1. The effect of changes in Kenya HIV guidelines on proportion of patients on ART and patient characteristics at initiation in Lumumba Health Centre, Western Kenya. The effect of changes in Kenya HIV guidelines on proportion of patients on ART and patient characteristics at initiation in Lumumba Health Centre, Western Kenya. Oyaro P 1, Armes MN 1,2, Dillabaugh L 1,2, Shade S 2, Cohen CR 1,2, Bukusi EA 1,2 UON Collaborative Meeting 21 st to 25 th January 2013 1. Family AIDS Care and Education Services (FACES), Research Care and Training Program, Center for Microbiology Research, Kenya Medical Research Institute, Kisumu, Kenya 2. Departments of Obstetrics, Gynecology and Reproductive Sciences; Pediatrics; Medicine; University of California San Francisco, San Francisco, CA, USA

2. Program Background  Family AIDS Care and Education Services (FACES) Family-focused program Collaboration between Kenya Medical Research Institute (KEMRI) and University of California, San Francisco (UCSF) Operational since September 2004 in Nyanza and Nairobi  FACES program areas Provider Initiated Testing and Counseling (PITC) Prevention of Mother to Child Transmission (PMTCT) HIV Care and Treatment Voluntary Male Medical Circumcision (VMMC)

3. Background  The Kenya National Guidelines on Antiretroviral Therapy (ART), guided by WHO guidelines, has rapidly evolved  Latest changes effected in September 2010 CD4 cut off of ≤250 cells/uL increased to ≤350 cells/uL WHO stage 4 broadened to both stage 3 and 4

4. When to start consortium Lancet,2009

5. Introduction

6. Study Objective  To determine the effect of the new guidelines on the proportion of patients initiating ART at a large clinic in Western Kenya

7. Lumumba HIV clinic

8. Study Methods  Retrospective cohort study at Lumumba Health Centre, Kisumu Adult patients ≥ 18 years Initiated on HAART prior to (October 2009 - April 2010) and after change in guideline (October 2010 - April 2011) Each patient followed up for one year Clinical outcomes followed for one year  Data abstraction from Open MRS and patient charts - demographic and clinical data  Chi-square and Wilcoxon-Mann-Whitney tests conducted for analysis

9. Results VariablesPrePostP-value Proportion initiating HAART13.2% (N=866) 25.3% (N=846) P<0.001 Median 6 months CD4 increase (cells/uL) 135151P<0.001 Median 12 months CD4 increase (cells/uL) 174154P<0.001 LTFU (≥ 3 months after the appointment) 23.7%14.1 %P= 0.003

10. Results  No difference in Median age in the two groups 32.5 vs 32 years  WHO Stage 2 was more common before guidelines changed (34.2%)  WHO Stage 1 was the most common stage following guideline change (39%; p=0.03)

11. Conclusion The latest change in the guidelines led to:  A higher proportion of the newly enrolled patients initiated on ART  Initiation at earlier/healthier WHO stage  Greater increase in median CD4 cell count at 6- months  Interestingly, there were fewer lost to follow- up patients with new guidelines

12. Acknowledgements  PEPFAR  CDC  MoH staff  FACES Staff  UON meeting organizers

13. End.