Socio-economic Determinants of Disease Progression among HIV Infected adults in Kenya

Abstract

Background: Socioeconomic determinants have been shown to have an effect on the progression of HIV diseaseevidenced by studies carried out largely in developed countries. Knowledge of these factors could inform onprioritization of populations during scale up of highly active antiretroviral therapy (HAART) constrained healthsystems. The objective of this study was to identify socioeconomic correlates of HIV disease progression in an adultKenyan population.Methods: We analysed data from 312 HIV positive individuals, drawn from a cohort enrolled in a randomizedclinical trial investigating the effectiveness of Acyclovir in the prevention of HIV transmission among serodiscordantcouples. In this study we included individuals with CD4 counts ≥350 cells/mm3and World Health Organization(WHO), clinical stage one or two. The exposure variables measured were: - daily household income available forexpenditure, age, gender, housing type and level of formal education. We used a composite outcome of diseaseprogression to WHO clinical stage 3 or 4 or a laboratory outcome of CD4 count below 350 cells/mm3after twoyears of follow-up. Logistic regression was used to determine associations of variables that were found to besignificant at univariate analysis, and to control for potential confounders.Results: Seventy eight (25 %) individuals reported HIV disease progression. Majority (79.9 %) were female. Themedian age was 30 year and 93.6 % had attained a primary level of education. Median CD4 at enrolment into theclinical trial was 564 cells/mm3; those who had disease progression were enrolled with a significantly (p< 0.001)lower CD4 count. Daily household income available for expenditure adjusted for CD4 count at enrolment wasassociated significantly (p= 0.04) with HIV disease progression. Disease progression was five times more likely tooccur in study subjects with daily income available for expenditure of less than US$1 compared to those with morethan US$ 5 available for daily expenditure [adjusted Odds Ratio 4.6 (95 % Confidence Interval 1.4–14.4)]. Diseaseprogression was not associated with age, gender, type of housing or level of education attained (p< 0.05).Conclusion: Populations with low household incomes should be considered vulnerable to disease progression andshould therefore be prioritized during the scale up of HAART for treatment as prevention.