Scaling-up HIV treatment programmes in resource-limited settings: the rural Haiti experience.
OBJECTIVE
To scale-up a successful HIV/AIDS treatment project and provide comprehensive care to an entire Département du Centre (population 550 000) in rural Haiti, thereby demonstrating that community-based treatment of HIV is feasible and highly effective in resource-limited settings, and serving as a successful model for others to replicate.


METHODS
In the Département du Centre of rural Haiti comprehensive HIV and tuberculosis treatment is provided free of charge to anyone who presents for care. All those who meet clinical enrolment criteria are treated with highly active antiretroviral therapy (HAART).


METHODS
HAART was provided in the context of a comprehensive programme of HIV, tuberculosis (TB), sexually transmitted disease (STD) of the project, treatment and prevention, and women's health services at four sites in the first year. At each site, the medical facility was renovated, additional staff were hired as needed, and a network of accompagnateurs (community health workers) was established throughout the surrounding villages to serve as a link with the community, and to provide directly observed treatment (DOT).


RESULTS
In the first year of programme scale-up, over 8000 patients were followed for HIV, and over 1050 were treated with DOT HAART. Adherence to HAART was very high, and clinical outcomes were excellent: all patients responded with weight gain and improved functional capacity, and fewer than 5% required medication changes due to side effects. Viral load was tested among a subset of patients showing that 86% had undetectable viral loads.


CONCLUSIONS
Community-based care of AIDS has been highly effective in rural Haiti. With more international financial support for HIV/AIDS treatment in resource-limited settings, there should be no barriers to access to life-saving HAART for those who need it most.
Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA. skoenig@partners.org
Serena P
SP
Koenig
Fernet
F
Léandre
Paul E
PE
Farmer
D023241:Antiretroviral Therapy, Highly Active; D003153:Community Health Services / Q000458:organization & administration*; D023801:Directly Observed Therapy; D015658:HIV Infections / Q000188:drug therapy*; D006205:Haiti; D006801:Humans; D010342:Patient Acceptance of Health Care; D018579:Patient Selection; D011204:Poverty Areas; D015397:Program Evaluation; D012423:Rural Health; D019035:Rural Health Services / Q000458:organization & administration*