Program Supplement [International Conference on AIDS (14th: 2002: Barcelona, Spain)]

and adherence questionnaires, similar degrees of compliance
were found for both regimens.
Conclusion: At 24 weeks, the compact, IDV/RTV + EFV
nucleoside-sparing regimen yielded similar promising
surrogate marker efficacy and safety data as compared with
results achieved using the PI + NNRTI foundation plus D4T.
Corresponding author: Stek, Michael, Merck&Co, One Merck
Drive, P.O. Box loo, Whitehouse Station NJ 08889, United
States, Tel: +i 908 423 3277, Fax: [phone],
Email: michael [email protected]
[ LBPP2209
Implementation of an antiretroviral access program (CARE)
in HIV-1 infected individuals in resource poor settings:
initial experiences
van Leeuwen, Remko1, Salif Sow, Papa2, Bissagnene, E3, Kityo,
Cissy4, Waweru, H5, Waalberg, Esther6, Lange, Joep', CARE
project team, on behalf of6 (The Netherlands; 2Senegal; 3C6te
d'lvoire; 4Uganda; 5Kenya; 6Switzerland; 7)
Issues: One of the key debates after the previous World AIDS
meeting was how to scale-up access to antiretroviral (ARV)
therapy in resource poor settings. The WHO estimates that 6
million people are in direct need of ARV treatment but only a
fraction has access to it. CARE (Cohort program to evaluate
Access to anti-Retroviral therapy and Education) is a pilot
program designed to provide ARVs along with comprehensive
clinical care in 4 African countries. We describe the first
experiences from this project.
Description: This a single-arm, 96 week, open-label cohort
program in 200 subjects in Kenya, Uganda, Senegal and C6te
d'lvoire. ARV- nalve HIV-1 infected patients, who are unable to
afford ARVs, with a CD4-count 350/mm3 are treated with
SQV/r 16oo/loo mg od plus AZT 300oo mg bid and 3TC 150 mg
bid. Educational programs to increase general knowledge of
HIV/AIDS, HIV awareness, prevention strategies, and
treatment adherence are offered to patients and healthcare
providers. The program also includes pharmacoeconomic and
pharmacokinetic substudies. The results of the program will be
used to determine the feasibility and cost-effectiveness of
providing access to ARVs in developing countries.
Lessons learned: Prior to initiation of patients on ARV, there were
considerable logistical and administrative challenges, including
establishment of suitable local infrastructure (computer,
refrigerator, OPD clinic rooms), ethical approval, GCP consensus,
transfer of funds, shipment, importation and storage of drugs.
Comprehensive educational resource material was generated by
an international faculty at multidisciplinary onsite workshops.
Recommendations: It took 12 months to overcome all hurdles,
which was longer than anticipated. Patients are now being
enrolled quickly. These first experiences from the CARE project
may facilitate implementation of other access programs. The
CARE program could serve as a model for access to ARVs and
healthcare in a resource poor setting.
Corresponding author: van Leeuwen, Remko, IATEC, Room TI222, AMC- Meibergdreef 9, 11o5AZ Amsterdam, The
Netherlands, Tel: [phone], Fax: [phone],
Email: [email protected]

[ LBPP2210
Reducing mother to child transmission of HIV-1 in Barbados.
Cost-effectiveness of the PACTG o76 protocol in a middle
income, low prevalence setting
Adomakoh, Sarah, Kumar, Alok, St. John, Anne (Barbados)
Background: Eastern Caribbean governments have identified
PMTCT, as the most urgently required HIV prevention
intervention. We estimate cost-effectiveness of PMTCT using
the PACTGo76 protocol in Barbados and use estimates
generated toproduce a model to assess the cost effectiveness
under varied treatment settings.
Methods: Mother-baby pairs given Zidovudine (ZDV) and those
not given ZDV between the periods January 1993 to Dec 1998
were studied. Costs associated with identification of HIV-1
infected pregnant women, prevention of transmission, and
treatment of all newborns were identified. Childhood HIVrelated medical costs were also collected. Costs were
calculated at a discount rate of 3% to allow for time
preference.
Results: Lifetime cost of treating an HIV infected child is
US$8665. At 0.9% HIV-1 sero-prevalence, screening uptake of
75%, and 14 weeks median duration on ZDV, the PACTo76
protocol costs $145,883, averts 26 cases, is cost-saving at a
net cost of ($78,149) and generates 2075 DALYS. The
intervention ceases to be cost-saving, yet is still highly cost
effective, at HIV-1 prevalence rates below 0.5%. At 0.5% seroprevalence, the intervention averts 14 cases at a net cost of
$3873, cost per case averted of $276, generates 1128 DALYS at
$3.43 per DALY. Consideration of amortised training costs has
no significant effect on cost-effectiveness. When a long course
(20o weeks) antenatal duration on ZDV is considered, the
regimen is most effective, yet significantly more costly than the
observed duration.
Conclusion: Universal screening and PMTCT of HIV-1 using the
modified PACTGo76 protocol is highly cost-effective in the
Barbadian setting. The moderately shortened duration on ZDV
compared with the long-course of 20 weeks allows for the
maintenance of cost-effectiveness under a wide range of HIV-1
sero-prevalence, uptake and treatment acceptance rates. This
is so even in settings where training and programme set-up
costs will be observed.
Corresponding author: Adomakoh, Sarah, Hambaville House,
Bannatyne, Christchurch, Barbados, Tel: [phone],
Fax: [phone]o6, Email: [email protected]

32 Program Supplement