In Uganda, for instance, only two thirds of adults and a quarter of the children needing treatment are in fact treated. In the cities some 10% of the population is infected, in rural areas 6%, which means more than 1.2 million people (will) need treatment.
Barbara Castelnuovo of Makerere University in Kampala, Uganda, figured out how treatment can be improved in resource limited settings: when best to start treatment, how safe are the different treatment regiments, how do you check if the treatment works …
She did her research with patients receiving antiretroviral treatment at the clinic of the Infectious Diseaeses Institute of Kampala. Most patients who died, were in a late stadium of the disease and had a low count of CD4 immune cells. Indications that treatment had started too late. The phenomenon receiving recently quite some attention by scientists (IRIS, immune reconstitution inflammatory syndrome), when the immune system through the treatment recovers so well that it overshoots, in reality causes only a limited number of deaths. Patients sometimes were put to fast on (costly) second line medicines.
The patients can be helped faster if nurses take over part of the follow-up from the physicians, and when patients can collect their refills directly from the pharmacist, without each time first collecting a prescription from a doctor. Without endangering the quality of care.
All in all: certainly in these difficult times when western help threatens to shrink, it is important that funds for AIDS control are used as effectively as possible.