Community-based treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy).
In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths. In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART). Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries where human immunodeficiency virus (HIV) takes its greatest toll. Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of the infrastructure necessary for using them wisely. We re- examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment programme based on lessons gained in TB control. With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit. The inclusion criteria and preliminary results are presented. We conclude that directly observed therapy (DOT) with HAART, "DOT-HAART", can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs.
Farmer
P
P
Department of Social Medicine, Harvard Medical School, Boston, MA, USA. PIHPaul@aol.com
Léandre
F
F
Mukherjee
J
J
Gupta
R
R
Tarter
L
L
Kim
J Y
JY
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy* / Q000401:mortality; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000706:statistics & numerical data*; D000995:Antitubercular Agents / Q000008:administration & dosage; D003153:Community Health Services; D003906:Developing Countries; D023801:Directly Observed Therapy; D016527:Drug Costs; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D017063:Outcome Assessment, Health Care; D011203:Poverty; D015980:Public Health Practice; D018088:Tuberculosis, Multidrug-Resistant / Q000517:prevention & control
D000995:Antitubercular Agents