When to Start in Uganda

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The following post is by HIVMA Executive Director Andrea Weddle, reporting from the International AIDS Conference in Vienna.

“There’s no separate science for the rich and poor. The research applies to both,” said Dr. Peter Mugyenyi when asked whether “when to start to HIV treatment” was a real question for Uganda and countries in sub-Saharan Africa.  Mugyenyi, Director and Founder of the Joint Clinical Research Center in Kampala, Uganda, made the statement during a panel discussion on treatment initiation Tuesday at IAS 2010. He followed up by saying the reality on the ground is that while patients enter care late in other parts of the world like the U.S., they come to care very, very, very late in Uganda.

Mugyenyi highlighted PEPFAR’s successes as evidence that treatment expansion works, but also can be fragile. While many countries, including the U.S., are retreating on their financial support for fighting global AIDS, Mugyenyi reminded us that, “AIDS is not in a recession.”Without a renewed donor commitment, Mugyenyi said HIV infections will increase and AIDS care would continue to be emergency rather than preventive medicine Uganda, where a majority of people access treatment only after they are very sick. An investment in global AIDS would reorient the system and pay off for both the patient and the health system, he said, adding that the cost of treating an opportunistic infection like cytomegalovirus for one month is equal to the cost of providing HIV treatment for three years in Uganda.

In the meantime, Mugyenyi’s program will continue to stretch limited resources through program efficiencies, like eliminating unnecessary tests such as CD4 monitoring when clinical observation is a reliable alternative.

Mugyenyi’s remarks posed a reminder of how far we are from a global standard for HIV care, as well as from the latest “science” benefiting the rich and poor equally.

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