Kenya is experiencing an alarming increase in advanced HIV disease cases despite the significant efforts made in the detection and treatment of HIV over the years.
According to the National Aids and STI Control Program (NASCOP), chief executive Rose Wafula, the disease, which is a severe stage of infection, is exposing patients to opportunistic infections such as menengitis, diarrhea, and Tuberculosis.
Dr Wafula attributes advanced HIV disease to treatment disruptions, which lowers a patient’s body immune system which results in opportunistic infections.
“HIV patients need a lot of support while on treatment. Being put on a lifetime treatment is not easy for example, people default on a five-day treatment, think of a lifetime one?” she asked.
World Health Organisation (WHO) defines advanced HIV disease as CD4 cell count <200cells/mm3 or stage 3 or 4 in adults and adolescents. All children younger than five years of age are considered to have advanced HIV disease, same as individuals new to antiretroviral therapy (ART) and those resuming treatment after a break.
According to a report by NASCOP, Kenya has made remarkable progress in combating HIV, but its prevalence still poses a public health challenge.
The percentage of adults (aged 15-49) living with HIV has dropped from around 10% in the mid-1990s to 4.9% in 2023. The report also revealed approximately 1.4 million people living with HIV. Among these, 1,350,447 were aware of their status, and 1,112,254 were on Antiretroviral Therapy (ART). However, only 1,024,795 had achieved viral suppression.
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This sudden surge in advanced HIV disease cases is largely attributed to factors such as delayed diagnosis, late initiation of treatment, and inconsistent adherence to antiretroviral therapy.
Nearly one-third of HIV patients seek care only after reaching advanced stages of the disease, which contributes to advanced HIV disease, particularly among men.
Unlike women, men often delay seeking medical services until the disease has advanced, making it hard to lower the viral load.
“Men only come for medication when they are very sick, at a time when they already have opportunistic infections,” Dr Wafula said.
Even with the antiretroviral therapy, people living with AHD are at high risk of mortality. Tragically, over 50% of HIV-related deaths are linked to advanced HIV disease.
The most common causes of severe illness and death are tuberculosis, severe bacterial infections and cryptococcal meningitis. The reluctance to seek treatment promptly is often influenced by stigma, lack of awareness, and restricted access to healthcare services.
WHO suggests providing a comprehensive set of interventions, such as screening, treatment, and prophylaxis for major opportunistic infections, along with rapid ART initiation and intensified adherence support interventions, to decrease morbidity and mortality in individuals with AHD.
The goal of the AHD package is to enhance access to essential medicines and diagnostic tools for managing prevalent sources of illness and mortality.
Following the Ministry of Health’s announcement regarding the implementation of a three-step HIV testing algorithm, Dr Wafula, highlighted that this shift aims to enhance testing accuracy.
WHO recommends this approach when a country’s HIV prevalence falls below five percent.
In this three-test method, a diagnosis of HIV is only confirmed after three consecutive positive tests. Though false positives are rare, they are more likely in low HIV prevalence areas, necessitating additional confirmation tests as prevalence decreases.
Dr Wafula also emphasized that individuals already on ARV treatment do not require retesting.
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