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Evidence for optimizing highly active antiretroviral
treatment (HAART) in Kenya
Dr. Washingtone Ochieng
• CNHR RCDG Fellow returning from Harvard University, U.S.A
• Research Host: CREATES
Summary: HIV Prevalence & treatment
Declining prevalence,
rising numbers!
• Longevity- ART
• More PLWH
TREATMENT
• ARV access improved
• Monitoring not so
• Adherence & failure
Study sites
Relevance to Policy
• Great progress at controlling the HIV epidemic, but
• Exposure trends and sources are increasing
• Substance use, Commercial sex, same sex etc.
• Increased ARV access- likely to drive resistance and misuse
• Weak monitoring structures- need evidence-backed guidance
Treatment failure and underlying influencers
• Overall, 35.9% of all patients failed treatment
• Failure highest among Patients receiving D4T(stavudine) regimen
• First-line D4T discontinued elsewhere but still widely used in Kenya
• 33.3% of the patients developed resistance to major drugs in use
• Single viral load test is efficient for treatment failure definition
Peer support improves adherence & treatment outcome
Adherence
Viral load
Peer Support
*
*
*
*
*
*
• Patients active in peer support programs had good adherence
• Patient with good adherence had lower viral load
HIV as a collection of sub-epidemics of many virus strains
SUBTYPE/Strain
A
B
C
D
Recombinants
% HIV diversity within in
Envelope (vaccine target)
Pol (drug target)
79
0
0
0
21
• Observed increased diversity of HIV in the drug-target genes
• Identified HIV-1 subtype B, only common in Europe & the Americas
• Multiple strains complicate disease & treatment outcomes
67
5
14
10
5
Increased burden of infection among substance users.
• 66.2% injectors and 33.8% non-injectors
• HIV-1 prevalence; 87.5% among injectors.
• Hepatitis C prevalence; injectors (16.3%) & non-injectors (4.3%)
Policy decision-points:
①Implement point-of-care viral load testing to monitor failure
②Implement patient-focused adherence support programs
 Strengthen patient-physician and patient-patient relationships
③Regularize drug toxicity testing- D4T regimen phase-out per WHO
④Institutionalize drug resistance testing (reference testing centers)
⑤Capacity building- train and impart relevant skills on testing
Policy decision-points-cont…
6). Public health approach to alleviate behavioral risks
• Substance replacement therapy; treatment-as-a-prevention
• Pre-exposure prophylaxis; Test-and-treat’; self-reporting support
7). Ministry of Health to partner with research groups to
• Support research activities that will enhance informed policy decisions
• Actively monitor disease epidemiology and genetics
Summary
• HIV treatment access has improved- Monitoring needs scaling
• Patient Participation in adherence programs useful
• Drug/substance abuse compromising gains
• Policy decisions to intersect with Research evidence
• Other outcomes:
• Graduate & undergraduate trainings, publications, Conferences
Acknowledgement
• Centre for Research in Therapeutic Sciences (CREATES)
• Consortium for National Health Research (CNHR) for funding