‘Radical’ Antiretroviral Drug Program in Botswana Becomes ‘Test Case’ for AIDS Treatment in Region
The success of the Botswana's "radical" antiretroviral drug program has made the country a "test case" for AIDS treatment in sub-Saharan Africa, the Christian Science Monitor reports (Itano, Christian Science Monitor, 5/7). Botswana, which has the world's highest HIV prevalence rate -- 38.5% of people between the ages of 14 and 49 are estimated to be HIV-positive -- began offering treatment last year through a partnership with drug maker Merck and the Bill & Melinda Gates Foundation (Kaiser Daily HIV/AIDS Report, 9/12/2002). There are currently four clinics around the country that provide antiretrovirals and counseling for 6,000 HIV-positive people, and the government hopes to have 13 clinics open by the end of the year. The antiretroviral drugs alone cost the country between $1,200 and $3,000 a year per patient, but since the program is still in its nascent stages, the additional cost of new clinic buildings and equipment has put the price of the program at between $7,000 and $10,000 a year per patient, according to Ernest Darkoh, operations director of the 15-month-old program. The total cost for the first year of the program was $30 million (Christian Science Monitor, 5/7). Merck has agreed to provide $50 million over five years to help finance the project and has also agreed to "undertak[e]" the provision of free antiretroviral drugs, according to the Associated Press. The program is "beginning to make headway" in treating HIV-positive people in the country, reducing HIV prevalence among pregnant women from 36.2% in 2001 to 35.4% last year, which is a small change but an "encouraging sign," the Associated Press reports (Motseta, Associated Press, 5/6). In addition, patients in the program have 90% to 100% drug regimen adherence rates, which is as much as 20% higher than adherence rates in the most successful programs in Western countries. Doctors attribute this success to the intensive counseling given to patients as part of the program and to the effectiveness of the drugs (Christian Science Monitor, 5/7).
'No Room for Mistakes'
Botswana is the first country in Africa to commit to the widespread distribution of antiretroviral drugs through its public health system (Associated Press, 5/6). The government therefore recognizes that there is "no room for mistakes," because the success or failure of the program could "affect future AIDS treatment" throughout Africa, according to the Monitor. Many other African countries have said that Botswana's diamond wealth has made the program possible and that the Botswana program's "steep price tag" makes it impossible for them to afford similar programs. Regardless, the success of the program has "invigorated" Botswana's medical community and made it an international center for AIDS research, as scientists are coming to the country to conduct HIV research and young scientists are receiving training in a new $3 million research laboratory, according to the Monitor (Christian Science Monitor, 5/7). The government has said that it will try to eradicate new HIV infections by 2016 (Associated Press, 5/6).