What Works for Women and Girls

Geneva, Switzerland (November 2–4, 2009), noted that “In 2007 alone, there were 2.7 millionnew HIV infections. By the end of 2008, more than 4 million people were accessing antiretroviraltherapy in low- and middle-income countries. That same year, an estimated 5.5 million inimmediate need of treatment could not access it. Current efforts to treat HIV are not keepingpace with all those who need therapy. Without a dramatic reduction in new HIV infections,this trend will continue (WHO, 2009j).What Works—Treatment: Provision and Access1. Antiretroviral therapy has been successfully administered to both men and womenwith good adherence, good patient retention, and good clinical outcomes in resourcepoorsettings; results have been similar to those achieved in resource-rich countries.EVIDENCE1. Antiretroviral therapy has been successfully administered to both men and women withgood adherence, good patient retention, and good clinical outcomes in resource-poorsettings; results have been similar to those achieved in resource-rich countries.A systematic comparison of antiretroviral therapy on mortality of HIV-positive patients inboth low-income and high-income countries found that antiretroviral therapy is feasibleand effective in low-income settings. Mortality was higher in the first few months oftreatment for patients in low-income settings. Those in low-income settings startedtreatment with considerably more advanced immunodeficiency than those from industrializedcountries, but virological and immunological response to HAART were similarin both settings. The study compared 4,810 treatment-naïve adult patients (51% female)from 18 HAART programs in Africa, Asia and South America (low-income settings)with 22,217 treatment-naïve adults (25% female) in 12 HIV cohort studies from Europeand North America (high-income settings) and compared baseline characteristics andoutcomes during the first year of HAART (ART-LINC & ART-CC, 2006). (Gray III)(treatment, HAART, Africa, Asia, South America, Europe, North America)A review of nine articles and 18 abstracts until 2006 from sub-Saharan Africa, with12,116 patients found favorable levels of adherence, with 77% of patients achieving 95%adherence according to patient self-reports. Adherence from studies in sub-SaharanAfrica showed that that more patients were adherent than patients in North America,based on 31 studies with 17,537 patients (Mills et al., 2006). (Gray IV) (adherence, treatment,sub-Saharan Africa, North America)172 CHAPTER 7 TREATMENT