AEGiS-10CROI: Use of Antiretroviral Therapy in Developing Countries: A Biosocial Analysis.

10th Conference on Retroviruses and Opportunistic Infections

Boston, MA USA - February 10 -14, 2003

Use of Antiretroviral Therapy in Developing Countries: A Biosocial Analysis.

Conf Retroviruses Opportunistic Infect 2003 Feb 10-14;10th: abstract no. 48
Farmer P; Brigham and Women's Hosp and Partners In Health, Boston, MA

BACKGROUND: Over 95% of the burden of HIV disease is to be found in resource-poor settings, but to date there have been almost no donor-funded programs seeking to integrate HIV prevention efforts with the full range of therapeutic options required to treat advanced HIV disease effectively in such settings. With a GNP of less than $500 per year, Haiti has the highest HIV prevalence outside of Sub-Saharan Africa. In 1995-96, Partners In Health introduced AZT to the formulary of a prenatal clinic based Haiti's central department (population 550,000); in 1998-99, we used an established tuberculosis-control program to introduce "DOT-HAART" -- directly observed therapy with highly active antiretroviral therapy.

METHODS: A "biosocial analysis" relying on a complementary methodologies (cohort analysis, serosurveillance, chart reviews, ethnographic study, focus groups, and open-ended interviews with patients [pts] and staff) was used to assess the impact of DOT-HAART in a program providing HIV care to over 3,000 pts, some 12% of whom received DOT-HAART by late 2002. Operational research sought to assess both the costs of DOT-HAART and its impact on costs of hospitalization.

RESULTS: The DOT-HAART project in central Haiti suggests that effective use of ARVs is feasible in even the most resource-poor settings. HIV mortality declined sharply even though only 12% of all seropositive pts received ARVs; in this subset, tuberculosis incidence declined by > 50% between 1999-2002. Biosocial analysis of secular trends revealed a sharp increase in demand for voluntary counseling and testing during the years following introduction of ARVs. Operational research shows that costs of ARVs have declined during each year of the project; a declining proportion of hospital admissions are related to HIV. Less easy to quantify are trends revealed through ethnographic research: diminished AIDS-related stigma, improved quality of life for pts, improved staff morale, and more widespread interest in prevention efforts.

CONCLUSIONS: The Haiti project suggests that, in the context of a mature epidemic, the introduction of ARVs may strengthen prevention efforts while reducing AIDS mortality, tuberculosis incidence, and HIV-associated hospitalizations. False debates regarding "prevention versus treatment" have delayed effective integration of HIV prevention and care. These delays have taken their greatest toll in precisely those areas where HIV is already the leading cause of young adult deaths.

Keywords: AEGIS, Developing Countries, HIV, Antiretroviral Therapy, Highly Active, HIV Infections, Acquired Immunodeficiency Syndrome, Prevalence, Anti-HIV Agents, Incidence, Zidovudine, Tuberculosis, Reverse Transcriptase Inhibitors, HIV Protease Inhibitors, Cohort Studies, Drug Therapy, Combination, Africa South of the Sahara, Haiti, Adult, Human, therapy, analysis, utilization, mortality, drug therapy

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Copyright © 2003 - Foundation for Retrovirology and Human Health. Reproduction of this abstract (other than one copy for personal reference) must be cleared through the Foundation for Retrovirology and Human Health. Licensed (AIDSLINE) from National Library of Medicine.