Nascop sounds alarm over rising cases of advanced HIV

Up to a third of all people being diagnosed with HIV in Kenya are already in advanced stages of the disease, the onset of Aids.

At this stage, the patients are at an extremely high risk of opportunistic infections and death.

Dr Lazarus Momanyi, a technical assistant at the National Aids and STIs Control Programme, said men are most affected, mainly due to their poor health seeking behaviour. They wait until they are sick before seeking help.

“People living with advanced HIV disease often present themselves to care when they have very low CD4 cell counts and are at a higher risk for disease progression, development of opportunistic infections, and death,” Momanyi said.

Advanced HIV disease is characterised by a CD4 cell count of less than 200 cells/mm³ or the presence of severe clinical symptoms categorised as WHO stage 3 or 4 events, what is called Aids.

The most common causes of severe illness and death for people with AHD are tuberculosis, severe bacterial infections and cryptococcal meningitis.

Kenyans presenting with AHD include individuals who are new to antiretroviral therapy, those who have interrupted their treatment and returned to care, or those experiencing treatment failure.

“For adults and children above five years, advanced HIV diseases is defined as CD4 cell count of less than 200cell/mm3 or WHO stage 3 or 4 event. It includes both ART naïve individuals and those who interrupt treatment and return to care and those on ART with treatment failure. All children younger than five years old with HIV are considered as having advanced HIV disease, although children who have been on treatment for over a year and are clinically stable are not considered to have AHD,” Momanyi said.

At least 140 health facilities have been designated to handle the growing number of people presenting with advanced HIV disease.

The centres were selected by counties with support from Nascop. The new centres are hospitals equipped to provide all the care the patients need.

“They are hospital-level facilities, where comprehensive packages of AHD care can be implemented with clinical expertise in management of critically unwell AHD patients,” Momanyi said.

Each centre must have a trained medical officer and proper laboratory capacity to monitor renal function, complete blood count, biochemistry and other relevant diagnostics.

“They will serve as referral sites and will manage patients in need of hospitalisation and regular monitoring, such as treatment of cryptococcal meningitis.”

Dr Momanyi spoke in Machakos at a meeting organised by the National Empowerment Network of People Living with HIV/Aids in Kenya (Nephak) to engage journalists, technical experts, and communities on ways to support persons living with HIV or AHD.

The meeting was part of Nephak’s advocacy activities supported by the Global Network of People Living with HIV.

GNP’s main agenda covers sexual and reproductive health, human rights and empowerment of people living with HIV.

Nephak chairperson Nelson Otwoma said the new trend is reversing gains Kenya had made in almost ending advanced HIV. Nephak is the umbrella association for Kenyans living with the virus.

“HIV related deaths are coming back because we are still seeing people not taking up testing of HIV, delaying testing or doing it when it is too late, particularly men. Men are coming to care too late. By the time they are diagnosed with advanced HIV disease, their immune systems are severely compromised. We need to address the barriers that prevent men from accessing care early,” Otwoma said.

WHO recommends a package of interventions including screening, treatment and prophylaxis for major opportunistic infections, rapid ART initiation, and intensified adherence to support interventions.

Momanyi said there was an urgent need to optimise early detection and diagnosis of AHD by implementing effective screening.

“Going forward, healthcare workers will use CD4 tests to identify AHD while screening all newly diagnosed PLHIV, those returning to care after treatment interruptions and those with suspected treatment failure.”

Kenya is working on AHD implementation plan, which is still in its draft stage. The will guide healthcare workers to ensure access to common opportunistic infections screening, treatment and prophylaxis and linkages to other healthcare services.