Photo: Blood is drawn for an HIV test at the MSF Dipping Tank community testing campaign at Nhletsheni, in Shiselweleni region. Swaziland 2012 © Giorgos Moutafis
Trying Out New Approaches to HIV Treatment
Thirty years into the HIV/AIDS epidemic and more than a decade since the introduction of antiretroviral treatment (ART) in developing countries, the latest scientific evidence shows that the treatment keeps people healthy and prevents the virus from spreading. MSF is now treating more than 222,000 people for HIV/AIDS in 23 countries and introducing new approaches to treatment including earlier provision of ART to pregnant women living with HIV, expanded testing and treatment programs, and using improving technological monitoring techniques to track patient progress. Here, Micaela Serafini, MSF medical referent, discusses MSF’s efforts to treat HIV/AIDS in Swaziland.
Why is it important to provide antiretroviral treatment to people living with HIV while their immune system is still strong?
Today, we measure the level of an HIV-positive person’s white blood cells [CD4 cells] to determine when to start them on treatment, because this is an indicator of how strong their immune system is. Right now, the World Health Organization recommends starting people on ART when their CD4 cell count drops to 350 cells per mm3 of blood, but asks countries to consider earlier ART for pregnant women and HIV-positive partners in couples where one person is HIV-positive and the other is not, or “sero-discordant” couples. A healthy person’s CD4 count ranges from 800 to 1,200 cells per mm3—the lower the count, the more prone a person is to becoming ill from opportunistic infections like tuberculosis.
In Swaziland, MSF is studying the feasibility and acceptance of the “Test and Treat” (T&T) model, the most radical option of Treatment as Prevention (TasP). It involves providing all HIV-positive people with treatment, regardless of their CD4 count. This approach would allow us to have a maximum impact on reducing illness, as well as transmission of HIV in the community.
We are currently paving the way for TasP in Swaziland with the implementation of a greatly improved treatment protocol for pregnant women in order to better prevent mother-to-child transmission of HIV, or PMTCT, and help keep mothers healthy. The protocol is referred to as “Option B+.” In a nutshell, PMTCT Option B+ is T&T for pregnant women—we aim to start all HIV-positive pregnant women on life-long treatment, regardless of their CD4 count.
This new pilot project is just starting in the south of the country, in the Shiselweni region, which has a population of 208,000 people. We hope to start PMTCT B+ this month and from there put 3,000 pregnant women on ARV treatment every year. In 2013, we will expand this approach to other vulnerable groups and eventually to all HIV-positive adults in the region.