MSF AIDS treatment experience: Facts and figures

ALT Espen Rasmussen

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 12,000 patients in 22 countries.

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 1,100 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 2,000 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 12,000 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.