KAIS 2007 1 - Kenya National AIDS & STI Control Programme ...

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Care and Treatment of AdultsInfected with HIV10.1 KEY FINDINGS• Nationwide, 12.1% of HIV-infected adults were taking cotrimoxazole or Septrindaily to prevent infections; more than 1.25 million HIV-infected people were inneed of cotrimoxazole.• Overall, 40.5% of ARV-eligible adults were taking ARVs. At the time of thesurvey, an estimated 214,000 people were eligible for daily ARVs but not takingany.• Among those who knew they were infected with HIV, access to care andtreatment was high: 76.1% were taking cotrimoxazole daily, and 91.6% of ARVeligibleadults were taking ARVs.10.2 INTRODUCTIONDaily cotrimoxazole and treatment with antiretroviral (ARV) medication, along with other HIVspecificcare (see Chapter 11 of this report), prevent illness and disease and dramatically prolongthe lives of people with HIV. In one prospective study, cotrimoxazole and ARV therapy combinedwere associated with a 92.0% reduction in mortality among HIV‐infected participants after 16weeks of follow‐up compared to when these participants were not taking either therapy. 15 TheMinistry of Medical Services recommends daily cotrimoxazole or a similar antibiotic, for everyonewith HIV, regardless of CD4 count or disease stage. This recommendation is in line with WorldHealth Organization (WHO) guidelines and is supported by currently available evidence.ARVs target HIV at different sites to reduce or stop replication of the virus. They are the mosteffective intervention for prolonging survival and improving quality of life for people with HIV.Although the optimal time to begin ARVs remains unresolved, beginning treatment in patientswith severe immunosuppression and/or symptoms indicative of immune damage is beneficial.15Mermin J, Were W, Ekwaru JP, Moore D, Downing R, Behumbiize P, Lule JR, Coutinho A, Tappero J, Bunnell R.Mortality in HIV‐infected Ugandan adults receiving antiretroviral treatment and survival of their HIV‐un‐infectedchildren: a prospective study. Lancet 2008; 371: 352‐59.KAIS 2007 180
The Ministry of Medical Services recommends that adults with advanced HIV disease—definedas patients with WHO stage I or II disease (see Data in Context: WHO Clinical Staging) with aCD4 count of less than 250 cells/μL—should be started on ARV therapy. 2 These guidelines alsostate that anyone with WHO stage III disease with a CD4 cell count of less than 350 cells/μL orWHO stage IV disease regardless of CD4 count should begin treatment with ARVs. In some areasof Kenya, CD4 testing is not available; in these settings all patients with WHO stages III and IVare eligible to begin ARVs.This chapter examines use of cotrimoxazole and ARVs among HIV‐infected adults. In this report,coverage of care and treatment is defined as the proportion of all HIV‐infected adults who may ormay not have known their status and who reported receiving treatment or a service. Coveragewas greatly influenced by the fact that only 16.4% of HIV‐infected adults knew that they wereinfected (see chapter 4 on HIV testing). Access to care and treatment is defined as the proportionof HIV‐infected adults who knew their status and who reported receiving treatment or a service.Access therefore reflects links to health care facilities.There are a number of reasons why HIV‐infected adults may not take daily cotrimoxazole or whyeligible HIV‐infected adults may not take daily ARVs; some may relate to the health care system,while others relate to the individual. Many have never been tested for HIV and are therefore notaware of their HIV status, which is a significant barrier. Among those aware, some adults may nottake cotrimoxazole or ARVs because they lack knowledge on appropriate use or may be unwillingto take medications because they feel healthy or because they suffered from adverse side effectsfrom medications. Additionally, while these medications should be available, wait times at healthcentres or stigma against HIV may prevent enrollment of HIV‐infected adults in care andtreatment. The 2007 KAIS did not capture reasons for not taking daily cotrimoxazole or ARVs (ifeligible) among those aware of their HIV status.2NASCOP, Kenya National Clinical Manual for ART Providers, 2nd Edition, 2007.KAIS 2007 181
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KAIS 2007 1
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P.O. Box: 9361 Code: 00202 Nairobi,
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KEMRIKNASPKNBSKshLLITNMCHmlμLMOMSM
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KEY FINDINGS: HIV PREVENTION• Amo
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Among HIV‐uninfected women, 71.2%
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Men 5.4 26.3 1.9Total 7.1 35.1 1.8O
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Kenya is also committed to the “T
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Table 1.4 Distribution of sampled c
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1.7 SURVEY IMPLEMENTATIONTrainingIn
