title: The adult population impact of HIV care and antiretroviral therapy in a resource poor setting, 2003-2008.
abstract: 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.
  
  
  METHODS
  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/μl. 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. igc5@cdc.gov
authors.forename: Julia W
authors.initials: JW
authors.lastname: Gargano
authors.forename: Kayla
authors.initials: K
authors.lastname: Laserson
authors.forename: Hellen
authors.initials: H
authors.lastname: Muttai
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.forename: Vincent
authors.initials: V
authors.lastname: Orimba
authors.forename: Mirabelle
authors.initials: M
authors.lastname: Adamu-Zeh
authors.forename: John
authors.initials: J
authors.lastname: Williamson
authors.forename: Maquins
authors.initials: M
authors.lastname: Sewe
authors.forename: Lennah
authors.initials: L
authors.lastname: Nyabiage
authors.forename: Karen
authors.initials: K
authors.lastname: Owuor
authors.forename: Dita
authors.initials: D
authors.lastname: Broz
authors.forename: Barbara
authors.initials: B
authors.lastname: Marston
authors.forename: Marta
authors.initials: M
authors.lastname: Ackers
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000401:mortality; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001344:Autopsy; D018791:CD4 Lymphocyte Count; D003141:Communicable Diseases / Q000401:mortality; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012423:Rural Health; D014376:Tuberculosis / Q000401:mortality
chemical_list: D019380:Anti-HIV Agents