Nairobi - Millions of people with AIDS could benefit from life-saving antiretroviral medicines, but it will only happen if treatment models become much better adapted to the real-life situation of developing countries, according to Médecins Sans Frontières.

By beginning to implement this approach in some of its own projects, MSF will have more than quadrupled the number of patients receiving ARV treatment by the end of the year.

"Unless the world changes its approach to treating AIDS, the millions of people who need treatment are unlikely to gain access to it," says Dr Morten Rostrup, President of the International Council of MSF. "Adaptation means fewer pills per day, fewer lab tests and free treatment, dispensed in the communities where people live, that is at district facilities and at community health posts."

MSF has begun implementing adapted treatment approaches in its programmes. In Malawi, MSF is treating 2,000 patients using a triple fixed-dose combination - one pill twice a day.

Unlike in AIDS treatment schemes in developed countries, in this programme the use of laboratory tests is minimised and treatment can begin after a positive HIV test and clinical assessment by trained staff, who could be a nurse or clinical officer. This has allowed the numbers on treatment to be expanded rapidly: 250 new patients were added last month.

"We are adapting the AIDS treatment model to real-life circumstances here," said Didakus Odhiambo Oola, MSF's head of mission in Malawi. "The use of three-in-one pills plus extensive training of, and increased reliance on, clinical officers and nurses has enabled us to get and keep more patients on treatment."

In Malawi, MSF offers ARV treatment free of charge. The annual drug cost per patient covered by the project is US$288. The cost of ARVs is critical considering that the Malawi government is in the process of implementing a Ministry of Health treatment programme with help from the Global Fund for AIDS, TB and Malaria.

With input from industry experts, MSF has estimated that a target price of US$70 for annual treatment per person is achievable. Reaching this goal would mean that four times as many people could be treated with the same drug budget in Malawi.

In Kenya, MSF treats 1,200 people with antiretrovirals, in four projects (in Mathare and Mbagathi in Nairobi, in Homa Bay and in Busia). Most patients receive their medicines as three-in-one pills and all MSF patients receive their treatment free of charge.

"Our experience convinces us that treatment must be free for patients," said Christine Jamet, head of mission in Kenya. "If there was a fee, many of those who desperately need these lifesaving drugs would not be able to get them."

MSF is supportive of the World Health Organization's ambitious new goal of scaling up AIDS treatment in developing countries, and has been sharing its expertise and experience with the WHO AIDS team. MSF is also working with endemic country governments to assist their efforts to scale-up treatment.

Today, MSF is treating more than 9,000 people in 42 projects in 19 countries and expects this to increase to 11,000 by the end of the year - an increase from 2700 patients in January 2003. MSF plans to have more than 25,000 patients under treatment by the end of 2004. MSF offers treatment as part of comprehensive HIV/AIDS programmes which include voluntary counselling and testing, prevention education, treatment of opportunistic infections and dietary support.

For MSF's technical proposals to the WHO on simplifying treatment protocols, consult the report "ARV simplification in high-prevalence countries".