Ferreyra Cecilia, O'Brien Daniel, Alonso Beatriz, Al-Zomour Abdulbasset, Ford Nathan
Médecins sans Frontières Spain, Barcelona, Spain.
2Médecins sans Frontières, Amsterdam, Netherlands.
Confl Health. 2018 Jul 2;12:30. doi: 10.1186/s13031-018-0161-1. eCollection 2018.
Unstable settings present challenges for the effective provision of antiretroviral treatment (ART). In this paper, we summarize the experience and results of providing ART and implementing contingency plans during acute instability in the Central African Republic (CAR) and Yemen.
In CAR, MSF has provided HIV care in three conflict-affected rural regions; these were put on hold throughout the acute phase of violence. "Run-away bags" containing 3 or 4 months of ART were distributed to patients at MSF facilities. Among 1820 HIV patients enrolled into care, 1440 (79%) initiated ART. By December 2016, 782 (54%) patients were still under ART, 354 (25%) have been lost to follow up and 182 (13%) had died. In 2013, when violence disrupted services, 683 patients were receiving ART. Between September-December 2013, 594 (87%) patients received runaway bags and by February 2014, 313 (53%) of these patients returned to the clinic.In Yemen, when violence erupted, patients received a health card that included a helpline to call in case of drug shortages in admission to emergency stocks; this was not possible in CAR due to lack of a functioning telephone network. One thousand six hundred fifty-five PLWHA have been enrolled in care and 1470 (89%) initiated ART; 1056 (72%) are still followed on ART, 126 (9%) were lost to follow up, and 288 (20%) died. In January 2011 clashes began and by April 2011 MSF medical activities were interrupted. Of the 363 patients receiving ART, 363 (100%) received emergency bags to cover 9 months and by February 2012, 354 (98%) patients returned to care. In March 2015 a new wave of conflict affected Yemen, forcing HIV activities to revert to contingency planning.
This experience provides further evidence that provision of HIV treatment and emergency drug stocks can be successfully provided to most patients in both conflict-affected settings.
不稳定的环境给有效提供抗逆转录病毒治疗（ART）带来了挑战。在本文中，我们总结了在中非共和国（CAR）和也门急性不稳定期间提供ART及实施应急计划的经验和结果。
在中非共和国，无国界医生组织在三个受冲突影响的农村地区提供艾滋病毒护理；在暴力的急性期，这些服务都暂停了。装有3至4个月ART药物的“应急包”被分发给无国界医生组织设施中的患者。在1820名登记接受护理的艾滋病毒患者中，1440人（79%）开始接受ART治疗。到2016年12月，782名（54%）患者仍在接受ART治疗，354人（25%）失访，182人（13%）死亡。2013年，暴力事件扰乱服务时，有683名患者正在接受ART治疗。在2013年9月至12月期间，594名（87%）患者收到了应急包，到2014年2月，这些患者中有313人（53%）返回了诊所。在也门，暴力事件爆发时，患者收到了一张健康卡，其中包括一条在入院时药品短缺或需要紧急储备时可拨打的求助热线；由于缺乏正常运行的电话网络，在中非共和国无法做到这一点。1655名艾滋病毒感染者已登记接受护理，1470人（89%）开始接受ART治疗；1056人（72%）仍在接受ART随访，126人（9%）失访，288人（20%）死亡。2011年1月冲突开始，到2011年4月，无国界医生组织的医疗活动被中断。在363名接受ART治疗的患者中，363人（100%）收到了可维持9个月的应急包，到2012年2月，354人（98%）患者恢复了护理。2015年3月，新一轮冲突影响了也门，迫使艾滋病毒防治活动再次恢复到应急计划状态。
这一经验进一步证明，在两个受冲突影响的环境中，都可以成功地为大多数患者提供艾滋病毒治疗和紧急药品储备。
