population can improve strategies to identify undiagnosed positives and assist in targeting the provision of HIV services to improve health outcomes. We describe the characteristics of newly diagnosed HI...

Background Over the last decade, the Kenyan HIV treatment program has grown exponentially, with improved survival among people living with HIV (PLHIV). In the same period, noncommunicable diseases (NCDs) have become a leading contributor to disease burden. We sought to characterize the burden of four major NCDs (cardiovascular diseases, cancer, chr...

Geospatial analyses, can help in location-focused HTS planning to increase diagnosis of PLHIV and reach the “first 90”. The purpose was to assess spatial distribution of HIV-positives (yield) by HTS sites, and within counties and to identify constituencies with highest HTS yield and their spatial distribution.

Problem/condition: Use of human immunodeficiency virus (HIV)-mortality surveillance data can help public health officials monitor, evaluate, and improve HIV treatment programs. Many high-income countries have high-coverage civil registration and vital statistics (CRVS) systems linked to case-based HIV surveillance on which to base HIV mortality es...

Purpose: Informing adolescents of their own HIV infection is critical as the number of adolescents living with HIV increases. We assessed the association between HIV disclosure and retention in care and mortality among adolescents aged 10-14 years in Kenya's national program. Methods: We abstracted routinely collected patient-level data for adol...

BACKGROUND A universal health care identifier (UHID) facilitates the development of longitudinal medical records in health care settings where follow up and tracking of persons across health care sectors are needed. HIV case-based surveillance (CBS) entails longitudinal follow up of HIV cases from diagnosis, linkage to care and treatment, and is re...

Aggregate data for spatial model-fitting.

Spatial-statistical analysis approach.

Background: Understanding sexual risk among youth can inform the design of effective HIV prevention interventions. Methods: The 2012 Kenya AIDS Indicator Survey was a nationally representative population-based survey. We administered a questionnaire and collected blood samples for HIV testing. We examined factors associated with unsafe sex among...

In a spatially well-known and dispersed HIV epidemic, identifying geographic clusters with significantly higher HIV-prevalence is important for focusing interventions. We conducted geo-spatial analysis on data from a nationally representative Kenya AIDS Indicator Survey 2012 to identify clusters with high number of HIV-infected persons 15-64 years...

Data used in the analysis. This file contains Stata data used for these analyses. (DTA)

Introduction: At the individual level, there is clear evidence that Human Immunodeficiency Virus (HIV) transmission can be substantially reduced by lowering viral load. However there are few data describing population-level HIV viremia especially in high-burden settings with substantial under-diagnosis of HIV infection. The 2nd Kenya AIDS Indicato...

Background Giardia duodenalis is an important intestinal protozoan in humans worldwide with high infection rates occurring in densely populated and low resource settings. The parasite has been recorded to cause diarrhea in children. This study was carried out to identify G. duodenalis assemblages and sub-assemblages in children presenting with diar...

Introduction Globally Cryptosporidium and Giardia species are the most common non-bacterial causes of diarrhoea in children and HIV infected individuals, yet data on their role in paediatric diarrhoea in Kenya remains scant. This study investigated the occurrence of Cryptosporidium species, genotypes and subtypes in children, both hospitalized and...

Alignment showing difference in isolates. (PDF)

Cryptosporidium GP60 subtypes consist of a variable number of ‘‘A” (TCA), ‘‘G” (TCG), ‘‘T” (TCT) and ‘‘R” (ACATCA). (PDF)

Sub-Saharan Africa (SSA) bears the heaviest burden of the HIV epidemic. Health workers play a critical role in the scale-up of HIV programs. SSA also has the weakest information and communication technology (ICT) infrastructure globally. Implementing interoperable national health information systems (HIS) is a challenge, even in developed countries...

With improvements in technology, electronic data capture (EDC) for large surveys is feasible. EDC offers benefits over traditional paper-based data collection, including more accurate data, greater completeness of data, and decreased data cleaning burden. The second Kenya AIDS Indicator Survey (KAIS 2012) was a population-based survey of persons ag...

In Kenya, mathematical models estimate that there are approximately 220,000 children aged less than 15 years infected with HIV. We analyzed data from the second Kenya AIDS Indicator Survey (KAIS 2012) to estimate the prevalence of HIV infection among children aged 18 months to 14 years. KAIS 2012 was a nationally representative 2-stage cluster samp...

Background: With improvements in technology, electronic data capture (EDC) for large surveys is feasible. EDC offers benefits over traditional paper-based data collection, including more accurate data, greater completeness of data, and decreased data cleaning burden.

Background The distribution of and factors associated with intestinal parasitic infections are poorly defined in high risk vulnerable populations such as urban slums in tropical sub-Saharan Africa. Methods In a cross sectional study, children aged 5 years and below who presented with diarrhoea were recruited from selected outpatient clinics in Muk...

Cryptosporidium parasites are leading causes of enteric disease, especially in children. A prospective survey on the prevalence of cryptosporidiosis in children less than five years of age was undertaken at six microbiology laboratories in Kenya on fecal samples submitted for routine parasite and ova investigations. Analysis of 4,899 samples over a...

Cryptosporidium parasites are leading causes of enteric disease, especially in children. A prospective survey on the prevalence of cryptosporidiosis in children less than five years of age was undertaken at six microbiology laboratories in Kenya on fecal samples submitted for routine parasite and ova investigations. Analysis of 4,899 samples over a...