Posts tagged HIV

Photo by Delphine Goux/MSF

“My baby needs me to take HIV drugs everyday but I cannot walk 5 hours every month to get them”

Name: Ana Maria Manuel
Location: Mozambique

An HIV-positive pregnant or breastfeeding woman who is not on antiretroviral treatment has one out of three chance of transmitting the virus to her baby. In 2013, 240,000 children were infected through their mothers. When women like Ana, above, are on effective ARV treatment, the risk of transmitting the virus to babies is reduced to less than four percent. “I started treatment in 2005 thanks to my counselor who really encouraged me to be on ARVs,” says Ana. “I know it’s very important because I have three children. Because I am very serious about my treatment, they are thankfully all HIV-negative. But it’s hard to be good and adhere to treatment when the clinic is so far away.” On World AIDS Day, Dec. 1, MSF is calling for health providers to adapt treatment to realities of patients’ lives: https://www.doctorswithoutborders.org/article/world-aids-day-portraits-my-life-my-hands

Photo by Munyaradzi Makari/MSF

“I don’t enjoy being at the clinic. Bring ARVs to the community”

Name: Bev Murevi
Location: Zimbabwe

HIV patients need daily antiretroviral (ARV) treatments, a diagnosis that requires monthly trips to the clinic to pick up drugs. Bev, above, has been on ARV for five years and has to walk over seven miles each way to get to the clinic to pick up her drugs. Community Antiretroviral Treatment Groups (CAGs) help patients by decreasing trips to the clinic to only once a year. “With the CAGs, I can rely on my group members to bring drugs to me, except when I have to go in person to see my clinician for my yearly check up,” says Bev. “CAGs give us a chance to rest.” That being said, patients still agree that it would be better if treatments were closer than a half-marathon’s journey. On World AIDS Day, Dec. 1, MSF is calling for health providers to adapt treatment to realities of patients’ lives: https://www.doctorswithoutborders.org/article/world-aids-day-portraits-my-life-my-hands

Many of the places where  Doctors Without Borders/Médecins Sans Frontières (MSF) works are societies where it is difficult for women to implement contraception in their relationships and where women are not encouraged or allowed to freely access health care. A woman’s health is often a family business and she needs her husband’s permission to go to the doctor, sometimes even to receive lifesaving treatment. Without a supportive family, getting tested for and taking treatment for HIV/AIDS can be very challenging for women. More than 90 percent of HIV-positive children contract the virus from mother during pregnancy, birth, or breastfeeding. MSF is working to break the transmission chain. Go to doctorswithoutborders.org to learn more.

There is no cure for HIV/AIDS, although treatments are much more successful than they used to be. A combination of drugs, known as anti-retrovirals (ARVs), help combat the virus and enable people to live longer, healthier lives without their immune system rapidly declining. Doctors Without Borders/Médecins Sans Frontières (MSF) HIV/AIDS programs offer HIV testing with pre- and post-test counseling, treatment and prevention of opportunistic infections, prevention of mother-to-child transmission, and provision of ARVs for people in the late stages of the disease. Our programs also generally include support of prevention, education, and awareness activities to help people understand how to prevent the spread of the virus. Go to doctorswithoutborders.org to learn more.

Photo by Sven Torfinn

Swaziland is in the middle of a medical crisis. The highest HIV prevalence in the world and the emergence of drug-resistant TB threaten to have a disastrous effect on the social and economic situation there.

Millions of people in developing countries are still waiting for the AIDS revolution. Join us for a Twitter chat on how millions of people are still waiting for the AIDS revolution: Friday, Dec. 6, 11am EST/5pm CET @MSF_SouthAfrica

HIV TREATMENT COSTS

The price of antiretroviral (ARV) drugs may have dropped around 99% over the past decade, but access to treatment remains an issue. Patents on new ARV drugs cause prices to skyrocket, making them unaffordable for people in low and middle-income countries. 

Learn more in MSF Access Campaign’s 16th edition of Untangling the Web

Photo by Ton Koene

The upheaval in Central African Republic has meant HIV treatment interruptions and mounting medical needs. Meanwhile, health workers flee with their families to safety and the malaria season starts. MSF tries to respond to this ‘crisis on top of a crisis’.“ 

Read more - http://www.doctorswithoutborders.org/news/article.cfm?id=6804

Illustration: India 2013 © George Butler

MSF’s HIV/TB Project in Mumbai

MSF invited illustrator George Butler to visit our HIV and MDR-TB project in Mumbai, India to capture our activities there. He returned with images and stories of families affected by multidrug-resistant TB, their care givers, and the MSF team responsible for their treatment.

Photo: An MSF staff member uses a SAMBA tool for rapid viral load monitoring. Malawi 2011 © Nabila Kram

MSF Research Points to Ways to Expand Viral Load Testing for HIV in Developing Countries

“Viral load monitoring—a test that measures the amount of virus in a person’s blood and thus the effectiveness of antiretroviral treatment—is critical in allowing treatment failure to be detected earlier, and ensuring that people receive the support they need to adhere to treatment,” said Dr. Jennifer Cohn, medical coordinator for MSF’s Access Campaign. “It’s a standard part of HIV disease management in developed countries but due to high costs and the lack of suitable technology, this type of virological monitoring is almost non-existent in developing countries. We need to challenge this state of affairs by ensuring there is financial and political support for roll-out of viral load in remote settings as a routine part of decentralized care.”

The two main barriers to roll-out of viral load concern the cost of testing and the difficulties of sample collection and transport. In two studies to be presented at CROI from its projects in Thyolo, Malawi, MSF will show how viral load monitoring can be adapted for resource-limited settings by using novel technologies and strategies to address these barriers.

The first study looked at simplification. Instead of conducting a blood draw, which requires a nurse, MSF was able to acquire blood samples by performing a simple finger-prick in order to prepare dried blood spots, which were then transported to a laboratory with viral load testing capabilities. Because dried blood spots (DBS) are easy to prepare, extremely stable at room temperature, and can even be sent in the mail, the finger-prick method of collecting samples in conjunction with the practicality of using DBS helps to overcome the challenges of health worker shortages and lack of sophisticated sample transportation networks for blood-based samples. This makes access to viral load testing easier for patients in rural areas, who no longer need to travel long distances to reach facilities with testing capacity.

A second viral load study to be presented at CROI looked at overcoming cost barriers preventing routine viral load implementation. MSF evaluated the accuracy and cost-saving of pooling samples of dried blood spots compared to individual viral load testing in a rural district laboratory in Thyolo, Malawi. 

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.