The adult population impact of HIV care and antiretroviral therapy in a resource poor setting, 2003-2008

AIDS. 2012 Jul 31;26(12):1545-54. doi: 10.1097/QAD.0b013e328353b7b9.


Objective: To describe the population uptake of HIV care including antiretroviral therapy (ART) and its impact on adult mortality in a rural area of western Kenya with high HIV prevalence during a period of rapid HIV services scale-up.

Design: Adult medical chart data were abstracted at health facilities providing HIV care/ART to residents of a Health and Demographic Surveillance System (HDSS) and linked with HDSS demographic and mortality data.

Methods: We evaluated secular trends in patient characteristics across enrollment years and estimated proportions of HIV-positive adult residents receiving care. We evaluated adult (18-64 years) population mortality trends using verbal autopsy findings.

Results: From 2003 to 2008, 5421 HDSS-resident adults enrolled in HIV care; 61.4% (n=3331) were linked to HDSS follow-up data. As the number of facilities expanded from 1 (2003) to 17 (2008), receipt of HIV services by HIV-positive residents increased from less than 1 to 29.5%, and ART coverage reached 64.0% of adults with CD4 cell count less than 250 cells/μl. The proportion of patients with WHO stage 4 at enrollment decreased from 20.4 to 1.9%, and CD4 cell count testing at enrollment increased from 1.0 to 53.4%. Population-level mortality rates for adults declined 34% for all causes, 26% for AIDS/tuberculosis, and 47% for other infectious diseases; noninfectious disease mortality rates remained constant.

Conclusion: The initial years of rapid HIV service expansion coincided with a drop in adult mortality by a third. Continued expansion of population access to HIV clinical services, including ART, and program quality improvements will be necessary to achieve further progress in reducing HIV-related morbidity and mortality.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acquired Immunodeficiency Syndrome / mortality
  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Autopsy
  • CD4 Lymphocyte Count
  • Communicable Diseases / mortality
  • Delivery of Health Care / statistics & numerical data*
  • Female
  • HIV Infections* / drug therapy
  • HIV Infections* / mortality
  • Humans
  • Kenya / epidemiology
  • Male
  • Middle Aged
  • Mortality / trends*
  • Patient Acceptance of Health Care / statistics & numerical data*
  • Rural Health
  • Tuberculosis / mortality


  • Anti-HIV Agents