Committed treatment with free testing and free drugs has saved the lives of thousands of Zambian HIV patients, researchers said on Sunday, according to Reuters. They said their new approach proves wrong the perceived wisdom that it is simply not possible to provide sophisticated AIDS care to patients in the poorest of countries. Contrary to some predictions, patients took their pills, came to clinics for follow-up checks -- and have lived, Dr. Jeff Stringer of the University of Alabama at Birmingham told the International AIDS Conference in Toronto. Survival rates compare to those seen in the developed world, Stringer told a news conference. "The majority of patients that we started on therapy, had they not gained access, would have died," Stringer said. His team treated more than 16,000 patients for the 18 months between April 2004 and November 2005, testing their blood and giving them the drug cocktails that can suppress the AIDS virus. "We use any drugs we can get our hands on," Stringer said. They got funding from the U.S. government, the Elizabeth Glaser Pediatric AIDS Foundation, the Global Fund for AIDS, Tuberculosis and Malaria and the Zambian government. They initially saw 21,755 patients at clinics in Lusaka, the densely populated Zambian capital where an estimated 22 percent of adults are infected with HIV. Of these, about 16,000 were given HIV drugs. Another 5,500 were considered not ready for various reasons but were watched. Of those treated, 1,142 died and 3,400 did not return for appointments. As of November, 11,591 were alive, Stringer told the conference. Of those not treated, 192 died, 2,149 are alive and the rest could not be accounted for. Most of those who died -- 792 -- died within the first 90 days of the program, Stringer said. This is largely because they were already too sick, he said. "In our setting (the problem is) actually getting the patients to come in before they are deathly ill," Stringer said. "They arrive literally in wheelbarrows, which is the Zambian equivalent of an ambulance." Those who died were usually very thin, anemic, and infected with diseases such as tuberculosis. But after the first 90 days, the death rate plummeted, Stringer's team reports in a special issue of the Journal of the American Medical Association, timed to coincide with the conference. Now they are treating more than 30,000 patients. Stringer attributed the program's success to four factors: 1) funding; 2) a solid commitment from the Zambian government including making the drugs available free; 3) using physician's assistants because of a doctor shortage and 4) developing electronic records that made it easy to track a patients' progress and to study the results. The patients are followed carefully. Those who failed to keep appointments were tracked down and encouraged to come back, because taking medications on time is key to controlling the AIDS virus. But Stringer said this and other, much smaller studies show the approach can work in urban areas. In rural areas there are fewer resources and fewer health workers, but patient follow-up is far easier. "There are no secrets in these villages and everyone knows somebody is supposed to be taking the medicines. The idea of losing someone to follow-up in a village is unheard of," Stringer said.
