August 13, 2006 

Birmingham, Ala. - The rapid expansion of free HIV/AIDS treatment programs at urban clinics in Zambia has dramatically increased patient survival rates, indicating the programs’ continued expansion in sub-Saharan Africa is viable and can produce good results, according to a study by University of Alabama at Birmingham (UAB) researchers published in the Aug. 16 issue of the Journal of the American Medical Association.

Jeffrey S.A. Stringer, M.D., UAB associate professor of obstetrics and gynecology, along with colleagues from the Centre for Infectious Disease Research in Lusaka, Zambia, a UAB partnering HIV research and prevention site, presented the study’s findings Aug. 13 at the International AIDS Conference in Toronto.

Zambia’s population is among the world’s most affected by AIDS. Nearly16 percent of the adult population is HIV- positive. In 2003, Zambia saw more than 90,000 deaths resulting from HIV and AIDS. Because most of Zambia’s 11.5 million people live in poverty, historically, only wealthy citizens had access to antiretroviral therapy from private medical practices. However, the Zambian Ministry of Health, in an effort to provide public access to treatment, in 2002 started pilot antiretroviral therapy distribution programs at two of the country’s largest hospitals. The program filled quickly and in May 2004 was expanded to four clinics in the Lusaka Urban District.

After the first 18 months of the pilot program, all fees for patients seeking care were eliminated, antiretroviral therapy and laboratory tests were provided free of charge and the program was expanded again to 14 additional urban sites.

“At the time of the pilot program began, we were uncertain that complex, long-term HIV care could be delivered in a setting with so few physicians and so little physical and technical resources,” Stringer said. “However, treatment and survival rates have turned out to be very, very good despite these obstacles.”

Stringer and colleagues evaluated outcomes among more than 16,000 patients receiving antiretroviral therapy at the 18 facilities between April 2004 and Nov. 2005. They looked at survival, treatment failure rates and CD4 cell count response, a measure of the state of the immune system. The lower the CD4 count, the more likely secondary infections or illnesses will develop.

They found that of the more than 21,755 patients that entered the program during the study period, 16,198 received antiretroviral therapy. Of those 16,198, 1,142 patients died; and 792 died within the first 90 days of beginning therapy. After the first 90 days, there were five deaths per 100 patients, comparable to survival rates in the developed world. CD4 cell responses also were similar to those in developed nations.

Stringer said four factors account for the success of the rapid expansion of the program.

“First, the leadership and advocacy for the program provided by the Zambian government, demonstrated by its decision to eliminate patient fees, was key. Second, although physician shortages prevented medical oversight at every facility, clinical officers and nurses at each site followed strict protocols for patient care. In addition, all patient data was entered into an electronic monitoring system, capturing data that assisted in patient care and clinic management. Finally, the large financial resources made available by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) also contributed to the program’s success,” he said. “We believe the early success of the Lusaka District ART Program calls for optimism. This success demonstrates that it is possible, with the proper resources and local government commitment, to treat thousands of people in urban African settings.”

This research was supported by a multi-country grant to the Elizabeth Glaser Pediatric AIDS Foundation from the U.S. Centers for Disease Control and Prevention. Additional support is provided by National Institutes of Health grants and an Elizabeth Glaser Pediatric AIDS Foundation grant.