[112] TREATMENT OF HIV DISEASE WITH HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) IN CHIRADZULU DISTRICT, MALAWI

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] TREATMENT OF HIV DISEASE WITH HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) IN CHIRADZULU DISTRICT, MALAWI

[AUTHOR(S):] N Durier
Médecins Sans Frontières-France/Chiradzulu District collaborative Team, Médecins Sans Frontières, Blantyre, Malawi, Ministry of Health and Population, Malawi

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 112
Antiviral Therapy 2003; 8(Suppl. 1):S211

[ABSTRACT:] Background: HAART continues to be denied to millions of HIV patients in limited resource settings

Objective: To implement a model of treatment with HAART in Chiradzulu District (CD), Malawi.

Description: Médecins Sans Frontières (MSF) and the MOHP launched a project of free HAART in August 2001. In the district’s two hospitals and 10 health centres, non-nucleoside-containing HAART is offered to HIV-infected adults and children presenting with AIDS or CD4 counts <200 cells/ml or <15%. Laboratory use is minimal. Numerous education methods are used to optimize drug adherence. CD4 counts are re-assessed every 6–12 months. A second line regimen is available in case of treatment failure.

Results: 115,000 adults live in Chiradzulu. 15–20% are estimated HIV-infected. In 2002, 1350 patients attended our HIV clinics. Approximately 200 new patients present each month. As of February 2003, 496 patients 32 children) started HAART. Adult median baseline CD4 count was 109 cells/ml (10.2% for children). 64 patients (12.9%) died, 15 (3%) were lost to follow-up, four (0.8%) were off treatment for noncompliance and nine others (1.8%) for recent toxicity or opportunistic infection treatment. 404 (81.4%) remain on ARV. At their last visit 93% reported taking >80% of prescribed ARVs. For adults, median CD4 change was +142 cells at 6 months (n=83) and 133 cells at 12 months (n=35). Presently, around 60 patients start treatment each month.

Conclusions: Results are showing the feasibility of large-scale HAART in under-privileged areas. Our experience is also being incorporated into the design of the national HIV/ARV programme.

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