AFRO-NETS> New article on use of ARVs in Khayelitsha South Africa

[Richard Laing <laingr@who.int>]

New article on use of ARVs in Khayelitsha South Africa
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Readers of AFRO-NETS may be interested in a recent article in the Es-
sential Drugs Monitor on ARV treatment in a poor African environment. 
 
The article is titled "Demystifying antiretroviral therapy in re-
source-poor settings" and is by Toby Kasper, David Coetzee, Francoise 
Louis, Andrew Boulle, Katherine Hilderbrand. The article asks the 
question "Is ARV treatment possible in severely resource-constrained 
environments?" 
 
This article shows that it can be achieved, by highlighting the ex-
perience in Khayelitsha, a poor township near Cape Town, South Af-
rica, where Médecins Sans Frontières has been supporting a programme 
since 1999. This is one of the first articles providing data to docu-
ment successful treatment. The article discusses the keys to success: 
affordable drugs; involvement of the community, and involvement of 
the patients. It concludes that the time has come to scale up from 
pilot projects to widespread access to ARV treatment.
 
The original article can be downloaded as an attached e-mail from 
SatelLife using their Getweb function. To do this send a message to 
mailto:getweb@healthnet.org
Leave the subject line blank and in the message section write:
 
begin
get http://www.who.int/medicines/mon/32_11.pdf
end
 
While the numbers are relatively small (180 patients) the results are 
impressive. After nine months, 88% of patients were alive and as many 
were very ill when they started therapy this shows that ARV's can be 
effectively used in an environment such as Khayelitsha in which 50% 
of residents are unemployed and 70% live in shacks. Much of the care 
was provided by nurses. 
 
There are some interesting aspects of this report. The first relates 
to the selection criteria for patients. There were clear criteria for 
inclusion (CD4 count less than 200, WHO disease stage 3 or 4, resi-
dence in Khayelitsha and patients must have attended regularly for at 
least 3 months) In addition a system was established of community in-
put into the selection of patients for treatment. This careful proc-
ess may have been an important part of their success.
 
The second issue that interests me is the use of CD4 and viral load 
counts. Clearly for this study they needed to have this information 
available to demonstrate that really sick patients were being effec-
tively treated and were improving. But what is not clear to me is 
whether this testing itself actually changed outcomes. If these pa-
tients had been selected in the same way and treated with empirical 
regimens would the results have been the same? 
 
The final point that interests me is the information about the effect 
of treatment on the success of prevention programs. The authors say 
in their final paragraph "The synergy between treatment and preven-
tion has been striking, with the availability of treatment providing 
a powerful incentive to learn one's status. It was thus no surprise 
that a recent survey of nine sites around South Africa found that 
Khayelitsha had the highest rates of HIV testing and desire to be 
tested among those yet to be tested as well as the highest level of 
condom use." Impressive!
 
Richard Laing (Medical Officer) 
Policy, Access and Rational Use
Essential Drugs and Medicines Policy
World Health Organization 
CH-1211 Geneva 27, Switzerland 
Tel: +41-22-791-4533
Fax: +41-22-791-4167
mailto:laingr@who.int

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