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Session 65 Poster Session Antiretroviral Chemotherapy in Resource Limited Settings Session Time: 4:30-6:30 pm Room 4E-F

457-W. Review of Antiretroviral Therapy in the Private Sector in Nairobi, Kenya D. Macharia*1, G. Lule2, D. Silverstein2, G. Tesfaledet3, S. Patel4, D. M. Owili3, L. W. Chang5,6, L. Nganga1, K. M. DeCock1, and P. J. Weidle6 1CDC-Kenya, Nairobi; 2Nairobi Hosp., Kenya; 3Aga Kahn Hosp., Nairobi, Kenya; 4M.P. Shah Hosp., Nairobi, Kenya; 5Emory Univ. Sch. of Med. and Rollins Sch. of Publ. Health, Atlanta, GA; and 6CDC, Atlanta, GA Background: Though the majority of the HIV-infected Africans who are aware of their HIV status and for whom antiretroviral (ARV) medications are clinically indicated cannot afford them, some can obtain drugs through the private sector. Methods : We reviewed charts of patients who received ARVs from 5 private physicians in Nairobi, Kenya since October 1996. We analyzed prescribing practices, sustainability, and virologic response to ARV therapy. Patient status as of June 15, 2001, was recorded as: active in care; died; lost to follow-up; transferred care; stopped ARV; or moved. For analysis of sustainability of remaining on ARV therapy, patients were considered on therapy until their last visit to the physician or death unless they had stopped ARV therapy or were lost to follow-up. HAART was defined according to US DHHS guidelines (April 23, 2001). Results : We reviewed charts of 300 patients (41% women) - median age of 38 years (range 5-65 yrs), baseline CD4+ count of 89 cells/mm3 and viral load of 116,652 copies/mL, - who received ARVs for a median of 8.2 months (IQR 2.8-2). Of these, 217 (72%) were started on HAART. The number started on a HAART regimen from October 1 - December 31, 1996 was 3 (30%) of 10; in 1997, 22 (43%) of 51; in 1998, 35 (58%) of 60; in 1999, 45 (69%) of 65; in 2000, 48 (96%) of 50; and January 1 - June 15, 2001 was 64 (100%) of 64 (chi2 for trend, p<0.001). For the 83 patients not started on HAART, reasons were financial for 27, drug interaction with rifampin for 21, HAART not yet widely available for 15, other for 20. As of June 15, 2001, 159 (53%) patients were active in care, 45 (15%) lost to follow-up, 34 (11%) known to have died, 27 (9%) transferred care, 23 (8%) stopped ARV, and 12 (4%) moved. The probability of remaining on ARV therapy at 1 year was 0.78 (number under observation = 124) and at 2 years was 0.66 (number under observation = 66). Viral load was <400 copies/mL between 1-6 months for 45 (59%) of 76, 6-12 months for 26 (47%) of 55, 12-18 months for 20 (49%) of 41, and 18-24 months for 10 (32%) of 31. Conclusions: ARV prescribing in these private practices in Nairobi were consistent with international standards. Patients were treated with ARVs for an extended period of time and had demonstrable virologic responses. Efforts to train more practitioners, develop cheaper monitoring tests, and further reduce prices for drugs could increase the number of persons treated in the private sector in Kenya.

©2002 9th Conference on Retroviruses and Opportunistic Infections