Little is known about how to implement complex HIV-1 treatment programmes in resource-limited countries. Paul Weidle from the Centers for Disease Control and Prevention, USA, and colleagues from Uganda assessed the UNAIDS/Uganda Ministry of Health HIV Drug Access Initiative—one of the first pilot antiretroviral programmes in Africa—in which patients paid for their medications at negotiated reduced prices.
912 patients were treated at five Ugandan centres; the investigators assessed the care of 476 patients at three centres, of whom 399 started antiretroviral therapy. Most patients accessed care at an advanced stage of HIV disease (median CD4 cell count 73 cells/mm3; viral load 193 817 copies/ml). Half the patients (51%) received highly active antiretroviral therapy (HAART), just under half (47%) received dual nucleoside reverse transcriptase inhibitors (2NRTIs), and 2% received a single NRTI.
An effective system for medical care and drug distribution was implemented resulting in an uninterrupted supply of drugs that supported sustainable management of patients. Patients returning for visits reported good adherence to treatment and achieved beneficial virologic and immunologic responses similar to those seen in more developed settings. The percentage of patients surviving and staying on therapy at six months was 63% and at one-year was 49%. Those with most advanced disease, a CD4 white blood cell count of less than 50 per microlitre of blood, were nearly three times as likely to die.
Paul Weidle comments: "This pilot programme showed that AIDS patients in a developing country can be managed successfully with antiretroviral therapy. Promoting access to therapy earlier in the course of the patient's disease, increasing the use of HAART, and finding solutions to reasons for discontinuing therapy would further improve patients' outcome in this setting. Although limited in scope, this pilot initiative provides valuable information for expanding access to antiretroviral therapy throughout Africa, despite the many challenges that will be faced along the way. In this way, effective AIDS care can reach more of those in need."
Contact: Communications Office, CDC's National Center for HIV,STD, and TB Prevention; T) +1 404 639 8895
Journal
The Lancet