title: Evaluation of impact of long-lasting insecticide-treated bed nets and point-of-use water filters on HIV-1 disease progression in Kenya.
abstract: OBJECTIVE
  Among HIV-1-infected individuals in Africa, coinfection with malaria and diarrhoeal disease may be associated with more rapid HIV-1 disease progression. We sought to determine whether the use of long-lasting insecticide-treated bed nets and simple point-of-use water filters can delay HIV-1 disease progression.
  
  
  METHODS
  A prospective cohort study.
  
  
  METHODS
  Two HIV care sites in Kenya.
  
  
  METHODS
  HIV-1-infected adults not yet meeting criteria for antiretroviral therapy.
  
  
  METHODS
  One group received the standard of care, whereas the other received long-lasting insecticide-treated bed nets and water filters. Individuals were followed for up to 24 months.
  
  
  METHODS
  The primary outcome measures were time to CD4 cell count less than 350 cells/μl and a composite endpoint of time to CD4 cell count less than 350 cells/μl and nontraumatic death. Time to disease progression was compared using Cox proportional hazards regression.
  
  
  RESULTS
  Of 589 individuals included, 361 received the intervention and 228 served as controls. Median baseline CD4 cell counts were similar (P=0.36). After controlling for baseline CD4 cell count, individuals receiving the intervention were 27% less likely to reach the endpoint of a CD4 cell count less than 350 cells/μl (hazard ratio 0.73; 95% confidence interval 0.57-0.95). CD4 cell count decline was also significantly less in the intervention group (-54 vs. -70 cells/μl per year, P=0.03). In addition, the incidence of malaria and diarrhoea were significantly lower in the intervention group.
  
  
  CONCLUSIONS
  Provision of a long-lasting insecticide-treated bed net and water filter was associated with a delay in CD4 cell count decline and may be a simple, practical and cost-effective strategy to delay HIV-1 progression in many resource-limited settings.
authors: Department of Global Health, University of Washington, Seattle, Washington 98104, USA. walson@uw.edu
authors: Judd L
authors: JL
authors: Walson
authors: Laura R
authors: LR
authors: Sangaré
authors: Benson O
authors: BO
authors: Singa
authors: Jacqueline Mulongo
authors: JM
authors: Naulikha
authors: Benjamin K S
authors: BK
authors: Piper
authors: Krista
authors: K
authors: Yuhas
authors: Frankline Magaki
authors: FM
authors: Onchiri
authors: Phelgona A
authors: PA
authors: Otieno
authors: Jonathan
authors: J
authors: Mermin
authors: Clement
authors: C
authors: Zeh
authors: Barbra Ann
authors: BA
authors: Richardson
authors: Grace
authors: G
authors: John-Stewart
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D060085:Coinfection; D003362:Cost-Benefit Analysis; D003967:Diarrhea / Q000517:prevention & control; D018450:Disease Progression; D005260:Female; D005374:Filtration / Q000379:methods; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy; D015497:HIV-1; D006801:Humans; D057148:Insecticide-Treated Bednets / Q000706:statistics & numerical data*; D007630:Kenya; D008288:Malaria / Q000517:prevention & control; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis; D012959:Socioeconomic Factors; D013997:Time Factors; D019562:Viral Load; D014867:Water; D018508:Water Purification / Q000379:methods*
chemical_list: D019380:Anti-HIV Agents; D014867:Water