Abstract
HIV/AIDS pandemic in Sub-Saharan Africa is an epidemic. This is the case because out of the word’s HIV/AIDS infected population, 70% of this population resides in the region. The objective of this study was to analyse the HIV survival rate in Turkana County, a vast and remote region found in the northern section of the Kenyan Rift Valley. The study involved a sample of 1074 subjects that were urban and selected randomly from the Turkana district hospital database. The major variables were death and the time taken for the subjects to succumb to the HIV/AIDS virus. In addition to this, Kaplan–Meier and the Cox models were used to approximate the survival rates and the baseline relationship between variables. The study ascertained that the relationship between ART programs and HIV survival rates did exist and therefore the null hypothesis was rejected. However, it was difficult to pinpoint the exact factors that affect HIV survival rates in the county.
Introduction
HIV/AIDS is an international crisis whose management and consequent eradication has generated a lot of intellectual and public discourse. In the year 2008, it was estimated that “33.4million people were infected and living with the HIV virus”. Interestingly, 70% of this people are from sub-Saharan Africa. As such the region also attracts the largest number of causalities who succumb to the disease. It must be mentioned, than increase in “the access to antiretroviral therapy (ART) from 7% in 2004 to 42% in 2008 has played a crucial role in reducing the mortality rates as result of the disease in the Sub-Saharan region”. Based on this premise, the current scope of this thesis is to ascertain the survival rate of HIV patients in Sub-Saharan Africa. Specifically, the study shall be conducted in Turkana County, a remote region in the northern portion of the Kenyan Rift Valley.
Research Questions
i. What is the survival HIV survival rate in Turkana County?
ii. What factors determine the HIV survival rates in Turkana County?
iii. What are the implications of the HIV survival rates to the Sub-Saharan region?
Significance of the Research Questions
The objective of the study is to ascertain the HIV survival rates in Turkana County. As such the aforementioned research questions are statistically relevant to the scope of the thesis based on the fact that they shape the research methodology. This implies that the above mentioned questions shall be instrumental in gathering, processing and analysing quantitative data. In addition to this, these research questions shall hep determine whether the HIV/AIDS intervention measures in Turkana County and Sub-Saharan Africa are relevant or not. In other words, the research questions shall furnish the concerned parties with relevant information that shall make the fight against HIV/AIDS a surmountable challenge.
Hypotheses
H1<µ1=µ2>: ART programs in Turkana determine the HIV survival rates among adults in the county
H0<µ1≠µ2>: ART programs in Turkana do not determine the HIV survival rates among adults in the county
Participants and the Sampling Method
The research was conducted in Turkana County which is among some of the remote regions in the Sub-Saharan. The county has a population of 894,179people scattered across its jurisdictional boundaries. The HIV/AIDS prevalence rates in the county stand at 9% which is two points higher than the national average of 7%. This justifies the choice of the county for this study. The population in the county is largely rural and therefore has high illiteracy rates. A sample of 1074 antiretroviral naive patients was chosen from the Turkana district hospital database randomly based on their HIV/AIDS status. This figure was reached upon given the population of the county is close to one million and therefore i felt that was representative of the sample. The sampling criterion was based on the following key aspect.
First and foremost, it was a prerequisite for the patients to be HIV positive. Second, it was necessary that the patients be over the age of 18years old. This requirement is necessary given the age of informed consent in Turkana County and Kenya as a country is 18year and thereby it is unethical and illegal to use minors in any form of scientific research. Third, it was a requirement that the subjects have been recipient ART treatment in their previous two clinic visits. Finally, I excluded all the patients who had received ART treatment from other healthcare centres apart from Turkana district hospital for lack of CD4 count baseline. I was more concerned with urban population around Lodwar town because the rural population in Turkana County is not only inaccessible but also the health centres are few scattered greatly within the vast county. My objective was to reach as many as natives of the county a situation which was vey challenging but was overcome when the hospital personnel were involved in the study.
Procedure
My study used both primary and secondary data collecting techniques. As earlier mentioned, the sampling method is based on the secondary data available from the Turkana district hospital database. The primary data collection method was interviews. The decision to use interviews as the sole primary data collection technique was reached at because the subjects consisted of illiterate folks who could not fill in questionnaire. Secondly, due to language it made more sense to recruit the help Turkana district hospital employees. Finally as a result of financial constraints, it was more economically viable to use weekly patient clinic visits as an ideal platform for conducting the interviews. In addition, the interview method presented the least bias in the study.
The study was based on two variables of which one was dependent and the other independent. The independent variable was ART programs while the dependent one was HIV survival rates. The ART program is measurable in terms of the frequency the keeping their frequency information which was available in the district ART register. The HIV survival rate on the other hand was measured in terms of percentage of the subjects who survived as a result of the ART program. The variable used in the study used nominal as well ratio measurement scales. Finally my chosen alpha level for the research was 0.05. As a result, the main variables in this study were death and the duration taken for the patient to finally succumb to the HIV/AIDS virus.
Data Analysis
Statistical data analysis was based on the Epi-info 3.5.1 and STATA 10 packages. The choice of the two statistical packages was based on the fact that research period was three years and therefore the amount of data generated was staggering. In addition to this, as earlier mentioned the major variables in the study used both nominal and ratio measurement scales. The main variables of the research were death and the time taken for this phenomenon to occur. The time calculations were computed using the date of censoring, the lost-to follow-up date and transferred-out date among other parameters. This was further complemented by the analysis of the CD4 count and weight progression data collected on a bi-annual basis. Duration of time taken to die were measured in terms of time interval between the date of ART initiation and the date of event (death), the date transferred out (TO), the date of the first missed appointment for lost cases, and the date on which the patient completed the 24 months of follow up. Finally, the Kaplan–Meier and the Cox models were used to approximate the survival rates and the baseline relationship between variables. These models were chose because they were best placed to meet the objectives of the research questions. The test statistic value of the research was 0.03 which is lower than 0.05 implying that the null hypothesis was rejected.
Results and Discussion
As earlier mentioned, the test statistical value was 0.03. This figure is lower than the alpha value which was set at 0.05. This implies that the alternative hypothesis that ART programs in Turkana determine the HIV survival rates in the county does hold and therefore the null hypothesis is consequently rejected. These results only answered two of the three research questions; the fact that ART programs do determine survival rates and the consequent policy implications for stakeholders in the HIV/AIDS management sector in Sub-Saharan Africa. These results indicate that there exists a statistically significant relationship between ART programs and HIV survival rates. Relevant parties should therefore conduct to further research to determine how ART programs can be used to increase the HIV survival rates in Sub-Saharan Africa. Finally, it wasn’t easy to determine the specific factors that affect HIV survival rates which present another area for future research.
References
Alemu, A. W., & Sebastián, M. S. (2010). Determinants of survival in adult HIV patients on antiretroviral therapy in Oromiyaa, Ethiopia. Global Health Action 2010, 3: 5398 - DOI: 10.3402/gha.v3i0.5398 .
Arpadi, S. M. (2005). Growth failure in HIV-infected children. Durban, South Africa: World Health Organization.
Summers, A. (2005). Survival Analysis. London, UK: Oxford University Press.
