Haiti Project Proves Feasibility of AIDS Therapy in Developing World
By Deborah Mitchell
Originally published by Reuters Health, July 12, 2002
BARCELONA, Spain (Reuters Health) — The debate over how to get antiretroviral drugs to poor countries has sometimes seemed complicated as experts discussed the issue here this week at the XIV International AIDS Conference, but on Thursday one physician showed how the problem can be tackled in a straightforward and inexpensive way.
In 1998, Dr. Paul Farmer of Harvard Medical School in Boston, and associates, began an HIV treatment program in rural Haiti, the poorest country in the Western Hemisphere, without ongoing financial support from government or major international agencies, without tests to monitor viral load or CD4+ cell counts, and without extra medical staff. The clinic currently serves 2000 people, about 240 of whom are taking triple-therapy.
"It's a small project for a big problem," Dr. Farmer told Reuters Health. "But we've done it in Haiti under adverse conditions of every description—no roads, no communication, a rural area where you have to walk or use a donkey to get around," he explained. "If it can be done there it can be done anywhere."
Despite the fact that drug prices have dropped for many in the developing world, large treatment programs in Africa and other areas with high rates of infection have not yet materialized as governments and agencies debate issues such as whether prevention efforts are more cost-effective than treatment.
"No one seems to have actually done such projects in the world's poorest communities, although HIV is now the leading cause of young adult death in almost all of them," Dr. Farmer said in plenary session.
The Haiti project added AIDS treatment to existing HIV prevention and tuberculosis (TB) programs without using extra staff. In the absence of expensive tests to decide when to begin treatment, the clinicians use more straightforward approaches.
"As a clinician, if you have someone who shows up and looks like a skeleton and does not have TB and is seropositive, what are you going to do?" Dr. Farmer asked. Even without CD4 counts and viral load [tests]—which God knows we would love to have—we can save a lot of lives."
To make sure people take the drugs regularly the program enrolls volunteers from the community to visit patients every day. "We've underlined the solidarity element of this, with one community member serving another, one usually who is sick and the other who is well—sometimes both with HIV," he said. "So we've called them 'accompagnateurs.'"
The drugs, which cost about $122 per patient each month for a three-drug combination, make up 75% of the cost of the program. The other 25% is for salaries and treating acutely ill patients.
"Our own experience in Haiti suggests that, even without making claims for reduced transmission, it is clear that the impact of a 'low-tech' HIV prevention-and-care project could be measured," Dr. Farmer said in his presentation.
Funding from the new United Nations Global Fund for AIDS, TB and Malaria could expand the program, Dr. Farmer said.
