Elizabeth A Bukusi
Biographic Data
| ID | 165311 |
|---|---|
| NAME | Elizabeth A Bukusi |
| GIVEN NAMES | Elizabeth A |
| FAMILY NAME | Bukusi |
| SIGNATURE | BUKUSI E A |
| AFFILIATIONS | Kenya Medical Research Institute |
| ORCID | 0000-0002-2031-2808 |
| VERIFIED | Yes |
| TOTAL WORKS | 145 |
| TOTAL CITATIONS | 59 |
| AUTHOR COUNT | 145 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2008 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 4 |
Co-design of a digital health intervention to provide pharmacy-based, person-centered contraceptive decision support for youth in Kenya
Adolescent girls and young women (AGYW; age 15–24 years) face intersectional barriers to undesired pregnancy prevention, with profound health consequences. Community pharmacies remain a relatively untapped opportunity to improve the reach and quality of contraceptive care for youth. The purpose of this study was to co-design and prototype a digital health, person-centered contraceptive decision support application (the Mara Divas App) tailored fo…
A livelihood intervention improved nutritional, mental health and sexual health outcomes among HIV-affected adolescents in western Kenya
INTRODUCTION: Interventions that address household-level factors, including food insecurity (FI) and poverty, may reduce HIV risk and improve sexual and reproductive health (SRH) among adolescent girls and young women (AGYW). METHODS: (SM). SM was a multisectoral agricultural livelihood intervention designed to improve HIV health. At the trial end, we used linear and logistic regressions to compare differences between the intervention and control…
Implementing long-acting injectable HIV pre-exposure prophylaxis services at private pharmacies in Kenya
INTRODUCTION: Maximising the impact of new and forthcoming long-acting injectable HIV pre-exposure prophylaxis (PrEP) products will require novel delivery approaches that widen accessibility and prioritise clients' needs and preferences. To understand the potential barriers and facilitators to delivering injectable PrEP via private pharmacies in Kenya, we conducted qualitative formative research. METHODS: From July to September 2023, we interview…
An emerging Timer-2C framework for addressing barriers to research culture and productivity among local healthcare providers in the Middle East and sub-Saharan Africa
Contributions from healthcare professionals in the Middle East and North Africa (MENA) and sub-Saharan Africa (SSA) to global health research remain disproportionately low. We conceptualized the TIMER-2C framework to capture the multi-level barriers and facilitators shaping research productivity among local healthcare professionals in MENA and SSA. We conducted qualitative interviews using a modified Delphi approach comprising two rounds to: 1) i…
Young widowhood as a predictor of HIV risk behaviors in a high HIV prevalence setting in Siaya County, Kenya
BACKGROUND: Widowed women in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. OBJECTIVES: We examined the likely period of HIV exposure among widows living with HIV and the patterns and predictors of widowed women's HIV risk behaviors. METHODS: We performed a cross-sectional survey with an age-stratified random sample of widowed women in Siaya County, Kenya. We estimated the period of HIV exposure and the prevalence of HIV-risk beha…
Hazardous alcohol use is associated with sexual behaviors that increase risk for HIV acquisition among fishermen in a high HIV prevalence area of Kenya
Links between hazardous alcohol use and HIV acquisition are well documented, with less known about this relationship among fishermen, a priority group for HIV prevention. We examined associations between hazardous alcohol use and sexual risk behaviors among fishermen in Kenya using 2022 data from 733 fishermen in three Lake Victoria communities. Measures included the AUDIT-C and sexual relationship histories. Logistic regression models assessed a…
Water Insecurity is Associated with Intimate Partner Violence Among Women Living with HIV in Western Kenya
Household healthcare seeking patterns for emergent ill-health in Migori, Western Kenya
Background Healthcare-seeking decisions reflect personal assessments of illness etiology and severity to determine whether, how, and where to seek care. Understanding these contexts enables targeted interventions to address barriers and ensure timely access to quality services. We examined patterns of household healthcare seeking for emergent ill-health in Western Kenya. Methods As part of a multi-site mixed-methods study evaluating a patient-cen…
An in-depth interview study of women's perspectives on the effects of contraceptive use on future fertility in Ethiopia and Kenya
Infertility is a common perceived side effect of contraceptive use among women in sub-Saharan Africa, and fear of infertility can affect contraceptive choices. While no choice is inherently negative, it is critical that women have accurate information about side effects to ensure contraceptive decision-making agency. Despite the prevalence of infertility fears, little is known about women's specific beliefs, where they originate, and how they inf…
