E-drug: MSF Media Alert and Key Issues at Bangkok AIDS Conference
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Media Alert
Doctors Without Borders/Medecins Sans Frontieres (MSF)
XV INTERNATIONAL AIDS CONFERENCE IN BANGKOK
Doctors Without Borders/Medecins Sans Frontieres
(MSF) physicians and AIDS experts from around the
world will be attending the International AIDS
Conference in Bangkok, July 11-16. MSF attendees will be presenting the
experience and clinical data gained from treating 13,000 people living with
HIV/AIDS in 25 countries.
MSF speakers from Thailand, Malawi, South Africa, and other countries will
be available to speak on:
� MSF's experience treating HIV/AIDS in resource-poor settings
� The latest clinical outcomes from MSF's 13,000 patients on AIDS
treatment
� The ongoing need to scale up HIV/AIDS treatment now
� The urgent need for:
o affordable and effective fixed-dose combination AIDS medicines
o pediatric formulations of HIV/AIDS medicines and simplified
guidelines for treating children
o improved diagnostics tools for detecting treatment failure and
diagnosing opportunistic infections such as TB
o affordable second-line AIDS medicines
� The implementation of WTO rules and the impact of free trade
agreements, such as the US-Thai agreement, on access to affordable
medicines
MSF Press Conferences at the IAC:
* Monday, July 12, 1pm: MSF's AIDS Treatment Experience: Successes and
Challenges
* Tuesday, July 13, 1pm: Treating Children and the Need for Pediatric AIDS
Medicines
FOR MORE INFORMATION OR TO INTERVIEW ANY MSF PERSONNEL IN BANGKOK, PLEASE
CONTACT:
Kris Torgeson
In Bangkok: 05 173 6049
From abroad: +665 173 6049
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MEDECINS SANS FRONTIERES (MSF) AIDS TREATMENT EXPERIENCE:
FACTS AND FIGURES
July 2004
M�decins Sans Fronti�res (MSF) provides antiretroviral treatment to
more than 13,000 patients spread across 56 projects in 25 countries. MSF
has been caring for people living with HIV/AIDS in developing countries
since the mid 1990s, and the first MSF ARV
treatment projects began in 2000 (in Thailand and
South Africa).
The benefits of treatment
MSF's experience with antiretroviral treatment has been encouraging - and
proves that antiretroviral treatment is possible, even in the poorest and
most difficult settings. Patients rapidly respond to treatment, gaining
weight, staying healthy and resuming their normal lives.
The latest data of MSF's cohort of patients will be released at the Bangkok
International AIDS Conference. The data demonstrate encouraging clinical
and immunological responses in populations who start taking treatment when
they are already at very advanced stages of HIV/AIDS.
Communities also benefit. The availability of treatment lifts the stigma
attached to AIDS, allows people with HIV to be open about their status,
encourages others to go for testing to find out their HIV status, and
prompts the community to start talking openly about the disease.
MSF's programmes
MSF does not offer ARV treatment in a vacuum, but instead aims to include
treatment as part of a package of comprehensive care. Projects include
prevention efforts (health education, prevention of mother-to-child
transmission of HIV), voluntary counselling and testing, treatment and
prevention of opportunistic infections, ARV treatment and nutritional and
psychosocial support. MSF also works with some of the many international
and local NGOs which promote prevention and care efforts.
In nearly all of its ARV programmes, MSF provides treatment free of charge.
This is important in ensuring even the poorest have access to life-saving
treatment.
The countries where MSF treats patients with ARVs are: Benin, Burkina Faso,
Burundi, Cambodia, Cameroon, China, DR Congo, Ethiopia, Guatemala, Guinea,
Honduras, Indonesia, Kenya, Laos, Malawi, Mozambique, Myanmar, Peru,
Rwanda, South Africa, Thailand, Uganda, Ukraine, Zambia, Zimbabwe.
MSF and ARVs in Asia
In Asia, MSF is presently providing antiretroviral treatment to patients in
the following countries:
� In Thailand, MSF treats more than 1100 patients in seven projects:
Bang Kruai district hospital (Nonthaburi province), Ban Laem district
hospital (Petchaburi province), Kuchinarai district hospital (Kalasin
province), and in Sikhraphum, Thatum, Prasat and Sangha. Thailand has one
of the strongest networks of people living with HIV/AIDS groups in
developing countries, and a major focus of MSF's work in the country has
been to help strengthen PHA organisations.
� In Cambodia, MSF treats more than 2000 patients in five projects:
Phnom Penh, Siem Reap, Kompong Cham, Sotnikum and Takeo. Cambodia has one
of the highest HIV prevalence rates in Asia (2.6%), and MSF is working
closely with the country's ministry of health to help build its capacity to
fight the disease.
