Using new drug to simplify ART services in post conflict areas of Myanmar: a new approach to simplifying antiretroviral treatment (ART) of HIV in ceasefire group controlled border areas in Myanmar by using inexpensive generic atripla as first line across the China-Myanmar border
Issues: In ceasefire controlled areas of Kachin state, HIV prevalence among the general population is about 6.5%. Few of them can access any AIDS treatment.
Description: Atripla (the branded drug) is widely used for HIV treatment in the developed countries. It is a superior alternative because it has almost no toxicity and a more favorable resistance profile than the dominant 20 cent a day stavudine/lamivudine/nevirapine regimen used in Africa and Asia. one-pill perday is also very good for patient compliance. Recent availability of an FDA certified generic equivalent to Atripla costing only 53 cents per day encouraged us to use this less toxic alternative for rapid scale up of AIDS treatment in this high prevalence, poor and rural regions of Myanmar. Many resources were saved and less staff was used because patients did not need lab monitoring or frequent visits to a central clinic to check for ART toxicity, patients do not need to travel frequently to see the doctor, which is costly and not easy in this post conflict areas. This cost savings more than offset the higher cost of the generic Atripla. 1,430 (60% male and 40% female) patients were enrolled in the treatment program and 840 have been started on ART. 9% of the patients started ART have died. Only 2 patients were changed from the Atripla regimen because of side effects (efavirenz nightmares). Exams, symptom reviews, and adherence counseling without lab monitoring only needed every 3 months.
Lessons learned: The programme is cost effective, eay to ensure compliance and easy to manage. It could be raplicated in other post conflict settings.
Next steps: We continue using this regimen to treat more patients. A much larger effort will be needed to treat the 80,000-165,000 Burmese AIDS patients who qualify for ART.
B. Wang
Health Unlimited, Kunming, China