Characteristics of HIV infected patients cared for at "academic model for the prevention and treatment of HIV/AIDS" clinics in western Kenya.
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.


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


METHODS
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.


METHODS
Adult patients presenting for care at HIV clinics.


METHODS
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 +/- 197 mm3), 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.


CONCLUSIONS
Patients presenting to two Kenyan HIV clinics were predominantly female, ill and naive to retroviral therapy with substantial differences by clinic site and gender. Behavioural risk factors for HIV/AIDS were common. A thorough understanding of clinical and behavioural characteristics can help target prevention and treatment strategies.
Diero
L O
LO
Department of Medicine, Moi University, Faculty of Health Sciences, P.O. Box 4606, Eldoret, Kenya.
Shaffer
D
D
Kimaiyo
S
S
Siika
A M
AM
Rotich
J K
JK
Smith
F E
FE
Mamlin
J J
JJ
Einterz
R M
RM
Justice
A C
AC
Carter
E J
EJ
Tierney
W M
WM
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000503:physiopathology / Q000517:prevention & control; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007630:Kenya; D008297:Male; D017146:Models, Organizational; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D011635:Public Health Administration; D018570:Risk Assessment; D012307:Risk Factors; D019035:Rural Health Services / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014600:Utilization Review
D019380:Anti-HIV Agents