[Ip-health] Press release: MSF Warns Successful Global HIV Response Will Require Bigger Emphasis on Adherence

Michelle French Michelle.French at newyork.msf.org
Mon Jul 20 16:42:44 PDT 2015


MSF issued the following press release today at the IAS Conference in 
Vancouver.

More information about MSF at IAS: http://www.msf.ca/en/msf-at-ias-2015 


MSF Warns Successful Global HIV Response Will Require Bigger Emphasis on 
Adherence

New MSF report surveying lay counsellor policies across eight countries 
highlights major weaknesses for adherence support

Vancouver, 20 July, 2015—The international medical humanitarian 
organisation Médecins Sans Frontières (MSF) warned today that not enough 
is being done to ensure people on antiretroviral treatment (ART) reach and 
maintain ‘undetectable’ levels of virus in their blood.  Reversing the 
epidemic and achieving the UNAIDS 90/90/90 goals* will require much 
broader use of strategies to help people stay on track with their 
treatment, including adherence counselling, alongside routine viral load 
testing to make sure people’s treatment is working.
“Our experience to date on one hand is positive, with people who adhere to 
treatment living longer and healthier lives, but on the other hand, we see 
major gaps in the continuum of care that painfully illustrate the 
shortcomings of the HIV response,” said Dr. Helen Bygrave, HIV Medical 
Advisor for MSF’s South Africa Medical Unit. “The job is not over when you 
start someone on treatment—you need to regularly check to see if their 
treatment is working, and intervene quickly with counselling to help 
address any adherence problems. We talk about losing people through the 
cascade of care, but for some groups, the reality is a more like a cliff, 
and these gaps represent the clay feet of today’s mammoth—yet still 
inadequate—global HIV response.”
Particularly vulnerable groups include pregnant women, people with a 
detectable viral load, and children, whose rate of treatment failure is 
almost double that of adults.  But viral load monitoring combined with 
effective adherence counselling works. In Zimbabwe, for example, among 
people on ART, 86% achieved viral suppression, and of those with an 
initial high viral load almost half achieved viral suppression after an 
adherence intervention and support.
Ensuring that human resources are available to provide enhanced adherence 
counselling and tailored adherence interventions for vulnerable groups is 
crucial to achieving the goal of 90% viral suppression for all people on 
ART.  Sub-Saharan Africa has the double challenge of addressing both high 
HIV and high TB burdens with the lowest number of health care workers.  In 
an MSF report being released at the International AIDS Society (IAS) 
Conference in Vancouver, HIV TB counselling: who is doing the job?, MSF 
reviewed lay counsellor policies and practices in eight countries in the 
region and found highly variable job profiles, deployment, and training of 
lay counsellors.  In addition, four out of the eight countries were 100% 
reliant on donor funding for lay counsellors programmes and five countries 
had not yet begun the process of adding these essential workers to the 
health care workers rolls. 
“Without formal recognition and sustained support for lay counsellors, we 
cut our chances of ramping up testing, linking people to care, and helping 
people stay adherent on ART; without good adherence to ART, we will never 
decrease HIV transmission nor keep people healthy,” said Amanda Banda, HIV 
Advocacy Coordinator for MSF in Southern Africa.
Adherence counselling works best alongside viral load monitoring, the gold 
standard for ensuring that people’s treatment is working and that they are 
maintaining the desired ‘undetectable’ level of HIV, which is best for 
their own health and also reduces the likelihood of HIV transmission to 
close to zero. 
MSF data being released at the Vancouver conference from Kibera in Kenya 
supports the WHO proposal that if routine viral load is available, CD4 
monitoring can be safely stopped. Of those people with a CD4 higher than 
200 when they started treatment and who maintained virological 
suppression, none reduced their CD4 count below 200 by 24 months. 
After MSF’s introduction of routine viral load in some places, including 
in Zimbabwe for example, the identification of treatment failure and 
subsequent movement of patients on to second line ART considerably 
increased. However, MSF data from Zimbabwe illustrates the importance of 
ongoing adherence support: of those who switched and who had a viral load 
test between three to six months later, only 72.5% had undetectable levels 
of virus. 
Out of 54 developing countries surveyed by MSF, 47 include routine viral 
load monitoring in their treatment guidelines, in line with World Health 
Organization recommendations. However, in reality, viral load testing is 
only available in a handful of countries and only eight countries have 
dropped routine CD4 cell count testing for people on ART in favor of viral 
load.** 
“We should not be settling for anything less than offering all people on 
HIV treatment in developing countries the gold standard test that tells us 
their treatment is working,” said Banda. “We need to see much more global 
support for viral load monitoring and lay counsellors across the board if 
we expect people to reach and maintain undetectable levels of HIV.”
MSF started providing HIV treatment to people in developing countries in 
2000, and today supports more than 200,000 people living with HIV through 
MSF programmes. 
 *UNAIDS 90/90/90 goal states by 2020, 90% of all people with HIV will 
know their status; 90% of people diagnosed with HIV will be on ART; and 
90% of those on ART will have viral suppression.
**Cameroon, Kenya, Malawi, Namibia, South Africa, Swaziland, Thailand and 
Uganda
###


Michelle French
Sr. Communications Manager, MSF Access Campaign
Doctors Without Borders\Médecins Sans Frontières (MSF)
Office: +1.212.763.5735 | Mobile: +1.646.552.4600
michelle.french at newyork.msf.org | Skype: michellejfrench
www.msfaccess.org | twitter.com/MSF_access | www.facebook.com/MSFaccess



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