The adult population impact of HIV care and antiretroviral therapy in a resource poor setting, 2003-2008

被引:34
作者
Gargano, Julia W. [1 ,2 ]
Laserson, Kayla [3 ]
Muttai, Hellen [4 ]
Odhiambo, Frank [3 ]
Orimba, Vincent [3 ]
Adamu-Zeh, Mirabelle [3 ]
Williamson, John [4 ]
Sewe, Maquins [3 ]
Nyabiage, Lennah [5 ]
Owuor, Karen [3 ]
Broz, Dita [1 ,4 ]
Marston, Barbara [4 ]
Ackers, Marta [4 ]
机构
[1] Ctr Dis Control & Prevent, Epidem Intelligence Serv, Atlanta, GA 30333 USA
[2] Ctr Dis Control & Prevent, Natl Ctr Emerging & Zoonot Infect Dis, Atlanta, GA 30333 USA
[3] CDC Res & Publ Hlth Collaborat, Kenya Med Res Inst KEMRI, Nyanza, Kenya
[4] Ctr Dis Control & Prevent, Ctr Global Hlth, Atlanta, GA 30333 USA
[5] Kenya Minist Hlth, Nairobi, Kenya
关键词
AIDS/HIV; antiretroviral therapy; mortality; population surveillance; HUMAN-IMMUNODEFICIENCY-VIRUS; RURAL WESTERN KENYA; VERBAL AUTOPSY; TRIMETHOPRIM-SULFAMETHOXAZOLE; COTRIMOXAZOLE PROPHYLAXIS; MORTALITY; MORBIDITY; DEATHS; HEALTH; TUBERCULOSIS;
D O I
10.1097/QAD.0b013e328353b7b9
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
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. 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. 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. 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/mu l. 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. 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. (C) 2012 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins
引用
收藏
页码:1545 / 1554
页数:10
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