HIV status disclosure and ARV adherence among patients attending Jomo Kenyatta University comprehensive care clinic

Although Anti Retroviral Therapy (ART) is the single most important management of HIV infection, success in decreasing viral load depends on adherence to a strict regimen that requires taking the prescribed drugs daily at the specified times. Failure to daily intake of Anti Retrovirals (ARV) not only prevents treatment failure but may also lead to viral development of resistance to the drugs. The fact that HIV is mainly sexually transmitted means that it is associated with socially unaccepted practices such as premarital and extramarital as well as multiple sexual partners. Fear of such stigma related to these practices may thus prevent HIV status  disclosure and deny the patient social support that may be important inmanagement of the disease in general and adherence to ART in particular. This study was carried out in a three month period among 89 HIV positive patients attending Jomo Kenyatta University Hospitalf comprehensive care clinic (CCC). A questionnaire was administered to the patients to  investigate their knowledge regarding adherence and determine any association between disclosure of HIV and adherence. Their  socio-demographic characteristics were also documented and related to  adherence levels. The results indicate that although patients were aware of the importance of taking their medications on time, the adherence rateof 76% is below the recommended 95% optimum required for viral  suppression to undetectable levels. Those that had disclosed their status were more likely to be adherent than those that had not as indicated by a statistical correlation between disclosure adherence (P > 0.9). This study recommends that psychosocial support of HIV positive patients should emphasize disclosure as a strategy for increasing adherence to the required optimum levels.Key words: HIV, ART, ARV, disclosure, adherenc

A retrospective evaluation of proficiency testing, and rapid HIV test kits stock-outs among HTC facilities within Nairobi county

Background: Proficiency testing (PT) has been implemented as a form of External Quality Assurance (EQA) by the National HIV Reference Laboratory in Kenya since 2007 in order to monitor and improve on the quality of HIV testing and counselling HTC services.Objective: To compare concordance between National HIV Reference laboratory, and HIV testing and counseling (HTC) facilities.Design: A telephone survey was conducted to access consistencies in PT schemes. An independent EQA assessment questionnaire was developed and pretested on a randomly chosen sample of HTC facilities.Setting: HTC facilities selected from Client-initiated HTC and Provider initiated HTC facilities, within Nairobi County.Subjects: The HTC facilities were randomly selected (n = 45).Results: Inconsistencies and tremendous increase in non-participation in PT schemes. Gender χ² (5, N = 45) = 13.83; p= .017, experience using rapid test kits χ² (5, N =45) = 5.417; p = .020, and current facility ever participating in any PT scheme χ² (5, N = 45) = 15.38, p= .009, had significant effects in participation in PT schemes. Some facilities experienced test kits stock-outs most of the time (2.552 ≥ 3.777), while others sometimes (1.326 ≥ 2.551), t (43) =3.105; p= 0.003. However, there was no link between non participation in PT schemes and test kits stock-outs.Conclusion: The results generated by the study revealed inconsistencies in PT schemes and Test Kits stock-outs from 2012 up to May 2014. These findings will assist in the full adoption of HTC policy guidelines and ensure each and every HTC personnel participate in all PT quarters consistently. Challenges in forecasting, and quantification remains a major barrier to HTC supplies