title: HIV Prevalence, Estimated Incidence, and Risk Behaviors Among People Who Inject Drugs in Kenya.
abstract: OBJECTIVE
  HIV infection in sub-Saharan Africa increasingly occurs among people who inject drugs (PWID). Kenya is one of the first to implement a national needle and syringe program. Our study undertook a baseline assessment as part of evaluating needle and syringe program in a seek, test, treat, and retain approach.
  
  
  METHODS
  Participants enrolled between May and December 2012 from 10 sites. Respondent-driven sampling was used to reach 1785 PWID for HIV-1 prevalence and viral load determination and survey data.
  
  
  RESULTS
  Estimated HIV prevalence, adjusted for differential network size and recruitment relationships, was 14.5% in Nairobi (95% CI: 10.8 to 18.2) and 20.5% in the Coast region (95% CI: 17.3 to 23.6). Viral load (log10 transformed) in Nairobi ranged from 1.71 to 6.12 (median: 4.41; interquartile range: 3.51-4.94) and in the Coast from 1.71 to 5.88 (median: 4.01; interquartile range: 3.44-4.72). Using log10 viral load 2.6 as a threshold for HIV viral suppression, the percentage of HIV-infected participants with viral suppression was 4.2% in Nairobi and 4.6% in the Coast. Heroin was the most commonly injected drug in both regions, used by 93% of participants in the past month, typically injecting 2-3 times/day. Receptive needle/syringe sharing at last injection was more common in Nairobi (23%) than in the Coast (4%). Estimated incidence among new injectors was 2.5/100 person-years in Nairobi and 1.6/100 person-years in the Coast.
  
  
  CONCLUSIONS
  The HIV epidemic is well established among PWID in both Nairobi and Coast regions. Public health scale implementation of combination HIV prevention has the potential to greatly limit the epidemic in this vulnerable and bridging population.
authors.affiliation: *New York University College of Nursing, New York, NY; †Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY; and ‡National AIDS & STI Control Programme (NASCOP), Nairobi, Kenya.
authors.forename: Ann E
authors.initials: AE
authors.lastname: Kurth
authors.forename: Charles M
authors.initials: CM
authors.lastname: Cleland
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
authors.forename: Helgar
authors.initials: H
authors.lastname: Musyoki
authors.forename: John A
authors.initials: JA
authors.lastname: Lizcano
authors.forename: Nok
authors.initials: N
authors.lastname: Chhun
authors.forename: Peter
authors.initials: P
authors.lastname: Cherutich
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006678:HIV / Q000302:isolation & purification; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D015994:Incidence; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications*; D019562:Viral Load; D055815:Young Adult