Characteristics of hiv infected patients cared for at “academic model for the prevention and treatment of hiv/aids” clinics in Western Kenya

Abstract

Background: With the new initiatives to treat large numbers of HIV infected individuals in sub- Saharan Africa, policy makers require accurate estimates of the numbers and characteristics of patients likely to seek treatment in these countries. Objective: To describe characteristics of adults receiving care in two Kenyan public HIV clinics.

Design: Cross-sectional cohort analysis of data extracted from an electronic medical records system.

Setting: Academic Model for the Prevention and Treatment of HIV/AIDS (AMPATH) HIV clinics in Kenya's second national referral (urban) hospital and a nearby rural health center. Subjects: Adult patients presenting for care at HIV clinics.

Main outcome measures: Gender and inter-clinic stratified comparisons of demographic, clinical, and treatment data. Results: In the first nineteen months, 790 adults visited the urban clinic and 294 the rural clinic. Mean age was 36±9 (SD) years. Two-thirds were women; a quarter had spouses who had died of acquired immune deficiency syndrome (AIDS). HIV/AIDS behavioural risk factors (multiple sexual partners, rare condom use) and constitutional symptoms (fatigue, weight loss, cough, fever, chills) were common. Rural patients had more symptoms and less prior and current tuberculosis. Men more commonly presented with symptoms than women. The cohort CD4 count was low (223 ± 197mm3), with men having significantly lower CD4 count than women (185 ±175 vs 242 ± 205 p = 0.0007). Eighteen percent had an infiltrate on chest radiograph. Five percent (most often men) had received prior antiretroviral drug therapy, (7% in urban and 1% in rural patients, p = 0.0006). Overall, 393 (36%) received antiretroviral drugs, 89% the combination of lamivudine, stavudine, and nevirapine. Half received prophylaxis for tuberculosis and Pneumocystis jirovecii. Men were sicker and more often received antiretroviral drugs.