Factors Associated with Late Engagement to HIV Care in Western Kenya

Kwobah, Charles; Braitstein, Paula; Koech, Julius; Simiyu, Gilbert; Mwangi, Ann; Wools‐Kaloustian, Kara; Siika, Abraham

doi:10.1177/2325957414567682

Cited by 20 publications

(39 citation statements)

References 47 publications

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“…Weight loss which leads to severe and moderate malnutrition is common in HIV infection and can be caused by low dietary intake due to loss of appetite, mouth ulcers, food insecurity and also due to malabsorption of macronutrients and an altered metabolism [31]. Men were more likely to have undernutrition compared to women, and we attribute this to the established fact that they present late for HIV treatment and care with advanced HIV disease and low CD4 counts in Zimbabwe [32] and other African settings [33,34]. Lower CD4 cell counts have been found to be associated with severe and moderate malnutrition [14,29] and these are also associated with increased mortality [35].…”

Section: Discussionmentioning

confidence: 96%

“…Table 1 shows the socio-demographic characteristics of the 1,242 HIV-positive adults who were enrolled in this study. There were 849 (68%) females and the overall median age of all participants was 41 years (IQR, [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Slightly more study participants resided in the rural areas (n = 699, 56%) compared to urban areas (n = 543, 44%).…”

Section: Discussionmentioning

confidence: 99%

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Malnutrition status and associated factors among HIV-positive patients enrolled in ART clinics in Zimbabwe

et al. 2017

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Background: Sub-Saharan Africa suffers from a high burden of undernutrition, affecting 23.2% of its population, and in 2015 constituted 69% of the estimated people living with Human Immunodeficiency Virus (HIV) globally. Zimbabwe, in Southern African has a HIV prevalence of 14.7%, but malnutrition (under-and over-nutrition) in this population has not been characterized. A nationally representative survey was therefore conducted to determine malnutrition prevalence and associated factors among HIV-positive adults (≥15 years) enrolled at antiretroviral therapy (ART) clinics in Zimbabwe. Methods: Height and weight measurements were taken for all enrolled participants who had attended their scheduled clinic review visits. Malnutrition was determined using body mass index (BMI) calculations and classified as undernutrition (<18.5 kg/m

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Malnutrition status and associated factors among HIV-positive patients enrolled in ART clinics in Zimbabwe

et al. 2017

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“…This is because of different biological characteristics, including immunity that changes with age. It was also shown that older persons come to the clinic late [15] that could make their response to ART treatment poorer [16]. Contrary to these findings, other studies reported a null association between age and CD4 count increment [13, 19].…”

Section: Discussionmentioning

confidence: 99%

Time to immunologic recovery and determinant factors among adults who initiated ART in Felege Hiwot Referral Hospital, northwest Ethiopia

et al. 2017

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BackgroundCD4 cells are the major targets for human immunodeficiency virus (HIV) and treatment with Antiretroviral Therapy (ART) influences the CD4 cell count of HIV patients. In addition to ART, the time required to reach normal range of CD4 counts (500 cells/mm3) can be affected by clinical, socio-demographic, and behavioral factors. This retrospective cohort study was conducted to determine the incidence of having the normal range of CD4 cell counts and factors that affect the time required to reach this normal range among adult HIV patients who initiated into ART.MethodsData of 4 years were retrospectively retrieved from routinely registered characteristics of 937 ART users enrolled in 2010. Survival time until immunologic recovery and its determinant factors were examined using the frailty model with different parametric distributions alternatively.ResultsMost (80.8%) of the ART attendants had CD4 cell count of 200 cells/mm3 or less at initiation. The overall incidence rate of immunologic recovery was 12.67 persons per 1000 person-months (95% CI 11.30, 14.20). The dependency of frailties of immunologic recovery by residence was statistically significant (Theta = 0.05, p value = 0.006). Baseline age (Adjusted Hazard Ratio (AHR) = 0.98, 95% CI 0.97, 0.99), baseline CD4 count (AHR = 1.006, 95% CI 1.005, 1.008), and female sex (AHR = 1.34, 95% CI 1.03, 1.73) were significantly associated with shorter survival time for immunologic recovery.ConclusionHigher baseline CD4 count, lower baseline age, and female sex were positively associated with the time to immunologic recovery, which also dependent on proximity/residence of ART users. Therefore, further scale up of ART services with due emphasis to patients with low CD4 count at baseline particularly for male and older ART users are recommended to reach the normal range of CD4 count in a shorter time of treatment.

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“…Patients usually seek care from healers first and they only go to hospitals when advanced stages of their diseases are reached [17]. As far as HIV is concerned, stigma, being unaware of HIV-status could also explain these results [18]. Since we performed a retrospective data analysis, we could not assess whether these factors were involved in our study.…”

Section: Factors Associated With Late Presentation To Carementioning

confidence: 98%

“…This finding is important since it make it clear that the distance to the HIV center and its accessibility are not the issues leading to late presentation. However, in Kenya, Kwobah found that the distance to the health facility was an important factor for late presentation [18]. In this study, the authors considered late presenters as those who presented to care with CD4 cell count ≤ 100 cells /μL.…”

Section: Factors Associated With Late Presentationmentioning

confidence: 99%

Late Presentation to Care among People Living with HIV in Cotonou, Benin: A Retrospective Analysis from 2003 to 2014

Zannou¹,

Gandaho²,

Azon-Kouanou³

et al. 2017

OJIM

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Factors Associated with Late Engagement to HIV Care in Western Kenya

Abstract: Nearly one-quarter of HIV-infected patients in our setting present with advanced immune suppression at initial encounter. Being male, older age, and living further away from clinic are associated with late engagement to care.

Cited by 20 publications

References 47 publications

Malnutrition status and associated factors among HIV-positive patients enrolled in ART clinics in Zimbabwe

Malnutrition status and associated factors among HIV-positive patients enrolled in ART clinics in Zimbabwe

Time to immunologic recovery and determinant factors among adults who initiated ART in Felege Hiwot Referral Hospital, northwest Ethiopia

Late Presentation to Care among People Living with HIV in Cotonou, Benin: A Retrospective Analysis from 2003 to 2014

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