Daniel Kwaro
Biographic Data
| ID | 6939499 |
|---|---|
| NAME | Daniel Kwaro |
| GIVEN NAMES | Daniel |
| FAMILY NAME | Kwaro |
| SIGNATURE | KWARO D |
| AFFILIATIONS | Kenya Medical Research Institute |
| ORCID | 0000-0002-0929-8072 |
| VERIFIED | Yes |
| TOTAL WORKS | 26 |
| TOTAL CITATIONS | 0 |
| WORKS AS AUTHOR | 26 |
| WORKS AS EDITOR | 0 |
| FIRST PUBLICATION YEAR | 2011 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 0 |
How can complex interventions be adapted to context? A qualitative analysis of the implementation of DREAMS in three Kenyan settings
In Kenya, the DREAMS Partnership (“Determined, Resilient, Empowered, AIDS-free, Mentored and Safe”) aims to reduce new HIV cases among adolescent girls and young women (AGYW; aged 10–24) through a comprehensive programme of interventions. The impact of DREAMS varies across settings but reasons for this are not well understood. One potential reason is the differential implementation of DREAMS interventions due to on-the-ground adaptations made by …
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…
All-cause and cause-specific mortality trends among people with and without HIV in the Siaya health and demographic surveillance system, Kenya, 2011–2018
BACKGROUND: All-cause mortality among people with HIV (PWH) in sub-Saharan Africa declined after antiretroviral therapy's introduction, but data in rural settings on evolving causes of death as this population age remain limited. OBJECTIVES: To compare all-cause and cause-specific mortality trends among PWH and people without HIV (PWOH) in western Kenya using a prospective cohort study. METHODS: Data from the Siaya Health and Demographic Surveill…
A comparison of all-cause and HIV cause-specific mortality among children under 5 years of age before and during Covid-19 in Kenya, 2018–2022
The impact of the COVID-19 pandemic on pediatric mortality, including measures to ensure continuity of HIV care, is not well described in Kenya. We evaluated causes of death (COD) among decedents under 5 years of age both before and during the COVID-19 pandemic in Kenya. We analyzed Child Health and Mortality Prevention Surveillance (CHAMPS) data collected in February 2018–March 2022. We describe the proportional contribution of specific conditio…
What combination of interventions can optimise HIV prevention for adolescent girls and young women? Cohort analysis of DREAMS participation in urban and rural Kenya
Comprehensive intervention packages are recommended to address multiple sources of HIV risk for adolescent girls and young women (AGYW). DREAMS is a multi-component HIV prevention program designed to reduce HIV incidence among AGYW. We conducted a prospective cohort study among AGYW aged 13–22 years, randomly selected in rural Gem and urban Nairobi informal settlements followed from 2017/2018–2019. AGYW were classified into three groups: (1) invi…
Impact of a multilevel HIV prevention programme on adolescent girls and young women’s empowerment for risk reduction
Empowerment is key to person-centered HIV prevention. This study aims to evaluate the extent to which the Determined, Resilient, Empowered, AIDS-free, Mentored, Safe (DREAMS) Partnership promotes empowerment of adolescent girls and young women (AGYW) in Kenya. We conducted a mixed-methods study to examine DREAMS influence on empowerment precursors (resources, agency, institutional structures) and outcomes, guided by Kabeer’s framework for women’s…
Widowed and at risk
From a decade long follow-up, we show a disproportionately high and increasing prevalence of HIV among widowed women in Siaya, Kenya. Among both widowed and married women, there was an association between living with HIV and younger age, 10-year younger sexual partners and experiencing forced sex. Policies that prioritize widowed women could assist in the development of targeted interventions that address the unique challenges of this important s…
Burden of heat stress on residual work capacity among farmers living with chronic HIV in Siaya county, Kenya
This study will generate novel evidence on the impact of heat stress on labour capacity and sleep in HIV-positive populations, addressing a critical gap in climate-health research in sub-Saharan Africa. Findings will inform equitable adaptation strategies, such as work-rest cycles and hydration protocols, tailored to vulnerable subgroups, including women and individuals living with HIV
Because she doesn’t have a voice’. Perceptions of rejection amongst girls who have dropped out of school in rural western Kenya
Despite global commitments to girls’ education, many dropout prematurely facing health, social, and economic hardships. Using ten focus group discussions and ten in-depth interviews, this study explored issues identified as important in the lives of girls who had dropped out of school. Thematic analysis first revealed rejection as a central theme in the girls' experiences, prompting a deductive approach that identified five interrelated themes: (…
Physical effort during labour and behavioural adaptations in response to heat stress among subsistence farmers in Burkina Faso
Impact of DREAMS interventions on attitudes towards gender norms among adolescent girls and young women
The DREAMS partnership aims to deliver a comprehensive package to reduce HIV incidence among adolescent girls and young women (AGYW), including through shifting gender norms. We evaluate DREAMS’ effect on attitudes towards gender norms in two Kenyan settings. AGYW aged 15–22 in Nairobi (n = 852) and Gem (n = 761) were randomly selected for cohort enrolment in 2017–18 and followed-up to 2019. We described the proportion of AGYW and their male peer…