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Data processing included a number o
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Characteristic 2003 KDHS 2007 KAISQ
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Figure 1.11 Sampled clusters and el
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Table 1.11c Survey response rates b
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Population estimates reported in th
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2.4 HIV PREVALENCE AMONG YOUTHFigur
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Figure 2.6b HIV prevalence among ru
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2.7 HIV PREVALENCE BY PROVINCEFigur
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Figure 2.7c Estimated number of HIV
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2.9 HIV PREVALENCE BY EDUCATION LEV
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Figure 2.10b HIV prevalence among r
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2.11 HIV PREVALENCE BY TIME AWAY FR
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2.13 MALE CIRCUMCISION AND ASSOCIAT
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Figure 2.13c HIV prevalence among c
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Comparison of HIV Prevalence in the
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3.3 SEXFigure 3.3a HIV prevalence a
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Figure 3.4b. HIV prevalence among m
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3.7 PROVINCEFigure 3.7a HIV prevale
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2003 KDHS 1 2007 KAIS 2Marital stat
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3.10 WEALTH INDEXFigure 3.10a HIV p
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DATA IN CONTEXT: APPROACHES TO HIV
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Figure 4.3c Ever been tested for HI
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Figure 4.3e Ever been tested for HI
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Figure 4.3g Women aged 15-49 years
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Figure 4.4a Time since last HIV tes
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Figure 4.5a Reasons for not testing
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Increasing access to HIV testing wi
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4.7. Gaps and unmet needs• Two‐
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Figure 5.3b Self-reported HIV statu
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This section examines participants
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Figure 5.5a Knowledge of HIV status
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Figure 5.5c Percent of partnerships
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uninfected. A couple was considered
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Figure 5.6c Women and men aged 15-6
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Sexual Partners, Sexual DebutCircum
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Figure 6.3b. HIV prevalence among w
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Figure 6.3d. HIV prevalence among w
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Figure 6.3f. Men aged 15-64 years r
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In this section, “consistent cond
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Figure 6.4c. Marital or cohabiting
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Figure 6.5b. Young women and men ag
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Figure 6.5d. Young women and men ag
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Figure 6.6a. Male circumcision amon
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Figure 6.6d. HIV prevalence among m
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Knowledge, Attitudes and Beliefs ch
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Figure 7.3b. Most common source of
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Figure 7.3c Women and men aged 15-6
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Figure 7.3e Overall scores for 12 q
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Figure 7.3g Women and men aged 15-6
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Figure 7.3i Correct responses to se
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• If a female teacher has the AID
Page 130 and 131: 7.5. Perceived risk of HIV infectio
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Page 134 and 135: 7.6. Attitudes toward women’s rol
Page 136 and 137: who had never been tested for HIV o
Page 138 and 139: 8.2 INTRODUCTIONIn the absence of i
Page 140 and 141: 8.3 ANTENATAL CLINIC ATTENDANCE, 20
Page 142 and 143: 8.4 KNOWLEDGE OF MOTHER-TO-CHILD TR
Page 144 and 145: The analysis in this section consid
Page 146 and 147: Figure 8.5b Women aged 15-49 years
Page 148: • Incorrect communication or unde
Page 151 and 152: 8.8 CURRENTLY PREGNANT WOMEN: HIV T
Page 153 and 154: Among currently pregnant women, 7.1
