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

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