Family treatment

Univ Of Witwaterstrand, Johannesburg

Investigators

Linked publications, trials & patents

Abstract

The benefit of antiretroviral therapy is well established but limited to wealthy nations. A predefined, simple sequence of treatment regimens, providing highly active antiretroviral therapy (HAART), yet preserving treatment regimen options, focused on extending the durability of limited treatment options has the best potential to be implemented in poor countries at primary care centers. This project is designed to randomize households to one of two treatment strategies to measure the durability of the sequenced antiviral therapy regimens (AZT/3TC/ABC---> ddl/d4T/EFV or ddl/D4T/EFV--> AZT/3TC/ABC followed by AZT/ddl/lopinavir/RTV). Particular attention has been given to treatment options which can be sourced under the UNAIDS access pricing agreements. This study is important because: * South Africa has 15% of the worlds patients with HIV/AIDS of which 51% are in the two states covered by our consortium. * There are fewer doctors for the patients (l per 1,600 and less than 5 infectious diseases specialists) so HIV patient care must be delivered by personnel other than doctors in the primary care setting. * For HIV treatment to have the greatest social impact, and as alternative treatment for patients is not available, any study should consider treating the entire household to ensure maximum adherence and minimize sharing of drugs. The chief hypothesis of this project is that antiretroviral therapy can be implemented in a resource poor setting at a primary care facility with trained primary health care personnel other than doctors. The specific aims of the project include: 1. To compare the percentage of patients with undetectable viral load at 36 months of treatment using two different schedules of three treatment regimens of ART in adults (over 16 years) and children over the age of 1 year. 2. To address the cost and economic impact on families and society of the implementation of a predetermined schedule of antiretroviral therapy to "Safeguard the Household". 3. To describe the treatment outcomes in terms of morbidity, opportunistic and endemic infections and mortality of ART in a resource poor setting. To evaluate the contributing factors to treatment failure in a resource poor setting including but not limited to toxicity, resistance, compliance, and treatment interruption due to concomitant medication and intercurrent medical conditions.