AEGiS-15IAC: Non-medical eligibility criteria for pilot HIV/AIDS treatment programs in resource-poor settings: The Columbia University MTCT-Plus experience.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Non-medical eligibility criteria for pilot HIV/AIDS treatment programs in resource-poor settings: The Columbia University MTCT-Plus experience.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1278)

Rabkin M, Tonwe-Gold B, El-Sadr W
Columbia University, New York, United States

ISSUES: A fraction of patients (pts) living with HIV/AIDS in resource-poor settings (RPS) have access to care and treatment. Treatment programs have had to limit access in the face of overwhelming demand, creating both medical and non-medical ("social") eligibility criteria. The MTCT-Plus Initiative, which provides HIV/AIDS care and treatment to families in RPS, launched 12 programs in 8 countries in 2003. These share programmatic and medical eligibility criteria, but each has unique non-medical eligibility criteria.

DESCRIPTION: Prior to site initiation, each program formalized non-medical eligibility criteria, working with site staff, local ethical input, and community members. Eight sites require pts to live close to the clinic, 5 sites require a treatment partner (i.e. pts to disclose HIV status), 5 sites mandate a home visit, 4 enroll only pts committed to safer sex, 2 sites require support group participation, one site requires good prior clinic/antenatal attendance record, one excludes pts with active substance use, one excludes unstably housed pts & one strongly urges pts to utilize contraception.

LESSONS LEARNED: 12 demonstration programs with identical programmatic and medical eligibility criteria developed different non-medical ("social") eligibility criteria. The majority are intended to select the patient population most likely to be adherent to care and treatment. These criteria have evolved based on program experience.

RECOMMENDATIONS: In the absence of universally available care, programs have had to ration access. While medical indications for treatment can be standardized at the national and international level, non-medical eligibility criteria are best developed with input from local community and ethical consultations & need periodic assessment based on experience.

Keywords: AEGIS, Acquired Immunodeficiency Syndrome, HIV Seropositivity, Health Resources, Poverty, HIV Infections, Universities, Health Services Needs and Demand, Health Services Accessibility, Anti-HIV Agents, Health Services, Population, Research, Humans, therapy, organization & administration

040711
WeOrB1278