Abstract

Support for international AIDS treatment: combating multi-resistance in HIV patients in Latin America and the Caribbean with a multi-dimensional approach

J. Valencia

Aid for AIDS International, Operations, New York, United States

Issues: Patients developing multi-resistances to ARVs in Latin America and the Caribbean (LAC) are increasing. UNAIDS estimates that by 2008 over 51,000 people were receiving second/third line therapies in low/middle income countries worldwide. However, the capacity of medical professionals and the health system to provide these advanced treatments is limited.
Description: The Support for International Access to Treatment (SIAT) program at Aid for Aids International (AFAI) assists LAC local health systems' efforts to increase adherence and reduce resistance to treatment. SIAT includes three components: Provision of free ARV through AFAI's HIV Medicine Recycling initiative; patient counseling, follow-up and evaluation through the AIDS Treatment Access initiative; and health care provider education through Training for Health Professionals, providing continuous training and problem-solving assistance for health care professionals.
Lessons learned: Through SIAT, AFAI has helped more than 40,000 PLWHA by delivering over 50 million dollars in ARVs and training more than 750 LAC health professionals. In some countries, these initiatives might be the only way multi-resistant patients can access third line ARVs. Although, the vast majority of persons supported by our program have remained sensitive to first line ARVs, our records show a marked increase in requisitions for alternative drugs in new patients, from 3.2% in 2007 and previous years to 18.1% in 2009. We thus identify a lack of readiness, knowledge and/or interest by some many LAC governments to address the urgent needs of PLWHA who have developed multi-resistance.
Next steps: SIAT seeks now to build a network of trained health care providers who, in coordination with activists, could increase awareness about multi-resistance as a public health issue, its consequences, and the urgent need to address it. This network will not only create social discourse with health care providers around the issue but will also advance initiatives to increase social awareness and conduct political incidence.