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The adult population impact of HIV care and antiretroviral therapy in a resource poor setting, 2003-2008.
- Source :
-
AIDS (London, England) [AIDS] 2012 Jul 31; Vol. 26 (12), pp. 1545-54. - Publication Year :
- 2012
-
Abstract
- Objective: To describe the population uptake of HIV care including antiretroviral therapy (ART) and its impact on adult mortality in a rural area of western Kenya with high HIV prevalence during a period of rapid HIV services scale-up.<br />Design: Adult medical chart data were abstracted at health facilities providing HIV care/ART to residents of a Health and Demographic Surveillance System (HDSS) and linked with HDSS demographic and mortality data.<br />Methods: We evaluated secular trends in patient characteristics across enrollment years and estimated proportions of HIV-positive adult residents receiving care. We evaluated adult (18-64 years) population mortality trends using verbal autopsy findings.<br />Results: From 2003 to 2008, 5421 HDSS-resident adults enrolled in HIV care; 61.4% (n=3331) were linked to HDSS follow-up data. As the number of facilities expanded from 1 (2003) to 17 (2008), receipt of HIV services by HIV-positive residents increased from less than 1 to 29.5%, and ART coverage reached 64.0% of adults with CD4 cell count less than 250 cells/μl. The proportion of patients with WHO stage 4 at enrollment decreased from 20.4 to 1.9%, and CD4 cell count testing at enrollment increased from 1.0 to 53.4%. Population-level mortality rates for adults declined 34% for all causes, 26% for AIDS/tuberculosis, and 47% for other infectious diseases; noninfectious disease mortality rates remained constant.<br />Conclusion: The initial years of rapid HIV service expansion coincided with a drop in adult mortality by a third. Continued expansion of population access to HIV clinical services, including ART, and program quality improvements will be necessary to achieve further progress in reducing HIV-related morbidity and mortality.
- Subjects :
- Acquired Immunodeficiency Syndrome mortality
Adult
Autopsy
CD4 Lymphocyte Count
Communicable Diseases mortality
Female
Humans
Kenya epidemiology
Male
Middle Aged
Rural Health
Tuberculosis mortality
Anti-HIV Agents therapeutic use
Delivery of Health Care statistics & numerical data
HIV Infections drug therapy
HIV Infections mortality
Mortality trends
Patient Acceptance of Health Care statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1473-5571
- Volume :
- 26
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- AIDS (London, England)
- Publication Type :
- Academic Journal
- Accession number :
- 22441254
- Full Text :
- https://doi.org/10.1097/QAD.0b013e328353b7b9