E-DRUG: MSF on FDCs (3)
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Hi e-druggers
My first posting, so a brief introduction - I'm a general medical
practitioner and run On-Cue, a small company focussed on improving
adherence in 25 to 26 chronic conditions across Africa based in Cape Town,
South Africa.
[snip]
Nine MSF's 10 largest projects, treating over 6200 patients, use FDCs.
Seven
of these projects began treating patients in 2001 and 2002. Collated
results
in October 2003 showed that adherence was excellent, at 87.6% (9.9% died,
1.2% were lost to follow up, 0.8% were stopped due to poor compliance).
Clinical, immunological and where available virological results are
comparable to Western standards, even in severely ill patients.
I have my doubts that these adherence figures could be generalisable to a
wide scale roll out of ARVs. At least not from my (admittedly limited)
knowledge of the MSF project in Cape Town. The selection criteria for
inclusion in the programme may be valid (I don't know) but would be
politically impossible for governments to implement. The two that spring
to mind are the requirement of adequate nourishment and the requirement of
disclosure of HIV status to a household member in order to qualify for
ARVs. Can you imagine if government was perceived to be denying ARVs to
those who are undernourished (the poorest people) and those who had not
disclosed their status?
These two facts alone will select those who are likely to be more
adherent, but cannot be applied in a general roll out.
Kind regards
David
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