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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)
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 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)
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)
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 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)
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)
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)
Administering and monitoring therapy is crucial to the battle against HIV/AIDS in sub-Saharan Africa. Electronic medical records (EMRs) can aid in documenting care, monitoring drug adherence and response to therapy, and providing data for quality improvement and research. Faculty at Moi University in Kenya and Indiana and University in the USA opened adult(More)
BACKGROUND Several commonly used antiretrovirals (ARVs) require dose adjustments to prevent toxicities in the presence of renal insufficiency. Because no prospective studies of the prevalence or risk factors for kidney disease in stable outpatient human immunodeficiency virus (HIV)-infected indigenous African populations have been published to date, it is(More)