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Summary

Nearly 40 years after HIV/AIDS was first recognized, it continues to present challenges to effective measurement and control.  The incidence of new HIV infections and deaths are important measures of epidemic trends, while the proportion of persons living with HIV that know their status and are on treatment are important for monitoring progress towards control of the HIV pandemic.

In this thesis, Peter Young showed there were significant increases in coverage of HIV treatment in Kenya between 2007–2012, though with evidence of increasing socioeconomic disparities.  The thesis also showed that new HIV infections fell significantly in the highest-prevalence region of western Kenya from 2011–2016, as key programs scaled up, including voluntary medical male circumcision and antiretroviral treatment. The thesis also identified new, lower-cost ways of improving estimates of how many people know their HIV status and are on treatment by looking at the quantity of the virus in the blood of HIV-infected survey participants. Finally, through studies in the largest mortuaries in Nairobi and Kisumu, Kenya, the thesis reports that nearly one in six of all adult deaths in Nairobi were attributable to HIV, while nearly a quarter of all deaths in Kisumu were due to HIV/AIDS.  Finally, the thesis provides recommendations for improving measurement of HIV so that countries can gather relevant data to scale effective HIV/AIDS programs.