What do you do if you are HIV-positive and faced with taking a daily regimen of lifesaving antiretroviral drugs ... and you have to travel dozens of kilometers to a clinic and queue up for hours to get refills of the drugs, which cause unpleasant side effects such as nausea and diarrhea?
That is the reality for many HIV-infected people. Those who do not feel sick may decide to stop taking their medication or only take it sporadically. That may cause a resurgence of the virus and lead to the development of AIDS.
To prevent that, the nongovernmental health organization Medecins Sans Frontieres, or Doctors Without Borders, has begun to set up "adherence clubs" in South Africa — a country where 6.2 million people are HIV-positive.
In an interview with the New England Journal of Medicine, MSF field coordinator Lynne Wilkinson said the idea is to make it easier for relatively healthy HIV patients to stay engaged and on-schedule with their lifelong therapy.
“By requiring healthy patients to still come to clinics or to health care facilities to get treatment and care makes no sense when we are already overstretched," she said. "And so being able to manage patients in their communities, making it easier for them to stay on treatment, is definitely the way forward."
The community-based adherence clubs meet once every two months and now have some 30,000 members around South Africa's Western Cape province.
Trained counselors run the 45-minute group sessions, during which participants discuss challenges and adherence to treatment. They are given a prepackaged, two-month supply of antiretroviral drugs.
The state of their health, according to Wilkinson, is tracked at the meetings, with a rapid blood test that tells health workers how much virus is in a patient’s system.
“We can through the viral load [test to] see whether the patient is adherent," she said. "If they are not adherent, [we can] potentially red-flag the patient for increasing support and perhaps returning to the clinic for enhanced care." Healthy patients, on the other hand, can be told that they don't need to be seen at the clinic.
Wilkinson said the biggest challenge remains reaching HIV-infected men, many of whom wait until they are very sick before coming in for treatment, and young women who may not think they are harboring the AIDS virus.