HIV treatment 'failing' in Africa

BBC News, Tuesday, 16 October 2007

More than a third of patients on HIV medication in sub-Saharan Africa die or discontinue their treatment within two years of starting it, a survey shows.

The study found that many were too late taking up anti-retroviral (ARV) drugs, while for some it was impractical to travel to distant clinics.

The US researchers also found evidence that in cases where patients had to pay for ARVs, some stopped treatment. But it showed success rates vary depending on the programme and country.

Daily stress
Details of the study by the Boston University School of Public Health are published online by the Public Library of Science.

The researchers looked at antiretroviral programmes for HIV patients in 13 sub-Saharan countries. They found that two years on from the commencement of treatment, only 61.6% of all patients were still receiving medication. The researchers say there are many reasons for the fall-out rate. Many patients were too late in taking up ARVs in the first place and died within a few months of commencing treatment. Other patients dropped out because of problems with accessing the drugs - they may live some distance, for example, from the clinic which provided the medication.

There was also evidence, the researchers say, of patients discontinuing treatment because of the cost of the drugs in those cases where patients were charged for their ARVs.
Boston University's Dr Christopher Gill says in many cases, taking the ARVs may take a back seat to more pressing daily needs. "Receiving the drug itself is a major investment of a patient's time, so if you live 8 km from the nearest clinic and have to go there once a month and you don't have a ready means of transport it's a huge investment of your own time," he told the BBC.
"And if you're feeling well and you're worried about other things in terms of finding enough to eat or maintaining a job or finding a job I suppose if you were feeling well you might be tempted to see treatment as being a second-order priority.

Poverty
For the director of the Association of People with Aids in Kenya, poverty, a lack of education and an element of stigma are all part of the problem. "If people are not well educated on how to take the drugs, then some patients fall out, and if they do fall out then they develop resistance," Roland Gomol Lenya told the BBC. "We find some people also suffer from stigma: in some workplaces, people are not able to carry their ARVs and take their ARVs freely at workplaces.
"I think there are also the issues of poverty, and the people who administer ARVs should also look at the poverty element, because sometimes because of poverty people are not able to access the centres. "The centres are normally far away from where people live, and that has been a problem." The study shows that retention rates between individual ARV programmes vary widely across Africa. One programme in South Africa retained as many as 85% of their patients after two years while another in Uganda retained only 46% of patients after the same period of time.

Study Finds HIV Infection Rate in Ethiopia Rose By 26 Percent

The rate of the number of people tested for HIV/Aids in Ethiopia since February-August 2007 and found to be positive showed 26 % increase; compared to similar test conducted from November, 2006 -January 2007, a report compiled in September, 2007 disclosed.

The report entitled Millennium Aids Campaign Ethiopia (MAC-E) prepared FHAPCO (M&E Department) states the plans and actual performances carried out on HIV council ling and testing, ART treatments and the momentum for the continuation of the campaign to the third phase where the first two are already completed.

According to the report, in the first phase of the campaign that lasted from Nov 2006-Jan2007, 705,619 people were tested for HIV/AIDS and 37,943(5.4%) were found to be positive.
In the second phase, out of the 982,452 people tested, 70,470 were found to be positive (7.3%), according to the report, which showed a 26% increase by the end of August 2007.

The two major objectives of the campaign in the first phase were testing 320,000 people and enrolling 22,000 new patients to ART service; and more than double were tested. The ART plan for new patients fell short of the set target 11,582 but nevertheless a substantial increase from the previous trend, the report states.

In phase II of the campaign, though it was planned to test and council 1.8 million individuals over the seven months period, 982,452 were actually tested (53%) and 31,359 new individuals started ART (77%) from the 40, 710 planned to initiate.

In a round table discussion prepared yesterday at Internews meeting room, Dr. Yibeltal Assefa, health program officer at HAPCO discussed about the plan for the third phase of the program and the comprehensive Universal Access Program (UAP) set for 2010. He said, "three million test kits are prepared for the new year which will render by far better testing and counseling services than the past years." Sensitization, social mobilization and community conversation are also the major areas of emphasis given in the third phase, according to the officer. In the (UAP), it is planned to achieve to have one health center one test post in each woreda o f the country, Dr. Yibeltal indicated.

Daily Monitor (Addis Ababa)NEWS

Posted to the web 8 October 2007

By Endale Assefa