Trends and Determinants of Antiretroviral Therapy Patient Monitoring Practices in Kenya and Uganda.
BACKGROUND
Patients receiving antiretroviral therapy (ART) require routine monitoring to track response to treatment and assess for treatment failure. This study aims to identify gaps in monitoring practices in Kenya and Uganda.


METHODS
We conducted a systematic retrospective chart review of adults who initiated ART between 2007 and 2012. We assessed the availability of baseline measurements (CD4 count, weight, and WHO stage) and ongoing CD4 and weight monitoring according to national guidelines in place at the time. Mixed-effects logistic regression models were used to analyze facility and patient factors associated with meeting monitoring guidelines.


RESULTS
From 2007 to 2012, at least 88% of patients per year in Uganda had a recorded weight at initiation, while in Kenya there was a notable increase from 69% to 90%. Patients with a documented baseline CD4 count increased from 69% to about 80% in both countries. In 2012, 83% and 86% of established patients received the recommended quarterly weight monitoring in Kenya and Uganda, respectively, while semiannual CD4 monitoring was less common (49% in Kenya and 38% in Uganda). Initiating at a more advanced WHO stage was associated with a lower odds of baseline CD4 testing. On-site CD4 analysis capacity was associated with increased odds of CD4 testing at baseline and in the future.


CONCLUSIONS
Substantial gaps were noted in ongoing CD4 monitoring of patients on ART. Although guidelines have since changed, limited laboratory capacity is likely to remain a significant issue in monitoring patients on ART, with important implications for ensuring quality care.
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Emily
E
Dansereau
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Emmanuela
E
Gakidou
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Marie
M
Ng
Department of Pediatrics and Child Health, Makerere University, Kampala, Uganda.
Jane
J
Achan
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Roy
R
Burstein
RTI International, Research Triangle Park, North Carolina, United States of America.
Brendan
B
DeCenso
African Leaders Malaria Alliance, Kampala, Uganda.
Anne
A
Gasasira
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Gloria
G
Ikilezi
Action Africa Health-International, Nairobi, Kenya.
Caroline
C
Kisia
University of North Carolina, Chapel Hill, North Carolina, United States of America.
Samuel H
SH
Masters
IFC World Bank Group, Nairobi, Kenya.
Pamela
P
Njuguna
Department of Epidemiology, University of Washington, Seattle, Washington, United States of America.
Thomas A
TA
Odeny
Bill & Melinda Gates Foundation, Seattle, Washington, United States of America.
Emelda A
EA
Okiro
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
D Allen
DA
Roberts
Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, United States of America.
Herbert C
HC
Duber
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D008991:Monitoring, Physiologic / Q000639:trends*; D012189:Retrospective Studies; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load / Q000187:drug effects
D044966:Anti-Retroviral Agents