Only 60 percent of AIDS patients in Africa still take the drugs they need to stay alive two years after starting treatment, researchers reported on Monday, noting a grim reason many stopped: death.
Of the patients found no longer to be taking the drugs after two years, 40 percent died and the rest missed scheduled appointments, failed to pick up medication or may have transferred to other clinics. A small percentage stopped their treatment but continued to get other medical care at clinics where they started AIDS drugs.
"I don't want people losing heart from this, even though 60 percent isn't fabulous," said Sydney Rosen, an assistant professor at Boston University's School of Public Health, who led the study.
The study was published in the Public Library of Science Medicine journal.
Nearly all of the people on the anti-retrovirals would have died without them.
"If you think of this in terms of deaths avoided and orphans avoided, then this could be a success story," Rosen said.
The WHO estimated that AIDS treatment programs in the West retain about 80 percent of patients after two years.
The 60 percent for Africa is "a fairly gloomy conclusion," said Charlie Gilks, director of treatment at the WHO's AIDS department, who was unconnected to the paper. "But considering the huge challenges we started with, a 60 percent retention rate is not such a bad benchmark."
When the AIDS pandemic hit Africa, experts worried that its weak health systems would crumble under the stress. WHO's "3 by 5 program" aimed to put 3 million people on anti-retrovirals to fight AIDS by 2005. By the initiative's end, only 1.3 million were receiving them. Another 4.8 million patients still need the drugs, out of some 25 million people in Africa living with AIDS.
Rosen and colleagues examined 32 publications reporting on 74,192 patients in 13 African countries between 2000 and this year. Their report included many studies done in sub-Saharan Africa, particularly South Africa, which has the world's highest number of AIDS patients.
Experts noted the high numbers of deaths at the start of any AIDS treatment program. In Africa, people usually begin taking anti-retrovirals when they are much sicker than patients in the West.
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