Today, six million people with HIV/AIDS are in urgent need of antiretroviral (ARV)1 treatment in the developing world, 4.1 million of whom live in sub-Saharan Africa. An estimated 6,000 people die of AIDS each day in this region. After three years of experience providing ARV treatment as part of a continuum of care in resource-poor settings, MSF is keenly aware that simplification of treatment and monitoring is absolutely vital to scale up ARV treatment in high-prevalence countries.
This sentiment has been confirmed by the World Health Organization, which declared the lack of access to ARV treatment a “global health emergency” on 22 September 2003 and announced that it would release an emergency plan to scale-up access to ARV treatment for at least three million people by the end of 2005. As part of this effort, the WHO will produce simplified guidelines for ARV treatment and monitoring. These guidelines will need to be based on clear evidence and on actual field experience, with input from experts and people living with and affected by HIV/AIDS from high-prevalence and developed countries.
In recent months, MSF has been engaged in a consultation process about simplifying treatment, which included a questionnaire answered by 48 experts from high-prevalence countries and the international medical and scientific community, and a workshop that took place during the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) in Nairobi, Kenya on 20 September.
This report first outlines recommendations from the workshop on how to best use existing health infrastructures for wide-scale delivery of ARV treatment. Secondly, it outlines recommendations regarding adult regimens, paediatric regimens, HIV/TB co-infection, and diagnostic and laboratory tools, by answering the following key questions:
1. What can be done with existing tools to simplify ARV treatment?
2. What can be done to improve and adapt existing tools?
3. What new tools would be ideal for delivering ARV treatment, and what are the long-term strategies that will need to be employed to guarantee success?
The objective of these recommendations is to inform WHO’s simplified guidelines for scaling up ARV therapy in resource-poor settings, and to identify both short- and medium-term agendas for accessing and developing appropriate drugs and diagnostics for AIDS treatment in high-prevalence countries.
MSF will share the recommendations from this consultation process with inter-governmental organisations such as WHO, UNAIDS, and UNICEF; national HIV/AIDS programmes; non-governmental organisations, foundations, and academic institutions working in the field of HIV; associations of people living with HIV/AIDS; and donor governments.