[procaare] Part 5 - Harvard Consensus Statement on ARV Treatment for AIDS in Poor Counties

[Richard Marlink <marlink@hsph.harvard.edu>]

*The Harvard 'Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries;
has been broken into 6 parts in text format to be easily received by our forum members. To
view the entire document online, please go to: http://aids.harvard.edu - ProCAARE
Moderator*

PART 5

Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries

By Individual Members of the Faculty of Harvard University (*1)
[* To see the list of 148 signatories, please go to website as noted at the top *]

Conclusion: It is time for a New Global Initiative to Provide AIDS Treatment in the
Poorest Countries

As outlined at the beginning of this document, the leading objections to the widespread
use of HAART in poor countries relate to infrastructure, patient adherence and drug
resistance, cost, and political leadership. We believe this proposal systematically
addresses each objection in a manner that can be assessed in both large pilot programs and
clinical trials.
In summary:

1. Infrastructure: Our proposal recommends the use of existing and developing
infrastructures, such as networks that have been developed for directly observed therapy
for the treatment of tuberculosis, and for maternal- to- child HIV transmission. The
proposal also recognizes the immediate need to build additional infrastructure in
resource- poor countries through the support of donor funding.

2. Adherence/ drug resistance: The proposal recommends the use of simplified (once- or
twicedaily) HAART regimens in addition to directly observed therapy and other strategies
designed to achieve high levels of adherence. These strategies have been associated with a
high degree of treatment success and low levels of drug resistance in tuberculosis
treatment, and treatment for both diseases should be integrated. (*48)

3. Cost: At approximately $1,100 per patient per year, the total cost of treatment for 1 3
million HIV- infected individuals in Africa within 3- 5 years would be easily managed by
the world's wealthiest countries. Even at the five- year mark, the annual expenditure of
about $3.3 billion would represent only about 0.01% of the aggregate GNP of these
countries or about one cent (1¢) of each $100 of income in these economies. Extending
this program worldwide would add around 25 percent, so that the annual expenditure would
total approximately $4.2 billion in the fifth year. This is a small price to pay for
treatment on a meaningful scale in the midst of the worst worldwide pandemic in 600 years.
It will likely save millions of lives, while leaving abundant capacity to fund AIDS
prevention.

4. Leadership: The proposal recommends the establishment of an HIV/ AIDS Prevention and
Treatment Trust Fund, and calls on wealthy countries to provide financial and scientific
leadership, and poor countries to provide necessary political and institutional support at
both the national and community levels. Successful treatment delivery requires the full
involvement of national governments and communities in the ultimate design and
implementation of these interventions.

We conclude that a rapid scaling- up of scientifically monitored AIDS treatment in poor
countries will prove feasible, affordable, and highly effective. There should be no
further delay in launching a major international effort to save the lives of millions of
HIV- infected persons. This effort will also help prevent the transmission of HIV
infection to millions of healthy individuals in low- income and high- prevalence countries
through the introduction of AIDS treatment.


REFRENCES
***********
*48 Martin S. Hirsch, et. al., "Antiretroviral Drug Resistance Testing in Adult HIV- 1
Infection," Journal of the American Medical Association, May 10, 2000, Vol. 283, No. 18,
2417- 2426.

--
Send mail for the `ProCAARE' conference to `procaare@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to:  `owner-procaare@usa.healthnet.org'.