The incidence and risk factors of mortality associated with HIV and TB infections in Kenya

  • Onyango, Dickens Otieno (PhD Student)
  • van der Sande, Marianne (Promotor)
  • Grobbee, Diederick E. (Promotor)
  • Yuen, Courtney (Copromotor)
  • Wandiga, Steve (Copromotor)

Project Details


Despite decades of progress, tuberculosis (TB) and HIV have remained significant public health challenges in Kenya. Kenya is currently ranked among the 30 countries with the highest TB incidence and prevalence. The HIV prevalence in Kenya was 5.6% in the adult population in 2012 according to a national survey. The two diseases have a symbiotic relationship. While HIV increases the incidence of TB, TB is the leading cause of death among people living with HIV/AIDS. Mortality is commonly used as an indicator of the health status of a population and in evaluating health interventions. Death represents the worst of all health outcomes and is least prone to bias. Data on causes of death in the general population and among TB or HIV infected people is necessary for designing mortality prevention interventions. Although mortality is known to be high among TB and HIV infected people in Kenya, there is limited information on the immediate and underlying causes of death in this group. The causes of death among HIV or TB infected people in high burden settings such as Kenya remains poorly characterized in the literature.
Data from case based surveillance of TB, electronic medical records of people on HIV care and the Child Health Mortality Prevention Surveillance (CHAMPS) provide an opportunity for more accurate understanding of mortality causes. CHAMPS is a 20-year, multi-country study with mortality reviews of children under the age of five; the objectives are to document the preventable causes of under-5 mortality, paired with immediate public health action to reduce future mortality. Study staff approach parents within 24 hours of a child’s death and ask them to consent to minimally invasive tissue sampling (MITS), along with medical record review and a verbal autopsy. This study will use data obtained from case based surveillance of TB, data from an active TB case finding study, electronic medical records of people on HIV care and data from the CHAMPS surveillance study in Kenya to provide insight on TB and HIV related mortality.
This study will use data from case based TB surveillance to estimate the incidence of HIV-related mortality among clients on TB treatment and risk factors for mortality. Data from an ongoing study (CHAMPS) will be used to estimate HIV and TB cause specific mortality rates and to explore the immediate and underlying causes of mortality among children aged under five years. This study will also seek to evaluate the impact of interventions that have the potential to reduce TB and HIV mortality. Timely detection of cases allows for prompt treatment thereby avoiding mortality. Active case finding of TB cases is a strategy promoted by the World Health Organization. A study to pilot accelerated TB interventions as part of efforts to reduce transmission and mortality from TB has is underway in western Kenya. Data from this study will be used to model facility level factors associated with a high TB and HIV yield during the active case finding pilot. These findings could inform interventions to improve TB and HIV case finding in health facilities. The implementation of test and treat of HIV was expected to improve patient outcomes including mortality. This study will evaluate the impact of test and treat on treatment outcomes like client retention and mortality using electronic medical record data of patients on HIV care before and after the policy change.
The theme of this study is on mortality from TB and HIV which are important global public health challenges. The third sustainable development goal (SDG) aims to achieve good health for all by 2030. Ending the HIV and tuberculosis epidemics and reducing under five mortality to 25 per 1,000 live births are some of the specific targets under this SDG goal. This study focusses on understanding mortality among adults and children aged under five years, a subject that is important to the achievement of SDG targets.
Effective start/end date3/07/1931/01/23

IWETO expertise domain

  • B680-public-health