HIV Treatment in Resource-limited Countries

Combining engineering science with medical care to ensure the efficiency of treatments for AIDS in resource-limited countries may be an option, according to experts.

In an article published in the online edition of the BMC Health Services Research journal, researchers at Weill Cornell Medical College and the Clinton Foundation HIV/AIDS Initiative suggest that the use of sophisticated mathematical modelling approaches used in the field of operations research can help maximize the efficient use of limited resources, notably antiretroviral drugs and medical personnel.

"Operations research offers a powerful set of tools that have been used successfully in everything from World War II to Wal-Mart-style logistics planning. These tools ought to be used to increase the success of existing programs and to help expand access to HIV care and treatment in resource-limited countries," says lead author Dr. Wei Xiong, instructor in public health at Weill Cornell Medical College.

"For example, operations research could help with the planning of a national drug distribution system, or with predicting the demand for services at local clinics and the best ways to staff them," the researcher adds.

Co-investigator Dr. Nathaniel Hupert, associate professor of public health at Weill Cornell Medical College and associate attending physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, adds: "To date, HIV treatment scale-up has appropriately focused first on policy-level issues, such as program initiation and costs, and secondarily on operational-level issues. Now that many programs are in place, the potential gains from improved planning are great, especially given the high cost of antiretroviral drug therapy."

The authors further state that another problem in resource-limited settings is the lack of sufficient health care workers to diagnose and treat the millions of people living with HIV.

The Weill Cornell and the Clinton Foundation researchers say that they have used a computer simulation model to predict the amount of physician person-hours saved by shifting some duties to nurses for HIV clinics in Rwanda.

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According to them, their model suggests that if task-shifting were scaled up from a pilot program in three health centres to the national level, it could reduce the demand on public-sector physicians for HIV services by up to 78 per cent.

"The analysis suggested that implementation of such a program could allow the government of Rwanda to scale-up HIV treatment without overburdening its existing health-care system," Dr. Xiong says.

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The paper also highlights that another area ripe for improvements is the management of laboratory resources, which are often under-utilised or not maintained.

When there is an equipment breakdown, it often takes a prohibitively long time to get replacement parts or qualified repair technicians.

"The unique advantage of operations research is that it gives us the ability to evaluate and optimise outcomes of various scenarios -- such as determining the best approach for the management of lab equipment repair -- without impacting patients. Once we have the evidence for a new approach, a good case can be made that it should be implemented as policy, although any initiative should take into account the environments in which the projects are to be carried out, with all necessary ethical, cultural and political considerations," says Dr. Xiong.

Dr. Hupert adds: "While laudable progress has been made, the great majority of HIV patients are still under-treated or untreated.

Source-MJA
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