Farmer P, Léandre F, Mukherjee J, Gupta R, Tarter L, Kim J Y
Department of Social Medicine, Harvard Medical School, Boston, MA, USA.
Bull World Health Organ. 2001;79(12):1145-51.
In 2000, acquired immunodeficiency syndrome (AIDS) overtook tuberculosis (TB) as the world's leading infectious cause of adult deaths. In affluent countries, however, AIDS mortality has dropped sharply, largely because of the use of highly active antiretroviral therapy (HAART). Antiretroviral agents are not yet considered essential medications by international public health experts and are not widely used in the poor countries where human immunodeficiency virus (HIV) takes its greatest toll. Arguments against the use of HAART have mainly been based on the high cost of medications and the lack of the infrastructure necessary for using them wisely. We re- examine these arguments in the setting of rising AIDS mortality in developing countries and falling drug prices, and describe a small community-based treatment programme based on lessons gained in TB control. With the collaboration of Haitian community health workers experienced in the delivery of home-based and directly observed treatment for TB, an AIDS-prevention project was expanded to deliver HAART to a subset of HIV patients deemed most likely to benefit. The inclusion criteria and preliminary results are presented. We conclude that directly observed therapy (DOT) with HAART, "DOT-HAART", can be delivered effectively in poor settings if there is an uninterrupted supply of high-quality drugs.
2000年，获得性免疫缺陷综合征（艾滋病）超过结核病，成为全球成年人死亡的首要感染性病因。然而，在富裕国家，艾滋病死亡率已大幅下降，这主要归功于高效抗逆转录病毒疗法（HAART）的使用。抗逆转录病毒药物尚未被国际公共卫生专家视为基本药物，在人类免疫缺陷病毒（HIV）造成严重危害的贫困国家也未得到广泛应用。反对使用HAART的主要理由一直是药物成本高昂，且缺乏明智使用这些药物所需的基础设施。在发展中国家艾滋病死亡率上升和药品价格下降的背景下，我们重新审视了这些理由，并介绍了一个基于结核病控制经验的小型社区治疗项目。在有提供家庭治疗和直接观察治疗结核病经验的海地社区卫生工作者的协作下，一个艾滋病预防项目得以扩展，为一部分被认为最可能受益的HIV患者提供HAART。文中介绍了纳入标准和初步结果。我们得出结论，如果有不间断的高质量药物供应，直接观察疗法（DOT）联合HAART，即“DOT-HAART”，可在贫困地区有效实施。
