An innovative pilot program in six sub-Saharan African nations has proven effective and scalable in fighting HIV/AIDS in resource-limited areas. Data from the pilot SECURE THE FUTURE Community-Based Treatment Support Programs show that comprehensive medical treatment and care coupled with broad-based community social support can have a major impact in fighting the disease. Model program are in operation in KwaZulu Natal, South Africa; Maseru, Lesotho; Mbabane, Swaziland; Bobirwa Sub-District, Botswana; Caprivi Region, Namibia; and Koulikoro District, Mali. In the symposium, data were presented for the first time on the clinical outcomes data for 992 patients at 12 months and enhanced evaluation data on the value and impact of community services on clinical outcomes and QOL for a cohort of 587 patients -- all living in resource limited settings. Data were also presented for the first time on comprehensive activity data from all the sites on the provision of medical and community services, including 13,500 clients enrolled and 5,725 on antiretrovirals.

An intent-to-treat analysis from the first 992 patients on ARV therapy at SECURE THE FUTURE's Community-Based Treatment Support sites in South Africa, Namibia, Botswana and showed an overall efficacy of 64%, where efficacy is defined as a sustainable, greater-than-50 increase in CD4 count. The results also showed an increase in CD4 count to a median of 270 from a median of 105 before treatment was initiated. Viral load was undetectable in 92% of the 296 patients for whom viral load was tested, and adherence to medication was greater than 95% in 84% of the 522 patients for whom adherence was measured. Other successes are in the levels of HIV education and testing - including a 10-fold increase in the number of clients receiving voluntary testing and counseling since the program's inception - and in community mobilization to fight the disease and overcome its associated stigma.

Preliminary data from the independent evaluation of the community services provided to 587 patients on ARVs showed that those who report that they are satisfied with the community services they receive have a better quality of life, lower perceived stigma, faster rate of increase and higher levels of CD4 cells than patients who are not satisfied. The findings were similar with respect to the level of satisfaction with family support offered at the four centers evaluated.

Specifically, a cohort of patients satisfied with community services reached a median CD4 T-cell level of 251 at six months vs. a median level of 216 for a cohort of patients who also received these services but reported that they were not satisfied with them. Those satisfied with family support reached a median of 232 at six months vs. a median of 198 for a like cohort of those not satisfied. It is generally held that a CD4 count of 200 or less is associated with a higher rate of opportunistic infections and other serious complications of HIV.

Dr. Sebastian Wanless, Medical Director for SECURE THE FUTURE Southern Africa, also presented the poster, "SECURE THE FUTURE Community-based Treatment Support Programs Deliver Quality Care in Resource-limited Settings in Southern Africa."

Additional information on the SECURE THE FUTURE program and its progress to date was also presented in a number of panels and posters at the Toronto meeting.