[WePeF6677] Initiating a demonstration project of antiretroviral treatment in a resource constrained urban setting in South Africa

14th International AIDS Conference

Barcelona, Spain — July 7-12, 2002

[TITLE:] Initiating a demonstration project of antiretroviral treatment in a resource constrained urban setting in South Africa

[AUTHOR(S):] D. Dayal, G. Gray, J. McIntyre, A. Violari, M. Chersich¹

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. WePeF6677

BACKGROUND: South Africa has the fastest growing HIV-1 epidemic with 5 million infected individuals. 120,000 AIDS related deaths have occurred and is expected to increase to 450,000 by 2005. While HAART has impacted on AIDS morbidity and mortality in the USA, these therapies are largely unaffordable to people in developing countries. We initiated a demonstration project in collaboration with the International Solidarity Fund to assess the feasibility of delivering HAART in a resource- poor setting.

METHODS: This demonstration project aims to provide treatment to a 100 individuals (70% adults), with CD4 counts<200 cells/ml and who are committed to participating in a therapeutic program run by nurses and doctors. The primary goals are maximal and sustained suppression of viral load, restoration of immune status, decreasing hospital admissions and ensuring that participants are healthy enough to sustain and care for their families.

RESULTS: 53 adults (43 women: 10 men), mean age of 31.7 years are on treatment (3 individuals have fallen out of the study). Mean baseline CD4 count and viral load were 97 cells/ml and 281,454 copies/ml respectively. 10 patients have completed 12 weeks of therapy and all have viral loads below 400 copies/ml. There was no statistically significant improvement from their baseline weight (t-Test: P=0.187; 95%CI). Nineteen children (11 boys: 8 girls), mean age of 7.3 years remain on treatment, mean CD4 count and percentage is 362 cell/ml and 10%, the mean baseline and 12 week post-treatment viral load decreased from 352,871 to 2611 copies/ml. One patient died from severe PCP and 1 patient (CD4 count 35 cells/ml; viral load 146,000) reported a grade 3 peripheral neuropathy.

Conclusion: Patient and family participation contributed to the 98% compliance rate. Initiating HAART in this setting has positive impacts on the clinical course of HIV infection and on the lives of people living with AIDS.

Presenting author: Dinesh Dayal

1Perinatal HIV Research Unit, 8 Cowie Road, Forest Town, Johannesburg, 2193, South Africa.

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