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INCREASED ACCESS TO HAART IN RESOURCEPOOR SETTINGS IN MEDECINS SANS FRONTIERES PROGRAMS: CURRENT STATUS AND CHALLENGES Schaefer M , Couturier P , Ferradini L , Laouabdia K , Baron E4, Calmy A3 1 Mdecins Sans Frontires, Sydney, NSW, Australia ; 2 Epicentre, Paris, France; 3Access Campaign, Paris, France, 4 Mdecins Sans Frontires, Paris, France MSF, a medical humanitarian NGO, started to provide HAART to HIV patients in resource poor settings in 2001. Free-of-charge comprehensive care includes counselling for adherence, treatment of opportunistic infections OIs ; and HAART, mostly through HIV clinics. Patients are treated according to WHO guidelines and the vast majority of eligible patients receive WHO pre-qualified generic Fixed Dose Combinations FDCs ; . As of March 2005, MSF provides HAART to more than 25, 000 patients in 37 countries. In order to respond to needs in our respective settings we adapted our strategy to the context: we simplified the inclusion process, simplified treatment protocols by using generic FDCs, decentralised and improved adherence counselling and trained staff by involving the community . Ongoing program monitoring is done through FUCHIA follow-up and care of HIV infection and AIDS Epicentre, France ; . Treatment and safety outcomes were analysed in March 2004 on 12, 058 patients on HAART: our data suggests that immune restoration is as effective in our population as it is clinical trials in Europe and the US. Where virological data is available, we have observed a high rate of virological suppression. Our experience shows us that many challenges still need to be addressed effectively: medical challenges include the need for a robust, non toxic and easy-to-take first line; the possibility to diagnose failure and to have access to an alternative treatment; paediatric diagnosis and treatment is difficult, and access to feasible PMTCT is still an issue in most places. Programmatic lack of qualified and adequately paid health personnel, cost-sharing schemes ; , and political issues political commitment, access to good quality generics ; still remain largely unsolved. Large-scale implementation of HIV treatment programs through public services is highly insufficient in most resource poor settings. The need of skilled human resources is a key issue. Funding mechanisms should take this into account when budgeting for HIV AIDS programs. Many fundamental medical questions remain unanswered. Last but not least, the responsibility for adequately responding to this huge epidemic lies in the hands of national and supra-national bodies, because order flagyl.

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