Program Background

The effect of changes in The effect of changes in Kenya HIV guidelines on Kenya HIV guidelines on proportion of patients on proportion of patients on

ART and patient ART and patient characteristics at characteristics at

initiation in Lumumba initiation in Lumumba Health Centre, Western Health Centre, Western

Kenya.Kenya.  

Oyaro P1, Armes MN1,2, Dillabaugh L1,2, Shade S2, Cohen CR1,2, Bukusi EA1,2

UON Collaborative Meeting21st to 25th January 2013

1. Family AIDS Care and Education Services (FACES), Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya

2. Departments of Obstetrics, Gynecology and Reproductive Sciences; Pediatrics; Medicine; University of California San Francisco, San Francisco, CA, USA

Program BackgroundProgram Background

Family AIDS Care and Education Services (FACES)

• Family-focused program• Collaboration between Kenya Medical Research

Institute (KEMRI) and University of California, San Francisco (UCSF)

• Operational since September 2004 in Nyanza and Nairobi

FACES program areas • Provider Initiated Testing and Counseling (PITC)• Prevention of Mother to Child Transmission

(PMTCT)• HIV Care and Treatment• Voluntary Male Medical Circumcision (VMMC)

BackgroundBackground

The Kenya National Guidelines on Antiretroviral Therapy (ART), guided by WHO guidelines, has rapidly evolved

Latest changes effected in September 2010

• CD4 cut off of ≤250 cells/uL increased to ≤350 cells/uL

• WHO stage 4 broadened to both stage 3 and 4

When to start When to start consortiumconsortium

Lancet,2009Lancet,2009

IntroductionIntroduction

Study ObjectiveStudy Objective

To determine the effect of the new guidelines on the proportion of patients initiating ART at a large clinic in Western Kenya

Lumumba HIV clinicLumumba HIV clinic

Study MethodsStudy Methods Retrospective cohort study at

Lumumba Health Centre, Kisumu• Adult patients ≥ 18 years• Initiated on HAART prior to (October

2009 - April 2010) and after change in guideline (October 2010 - April 2011)

• Each patient followed up for one year• Clinical outcomes followed for one year

Data abstraction from Open MRS and patient charts - demographic and clinical data

Chi-square and Wilcoxon-Mann-Whitney tests conducted for analysis

ResultsResults

Variables Pre Post P-value

Proportion initiating HAART 13.2% (N=866)

25.3% (N=846)

P<0.001

Median 6 months CD4 increase (cells/uL)

135 151 P<0.001

Median 12 months CD4 increase (cells/uL)

174 154 P<0.001

LTFU (≥ 3 months after the appointment)

23.7% 14.1 % P= 0.003

Results Results No difference in Median age in the

two groups 32.5 vs 32 years

WHO Stage 2 was more common before guidelines changed (34.2%)

WHO Stage 1 was the most common stage following guideline change (39%; p=0.03)

Conclusion Conclusion The latest change in the guidelines led to:A higher proportion of the newly enrolled patients initiated on ART

Initiation at earlier/healthier WHO stage

Greater increase in median CD4 cell count at 6-months

Interestingly, there were fewer lost to follow- up patients with new guidelines

AcknowledgementsAcknowledgements PEPFAR

CDC

MoH staff

FACES Staff

UON meeting organizers

End.End.