Global Health

In Africa, Bringing AIDS Treatment Closer To Home

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Charles Kibe, right, a volunteer who works with HIV/AIDS-infected people in Nairobi. i

Charles Kibe, right, a volunteer who works with HIV/AIDS-infected people in the Korogocho slum in Nairobi, Kenya, attends a patient at a health clinic in December 2007. Simon Maina/AFP/Getty Images hide caption

toggle caption Simon Maina/AFP/Getty Images
Charles Kibe, right, a volunteer who works with HIV/AIDS-infected people in Nairobi.

Charles Kibe, right, a volunteer who works with HIV/AIDS-infected people in the Korogocho slum in Nairobi, Kenya, attends a patient at a health clinic in December 2007.

Simon Maina/AFP/Getty Images

The latest United Nations figures show that 35 percent more people in developing countries are receiving life-saving medicines for AIDS and HIV. But across Africa, fewer than half those who need treatment are getting it.

Meanwhile, funding for such treatment — much of which comes from the United States — is under serious pressure.

Recent research has focused on cheaper, simpler ways to deliver HIV/AIDS treatment in Africa. In the largest HIV clinical trial done yet in Africa, scientists say they found that patients gain little benefit from the expensive routine lab tests used to monitor AIDS treatment in wealthier countries — because most have to travel too far for the tests.

On a recent day at the HIV clinic at Patongo in northern Uganda, more than 100 people were waiting for medical attention. The district is typical of much of Africa, with vast distances, scattered villages and often impassable dirt roads.

Yet the clinic is the only place distributing life saving anti-viral medicines to a region where 14 percent of the people have the AIDS virus. So villagers make great efforts to get to the clinic.

Among those waiting were Christine Achan and her new baby. A week after giving birth, Christine had just walked almost 40 miles from her village to get the medicines she needs to treat AIDS.

"It takes me two days to get here and two days go get back," she said. "It is very difficult. But I do this because I want to be healthy so that I can look after my children."

Christine's husband died of AIDS three months earlier. Christine said many others in her village also have AIDS, but aren't getting help.

"I try to persuade them to come for treatment," she said. "But they find it very difficult to travel this far. Some have died because of this. My sister-in-law died recently."

One of the reasons that Christine and others can't turn to clinics in their own villages for drugs is that many current protocols demand patients undergo regular blood tests to make sure the medicines are working and to check for side effects.

But the tests are expensive and require sophisticated laboratories that are only available in some African cities.

The clinical trial data showed scientists in Uganda, Zimbabwe and Britain that the blood tests do little to extend survival rates. Doctors working on the study — known as DART (Development of AntiRetroviral Therapy in Africa) — say they have shown it is safe to give treatment in village clinics, rather than make patients to travel to centers with laboratories.

"In a village clinic like this, after we have trained health care workers and we are providing close supervision and support, we are able to provide HIV treatment to many more patients close to where they live," said Dr. Cissy Kityo, one of the DART investigators.

It's a controversial approach. When the results were released at this month's international AIDS conference in South Africa, some said the strategy would create a double standard of treatment between rich and poor nations.

But doctors at the centers where the research was carried out say that unless funding for AIDS is increased dramatically, routine testing will mean having to turn away some of those needing treatment — something that is already happening.

Most of the treatment in Uganda, for instance, is paid for by PEPFAR (The United States President's Emergency Plan for AIDS Relief), the special fund set up in 2003 by the Bush administration. But PEPFAR programs in the country are being told not take on new patients.

At the Joint Clinical Research Center in Kampala, a woman with a two-month-old baby was able to get treatment for her own case of AIDS. But there was no place in the adult program for the baby, even though the baby is showing the first symptoms of AIDS. The woman has no money to pay for medicines, so she is planning to go back to her village.

The clinic's adherence officer, Helen Nakyambadde, said the case is typical.

"I must say the patients are desperate," Nakyambadde said. "One patient said 'It looks like you guys have decided that my wife dies, but I will continue living because you cannot take her into care.' I remember all I said was: 'No, we love both of you, but our hands are tied because of limited funding.'"

The center's director, professor Peter Mugyenyi, has recently been in Washington to argue against the policy of capping numbers of patients. He says that recent findings like the DART study show that they can make existing budgets go farther.

"Everybody appreciates that there is a global financial crisis," Mugyenyi said. "DART has shown that there could be some savings out of not doing unnecessary tests and the savings from this could go towards treating an increasing number of patients who are in desperate need for their very survival."

At least 4 million more Africans currently need AIDS treatment. Without the medicines they will almost certainly die. Doctors facing this crisis say they hope more funding can be found. But they say they will also need to learn to treat more people for less money.



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