AIDS Indicator Survey 2007 - Kenya

Abstract
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The 2007 Kenya AIDS Indicator Survey (KAIS) is Kenya's first survey of its type and provides comprehensive information on HIV and other sexually transmitted infections (STIs). These data provide the information needed for advocacy and for planning appropriate interventions for HIV prevention, treatment and care. The 2007 KAIS builds upon previous national-level HIV estimates from the first population-based survey with HIV testing, the 2003 Kenya Demographic and Health Survey (KDHS); this allows us to compare prevalence estimates and important behavioural indicators between 2003 and 2007.

Geographic coverage
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The survey covered all the districts in Kenya. The data representativeness are at the following levels: national, urban/rural, provincial, district.

Analysis unit
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Person aged 15-64

Universe
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All women and men aged 15-64 years in selected households who were either usual residents or visitors present the night before the survey were eligible to participate in the individual interview and blood draw, provided they gave informed consent. For minors aged 15-17 years, parental consent and minor assent were both required for participation. Participants could consent to the interview and blood draw or to the interview alone. The inclusion criteria may have captured non-Kenyans living as usual residents or visitors in a sampled household. Military personnel and the institutionalized population (e.g. imprisoned) are typically not captured in household-based surveys, but may have been included in the 2007 KAIS if at home during the survey.

Kind of data
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Sample survey data [ssd]

Sampling procedure
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Administratively, Kenya is divided into eight provinces. Each province is divided into districts, each district into divisions, each division into locations, each location into sub-locations, and each sublocation into villages. For the 1999 Population and Household Census, the Kenya National Bureau of Statistics (KNBS) delineated sub-locations into small units called Enumeration Areas (EAs) that constituted a village, a part of a village, or a combination of villages. The primary sampling unit for Kenya's master sampling frame, and for the 2007 KAIS, is a cluster, which is constituted as one or more EAs, with an average of 100 households per cluster. The master sampling frame for the 2007 KAIS was the National Sample Survey and Evaluation Programme IV (NASSEP IV) created and maintained by KNBS. The NASSEP IV frame was developed in 2002 based on the 1999 Census. The frame has 1800 clusters, comprised of 1,260 rural and 540 urban clusters. Of these, 294 (23%) rural and 121 (22%) urban clusters were selected for KAIS.

The 2007 KAIS was conducted among a representative sample of households selected from all eight provinces in the country, covering both rural and urban areas. A household was defined as a person or group of people related or unrelated to each other who live together in the same dwelling unit or compound (a group of dwelling units), share similar cooking arrangements, and identify the same person as the head of household. The household questionnaire was administered to consenting heads of sampled, occupied households. All women and men aged 15-64 years in selected households who were either usual residents or visitors present the night before the survey were eligible to participate in the individual interview and blood draw, provided they gave informed consent. For minors aged 15-17 years, parental consent and minor assent were both required for participation. Participants could consent to the interview and blood draw or to the interview alone. The inclusion criteria may have captured non-Kenyans living as usual residents or visitors in a sampled household. Military personnel and the institutionalized population (e.g. imprisoned) are typically not captured in household-based surveys, but may have been included in the 2007 KAIS if at home during the survey.

The overall design for the 2007 KAIS was a stratified, two-stage cluster sample for comparability to the 2003 KDHS. The first stage involved selecting 415 clusters from NASSEP IV and the second stage involved the selection of households per cluster with equal probability of selection in the rural-urban strata within each district. The target of the 2007 KAIS sample was to obtain approximately 9,000 completed household interviews. Based on the level of household nonresponse reported in the 2003 KDHS (13.2% of selected households), 10,375 households in 415 clusters were selected for potential participation in the 2007 KAIS. Table 1.4 shows the provincial distribution of households and clusters originally sampled for the 2007 KAIS.

Sampling deviation
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Of the original 415 clusters, 402 were accessed and surveyed. Thirteen clusters were inaccessible due to impassable roads or tenuous security situations. All reported estimates and design weights for households, individual interviews, and blood draws are based on data from the 402 clusters.

Mode of data collection
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Face-to-face [f2f]

Research instrument
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Two questionnaires were used: a household questionnaire and an individual questionnaire. The content of the questionnaires was adapted from standard AIDS Indicator Survey questionnaires developed by ORC Macro, the 2003 KDHS HIV Module and previous surveys conducted in Africa. Various stakeholders in NACC, the National AIDS and STI Control Programme (NASCOP) and other HIV/AIDS organizations working in Kenya met to determine the key HIV program information needs and gaps. The KAIS Technical Working Group (TWG) modified existing questions and designed new questions to reflect current and emerging issues in HIV/AIDS in the country. The final questionnaires were translated from English into Kiswahili and 11 vernacular languages and back-translated into English to ensure accuracy. The questionnaires were further refined after a pilot study prior to distribution of the final versions to field staff.

