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[e-drug] AIDSmeds: Treatment Improvements & Challenges in 23 Countries

E-DRUG: AIDSmeds: Treatment Improvements & Challenges in 23 Countries

Article on report release by M�decins Sans Fronti�res that looks at the state 
of HIV treatment across 23 counties: for more details on the report, visit 


Study Explores Treatment Improvements, Challenges in 23 Countries by Tim Horn 

AIDS 2012: A new study conducted by Medecins Sans Frontieres/Doctors Without 
Borders (MSF) indicates that while the governments of 23 key countries have 
made improvements to get better antiretroviral (ARV) treatment to more people, 
implementation of innovative community-based strategies is lagging in some 
countries. The results of the study were reported by Sharonann Lynch, MSF�s HIV 
policy advisor, and her colleagues Tuesday, July 24, at the XIX International 
AIDS Conference (AIDS 2012) in Washington, DC.

The study, which is also reviewed in a report available online, used 25 
indicators in each of the 23 countries�MSF has HIV projects in 16�to show 
country progress ranging from coverage of ARV treatment and prevention of 
mother-to-child transmission (PMTCT), decentralized care out of hospitals and 
in the community, whether nurses instead of doctors can start patients on HIV 
and tuberculosis (TB) treatment�critical to relieving the burden on health 
systems and to get treatment further into communities�and how many health 
facilities in each country offer ARV therapy.

The data for the study were collected between March and June 2012.

Eleven of the 23 countries surveyed have reached ARV coverage�the ability to 
provide HIV treatment to those who require it medically�of 60 percent or more. 
Meanwhile, six countries are still reaching only a third of people in need.

The coverage rates of services for PMTCT are greater than 80 percent in six of 
the countries surveyed, but eight are still below 50 percent coverage.
In five countries, PMTCT coverage is below 30 percent.

Only eight of the 20 countries for which data was available provided ARV 
treatment in 30 percent of more public-sector health facilities. Meanwhile, in 
countries like Lesotho, Malawi and South Africa, more than 60 percent of health 
facilities offer ARV treatment.

Of the 18 sub-Saharan African countries in the study, 11 allow nurses to start 
people living with HIV on ARV therapy, with Kenya, South Africa, Swaziland, 
Uganda, Zambia and Zimbabwe having changed their policies in the last two years 
to allow this. Conversely, in Mozambique, with the highest HIV prevalence of 
the countries in the study, still does not allow nurses to initiate and manage 
ARV treatment. Additionally, only 14 of the 23 countries allow non-clinician 
lay workers to provide basic HIV services like prevention, testing and 
treatment adherence counseling.

The study authors also noted that while all countries in the survey had adopted 
World Health Organization-recommended (and better tolerated) ARVs, along with 
ARV therapy initiation at 350 CD4 cells (as opposed to the previous 
recommendation of 200), implementation in some countries is lagging due to 
funding shortfalls.

Also of concern is the finding that viral load monitoring�an essential tool for 
monitoring patients while on treatment�is widely available in only four 

�What we�re seeing is that governments are working to get better HIV medicines 
to their people, and to provide treatment closer to home so that more people 
can benefits,� said Lynch. �But there�s still a long way to go.
More countries need to shift policies to allow nurses to start people on 
treatment, and other works to monitor patients� treatment so treatment can be 
available in every clinic, in every village, in every country struggling with 

Joanna Keenan
Press Officer
M�decins Sans Fronti�res - Access Campaign
E: joanna.keenan[at]geneva.msf.org
T: twitter.com/joanna_keenan


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