Evaluation of the performance and the effects of the Antiretroviral Programme in Machakos and Mbagathi District Hospitals
Imbanga, Andes Z.
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The performance and the effects of antiretroviral therapy (ART) program at Machakos and Mbagathi district hospitals have not been evaluated since initiation in 2003. The aim of this study was to assess the performance and the effects of the ART program in the two hospitals. This was a retrospective cohort study with a cross sectional design at the two health facilities. Through an exit interview, 368 patients were used to assess the ART programme uptake and constraints. One hundred and sixty of the 368 patients and 80 referents who consented to a blood draw of five milliliters were used to assess the effects of HIV infection and antiretroviral therapy on some selected hematological and biochemical parameters. Hematological parameters were estimated using an MS4 Coulter counter while the biochemical parameters were determined using Reagent kits and optical densities read using Spectrophotometer 5010 Reader. Results from retrospective studies indicated an increase in the quarterly ARV drug uptake in the two facilities while the constraints militating against the ART program included additional costs such user and transport fee, long waiting times, and stigma and discrimination. Results also show that HIV infected naive subjects had reduced levels of weight, hemoglobin (Hb), mean corpuscular hemoglobin concentration (MCHC), packed cell volume (PCV), red blood cell count (RBC), white blood cell count (WBC), alanine transaminase (ALT), urea, creatinine (cr) (Mbagathi), and raised levels of mean cell volume (MCV), ALT (Machakos), and cr compared to referent subjects; HIV infected antiretroviral drug treated subjects at Mbagathi hospital had increased levels of weight, Hb, MCHC, PCV, RBC, MCV, and reduced levels of WBC, ALT, cr, and urea compared to those of HIV infected naive subjects while HIV infected antiretroviral treated subjects at Machakos hospital had the measured weight and hematological and biochemical parameters similar to those of the HIV infected naive subjects. In conclusion, ART uptake is moving towards the national target of 140,000 by 2008 in the two study sites but multiple constraints impede the programme performance, especially in Machakos. This in turn, may affect optimal adherence among ART clients resulting in resistance to first-line ARVs, and recourse to second-line ARVs, which are more costly. Hematological findings observed between HIV naive and referent subjects in Machakos suggest that locally circulating subtypes have developed resistant to the drug combination containing Stavudine, Lamivudine and Nevirapine which is being used. This calls for replacement of this drug combination and mapping of the circulating HIV genotypes in rural health facilities in the country.