Opening the black box of agency in contraceptive decision-making
Widowhood stigma as a fundamental cause of poor mental, sexual, and reproductive health outcomes in sub-Saharan Africa
Widows in sub-Saharan Africa experience stigma linked to their social identity of widowhood. Despite the known significant impacts of stigma on health and wellbeing, widowhood stigma is less conceptualized and studied and its effects on widows' mental, sexual and reproductive health are not delineated. We thematically reviewed literature mentioning widowhood stigma and its effects in Africa. Applying the fundamental cause theory to this literatur…
Effectiveness and experiences with differentiated service delivery of HIV care in Kisumu County, Kenya
The adoption of the test and treat policy by the World Health Organization (WHO) in 2015 led to an unprecedented increase in the number of people living with HIV (PLHIV) enrolling into HIV treatment, thereby increasing the burden on HIV service delivery. To compensate, WHO endorsed the Differentiated Service Delivery (DSD) approach to reduce the burden on the health care system and therefore support attainment of the UNAIDS 95-95-95 goals by 2030…
Enhancing engagement in HIV care among adolescents and young adults
Structural, psychological, and clinical barriers to HIV care engagement among adolescents and young adults living with HIV (AYAH) persist globally despite gains in HIV epidemic control. Phone-based peer navigation may provide critical peer support, increase delivery flexibility, and require fewer resources. Prior studies show that phone-based navigation and automated text messaging interventions improve HIV care engagement, adherence, and retenti…
Mentorship—A critical metric for career development and advancing global health
Mentorship plays a critical role in promoting career development and generating impactful research and programs, yet it is typically considered an altruistic endeavor and a luxury. Mentorship programs are largely unfunded and unsupported, particularly in the Global South. However, they are important in global health given the high need for mentors in many settings as well as the cross-cultural complexities and power dynamics inherent in the field…
Pathways between intimate partner violence and HIV care and treatment during pregnancy and postpartum
Intimate partner violence (IPV) is associated with suboptimal HIV treatment behaviors and health outcomes among perinatal women. Less is known about the postpartum phase or how distinct types of perinatal IPV exposure may inhibit HIV-related care. We conducted a qualitative study nested within an ongoing trial among perinatal women in rural Kenya to explore the influence of IPV on adherence to HIV treatment during pregnancy and postpartum. In 202…
Examining and classifying reasons for missing viral loads among adults living with HIV
Gaps in HIV RNA monitoring persist globally impeding the ability to determine clinical progress and outcomes. This study systematically evaluated provider (e.g., guideline non-adherence), system (e.g., laboratory error) and participant-level (e.g., refusal) drivers of missed viral load (VL) monitoring measurements among people with HIV in Kenya. Adults aged 18–65 years were followed across five health facilities in Kenya as part of a clinical tri…
Experiences around testing and linkage to HIV care among gay, bisexual and other men who have sex with men
Although the Kenyan Ministry of Health recognizes key populations in addressing the country's HIV epidemic, gay, bisexual, and other men who have sex with men (GBMSM) face challenges in HIV testing, linkage, and retention in care. This study aimed to inform the development of context-specific interventions to improve GBMSM's initiation in HIV care in Kenya. Drawing on in-depth semi-structured interview data from the Patient-Centered Care Project …
Expanding the reach of HIV pre-exposure prophylaxis (PrEP) among Kenyan adolescent girls and young women
Adolescent girls and young women (AGYW) seeking post-abortal care (PAC) remain at risk of unintended pregnancies and HIV due to infrequent condom use. Integrating HIV prevention services, such as PrEP, into PAC services offers an opportunity to enhance reach, uptake, and efficiency, particularly in high-burden settings like Kenya. However, data on acceptability, feasibility, and sustainability of PAC clinics as entry points for PrEP is limited. A…
Saving for a rainy day
Financial insecurity pushes female sex workers into risky sexual transactions. We piloted an economic empowerment intervention among female sex workers in Kenya to test if they could save part of their income from which to make withdrawals to avoid risky sexual encounters. We enrolled female sex workers and randomised half to the intervention arm, who were given instructions on how to save and withdraw money through a mobile platform, and half to…
