Recorded presentation

Rachel M. Cohen, Doctors Without Borders, 333 7th Ave, 2nd Floor, New York, NY 1001, 212-655-3773, rachel_cohen@newyork.msf.org

Purpose: Anti-retroviral (ARV) combination therapy has been demonstrated to provide major benefits for people with HIV/AIDS in resource-poor settings as well as in developed countries. The current challenge is to urgently scale-up access to ARV to the 6 million people in the developing world who are in immediate clinical need of treatment. Médecins Sans Frontières (MSF) will present the elements that have been vital to the success of its AIDS treatment projects in order to inform other scale-up initiatives.

Methods: Data were analyzed from 10 MSF projects in Africa and Asia in which more than 6,000 patients receive ARV treatment. Four projects are located in rural settings and six are in urban settings.

Results: Five key elements for success were identified: (1) free access to care; (2) treatment services linked to voluntary counseling and testing in order to create multiple entry points to HIV/AIDS care; (3) simplified treatment regimens, in particular the use of triple fixed dose combination therapy (FDC); (4) simplification of the selection process and the ongoing monitoring of patients, relying on clinical monitoring over resource-intensive laboratory tests; (5) decentralized treatment programs in order to ensure equitable access to care. This requires standardized protocols, trained nurses who initiate and monitor care, and mobile clinics. In each of the 10 treatment projects discussed, MSF has successfully employed many or all of these five key elements.

Recommendations: International donors such as the Global Fund, WHO, and the US government should take into account these important elements from MSF’s field experience in the implementation of broad treatment initiatives.

Learning Objectives: At the conclusion of this session, the participant will be able to

• Define the key elements of ARV treatment projects that should be included in initiatives to scale up treatment.
• Understand how these key elements are reflected in the operations of ARV projects.

Keywords: Antiretroviral Combination Therapy, HIV/AIDS

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Recorded presentation