Community-based treatment of advanced HIV disease: Introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy)

Article (PDF Available)inBulletin of the World Health Organisation 79(12):1145-51 · February 2001with45 Reads
DOI: 10.1590/S0042-96862001001200011 · Source: PubMed
In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths. In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART). Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries where human immunodeficiency virus (HIV) takes its greatest toll. Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of the infrastructure necessary for using them wisely. We re- examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment programme based on lessons gained in TB control. With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit. The inclusion criteria and preliminary results are presented. We conclude that directly observed therapy (DOT) with HAART, "DOT-HAART", can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs.
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    • "Partners In Health (PIH) was founded in the 1980s to provide medical and social services to the residents of Cange, a rural squatter settlement in Haiti's Central Plateau. ZL/PIH began to treat PLHIV with antiretroviral therapy in 1998 [19,20], using a package of services— from community health workers to conditional cash transfers to support adherence and retention in care [21]. With the advent of large scale HIV funding through the Global Fund to Fight AIDS, TB and Malawi (GFATM) and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) PIH and its Haitian sister organization Zanmi Lasante began to expand HIV prevention, care and treatment to support the public facilities in Central and Artibonite Departments, serving a primary catchment area of over 1.2 million. "
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