Experiences and perceptions of conditional cash incentive provision and cessation among people with HIV for care engagement
CCTs do not appear to exert their effects through motivation, but instead act through creating opportunities for better care engagement. This study helps us better understand the durability of financial incentives for HIV care engagement and support the idea that careful consideration be exercised when implementing incentives for sustainable engagement effects
There is no need to leave the beach to test”
While few fishermen had ever used HIVST, this study found high awareness, positive perceptions, and substantial willingness to use and distribute HIVST to other men. The "promoter" model, with known peers engaged in disseminating HIVST information and test kits, shows promise for engaging men in testing
Metrics of Mobility by Sex are Associated with HIV Incidence in Rural Kenya and Uganda
The complex and dynamic nature of human mobility requires use of multiple measures and sex-stratified analyses to fully understand its influence on HIV acquisition risk in specific populations and settings. Longitudinal population-based studies designed to measure the influence of mobility (which includes both short and long-term, temporary and permanent changes of residence across defined geopolitical boundaries) on HIV acquisition risk are rare…
Gaps in Effective HIV Pre-exposure Prophylaxis Screening and Uptake Among Fishermen in Kenya
Despite oral daily HIV pre-exposure prophylaxis (PrEP) effectiveness, uptake remains a challenge. Awareness of one's HIV status and engagement in prevention is essential to interrupting transmission among populations at high risk of HIV. We explored gaps in HIV risk perception, screening, and PrEP uptake among high HIV-risk fishermen living and working along Lake Victoria, Kenya. Data are from the Owete study (NCT04772469), which evaluated the im…
Engaging Mentor Mothers in Rapid Return of Viral Load Results to Pregnant and Postpartum Women Living with HIV
In Kenya, the primary driver of perinatal HIV transmission is disengagement from care. Virologic monitoring can reinforce adherence and enable timely intervention, yet results are often delayed. Among pregnant (≥ 27 weeks) and postpartum (≤ 6 months) women in HIV care in Kisumu Kenya, we conducted a pilot study in which Mentor Mothers (peer support) returned viral load results (GeneXpert) after a clinic visit between June-December 2023. We assess…
Spillover Effects of an Agricultural Livelihood Intervention Among People Living with HIV on Community Empowerment in Kenya
Transactional Fish-for-Sex Relationships Amid Declining Fish Access in Kenya
She mixes her business
Jaboya (“Sex for Fish”)
Men's Perspectives on Their Role in Family Planning in Nyanza Province, Kenya
Research has indicated that gender dynamics—and in particular men's disapproval of family planning—have had an influence on the low levels of contraceptive use in sub‐Saharan Africa. Limited evidence exists, however, on effective strategies to increase male approval. We conducted 12 focus group discussions with married men aged 20–66 (N = 106) in Kenya to explore FP perceptions. Men's disapproval of FP was associated with anxieties regarding male…
Property Rights Violations as a Structural Driver of Women’s HIV Risks
Gendered dimensions of population mobility associated with HIV across three epidemics in rural Eastern Africa
Mobility in sub-Saharan Africa links geographically-separate HIV epidemics, intensifies transmission by enabling higher-risk sexual behavior, and disrupts care. This population-based observational cohort study measured complex dimensions of mobility in rural Uganda and Kenya. Survey data were collected every 6 months beginning in 2016 from a random sample of 2308 adults in 12 communities across three regions, stratified by intervention arm, basel…
Perceived Impact of a Land and Property Rights Program on Violence Against Women in Rural Kenya
The current study focuses on a community-led land and property rights program in two rural provinces in western Kenya. The program was designed to respond to women's property rights violations to reduce violence against women and HIV risks at the community level. Through in-depth interviews with 30 women, we examine the perceived impact that this community-level property rights program had on violence against women at the individual and community…
Confirmatory Factor Analysis and Validation of the Sexual and Reproductive Empowerment Scale for Adolescents and Young Adults in Kenya
Understanding the levels of power that adolescent girls and young women exercise in their sexual and reproductive lives is imperative to inform interventions to help them meet their goals. We implemented an adapted version of the Sexual and Reproductive Health Empowerment (SRE) Scale for Adolescents and Young Adults among 500 adolescent girls and young women aged 15–20 in Kisumu, Kenya. We used confirmatory factor analysis (CFA) to assess factor …
We Don't Fear HIV. We Just Fear Walking around Pregnant.”
