Khayelitsha shows the way for antiretroviral therapy

The results of the antiretroviral treatment programme run by Medecins Sans Frontieres (MSF) in Khayelitsha clinics can be compared with results that are achievable anywhere in the developed world.

This was the claim by Dr Eric Goemaere of MSF about the pilot programme which began in Khayelitsha in May 2001. He said that of the 85 patients who underwent the treatment, most of whom were at the terminal stage of the disease, 92% now have undetectable viral loads.

Goemaere was speaking on Tuesday at a media briefing in Johannesburg on the return of representatives of the Treatment Action Campaign from Brazil with generic drugs for the Khayelitsha antiretroviral treatment programme.

“The questions about antiretroviral therapy are feasibility and affordability, and here we have shown that it is feasible. We don’t want to say it is simple, but it is feasible,” he said.

Proponents for the use of antiretroviral therapy (ART) have constantly come up against arguments that it is not possible to implement this treatment programme in South Africa as people in poor countries are not able to adhere to the treatment regimen.

Despite national government’s refusal to provide antiretroviral treatment, the MSF signed an agreement with the Western Cape health department nearly two years ago to implement the   programme in three government clinics in Khayelitsha and to test its feasibility.

In May last year, combination antiretroviral therapy was introduced to a group of people in advanced stages of AIDS. To date, 85 people have received antiretroviral therapy and 50 of these are receiving Brazilian medicines. With the Brazilian generic antiretrovirals, MSF can treat twice the number of people with the same amount of money.

Matthew Damane, who is living with AIDS and is on the antiretroviral programme, said “I have personally benefited from the MSF programme. I went to Brazil to bring back generics so that more people like me can have access to these medicines.”

Damane said his viral load was 95 000 (replications of the HIV-virus) before the treatment, but it is now undetectable. “I couldn’t even work before the treatment, but now I am well,” he said. He works as an HIV counsellor in Tygerberg Hospital.

There were side effects, but these were closely monitored by doctors. Damane was able to comply with the very complicated treatment regimen with the support of a family member who would remind him to take his tablets and with a peer support group. “I can’t forget to take my treatment because this is my life,” he said.

Goemaere said MSF was purchasing the antiretrovirals from a private pharmacy in Cape Town at a cost of $3,20 per patient per day. Now they are paying $1,55 per day with the Brazilian drugs. While they have had many offers of affordable medicines, MSF chose the Brazilian offer because “they were able to assure us quality and control by an internationally recognised institute”

MSF is currently using the antiretroviral drugs AZT, 3TC, co-formulated AZT/3TC, and nevirapine produced by FarManguinhos.  

“Our project shows that antiretroviral therapy is feasible in a resource-poor setting, contrary to those who insist that poor Africans are not able to successfully take these drugs. Patients who were critically ill are now returning to their normal lives,” Goemaere said.

 “We have seen firsthand that these drugs can be used safely and effectively, here in South Africa. As medical professionals it is our duty to offer these benefits to as many patients as possible.”

Zackie Achmat, chairperson of the Treatment Action Campaign, said the MSF would never be able to bring in enough medicines for the whole country, and called on government to apply for compulsory licences and to ensure that the medicines are produced locally.

Oxfam representative Don Mullins said the price of antiretroviral medicines, available at private pharmacies, had fallen but even at the reduced prices they were still unaffordable to most people. He said the way the patent was being used was a key barrier to making the drugs more affordable and that government could make use of compulsory licences for the local production of generic medicines.  

The World Trade Organisation meeting in Doha in November demonstrated that South Africa had been given international support in making use of the tool of compulsory licences in order to produce generics.

Related story: “AIDS activists “import” generics, defy government”


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