New York Times Examines Efforts to Reduce Number of HIV-Positive Patients in Africa Who Stop Taking Their Medications

In a first-person account in the New York Times, David Tuller of the University of California, Berkeley, writes of his experience shadowing a counselor with Family AIDS Care and Education Services (FACES), an organization in Kisumu, Kenya, that is working to identify patients who have defaulted on their HIV treatment and coax them to begin taking medications once again. "Epidemiologists refer to such patients as 'lost to follow-up,' and their increasing numbers in sub-Saharan Africa are causing concern among providers of HIV and AIDS care. Interruptions in treatment lead to viral strains that are resistant to the cheapest medications, and to higher rates of illness and death," according to the piece. "Several years ago, during the rapid international expansion of HIV drug distribution, researchers reported very high rates of adherence to treatment in sub-Saharan Africa -- as high as or higher than in the United States. More recently, however, studies have found that 15 to 40 percent of those who start treatment are lost to follow-up within one to three years."

The article details reasons patients may stop taking medications and notes several HIV programs in Africa that "are experimenting with various strategies to reduce loss to follow-up -- offering a two- or three-month supply of medication per clinic visit, delivering drugs directly to patients' homes and reimbursing them for transportation costs. FACES is exploring modest projects to raise patients' income and stabilize their lives, like creating a microfinance system to provide water pumps and other agricultural support to help them grow more crops" (10/26).

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