Kenya is experiencing an alarming rise in the number of individuals presenting with advanced HIV disease (AHD), with up to a third of all new HIV diagnoses being in the advanced stages of the disease. At this stage, known as AIDS, patients are at an elevated risk of opportunistic infections and death, prompting concern from health officials and organizations working in the field of HIV care.
Dr. Lazarus Momanyi, a technical assistant at the National Aids and STIs Control Programme (Nascop), noted that men are disproportionately affected by AHD due to poor health-seeking behaviors. Many men delay seeking medical assistance until they are seriously ill, which exacerbates the progression of the disease. “People living with advanced HIV disease often present themselves to care when they have very low CD4 cell counts and are at a higher risk for disease progression, development of opportunistic infections, and death,” Dr. Momanyi explained.
Advanced HIV disease is defined by a CD4 cell count of less than 200 cells per cubic millimeter or the presence of severe clinical symptoms, categorized by the World Health Organization (WHO) as stage 3 or 4 events, otherwise known as AIDS. Tuberculosis, severe bacterial infections, and cryptococcal meningitis are the most common causes of severe illness and death among individuals with AHD.
In Kenya, people presenting with AHD include those who are newly diagnosed with HIV, those who have interrupted their antiretroviral therapy (ART) and returned to care, or those experiencing treatment failure. Children under five years of age with HIV are automatically considered to have AHD, though children who have been on treatment for over a year and are clinically stable are not categorized as such.
To combat this growing challenge, Kenya has designated at least 140 health facilities to handle the increasing number of AHD cases. These centers were selected by counties with support from Nascop and are equipped to provide comprehensive care for patients with advanced HIV disease. According to Dr. Momanyi, these facilities are hospital-level centers with the capacity to manage critically ill AHD patients. “Each centre must have a trained medical officer and proper laboratory capacity to monitor renal function, complete blood count, biochemistry, and other relevant diagnostics,” he stated.
These facilities will also serve as referral sites for patients requiring hospitalization and frequent monitoring, particularly for those suffering from opportunistic infections such as cryptococcal meningitis. This initiative is part of a broader strategy to improve the management of AHD and ensure that patients receive timely and appropriate care.
The increasing number of AHD cases represents a reversal of the progress Kenya had made in reducing advanced HIV cases over the years. Nelson Otwoma, chairperson of the National Empowerment Network of People Living with HIV/Aids in Kenya (Nephak), voiced concern about the growing trend of HIV-related deaths. “We are still seeing people not taking up HIV testing, delaying testing, or doing it when it is too late, particularly men. By the time they are diagnosed with advanced HIV disease, their immune systems are severely compromised,” he said.
Nephak is the umbrella organization for people living with HIV in Kenya and has been actively involved in advocating for better care and support for those with AHD. The organization is also working closely with the Global Network of People Living with HIV (GNP) to promote sexual and reproductive health, human rights, and the empowerment of people living with HIV.
The World Health Organization recommends a package of interventions to address advanced HIV disease, including screening, treatment, and prophylaxis for major opportunistic infections, rapid ART initiation, and intensified adherence support interventions. Dr. Momanyi emphasized the urgent need for healthcare workers to optimize early detection and diagnosis of AHD by implementing effective screening protocols.
“Going forward, healthcare workers will use CD4 tests to identify AHD while screening all newly diagnosed people living with HIV (PLHIV), those returning to care after treatment interruptions, and those with suspected treatment failure,” Dr. Momanyi said.
Kenya is currently in the process of finalizing its AHD implementation plan, which will provide guidance to healthcare workers on ensuring access to screening, treatment, prophylaxis, and linkages to other healthcare services for patients with advanced HIV disease. The plan aims to bolster efforts to improve the quality of care and outcomes for people living with HIV, especially those at risk of AHD.
As the country continues to grapple with rising cases of advanced HIV, it is critical to address barriers that prevent timely diagnosis and treatment, particularly among men, to reverse the growing trend and ensure improved health outcomes for all individuals living with HIV.
