Developing Antiretroviral Therapy in Africa (DART) – Policy Recommendations
4 August 2010
Leading HIV investigators from the UK and Africa have demonstrated that many more people living with HIV in sub-Saharan Africa could be treated if laboratory tests were used in a targeted rather than routine way. In a short film now available to download from youtube, trial participants, practitioners and investigators connected to the trial explain how maintaining and scaling-up access to Antiretroviral Therapy (ART) in low- and middle-income countries could be possible on current funding levels, even in the midst of a global economic crisis.
The overwhelming message from DART is that ART saves lives, and that it can be delivered safely and successfully without the use of routine laboratory testing for drug toxicity and side effects. Use of routine CD4 testing for monitoring disease progression offers a small benefit to patients after the second year of therapy.
Trial investigators believe that in the current economic climate, priority should be given to widening access to first and second-line drugs to treat HIV. Resources are best focussed on strengthening healthcare systems and training well-supervised healthcare workers to deliver high quality care in rural areas. This benefits the health infrastructure for all, and allows precious laboratory capacity to be targeted towards the diagnosis of serious HIV-related illnesses and other conditions including chronic non-infectious diseases, other infections and cancer. The development of cheaper, point-of-care CD4 tests will enable cost-effective and practical monitoring of disease progression, as well as aiding initial diagnoses of HIV and helping to inform when treatment should be started.
DART was funded by the UK Medical Research Council, the UK Department for International Development and the Rockefeller Foundation. Drugs were provided by GlaxoSmithKline, Gilead Sciences, Boehringer-Ingelheim and Abbott. The pharmaceutical companies also funded some of the substudies which looked in more detail at specific issues related to delivering ART in Africa.
The Joint Clinical Research Centre and Infectious Diseases Institute in Kampala, MRC/Uganda Virus Research Institute Research Unit on AIDS in Uganda, Entebbe and University of Zimbabwe Clinical Research Centre in Harare collaborated with the MRC Clinical Trials Unit and Imperial College, London to carry out the research.