In Kenya, adolescent pregnancy rates are high, contraception utilization is low, and adolescent sexuality is stigmatized. We describe how perceptions of sexuality and pregnancy stigma influence decision‐making among adolescents in the informal settlements of Kisumu. We used purposive sampling to recruit 120 adolescent boys and girls aged 15–19 for focus group discussions. A semistructured interview guide was used to elicit social norms and commun…
Mechanisms and perceived mental health changes after a livelihood intervention for HIV-positive Kenyans
While food insecurity and poverty worsen mental health outcomes among people living with HIV/AIDS (PLHIV), few intervention studies have targeted poverty and food insecurity as a way to improve mental health. Among HIV-positive patients, addressing such upstream determinants may prove crucial to ensure better mental health and HIV clinical outcomes. We integrated longitudinal, qualitative research into a randomized trial of a livelihood intervent…
Nourishing networks
A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya
An Evaluation of the Middle East Research Training Initiative Tool in Assessing Effective Functioning of Research Ethics Committees
The effective functioning of a research ethics committee (REC) can be evaluated using self-assessment tools. The Middle East Research Ethics Training Initiative (MERETI) tool can be used by one member, typically the Chair, to score an REC. The consistency of these scores across several members of an REC has never been evaluated. This study examined whether results would be consistent irrespective of who conducts the assessment. One REC's effectiv…
"Wan Kanyakla" (We are together)
Health facility challenges to the provision of Option B+ in western Kenya
Current WHO guidelines recommend lifelong antiretroviral therapy (ART) for all HIV-positive individuals, including pregnant and breastfeeding women (Option B+) in settings with generalized HIV epidemics. While Option B+ is scaled-up in Kenya, insufficient adherence and retention to care could undermine the expected positive impact of Option B+. To explore challenges to the provision of Option B+ at the health facility level, we conducted forty in…
HIV/Aids and maternity care in Kenya
Although policies and programs exist to promote safe motherhood in sub-Saharan Africa, maternal health has not improved and may be deteriorating in some countries. Part of the explanation may be the adverse effects of HIV/AIDS on maternity care. We conducted a study in Kisumu, Kenya to explore how fears related to HIV/AIDS affect women's uptake and health workers' provision of labor and delivery services. In-depth qualitative interviews with 17 m…
The Association of HIV Counseling and Testing with HIV Risk Behaviors in a Random Population-based Survey in Kisumu, Kenya
HIV testing has been promoted as a key HIV prevention strategy in low-resource settings, despite studies showing variable impact on risk behavior. We sought to examine rates of HIV testing and the association between testing and sexual risk behaviors in Kisumu, Kenya. Participants were interviewed about HIV testing and sexual risk behaviors. They then underwent HIV serologic testing. We found that 47% of women and 36% of men reported prior testin…
Shamba Maisha
We demonstrated the feasibility of an income-generating micro-irrigation intervention among HIV-positive patients and the collection of health and economic data. While family income improved significantly, loan repayment rates were low- likely complicated by the drought that occurred in Kenya during the intervention period
HIV/Aids Stigma and Refusal of HIV Testing Among Pregnant Women in Rural Kenya
HIV/AIDS stigma is a common thread in the narratives of pregnant women affected by HIV/AIDS globally and may be associated with refusal of HIV testing. We conducted a cross-sectional study of women attending antenatal clinics in Kenya (N = 1525). Women completed an interview with measures of HIV/AIDS stigma and subsequently information on their acceptance of HIV testing was obtained from medical records. Associations of stigma measures with HIV t…
Attitudes and beliefs about anti-retroviral therapy are associated with high risk sexual behaviors among the general population of Kisumu, Kenya
