Introduction: The burden of cardiovascular disease (CVD) is increasing in sub-Saharan Africa with untreated hypertension being a major contributing factor. Understanding the magnitude of the problem and risk factors associated with HIV and long-term antiretroviral therapy (ART) is critically important for designing effective programs for diagnosing and treating hypertension in Kenya. Methods: In this cross-sectional study, we enrolled 300 persons with HIV (PWH) on long term ART (≥6 months) and 298 HIV-negative adults seeking care at the Kisumu County Hospital between September 2017 and May 2018. Hypertension was defined as blood pressure of ≥140/90mmHg or a previous hypertension diagnosis. Multivariate regression was used to assess the association between hypertension and HIV adjusting for age, sex, and known CVD risk factors. Results: Overall prevalence of hypertension was 22%. PWH had a lower prevalence of hypertension than HIV-negative persons (16% vs 27% respectively; p40 years, body mass index (BMI) >25 kg/m² and low-density lipoproteins ≥130mg/dL. Among PWH, being older than 40 years and higher BMI >30 kg/m² were associated with hypertension. Conclusion: Prevalence of hypertension was high, affecting nearly one in every 4 adults, and associated with older age, higher BMI and high low-density lipoproteins. PWH on long-term ART had significantly lower prevalence of hypertension compared to HIV-negative individuals, potentially due to increased access to healthcare services and interaction with prevention messaging. Interventions to increase screening for and prevention of hypertension in the community for all adults are warranted.

Background: Cisgender women in Kenya are at elevated risk of HIV acquisition during pregnancy and post partum. Acute HIV infection during pregnancy and breastfeeding accounts for approximately one-third of all vertical HIV transmissions. The World Health Organization recommends offering oral tenofovir-based pre-exposure prophylaxis (PrEP) to pregnant and postpartum women who are HIV negative but at substantial and ongoing risk for HIV acquisition. PrEP delivery for pregnant and postpartum women is expanding within routine maternal child health clinics in Kenya. However, approximately half of pregnant women discontinue PrEP within 30 days of initiation. Therefore, it is crucial to develop PrEP adherence strategies that enhance support for adherence when peripartum events and health issues pose challenges to sustaining PrEP adherence. Objective: We are conducting a randomized controlled trial to determine the effect of a bidirectional communication platform named Mobile Solutions for Women’s and Children’s Health (mWACh), which utilizes two-way SMS text messaging between patients and remote nurses to support PrEP adherence and address maternal health concerns in real time during the peripartum period. Methods: The mWACh-PrEP study is a randomized trial designed to support PrEP adherence during the peripartum period by comparing mWACh-PrEP to the standard of care (ie, in-clinic adherence counseling) among women who are HIV negative and initiating PrEP. Purposive sampling was used to select 5 facilities offering PrEP in antenatal clinics in Kisumu and Siaya Counties, and block randomization will be used to divide participants into groups. Participants in the intervention arm will receive a customized messaging curriculum via SMS text messages targeted toward their particular perinatal stage. The primary outcome, PrEP adherence at 6 months post partum, will be evaluated using a log-binomial regression model, adjusting for imbalanced baseline characteristics. Based on a previous study of directly observed dosing conditions, we will use a hair tenofovir concentration cutoff of 0.038 ng/mg (corresponding to 7 doses/week) as the primary adherence outcome measured at 6 months post partum (binary outcome). Qualitative interviews and cost-effective analyses will be conducted to understand the feasibility, acceptability, and economic impact of the intervention. Results: Enrollment began in March 2022 and is projected to continue until July 2023, with follow-up through March 2024. The study results are expected to be reported in 2025. Conclusions: This trial will provide insights into using mobile health to enhance PrEP adherence among pregnant and postpartum mothers. Additionally, the findings will have implications for the use of mobile health technology to improve adherence to other daily medications during the peripartum period. Trial Registration: ClinicalTrials.gov NCT04472884; https://clinicaltrials.gov/ct2/show/NCT04472884 International Registered Report Identifier (IRRID): DERR1-10.2196/41170