The household questionnaire gathered basic information from the head of the household on usual members and visitors in the household, including age, sex, education, relationship to the head of household, and orphanhood among children. Information was collected on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, property ownership, and mosquito nets. Heads of household were also asked whether the household had received specific types of care and support in the 12 months prior to the survey for any chronically ill adults, any household members who died, and any orphans and vulnerable children (OVC). The household questionnaire was also used to record the respondents’ consent for blood collection and testing.

The individual questionnaire collected information from eligible women and men aged 15-64 years on basic demographic characteristics, marriage, sexual activity, fertility, and family planning. In addition, the tool included questions regarding HIV and STI knowledge, attitudes and behaviours, HIV testing, HIV care and treatment uptake, and other health issues, such as tuberculosis, blood donation and medical injections.

Cleaning operations
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Data processing included a number of steps to prepare data collected in the field for analysis. The initial steps included editing questionnaires, both in the field and at KNBS, and double-data entry of all questionnaire responses to minimise errors. Data were entered using Census and Survey Processing System (CSPro) version 3.3.3 Once all survey responses were transferred to electronic format, the next step was to ensure full concordance between the two data entry databases, using paper questionnaires to resolve any discrepancies in transcription. A series of internal consistency and range checks helped to identify any illogical responses and to verify that responses adhered to skip patterns in the questionnaire. Data validation programs for data cleaning were written in Stata version 8.04 and corrections were entered directly in CSPro at KNBS.

A concurrent process of cleaning the raw laboratory data was conducted at the NHRL. The final, cleaned questionnaire database at KNBS was merged with the laboratory results database at the NHRL using unique survey identification numbers to ensure accurate matches (>99.9% of identification numbers were matched). After successfully merging the questionnaire and laboratory results databases, cluster and household identification numbers were serialized from 1-402 and from 1-25, respectively. Original cluster and household numbers, barcodes, and individual survey identification numbers were stripped from the database prior to weighting and analysis to ensure anonymity of survey participants.

Response rate
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Overall, participation rates in the 2007 KAIS were high. We calculated household response rate as the number of households consenting to the household interview divided by the total number of sampled households that were located and occupied. The individual interview response rate was calculated as the number of individuals who completed interviews divided by the number of individuals eligible for the individual interview based on the household census. Only those participating in the individual interview were eligible to participate in the blood draw. We calculated blood draw coverage as the number of blood draws divided by the number of all individuals eligible for the individual interview; the blood draw response rate reflects the number of successful blood draws divided by the number of individuals who completed individual interviews.

