provision of antiretroviral treatment in conflict settings the experience of médecins sans frontières提供抗逆转录病毒治疗在冲突设置无国界医生组织的经验.pdfVIP

OBrien et al. Conflict and Health 2010, 4:12 /content/4/1/12 R E S E A R C H Open Access Research Provision of antiretroviral treatment in conflict settings: the experience of Médecins Sans Frontières 1,2,3 4 4 1 4 1 1,5 Daniel P OBrien* , Sarah Venis , Jane Greig , Leslie Shanks , Tom Ellman , Kalpana Sabapathy , Lisa Frigati and Clair Mills1,6 Abstract Introduction: Many countries ravaged by conflict have substantial morbidity and mortality attributed to HIV/AIDS yet HIV treatment is uncommonly available. Universal access to HIV care cannot be achieved unless the needs of populations in conflict-affected areas are addressed. Methods: From 2003 Médecins Sans Frontières introduced HIV care, including antiretroviral therapy, into 24 programmes in conflict or post-conflict settings, mainly in sub-Saharan Africa. HIV care and treatment activities were usually integrated within other medical activities. Project data collected in the Fuchia software system were analysed and outcomes compared with ART-LINC data. Programme reports and other relevant documents and interviews with local and headquarters staff were used to develop lessons learned. Results: In the 22 programmes where ART was initiated, more than 10,500 people were diagnosed with HIV and received medical care, and 4555 commenced antiretroviral therapy, including 348 children. Complete data were available for adults in 20 programmes (n = 4145). At analysis, 2645 (64%) remained on ART, 422 (10%) had died, 466 (11%) lost to follow-up, 417 (10%) transferred to another programme, and 195 (5%) had an unclear outcome. Median 12-month mortality and loss to follow-up were 9% and 11% respectively, and median 6-month CD