Provision and Access
1. Antiretroviral therapy has been successfully administered to both men and women with good adherence, good patient retention, and good clinical outcomes in resource-poor settings; results have been similar to those achieved in resource-rich countries.
A systematic comparison of antiretroviral therapy on mortality of HIV- positive patients in both low-income and high-income countries found that antiretroviral therapy is feasible and effective in low-income settings. Mortality was higher in the first few months of treatment for patients in low- income settings. Those in low-income settings started treatment with considerably more advanced immunodeficiency than those from industrialized countries, but virological and immunological response to HAART were similar in both settings. The study compared 4,810 treatment-naïve adult patients (51% female) from 18 HAART programs in Africa, Asia and South America (low-income settings) with 22,217 treatment-naïve adults (25% female) in 12 HIV cohort studies from Europe and North America (high-income settings) and compared baseline characteristics and outcomes during the first year of HAART.
A review of nine articles and 18 abstracts until 2006 from sub-Saharan Africa, with 12,116 patients found favorable levels of adherence, with 77% of patients achieving 95% adherence according to patient self-reports. Adherence from studies in sub-Saharan Africa showed that that more patients were adherent than patients in North America, based on 31 studies with 17,537 patients.
Mills, E., J. Nachega, I. Buchan, J. Orbinski, A. Attaran, S. Singh, B. Rachlis, P. Wu, C. Cooper, L. Thabane, K. Wilson, G. Guyatt and D. Bangsberg. 2006. “Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North America: A Meta-analysis.” JAMA296 (6): 679-690.