Currently around one out of four HIV patients drops out of treatment. Keeping HIV patients in treatment could save millions of lives. It would also tackle the main flaw of the otherwise very successful ART programmes. The study’s recommendations were fed into new international guidelines on ART which will be presented at the International Aids Society (IAS) conference starting Sunday 30 June 2013.
“Over the past ten years, HIV patients receiving ART have multiplied 20 times, a huge success. But we still need to build experience with lifelong care. Health care facilities often lose track of patients along the way,” said Yibeltal Assefa of the federal HIV/AIDS Prevention and Control Office in Ethiopia. On Wednesday (26 June), Yibeltal Assefa obtained a PhD degree at the Vrije Universiteit Brussel (VUB) for his research at ITM.
The study analysed retention rates in Ethiopia in detail. After 24 months on ART, up to 85% of patients were still on treatment in some health facilities, while others retained only half of their patients. The more successful health facilities were keeping patients in treatment by making concrete and proactive efforts to retain patients, often in cooperation with community-based organisations.
“Simple and cheap interventions made the difference, not money or technology. Successful clinics used simple patient information systems and coordinated with the patients’ case manager. Instead of just waiting for the patient to show up each month, they would collect the patient’s contact details and those of relatives for the eventuality they would not,” said Assefa.
Based on observations in the most successful clinics, the researchers developed a framework to improve retention in care through simple and inexpensive interventions, which should be duly monitored, evaluated and adapted to specific contexts.
Interviews with patients showed that there were also socio-cultural factors explaining drop outs from ART treatment.
“Patients interrupt treatment because they fear stigma, or because health facilities are too geographically distant. Some of them decide to quit because they feel healthy and better. Others opt for traditional medicines. To fight back HIV/AIDS we must engage with patients and their communities to understand their actions,” said Assefa.
Antiretroviral therapy, a success story
ART helps people with HIV to live longer and healthier; it also lowers their chances of transmitting HIV to others. The therapy decreases the amount of the virus in a person’s bodily fluids, known as the ‘viral load’. This reduces the likelihood of the virus being passed on, which is referred to as ‘treatment as prevention’.
By the end of 2011, eight million people infected with HIV were on ART. This is a 20-fold increase compared to 2003, which is one of the most remarkable achievements in public health history.
WHO published the first global ART guidelines for adults and adolescents in 2002, and subsequently revised them in 2003, 2006 and 2010. At the IAS conference in Kuala Lumpur, WHO will present integrated and consolidated guidelines on the use of ARVs in adults, children and pregnant women for both prevention and treatment. Yibetal Assefa and ITM’s Prof. Wim Van Damme, co-promoter of Assefa’s PhD study, have both contributed to the new guidelines.
- Thesis: Scaling up Antiretroviral Treatment and Retaining Patients in Care in Resource-limited Settings: Lessons from Ethiopia, 2006-2012
- More information about the WHO’s HIV treatment guidelines
- IAS 2013
Instituut voor Tropische Geneeskunde