AIDS sufferers slack with drugs
Updated: 2007-10-17 07:20
Just 60 percent of AIDS patients in Africa still take the drugs they need to stay alive two years after starting treatment, researchers reported, noting a grim reason many stopped: death.
Of the patients found no longer to be taking the drugs after two years, 40 percent died and the rest missed scheduled appointments, failed to pick up medication or may have transferred to other clinics. A small percentage stopped their treatment but continued to get other medical care at clinics where they started AIDS drugs.
"I don't want people losing heart from this, even though 60 percent isn't fabulous," said Sydney Rosen, an assistant professor at Boston University's School of Public Health, who led the study. The study was published Monday in the Public Library of Science Medicine journal.
Nearly all of the people on the anti-retrovirals would have died without them.
"If you think of this in terms of deaths avoided and orphans avoided, then this could be a success story," Rosen said.
The World Health Organization estimated that AIDS treatment programs in the West retain about 80 percent of patients after two years.
The 60 percent for Africa is "a fairly gloomy conclusion," said Dr Charlie Gilks, director of treatment at the WHO's AIDS department, who was unconnected to the paper.
"But considering the huge challenges we started with, a 60 percent retention rate is not such a bad benchmark."
When the AIDS pandemic hit Africa, many experts worried that the continent's weak health systems would crumble under the stress. WHO's "3 by 5 program" aimed to put 3 million people on anti-retrovirals to fight AIDS by 2005. By the initiative's end, only 1.3 million were receiving them. Another 4.8 million patients still need the drugs, out of some 25 million people in Africa living with AIDS.
Rosen and colleagues examined 32 publications reporting on 74,192 patients in 13 African countries between 2000 and 2007. Their report included many studies done in sub-Saharan Africa, particularly South Africa, which has the world's highest number of AIDS patients.
Experts noted the high numbers of deaths at the start of any AIDS treatment program. In Africa, patients typically begin taking anti-retrovirals when they are much sicker than AIDS patients in the West.
WHO's Gilks also said patients may be more likely to continue to take medication when they don't have to pay for it. The study looked at programs in which patients paid for drugs and others in which drugs were free or partially subsidized.
Gilks noted that the data in the studies researchers examined were several years old. He suspects that these days, more patients are taking their medication - though the evidence to prove that isn't yet available.
"We clearly should be doing a lot better than 60 percent, but that is much more difficult than just identifying patients and getting the first pills into their mouths," he said.
Establishing smaller health centers outside large cities might help.
"Once you get more than 1,000 to 1,500 patients, the services get congested and patient adherence rates go down," said Dr Gilles van Cutsem, AIDS project coordinator for Medecins Sans Frontieres in Khayelitsha, South Africa. Van Cutsem was not connected to the study.
In big clinics where patients have to wait hours, patients who stay on treatment often drops sharply.
(China Daily 10/17/2007 page10)