Nearly one-third of patients offered free highly active antiretroviral therapy (HAART) in an HIV treatment program in 2005 in Nairobi, Kenya are declining the opportunity to beginning HAART. The reasons are not known, however anecdotal reports suggest that for some patients' access to appropriate nutrition may play a role.
In a collaborative effort with University of Nairobi Institute for Tropical and Infectious Diseases ( UNITID ), the overall goal of this study is to understand the dynamics of the PEPFAR funded HAART program in Nairobi by examining each key stages of the HAART delivery program. The specific aims of this study are: 1) to establish the proportion and characteristics of patients at five clinics in Nairobi who accept or decline to start HAART when offered free HAART and explore the determinants of HAART refusal using a survey on 400 consecutive patients offered to start HAART, and 2) to examine the electronic records of the Nairobi HAART program to determine i.e. a) the follow up rates and patient characteristics associated with these rates in the HAART delivery program i.e. for successive clinic visits, laboratory and pharmacy visits as well as adherence to HAART medications, and b) to describe the clinical outcomes of patients i.e. CD4 count, opportunistic infections, hospitalizations, deaths and loss to follow up and the factors associated with each outcome.
The success of HAART provision in Africa is not only dependent on the successful initiation of the HAART program but on the long-term sustainability of the HAART delivery and the resultant favorable health outcomes in the population rather than in only the individuals who are followed up. It is therefore vital to understand the successes and barriers of key stages of the HAART delivery process to ensure that appropriate and timely measures, if required, are instituted to maximize on the number of patients, who are identified to start HAART, to end up with the most favorable clinical and health outcomes possible. Identifying modifiable barriers to effective HAART use early may inform appropriately designed interventions in a timely fashion and identifying non-modifiable factors associated with the barriers may inform strategies to institute targeted preventive measures.
This study is an "initial AIDS research project" because this is the beginning of Dr Mwamburi's research career. The study will serve as the starting point of a research agenda on the success and quality of HAART delivery from acceptance to adherence in resource poor settings. This project coincides with the establishment and 5-year strategic plan of UNITID. This research agenda will include understanding the problems related to HAART acceptance and eventually adherence and quality of care and health outcomes in HAART care and designing interventions to counter the barriers. The study is a collaborative project because we propose to work jointly with The University of Nairobi Institute of Tropical and Infectious Diseases (UNITID). UNITID is currently establishing HIV treatment and vaccine trial cohorts. UNITID are strategically very suited for establishing a long-term partnership for international HIV/AIDS research. International participation in research is consistent with the goals of Tufts University and international HIV/AIDS research is in line with the global approach to fighting the HIV/AIDS epidemic.
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