Community-based approaches to HIV treatment in resource-poor settings

It is shown that it is possible to carry out an HIV treatment programme in a poor community in rural Haiti, and it is suggested that directly-observed therapy of chronic infectious disease with multidrug regimens can be highly effective in settings of great privation as long as there is sustained commitment to uninterrupted care that is free to the patient.

Abstract

Last year, HIV surpassed other pathogens to become the world's leading infectious cause of adult death. More than 90% of deaths occur in poor countries, yet new antiretroviral therapies have only led to a drop in AIDS deaths in industrialised countries. The main objections to the use of these agents in less-developed countries have been their high cost and the lack of health infrastructure necessary to use them. We have shown that it is possible to carry out an HIV treatment programme in a poor community in rural Haiti, the poorest country in the western hemisphere. Relying on an already existing tuberculosis-control infrastructure, we have been able to provide directly observed therapy with highly-active antiretroviral therapy (HAART) to about 60 patients with advanced HIV disease. Inclusion criteria and clinical follow-up were based on basic laboratory data available in most rural clinics. Serious side-effects have been rare and readily managed by community-health workers and clinic staff. We discuss objections to the widespread use of HAART, and suggest that directly-observed therapy of chronic infectious disease with multidrug regimens can be highly effective in settings of great privation as long as there is sustained commitment to uninterrupted care that is free to the patient.