Free drugs, testing save lives: study

Providing free drugs and testing has helped save thousands of lives in Zambia and could be expanded in sub-Saharan Africa, say researchers who found similar survival rates in the developed world.

Zambia's 11.5 million residents are among the world's poorest. About 22 per cent of people aged 15 to 49 in the capital city of Lusaka are infected with HIV.

Dr. Jeff Stringer of the University of Alabama at Birmingham and his colleagues looked at how well patients survived on antiretroviral therapy or ART, as well as tracking their viral loads to see whether HIV was suppressed successfully.

"In our setting [the problem is] actually getting the patients to come in before they are deathly ill," Stringer told a news conference Sunday at the International ADS Conference in Toronto. "They arrive literally in wheelbarrows, which is the Zambian equivalent of an ambulance."

A sea change is needed before Zambians will stop seeing HIV infection as a death sentence, but it could come as people see others getting better with treatment, he said.

Mortality rate high

The mortality rate was high within the first 90 days of starting therapy, the team found.Of the 1,120 whose death had been reliably recorded,792 died early because they were too sick to respond to the treatment, Stringer said. Most were very thin and anemic.

After 90 days though, the death rateplummeted, and CD4 levels, a measure of the strength of the immune system, were similar to those in the developed world, Stringer said.

Younger people showed more protection against treatment failure, the researchers found.

Since Zambia's brain drain has left a severe shortage of doctors, it was nurses and physician's assistants who gave HIV drugs to about 16,000 people.

"We believe the early success of the Lusaka District ART program calls for optimism," Stringer and his co-authors wrote in the Aug. 16 issue of JAMA, a special issue published for the conference.

"This experience demonstrates that it is possible, given proper resources and local government commitment, to treat thousands of people in urban African settings."

Fewer health-care workers

Rural areas of Africa have fewer health-care workers and medications. But in small communities, health-care workers know their patients personally, which makes it easier to follow up with those who aren't keeping appointments or taking their medications on time.

"There are no secrets in these villages and everyone knows somebody is supposed to be taking the medicines," Stringer said.

The majority of the costs were for recruiting patients, following up and testing them, rather than the medications, he added.

The study was funded by the U.S. government, the Elizabeth Glaser Pediatric AIDS Foundation, the Global Fund for AIDS, Tuberculosis and Malaria and the Zambian government.