Impact of DREAMS interventions on experiences of violence among adolescent girls and young women
DREAMS aims to reduce HIV incidence among adolescent girls and young women (AGYW) by tackling drivers of HIV risk including gender-based violence. We evaluate the impact of DREAMS on recent experiences of violence perpetuated by men against AGYW. AGYW cohorts were randomly selected from demographic platforms in South Africa (rural KwaZulu-Natal) and Kenya (Nairobi informal settlements and rural Gem sub-county). AGYW aged 13–22 years were enrolled…
The long-term impact of HIV/Aids on socio-economic status
HIV/AIDS is known to have adverse effects on individual and family socio-economic status due to the loss of productive time and over-expenditure in treatment. However, empirical data on how HIV/AIDS affects households' socio-economic status are insufficient. We linked socio-economic data from a Health and Demographic Surveillance System (HDSS) that implements an HIV/AIDS Longitudinal bio-behavioural survey (LBBS) to understand the long-term impac…
Impact of the DREAMS Partnership on social support and general self-efficacy among adolescent girls and young women
INTRODUCTION: The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to influence psychosocial processes that promote empowerment among adolescent girls and young women (AGYW), and reduce HIV incidence. We estimated the impact of DREAMS on aspects of AGYW's collective and individual agency (specifically, social support and self-efficacy), in three settings where DREAMS was implemented from 2016 until at leas…
Impact of Covid-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya
INTRODUCTION: Secondary school closures aimed at limiting the number of infections and deaths due to COVID-19 may have amplified the negative sexual and reproductive health (SRH) and schooling outcomes of vulnerable adolescent girls. This study aimed to measure pandemic-related effects on adolescent pregnancy and school dropout among school-going girls in Kenya. METHODS: We report longitudinal findings of 910 girls in their last 2 years of second…
Quality of life and well-being problems in secondary schoolgirls in Kenya
Background Adolescents in sub-Saharan Africa often report low levels of quality of life (QoL) and well-being, but reliable data are limited. This study examines which sociodemographic, health, and behavioral risk factors and adverse adolescent experiences are associated with, and predictive of, QoL in Kenyan secondary schoolgirls. Methods and findings 3,998 girls at baseline in a randomised controlled trial in Siaya County, western Kenya were med…
Does Venue of HIV Testing and Results Disclosure in the Context of a Research Study Affect Adolescent Health and Behavior? Results from a Study in Western Kenya
Ethical concerns about risks to minor adolescents participating in HIV prevention research is a barrier to their inclusion. One concern is whether HIV testing and results disclosure venue affects the health and behavior of adolescent participants. We assessed for differential effects on quality of life (QOL), depressive symptoms, and sexual behavior due to (1) testing venue (home or health facility) and (2) test result (HIV-positive, HIV-negative…
Is maternal HIV infection a risk factor for delayed or missed infant measles vaccination in western Kenya
Measles is a highly infectious virus and one of the leading causes of childhood morbidity and mortality in areas with low immunization rates. Despite the introduction of the measles vaccine preventing about 20 million deaths between 2000 and 2016, there still is a low uptake of the vaccine, especially in low-income countries. Maternal HIV positive status is identified as one of the factors inhibiting the uptake of the measles vaccine in some sett…
Pathways to Depression and Poor Quality of Life Among Adolescents in Western Kenya
Adolescent perceptions about participating in HIV-related research studies
Awareness and uptake of layered HIV prevention programming for young women
In representative population-based samples, awareness and uptake of DREAMS were high after 1 year of implementation. Evidence of 'layering' (receiving multiple interventions from the DREAMS core package), particularly among more socio-economically vulnerable AGYW, indicate that intervention packages can be implemented at scale, for intended recipients, in real-world contexts. Challenges remain for higher coverage and greater 'layering', including…
Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls
ClinicalTrials.gov NCT03051789 , 15th February 2017
Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya
I think the parent should be there because no one was born alone”
Despite a pressing need for adolescent HIV research in sub-Saharan Africa, ethical guidance for conducting research among minor adolescents is lacking. One ethical issue is the degree to which parents should be involved in the research process. The existing discourse is predominantly speculative and focuses on negative consequences of parental involvement. We use empirical data to describe the perspectives of Kenyan adolescents on parental involv…
Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings
