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HIV-Related Deaths in Nairobi, Kenya

Results From a HIV Mortuary Surveillance Study, 2015

Nyagah, Lilly M., MDa; Young, Peter W., MPHb; Kim, Andrea A., PhDb; Wamicwe, Joyce, MDa; Kimani, Maureen, MDa; Waruiru, Wanjiru, MPHc; Rogena, Emily, PhDd; Oduor, Johansen, MDe; Walong, Edwin, MDd; Waruru, Anthony, Mphilb; Oyugi, Julius, PhDf; Downer, Marie, MDb; De Cock, Kevin M., MDb; Sirengo, Martin, MDa

JAIDS Journal of Acquired Immune Deficiency Syndromes: May 1, 2019 - Volume 81 - Issue 1 - p 18–23
doi: 10.1097/QAI.0000000000001975
Epidemiology
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Background: Death is an important but often unmeasured endpoint in public health HIV surveillance. We sought to describe HIV among deaths using a novel mortuary-based approach in Nairobi, Kenya.

Methods: Cadavers aged 15 years and older at death at Kenyatta National Hospital (KNH) and City Mortuaries were screened consecutively from January 29 to March 3, 2015. Cause of death was abstracted from medical files and death notification forms. Cardiac blood was drawn and tested for HIV infection using the national HIV testing algorithm followed by viral load testing of HIV-positive samples.

Results: Of 807 eligible cadavers, 610 (75.6%) had an HIV test result available. Cadavers from KNH had significantly higher HIV positivity at 23.2% (95% CI: 19.3 to 27.7) compared with City Mortuary at 12.6% (95% CI: 8.8 to 17.8), P < 0.001. HIV prevalence was significantly higher among women than men at both City (33.3% vs. 9.2%, P = 0.008) and KNH Mortuary (28.8% vs. 19.0%, P = 0.025). Half (53.3%) of HIV-infected cadavers had no diagnosis before death, and an additional 22.2% were only diagnosed during hospitalization leading to death. Although not statistically significant, 61.9% of males had no previous diagnosis compared with 45.8% of females (P = 0.144). Half (52.3%) of 44 cadavers at KNH with HIV diagnosis before death were on treatment, and 1 in 5 (22.7%) with a previous diagnosis had achieved viral suppression.

Conclusions: HIV prevalence was high among deaths in Nairobi, especially among women, and previous diagnosis among cadavers was low. Establishing routine mortuary surveillance can contribute to monitoring HIV-associated deaths among cadavers sent to mortuaries.

aNational AIDS and STI Control Programme, Ministry of Health, Nairobi, Kenya;

bDivision of Global HIV and Tuberculosis (DGHT), U.S. Centers for Disease Control and Prevention (CDC), Nairobi, Kenya;

cUniversity of California San Francisco (UCSF), Nairobi, Kenya;

dUniveristy of Nairobi, Kenyatta National Hospital, Nairobi, Kenya;

eDivision of Forensic and Pathology Services, Ministry of Health, Nairobi, Kenya; and

fUniversity of Nairobi Infectious and Tropical Disease (UNITID), University of Nairobi, Nairobi, Kenya.

Correspondence to: Lilly Nyagah, MD, National AIDS and STI Control Programme, Ministry of Health, Strategic Information Unit, Kenyatta National Hospital Grounds, P. O Box 19361, Nairobi, Kenya (e-mail: lillymuthoni@yahoo.com).

Supported by the US President's Emergency Plan for AIDS Relief (PEPFAR) through the US Centers for Disease Control and Prevention (CDC) under the terms of cooperative agreements [#PS001814, GH000069]. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the funding agencies.

The authors have no funding or conflicts of interest to disclose.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.jaids.com).

Received February 28, 2018

Accepted November 11, 2018

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.