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[e-med] Etude sur les améliorations des traitements ARV, comparaison dans 23 pays(MSF)

[le rapport est disponible ici
en anglais seulement.CB]

July 24, 2012
Study Explores Treatment Improvements, Challenges in 23 Countries
by Tim Horn 

A new study conducted by Médecins Sans Frontières/Doctors Without Borders
(MSF) indicates that while the governments of 23 key countries have made
improvements to get 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. Indicators include 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

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

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, 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 HIV."

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