Integrated Regional Information Networks - October 2, 2003

The programme began with an initial enrolment of seven patients, but is expected to add about 10 patients per month, ultimately including 150 patients on ARV treatment by January 2005. Hilary Bower, deputy head of mission MSF-Holland in Goma, told PlusNews that MSF had made a five-year commitment to the programme, after which its sustainability and local capacity would be re-evaluated.

"A lot could change in five years," Bower said, adding that she hoped ARVs would become far more affordable by then.

As for capacity building, Bower said that MSF was working closely with local health authorities and personnel, in a concerted effort to show local residents and international donors that it was possible to have people taking ARVs safely in an unstable setting.

The seven individuals were selected from over 180 patients. Selection criteria included the need for each patient to have the support of one other individual to whom they have revealed their status; residence in Bukavu; and a demonstrated ability to adhere to clinic appointments and prophylactic medications.

MSF said that in the war-ravaged east, where people were more used to people dying of HIV/AIDS than living with it, and where local health structures had no capacity to provide ARVs, this initiative marked an important step in the fight against HIV/AIDS.

"In African settings, it has been unthinkable that someone with HIV could survive, let alone live a normal life," Corry Kik, the MSF project coordinator in Bukavu, said. "With ARVs this becomes a possibility. We hope ARV treatment will firstly have a huge effect on the lives of individuals, but also on the way people with HIV/AIDS are treated in the community."

Kik also said that taking ARVs presented significant challenges to patients in such a difficult setting: in addition to daily medication, patients also needed to have regular blood tests, regular medical check-ups and to learn to cope with the side effects of ARVs.

"Patients also need to understand that they have to take pills for the rest of their lives, even when they don't feel ill - a concept that is not always easy to absorb in a setting where most diseases are either cured or kill," he said.

Kik added that adherence was, however, crucial if resistance was to be prevented. Therefore, he said, patient education was almost as important a component in the new programme as the drugs themselves.

"We are hoping to encourage others to get tested, educated, treated," Bower said. "You are more likely to get tested if you see there is hope for life."

She said that contrary to some expectations, the number of people seeking to participate in the MSF programme had so far been limited, owing to the social stigma that still prevailed about HIV/AIDS.

MSF said that no accurate seroprevalence studies had yet been done in east. However, based on attendance at the agency's Voluntary Counselling and Testing centre for the year 2003, the HIV-positive level was 17 percent.

MSF said that ARV treatment was the most recent step in its efforts to fight HIV/AIDS, which also included voluntary testing and counselling; treatment for opportunistic infections and sexually transmitted diseases; home-based care; and nutritional and psychosocial support.

A second MSF ARV treatment programme is due to open in the national capital, Kinshasa, before the end of this month. By the end of 2005, MSF said it hoped to be treating 800 people.

MSF said it was already providing ARV treatment in several other African countries.

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