Treatment Issues: Newsletter of Experimental AIDS Therapies - Volume 17, Number 7-8, July / August 2003

This is an excerpt from an MSF report entitled, Positive Replications, which can be found in its entirety online at: www.accessmed-msf.org

The challenge of scaling up

There are many real and perceived barriers to expanding treatment to large numbers of people in the developing world. Among those most often referred to are lack of political will, the high price of ARVs; the lack of trained staff and other elements of healthcare infrastructure; the complexity of treatment protocols and laboratory monitoring.

Médecins Sans Frontières (MSF) believes these should not be viewed as reasons to accept the status quo. Despite facing many of these problems in its HIV/AIDS treatment projects around the developing world, MSF is showing that these barriers are not insurmountable. In July 2002, MSF was treating 2,300 patients in ten countries. At the Barcelona conference, MSF set itself the goal of doubling the number of patients it treated by the end of 2003. Now MSF has 23 projects in 14 countries with 4,447 patients (310 of these are children) receiving ART.

MSF’s most frequently used first-line regimen is stavudine, lamivudine and nevirapine and fixed dose versions of these combinations are being used in a majority of projects. In MSF projects the price of first-line therapies ranges from US $277 (Cameroon) to US $593 (Ukraine) per patient per year.

Médecins Sans Frontières has been caring for people living with HIV/AIDS in developing countries since the early 1990s, and the first ARV treatment projects began in 2000. As of June 2003 more than 5,000 people have received ARVs in MSF projects. Eighty eight percent of these are still on treatment.

Although the places and contexts are very different for each of these treatment projects, a certain number of common denominators exist: MSF focuses on offering care to the poorest and most destitute people; and to ensure that a maximum number of people can be treated and that programmes are sustainable, efforts are made to identify the least expensive sources of medicines. In many cases, this means using generic versions of ARVs.

MSF does not offer ART in a vacuum, but instead aims to integrate treatment into a continuum of care: projects include prevention efforts (health education, prevention of mother-to-child transmission of HIV), voluntary counselling and testing (VCT), treatment of opportunistic infections, ART and nutritional and psychosocial support.

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