Research reveals that in Lagos, Nigeria, among patients who had to pay for their own AIDS care, 44% had multiple treatment interruptions or took insufficient dosages due to lack of funds. The medical effects of this are extremely worrying.

MSF: Abuja - Having to pay for HIV/AIDS care increases the risk of treatment failure, according to new research from Médecins Sans Frontières (MSF) to be presented this week at the International Conference on AIDS and Sexually transmitted infections in Africa (ICASA), in Abuja, Nigeria.

The research revealed that in Lagos, Nigeria, among patients who had to pay for their own AIDS care, 44% had multiple treatment interruptions or took insufficient dosages due to lack of funds. The medical effects of this are extremely worrying.

Once enrolled in MSF's programme, where care is free, these 'treatment interrupters' had only half the immune system recovery (measured by rise in CD4 count) compared to those receiving treatment for the first time.

"These patients are more vulnerable to AIDS-related infections such as pneumonia or tuberculosis", said Dr Jens Wenkel of MSF. "So forcing people to pay, and thereby risking treatment interruptions, can make this life-prolonging treatment less effective. If we want people to survive on treatment, we have to ensure access to free care."

The Nigerian government is insisting that public hospital patients pay for at least part of their own AIDS care including drugs and monitoring.

"This is ludicrous. According to our survey, nearly 50% of these patients live on less than US$36 per month, yet they are paying between US$8 and US$67 per month for a recommended package of care," said Dr Wenkel.

To pay for their care, 39% of respondents reported borrowing or begging, while 18% said they had been forced to sell property. Many patients reported erratic consumption of medicines, including skipping or sharing doses, which can lead to insufficient drug levels in the blood.

The research was conducted between August and November 2005 among 122 patients who previously had to pay for their AIDS drugs and diagnostics and were later enrolled in the MSF program in General Hospital Lagos, Lagos Island.

A similar trend was found in Kinshasa, Democratic Republic of Congo, where a user fee proved to be a significant barrier to accessing care. When MSF abolished the clinic fee, the regularity of attendance in the ARV clinic improved considerably.

MSF currently provides antiretroviral treatment to over 57,000 people living with HIV/AIDS in 29 countries. In Nigeria, MSF is treating more than 950 patients with ARVs in a comprehensive care clinic in Lagos.

"This is taking place after successful trials were done in Sweden to determine any side effects," said Kisali Pallangyo, the principal of the Muhimbili University College of Health Sciences (MUCHS) in Dar es Salaam.

MUCHS, which is a university teaching hospital, will conduct the trials but only in Dar es Salaam.

Speaking at the college's graduation ceremony Pallangyo, who is a professor of medicine, said the clinical trials of the vaccination were being supported by the Swedish International Development Agency and the European Union.

"This is not a guaranteed vaccine and people should not take the HIV/AIDS problem lightly believing a medical solution has now been struck," he said.

He said a "preventive vaccine" was not expected before 2011. The vaccine code named DNA-MVA, he said, was developed by researchers at the Swedish Institute of Infectious Disease Control. Studies on it started in 1994.

Wednesday December 7, 04:22 PM

"Nobody has taken up the vaccine development for tuberculosis. Gates has extended support in this endeavour," Indian health minister Anbumani Ramadoss told reporters after a meeting with the Microsoft boss on Tuesday.

Gates, who was in India to address an IT conference, did not give details about his financial support, but said there were "many commitments."

Around 1.7 million people died of TB in 2003 around the world, including those co-infected with HIV, according to a recent report from the World Health Organisation.

India, which is facing a growing AIDS epidemic, accounts for 25 percent of the world's tuberculosis patients.

The Bill and Melinda Gates Foundation, founded in 1995, which works to improve public health and education in developing countries, has also launched an AIDS prevention campaign in India.

Oral HIV Test Turns Up False Results in SF

A promising new oral HIV test that uses fluid swabbed from the mouth to quickly and easily detect the virus that causes AIDS incorrectly diagnosed a quarter of the people who tested positive in San Francisco, city health officials found.

Forty-seven people who tested positive after using the OraQuick Advance HIV test in city clinics were not infected at all, the San Francisco Department of Public Health said this week.

Investigators learned of the errors after follow-up blood screenings gave the patients a clean bill of health, and health officials stopped using the test at City Clinic, the health department's primary testing location for HIV.

At the same time, the U.S. Food and Drug Administration, which approved the OraQuick test for professional use last year, is now considering a request from drug maker Orasure Technologies, of Bethlehem, Pa., to approve it for home use and over-the-counter sales.

"We need to vigorously look at this," said Jeffrey Klausner, San Francisco's director of sexually transmitted disease prevention and control services. "You wouldn't want to have a home test with this problem."

Klausner said there are no known instances in which the test missed an HIV infection that a traditional blood screening would have caught.

Orasure Technologies chief executive Douglas Michels said San Francisco is the only city that has reported the problem, and data collected from thousands of oral tests conducted in cities across the country show the test is reliable.

A statewide survey by the California Department of Health Services that was prompted by the San Francisco findings has not yet found a similar problem.

"We do not have any reason to believe our product is not performing to specification," Michels said. "We have every confidence that the test is reliable and accurate."

One explanation for the spate of false positives might be that there is something something unique about the San Francisco group, such as a high number of people with hepatitis, that may unexpectedly interfere with the test results, said Deanne Sykes, a research scientist for the California Office of AIDS.

"We will watch it," she said. "We will monitor it to see if there is something consistent we can pinpoint."