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OBJECTIVES To assess whether community-based care delivered by people living with HIV/AIDS (PLWAs) could replace clinic-based HIV care. DESIGN Prospective cluster randomized controlled clinical trial. SETTING Villages surrounding 1 rural clinic in western Kenya. SUBJECTS HIV-infected adults clinically stable on antiretroviral therapy (ART). (More)
We evaluated performance, accuracy, and acceptability parameters of unsupervised oral fluid (OF) HIV self-testing (HIVST) in a general population in western Kenya. In a prospective validation design, we enrolled 240 adults to perform rapid OF HIVST and compared results to staff administered OF and rapid fingerstick tests. All reactive, discrepant, and a(More)
BACKGROUND AND OBJECTIVE The HIV/AIDS epidemic in sub-Saharan Africa is decimating populations, deteriorating economies, deepening poverty, and destabilizing traditional social orders. The advent of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) made significant supplemental resources available to sub-Saharan national programs for the(More)
BACKGROUND The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care,(More)
Health care for patients with HIV infection in developing countries has increased substantially in response to major international funding. Scaling up treatment programs requires timely data on the type, quantity, and quality of care being provided. Increasingly, such programs are turning to electronic health records (EHRs) to provide these data. We(More)
BACKGROUND A major obstacle facing many lower-income countries in establishing and maintaining HIV treatment programmes is the scarcity of trained health care providers. To address this shortage, the World Health Organization has recommend task shifting to HIV-infected peers. METHODS We designed a model of HIV care that utilizes HIV-infected patients,(More)
AIMS Dual epidemics of human immunodeficiency virus (HIV) and alcohol use disorders, and a dearth of professional resources for behavioral treatment in sub-Saharan Africa, suggest the need for development of culturally relevant and feasible interventions. The purpose of this study was to test the preliminary efficacy of a culturally adapted six-session(More)
Two-thirds of those with HIV worldwide live in sub-Saharan Africa. Alcohol use is associated with the HIV epidemic through risky sex and suboptimal ARV adherence. In western Kenya, hazardous drinking was reported by HIV (53%) and general medicine (68%) outpatients. Cognitive behavioral treatment (CBT) has demonstrated strong efficacy to reduce alcohol use.(More)
BACKGROUND The President's Emergency Plan for AIDS Relief committed $15 billion to addressing HIV in resource-poor settings. OBJECTIVE To assess the impact of The President's Emergency Plan for AIDS Relief on the treatment services of an HIV care program. DESIGN, SETTING, AND PATIENTS Cohort study utilizing computerized medical records of nonpregnant(More)
OBJECTIVES To determine the clinical and immunological outcomes of a cohort of HIV-infected patients receiving antiretroviral therapy. DESIGN Retrospective study of prospectively collected data from consecutively enrolled adult HIV-infected patients in eight HIV clinics in western Kenya. METHODS CD4 cell counts, weight, mortality, loss to follow-up and(More)