Attitudes and beliefs about antiretroviral therapy (ART) may affect sexual risk behaviors among the general population in sub-Saharan Africa. We performed a cross-sectional population-based study in Kisumu, Kenya to test this hypothesis in October 2006. A total of 1655 participants were interviewed regarding attitudes and beliefs about ART and their sexual risk behaviors. The majority of participants, (71%) men and (70%) women, had heard of ART. …
Acceptability and feasibility of integration of HIV care services into antenatal clinics in rural Kenya
The aim of this study was to explore the perspectives of healthcare providers on the advantages and disadvantages of integrating HIV care services, including highly active antiretroviral therapy (HAART), into antenatal care (ANC) clinics in rural Kenya. We conducted a qualitative study using in-depth interviews and thematic analysis; 36 healthcare providers from six health centres in Nyanza Province, Kenya participated. Effects on service provide…
Predictors of Linkage to Care Following Community-Based HIV Counseling and Testing in Rural Kenya
Medical pluralism on Mfangano Island
Antiretroviral Prophylaxis for HIV Prevention in Heterosexual Men and Women
BACKGROUND: Antiretroviral preexposure prophylaxis is a promising approach for preventing human immunodeficiency virus type 1 (HIV-1) infection in heterosexual populations. METHODS: We conducted a randomized trial of oral antiretroviral therapy for use as preexposure prophylaxis among HIV-1-serodiscordant heterosexual couples from Kenya and Uganda. The HIV-1-seronegative partner in each couple was randomly assigned to one of three study regimens-…
Factors associated with pregnant women's anticipations and experiences of HIV-related stigma in rural Kenya
Pregnant women who fear or experience HIV-related stigma may not get care for their own health or medications to reduce perinatal transmission of HIV. This study examined factors associated with anticipating and experiencing HIV-related stigma among 1777 pregnant women attending antenatal care clinics in rural Kenya. Women were interviewed at baseline, offered HIV testing and care, and a sub-set was re-interviewed at 4-8 weeks postpartum. Women w…
Patient satisfaction with integrated HIV and antenatal care services in rural Kenya
A cluster randomized controlled trial was initiated in Kenya to determine if full integration (FI) of HIV care, including HAART, into antenatal care (ANC) clinics improves health outcomes among HIV-infected women and exposed infants, compared to a non-integrated (NI) model. This article examines ANC clients' satisfaction with and preferences regarding HIV-integrated services. In this cross-sectional study, pregnant women attending five FI clinics…
Transactional sex in the fishing communities along Lake Victoria, Kenya
The study describes the nature, context and implications of a unique form of transactional sexual relationships in the fishing communities along Lake Victoria in Kisumu County, Kenya. We conducted 12 focus group discussions and 17 key informant interviews among fishermen, fishmongers and fish transporters in Kisumu. Women fishmongers in the fishing communities commonly form relationships with fishermen, which are often sexual, as part of the jabo…
Socio-demographic and health associations with body mass index at the time of enrollment in HIV care in Nyanza Province, Kenya
Low body mass index (BMI) at the time of enrollment into HIV care has been shown to be a strong predictor of mortality independent of CD4 count. This study investigated socio-demographic associations with underweight (BMI < 18.5) among adults in Nyanza Province, Kenya, upon enrollment into HIV care. BMI, socio-demographic, and health data from a cross-sectional sample of 8254 women and 3533 men were gathered upon enrollment in the Family AIDS Car…
Social context and drivers of intimate partner violence in rural Kenya
More than half of rural Kenyan women experience intimate partner violence (IPV) in their lifetime. Beyond physical consequences, IPV indirectly worsens maternal health because pregnant women avoid antenatal care or HIV testing when they fear violent reprisal from partners. To develop an intervention to mitigate violence towards pregnant women, we conducted qualitative research in rural Kenya. Through eight focus group discussions, four with pregn…
Fertility intentions among HIV-infected, sero-concordant couples in Nyanza province, Kenya
