E-DRUG: MSF on FDCs (4)
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Dear David,
I am responding to your posting in e-drug about enrolment requirements to
access ART at the Khayelitsha HIV/AIDS clinics.
You are right that there is unfortunately still too little information
available about adherence to ART in resource-poor settings.
Most of the programmes are still relatively young, and yet they are
producing already information which is key to inform the scaling up of
treatment.
In Khayelitsha, we implement an adherence support programme that prioritizes
the patient's understanding of his/her HIV condition and what ART is about.
We have observed that encouraging treatment education promotes
self-responsibility on the HIV condition and on the importance of adherence.
We are currently finishing a study on self reported adherence over a recall
period of 4 days (using a modified survey tool from the questionnaire
developed by the ACTG). The study reflects indeed high levels of adherence
(>95% doses taken on time in the last 4 days) in nearly 90% of the patients
1, 3 and 12 months after initiation of ART. These results
correlate well with clinical outcomes. The study is still ongoing, but the
preliminary results were already presented in the National AIDS Conference
in Durban (August 2003) and ICASA Conference in Nairobi (September 2003).
There is an unnaccuracy in your interpretation of our enrolment process. It
is not true that people have to be well nourished to access ART. In fact
there is no requirement related to nutritional status at all. So far we have
been requesting people to disclose to at least one person who will act as
his/her treatment assitant. It does not have to be a member of the household
but anyone they choose (can be a neighbour or a friend). The assistant will
be aware not only of the status, but will come to the clinic as well for
basic treatment education, so that it can act as a supporter to the
treatment. The reason to implement this requirement in the early stages of
the programme was to make sure that people had the support from at least one
person they could trust or they felt comfortable speaking about their
treatment in an environment where discrimination is high. May be, as access
to treatment becomes more widespread, and with the help of community
education work about HIV and treatment, the role of the treatment assistant
will change, since society will slowly gain in openess about HIV infection
and in understanding about what the medical services can offer to people.
We are observing such trend in Khayelitsha but for the moment we still keep
the requirement, since, having nearly 1000 people on ART already, we have
never had a case of someone who hasn't accessed treatment
when clinically needed because of not willing to disclose to one person, or
not finding the person they are willing to disclose to. Obviously, open
disclosure is people's individual choice.
Therefore, it is misleading to interpret this requirement as if people who
have difficulties to disclose are denied access to ART.
If you are interested to receive more information about the programme or,
since you are based in Cape Town, if you would like to visit the Khayelitha
HIV/AIDS clinics, let me know and we can make arrangements.
Best regards,
Marta Darder
MSF South Africa
Khayeltisha, Cape Town
Ph +27 21 3645490
martad@xsinet.co.za
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