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 Saturday 01 August 2009
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AFRICA: Fewer lab tests could save more lives

Photo: Siegfried/IRIN
The trial investigators calculated that for CD4 count testing to be cost-effective in Uganda, the cost would have to come down from US$9 per test to $3.80
JOHANNESBURG, 28 July 2009 (PlusNews) - Antiretroviral (ARV) treatment can be delivered safely and effectively in remote or resource-limited settings where regular laboratory monitoring cannot be carried out, according to findings from a study presented at the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention, in Cape Town last week.

The Development of Anti-Retroviral Therapy in Africa (DART) clinical trial, conducted in Uganda and Zimbabwe by the United Kingdom's Medical Research Council, with funding from the UK Department for International Development and the Rockefeller Foundation, aimed to find out whether laboratory monitoring resulted in significantly better outcomes for patients receiving ARV treatment in low-income countries.

The trial recruited 3,316 patients ready to begin ARV treatment and randomly divided them into two groups. The first group were given a CD4 count (to measure immune system strength) and drug toxicity tests every three months after starting treatment; the second group had the same tests but the results were only shared with their doctors if they showed a serious abnormality. Otherwise, their doctors relied only on clinical monitoring.

After five years, 90 percent of people in the first group were still alive, compared to 87 percent in the second group; 22 percent of people in the first group had developed a new AIDS-related illness, compared to 28 percent in the second group.

There was no difference in drug-related side effects, and other differences between the groups did not emerge until the third year of treatment, leading the researchers to conclude that clinical monitoring alone is sufficient for patients in their first two years of treatment.

The findings have important implications for countries where the number of people started on ARVs has been limited, not only by the cost of drugs but by the cost of laboratory monitoring and the distance patients have to travel to clinics offering these services.

"Thanks to DART, governments now have evidence that expensive blood tests aren't needed routinely for HIV treatment to be successful and safe," commented one of the study's principal investigators, Prof Peter Mugyenyi, of the Joint Clinical Research Centre in Uganda.

''This could make a huge difference to people who live in remote areas that are many days' walk from the nearest hospital or laboratory''
"It also means that treatment could be delivered locally, as long as health care workers have the right training, support and supervision," he added. "This could make a huge difference to people who live in remote areas that are many days' walk from the nearest hospital or laboratory."

A cost analysis of the data concluded that one-third more people could be successfully treated for HIV in Africa if expensive laboratory tests were not used routinely.

However, the DART study results conflict with a recent study in western Kenya which found that more, not less, laboratory monitoring was needed to prevent patients from being switched to more expensive second-line ARV regimens unnecessarily.

Commenting on the findings of the Kenya study in the British medical journal, The Lancet, two HIV experts described "improved access to appropriate laboratory tests for initiating and monitoring ART [antiretroviral treatment]" in resource-limited settings as "a critical area of need".

A number of speakers at the IAS Conference were also critical of what they perceived as a growing gap between standards of HIV/AIDS treatment and care in the developed and developing worlds, but Prof Charles Gilks, of Imperial College, London, another of the DART study's principal investigators, argued that "until universal access [to treatment] can be achieved, the priority should be getting untreated patients on ART".


Theme(s): (PLUSNEWS) Care/Treatment - PlusNews, (PLUSNEWS) HIV/AIDS (PlusNews)


[This report does not necessarily reflect the views of the United Nations]
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