Experts worry about high HIV deaths despite treatment

Top health officials are alarmed over high HIV death rates in Nairobi despite widespread coverage of anti-retroviral treatment.

The officials, who tested all bodies at the Kenyatta National Hospital and Nairobi City mortuaries for HIV, suggest the situation could be worse in the rest of the country.

Findings of the study contradict the official and donor narrative that Kenya is winning the war against the scourge.

The heads of the National Aids and STD Control Programme Dr Martin Sirengo, US Centre for Disease Control and Prevention–Kenya, Dr Kevin De Cock, and the Chief Government Pathologist Dr Johansen Oduor say this is a highly unexpected development.

Other senior officials involved in the study are from Kenyatta National Hospital, University of Nairobi‘s School of Medicine, Kenya National Bureau of Statistics, the University of California and Avenir Health both in the US and the Ministry of Health.

The study assessed the number of adults in Nairobi dying of HIV and compare the data with current official estimates.

Risk of death

The findings which appear in the journal Plos One shows almost 21 per cent of the dead at the two mortuaries were HIV positive with 16.1 per cent dying of the virus.

Although 73.6 per cent of HIV positive adults in Nairobi are on ARVs, the report says their risk of death in this group is four-fold greater than in the uninfected.

The study concludes that 16.1 per cent of all adult deaths in the city can be attributed to HIV infection, which is quite surprising.

Official ARV coverage statistics in Nairobi put this at 73.6 per cent, which is 61.1 per cent for males and 82.3 per cent for females with deaths estimated at 11.4 per cent. But with actual HIV related death rates shown to be at 16.1 per cent the authors say with the current high ARV coverage about one in six deaths should have been avoided. “Given the rapid increase in coverage of life-saving treatment, a commensurate decrease in mortality in HIV-infected populations would be expected,” says the study.

This situation undermines the official narrative that Kenya is winning the war against HIV. “This may help explain why HIV prevalence has not increased in recent years in spite of continued new infections and a rapid expansion of public HIV care and treatment services.”

To arrest or reverse the situation the authors suggest that more be done to diagnose those infected, expand ARV coverage and make sure patients are retained in treatment programmes. At an international HIV conference in Paris, France last month high rates of HIV treatment failure and infection with drug resistant strains in Kenya were reported.