14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. B10598

ISSUES: In the past year AIDS overtook TB as the world's leading infectious cause of adult deaths. Since the advent of highly active antiretroviral therapy (HAART), AIDS-related mortality has dropped sharply in the developed world, however, antiretroviral agents are not widely used in poor countries where HIV takes its greatest toll. Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of infrastructure necessary for using them wisely. We re-examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment program based on lessons gained in TB control.

DESCRIPTION: With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit.

LESSONS LEARNED: Of over 1500 HIV-positive patients diagnosed and followed at Clinique Bon Sauveur located in rural Haiti, more than 100 are currently receiving antiretroviral therapy. The clinical response to therapy was favorable in 59 of the first 60 patients (more than 40 additional patients were enrolled in 2001). In a subset of 21 patients whose viral loads were tested, 18 (86%) had no detectable virus in peripheral blood. Patients with advanced HIV-disease who were not responding to standard treatment for opportunistic infections demonstrated dramatic improvements in recovery within weeks after provision of HAART.

Recommendations: We conclude that directly observed therapy (DOT) with HAART (DOT-HAART) can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs. We recommend that sustainable mechanisms for procurement of antiretroviral drugs by the international community (eg Global Fund) should be expedited for Haiti and other resource-poor countries.

Presenting author: Paul Farmer

1Partners In Health and Harvard Medical School and Zanmi Lasante, PIDSC 1st Floor, 641 Huntington Avenue, Boston, MA 02115, United States.

2Zanmi Lasante, Cange, Haiti.

3Partners in Health and Harvard Medical School, Boston, United States.

4Partners AIDS Research Center, Boston, United States.

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Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.