In May 2015, the National AIDS & STI Control Programme (NASCOP) requested staff at the Kenya Medical Research Institute (KEMRI) Wellcome Trust Research Programme (KWTRP) to help offer a Test and Treatment (TaT) Programme for newly diagnosed Key Populations (KP) at the Malindi sub-County Hospital in Kenya. For purposes of this study, the HIV care continuum will be defined as the proportion of MSM, and FSW, who were newly diagnosed as HIV positive, registered at Comprehensive care clinic (CCC), and started Anti-retroviral Therapy (ART) within 4 weeks of diagnosis. So far this has included 73 MSM, and 84 FSW. At 6 and 12 months following ART initiation, viral loads will be assessed to determine the proportion of MSM, FSW, who have suppressed viral loads.
This project is part embedded in a larger protocol (SERU 3418; PI Dr. Makobu) – a prospective study that will characterise the HIV care and prevention continuum. My project will be a retrospective review of data collected, a description of indicators of the care continuum, and an analysis of adherence outcomes.
Viral load measured at 6 and 12 months will be treated as a multiple-failure outcome. Monthly-, or two monthly adherence will be measured as a time-varying binary outcome (≥90% vs. <90% of pills taken) by pill count. We will explore adherence measures over time and estimate adherence trajectories using generalised estimating equation (GEE) models.
Missed follow-up will be defined as failure of the client to attend scheduled clinic visits for 3 consecutive months. This will be based on the number of months the client is out of ART medication.
The outcomes of this project will help characterise the care continuum in MSM and FSW in Malindi hospital, and may help define factors that will be associated with ART adherence in MSM and FSW.