MSF reports “horrific” HIV treatment access in Congo

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“The conditions surrounding access to care for people living with HIV/AIDS in [the Democratic Republic of Congo (DRC)] are horrific,” according to a press release issued Wednesday from the international humanitarian organization Médecins Sans Frontières (MSF) or Doctors without Borders.

With more than 1 million people infected with HIV in the African nation, 350,000 could benefit from antiretroviral treatment (ART), according to the release. It was not clear whether or not that estimate was based on the current World Health Organization (WHO) treatment guidelines – those with CD4 counts at or below 350 copies per mm3 should be on ART. Meanwhile, only about 44,000 people, or 15 percent of those in need, are receiving treatment, one of the lowest rates in the world.

“The situation here reminds me of the time before any antiretroviral (ARV) treatment was available,” said Anja De Weggheleire, MSF’s medical coordinator in DRC, in the release.Our doctors face serious complications every day that could be prevented if patients received early ARV treatment.”

Prevention of mother-to-child transmission (PMTCT) rates look even worse – the release notes an estimated one percent of HIV-infected pregnant women in the DRC have access to antiretroviral therapy. Approximately one out of every three babies born to a mother with untreated HIV infection will be born with the virus.  Universal access to PMTCT services is considered the cornerstone of achieving an AIDS-free generation.

The DRC’s recent history of violent conflict and civil unrest makes service and supplies delivery an enormous challenge there, especially in the eastern part of the country. Nonetheless according to MSF’s 2010 country report, the organization has been making strides in the country and has a strong presence – with nearly 2,800 staff on the ground at the end of 2010. They’ve been working in the DRC since 1981, and in 2010 added 850 new patients to the ART register.

The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program is also actively supporting the DRC’s AIDS response – contributing more than $75 million to the cause between fiscal years 2007 and 2009. The latest numbers show PEPFAR supports 4,400 individuals on ART there, and 23,400 HIV-infected individuals have received care and support over the years, to include tuberculosis screening and treatment. In 2010 PEPFAR provided 1,300 pregnant women with PMTCT services as well.

Sadly, the PEPFAR program was dealt a $92 million cut in the 2012 budget negotiations, and outlook for the coming years does not look good with deficit reduction plans in the works. The MSF release notes recent financial troubles at other donor organizations such as The Global Fund to Fight AIDS, Tuberculosis and Malaria – DRC’s number one supplier of HIV drugs – and the consequential funding reductions or withdrawals as potentially detrimental to the DRC AIDS response.  The Global Fund announced in November that it will not be funding an 11th round of grants due to financial constraints.

“If nothing is done, it is highly likely that the 15,000 people currently on the waiting list and in urgent need of ARVdrugs will be dead within three years,” De Weggheleire said in the release. A report from Bloomberg reported last week that 28,000 people with HIV that they targeted to start on ART by 2014 might not do so now due to shortfalls in foreign aid, which pay for the DRC’s AIDS drugs.

“As horrifying as that number is, it represents only the tip of the iceberg when you realize that most people living with HIV/AIDS in DRC do not know their HIV status. Many will die in silence and neglect,” DeWeggheleire said.

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