title: Antiretroviral treatment scale-up among persons living with HIV in Kenya: results from a nationally representative survey.
abstract: BACKGROUND
  In 2007, 29% of HIV-infected Kenyans in need of antiretroviral therapy (ART), based on an immunologic criterion of CD4 ≤350 cells per microliter, were receiving ART. Since then, substantial treatment scale-up has occurred in the country. We analyzed data from the second Kenya AIDS Indicator Survey (KAIS 2012) to assess progress of treatment scale-up in Kenya.
  
  
  METHODS
  KAIS 2012 was a nationally representative survey of persons aged 18 months to 64 years that collected information on HIV status, care, and treatment. ART eligibility was defined based on 2 standards: (1) 2011 Kenya eligibility criteria for ART initiation: CD4 ≤350 cells per microliter or co-infection with active tuberculosis and (2) 2013 World Health Organization (WHO) eligibility criteria for ART initiation: CD4 ≤500 cells per microliter, co-infection with active tuberculosis, currently pregnant or breastfeeding, and infected partners in serodiscordant relationships. Blood specimens were tested for HIV antibodies and HIV-positive specimens tested for CD4 cell counts.
  
  
  RESULTS
  Among 13,720 adults and adolescents aged 15-64 years, 11,626 provided a blood sample, and 648 were HIV infected. Overall, 58.8% [95% confidence interval (CI): 52.0 to 65.5) were eligible for treatment using the 2011 Kenya eligibility criteria and 77.4% (95% CI: 72.4 to 82.4) using the 2013 WHO eligibility criteria. Coverage of ART was 60.5% (95% CI: 50.8 to 70.2) using the 2011 Kenya eligibility criteria and 45.9% (95% CI: 37.7 to 54.2) using the 2013 WHO eligibility criteria.
  
  
  CONCLUSIONS
  ART coverage has increased from 29% in 2007 to 61% in 2012. If Kenya adopts the 2013 WHO guidelines for ART initiation, need for ART increases by an additional 19 percentage points and current coverage decreases by an additional 15 percentage points, representing an additional 214,000 persons who will need to be reached.
authors.affiliation: *Kenya Field Epidemiology and Laboratory Training Programme, Ministry of Health, Nairobi, Kenya; †Global Health Sciences, University of California, San Francisco, San Francisco, CA; ‡Division of Global HIV/AIDS Center for Global Health, Centers for Disease Control and Prevention, Nairobi, Kenya; §National AIDS and Sexually Transmitted Infection (STI) Control Programme, Ministry of Health, Nairobi, Kenya; and ‖National Public Health Laboratories Services, Ministry of Health, Nairobi, Kenya.
authors.forename: Jacob O
authors.initials: JO
authors.lastname: Odhiambo
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Kellogg
authors.forename: Andrea A
authors.initials: AA
authors.lastname: Kim
authors.forename: Lucy
authors.initials: L
authors.lastname: Ng'ang'a
authors.forename: Irene
authors.initials: I
authors.lastname: Mukui
authors.forename: Mamo
authors.initials: M
authors.lastname: Umuro
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Mohammed
authors.forename: Kevin M
authors.initials: KM
authors.lastname: De Cock
authors.forename: Davies O
authors.initials: DO
authors.lastname: Kimanga
authors.forename: Sandra
authors.initials: S
authors.lastname: Schwarcz
mesh_terms: D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D004522:Educational Status; D004608:Eligibility Determination; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D007630:Kenya; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D014944:World Health Organization; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
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