They Call It 'Patient Selection' in Khayelitsha: The Experience of Medecins Sans Frontieres-South Africa in Enrolling Patients to Receive Antiretroviral Treatment for HIV/AIDS

摘要

In 1999, Medecins Sans Frontieres (MSF) set out to explore and demonstrate the feasibility of preventing and treating HIV/AIDS in a so-called resource-poor, economically and socially disadvantaged setting. The first MSF mission to incorporate antiretro-viral (ARV) treatment into its HIV-AIDS-oriented medical program was undertaken in Bangkok. The second project was launched in Khayelitsha where MSF has been providing ARV treatment for persons with HIV/AIDS since May 2001. Khayelitsha is an enclave of some 500,000 inhabitants, most of whom live in corrugated-iron shacks, without running water or electricity. Unemployment is extremely high; crime and violence (including robbery, domestic violence, rape, and murder) are rampant. The general prevalence of HIV/AIDS is 26%, measured among pregnant women. The tuberculosis incidence rate is one of the world's highest for open-space sites (1,380/100,000). Unsurprisingly, TB/HIV coinfection is very high too: 63% of those with TB are also infected with HIV.