The impact of the President's Emergency Plan for AIDS Relief on expansion of HIV care services for adult patients in western Kenya

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 adults enrolled into the Academic Model for the Prevention and Treatment of HlV/AIDS system, in western Kenya between 27 November 2001 and 24 July 2006. Main outcomes measures: Number of clinics and patients enrolled in Academic Model for the Prevention and Treatment of HIV/AIDS, as well as patient demographics, immunologic, and clinical characteristics during three periods defined by the availability of combination antiretroviral therapy (cART). Results: Enrollment as of May 2006 was 23 539. Mean monthly enrollment increased from 64 to 815 between periods 1 and 3. The median CD4 cell count at enrollment during period 3 (172 cells/mu l) was significantly higher than for period 2 (119 cells/mu l; P<0.001). World Health Organization stage at enrollment differed significantly between periods with 6.7% having stage 4 disease in period 3 compared with 13.8% during period 1 (P<0.001). Significantly more patients had complete documentation of cART eligibility, during period 3 as compared with the previous periods. Time from enrollment to cART initiation decreased from a median of 64 weeks in period 1 to 12 weeks during period 3 (P < 0.001). Conclusion: The President's Emergency Plan for AIDS Relief funding has allowed Academic Model for the Prevention and Treatment of HIV/AIDS to significantly increase the number of individuals receiving HIV care and provided the ability to expand services allowing for identification of patients earlier in their disease process. (C) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins