Decentralization of HIV care and treatment services in Central Province, Kenya: Adult patient characteristics and outcomes Presenting author: William Reidy, PhD Reidy W, Hawken M, Wang C, Koech E, Elul B, and Abrams EJ for the Identifying Optimal Models of HIV Care in Africa: Kenya Consortium
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Decentralization of HIV care and treatment services in Central Province, Kenya:
Decentralization of HIV care and treatment services in Central Province, Kenya: Adult patient characteristics and outcomes. Presenting author: William Reidy , PhD Reidy W, Hawken M, Wang C, Koech E, Elul B, and Abrams EJ - PowerPoint PPT Presentation
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Decentralization of HIV care and treatment services
in Central Province, Kenya: Adult patient characteristics and
outcomesPresenting author: William Reidy, PhD
Reidy W, Hawken M, Wang C, Koech E, Elul B, and Abrams EJ
for the Identifying Optimal Models of HIV Care in Africa: Kenya Consortium
Background: Kenya
• Population: 38.6 million
• Adult HIV prevalence: 6.2%
• Living with HIV: 1.6 million
• Estimated annual number of newly infected: 100,000
• Number died of AIDS-related causes in 2011: 49,126
Background: Decentralization of HIV care in Kenya
• HIV care/ART in Kenya was provided in a small number of secondary health facilities (HF): – District, sub-district, provincial, or
teaching/national referral hospitals• Beginning in 2004, started scaling up HIV
clinics at smaller, primary HF:– Health centers and dispensaries
• Performance of primary HF during scale-up is not well-established
Objective• To compare the performance of
primary and secondary HF in Central Province, Kenya during a period of scale-up: –Patient volume–Patient and facility characteristics–Quality of care–Patient retention
Population and data sources• 37 of 52 government health facilities in
Central Province supported by ICAP at Columbia University via PEPFAR funding – 15 secondary and 22 primary HF
• Included patients enrolled between 2006-10 (N= 26,690)
• Data sources:– HIV care/ART data from patient-level databases
maintained by facility staff– Annual facility survey conducted by ICAP
Key variables and outcomes (1)
• Patient volume– Number of patients enrolled in HIV
care, by year• Patient characteristics
– Gender, age, WHO stage, CD4 count at enrollment and ART initiation
• Facility characteristics– Rural/non-rural, nurse ART provision,
CD4 machine on-site
Key variables and outcomes (2)
• Quality of care– Assessment of ART eligibility
(CD4/WHO), prompt ART initiation• Patient retention
1. Death: Recorded as dead in facility database
2. Loss to follow-up: Not dead, not transferred out, and not attending clinic for >6 months for patients on ART, or >12 month for pre-ART patients