� In China, MSF treats more than 150 patients in two projects, in
Xiangfan, Hubei province, and Nanning, Guangxi autonomous region. MSF's
programmes are only newly launched and are aimed at working with local
medical staff to provide care and treatment, particularly to poor and
marginalized rural populations.
� In Myanmar, MSF treats more than 150 patients in three projects, in
the capital Rangoon, and in Shan and Kachin states.
� In Laos, MSF treats more than 100 patients in one project, in
Savannakhet. This ARV programme is the first ever established in the
country.
� In Indonesia, MSF treats more than 50 patients in one project, in
Merauke, Irian Jaya.
Expanding the numbers of people who benefit
The number of patients MSF treats has increased rapidly over the past two
years. Today, the total is 13,000 patients in 25 countries. At the time of
the last International AIDS Conference, in July 2002, MSF was treating
1,500 patients in 10 countries. In December 2003, MSF was treating 9,000
patients in 22 countries.
In large part, this rapid expansion of numbers benefiting from treatment is
because MSF has sought wherever possible to adapt ARV treatment protocols
to poor countries. These "simplification" measures have included:
� Using fixed dose combination tablets, which mean that patients only
need to take one pill twice a day, making it easier for patients to adhere
to treatment,
� Introducing simplified inclusion for new patients based on clinical
criteria;
� Training nurses and clinical officers to be more involved in
initiating and monitoring treatment; and
� Offering care closer to communities in need, at local health clinics
rather than distant district or national hospitals.
These measures have considerably aided MSF's efforts to expand the numbers
of people benefiting from antiretroviral treatment.
As of May 2004, 76% of new patients within MSF projects were starting
treatment on the one-pill-twice-a-day regimen, while approximately half of
all MSF ARV patients receive fixed dose combinations. The most frequently
used FDC is a triple combination of lamivudine, stavudine and nevirapine,
usually sourced from the Indian generic manufacturers Cipla and Ranbaxy.
The quality, efficacy and safety of these fixed dose combinations has been
approved by the World Health Organization, and in each country they have
been registered for use by the relevant drug regulatory authorities.
As a non-governmental organisation, MSF has neither the capacity nor the
mandate to provide access on a regional or national level. The
responsibility rests with governments, who will continue to need massive,
sustained technical and financial support from international actors.
Future challenges
Although successful, MSF ARV programmes face the same challenges as others
who are treating in resource-poor settings: prices are still prohibitively
high, sophisticated laboratory equipment is too often required (and
lacking), and the needs of patients in developing countries are still not
being adequately catered for.
There are specific urgent challenges that need to be faced up to, and
solved:
� Child neglect: 2.5 million children are infected with HIV, and yet
there are no paediatric fixed-dose combinations and unclear protocols;
� TB/HIV, double trouble: Twelve million AIDS patients are also
infected with tuberculosis, the most common and deadliest opportunistic
infection, and yet there are presently no reliable means to detect TB in
HIV positive patients.
� Inequity in treatment for women: Existing protocols for prevention of
mother-to-child transmission use ineffective monotherapy, rather than
triple therapy which is safer and more effective. Both mother and child
also need to be able to access treatment, if needed.
� When to switch: There needs to be ways to detect treatment failure in
time, and yet monitoring tools are still too expensive and poorly adapted
to poor countries;
� Second line too expensive: When patients do eventually fail their
first-line treatment, the price of second-line ARVs are five to 10 times
higher;
� Action lacking: Increased attention for the need to expand treatment
has not yet translated into real action in rolling out treatment in the
countries that are hardest hit by the epidemic.
� Lack of R&D: Efforts to produce better medicines, simplified
treatment regimens, potential vaccines and simpler monitoring tools adapted
to developing countries need a boost worldwide.
� Patents before patients: Strong government action is often needed to
ensure that patents on drugs don't prevent access to essential medicines,
and yet intellectual property restrictions, through the World Trade
Organisation and bilateral trade agreements, are tightening.
FOR MORE INFORMATION OR TO INTERVIEW ANY MSF PERSONNEL IN BANGKOK, PLEASE
CONTACT:
Kris Torgeson
In Bangkok: 05 173 6049
From abroad: +665 173 6049
---
Rachel M. Cohen
U.S. Director, Campaign for Access to Essential Medicines
Doctors Without Borders/M�decins Sans Fronti�res (MSF)
333 Seventh Avenue, 2nd Floor * New York, NY * 10001-5004 * USA
Tel: +1-212-655-3762
Mobile: +1-917-331-9077
Fax: +1-212-679-7016
E-mail: rachel.cohen@newyork.msf.org
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