DREAMS is, to date, the most ambitious effort to scale-up combinations or 'packages' of multi-sectoral interventions for HIV prevention. Evidence of its effectiveness in reducing HIV incidence among AGYW, and demonstrating which aspects of the lives of AGYW were changed, will offer valuable lessons for replication
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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…
I think the parent should be there because no one was born alone”
Despite a pressing need for adolescent HIV research in sub-Saharan Africa, ethical guidance for conducting research among minor adolescents is lacking. One ethical issue is the degree to which parents should be involved in the research process. The existing discourse is predominantly speculative and focuses on negative consequences of parental involvement. We use empirical data to describe the perspectives of Kenyan adolescents on parental involv…
Evaluating the impact of the DREAMS partnership to reduce HIV incidence among adolescent girls and young women in four settings
DREAMS is, to date, the most ambitious effort to scale-up combinations or 'packages' of multi-sectoral interventions for HIV prevention. Evidence of its effectiveness in reducing HIV incidence among AGYW, and demonstrating which aspects of the lives of AGYW were changed, will offer valuable lessons for replication
Awareness and uptake of layered HIV prevention programming for young women
In representative population-based samples, awareness and uptake of DREAMS were high after 1 year of implementation. Evidence of 'layering' (receiving multiple interventions from the DREAMS core package), particularly among more socio-economically vulnerable AGYW, indicate that intervention packages can be implemented at scale, for intended recipients, in real-world contexts. Challenges remain for higher coverage and greater 'layering', including…
Menstrual cups and cash transfer to reduce sexual and reproductive harm and school dropout in adolescent schoolgirls
ClinicalTrials.gov NCT03051789 , 15th February 2017
Consent Challenges and Psychosocial Distress in the Scale-up of Voluntary Medical Male Circumcision Among Adolescents in Western Kenya
Is maternal HIV infection a risk factor for delayed or missed infant measles vaccination in western Kenya
Measles is a highly infectious virus and one of the leading causes of childhood morbidity and mortality in areas with low immunization rates. Despite the introduction of the measles vaccine preventing about 20 million deaths between 2000 and 2016, there still is a low uptake of the vaccine, especially in low-income countries. Maternal HIV positive status is identified as one of the factors inhibiting the uptake of the measles vaccine in some sett…
Pathways to Depression and Poor Quality of Life Among Adolescents in Western Kenya
Adolescent perceptions about participating in HIV-related research studies
Impact of the DREAMS Partnership on social support and general self-efficacy among adolescent girls and young women
INTRODUCTION: The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to influence psychosocial processes that promote empowerment among adolescent girls and young women (AGYW), and reduce HIV incidence. We estimated the impact of DREAMS on aspects of AGYW's collective and individual agency (specifically, social support and self-efficacy), in three settings where DREAMS was implemented from 2016 until at leas…
Impact of Covid-19 lockdowns on adolescent pregnancy and school dropout among secondary schoolgirls in Kenya
INTRODUCTION: Secondary school closures aimed at limiting the number of infections and deaths due to COVID-19 may have amplified the negative sexual and reproductive health (SRH) and schooling outcomes of vulnerable adolescent girls. This study aimed to measure pandemic-related effects on adolescent pregnancy and school dropout among school-going girls in Kenya. METHODS: We report longitudinal findings of 910 girls in their last 2 years of second…
Quality of life and well-being problems in secondary schoolgirls in Kenya
Background Adolescents in sub-Saharan Africa often report low levels of quality of life (QoL) and well-being, but reliable data are limited. This study examines which sociodemographic, health, and behavioral risk factors and adverse adolescent experiences are associated with, and predictive of, QoL in Kenyan secondary schoolgirls. Methods and findings 3,998 girls at baseline in a randomised controlled trial in Siaya County, western Kenya were med…
Does Venue of HIV Testing and Results Disclosure in the Context of a Research Study Affect Adolescent Health and Behavior? Results from a Study in Western Kenya
Ethical concerns about risks to minor adolescents participating in HIV prevention research is a barrier to their inclusion. One concern is whether HIV testing and results disclosure venue affects the health and behavior of adolescent participants. We assessed for differential effects on quality of life (QOL), depressive symptoms, and sexual behavior due to (1) testing venue (home or health facility) and (2) test result (HIV-positive, HIV-negative…
Impact of DREAMS interventions on experiences of violence among adolescent girls and young women
DREAMS aims to reduce HIV incidence among adolescent girls and young women (AGYW) by tackling drivers of HIV risk including gender-based violence. We evaluate the impact of DREAMS on recent experiences of violence perpetuated by men against AGYW. AGYW cohorts were randomly selected from demographic platforms in South Africa (rural KwaZulu-Natal) and Kenya (Nairobi informal settlements and rural Gem sub-county). AGYW aged 13–22 years were enrolled…
