Water filter provision and home-based filter reinforcement reduce diarrhea in Kenyan HIV-infected adults and their household members.
Among human immunodeficiency virus (HIV)-infected adults and children in Africa, diarrheal disease remains a major cause of morbidity and mortality. We evaluated the effectiveness of provision and home-based reinforcement of a point-of-use water filtration device to reduce diarrhea among 361 HIV-infected adults in western Kenya by comparing prevalence of self-reported diarrhea before and after these interventions. After provision of the filter, 8.7% of participants reported diarrhea compared with 17.2% in the 3 months before filter provision (odds ratio [OR] = 0.39, 95% confidence interval [95% CI] = 0.23-0.66, P < 0.001). The association was similar among 231 participants who were already taking daily cotrimoxazole prophylaxis before being given a filter (OR = 0.47, 95% CI = 0.25-0.88, P = 0.019). Educational reinforcement was also associated with a modest reduction in self-reported diarrhea (OR = 0.50, 95% CI = 0.20-0.99, P = 0.047). Provision and reinforcement of water filters may confer significant benefit in reducing diarrhea among HIV-infected persons, even when cotrimoxazole prophylaxis is already being used.
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington ppav@uw.edu.
Patricia B
PB
Pavlinac
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Jaqueline M
JM
Naulikha
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Linda
L
Chaba
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Naomi
N
Kimani
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Laura R
LR
Sangaré
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Krista
K
Yuhas
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Benson O
BO
Singa
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Grace
G
John-Stewart
Department of Epidemiology, University of Washington, Seattle, Washington; Kenya Medical Research Institute, Centre for Clinical Research, Nairobi, Kenya; Department of Pediatrics, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Center for AIDS Research Biometrics Core, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington.
Judd L
JL
Walson
D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D060085:Coinfection; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000469:parasitology / Q000517:prevention & control*; D060766:Drinking Water / Q000382:microbiology / Q000469:parasitology; D005260:Female; D005374:Filtration; D006678:HIV; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D018508:Water Purification
D000890:Anti-Infective Agents; D060766:Drinking Water; D015662:Trimethoprim, Sulfamethoxazole Drug Combination