Early, rural-based HIV care offers hope in Africa

Treating HIV patients in remote areas of Africa soon after they are infected and using community care teams instead of doctors can cut costs and help people live longer than those treated later, a charity said on Thursday.

Medecins Sans Frontieres (MSF) said research in Mozambique and in Lesotho, where 23 percent of adults have HIV, suggested implementing early treatment cut death rates and made it easier for patients to keep taking their drugs.

"Treating people before they get very sick is better for the individual, better for the community and actually lessens the burden on the health system," Helen Bygrave, a doctor working with MSF in Lesotho, told an AIDS conference in Vienna.

Several high-profile speakers at the Vienna AIDS conference have called for a new efficiency drive in global AIDS care, saying that in tough economic times, it is important to squeeze value out of every dollar of donor funding.

MSF said an analysis of 1,128 patients in rural Lesotho found that patients were 70 percent less likely to die within two years than patients treated later.

It also found patients treated early were 60 percent less likely to need expensive hospital care compared with those who start treatment when their disease was already advanced.

AIDS DRUGS

The strength of a person's immune system is measured by CD4 cells and this measure is used by doctors to assess when HIV patients should start receiving AIDS drugs. WHO previously recommended starting treatment when a CD4 count dropped below 200 but it now advises starting treatment at 350 or below.

In a second programme involving 1,400 people in Mozambique where HIV patients formed community groups so that only one of them needed to travel to the health clinic each month to get the AIDS drugs for the entire group, MSF found that patients remained healthy and stuck to their medicines programmes.

After 13 months, less than three percent of patients had died, and less than one percent had stopped taking their drugs.

Around 67 percent of the 33.4 million people with HIV globally are in sub-Saharan Africa.

Nathan Ford, MSF's medical coordinator, said the charity had noticed during its work in Mozambique that transport costs and distance to health clinics were preventing many HIV patients from getting their AIDS drugs and sticking to treatment.

"By overcoming this requirement that healthy patients, who are stable on medication, have to go to a clinic every month to pick up drugs, and instead ensuring that those medicines are available in the setting where they live, we've had a phenomenal effect on patient retention," Ford said.

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By Kate Kelland