ARV Treatment: Special Focus
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ARV Treatment: Special Focus Back to Main Page |
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Probably, we are agree in some considerations about the HIV problem in each developing country: 1. Generally donīt exist adequate information about the magnitude of the problem, its tendency and its relation with: a- Other communicable diseases (tuberculosis, malaria, etc) b- Other prevalent non communicable diseases (acute respiratory infections-ARI, etc.) c- National epidemiological pattern respect to tropical diseases d- Proportion of each etareous group (years old) in the country. e- Coverage of public and private health establishments f- Coverage and capacity of their laboratory net in order to detect HIV population g- Level of coverage of AIDS/HIV national programmes, if exist (local or national coverage). h- Efficacy and efficiency of those HIV/AIDS national programmes. i- Level of budget dedicated to AIDS/HIV, other communicable diseases, and others. National public health budget. j- Level of political support in each programme. k- Level of government support to HIV/AIDS programme. l- Level of development and coverage of independent press. m- Number and coverage of non-governmental agencies dedicated to HIV/AIDS problem. n- Level of develop of local pharmaceutical industries and national politics of market (restrictions in dispensation, etc) o- Level of foreign assistance. In brief, we need INFORMATION with high level of confidence in order to know the magnitude of each national HIV problem, the level of actual coverage, their future capacity and quality, their political vision of their leaders and social net about the disease, etc. So, in my opinion, previously to consider ARV treatment, we need urgently operational and epidemiological background. Then we need to improve the quantity and quality of attention, establishing international viable and realistic standards before to introduce new drugs. Otherwise, weīll unnoticed produce more problems and more drug resistance, so more lethality, relapses and failures and extension of global drug resistance. We need a consensus in order to develop priorities in the interventions in HIV/AIDS epidemic in developing countries: 1- First, to obtain actual information. 2- To improve the representivity, quality and opportunity of information, the coverage and quality of attention. 3- To establish confident operational and epidemiological indicators that permit to decide when to support interventions in ARV drugs supply. 4- Assurance of national government support. To establish indicators that permit to monitor the level of political support. 5- To recommend interventions in co-morbidity: tuberculosis, malaria, bacterial infections, etc. 6- Assurance of at least a minimum quality of biosecurity in public hospitals where the AIDS patients receive treatment. Example: if you decide to initiate a programme of supply of ARV treatment in your hospital and two months later 10 percent of your HIV patients acquire intra-hospitalary multidrug resistant tuberculosis (MDR-TB). The economic source employed in ARV drugs for these patients will be in critical situation since political view and other. 6- To contribute at the national access of treatment only in conditions of assurance of quality: an efficient HIV/AIDS national programme, to apply DOT treatment (directly observed treatment), equity, in observance of national priorities in health politics. Is imperative the assistance of developed countries, including international budget. Probably, we may to consider as an alternative INTERCHANGE INVESTMENT IN HEALTH BY FOREIGN DEBT. For example, for each annualized dollar in foreign debt, the developing country may to dedicate 0.5 dollar in AIDS national programme and co-morbidity, including other communicable diseases, and finally to obtain budget for ARV drug treatment. One previous consideration for this proposition is to accept that: a- First, HIV pandemic is a world problem and not only a third world problem (remember the reappearance of TB and MDR-TB in developed world). b- Second, wonīt to have developed country free of HIV epidemic, in spite of extensive use of ARV treatment if a developing country has HIV epidemic. c- Third, for developed and developing countries will be a cost-efficacy measure to extend the access at ARV combination treatment, whenever AIDS national programme can indorse good practices and a minimum established international standards of quality for developing countries. d- We need indicators that permit us to know when to persuade the governments of developing countries in order to increase their budgets for HIV/AIDS national programme without decrease sources for more prevalent and lethal diseases (probably with less press coverage and less political support). Itīs an ethical priority. Thanks for your time and attention. With my regards. Dr Oswaldo JAVE CASTILLO Pneumologist Consultant of Tuberculosis Control Programme, National "Dos de Mayo" Hospital, Lima, Peru. |
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