Background: Childhood vitamin A deficiency leads to increased morbidity and mortality. Human milk is the only source of vitamin A for exclusively breastfed infants. Dried Moringa oleifera leaf powder (moringa) is a good food source of provitamin A and other carotenoids. Its effect during lactation on human milk vitamin A and carotenoid content is unclear. Objectives: Our objective was to investigate the effect of maternal moringa consumption on human milk retinol and carotenoid concentrations and maternal and infant vitamin A status. Methods: We conducted a 3-month pilot single-blinded cluster-randomized controlled trial in breastfeeding mother–infant pairs (n = 50) in Kenya. Mothers received corn porridge with (20 g/d) or without moringa with complete breast expressions and maternal and infant serum collected at enrollment (infant <30 days old) and 3 months. Milk was analyzed for retinol and selected carotenoids; maternal/infant serum was analyzed for retinol binding protein (RBP). Results: 88% (n = 44) pairs completed milk and serum samples. Four mothers (9%) had vitamin A deficiency (RBP <0.07 µmol/L); 11 (25%) were vitamin A insufficient (VAI; RBP <1.05 µmol/L). Alpha-carotene concentration in milk was higher in the moringa than the control group at baseline (p = 0.024) and at exit (least squares means, LSM, 95%CI µg/mL 0.003, 0.003–0.004 moringa vs. 0.002, 0.001–0.003 control, n = 22/cluster; p = 0.014). In mothers with VAI, alpha-carotene was higher in the moringa group than controls at exit (LSM, 95%CI µg/mL 0.005, 0.003–0.009 moringa, n = 3, vs. 0.002, 0.000–0.004 control, n = 8, p = 0.027) with no difference at baseline. Milk carotenoids did not correlate with vitamin A status (serum RBP) in infants or mothers. Conclusions: Maternal moringa consumption did not impact concentration of milk vitamin A and resulted in limited increase in milk carotenoids in this cohort.

Introduction: Sexually transmitted infections (STIs) in pregnancy contribute to poor perinatal outcomes and increased HIV acquisition risk, underscoring the importance of delivering STI/HIV services within antenatal care. Few studies evaluate women's perspectives on the co‐delivery of antenatal STI testing and HIV pre‐exposure prophylaxis (PrEP). We sought to understand motivations for and experiences with STI testing among pregnant women who initiated HIV PrEP.Methods: We conducted semi‐structured in‐depth interviews (IDIs) among a subset of women enrolled in a randomized trial in Western Kenya (NCT04472884) who initiated PrEP within antenatal clinics and tested for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) in pregnancy and/or postpartum. As part of parent study procedures, IDIs were conducted between September 2023 and April 2024. Interviews were recorded, transcribed and thematically analysed using deductive and inductive methods. The Health Belief Model guided exploration of STI testing experiences, motivations for testing and the impact of testing on PrEP use.Results: Overall, 39 women who initiated PrEP during pregnancy and tested for CT/NG participated in IDIs; six tested positive for CT and/or NG. Median age was 26 years (IQR 21–29), 77% of participants had >8 years of education, 15% were employed and 72% were married. Most (86%) did not know their partner's HIV status, and 82% persisted with PrEP use at 9 months postpartum. Perceived vulnerability to STI/HIV acquisition, fear of adverse outcomes from untreated infections (e.g. pregnancy loss or harm to baby) and desire to alleviate symptoms (e.g. abnormal discharge) motivated STI testing uptake when offered during antenatal visits. Provision of STI‐related education, availability of STI services (i.e. immediate treatment, expedited partner therapy) and supportive interactions with providers promoted positive experiences with STI testing. STI testing encouraged health‐promoting behaviours, including sustained PrEP use, even when STI results were negative, as testing made women feel proactively involved in preventing HIV/STI complications for themselves and their infants.Conclusions: In this qualitative evaluation among women who initiated PrEP in pregnancy, STI testing encouraged PrEP use, even when results were negative. Incorporating STI testing within PrEP delivery in antenatal care represents an opportunity for addressing HIV/STI in this priority population.

[This corrects the article DOI: 10.2196/41170.].