http://ir.mu.ac.ke:8080/jspui/handle/123456789/7 2026-09-14T11:58:53Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10506 Title: Determinants of HIV interruption in treatment in Murang’a County, Kenya: a sequential explanatory mixed-methods study Authors: Humphrey, John; Njiru, Moses Muriithi; Ndege, Samson; Diero, Lameck; Owiny, Maurice Abstract: Globally, approximately one-in-four people living with HIV (PLHIV) experiences interrup-tion in treatment (IIT), risking viral rebound, transmission, morbidity, and mortality.Murang’a County reported 82% viral suppression coverage, below Kenya’s 94%. Thisstudy assessed IIT magnitude and determinants using sequential-explanatory mixedmethods across nine high-volume facilities (Jan 2023–Jun 2024). PLHIV missing clinicalappointments by >30 days were compared with those retained using descriptive statis-tics, chi-square, and logistic regression. Among 11,472 PLHIV, 6.5% (742) experienced IIT;50.8% (377) did not return to care. IIT was associated with age 20–24 (aRR =2.02), 25–49years (aRR = 2.27), male (aRR = 1.42), viral non-suppression (aRR = 6.35), invalid viral load(aRR = 9.59), ART duration 6–12 months (aRR = 4.96), and WHO stages 3&4 (aRR = 2.08)(All p < 0.001). Focus group discussions revealed HIV undetectable VL equals untransmit-table knowledge gaps, negative service experiences, transport costs, long waits, fre-quent clinic visits, pill burden, stigma, and prayers replacing ART barriers. PLHIV with IITexperienced prolonged care disengagement, with higher rates among younger PLHIV,men, those with unsuppressed and older VL, early ART, and advanced HIV disease, influenced by individual, healthcare systems, treatment-related, and sociocultural barriers.Strengthening early tracing, differentiated service delivery, longer-acting ART, VL moni-toring adherence, HIV literacy, and stigma reduction is critical to improving retention. 2026-08-01T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10505 Title: How community dialogues influence norm change around female genital mutilation: a mediation analysis from a high- burden Kenyan setting Authors: Matanda, Dennis Juma; Undie, Chi-Chi; Arnott, Claire; Kawai, David; Wanyonyi, Herbert Barasa; Rutto, Viola; Obare, Francis; Muthuri, Stella; Mchenga, Martina Abstract: ntroduction Female genital mutilation (FGM) remains highly prevalent in parts of Kenya, including Narok County, where marriageability expectations and social sanctions continue to sustain the practice. Although community- dialogue interventions are central to strategies to end FGM, evidence on their effects and mechanisms of influence remains limited. Methods We conducted a cross-sectional survey of 2658 respondents (1272 women and 1386 men) aged 15–60 years in Narok County in 2024. The primary exposure was participation in mixed-sex community dialogues with participation in couples-only dialogues as secondary exposure. Outcomes were measured using survey items adapted from established FGM and social norms literature, including a composite index of beliefs favourable to cutting and single-item measures of intention to cut a daughter, perceived marriageability expectations and opposition to FGM. Analyses used generalised estimating equations, predicted probabilities and generalised structural equation models to assess mediation pathways. Results Participation in community dialogues was associated with more progressive norms, including lower odds of endorsing pro-cutting beliefs (adjusted OR (aOR) 0.61, 95% CI 0.48 to 0.76), intending to cut a daughter (aOR 0.49, 95% CI 0.37 to 0.64) and perceiving uncut girls as unmarriageable (aOR 0.53, 95% CI 0.43 to 0.66), and higher odds of opposing FGM (aOR 2.39, 95% CI 1.84 to 3.11). Couples-only dialogues had smaller and less consistent associations. Predicted probabilities indicated substantial positive associations among participants exposed to community dialogues alone or combined with couples’ sessions. Mediation analysis showed that 88% of the effect of community dialogues on opposition to FGM indirectly linked through shifts in pro-cutting beliefs, intentions to cut and marriageability expectations, with intentions representing the strongest linkages. Conclusion Community dialogues are strongly associated with shifts in the social expectations and intentions that underpin FGM in a high-burden Kenyan context. These findings provide support for dialogue- centred strategies