摘要
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2007年肯尼亚艾滋病指标调查（KAIS）是肯尼亚首次进行此类调查，提供了关于艾滋病和其它性传播感染（STIs）的全面信息。这些数据为倡导和规划适当的艾滋病预防、治疗和干预措施提供了所需信息。2007年KAIS在2003年肯尼亚人口与健康调查（KDHS）的基础上进行，该调查是首个进行艾滋病检测的人口基础调查，从而允许我们比较2003年和2007年之间的患病率和重要行为指标。
地理覆盖范围
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调查覆盖了肯尼亚的所有地区。数据代表性包括以下层级：全国、城市/农村、省级、地区。
分析单元
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15-64岁的人口
总体
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所有年龄在15-64岁之间，在所选家庭中居住或前一夜在场的妇女和男子，无论是常住居民还是访客，只要他们提供了知情同意，均有资格参加个体访谈和血液抽取。对于15-17岁的未成年人，需要父母同意和未成年人同意才能参与。参与者可以同意参加访谈和血液抽取，或仅同意参加访谈。可能包含的纳入标准可能捕捉到了在抽样家庭中作为常住居民或访客生活的非肯尼亚人。军事人员和机构化人口（例如囚犯）通常不在基于家庭的调查中被捕捉，但在2007年KAIS中，如果他们在调查期间在家，可能会被包括在内。
数据类型
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样本调查数据 [ssd]
抽样程序
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在行政上，肯尼亚分为八个省。每个省分为地区，每个地区分为分区，每个分区分为地点，每个地点分为次地点，每个次地点分为村庄。对于1999年人口和家庭普查，肯尼亚国家统计局（KNBS）将次地点划分为称为普查区（EAs）的小单位，这些单位构成了一个村庄、村庄的一部分或村庄的组合。肯尼亚主抽样框架的基本抽样单位，以及2007年KAIS，是一个集群，由一个或多个EAs组成，每个集群平均有100户人家。2007年KAIS的主抽样框架是由KNBS创建和维护的全国样本调查和评估计划IV（NASSEP IV）。NASSEP IV框架是在2002年基于1999年普查开发的。该框架有1800个集群，由1260个农村和540个城市集群组成。其中，294个（23%）农村和121个（22%）城市集群被选入KAIS。
2007年KAIS在国家的八个省份中选定代表性家庭样本进行调查，覆盖了城市和农村地区。家庭被定义为一起居住在同一住宅单元或院落（一组住宅单元）、有类似的烹饪安排并认同同一人为户主的人或人群。对同意参加的家庭户主进行了家庭问卷的发放。所有年龄在15-64岁之间，在所选家庭中居住或前一夜在场的妇女和男子，无论是常住居民还是访客，只要他们提供了知情同意，均有资格参加个体访谈和血液抽取。对于15-17岁的未成年人，需要父母同意和未成年人同意才能参与。参与者可以同意参加访谈和血液抽取，或仅同意参加访谈。可能包含的纳入标准可能捕捉到了在抽样家庭中作为常住居民或访客生活的非肯尼亚人。军事人员和机构化人口（例如囚犯）通常不在基于家庭的调查中被捕捉，但在2007年KAIS中，如果他们在调查期间在家，可能会被包括在内。
2007年KAIS的整体设计是一个分层两阶段集群样本，以便与2003年KDHS进行比较。第一阶段涉及从NASSEP IV中选择415个集群，第二阶段涉及在每个地区的城乡层内以相等的概率选择每个集群的家庭。2007年KAIS样本的目标是获取大约9,000份完成的家庭访谈。根据2003年KDHS中报告的家庭非响应率（13.2%的选定家庭），在415个集群中选定了10,375个家庭参与2007年KAIS。表1.4显示了2007年KAIS最初采样的家庭和集群的省级分布。
抽样偏差
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原始的415个集群中，有402个集群被访问并进行了调查。由于道路无法通行或安全状况不稳定，有13个集群无法访问。所有报告的估计值和设计权重均基于402个集群的数据。
数据收集方式
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面对面 [f2f]
研究工具
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使用了两个问卷：家庭问卷和个体问卷。问卷内容改编自ORC Macro开发的标准化艾滋病指标调查问卷、2003年KDHS艾滋病模块和非洲之前进行的其他调查。NACC、国家艾滋病和性传播疾病控制计划（NASCOP）及其他在肯尼亚工作的HIV/AIDS组织的各种利益相关者聚集一堂，确定关键的艾滋病项目信息需求和差距。KAIS技术工作组（TWG）修改了现有问题并设计了新问题，以反映该国HIV/AIDS领域的当前和新兴问题。最终问卷从英语翻译成斯瓦希里语和11种地方语言，并回译成英语以确保准确性。在将最终版本分发给现场工作人员之前，对问卷进行了试点研究，并进行进一步细化。
家庭问卷从家庭户主那里收集了有关家庭常规成员和访客的基本信息，包括年龄、性别、教育、与户主的亲属关系以及儿童中的孤儿状况。收集了有关家庭住宅单元特征的信息，例如水源、厕所设施类型、房屋地板使用的材料、财产所有权和蚊帐。户主还被问及家庭是否在调查前的12个月内为任何慢性病患者、任何家庭成员的死亡或任何孤儿和脆弱儿童（OVC）提供了特定的护理和支持。家庭问卷还用于记录受访者同意血液采集和检测。
个体问卷收集了符合条件的15-64岁妇女和男子关于基本人口统计特征、婚姻、性行为、生育和家庭规划的信息。此外，该工具还包括关于HIV和STI知识、态度和行为、HIV检测、HIV护理和治疗接受情况以及其他健康问题（如肺结核、献血和医疗注射）的问题。
数据清理操作
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数据处理包括多个步骤，以准备分析在野外收集的数据。初始步骤包括在野外和KNBS对问卷进行编辑，以及将所有问卷响应的双倍数据输入以最大限度地减少错误。使用人口和住户普查处理系统（CSPro）版本3.3.3进行数据输入。一旦所有调查响应都转移到电子格式，下一步就是确保两个数据输入数据库之间完全一致，使用纸质问卷来解决转录中的任何差异。一系列内部一致性和范围检查有助于识别任何不合逻辑的响应，并验证响应是否符合问卷中的跳转模式。用于数据清理的数据验证程序是用Stata版本8.04编写的，并在KNBS的CSPro中直接输入更正。
在NHRL进行了清理原始实验室数据的并行过程。KNBS的最终清理问卷数据库与NHRL的实验室结果数据库合并，使用唯一的调查识别号码以确保准确的匹配（>99.9%的识别号码已匹配）。在成功合并问卷和实验室结果数据库后，集群和家庭识别号码分别从1-402和1-25进行序列化。在加权和分析之前，从数据库中删除了原始集群和家庭号码、条形码和个体调查识别号码，以确保调查参与者的匿名性。
响应率
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总体而言，2007年KAIS的参与率很高。我们计算的家庭响应率是同意家庭访谈的家庭数量除以已定位和居住的选定家庭总数。个体访谈响应率是完成访谈的个人数量除以根据家庭普查有资格进行个体访谈的个人数量。只有参加个体访谈的人才有资格参加血液抽取。我们计算血液抽取覆盖率为血液抽取数量除以所有有资格进行个体访谈的个人数量；血液抽取响应率反映了成功血液抽取的数量除以完成个体访谈的个人数量。