Research in sub-Saharan Africa has shown significant diversity in how HIV influences infected couples' fertility intentions. Supporting HIV-infected, sero-concordant couples in sub-Saharan Africa to make informed choices about their fertility options has not received sufficient attention. In-depth interviews were conducted among 23 HIV-positive, sero-concordant married couples in Kenya, to better understand how HIV impacted fertility intentions. …
Property Rights Violations as a Structural Driver of Women’s HIV Risks
What community-level strategies are needed to secure women's property rights in Western Kenya? Laying the groundwork for a future structural HIV prevention intervention
Despite the recognized need for structural-level HIV prevention interventions that focus on economic empowerment to reduce women's HIV risks, few science-based programs have focused on securing women's land ownership as a primary or secondary HIV risk reduction strategy. The current study focused on a community-led land and property rights model that was implemented in two rural areas of western Kenya where HIV prevalence was high (24-30%) and pr…
“It is all about the fear of being discriminated [against]…the person suffering from HIV will not be accepted”
Interventions focusing on reduction of stigma, increasing safe disclosure of HIV status, and improved dependent relationships may improve retention in care of YLWH
HIV serostatus and disclosure
Health care workers and counselors need to receive support in order to improve skills required for diagnosing, monitoring and managing psychosocial aspects of the care of pregnant and HIV positive women including facilitating disclosure to male partners in order to improve both maternal and child health outcomes
Plasmodium falciparum Infection is Associated with Epstein–Barr Virus Reactivation in Pregnant Women Living in Malaria Holoendemic Area of Western Kenya
She mixes her business
Providers' perspectives on male involvement in family planning in the context of a cluster-randomized controlled trial evaluating integrating family planning into HIV care in Nyanza Province, Kenya
Integration of family planning (FP) services into HIV care and increasing male partner involvement in FP are being explored as strategies to reduce unmet need for contraception. Providers' views can give valuable insight into current FP care. We evaluated the perspectives of HIV care providers working at HIV clinics in Nyanza Province, Kenya, on male partner involvement in FP. This qualitative study was part of a cluster-randomized controlled tri…
Achieving pregnancy safely
In female-positive HIV-serodiscordant couples desiring children, home timed vaginal insemination (TVI) of semen during the fertile period along with consistent condom use may reduce the risk of HIV transmission when the man is HIV-uninfected. In sub-Saharan Africa, up to 45% of HIV-infected women desire to have more children. HIV viral load assessment is not routinely available in low-resource countries for monitoring adherence and response to an…
Integrating family planning and HIV services in western Kenya
Little information exists on the impact of integrating family planning (FP) services into HIV care and treatment on patients' familiarity with and attitudes toward FP. We conducted a cluster-randomized trial in 18 public HIV clinics with 12 randomized to integrated FP and HIV services and 6 to the standard referral-based system where patients are referred to an FP clinic. Serial cross-sectional surveys were done before (n = 488 women, 486 men) an…
Women now wear trousers’
Gender inequity has been closely linked with unmet need for family planning among women in sub-Saharan Africa but the factors related to male family planning disapproval are not well-understood. This qualitative study explored men's perspectives of gender roles and cultural norms as they pertain to family planning. Twelve small group meetings were held with 106 married men in Nyanza Province, Kenya. Shifting gender relations made the definitions …
Medicine (127 works) · HIV/AIDS Research and Interventions (98 works) · Adolescent Sexual and Reproductive Health (81 works) · Environmental health (74 works) · Family medicine (67 works) · Nursing (61 works) · Sociology (57 works) · Population (56 works) · Psychology (56 works) · Public health (52 works)