Data collected from the dead in Kenya show HIV is still killing more than expected despite reports of Aids decline and high use of antiretroviral drugs.
A study at two high volume mortuaries in Kisumu County shows up to 17 per cent of deaths were caused by HIV, questioning the effectiveness of the ARVs programme.
Either the medicines are not working, patients are not on medications as claimed, there is poor adherence of drugs or use of sub-optimal regimen, suggests the study.
For example, all the dead HIV positive children had unsuppressed viral loads. “This indicates that they were possibly not on ARVs, had just recently been initiated on the drugs, were not adhering to the medicines, were on a sub-optimal regimen, or were experiencing treatment failure.”
The study by Kenya’s Ministry of Health and the US Centres for Disease Control and Prevention among others had tested 851 bodies received at two major mortuaries in Kisumu for a three month period.
The study published in the journal Plos One early this month (1st July 2021) was carried out at Jaramogi Oginga Odinga Teaching and Referral Hospital and Kisumu County Referral Hospital mortuaries, both receiving more than 70 per cent of the dead in the region.
The team says over one quarter, 28.5 per cent of decedents received at the two facilities were HIV-positive.
Overall, HIV was considered the cause of death in 17 per cent of the population consisting of 19 per cent in adults and 11 per cent of children. At all ages, including children, HIV related deaths were higher in males than females.
“Our study documented a higher than expected prevalence of HIV infection among decedents received by the two high-volume mortuaries in western Kenya,” says the report.
This the researchers say is despite substantial scale-up of HIV services, indicating HIV disease remains a leading cause of death in western Kenya.
Estimates by Kenya’s National AIDS and STI Control Program (NASCOP) show HIV prevalence in adults to have reduced from 7.1 per cent in 2007 to 5.6 per cent in 2012 and to 4.9 per cent in 2019.
This decline is attributed to high ARVs coverage at 95.7 per cent viral load suppression at 88.4 and testing at 79.4.
The programme also indicates deaths to have declined from an estimated 64,000 in 2010 to about 28,500 in 2018.
However the current and an earlier similar study at Kenyatta National Hospital mortuary and the Nairobi City Mortuary in Nairobi suggests HIV related deaths to be much higher – more than expected.
The study seems to suggest that the high rates of testing, viral suppression and ARVs coverage published by NASCOP, may be erroneous
For example, while all hospital admitted patients are supposed to be tested for HIV, only a third had this status documented in the current study.
“It is a cause for concern that only about one-third of inhospital decedents had their HIV status documented in their medical records.”
The study also found a high proportion of decedents virally non-suppressed suggesting that many may not have been on ARVs or had failed treatment.
“Clearly, increased effort is required to diagnose all persons with HIV and assure rapid initiation of ARVs, adherence to treatment, and appropriate laboratory monitoring,” says the study.
The team found infected children were over ten times more likely to die than their HIV-uninfected counterparts.
This the study says is despite the country reporting that 80 per cent of HIV-infected children had been identified, 93.2 per cent were on ARVs, and 67.1 per cent virally suppressed
The authors attribute what looks like HIV programme failure probably to late ARVs initiation, drug resistance, poor adherence, and treatment interruptions.
Despite progress, the study recommends increased efforts to prevent and treat HIV infection and disease and avert deaths.
By Gatonye Gathura