ESTHER Rwanda-Luxembourg HAART Program for Patients with Advanced-stage Disease and Limited Resources

摘要

Setting up a large-scale comprehensive care programme for patients with advanced-stage disease and limited resources is a major challenge. This study describes the organization of a programme for patients with limited resources subsidised by ESTHER Luxembourg program (Ensemble de Solidarite Therapeutique Hospitaliere En Reseau), in the Central University Hospital of Kigali (CHUK) and difficulties encountered. The cohort includes 1603 patients under HAART and opportunistic infection (OI) prophylaxis since April 2003 in internal medicine and paediatrics at CHUK. Among patients under HAART, stage 3 and 4 represent 89,5(percent). The number of death under HAART amounts to 56/982 (5,7with an average follow-up of 5 months. 99,5(percent) of patients are treated on first line regimen and 4,6(percent) changed treatment for intolerance. Medical staff of the hospital had to be reorganized, without increase in the number of doctors, but with a strong team of counsellors, nurses and social workers. Standardized tools were developed for follow up and home visits. Among major problems, care for OI was difficult, because of irregular procurement of drugs and reagents, lack of consensus workup flowcharts and treatment protocols and an insufficient number of doctors to cover proper care of hospitalised patients and outpatient ARV clinics, which contributes to a high intrahospital mortality rate before staring HAART. Care for patients with limited financial resources is possible, including ARV therapy. It needs appropriate amounts of trained staff, drugs and reagents and reorganization of services, with reassignment of tasks for staff, empowerment of non-medical staff and standardized tools.