ARV treatment can work in poor communities

Two pilot antiretroviral (ARV) programmes, underway in South Africa and Uganda, have demonstrated that AIDS treatment campaigns are possible in poor communities. What's missing to scale-up these initiatives into national programmes is funding, and the political will, healthcare workers say. In a small rural health centre attached to Masaka hospital in southern Uganda, 53 people living with AIDS have been receiving ARVs since February. Three pills twice a day has made a dramatic difference to their lives, with an increase in CD4 cell (cells that orchestrate the body's immune response) counts and a general overall improvement to their health within three months of treatment. Dr Dickson Opul, of the Uganda Business Coalition that works with the Masaka clinic, said that the patients had to meet a number of criteria before treatment could begin. The volunteers had to be "clinically stable" and be able to walk unassisted. They had to attend regimen-adherence workshops, as well as demonstrate family support and the backing of community-based organisations. Three patients who initially started on the course subsequently died as a result of kaposi's sarcoma or cryptococcal meningitis. Opul explained that they had started their treatment too late. The remainder have managed to stay on the programme, with only three showing drug-related side-effects such as skin rashes. The Masaka findings have been replicated at the Ithembalabantu ("People's Hope") clinic in KwaZulu-Natal, South Africa. Out of 60 patients that started the programme this year, two have since died of pneumonia. But the rest have shown increased CD4 cell counts, weight gain, and improvement in thrush and skin conditions. Dr Paul Musoke, who runs the Ithembalabantu clinic, said the results were all the more impressive given the social stigma still attached to AIDS in the community. People living with the disease have to battle the ignorance of their neighbours, the poor care they receive from the public health system, and poverty. ARVs alone are not a solution to HIV/AIDS or the only way of managing infection. But the two pilot programmes, funded by the US-based AIDS Healthcare Foundation, have demonstrated that people from disadvantaged communities can stick with, and benefit from, ARV treatment when it is provided free of charge. "When death is around you [among family and friends], people have no trouble being adherent to the regimen," said Opul. "ARV therapy can be delivered successfully by an NGO-driven programme to an informed and educated rural patient population." For Opul, the key is the "enabling environment" that governments must create. "First and foremost is the need for the political commitment and the will to provide the guidance to involve NGOs and people living with AIDS in ARV or treatment-related programmes," he told IRIN. Governments in most African countries do not have the funds or the capacity to provide a national treatment programme without external funding and community-based partners. But, "you don't have to have the public health systems in place, NGOs can do it," said Opul. "We are a model of NGOs complementing the functions of the state. You need specialised NGOs with the necessary resources." At the opening of the XIV International AIDS conference in Barcelona on Sunday, Peter Piot, the head of UNAIDS, questioned why only 30,000 Africans were receiving ARV treatment when a hundred times that number needed it. His answer was the lack of political will at both the global and national level. "Treatment is technically feasible in every part of the world. Even the lack of infrastructure is not an excuse ... Ten billion dollars annually [for the Global Fund against AIDS] is all it will take for a minimum credible response to the epidemic. It is three times more than is available today." Piot also tackled the controversy over whether the priority of the Global Fund should be aimed at financing prevention or treatment. "Prevention and care are complementary not competing priorities," he said. "Prevention secures the future. Treatment saves lives and money immediately." Under the Masaka pilot programme, it cost US $740 to provide one patient with a year's supply of ARVs. But prices are falling, and therefore increasing the numbers of people that can be reached. Last year, the Indian generics manufacturer Cipla agreed to supply the Nigerian government with a three-drug ARV therapy at US $350 per patient per year. Fred Minandi, a farmer from Malawi who has benefited from a Medecins Sans Frontieres (MSF)-funded ARV programme explained: "For us [people living with AIDS] talking about prevention is too late. But we still have the right to be treated. Not only for me and my family, but for my entire country."