Research: Kenya

Nairobi, KENYA

Kenya is receiving funding to expand HIV treatment under the President’s Emergency Plan for AIDS Relief (PEPFAR), which aims to provide highly active antiretroviral therapy (HAART) medication on a large scale. Early reports suggest that refusal of HIV treatment and poor adherence may become major long-term problems. Addressing these issues early in the treatment campaign is important for the success of HAART provision in Africa. In collaboration with the University of Nairobi Institute for Tropical and Infectious Diseases (UNITID), we are conducting two studies at five sites in Nairobi, Kenya: four clinics in Kangemi, Tigoni, Pumwani and Majengo, and the University of Nairobi Health Services for students and staff.

The studies are:

Understanding the Dynamics of HAART Delivery in Five Clinics in Nairobi: A Health Services and Outcomes Research Project

The overall goal of this study is to understand the dynamics of the PEPFAR-funded HAART program in Nairobi by examining each key stage of the HAART delivery program. In 2005, nearly one-third of patients offered free HAART in an HIV treatment program in Nairobi, Kenya, declined it. For the proportion of patients who accept and start HAART, poor adherence to HAART medications, treatment failure, and the development of HIV resistance are some of the additional challenges that face patients, care providers and policy makers. A systematic examination of the successes and the barriers to HAART delivery in resource-constrained environments is critical in the early implementation of widespread HAART delivery in sub-Saharan Africa.

Improving Medication Adherence in an HIV Treatment Expansion Program in Kenya: Operation Evaluation and Cost Analyses

Understanding the full operational dynamics of the antiretroviral treatment expansion program and testing the feasibility and acceptability of potentially beneficial interventions are important first steps in promoting the success of HAART programs in the continent. This study will:

• determine whether the reasons associated with refusing HAART represent modifiable factors.
• inform the design of strategies to improve HAART uptake for those who need it through understanding the patients’ perspective and the real problems that the patients face at the time they are offered HAART.
• determine whether targeted directly observed therapy (TDOT) is a feasible, acceptable and sustainable adherence support strategy to minimize mortality and treatment failure and prevent HIV resistance.

Universal directly observed therapy (DOT) for HAART – in which DOT is offered to all patients for as long as the patients are on HAART – is complex and costly. With constrained resources in Kenya, it is important to design an adherence support program that is both effective and sustainable. The targeted DOT (TDOT) study hypothesizes that TDOT – in which DOT is offered only to patients at a high risk of death and treatment failure – will reduce mortality, treatment failure and HIV resistance nearly as effectively as universal DOT, but at a lower cost.