Craig R Cohen
Dados Biográficos
| ID | 165312 |
|---|---|
| NOME | Craig R Cohen |
| PRENOMES | Craig R |
| SOBRENOME | Cohen |
| ASSINATURA | COHEN C R |
| AFILIAÇÕES | University of California, San Francisco |
| ORCID | 0000-0001-8654-6634 |
| VERIFICADO | Sim |
| TOTAL DE OBRAS | 77 |
| TOTAL DE CITAÇÕES | 27 |
| TOTAL COMO AUTOR | 77 |
| TOTAL COMO EDITOR | 0 |
| PRIMEIRO ANO DE PUBLICAÇÃO | 2008 |
| ANO MAIS RECENTE DE PUBLICAÇÃO | 2026 |
| ÍNDICE H | 3 |
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…
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…
Exploring patients’ and healthcare providers’ knowledge and perceptions of benefits, challenges, and resource requirements in integrating telemedicine services into routine HIV care in western Kenya
Telemedicine offers a patient-centered approach to chronic care, including HIV. However, its uptake depends on the users' perceptions of its benefits and challenges. We explored patients' and providers' knowledge, perceptions, benefits, challenges, and resource needs for integrating telemedicine into routine HIV care. We conducted a qualitative study involving eight gender-stratified focus group discussions and 23 key informant interviews with pe…
Water Insecurity is Associated with Intimate Partner Violence Among Women Living with HIV in Western Kenya
Productivity benefits of treatment of depression and post-traumatic stress disorder in Kenya
INTRODUCTION: Depression and post-traumatic stress disorder (PTSD) significantly contribute to the global disease burden, adversely affecting health, medical costs and economic productivity. The SMART-DAPPER project in western Kenya approached this challenge by deploying trained non-specialists to administer proven depression and PTSD treatments. METHODS: Participants were public sector primary care outpatients at Kiumu County Hospital with major…
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…
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…
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
Defining a screening tool for post-traumatic stress disorder in East Africa
Background: Scalable PTSD screening strategies must be brief, accurate and capable of administration by a non-specialized workforce. Methods: We used PTSD as determined by the structured clinical interview as our gold standard and considered predictors sets of (a) Posttraumatic Stress Checklist-5 (PCL-5), (b) Primary Care PTSD Screen for the DSM-5 (PC-PTSD) and, (c) PCL-5 and PC-PTSD questions to identify the optimal items for PTSD screening for …
Exploring HIV risk perception mechanisms among youth in a test-and-treat trial in Kenya and Uganda
Understanding risk perception and risk-taking among youth can inform targeted prevention efforts. Using a health beliefs model-informed framework, we analysed 8 semi-structured, gender-specific focus group discussions with 93 youth 15–24 years old (48% male, 52% female), drawn from the SEARCH trial in rural Kenya and Uganda in 2017–2018, coinciding with the widespread introduction of PrEP. Highly connected social networks and widespread uptake of…
“We chose PrEP because I wanted to be sure that this child my wife was going to conceive was indeed mine.” Factors influencing the choice of safer conception methods and experiences with its use
The differences in method preferences and experiences voiced by participants in this study and in other studies from the region point to the importance of having a variety of safer conception options in the service delivery package and addressing concerns about paternity, intimacy, and method-related attributes to enable HIV sero-discordant couples to safely achieve their reproductive goals
Increased Stillbirth Rates and Exposure to Environmental Risk Factors for Stillbirth in Counties with Higher Social Vulnerability
Cost comparison of a rapid results initiative against standard clinic-based model to scale-up voluntary medical male circumcision in Kenya
Voluntary male medical circumcision (VMMC) reduces HIV acquisition by up to 60%. Kenya has successfully scaled up VMMC to an estimated 91% of eligible men and boys in certain regions in combination due to VMMC and cultural circumcisions. VMMC as a program is implemented regionally in traditionally non-circumcising counties where the prevalence is still below 91%, ranging from 56.4% to 66.7%. Given that funding toward VMMC is expected to decline i…
Sex specific differences in HIV status disclosure and care engagement among people living with HIV in rural communities in Kenya and Uganda
Non-disclosure of human immunodeficiency virus (HIV) status can hinder optimal health outcomes for people living with HIV (PLHIV). We sought to explore experiences with and correlates of disclosure among PLHIV participating in a study of population mobility. Survey data were collected from 1081 PLHIV from 2015–16 in 12 communities in Kenya and Uganda participating in a test-and-treat trial (SEARCH, NCT#01864603). Pooled and sex-stratified multipl…
Preventing HIV and achieving pregnancy among HIV sero-different couples
Safer conception services are needed to minimize HIV transmission among HIV sero-different couples desiring pregnancy. Few studies have evaluated the choices couples make when offered multiple safer conception methods or real-world method acceptability and effectiveness. We piloted a comprehensive safer conception program ( Clintrials . gov identifier: NCT03049176) for HIV sero-different couples planning pregnancy in Zimbabwe to measure feasibili…
Financial and Food Insecurity are Primary Challenges to Breastfeeding for Women Living with HIV in Western Kenya
Nothing about us without us
Comparing the effect of a multisectoral agricultural intervention on HIV-related health outcomes between widowed and married women
