High numbers of people dying from AIDS in Sub-Saharan Africa

They remain left out of the global HIV response without access to treatment that prevents AIDS or the medical care they need.

Global attention is needed to prevent and treat AIDS in the antiretroviral era, as half of the patients admitted to Médecins Sans Frontières (MSF) / Doctors Without Borders hospitals are already on treatment and yet are showing clinical signs of failure.

Data from MSF-supported hospitals presented at the IAS Conference in Paris, highlights that in MSF-run and MSF-supported hospitals in Democratic Republic of Congo (DRC), Guinea, Kenya and Malawi, people arrive with such severe immune failure that overall mortality for patients presenting with AIDS is between 30 and 40 percent. Almost one-third of those deaths occur within 48 hours.

The main causes of illness and death are:

  • Treatment failure or interruption
  • Late diagnosis leading to delayed treatment

Says David Maman, MSF Epicentre epidemiologist: “Despite extensive access to antiretrovirals, there has not been the expected drop in late-stage presentations of HIV in developing countries. What’s different is that among people admitted to hospitals, the majority are already diagnosed and many have been on treatment for several years. We’re pushing to switch these patients to second-line antiretrovirals more rapidly.”

At community level, MSF population surveys show that a proportion of people living with AIDS in communities in southern and eastern Africa remain untested and untreated.

“People are still being diagnosed late. We need new ways to detect those left out, early on, before they arrive at hospital in often fatal condition or die at home without ever receiving care. Stigma and lack of information still remain high, leading to delayed treatment or no testing and treatment at all. This illustrates the need to complement increased antiretroviral coverage at community level with improved care for those on treatment for years,” says Gilles van Cutsem, MSF HIV Advisor.

WHO issues 1st ever guidelines for the treatment in low-resource settings

Clinicians, including from MSF, have increasingly voiced concern over the lack of attention and means going towards the prevention and treatment of AIDS across Africa. The World Health Organisation (WHO) on July 24, issued its first ever guidelines for the treatment of AIDS in low-resource settings. While this is a positive step forward, MSF calls for the urgent implementation of the guidelines with additional measures to address potential drug resistance and treatment failure.

Homa Bay, Kenya: Winnie, 25 years, tested HIV positive in 2015 and prescribed antiretrovirals. For two years, she was referred to numerous health facilities which made a proper diagnosis and treatment difficult. She was recently admitted for severe vomiting and diarrhoea. She was married but now lives with her mother.

Key interventions urgently needed to prevent and treat AIDS

  • The rapid rollout of ‘test and start’
  • CD4 baseline testing at ART initiation
  • Routine viral load testing
  • Point of care diagnostics for tuberculosis
  • Improved treatment for cryptococcal meningitis
  • Rapid switch to second-line ART for failing and advanced patients
  • Swift, effective and accessible treatment for opportunistic infections.

MSF is also calling for

  • Models of care geared towards prevention, treatment and support
  • Free specialised hospital-based care for patients

Waning global political will and shrinking funding

With global political will on the decline, shrinking HIV funding will restrict community responses, including targeted testing and improved treatment literacy and adherence as well as the services of health workers, laboratories and diagnostics.

 

 

  AUTHOR
Caxton Central

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