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Open Access Research article

Effect of Improved access to Antiretroviral Therapy on clinical characteristics of patients enrolled in the HIV care and treatment clinic, at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania

Sabina F Mugusi14*, Julius C Mwita2, Joel M Francis1, Said Aboud35, Muhammad Bakari2, Eric A Aris1, Andrew B Swai1, Ferdinand M Mugusi2, Kisali Pallangyo2 and Eric Sandstrom4

Author Affiliations

1 Department of Internal Medicine, Muhimbili National Hospital, Dar es Salaam Tanzania

2 Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam Tanzania

3 Department of Microbiology, Muhimbili University of Health and Allied Sciences, Dar es Salaam Tanzania

4 Department of Infectious Disease, Karolinska Institute, Stockholm Sweden

5 Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden

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BMC Public Health 2010, 10:291  doi:10.1186/1471-2458-10-291

Published: 28 May 2010

Abstract

Background

Sub-Saharan Africa has been severely affected by the HIV and AIDS pandemic. Global efforts at improving care and treatment has included scaling up use of antiretroviral therapy (ART). In Tanzania, HIV care and treatment program, including the provision of free ART started in 2004 with a pilot program at Muhimbili National Hospital in Dar es Salaam. This study describes the socio-demographic and clinical features of patients enrolled at the care and treatment clinic at MNH, Dar es Salaam, Tanzania.

Methods

A cross-sectional study looking at baseline characteristics of patients enrolled at the HIV clinic at MNH between June 2004 - Dec 2005 compared to those enrolled between 2006 and September 2008.

Results

Of all enrolled patients, 2408 (58.5%) were used for analysis. More females than males were attending the clinic. Their baseline median CD4 cell count was low (136 cells/μl) with 65.7% having below 200 cells/μl. Females had higher CD4 cell counts (150 cells/μl) than males (109 cells/μl) p < 0.001). The most common presenting features were skin rash and/or itching (51.6%); progressive weight loss (32.7%) and fever (23.4). Patients enrolled earlier at the clinic (2004-5) were significantly more symptomatic and had significantly lower CD4 cell count (127 cells/μl) compared to CD4 of 167 cells/μl in those seen later (2006-8) (p < 0.001).

Conclusion

Patients enrolled to the MNH HIV clinic were predominantly females, and presented with advanced immune-deficiency. Improved access to HIV care and treatment services seems to be associated with patients' early presentation to the clinics in the course of HIV disease.