Our study is among the first comparing the effect of a livelihood intervention on HIV health outcomes among widowed and married women. Widowed women experienced similar benefits as married women on individual-level outcomes, but weaker benefit on outcomes dependent on their external environment like enacted stigma and social support. Future trials and programs targeting widowed women should bolster stigma reduction and social support
Patient preferences for HIV service delivery models; a Discrete Choice Experiment in Kisumu, Kenya
Novel “differentiated service delivery” models for HIV treatment that reduce clinic visit frequency, minimize waiting time, and deliver treatment in the community promise retention improvement for HIV treatment in Sub-Saharan Africa. Quantitative assessments of differentiated service delivery (DSD) feature most preferred by patient populations do not widely exist but could inform selection and prioritization of different DSD models. We used a dis…
First cases of Sars-CoV-2 infection and secondary transmission in Kisumu, Kenya
We investigated the first 152 laboratory-confirmed SARS-CoV-2 cases (125 primary and 27 secondary) and their 248 close contacts in Kisumu County, Kenya. Conducted June 10–October 8, 2020, this study included interviews and sample collection at enrolment and 14–21 days later. Median age was 35 years (IQR 28–44); 69.0% reported COVID-19 related symptoms, most commonly cough (60.0%), headache (55.2%), fever (53.3%) and loss of taste or smell (43.8%)…
Improvements in pediatric and adolescent HIV testing and identification in western Kenya under the Accelerating Children’s HIV/Aids Treatment initiative
Pediatric HIV remains a significant global concern, with 160,000 new infections annually. Accelerating Children’s HIV/AIDS Treatment (ACT) provided a strategic response to the “treatment gap” for children. We examined whether activities under ACT increased testing and identification of youth living with HIV (YLWH). Family AIDS Care & Education Services implemented ACT across 130 health facilities in western Kenya between October 2015 and Septembe…
Relationship Power, Antiretroviral Adherence, and Physical and Mental Health Among Women Living with HIV in Rural Kenya
Little is known about the association of gender-based power imbalances and health and health behaviors among women with HIV (WWH). We examined cross-sectional baseline data among WWH in a cluster-randomized control trial (NCT02815579) in rural Kenya. We assessed associations between the Sexual Relationship Power Scale (SRPS) and ART adherence, physical and mental health, adjusting for sociodemographic and social factors. SRPS consists of two subs…
Mobility is Associated with Higher-risk Sexual Partnerships Among Both Men and Women in Co-resident Couples in Rural Kenya and Uganda
Population mobility is associated with higher-risk sexual behaviors in sub-Saharan Africa and is a key driver of the HIV epidemic. We conducted a longitudinal cohort study to estimate associations between recent mobility (overnight travel away from home in past six months) or migration (changes of residence over defined geopolitical boundaries) and higher-risk sexual behavior among co-resident couples (240 couples aged ≥ 16) from 12 rural communi…
She mixes her business
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…
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…
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…
A Qualitative Investigation of the Impact of a Livelihood Intervention on Gendered Power and Sexual Risk Behaviors Among HIV-Positive Adults in Rural Kenya
"Wan Kanyakla" (We are together)
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…
Heterosexual HIV-1 transmission after initiation of antiretroviral therapy
Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, India
In Karnataka, India only one-third of HIV-infected pregnant women received antiretroviral prophylaxis at delivery in 2007 through the state government's prevention of parent-to-child HIV transmission (PPTCT) program. The current qualitative study explored the role of HIV-associated stigma as a barrier to access PPTCT services in the rural northern Karnataka district of Bagalkot using in-depth interviews and focus group discussions with HIV-infect…
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…
Conceptual framework for understanding the bidirectional links between food insecurity and HIV/Aids
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-…
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…
Social determinants, lived experiences, and consequences of household food insecurity among persons living with HIV/Aids on the shore of Lake Victoria, Kenya
Food insecurity is a considerable challenge in sub-Saharan Africa, disproportionately affecting persons living with HIV/AIDS. This study investigates the lived experience, determinants, and consequences of food insecurity and hunger among individuals living with HIV/AIDS on the shore of Lake Victoria in Suba District, Kenya. Parallel mixed methods included semi-structured interviews and administration of the Household Food Insecurity Access Scale…
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…
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. …
“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
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 …
Around the Table
The objective of this study was to investigate the relationship among socioeconomic status, social support, and food insecurity in a rural Kenyan island community. A cross-sectional random sample of 111 female heads of households representing 583 household members were surveyed in Mfangano Island, Kenya from August to October 2010 using adaptations of the Household Food Insecurity Access Scale and the Medical Outcomes Study Social Support Survey.…
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…
Medicine (69 obras) · HIV/AIDS Research and Interventions (56 obras) · Adolescent Sexual and Reproductive Health (40 obras) · Environmental health (40 obras) · Family medicine (35 obras) · Sociology (33 obras) · Nursing (31 obras) · Psychology (27 obras) · Public health (27 obras) · Population (26 obras)