MSF: Clear roadmap & political will required for HIV response in West & Central Africa

HIV response in West and Central Africa will not succeed if key barriers remain unaddressed

Monday, July 3, 2017 — As African heads of state meet today in Addis Ababa to endorse the  Emergency catch-up plan led by UNAIDS to accelerate HIV treatment in West and Central Africa, the international humanitarian medical organisation Doctors Without Borders (MSF) reiterates its call for a clear roadmap and strong political commitment from affected governments and all international stakeholders, towards removing longstanding barriers and implementing proven simplified strategies that will boost lifesaving treatment for 4.7 million living with HIV not yet accessing antiretroviral therapy (ART).

Lower rates of HIV prevalence in the region’s 21 countries, ranging from 2-10%, have long resulted in less attention and investment in its overall HIV response. Here, only 28% of people and 20% of children living with HIV have access to ART, resulting in high numbers of deaths and an incidence outpacing treatment initiations. MSF’s related ‘Out of Focus’ report, released in April 2016 identified numerous critical obstacles that prevent the wider scale-up of HIV treatment in the region. Faced with these obstacles, staff in MSF-supported HIV hospital centres in Conakry, Guinea and Kinshasa, DRC report that patients arrive in such advanced stages of HIV that 43% and 36% of them respectively die within 48 hours of admission. A third of them will die overall.  

Today’s meeting is aimed at deepening engagement from governments, key policy makers and donors towards the implementation of a regional emergency HIV plan and furthering country-specific acceleration plans in fourteen priority countries to start[1]. MSF strongly commends the vital leadership shown by UNAIDS and African states in initiating the Acceleration Plan. African leaders are urged to address any limiting factors which may prevent its full realisation. These include legal and policy blockages, centralised health systems, weak procurement and supply chain management, financial barriers including user fees for patients, and high levels of stigma. MSF also asks for the Acceleration Plan to soon include remaining countries in the region that face similar treatment gaps.

“This is a pivotal opportunity to anchor governments’ efforts in clearly defined and inclusive country action plans that tackle the many obstacles that people living with HIV face every day. Each patient presenting with late stage AIDS in our hospitals is a terrible testimony to these challenges. Our patients tell us often of unimaginable suffering simply trying to access diagnosis and treatment: empty shelves, insurmountable fees and transport costs, long queues, and stigma and discrimination in health facilities,” said Joanne Liu, MSF International President.

Key strategies central to the HIV response in southern and eastern Africa during the 2000s would strongly support a wider response based on quality care for patients. Along with other organisations, MSF calls for the elimination of user-fees that would enable a move to ‘test & start’ (immediate treatment on diagnosis) and keep people healthy on lifelong treatment. Improvements in supply management and last mile delivery should also include strong monitoring mechanisms of stock outs by civil society and patient organisation.

Reaching wider numbers will require the implementation of ‘task-shifting’, where basic tasks are delegated to nurses and lay health workers to carry out tests, prescribe and dispense ARVs, counsel patients and contact defaulters. These so-called ‘differentiated models of care’ have been successfully piloted by MSF in Kinshasa, DRC and Zemio, Central African Republic, allowing the decentralisation of simplified HIV service delivery models to health facility and community levels.

The role played by civil society and patient associations in the HIV response is essential. MSF witnesses the reluctance of health ministries and governments and international implementing partners to fully include civil society and communities service delivery, testing and adherence support, as well as stigma reduction activities and service monitoring. The ‘community treatment observatories’ now running in Burkina Faso, Cameroun and DRC are strong examples of this watchdog function.  These valuable entities require steady funding and technical support and should be scaled up in all countries in the region.

“West Africa, civil society and communities of people living with HIV groups remain isolated and under-funded, with little support from international civil society, governments and donors. In Eastern and Southern Africa, engaging people living with HIV in the responses contributed to vigorous achievements overall in increasing antiretroviral coverage, support and care. We need to invigorate treatment literacy which gives people autonomy over their care and addressing stigmatising attitudes.” said Amanda Banda, MSF’s HIV Advocacy Coordinator.

-ENDS

MSF currently supports treatment for over 200,000 patients in 19 countries, primarily in Africa. This includes HIV programs and activities in West and Central Africa: DRC, Guinea, CAR, Chad, Niger, Mali as well as other countries with low ART coverage such as South Sudan, Yemen and Myanmar.

MSF’s Out of Focus Report

Download full report: www.doctorswithoutborders.org/article/out-focus

Out of Focus Executive Summary: https://www.msf.org.za/about-us/publications/briefing-documents/out-focus-international-report-hiv-west-and-central-africa

[1] Benin, Burkina Faso, CAR, Cameroun, DRC, Gabon, Guinea, Ivory Coast, Liberia, Nigeria, Tchad, Togo, Senegal and Sierra Leone (UNAIDS)

Medecins Sans Frontieres (MSF) laboratory technician Gentile Lusamba examines cerebral spinal fluids from an HIV patient in the laboratory of the Kabinda Hospital in Kinshasa, Democratic Republic of Congo. Photographer: Tommy Trenchard
This man was kicked out of his house by his sister in law after being diagnosed wit HIV. He has been taking Antiretroviral drugs (ARVs), which he collects from the Kabinda Hospital, and has almost recovered sufficiently to restart his work. Photographer: Tommy Trenchard
Elise, 12, was infected by the HIV virus during her mother's pregnancy. She has been taking antiretroviral treatment (ARVs) for six years. <br/><br/>Elise received her treatment erratically in the early years because of her mother's lack of knowledge on how best to care for an HIV positive child. As a result Elises developed a resistance to the first set of antiretroviral drugs. She had to switch to an alternative set of ARV drugs which have had stronger side effects and are much more difficult to digest, making it an even bigger challenge for her to fully benefit from the life-saving medication.<br/><br/>Elise's fight against HIV became more difficult and painful each day and she lost the battle and died a few days after these pictures were taken. She passed away in the loving care of her mother and MSF's medical team. Her mother Agathe wanted MSF to publish these pictures. « It cannot help Elise, but it may help others in the country », she said. Photographer: Rosalie Colfs
Philomène 47, discovered that she was HIV positive 14 years ago while she was pregnant. Philomène and her husband overcame the initial shock of the diagnosis and thanks to long counselling sessions with MSF teams they have managed to build a relationship and family life almost like anybody else's.<br/><br/>Since Philomène was put on a on antiretroviral treatment that prevents the transmission of the virus from mother to child, she and her husband have had two children who are HIV negative.<br/><br/><br/>Philomène is also a dedicated activist within the community group RENOAC which helps Congolese people live positively with HIV. While working as a RENOAC volunteer, she met Emerence, a young girl who had been abandoned by her family. Emerence now lives with Philomène's family who considers her like their own child.<br/><br/>This photo story highlights the different aspects of Philomène's life : as a woman living with HIV, a mother, wife, and activist. Photographer: Rosalie Colfs