Pyne-Mercier Lee D, John-Stewart Grace C, Richardson Barbra A, Kagondu Njeri L, Thiga Joan, Noshy Haidy, Kist Nadia, Chung Michael H
Department of Global Health, University of Washington, Seattle, WA, USA.
AIDS Care. 2011 May;23(5):562-8. doi: 10.1080/09540121.2010.525615.
Over 1000 individuals were killed and 600,000 were displaced during post-election violence (PEV) in Kenya in 2008. Antiretroviral therapy (ART) depends on continuous access to medications which may have been interrupted due to PEV. In a mixed-methods retrospective review, treatment interruption of ART during PEV was measured among 2534 HIV-positive adults attending the Coptic Hope Center for Infectious Diseases in Nairobi, Kenya. Clients experiencing treatment interruption were compared between the PEV period (30 December 2007 to 28 February 2008) and the same time period one year earlier. Treatment interruption was defined as visiting the pharmacy ≥48 hours after antiretrovirals were calculated to have been completed. Despite clinical services remaining open throughout the PEV period, more clients (16.1%) experienced treatment interruption than during the comparison period (10.2%). Mean daily pharmacy visits were significantly lower (87 vs. 104; p < 0.006) and more variable (p = 0.03) during PEV. Among clients present at both periods (n = 1605), the odds of treatment interruption were 71% higher during PEV (95% confidence interval [CI], 34-118%). In multivariate analysis, men (odds ratio [OR], 1.37; 95% CI, 1.07-1.76) and clients traveling ≥3 hours to clinic (OR, 1.86; 95% CI, 1.28-2.71) were significantly more likely to experience treatment interruption. Clients affected by PEV were interviewed about factors associated with treatment interruption using semi-structured methods. Clients described fear, lack of transportation, and violence as contributing to treatment interruption. Widespread violence associated with the 2007 election in Kenya revealed the dependence of HIV patients on a stable civil society and infrastructure to access medications. Without the ability to maintain consistent HIV therapy, some patients face rapid treatment failure. HIV programs should have appropriate contingency plans wherever political instability may occur. Peace may be one of the most effective and most important public health interventions in Africa.
2008年肯尼亚发生选举后暴力事件（PEV），造成1000多人死亡，60万人流离失所。抗逆转录病毒疗法（ART）依赖于持续获取药物，而这些药物可能因选举后暴力事件而中断。在一项混合方法的回顾性研究中，对肯尼亚内罗毕科普特传染病希望中心的2534名艾滋病毒阳性成年人在选举后暴力事件期间抗逆转录病毒疗法的治疗中断情况进行了测量。将经历治疗中断的患者在选举后暴力事件期间（2007年12月30日至2008年2月28日）与一年前的同一时期进行比较。治疗中断被定义为在计算抗逆转录病毒药物已服完后≥48小时才去药房取药。尽管在整个选举后暴力事件期间临床服务仍在开放，但经历治疗中断的患者（16.1%）比比较期间（10.2%）更多。选举后暴力事件期间，平均每日药房就诊次数显著减少（87次对104次；p<0.006）且变化更大（p = 0.03）。在两个时期都就诊的患者（n = 1605）中，选举后暴力事件期间治疗中断的几率高出71%（95%置信区间[CI]，34 - 118%）。在多变量分析中，男性（比值比[OR]，1.37；95% CI，1.07 - 1.76）以及前往诊所路程≥3小时的患者（OR，1.86；95% CI，1.28 - 2.71）经历治疗中断的可能性显著更高。采用半结构化方法就与治疗中断相关的因素对受选举后暴力事件影响的患者进行了访谈。患者称恐惧、交通不便和暴力是导致治疗中断的原因。2007年肯尼亚选举相关的广泛暴力事件揭示了艾滋病毒患者对稳定的公民社会和基础设施以获取药物的依赖。如果无法维持持续的艾滋病毒治疗，一些患者会面临快速治疗失败的情况。无论何处可能出现政治不稳定，艾滋病毒项目都应有适当的应急计划。和平可能是非洲最有效且最重要的公共卫生干预措施之一。
