USAID Programs: Antiretroviral Therapy
The U.S. Agency for International
Development is committed to improving access to antiretroviral
drugs for HIV/AIDS
in developing countries. Antiretroviral drugs have been used
extensively in the developed world for a number of years
to improve the quality of life and extend the life of those
infected with HIV. USAID’s care and treatment activities
for HIV/AIDS have expanded to include the introduction of
these life-saving antiretroviral drug therapies in developing
countries. Antiretroviral drugs are one aspect of a comprehensive
care and support program that includes meeting the medical,
psychological, socioeconomic, and legal needs of those affected
by HIV/AIDS. These
drugs are critical to not only treat HIV infection, but
also are critical for the
prevention of mother-to-child
transmission of HIV. As part of President Bush’s
International Mother and Child HIV Prevention Initiative,
USAID has implemented programs to administer antiretroviral
drugs to the mother and infant. In addition, USAID is a
key partner in President Bush’s Emergency Plan for
AIDS Relief. The Emergency Plan aims to support treatment for at least two million people living with HIV/AIDS, prevent seven million new infections, and support care for 10 million people infected with and affected by HIV, including orphans and vulnerable children.
Background
USAID has been managing HIV prevention programs in developing countries
since 1987. Since 1997, USAID has steadily added AIDS care and support components
to its network of prevention services. At the beginning of the 21st century,
the declining price of antiretroviral drugs has permitted the integration
of antiretroviral treatment and management into relevant prevention and
care programs. USAID has taken a leadership role in this introduction, as
outlined below. Ultimately, these service delivery systems will be sustained
with increasing support from host-country government budgets, and staffed
with well-trained personnel who can continue the training process.
Antiretroviral Drug Introduction
There are many complex issues related to the introduction of antiretroviral
drugs in resource constrained settings. While answers to some of these complex
issues are known in the developed world, their impact in developing countries
is much less defined. These issues include: ease of administration and adherence
to therapy protocols; drug tolerance and side effects; development of antiviral
resistance; development of national HIV clinical management guidelines;
reliable laboratory support to monitor treatment; and management of drug
selection, supplies, storage and distribution.
USAID has developed learning
sites to introduce antiretroviral treatment in this type
of setting in Ghana, Kenya, and
Rwanda. These three USAID introductory sites will be models
for antiretroviral treatment that governments and the private
sector can expand to a national level, with the support
of the President Bush’s Emergency Plan for AIDS Relief.
USAID will rapidly distill replicable lessons learned from
these sites through site-specific analysis as well as cross-site
comparisons. From that body of knowledge, USAID will expand
its array of sites for antiretroviral introduction to other
settings in the world. By the end of 2003, approximately
500 patients will receive treatment in the three countries.
On February 27, 2003 four HIV-positive patients at the
Biryogo Medical and Social Center in Rwanda became the
first to receive antiretroviral therapy under a new USAID-supported
effort. These first four patients are women; three are
widows caring for their own children as well as orphans
from the 1994 war and genocide. None of them is able to
work because of HIV-related illnesses. The fourth woman
is a 20-year-old unmarried student who aspires to be a
laboratory technician and continue her education at the
university level. The treatment program will build on existing
HIV counseling and testing services, and expand the range
of medical care and support services that are available
to HIV-infected individuals. In this site, a major focus
will be on supporting community responses to provide home-based
care as a complement to clinic-based services. A second
site will begin treatment later in the year.
In Ghana, the "Start" program is a comprehensive
prevention, care and treatment program that is designed
to define, refine and document approaches to HIV/AIDS service
delivery in resource-poor settings. "Start" will
begin in two districts in the Eastern Region of Ghana,
where an estimated 18,000 people out of 240,000 are HIV
positive. The program is using two implementation models,
one in a comprehensive district program and the other in
a teaching hospital. The first site is ready to begin treatment
and the two teaching hospitals will follow soon. The government
of Ghana will utilize funds from the Global Fund to Fight
AIDS, Tuberculosis, and Malaria to expand the number of
people treated at the three USAID supported sites. This
will be the first example of USAID programs leveraging
Global Fund resources for AIDS treatment. USAID assistance
in developing the skills and infrastructure necessary to
provide these treatment services will help ensure that
the Global Fund resources achieve maximum impact.
In Kenya, USAID started ARV treatment in Mombasa, Kenya,
on May 23, 2003. This program has created a learning site
for the safe introduction and effective use of antiretroviral
drugs in Mombasa District by strengthening the existing
HIV clinic at the Coast General Provincial Hospital and
the voluntary counseling and testing services of two primary
health care centers. These facilities will be linked through
explicit referral and follow-up systems with communities
and community-based health and support organizations. The
lessons learned from initiating antiretroviral therapy
in Mombasa will feed back immediately to national policy
makers and stakeholders.
Capacity Development
Recognizing that expanding access to antiretroviral treatment
requires more than simply providing the necessary drugs,
USAID is developing the infrastructure and skills necessary
to effectively deliver antiretroviral drugs in the introductory
sites. This involves training physicians in HIV clinical
management; training medical center staff on the fundamentals
of antiretroviral therapy and treatment of opportunistic
infections, patient counseling, and treatment adherence;
and upgrading laboratory equipment to permit ongoing biological
monitoring of the patients. USAID programs also strengthen
systems for obtaining and distributing drugs and develop
necessary laws and policies to ensure a quality program for
the procurement, delivery, and administration of antiretroviral
drugs.
Antiretroviral Prophylaxis for HIV Infected Mothers
In addition to the importance of antiretroviral drugs
for treatment of HIV infection, specific antiretroviral drugs are key to
preventing transmission
of HIV from infected mothers to their children. Recent studies
have shown that short, affordable courses of antiretroviral therapy for
HIV-infected
pregnant women can reduce HIV transmission to newborn babies
by 20 to 50 percent. Providing these antiretroviral drugs is one aspect
of USAID’s
focus on a comprehensive approach to preventing mother-to-child
transmission. USAID currently supports over 100 programs in 11 countries,
including South
Africa, Uganda, Romania, and Haiti, for the prevention of
mother-to-child transmission of HIV.
Public-Private Partnerships
The U.S. Agency for International Development, Office
of HIV/AIDS has an “open
door” policy inviting all businesses to partner in the fight against
HIV/AIDS. This includes several ongoing initiatives with
multi-national corporations designed to extend HIV/AIDS treatment to employees
and dependents
living in Africa and to support local communities. In Ghana,
a U.S.-Dutch collaboration underway will create private sector clinics able
to provide
treatment to employees of private corporations wishing to
provide treatment under employee benefits plans. USAID provides technical
assistance to the
Coca Cola Foundation for Africa to support prevention education,
voluntary counseling and testing and treatment for Coca Cola distributors
employees
and dependents in 56 countries across the African continent.
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July 2005
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