The use of a home-based anti-retroviral treatment could significantly reduce mortality among adults with HIV in poor nations, especially in Africa, according to a study released yesterday.
Anti-retroviral treatment (ART) is the most effective clinical intervention for reducing the death rate of people with HIV, but those in developing nations -- where 90 percent of those infected live -- have limited access to the life-prolonging drugs.
The standard, triple-drug treatment is only available to about 10 percent of those in need in sub-Saharan Africa, international health officials say.
Barriers to treatment include a lack of funds, the high cost of the medication, a shortage of trained healthcare providers, and long distances between clinics and patients.
Jonathan Mermin of the Centers for Disease Control and Prevention in Nairobi and his colleagues monitored a group of HIV patients and their families in rural Uganda through a phased series of treatments over a five-year period.
They began in 2001 by providing basic counseling, diarrhoea prevention and hygiene education to 466 HIV-infected adults and 1481 households without any infected members over a five-month period.
In a second phase, a daily dose of antibiotics was administered to HIV patients to fight bacteria that take advantage of compromised immune systems.
In the third phase, between 2003 and 2005, 138 HIV-infected adults from the original group and 907 new HIV-infected participants and their households were enrolled in an anti-retroviral therapy study.
Households were visited every week by non-professional providers, and no clinic visits were scheduled.
The ART drugs given were lamivudine, stavudine and nevirapine, three types of reverse transcriptase inhibitor.
The researchers said that during the first 16 weeks of combined ART and antibiotic treatment, mortality among HIV-infected participants was 55 percent less than with the antibiotics mixture alone.
And compared with no intervention whatsoever, the combination resulted in a 95 percent reduction of mortality.
"These results were achieved even though no routine clinic visits were scheduled after initial enrollment, and home visits were provided by trained lay providers," the authors said.
"Our findings support the efforts to bring ART to people with HIV throughout the world, irrespective of geographic or socioeconomic background," they said.
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