Only 60 percent of Aids patients in Africa still take the drugs they need to stay alive two years after starting treatment, researchers reported, noting a grim reason many stopped: death.
Of the patients found no longer to be taking the drugs after two
years, 40 percent died and the rest missed scheduled appointments,
failed to pick up medication or may have transferred to other clinics.
A small percentage stopped their treatment but continued to get other
medical care at clinics where they started Aids drugs.
"I don't want people losing heart from this, even though 60 percent
isn't fabulous," said Sydney Rosen, an assistant professor at Boston
University's School of Public Health, who led the study. The study was
published Monday in the Public Library of Science Medicine journal.
Still saving lives
Nearly all of the people on the anti-retrovirals would have died
without them. "If you think of this in terms of deaths avoided and
orphans avoided, then this could be a success story," Rosen said.
The World Health Organisation estimated that Aids treatment programmes
in the West retain about 80 percent of patients after two years.
The 60 percent for Africa is "a fairly gloomy conclusion," said Dr Charlie Gilks, director of treatment at the WHO's Aids department, who
was unconnected to the paper. "But considering the huge challenges we
started with, a 60 percent retention rate is not such a bad benchmark."
When the Aids pandemic hit Africa, many experts worried that the
continent's weak health systems would crumble under the stress. WHO's
"3 by 5 program" aimed to put 3 million people on anti-retrovirals to
fight Aids by 2005. By the initiative's end, only 1.3 million were
receiving them. Another 4.8 million patients still need the drugs, out
of some 25 million people in Africa living with Aids.
Rosen and colleagues examined 32 publications reporting on 74 192
patients in 13 African countries between 2000 and 2007. Their report
included many studies done in sub-Saharan Africa, particularly South
Africa, which has the world's highest number of Aids patients.
Experts noted the high numbers of deaths at the start of any Aids
treatment programme. In Africa, patients typically begin taking
anti-retrovirals when they are much sicker than Aids patients in the
Better when it is free
WHO's Gilks also said patients may be more likely to continue to
take medication when they don't have to pay for it. The study looked at
programmes in which patients paid for drugs and others in which drugs
were free or partially subsidised.
Gilks noted that the data in the studies researchers examined were
several years old. He suspects that these days, more patients are
taking their medication - though the evidence to prove that isn't yet
"We clearly should be doing a lot better than 60 percent, but that
is much more difficult than just identifying patients and getting the
first pills into their mouths," he said.
Smaller centres can help
Establishing smaller health centres outside large cities might help.
"Once you get more than 1 000 to 1 500 patients, the services get
congested and patient adherence rates go down," said Dr Gilles van
Cutsem, AIDS project coordinator for Medecins Sans Frontieres in
Khayelitsha, South Africa. Van Cutsem was not connected to the study.
In big clinics where patients have to wait hours just to get their
tablets, he said that the numbers of patients who stay on treatment
often drops sharply.
There is also the problem of lack of transport. Many Aids patients
who desperately need the treatment are too sick to walk to the nearest
clinic, and they have few options.
"If we only treat patients in big clinics, then we are sacrificing
the ones who are very sick who cannot walk very far," van Cutsem said.
Education is crucial
Educating patients on the importance of their treatment is also
"We need to help patients have a clear understanding of why they
should take their anti-retrovirals and what will happen to them if they
don't," said Dr Alison Grant, an Aids epidemiologist at the London
School of Hygiene and Tropical Medicine.
Experts also said the study results underline the importance of
reducing HIV infection in the first place.
Prevention is best
"The best treatment is prevention," said Daniel Halperin, an AIDS
expert at Harvard University's School of Public Health.
Earlier this year, research suggested that male circumcision can cut
the risk of HIV transmission by up to 60 percent. Focusing on
strategies like circumcision might enable experts to reduce the
ultimate numbers of Aids patients.
"If we can prevent this epidemic, then that will solve a lot of the
treatment issues eventually," Halperin said. "Otherwise, we may not be
able to keep up with so many patients. – (Sapa-AP)