to eliminate FGM. Beliefs, intentions and marriageability norms are key intermediate indicators for monitoring normative change 2026-02-01T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10504 Title: Masculinity-informed therapeutic discussions: strengthening father engagement and family mental health systems Authors: Giusto, Ali; Johnson, Savannah; Jaguga, Florence; Korir, Mercy; Rono, Wilter; Gonzalez, Juan Carlos; Aburi, Dan; Mania, Winnie Abstract: Objective: Men underuse mental health services in part because of masculine norms. Few interventions focus on masculinity in therapeutic contexts, especially in low- and middle-income countries. This study analyzed transcripts from masculinity-focused therapeutic sessions with fathers in Kenya to explore masculine norms and intersections with the therapeutic process. Methods: The study examined transcripts from fathers (N=9) who participated in a pilot trial of LEAD (Learn, Engage, Act, Dedicate), a five-session father-focused intervention addressing alcohol use, depression, and family engagement in Kenya. Applied thematic content analysis was conducted to explore themes of masculinity, fatherhood, and facilitators or barriers to clinical processes guided by the gender role strain theory and motivational interviewing research. Results: Fathers described four core scripts shaping masculine identity: financial provision, intergenerational models of authority and alcohol use, fatherhood as an earned identity, and emotional suppression. Facilitators of engagement (e.g., openness) that emerged in transcripts included peer-father counselors’ shared identity, masculinity-aligned affirmations, structured reflection that seemed to create emotional safety, and reframing of vulnerability as a strength. Counselors flexibly balanced fidelity with responsiveness, pausing manual content to support fathers’ processing of grief and trauma. These processes appeared to scaffold change talk, values clarification, and redefinition of masculine identity, aligning with documented reductions in alcohol use, depression, and family conflict from the original pilot trial. Conclusions: The findings demonstrate how masculinity-informed discussions can function as intervention and engagement strategies. The results suggest practical strategies for adapting evidence-based treatments to better engage men globally and in family-focused settings. 2026-01-01T00:00:00Z http://ir.mu.ac.ke:8080/jspui/handle/123456789/10503 Title: Adapting a substance use screening and brief intervention for peer-delivery and for youth in Kenya Authors: Jaguga, Florence; Ott, Mary A.; Kwobah, Edith Kamaru; Apondi, Edith; Giusto, Ali; Barasa, Julius; Kosgei, Gilliane; Rono, Wilter; Korir, Mercy; Puffer, Eve S. Abstract: Background Substance use is a major problem among youth in sub-Saharan Africa, yet interventions that address this problem are scarce within the region. Screening and brief intervention is a cost-effective, efficacious, and easy to scale public health approach to addressing substance use problems. We conducted a pilot study to evaluate the feasibility of implementing a peer delivered screening and brief intervention program for youth in Kenya. The goal of this paper is to report on the process of adapting the Alcohol Smoking and Substance Involvement Screening Test for Youth-linked Brief Intervention (ASSIST-Y-linked BI) program for peer delivery and for the Kenyan context prior to the pilot. Methods The adaptation process was led by a multi-disciplinary team comprised of psychiatrists, pediatricians, and psychologists. We utilized the ADAPT-ITT framework to adapt the ASSIST-Y-linked BI. The ADAPT-ITT framework consists of 8 phases including Assessment, Decision making, Adaptation, Production, Topical Experts, Integration, Training, and Testing the evidence-based intervention. Here, we report on phases 1–7 of the framework. The results of the pilot testing will be out in 2023. Results Overall, we made surface level adaptations to the ASSIST-Y-linked BI program such as simplifying the language to enhance understandability. We maintained the core components of the program i.e., Feedback, Responsibility, Advice, Menu of Options, Empathy, Self-efficacy (FRAMES). Conclusions Our paper provides information which other stakeholders planning to implement the ASSIST-Y-linked BI for youth in sub-Saharan Africa, could use to adapt the intervention. 2023-01-01T00:00:00Z