[MoPeB3225] The senegalese initiative on access to antiretroviral therapy: current situation and perspectives, how to translate pilot study results to public health realities in a country with limited resources

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] The senegalese initiative on access to antiretroviral therapy: current situation and perspectives, how to translate pilot study results to public health realities in a country with limited resources

[AUTHOR(S):] P.S.S. Sow Papa Salif, N.F.G. Ngom Gueye Ndèye Fatou, N.D. Diakhate Ndella, S.T. Thiam Sophie, B.N. Ndiaye Bara, K.D. Diop Karim, S.B. Badiane Salif, O.S. Sylla Omar¹, P.M.G. Gueye Papa Mandoumbe², N.C.T. Toure Kane Ndèye Coumba, S.M. Mboup Souleymane³, I.L. Lanièce Isabelle, I.N. Ndoye Ibra⁴

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoPeB3225

BACKGROUND: The Senegalese Initiative on access to antiretroviral is a subsidized governmental initiative which was set up on august 1998 in order to facilitate access to care for Senegalese patients. Its consisted to build a pilot study according to our limited resources and after to evaluate this experience in order to scale up for a nationwide use.

METHODS: Inclusion criteria's were defined: symptomatic patients category C (CDC classification 1993), mildly symptomatic patients with CD4 cell counts less than 350 and asymptomatic with CD4 less than 200. The follow up monitoring included: viral load and CD4 after the first month of the ARV initiation and every six month. Biochemistry, haemoglobin evaluation, liver and renal functions were done every four months. Triple ARV therapy was the standard used regimen.

RESULTS: During the study period (august 1998 to December 2001), 470 patients were included in this pilot study. 80.9% of the patients were ARV naïves and the majority were very immunodepressed; the mean CD4 cell counts was 105 /mm³ and the mean viral load 81.650 copies / ml. After 39 months of follow up, 86% reported having taking at least 80% of the drugs, 5 patients abandon and 20 patients died. After the first month of antiretroviral therapy, 84.2% patients had a viral load less than 200 copies / ml. The mean CD4 cell counts increased from 105 at day 0 to 230 at month 18 and 280 at month 36. The main pathological events during follow up were polyneuritis and anaemia. The results of this pilot Senegalese demonstrated the feasibility of use of ARV in limited resources countries.

CONCLUSIONS: The challenge now of the Senegalese Initiative for Access to antiretroviral therapy is how to scale up for a nationwide ARV use in terms of human resources outside the capital city, health infrastructures capabilities and the monitoring model. Laboratory technicians in the other regions were trained for the Dynabeads method for CD4 evaluation.

Presenting author: Papa Salif SOW

1Fann Hospital, Fann Hospital Dakar, BP 5035, Senegal, Senegal.

2Hopital Principal, Dakar, Senegal.

3Dantec Hospital, Dakar, Senegal.

4PNLS, Dakar, Senegal.

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MoPeB3225