A massive scale-up of HIV/AIDS treatment programs at urban primary care sites in Zambia has produced favorable patient outcomes, demonstrating that expansion of such programs in sub-Saharan Africa is feasible, with good results, according to a study in the August 16 issue of JAMA, a theme issue on HIV/AIDS.
Jeffrey S.A. Stringer, M.D., of the Centre for Infectious Disease Research in Zambia, Lusaka, and the University of Alabama at Birmingham, presented the findings of the study today at a JAMA media briefing at the International AIDS Conference in Toronto.
Zambia's 11.5 million residents are among the world's poorest and most severely affected by acquired immunodeficiency syndrome (AIDS), according to background information in the article. About 16 percent of the adult population is infected with human immunodeficiency virus 1 (HIV 1), including 22 percent in the capital city Lusaka. In 2003, more than 90,000 Zambians died of HIV disease. Historically, only the wealthiest citizens have had access to antiretroviral therapy (ART) for HIV through private medical practices.
The Zambian Ministry of Health, aiming to provide public access to treatment, in 2002 started pilot ART distribution programs at two of the country's largest hospitals. The program filled almost immediately and in May 2004 expanded to four clinics in the Lusaka Urban District, which were staffed primarily by clinical officers and nurses. In the following 18 months, all fees for patients seeking care were eliminated, ART and laboratory tests were offered for free and the program expanded to 14 additional urban sites. "At the time of program initiation, there was widespread uncertainty that complex, long-term HIV care could be delivered in a setting with so few physicians and so little physical and technical resources," the authors write.
Dr. Stringer and colleagues report on their initial experience with the program and evaluate outcomes among more than
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