Africa HIV City Care Questioned

More people with HIV//AIDS in Africa could be treated if routine laboratory testing to monitor the disease were dropped in favor of clinically driven monitoring, according to new research.

More than 6 million people in Africa need AIDS treatment, but just 2.2 million receive it. The cost savings of switching to clinically driven monitoring could boost the number of patients receiving treatment by one-third, said one physician.

The study, presented Tuesday at the 5th International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Cape Town, involved 3,316 HIV-positive patients in Uganda and Zimbabwe. The patients were put into treatment and randomly assigned to either laboratory and clinical monitoring (LCM) or clinically driven monitoring (CDM). After five years, 90 percent of patients who underwent treatment and LCM were still alive, compared to 87 percent who received treatment without quarterly hematology, toxicity, and CD4 testing.

"I would describe [this study] as a breakthrough, because we now understand that the intensive laboratory tests which are routinely done in the West only bring marginal benefits," said Dr. Peter Mugyenyi of the Joint Clinical Research Center in Kampala, Uganda. "We could actually do nearly as well by very good clinical monitoring of patients, making sure that trained health care providers look at their symptoms and signs and determine whether treatment needs to be changed or whether they need to have any modification in their care and treatment."

Laboratory testing is expensive and frequently based in cities, hours away from patients' home villages. By de-linking treatment from routine lab monitoring, trained health care workers could provide supervision and support to many more patients closer to where they live.

"Crucially, the money saved from paying for these tests could enable more people to safely receive treatment, including those who for whatever reason are unable to travel to the laboratories," said Mike Foster, Britain's international development minister.

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