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

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Health Care Utilization, Tuberculosisand Preventive Services among HIVinfectedAdults11.1 KEY FINDINGSHealth care utilization• HIV-infected adults aware of their status were significantly more likely toaccess outpatient care in the four weeks before the survey compared to HIVinfectedadults unaware of their status (51.2%% and 22.9%, respectively).• HIV-infected adults aware of their status were significantly more likely to behospitalised in the six months prior to the survey compared to HIV-infectedadults unaware of their status (14.1% and 3.2%, respectively).Tuberculosis (TB)• HIV-infected adults were significantly more likely to have ever been diagnosedwith TB compared to HIV-uninfected adults (9.6% and 1.8%, respectively).• The majority of adults who had ever been diagnosed with TB had completed TBtreatment (84.1% and 55.8%, respectively). These estimates did not differbetween HIV-infected and HIV-uninfected adults.• Among HIV-infected adults who had ever been diagnosed with TB, 61.1% wereaware of their HIV infection, compared to only 11.1% among those who had not.Preventive services• Almost half (45.5%) of HIV-infected adults lived in a household that treated itsmain source of drinking water, most commonly by boiling. There were nodifferences between those aware or unaware of their HIV infection.• Among all HIV-infected adults, 45.3% slept under a mosquito net the nightbefore the survey and 20.2% slept under a treated net. There were nodifferences between those aware or unaware of their HIV infection.• Among HIV-infected adults aware of their HIV infection, 36.4% were takingmulti-vitamins.11.2 INTRODUCTIONWithout appropriate care and treatment, the vast majority of adults with HIV will sufferKAIS 2007 196
debilitating illness leading to hospitalisation, loss of income, disruptions to their family life andeventually death. Today, HIV/AIDS does not need to be an acute, debilitating disease. It ispossible to delay or prevent disease and improve the quality of life for persons with HIV througha comprehensive approach to health care that emphasizes a continuum of support, extendingbeyond just antiretroviral therapy (see Chapter 10 in this report for findings on cotrimoxazole andARV usage). HIV‐infected adults need access to health care facilities and an array of preventiveservices. In this chapter, we report on aspects of HIV care for infected adults, including use ofoutpatient and inpatient services; co‐infection with tuberculosis (TB); and uptake of preventionpractices, including treatment of drinking water, mosquito nets and nutritional supplements.Appendix B.11 provides sample sizes and 95% confidence intervals for estimates presented in thischapter. Throughout the chapter, the term significant indicates a chi‐square p‐value less than 0.05;marginally significant indicates a p‐value between 0.05 and 0.10, inclusive; and not significantindicates a p‐value greater than 0.10.Population estimates reported in this chapter were calculated based on the 2007 projected populationby province, age and sex reported in the Revised Population Projections for Kenya 2000‐2020, KenyaNational Bureau of Statistics (August 2006).Weighted national estimates for selected indicators from the2007 KAIS were used in these calculations. Detailed methods used for calculating population estimatesare described in Appendix A.11.3 HEALTH CARE UTILIZATIONIn the following analyses, we report on estimated outpatient service use and inpatient admissionsfor HIV‐infected adults. These data are useful in understanding patterns in utilization, especiallydifferences in use between HIV‐infected persons who are aware and those who are unaware oftheir HIV status. Health facility encounters among HIV‐infected persons unaware of their HIVinfection serve as opportunities for diagnosis of HIV; utilization among those aware of their HIVinfection can help plan for growing burden on the system as increasing numbers of peoplebecome aware of their HIV status. Data on uptake of outpatient services and hospitalisations werecollected at the household level; that is, the head of the household who answered the householdquestionnaire reported on health care visits for all members of the household listed.KAIS 2007 197
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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
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7.5. Perceived risk of HIV infectio
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Figure 7.5c Reasons given for havin
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7.6. Attitudes toward women’s rol
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who had never been tested for HIV o
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8.2 INTRODUCTIONIn the absence of i
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8.3 ANTENATAL CLINIC ATTENDANCE, 20
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8.4 KNOWLEDGE OF MOTHER-TO-CHILD TR
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The analysis in this section consid
Page 146 and 147: Figure 8.5b Women aged 15-49 years
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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 and 180: 9.6 Gaps and unmet needs• HIV pre
Page 181 and 182: The Ministry of Medical Services re
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: 10.5 GAPS AND UNMET NEEDS• The es
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
Page 227 and 228: 12.7 Gaps and unmet needs• Increa
Page 229 and 230: also at substantially elevated risk
Page 231 and 232: Figure 13.3b Prevalence of syphilis
Page 233 and 234: Figure 13.3d Prevalence of syphilis
Page 235 and 236: Figure 13.3f Prevalence of syphilis
Page 237 and 238: Figure 13.4b Prevalence of syphilis
Page 239 and 240: 13.6 GAPS AND UNMET NEEDS• Patien
Page 241 and 242: Household Characteristics andImpact
Page 243 and 244: Figure 14.3a Sex of head of househo
Page 245 and 246: 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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