Aids therapy rates falling off in Africa

[Guest guest]

Aids therapy rates falling off in Africa

By ZACHARY OCHIENG

Special Correspondent

About half of the people starting antiretroviral therapy programmes

(ART) in sub-Saharan Africa are no longer receiving treatment after

two years, according to a research paper published on October 16 by

the US-based Public Library of Sciences (PLoS) medical journal.

Sydney Rosen of the Centre for International Health and Development

at Boston University's School of Public Health, Mathew Fox of the

Health Economics Research Office of the Wits Health Consortium in

South Africa and Gill of the Infectious Diseases Section,

Department of Medicine, Boston Medical Centre, conducted the study,

titled, Patient Retention in Antiretroviral Therapy Programmes in sub-

Saharan Africa: A Systematic Review.

The study was funded by the Doris Duke Charitable Foundation under

the Operations Research for Aids Care and Treatment Award (Oracta)

programme and the US National Institutes of Health.

The overall success rates of African treatment programmes may

actually be even lower, if one takes into account that programmes

with very low retention may be unlikely to publish their results.

This study therefore indicates that a worrying number of patients in

sub-Saharan Africa who need ART are lost from treatment programmes.

Because many of these patients are lost due to their death from Aids,

one way to improve retention might be to start treating people with

ART earlier, before they become seriously ill from HIV. Better

efforts to find out exactly why patients drop out of programmes (for

example, the cost of drugs and/or of transport to clinics) might

reduce the number of patients lost. The researchers also suggest that

ART programmes with very high retention rates might serve as models

to improve retention rates in other programmes.

Long-term retention of patients in sub-Saharan Africa's rapidly

expanding ART programmes for HIV and Aids is essential for these

programmes' success but this has received relatively little

attention. In conducting the study, the researchers searched Medline,

other literature databases, conference abstracts, publications

archives and the " gray literature " (project reports available online)

between 2000 and 2007 for reports on the proportion of adult patients

retained after 6 months or longer in sub-Saharan African, non-

research ART programmes, with and without donor support.

Estimated retention rates at 6, 12, and 24 months were calculated and

plotted for each programme. In sensitivity analyses, the researchers

considered best-case, worst-case, and midpoint scenarios for

retention at two years; the best-case scenario assumed no further

attrition beyond that reported, while the worst-case scenario assumed

that attrition would continue in a linear fashion.

The researchers reviewed 32 publications reporting on 33 patient

cohorts (74,192 patients, 13 countries). For all studies, the

weighted average follow-up period reported was 9.9 months, after

which 77.5 per cent of patients were retained.

Loss to follow-up and death accounted for 56 per cent and 40 per cent

of attrition respectively. Of those reporting 24 months of follow-up,

the best programme retained 85 per cent of patients and the worst

retained 46 per cent.

The researchers conclude that since the inception of large-scale ART

access early in this decade, ART programmes in Africa have retained

about 60 per cent of their patients at the end of two years.

About 25 million people in sub-Saharan Africa are infected with HIV.

Every year, about three million more people become infected with the

virus and two million die from Aids in the region, where the pandemic

has reduced life expectancy, orphaned many children and reversed

economic growth.

For ART to work, HIV-infected individuals whose immune systems have

been damaged by the virus have to take antiretroviral drugs regularly

for the rest of their lives. If people take ART irregularly or stop

taking their medications, they may become sicker or die, or the

viruses they carry may become resistant to antiretroviral drugs.

http://www.nationmedia.com/eastafrican/current/News/news121020076.htm

[Guest guest]

Aids therapy rates falling off in Africa

By ZACHARY OCHIENG

Special Correspondent

About half of the people starting antiretroviral therapy programmes

(ART) in sub-Saharan Africa are no longer receiving treatment after

two years, according to a research paper published on October 16 by

the US-based Public Library of Sciences (PLoS) medical journal.

Sydney Rosen of the Centre for International Health and Development

at Boston University's School of Public Health, Mathew Fox of the

Health Economics Research Office of the Wits Health Consortium in

South Africa and Gill of the Infectious Diseases Section,

Department of Medicine, Boston Medical Centre, conducted the study,

titled, Patient Retention in Antiretroviral Therapy Programmes in sub-

Saharan Africa: A Systematic Review.

The study was funded by the Doris Duke Charitable Foundation under

the Operations Research for Aids Care and Treatment Award (Oracta)

programme and the US National Institutes of Health.

The overall success rates of African treatment programmes may

actually be even lower, if one takes into account that programmes

with very low retention may be unlikely to publish their results.

This study therefore indicates that a worrying number of patients in

sub-Saharan Africa who need ART are lost from treatment programmes.

Because many of these patients are lost due to their death from Aids,

one way to improve retention might be to start treating people with

ART earlier, before they become seriously ill from HIV. Better

efforts to find out exactly why patients drop out of programmes (for

example, the cost of drugs and/or of transport to clinics) might

reduce the number of patients lost. The researchers also suggest that

ART programmes with very high retention rates might serve as models

to improve retention rates in other programmes.

Long-term retention of patients in sub-Saharan Africa's rapidly

expanding ART programmes for HIV and Aids is essential for these

programmes' success but this has received relatively little

attention. In conducting the study, the researchers searched Medline,

other literature databases, conference abstracts, publications

archives and the " gray literature " (project reports available online)

between 2000 and 2007 for reports on the proportion of adult patients

retained after 6 months or longer in sub-Saharan African, non-

research ART programmes, with and without donor support.

Estimated retention rates at 6, 12, and 24 months were calculated and

plotted for each programme. In sensitivity analyses, the researchers

considered best-case, worst-case, and midpoint scenarios for

retention at two years; the best-case scenario assumed no further

attrition beyond that reported, while the worst-case scenario assumed

that attrition would continue in a linear fashion.

The researchers reviewed 32 publications reporting on 33 patient

cohorts (74,192 patients, 13 countries). For all studies, the

weighted average follow-up period reported was 9.9 months, after

which 77.5 per cent of patients were retained.

Loss to follow-up and death accounted for 56 per cent and 40 per cent

of attrition respectively. Of those reporting 24 months of follow-up,

the best programme retained 85 per cent of patients and the worst

retained 46 per cent.

The researchers conclude that since the inception of large-scale ART

access early in this decade, ART programmes in Africa have retained

about 60 per cent of their patients at the end of two years.

About 25 million people in sub-Saharan Africa are infected with HIV.

Every year, about three million more people become infected with the

virus and two million die from Aids in the region, where the pandemic

has reduced life expectancy, orphaned many children and reversed

economic growth.

For ART to work, HIV-infected individuals whose immune systems have

been damaged by the virus have to take antiretroviral drugs regularly

for the rest of their lives. If people take ART irregularly or stop

taking their medications, they may become sicker or die, or the

viruses they carry may become resistant to antiretroviral drugs.

http://www.nationmedia.com/eastafrican/current/News/news121020076.htm