Arsène Kpangon (EV 2013)
In this blog post, I’ll report on a meeting which took place at the ICASA conference on Tuesday (December 10th). The meeting brought together five HIV/AIDS and global health specialists from around the world. The session was moderated by Professor Mark Nelson from Imperial college of London and focused on the gap between theory and reality of treatment in Low and middle Income Countries (LMICS). The four participants around the table were Dr Kwasi Torpey from Nigeria, Prof Joep Lange from the Netherlands, Prof Serge-Paul Eholié from Ivory-Coast, and Prof Quarraisha Abdoul-Karim from South-Africa.
Each presentation was followed by a short roundtable discussion. Joep Lange showed in his presentation how earlier initiation of ART could improve the outcomes of People Living With HIV/AIDS (PLWHA). Eholié discussed the standard of ART treatment nowadays in sub-Saharan Africa. He emphasized the necessity to use viral load for monitoring PLWHA in sub-Saharan Africa. However, he failed to understand why in developed countries patients have access to CD4, viral load and genotyping monitoring while at the same time the international community wants to oblige sub-Saharan settings to reduce access to CD4 and focus instead on viral load assessment. He also stressed that all care provided to PLWHA should be free in order to increase adherence. Quarraisha Abdoul-Karim in her presentation highlighted the results of the CAPRISA trial in South-Africa. In addition, she emphasized concepts such as treatment as prevention (TasP) and pre-exposure prevention (PreP) with microbicides, and showed how the scale up of ART in South Africa has improved the life expectancy between 2001- 2010.
The roundtable discussions between these specialists showed the urgent need to scale up viral load monitoring in Africa. However, all of these experts asked how this can be done given the budget constraints in these settings. Some of the people who attended the session proposed to improve fiscal revenue in sub-Saharan African settings and reduce corruption in order to increase government engagement in the health care of the populations.