Operations Research Around the Introduction of Antiretrovirals in the Management of HIV-infected Individuals in Mombasa, Kenya
The Council’s Horizons program tested an innovative DAART approach and compared it with the standard HAART approach in six health facilities in Kenya
A pilot project was initiated in Mombasa to introduce highly active antiretroviral therapy (HAART) in public health facilities where a major concern is the ability of patients to adhere to strict medication schedules. Horizons researchers tested an innovative directly administered antiretroviral therapy (DAART) approach and compared it with the standard HAART approach in six health facilities through a prospective, randomized, controlled study. Researchers also documented changes in sexual risk behavior and in stigma and discrimination perceived and experienced by HIV-infected persons receiving HAART; and examined the costs and economic impact associated with antiretroviral introduction. Study partners included the International Centre for Reproductive Health, the Coast Provincial General Hospital, FHI/IMPACT, Management Sciences for Health RPM Plus, and the University of Ghent.
A total of 234 HIV-infected treatment-naive patients (DAART: 116 patients, non-DAART: 118 patients) were enrolled and all received a non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimen. DAART patients received twice weekly observed medication and adherence support for 24 weeks, followed by routine monthly follow-up. Non-DAART patients received standard monthly follow-up. Follow-up was carried out at three treatment sites and six observation sites. Adherence was measured using clinic-based pill counts every month.
Key findings include:
- DAART was more effective in promoting adherence during the 24-week intervention period than standard of care, but the effect was not sustained post-intervention. DAART patients had greater improvements in body mass index and depression scores than non-DAART patients. Results suggest that DAART is effective for improving adherence in this setting, but the optimal length of the intervention for sustaining adherence and its transition to standard care may warrant further research.
- Perceived health improved, reported incidence of illness and use of health services declined, and labor force participation increased within 12 months of initiating therapy. These findings support the value of antiretroviral therapy (ART) in helping individuals be productive members of their households and society.
- There was no increase in unsafe sex among patients. However, there remained a risk of HIV transmission as a result of unprotected sex with an HIV-negative or unknown status partner. Safer sex counseling needs special emphasis in ART programs.
- Levels of internalized stigma decreased after 12 months on treatment. Participants also disclosed to a greater number of family members. Despite these positive changes, internalized stigma remains a problem for many respondents and warrants increased stigma reduction activities in the community.
Implementation of clinic-based modified-directly observed therapy (m-DOT) for ART: Experiences in Mombasa, Kenya (abstract)
Munyao,Paul; Luchters,Stanley; Chersich,Matthew F.; Kaai,Susan; Geibel,Scott; Mandaliya,Kishorchandra N.; Temmerman,Marleen; Rutenberg,Naomi; Sarna,Avina
AIDS Care 22(2): 187-194
Publication date: 2010
Changes in sexual risk taking with antiretroviral treatment: Influence of context and gender norms in Mombasa, Kenya (abstract)
Sarna,Avina; Chersich,Matthew F.; Okal,Jerry; Luchters,Stanley; Mandaliya,Kishorchandra N.; Rutenberg,Naomi; Temmerman,Marleen
Culture, Health and Sexuality 11(8): 783-797
Publication date: 2009
Safer sexual behaviours after 12 months of antiretroviral treatment in Mombasa Kenya: A prospective cohort (abstract) (PDF)
Luchters,Stanley; Sarna,Avina; Geibel,Scott; Chersich,Matthew F.; Munyao,Paul; Kaai,Susan; Mandaliya,Kishorchandra N.; Shikely,Khadija; Rutenberg,Naomi; Temmerman,Marleen
AIDS Patient Care and STDs 22(7): 587-594
Publication date: 2008
Sexual risk behavior and HAART: A comparative study of HIV-infected persons on HAART and on preventive therapy in Kenya (abstract)
Sarna,Avina; Luchters,Stanley; Geibel,Scott; Kaai,Susan; Munyao,Paul; Shikely,Khadija; Mandaliya,Kishorchandra N.; van Dam,C.Johannes; Temmerman,Marleen
International Journal of STD and AIDS 19(2): 85-89
Publication date: 2008
Short- and long-term efficacy of modified directly-observed antiretroviral treatment in Mombasa, Kenya: A randomised trial (abstract)
Sarna,Avina; Luchters,Stanley; Geibel,Scott; Chersich,Matthew F.; Munyao,Paul; Kaai,Susan; Mandaliya,Kishorchandra N.; Shikely,Khadija; Temmerman,Marleen; Rutenberg,Naomi
Journal of Acquired Immune Deficiency Syndromes 48(5): 611-619
Publication date: 2008
Changes in stigma among a cohort of people on antiretroviral therapy: Findings from Mombasa, Kenya (PDF)
Kaai,Susan; Sarna,Avina; Luchters,Stanley; Geibel,Scott; Munyao,Paul; Mandaliya,Kishorchandra N.; Shikely,Khadija; Temmerman,Marleen; Rutenberg,Naomi
Horizons Research Summary
Publication date: 2007
Impact of antiretroviral therapy on household economics: Findings from Mombasa, Kenya (PDF)
Homan,Rick; Jaikishan,Desai; Munyao,Paul; Sarna,Avina; Geibel,Scott
Horizons Research Summary
Publication date: 2007
Promoting adherence through a directly administered antiretroviral therapy strategy in Mombasa, Kenya (PDF)
Sarna,Avina; Luchters,Stanley; Geibel,Scott; Chersich,Matthew F.; Munyao,Paul; Homan,Rick; Kaai,Susan; Mandaliya,Kishorchandra N.; Temmerman,Marleen; Rutenberg,Naomi
Horizons Research Summary
Publication date: 2007
Sexual risk behaviors of HIV-positive persons receiving ART in Mombasa, Kenya: Longitudinal study findings (PDF)
Luchters,Stanley; Sarna,Avina; Geibel,Scott; Chersich,Matthew F.; Munyao,Paul; Kaai,Susan; Mandaliya,Kishorchandra N.; Rutenberg,Naomi; Temmerman,Marleen
Horizons Research Summary
Publication date: 2007
Operations research (PDF)
Kaai,Susan; Sarna,Avina; van Dam,C.Johannes; Hawken,Mark; Ritzenthaler,Robert
from Delivering Antiretroviral Therapy in Resource-Constrained Settings, pp. 105-112
Publication date: 2005
Adherence to Antiretroviral Therapy in Adults: A Guide for Trainers (PDF)
Horizons Program; International Centre for Reproductive Health; Mombasa Coast Province General Hospital
Publication date: 2004
Project Stats
Location: Kenya (Mombasa)
Program(s):
HIV and AIDS
Topic(s):
HIV care, support, and treatment
Stigma and discrimination
Duration: 5/2003 - 6/2007
Population Council researchers:
Scott Geibel
Naomi Rutenberg
Avina Sarna
Non-Council collaborators:
Bomu Mkomani Clinic
Government of Kenya
Likoni, Bamburi, and Magongo Health Centres
Mark Hawken (International Centre for Reproductive Health)
Marleen Temmerman (University of Ghent)
Ministry of Health
Port Reitz District Hospital
Rick Homan (Family Health International)
Stanley Luchters (International Centre for Reproductive Health)
Donors:
Management Sciences for Health RPM Plus
US Agency for International Development
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