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AIDS:
doi: 10.1097/QAD.0b013e32831cc0e6
Clinical Science

The impact of the President's Emergency Plan for AIDS Relief on expansion of HIV care services for adult patients in western Kenya

Wools-Kaloustian, Karaa,b; Kimaiyo, Silvesterb; Musick, Beverlye; Sidle, Johnb,c; Siika, Abrahamb; Nyandiko, Winstonef; Einterz, Robertc; Tierney, William Mc,d; Yiannoutsos, Constantin Te

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Abstract

Background: The President's Emergency Plan for AIDS Relief committed $15 billion to addressing HIV in resource-poor settings.

Objective: To assess the impact of The President's Emergency Plan for AIDS Relief on the treatment services of an HIV care program.

Design, setting, and patients: Cohort study utilizing computerized medical records of nonpregnant adults enrolled into the Academic Model for the Prevention and Treatment of HIV/AIDS system, in western Kenya between 27 November 2001 and 24 July 2006.

Main outcomes measures: Number of clinics and patients enrolled in Academic Model for the Prevention and Treatment of HIV/AIDS, as well as patient demographics, immunologic, and clinical characteristics during three periods defined by the availability of combination antiretroviral therapy (cART).

Results: Enrollment as of May 2006 was 23 539. Mean monthly enrollment increased from 64 to 815 between periods 1 and 3. The median CD4 cell count at enrollment during period 3 (172 cells/μl) was significantly higher than for period 2 (119 cells/μl; P < 0.001). World Health Organization stage at enrollment differed significantly between periods with 6.7% having stage 4 disease in period 3 compared with 13.8% during period 1 (P < 0.001). Significantly more patients had complete documentation of cART eligibility, during period 3 as compared with the previous periods. Time from enrollment to cART initiation decreased from a median of 64 weeks in period 1 to 12 weeks during period 3 (P < 0.001).

Conclusion: The President's Emergency Plan for AIDS Relief funding has allowed Academic Model for the Prevention and Treatment of HIV/AIDS to significantly increase the number of individuals receiving HIV care and provided the ability to expand services allowing for identification of patients earlier in their disease process.

© 2009 Lippincott Williams & Wilkins, Inc.

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