Monitoring HIV treatment in developing countries.
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Anti-HIV Agents↗
Biomedical subjects
Serena P Koenig
Publications and source records attributed to Serena P Koenig.
Integrated HIV prevention and care strengthens primary health care: lessons from rural Haiti.
Three decades ago, the world's ministries of health declared primary health care--the delivery of basic preventive and curative services--a top priority. Since then, however, the world's poorest countries have not met most primary health care goals. Twenty-six years after the Declaration of Alma Ata, we are said to be living in a time of "limited resources," a phrase that construes various health interventions as competing priorities. As HIV has become the leading infectious cause of adult death in much of the world, it is difficult to argue that AIDS prevention and care are not ranking priorities for primary health care, yet precisely such arguments have held sway among international health policy makers. We present new information emerging from the scale-up of an established and integrated AIDS prevention-and-care program, based initially in a squatter settlement in central Haiti, to a second site in rural Haiti. The program includes robust prevention efforts as well as community-based therapy for advanced AIDS; three related components--women's health and active case finding and therapy for tuberculosis and sexually transmitted infections--were central to this effort. We tracked changes in key indices over the 14 months following the introduction of these services to a public clinic in central Haiti. We found that integrated AIDS prevention and care, including the use of antiretroviral agents, to be feasible in resource-poor settings and that such efforts may have favorable and readily measured impact on a number of primary health care goals, including vaccination, family planning, tuberculosis case finding and cure, and health promotion. Other collateral benefits, though less readily measured, include improved staff morale and enhanced confidence in public health and medicine. We conclude that improving AIDS prevention and treatment can help to reinvigorate flagging efforts to promote universal primary health care.
Adult↗
Scaling-up HIV treatment programmes in resource-limited settings: the rural Haiti experience.
OBJECTIVE: To scale-up a successful HIV/AIDS treatment project and provide comprehensive care to an entire Département du Centre (population 550 000) in rural Haiti, thereby demonstrating that community-based treatment of HIV is feasible and highly effective in resource-limited settings, and serving as a successful model for others to replicate. PARTICIPANTS: In the Département du Centre of rural Haiti comprehensive HIV and tuberculosis treatment is provided free of charge to anyone who presents for care. All those who meet clinical enrolment criteria are treated with highly active antiretroviral therapy (HAART). INTERVENTION: HAART was provided in the context of a comprehensive programme of HIV, tuberculosis (TB), sexually transmitted disease (STD) of the project, treatment and prevention, and women's health services at four sites in the first year. At each site, the medical facility was renovated, additional staff were hired as needed, and a network of accompagnateurs (community health workers) was established throughout the surrounding villages to serve as a link with the community, and to provide directly observed treatment (DOT). RESULTS: In the first year of programme scale-up, over 8000 patients were followed for HIV, and over 1050 were treated with DOT HAART. Adherence to HAART was very high, and clinical outcomes were excellent: all patients responded with weight gain and improved functional capacity, and fewer than 5% required medication changes due to side effects. Viral load was tested among a subset of patients showing that 86% had undetectable viral loads. CONCLUSION: Community-based care of AIDS has been highly effective in rural Haiti. With more international financial support for HIV/AIDS treatment in resource-limited settings, there should be no barriers to access to life-saving HAART for those who need it most.
Antiretroviral Therapy, Highly Active↗