• Provision of antiretroviral treatment in conflict settings: the experience of Médecins Sans Frontières

      O'Brien, Daniel P; Venis, Sarah; Greig, Jane; Shanks, Leslie; Ellman, Tom; Sabapathy, Kalpana; Frigati, Lisa; Mills, Clair; Public Health Department, Médecins Sans Frontières, Amsterdam, Netherlands; 2Department of Infectious Diseases, Geelong Hospital, Geelong, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia; Médecins Sans Frontières, London, UK; School of Child and Adolescent Health, Red Cross Childrens' Hospital, Capetown, South Africa; Te Kupenga Hauora Maori, Faculty of Medical and Health Sciences,University of Auckland, Auckland, New Zealand (2010-06-17)
      ABSTRACT: INTRODUCTION: Many countries ravaged by conflict have substantial morbidity and mortality attributed to HIV/AIDS yet HIV treatment is uncommonly available. Universal access to HIV care cannot be achieved unless the needs of populations in conflict-affected areas are addressed. METHODS: From 2003 Médecins Sans Frontières introduced HIV care, including antiretroviral therapy, into 24 programmes in conflict or post-conflict settings, mainly in sub-Saharan Africa. HIV care and treatment activities were usually integrated within other medical activities. Project data collected in the Fuchia software system were analysed and outcomes compared with ART-LINC data. Programme reports and other relevant documents and interviews with local and headquarters staff were used to develop lessons learned. RESULTS: In the 22 programmes where ART was initiated, more than 10,500 people were diagnosed with HIV and received medical care, and 4555 commenced antiretroviral therapy, including 348 children. Complete data were available for adults in 20 programmes (n = 4145). At analysis, 2645 (64%) remained on ART, 422 (10%) had died, 466 (11%) lost to follow-up, 417 (10%) transferred to another programme, and 195 (5%) had an unclear outcome. Median 12-month mortality and loss to follow-up were 9% and 11% respectively, and median 6-month CD4 gain was 129 cells/mm 3.Patient outcomes on treatment were comparable to those in stable resource-limited settings, and individuals and communities obtained significant benefits from access to HIV treatment. Programme disruption through instability was uncommon with only one program experiencing interruption to services, and programs were adapted to allow for disruption and population movements. Integration of HIV activities strengthened other health activities contributing to health benefits for all victims of conflict and increasing the potential sustainability for implemented activities. CONCLUSIONS: With commitment, simplified treatment and monitoring, and adaptations for potential instability, HIV treatment can be feasibly and effectively provided in conflict or post-conflict settings.
    • Similar mortality and reduced loss to follow-up in integrated compared with vertical programs providing antiretroviral treatment in sub-saharan Africa.

      Greig, Jane; O'Brien, Daniel P; Ford, Nathan; Spelman, Tim; Sabapathy, Kalpana; Shanks, Leslie; Manson Unit, Médecins sans Frontières, Saffron Hill, London, UK. jane.greig@london.msf.org (2012-04-15)
      Vertical HIV programs have achieved good results but may not be feasible or appropriate in many resource-limited settings. Médecins sans Frontières has treated HIV in vertical programs since 2000 and over time integrated HIV treatment into general health care services using simplified protocols. We analyzed the survival probability among patients receiving antiretroviral therapy (ART) from 2003 to 2010 in integrated versus vertical programs in 9 countries in sub-Saharan Africa.
    • Treatment outcomes from the largest antiretroviral treatment program in Myanmar (Burma): a cohort analysis of retention after scale-up.

      Sabapathy, Kalpana; Ford, Nathan; Chan, Khin Nyein; Kyaw, Moe Kyaw; Elema, Riekje; Smithuis, Frank; Floyd, Sian; Imperial College London, London, United Kingdom; Medecins Sans Frontieres, Amsterdam, The Netherlands, Medecins Sans Frontieres, Geneva, Switzerland; Medecisn Sans Frontieres, Yangon, Myanmar; Medical Action Myanmar, Yangon, Myanmar; London School of Hygiene and Tropical Medicine, London, United Kingdom. (2012-06-01)
      Antiretroviral treatment (ART) coverage in Myanmar is well below average. This study describes retention and baseline predictors of prognosis from the largest ART program in the country.
    • Uptake of home-based voluntary HIV testing in sub-Saharan Africa: a systematic review and meta-analysis

      Sabapathy, Kalpana; Van den Bergh, Rafael; Fidler, Sarah; Hayes, Richard; Ford, Nathan; London School of Hygiene and Tropical Medicine, London, UK. kalpana.sabapathy@lshtm.ac.uk (2012-12-04)
      Improving access to HIV testing is a key priority in scaling up HIV treatment and prevention services. Home-based voluntary counselling and testing (HBT) as an approach to delivering wide-scale HIV testing is explored here.