The long-term impact of HIV/Aids on socio-economic status
HIV/AIDS is known to have adverse effects on individual and family socio-economic status due to the loss of productive time and over-expenditure in treatment. However, empirical data on how HIV/AIDS affects households' socio-economic status are insufficient. We linked socio-economic data from a Health and Demographic Surveillance System (HDSS) that implements an HIV/AIDS Longitudinal bio-behavioural survey (LBBS) to understand the long-term impac…
Impact of DREAMS interventions on attitudes towards gender norms among adolescent girls and young women
The DREAMS partnership aims to deliver a comprehensive package to reduce HIV incidence among adolescent girls and young women (AGYW), including through shifting gender norms. We evaluate DREAMS’ effect on attitudes towards gender norms in two Kenyan settings. AGYW aged 15–22 in Nairobi (n = 852) and Gem (n = 761) were randomly selected for cohort enrolment in 2017–18 and followed-up to 2019. We described the proportion of AGYW and their male peer…
A comparison of all-cause and HIV cause-specific mortality among children under 5 years of age before and during Covid-19 in Kenya, 2018–2022
The impact of the COVID-19 pandemic on pediatric mortality, including measures to ensure continuity of HIV care, is not well described in Kenya. We evaluated causes of death (COD) among decedents under 5 years of age both before and during the COVID-19 pandemic in Kenya. We analyzed Child Health and Mortality Prevention Surveillance (CHAMPS) data collected in February 2018–March 2022. We describe the proportional contribution of specific conditio…
What combination of interventions can optimise HIV prevention for adolescent girls and young women? Cohort analysis of DREAMS participation in urban and rural Kenya
Comprehensive intervention packages are recommended to address multiple sources of HIV risk for adolescent girls and young women (AGYW). DREAMS is a multi-component HIV prevention program designed to reduce HIV incidence among AGYW. We conducted a prospective cohort study among AGYW aged 13–22 years, randomly selected in rural Gem and urban Nairobi informal settlements followed from 2017/2018–2019. AGYW were classified into three groups: (1) invi…
Impact of a multilevel HIV prevention programme on adolescent girls and young women’s empowerment for risk reduction
Empowerment is key to person-centered HIV prevention. This study aims to evaluate the extent to which the Determined, Resilient, Empowered, AIDS-free, Mentored, Safe (DREAMS) Partnership promotes empowerment of adolescent girls and young women (AGYW) in Kenya. We conducted a mixed-methods study to examine DREAMS influence on empowerment precursors (resources, agency, institutional structures) and outcomes, guided by Kabeer’s framework for women’s…
Widowed and at risk
From a decade long follow-up, we show a disproportionately high and increasing prevalence of HIV among widowed women in Siaya, Kenya. Among both widowed and married women, there was an association between living with HIV and younger age, 10-year younger sexual partners and experiencing forced sex. Policies that prioritize widowed women could assist in the development of targeted interventions that address the unique challenges of this important s…
Burden of heat stress on residual work capacity among farmers living with chronic HIV in Siaya county, Kenya
This study will generate novel evidence on the impact of heat stress on labour capacity and sleep in HIV-positive populations, addressing a critical gap in climate-health research in sub-Saharan Africa. Findings will inform equitable adaptation strategies, such as work-rest cycles and hydration protocols, tailored to vulnerable subgroups, including women and individuals living with HIV
Because she doesn’t have a voice’. Perceptions of rejection amongst girls who have dropped out of school in rural western Kenya
Despite global commitments to girls’ education, many dropout prematurely facing health, social, and economic hardships. Using ten focus group discussions and ten in-depth interviews, this study explored issues identified as important in the lives of girls who had dropped out of school. Thematic analysis first revealed rejection as a central theme in the girls' experiences, prompting a deductive approach that identified five interrelated themes: (…
Physical effort during labour and behavioural adaptations in response to heat stress among subsistence farmers in Burkina Faso
How can complex interventions be adapted to context? A qualitative analysis of the implementation of DREAMS in three Kenyan settings
In Kenya, the DREAMS Partnership (“Determined, Resilient, Empowered, AIDS-free, Mentored and Safe”) aims to reduce new HIV cases among adolescent girls and young women (AGYW; aged 10–24) through a comprehensive programme of interventions. The impact of DREAMS varies across settings but reasons for this are not well understood. One potential reason is the differential implementation of DREAMS interventions due to on-the-ground adaptations made by …
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…
Medicine (18 works) · Adolescent Sexual and Reproductive Health (17 works) · HIV/AIDS Research and Interventions (15 works) · Demography (10 works) · Environmental health (10 works) · Population (10 works) · Psychological intervention (9 works) · Psychology (8 works) · Family medicine (7 works) · Nursing (7 works)