Calmy A, Goemaere E, Durier N; International Conference on AIDS (15th : 2004 : Bangkok, Thailand).

Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. ThPeB7231.

Medecins sans Frontieres, Geneva, Switzerland

Issues: ARV treatment in resource-poor settings has been proven possible. However, the challenge is now to implement these programs on a larger scale. We aim to show which models MSF has used in providing ARVs in its projects. Description: We analysed 10 MSF projects in Africa and Asia representing more than 6000 ARV treated patients. Projects are in rural or in urban settings. Lessons learned: Access to care is free and is provided through HIV clinics. Where existing, all services (antenatal care, out- and inpatient department, home based care, TB care) are linked to voluntary counselling and testing in order to create multiple entry points to care. Patients were eligible for ARV treatment according to WHO guidelines. Prior attendance to the clinic is a common eligibility criteria. The simplification of the selection process is ongoing; in 2 places CD4 counts are no longer used in determining who receives ARVs in stage 4 patients. First line treatment is 3TC/d4T/NVP in fixed dose combination (FDC) in 9 out of 10 projects. ART follow up on biological toxicity indicators is no longer systematic. Viral load is carried out for treatment monitoring in 2 projects only. Optimal use of human resources is a challenge. Training of nurses for follow up and staging has become an urgent need. Standardized guidelines are used in every clinic. In Malawi, the program is decentralized through a mobile clinic in one district; plans are made to ensure follow-up of ARV treatment in health centres. Recommendations: In order to simplify treatment and scale up access to ARV in resource-poor settings, the use of FDCs, standardized protocols for initiation of treatment and follow-up, and training of nurses are essential. Access to care depends on the multitude of entry points and on free treatment. The MSF AIDS care package model is adaptable to a number of settings and populations.

Publication Types:

• Meeting Abstracts

Keywords:

• Acquired Immunodeficiency Syndrome
• Africa
• Antiretroviral Therapy, Highly Active
• Asia
• CD4 Lymphocyte Count
• Counseling
• HIV Infections
• HIV Seropositivity
• Health Resources
• Humans
• Malawi
• Models, Biological
• Poverty
• Research Design
• drug therapy
• therapy

Other ID:

• GWAIDS0036795

UI: 102281011

From Meeting Abstracts