Page 155 and 156: Among pregnant, HIV‐uninfected wo
Page 157 and 158: Figure 8.11b Desire for a child in
Page 159 and 160: 8.12 CONTRACEPTIVE USEThe next figu
Page 161 and 162: Figure 8.12c Contraceptive use* amo
Page 163 and 164: Blood and Injection Safety chapter
Page 165 and 166: D ATA IN C ONTEXT: N ATIONAL B LOOD
Page 167 and 168: Figure 9.3a Source of blood donatio
Page 169 and 170: Figure 9.3b Source of blood donatio
Page 171 and 172: Figure 9.3d Source of blood donatio
Page 173 and 174: 9.4 Blood transfusionsAlthough the
Page 175 and 176: 10080Injec tionsPillsNo preferenceW
Page 177 and 178: HIV prevalence among adults who rep
Page 179: 9.6 Gaps and unmet needs• HIV pre
Page 183 and 184: 10.3 COTRIMOXAZOLE PROPHYLAXIS FOR
Page 185 and 186: Coverage also varied significantly
Page 187 and 188: 10.4 ARV ELIGIBILITY, COVERAGE AND
Page 189 and 190: ARV coverage was estimated by takin
Page 191 and 192: Figure 10.4b ARV coverage among HIV
Page 193 and 194: DATA IN CONTEXTEstimates of HIV-inf
Page 195 and 196: 10.5 GAPS AND UNMET NEEDS• The es
Page 197 and 198: debilitating illness leading to hos
Page 199 and 200: Among HIV‐infected adults (83.6%
Page 201 and 202: Figure 11.3d HIV-infected adults ag
Page 203 and 204: Figure 11.4b HIV-infected adults ag
Page 205 and 206: Figure 11.4d HIV-infected adults ag
Page 207 and 208: DATA IN CONTEXTHIV Basic Care Packa
Page 209 and 210: Figure 11.5b HIV-infected adults ag
Page 211 and 212: Figure 11.6b Percent of HIV-infecte
Page 213 and 214: 11.8 GAPS AND UNMET NEEDS• Counse
Page 215 and 216: 12.3 HSV-2 prevalenceHSV‐2 preval
Page 217 and 218: 807071.0WomenMen64.3HSV-2 Prevalenc
Page 219 and 220: Figure 12.3d HSV-2 prevalence among
Page 221 and 222: Figure 12.4b HSV-2 prevalence among
Page 223 and 224: Figure 12.5a HIV prevalence by HSV-
Page 225 and 226: Figure 12.6b Condom use during last
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Figure 13.3b Prevalence of syphilis
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Figure 13.3d Prevalence of syphilis
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Figure 13.3f Prevalence of syphilis
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Figure 13.4b Prevalence of syphilis
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13.6 GAPS AND UNMET NEEDS• Patien
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Household Characteristics andImpact
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Figure 14.3a Sex of head of househo
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Figure 14.3d Household population,
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14.5 PREVALENCE OF HIV-AFFECTED HOU
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Figure 14.5c HIV-affected household
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social and economic conditions of h
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households used chemical disinfecta
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14.7 HOUSEHOLD OWNERSHIP OF MOSQUIT
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Figure 14.7b HIV-affected and HIV-u
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Table 14.7b Source of bednets among
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Overall, 52.3% percent of children
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14.9 CARE AND SUPPORT FOR ORPHANS A
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For consistency with other populati
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Returning Test Results15.1 KEY FIND
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Figure 15.3b. Participants aged 15-
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Figure 15.3d. Participants aged 15-
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Figure 15.3f. Participants aged 15-
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15.4 RETURNING TO RECEIVE TEST RESU
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Figure 15.5 Women aged 15-64 years
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Methods of the 2007 KAISThis Append
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ClustersHouseholdsProvince Rural Ur
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and treatment services and other he
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The KEMRI Ethical Review Committee
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Red top (5 ml)Whole blood collected
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algorithm using two HIV EIAs (Viron
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Figure A5.a. Structure and flow of
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Recruitment and training of results
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observe confidentiality of particip
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Documentation. Results counsellors
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Normalisation of weightsNormalised
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This report presents the results of
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