[e-drug] HIV+ Africans can adhere to ART (cont'd)

E-drug: HIV+ Africans can adhere to ART (cont'd)
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Dr Urquhart raises some important issues. We run the largest
disease management programme in South Africa for members of
contracted medical insurance schemes who are living with
HIV/AIDS, and currently have over 12000 people registered, most
of whom are taking antiretroviral therapy.

We employ 4 registered nurses who telephonically contact every
person after medication is approved to explain how the drugs
should be taken and offer support. Regular contact is maintained
and the patient's responsiblities in managing their medication are
stressed.

With the reduction in the prices of some antiretroviral drugs in
developing countries, we are now in the fortunate position of being
able to fund highly active therapy in most cases, but this comes at
a cost in view of the complexity of therapy and additional
side-effects and drug interactions.

We are also struggling to find ways of accurately measuring
adherence to therapy. On a basic level we can determine who is
actually claiming for their drugs and who is not, but we cannot
establish with certainty that patients have actually taken the drugs,
even when they do claim for them. Electronic solutions will
unfortunately be too costly.

While the clinical outcomes and reduction in hospitalisation suggest
that the majority are taking their drugs correctly, despite concerns
to the contrary, as Dr Urquhart points out the spectre of drug
resistance remains a major worry.

Possibly simplified regimens (eg daily instead of twice a day or
combination products) or even directly observed therapy may
provide a partial solution. We believe, however, that on-going
education remains an important component of any programme
requiring this level of adherence to therapy.

Dr Leon Regensberg
Aid for AIDS
South Africa
e-mail: lregensberg@pbm.co.za
Ph: +27-21- 6586437
Fax +27-21- 6586426
Mobile +27-82-7814494

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