End in sight to Aids drug treks?

By Tom Gibb
BBC News, Patongo, northern Uganda

Christine Achan says many villagers cannot make the journey to get drugs

A week after giving birth to her sixth child, Christine Achan walked 60 km (37 miles) from her village in northern Uganda to get life-saving anti-retroviral drugs to stop her and her baby becoming sick with Aids.

Doctors say it is villagers like her that the results of Africa's largest and longest running clinical test, the Dart trial, should help.

The research suggests that more HIV/Aids patients in Africa could be treated if funds were switched from expensive laboratory testing to local care in villages.

As she waited to see the doctor in the clinic at Patongo, Christine Achan said: "It takes me two days to get here and two days to get back.

"It is very difficult. But I do this because I want to stay healthy so that I can look after my children."

I try to persuade them to get treatment, but they find it very difficult to travel this far, some have died because of this Christine Achan

Ms Achan left her eldest child, who is 12, in charge of the others. Her husband died of Aids three months ago, too weak to make the journey.

She called her baby Odongo, which means "child born after the loss of his father".

This was a preventable death. Anti-retroviral drugs are very effective in keeping the HIV virus suppressed and preventing the onset of Aids.

But to get the drugs villagers have to go to Patongo. Part of the reason for this is that the normal monitoring of treatment also requires patients to do routine blood tests to check for side effects and to make sure that the medicines are working.

Technicians come to the Patongo clinic once a fortnight to take blood.

Marginal benefits

They then have to drive the samples another four hours down dirt roads to the nearest laboratory in the northern city of Gulu.

Results are brought back to the clinic two weeks later.

Three people a minute die of Aids in Africa

"Doing these tests is very, very challenging," says Dr Lugemwa Abbas, who runs the clinic.

"Sometimes you find that our patients have to walk 50 or 60 km on the days we do blood tests. They sleep here and walk back the following day."

But the results of the Dart trial do now offer some hope. They suggest that the routine laboratory tests actually have only marginal benefits for patients.

Doctors say this should make it easier to train and supervise health workers in village clinics to distribute the medicines, only using laboratories when clinically necessary.

"It would mean that patients don't have to move so frequently to the centre for blood tests," says Dr Abbas.

"We could take the drugs to where they are - meaning that it is more flexible. Many more people would enrol on HIV programmes."

Impassable roads

Ms Achan says there are many others in her village who need treatment and cannot make the journey.

"I try to persuade them to get treatment, but they find it very difficult to travel this far. Some of them have died because of this," she says.

Her sister in law also died of Aids recently.

Patongo is a very typical region in Africa, with often impassable roads and large distances between scattered villages.

Fourteen per cent of the population is estimated to be HIV positive, more than elsewhere in Uganda.

Despite promises of universal treatment, three people a minute still die of Aids in Africa.

More than four million Africans still urgently need anti-retroviral treatment.