ART can successfully tackle advanced disease in resource poor settings, reports MSF

Preliminary results of a study of antiretroviral treatment (ART) provided by Médecins Sans Frontières as part of a package of services available at three government-run primary health care centres of a poor South African township, suggest that ART can be successfully used to tackle advanced disease in a resource-poor setting.

Toby Kasper of MSF made a presentation about treatment using Brazilian-made generic ARVs at three dedicated HIV clinics in Khayelitsha, a poor township about 30km from Cape Town.

MSF started the clinics with 3,000 patients in April 2000. They offer triple therapy together with CD4+ T cell and viral load counts. Third line treatment is quadruple therapy.

Patients with advanced disease (CD4+ T cell counts <200, WHO stage 3/4) were eligible for the programme and 180 were enrolled, all with poor health and few with prior ARV experience.

Kasper reported that 88% were still living after nine months. There was no control group “but we are sure there would be many more deaths without therapy”. He said the incidence rates of OIs were 69% less, with TB 85% less, than studies show in non-treated people. He reported substantial increases in CD4 T cell counts and lower viral loads after six months.

Kasper commented: “Recently there have been a number of articles published suggesting that treatment and prevention are diametrically opposed. Our experience in Khayelitsha is precisely the opposite. What we see is treatment promoting prevention and prevention promoting treatment.”

Kasper said the patients, the provincial government, the University of Cape Town and the Treatment Action Campaign were partners in the project and then he explained the process for selecting participants. Doctors made the first selection on the basis of the diagnostic assays. The second phase, to decide which of those eligible would actually receive treatment, was made by community-based groups.

The treatment was provided free to patients together with an adherence support programme, and Kasper added: “MSF believes the government could be doing a lot more to provide ART. There is a lot of health care capacity in South Africa. There is a lot more that could be done than is being done now.”

The authors conclude: “These results support calls to expand access to antiretrovirals in developing countries.”

T Kasper1, K Hilderbrand1, N Tshabane et al. Antiretroviral therapy in primary health care centers in a South African township. XIV International AIDS Conference, Barcelona, 7-12 July. Abstract MoOrB1095.