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After the 18th International AIDS Conference, Possibilities for Scaling Up Optimal HIV/AIDS Treatment
July 23, 2010
This originally ran as a guest post on the Speaking of Medicine PLoS community blog
By Sharonann Lynch, HIV/AIDS Policy Advisor, Campaign for Access to Essential Medicines, Doctors Without Borders/Médecins Sans Frontières
In a two-year study of 1,128 patients from rural Lesotho, where the government has adopted new World Health Organization (WHO) guidelines, patients starting treatment earlier (at CD4 count <350) were 70 percent less likely to die, 40 percent more likely to remain in care, and more than 60 percent less likely to be hospitalized compared with those started when their disease was already advanced (CD4 <200).
After all the talk and spectacle, many of us—people with HIV/AIDS, clinicians, researchers, and activists—will have to go back to reality: to townships and rural villages still ravaged by the virus; to congested clinics with waiting lists for treatment; and to rich country capitals where donors are ignoring the science and retreating from their commitment to fully fund universal access to treatment, telling us to get used to this new reality—we are in the midst of global economic recession, after all.
At the conference there was a lot of talk about cost-effectiveness and efficiency as a means to mitigate funding shortfalls. Sure, we need to avoid waste and the obscene number of consultants and reports that sit on shelves in Washington, Geneva, and London. But how do the actual people fit in to these crude calculations? What is the cost-benefit to their lives, families, and communities?
We are advocating for a different vision: for patient-centered efficiencies that will increase access to treatment and reduce the burden on patients in taking toxic drugs, reporting excessively to health facilities, and traveling great distances to seek care. We also want efficiencies to reduce the requirements on the health system, for example through task-shifting and community-based, out-of-facility approaches to drug dispending and social support. And economists are telling us these sorts of efficiencies will even be cost-saving in the long run.
So how do we build on Lesotho’s example and get more patients on treatment? Here are some forward-looking ideas that could change the game:
Support research to radically simplify and optimize the package of ARV treatment, including:
If we want to bend the curves of the HIV epidemic, we should seriously consider and put into action radical game-changers such as these.
Learn more about MSF’s efforts for HIV/AIDS at aids2010.msf.org