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A Program to Provide Antiretroviral Therapy to Residents of an Urban Slum in Nairobi, Kenya

Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Kenya, bmarston{at}cdc.gov

Doris K. Macharia, MMed

Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Kenya

Lucy Nga'nga, MMed

Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Kenya

Mary Wangai, MD, MPH

Republic of Kenya Ministry of Health

Festus Ilako, MMed

African Medical and Research Foundation-Kenya

Odylia Muhenje, MA

Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Kenya

Mette Kjaer, MSci

African Medical and Research Foundation-Kenya

Anthony Isavwa, BA

Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Kenya

Andrea Kim, PhD

Global AIDS Program, CDC, Atlanta, Georgia

Kenneth Chebet, MBChB, MPH

Republic of Kenya Ministry of Health

Kevin M. DeCock, MD

Global AIDS Program, Centers for Disease Control and Prevention (CDC)-Kenya

Paul J. Weidle, PharmD, MPH

Division of HIV/AIDS Prevention, CDC, Atlanta, Georgia

Objective: To evaluate retention in care and response to therapy for patients enrolled in an antiretroviral treatment program in a severely resource-constrained setting. Methods: We evaluated patients enrolled between February 26, 2003, and February 28, 2005, in a community clinic in Kibera, an informal settlement, in Nairobi, Kenya. Midlevel providers offered simplified, standardized antiretroviral therapy (ART) regimens and monitored patients clinically and with basic laboratory tests. Clinical, immunologic, and virologic indicators were used to assess response to ART; adherence was determined by 3-day recall. A total of 283 patients (70% women; median baseline CD4 count, 157 cells/ mm³; viral load, 5.16 log copies/mL) initiated ART and were followed for a median of 7.1 months (n = 2384 patient-months). Results: At 1 year, the median CD4 count change was +124.5 cells/mm³ (n = 74; interquartile range, 42 to 180), and 71 (74%) of 96 patients had viral load <400 copies/mL. The proportion of patients reporting 100% adherence over the 3 days before monthly clinic visits was 94% to 100%. As of February 28, 2005, a total of 239 patients (84%) remained in care, 22 (8%) were lost to follow-up, 12 (4%) were known to have died, 5 (2%) had stopped ART, 3 (1%) moved from the area, and 2 (< 1% ) transferred care. Conclusions: Response to ART in this slum population was comparable to that seen in industrialized settings. With government commitment, donor support, and community involvement, it is feasible to implement successful ART programs in extremely challenging social and environmental conditions.

Key Words: AIDS • resource-limited • slum • antiretroviral treatment • Africa

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 6, No. 2, 106-112 (2007)
DOI: 10.1177/1545109707300688


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