By Mercy Kachenge
Nairobi, Kenya: Kenya has taken significant steps in addressing a critical condition known as Advanced HIV Disease. This condition has raised concerns among experts and researchers due to its association with a low CD4 cell count, typically below 200, and its prevalence among children under the age of 5.
The World Health Organization (WHO) defines advanced HIV disease as any person living with HIV with a CD4 count of less than 200 cells or stage 3 or 4 in adults and adolescents and all children under the age of five are considered to have an Advanced HIV Disease (AHD).
Kenya is among the top ten countries with a high prevalence of Advanced HIV Disease. To address this, the National HIV Guidelines have established a comprehensive care package for individuals living with HIV.
This package includes screening for prevalent opportunistic infections like Tuberculosis (TB), diagnosis, and treatment of opportunistic infections, and the initiation of Antiretroviral Therapy (ART). Several measures have been implemented to enhance care and reduce the incidence of AHD.
These include coordination of services, revamping CD4 testing, adopting WHO recommendations for the treatment of cryptococcal meningitis, building the capacity of healthcare workers, and strengthening referral systems for AHD.
Nelson Otwoma, Director at the National Empowerment Network of People Living with HIV/AIDS in Kenya (NEPHAK), stated that people confuse AHD since they believe it only affects those individuals who had HIV for a long or confuse it with non-communicable diseases such as hypertension or diabetes. However, AHD is mainly linked with conditions where HIV is unmanaged which leads to severe damage to the body.
“For children, the situation of AHD is different since the immune system is compromised thus they rely on CD4 counts to determine it which is considered to be cumbersome,” he said.
Dr. Lazarus Momamyi, Technical Advisor for NASCOP new infections are prevalent among women which stands at 5.3 percent unlike men which stands at 2.6 percent and 41 percent of these new infections occur among young adolescents and young people aged between 15 to 24 years.
“Over 1.3 million people are on Antiretroviral Treatment (AT) and out of 1.37 million of people living with HIV, they have achieved a viral suppression of 94 percent among those on treatment,” he said.
Dr. Lazarus noted that despite the success, there is still an occurrence of preventable Advanced HIV-related disease. In 2022, estimates indicated that 18,273 people died as a result of AIDS-related conditions including malnutrition among children . Tuberculosis and infections.
“These deaths can be prevented since the healthcare system has the capacity to address them”, he said.
Adding “Late diagnosis has made people still presenting with severe illness since the individuals take a long time to learn their HIV status and by the time they are tested, they find out they are living with the virus and the immunity may have already declined”.
He explained further that stigma is still playing a role in interrupting treatment since individuals with AHD are not able to disclose it to their partner which means they are taking their medication in secrecy. Some individuals have also interrupted treatment by stopping to take their medications due to faith reasons as believing they can be prayed for and get healed.
According to NEPHAK, they are trying to analyze their data and know the characteristics of individuals who like to interrupt treatment or not so that they can be able to support them not to interrupt treatment.
“Another contributor to treatment interruptions is the issue of patients not not adhering to medication which leads to treatment failure thus making the drugs no longer working and therefore leading to virus replicating and destroying the CD4 which is the immunity of a person dropping and being vulnerable and acquiring some of the opportunity infections” Otwoma noted.
He urged that scaling up HIV self-testing will ensure individuals are able to know their status without visiting health facilities and this will ensure they engage with treatment to avoid issues of treatment interruptions. Also, the associated interruption is linked with stigma and data analysis is being conducted to ensure individuals who interrupt treatment through community health promoters are able to track and bring them back to the healthcare facility.
Tuberculosis is the leading cause of mortality to people living with HIV since the coinfection rate between Tuberculosis and HIV is around 25% thus they are leveraging it by ensuring they screen individuals living with HIV for TB when they visit the health facility and even scaling up the use of X-ray to help screen better for TB.
Additionally, Dr. Momanyi stated “There are interventions that have been put in place to reduce mortalities through developing the capacity of healthcare workers to identify and diagnose Advanced HIV disease and manage some opportunistic infections. Also desensitize healthcare workers that will ensure they are able to handle AHD cases with quality care, revamping diagnostic systems through the test called CD4.”
Furthermore, they are also planning to adopt a more effective and safer treatment for some of the cryptococcal meningitis through funders like Global Fund that will enable NEPHAK to procure medication for those living with HIV.
Otwoma emphasized the importance of an integrated approach which is based on a patient-centered approach that is already adopted in other counties in Kenya that entails one healthcare with the client and the same health system.
Dr. Momanyi noted that each year, they conduct annual estimates to assess various aspects of our HIV response, including the number of people living with HIV, those on treatment, and the mother-to-child transmission (MTCT) rate. Our goal is to reduce the MTCT rate to below percent. Currently, this rate is over 7%. Achieving our goal of eliminating mother-to-child transmission requires bringing this rate below 5%.
In addition to these estimates, they have also analyzed program data to determine how many children who are tested for HIV are actually found to be positive. Factors contributing to mother-to-child transmission include home deliveries where women who initially started treatment but then interrupted it, leading to high viral loads and subsequent transmission to their child and they are analyzing these factors to identify effective interventions to prevent such transmissions.
“Our goal is to ensure that by 2027, no child should be infected with HIV. We aim to end AIDS in children by that same year,” Dr. Momanyi said.
