Zambia has announced that an adult antiretroviral therapy programme for 10,000 adults will begin before the end of the year, according to Zambian Health Minister Dr Brian Chituwo. Access to treatment will be funded by a grant from the Global Fund to Fight AIDS, TB and Malaria, as well as funds from the World Bank.
Treatment is currently available at a cost of $300 a year in the private sector, which places it beyond the reach of all but the wealthiest members of a society where the average income is around $280. More than 80% of the population are living at subsistence level with no permanent job, so the government scheme will only require a contribution towards costs (as yet undefined). It is estimated that more than 500,000 people in Zambia already have HIV infection.
The pilot scheme will begin at eight sites (the capital, Lusaka, together with Ndola, Livingstone, Kasama, Mukinge and St Francis) using generic antiretrovirals procured in bulk. Initially, mothers with HIV identified through sites offering treatment to prevent mother to child transmission of HIV will be prioritised, along with fathers and infants born with HIV disease. National guidelines on clinical eligibility for treatment are due to be published shortly; it is likely that these will draw heavily on recommendations made by the World Health Organisation earlier this year, discussed in detail elsewhere on this website.
A package of care that will include not only antiretroviral treatment but also treatment and secondary prophylaxis of common opportunistic infections is planned, together with provision of food supplements (critical in a country now experiencing severe food shortages), treatment information and counselling and access to home care, income generation programmes and support groups.