Mozambique has ambitious AIDS plan

A flood of donor dollars is underwriting the country’s HIV/AIDS programme,
with $330-million coming from the Clinton Foundation, $54-million coming from
a Global Fund grant, and $55-million from the World Bank,mainly to fund prevention.

“Mozambique only has 461 doctors in the whole country to treat a population of 18.5 million people. This is one of the lowest figures per capita in the world. So this is a
very ambitious programme,” Dr Marc Biot, the country representative for Medicins sans Frontieres (MSF), told the Metropolitan AIDS conference in Maputo.

Unlike in South Africa, MSF is in partnership with the Mozambican government to address HIV/AIDS treatment.

Interestingly, the Mozambican model is similar to that being envisaged for South Africa’s anti-retroviral roll-out.

The programme is built around “integrated health networks”. At the heart of these networks are day hospitals. HIV positive patients are referred to these day hospitals from a range of places, such as clinics and HIV voluntary counselling and testing centres.

The day hospitals manage whatever treatment people with HIV/AIDS need, including antiretroviral therapy. Doctors see patients every three months, while nurses see them
monthly.

Since January, only two integrated networks have been set up; one in Maputo and the other in Tete. Remarkably, these have already tested 17 000 people, 32% of which were HIV positive. The estimated prevalence for the country is 13.5%.

The two centres are now managing the treatment and care of 4 000 patients and 282 of these are taking anti-retroviral drugs.

“Patients were very sick to start with, with an average CD4 count (measure of immunity) of 85,” said Biot. Most normal people have CD4 counts of over 600.

“Seven patients have died in the past 50 days, and a quarter of patients had to adapt their treatment programmes to feel better,” said Biot. “But the good thing is that
most had to adapt their doses because they gained weight.”

The vast majority of patients (89%) are taking the drugs properly.

“Only 7.3% had severe side effects. Average weight gain is 8kgs and the average CD4 count has jumped to 148,” said Biot.

The painful part about weight gain is that patients start feeling hungrier and ask their health workers for food.

These patients have had a four-session treatment training programme, which has taught them how their drugs work and what side effects to expect.

“Patients also have to sign an adherence contract in which they promise to take their drugs properly. They need to choose a “treatment buddy”, someone close to
them who will help them to take their drugs,” said Biot.

The drugs do not work properly unless patients adhere 95% of the time. To make it easier for patients to take the drugs, MSF has given them special pill boxes that were
pioneered by MSF’s treatment programme in Khayelitsha in Cape Town.

These pill boxes have 14 compartments, two for each day of the week as most patients take two pills every day. Patients then fill their pill boxes for the week, putting
one pill in the compartment with a sun on it and the other into the one with the moon on it. This helps them to keep track of whether they have taken their morning and evening doses every day.

Over the next five years, 129 integrated networks are planned and the country aims to have 132 000 people on ARV treatment.

“Mozambique has a very poor health infrastructure, but there are some good things. The vaccination rate of children by the age of a year is 88% and 75% of TB patients
finish their six-month treatment,” said Biot.

One great difficulty in addressing the epidemic, however, is the lack of food. Nyeleti Mondlane from the organisation for people with AIDS, Vida Postitiva, says it is very
difficult to warn communities about a virus that could kill them in the next few years when they have no food to eat in the next few days.

E-mail Kerry Cullinan

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