| dc.description.abstract | Despite widespread Antiretroviral Therapy (ART) availability, patients put on treatment suffer early mortality due to a number of factors. The Clinic-based ART Diagnostic Evaluation (CLADE) study is an open label, randomized control trial (RC'f) evaluating feasibility and superiority of2 ART treatment monitoring approaches in treatment-naive adults in district-level, non-research clinics in rural Kenya. A secondary objective is to examine baseline characteristics and mortality outcomes. Descriptive summary statistics and multivariate logistic regression (RR, 95% CI) are used to evaluate baseline characteristics and relationships with 6 month mortality. 820 adults were enrolled in the study (57.6% female, Mean age=37.6 (SD 9.0) years) with advanced disease: Mean CD4 count =166 (SDI06) cells/rum', Mean Viral Load = 231,901 (SD 246,242) copies/ml, WHO Stage III or IV= 28.8%, and Body Mass Index (BMI) <18.5=23.3%. 818 (99.7%) of those enrolled started ART treatment and were followed up in the study. Overall there were 70 deaths in the study (8.6%), the majority occurring within 6 months of initiating ART (80.0 %,).
There was no significant study Arm differences (p=O.I) at 6 months. Univariate Logistic regression showed CD4 count (p<O.OOOI), Viral Load (p=0.0~6),
World Health Organization (WHO) Staging (p<O.OOOI), Body Mass Index (BMI p<O.OOOl) and Hemoglobin (Hgb p=0.005) were independently associated with early mortality. In Multivariate analysis WHO staging (p=0.045) and Hemoglobin (Hgb p=0.023) levels were the only significant factors predicting early mortality controlling for CD4 count result, viral load and Body Mass Index (BMI). and early initiation of ART treatment. Intervention measures to deal with malnutrition and anemia need to be put in place to improve survival and anemia need to be put in place to improve survival. Early Mortality still remains a challenge in HIV positive patients starting ART in rural clinics of South Rift Valley, Kenya. However this can be reduced by early HIV diagnosis | en_US |
