HAART Program Five years of experience: The Heineken-PharmAccess - Contributions to the XVI International AIDS Conference August 13-18, 2006 ...
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Five years of experience:
The Heineken-PharmAccess
HAART Program
Contributions to the XVI International AIDS Conference
August 13-18, 2006, Toronto, Canada
1
Five years of experience:
The Heineken-PharmAccess HAART Program
Introduction Several of these experiences, data, and observations have
After a year of thorough preparatory work in association been summarized in abstracts and compiled in this brochure.
with the PharmAccess Foundation, Heineken International These abstracts emphasize the fact that the private sector
launched its HIV/AIDS-HAART Program in Rwanda and can indeed help in the fight against HIV/AIDS by sharing –
Burundi on the 1st of September 2001. The (printed) critical – experiences with the outside world and by being
HIV/AIDS policy and treatment program had the full support receptive to new developments.
of the Executive Board of Heineken and it still does. Since
then it has become evident that that support is a conditio
sine qua non for the success of the HAART Program. Many
people at Heineken have contributed to the program’s
success, but the experiences gained through the Henk Rijckborst, MD
collaboration with PharmAccess, NGOs, governments and Director
universities gave an added dimension to the program. Heineken International Health Affairs
3
Heineken’s experiences in a Public-Private
Partnership (PPP) forum regarding HIV/AIDS
treatment programs
H. Rijckborst1, S. Van der Borght1, T. Rinke de Wit2, A. de Roos3
1
Heineken International Health Affairs, Amsterdam, the Netherlands,
2
PharmAccess Foundation, Amsterdam, the Netherlands,
3
Dutch Ministry of Foreign Affairs, The Hague, the Netherlands
Issues Lessons learned
Since September 2001 Heineken has been making HAART Since there are significant differences between the four
available to local employees and their dependents in Africa, multinationals in terms of geographic location, HIV policy and
in collaboration with the NGO PharmAccess. Heineken and target populations, it has been time-consuming to formulate
PharmAccess are members of a PPP forum, which includes a concerted strategy that applies to all six PPP stakeholders.
Unilever, RD/Shell, Celtel International and the Dutch Despite different approaches and distinct organizational
Ministry of Foreign Affairs (BuZa). This PPP forum strives to cultures, the cooperation and exchange between public and
increase access to HAART programs to people who are private partners is felt to be useful in order to expand
not employed by those private-sector companies. The Dutch access to HIV/AIDS treatment and care. It is concluded that
government strongly encourages this kind of cooperation small collaborative projects between a subgroup of the
between the private and public sector. PPP stakeholders is most realistic, with important roles to be
played by PharmAccess (medical quality control) and BuZa
Description (funding for communities).
Heineken’s HAART program focuses on its own employees
and their dependents. The vision of Heineken is to cooperate
with other partners of the PPP forum to play an active role
in the scaling-up of treatment programs in African countries.
The PPP members have identified several potential pilot
projects in which to cooperate and to refer their
own employees to external medical centers for HAART.
People not employed by these private organizations could
simultaneously have access to treatment, to be funded by
the Dutch Ministry of Foreign Affairs. The modalities
for public-private cooperation could vary depending on the
circumstances, needs and bottlenecks in the respective
countries.
4
Four-year survival in the Heineken workplace
HAART program in Africa
S. Van der Borght1, H. Rijckborst1, D. Biteziminsi2, P. Clevenbergh3,
Heineken African Medical Staff
1
Heineken International Health Affairs, Amsterdam, the Netherlands,
2
Bralirwa, Gisenyi, Rwanda,
3
PharmAccess Foundation, Amsterdam, the Netherlands
Issues If we consider the patients lost-to-follow-up as dead at the
Since September 2001 the Heineken companies in Africa time of the last visit, the survival curve becomes:
provide free Highly Active Antiretroviral Treatment to
employees and their family members. This observational Kaplan-Meier survival estimate
study documents the survival probability of HIV-infected
patients who have been given HAART in 14 company sites
in five countries in Africa. Different mechanisms have been
put in place to guarantee the quality of care that the
program is offering.
Description
A prospective HAART database has been put in place at all
Heineken operating companies in Africa. Patients are treated The proportion surviving is 0.93 at 1, 0.90 at 2, 0.85 at 3,
with an nNRTI (first line), followed by an NRT/Boosted PI and 0.85 at 4 years.
(second line). The patient data over the period September
2001 - December 2005 were subjected to Kaplan Meier Survival of patients under HAART in this workplace-based
survival analysis. The starting point is the day the patient program is good; employees will live longer and continue to
started antiretroviral treatment (CD4 < 300/µl or CDC C have a productive life.
classification).
time: 0 1 2 3 4
nr at risk: 265 177 121 57 17
If we consider the patients lost to follow-up as alive we
obtain the following graph:
Kaplan-Meier survival estimate
The proportion surviving is 0.96 at 1 year, 0.93 at 2, 0.90
at 3, and 0.90 at 4 years
5
The impact of HAART on economic indicators
in three central African breweries
S. Van der Borght1, F. Beneficiale2, E. Kamo3, J.-P. Kabarega4, C. Kitenge5,
P. Clevenbergh6, K. Colebunders7
1 4
Heineken International Health Affairs, Amsterdam, Brarudi, Kigali, Rwanda,
5
the Netherlands, Bralima, Kinshasa, the Democratic Republic of the Congo,
2 6
Brarudi, Gitega, Burundi, PharmAccess Foundation, Amsterdam, the Netherlands,
3 7
Brarudi, Bujumbura, Burundi, University of Antwerp, Antwerp, Belgium
Background Annual percentage medical absenteeism
(Rwanda, Burundi, DRC)
Since September 2001, Heineken companies in Africa offer 60
All-cause mortality
free Highly Active Antiretroviral Treatment (HAART) 50 decreased from
40
to employees and their official dependents. If a treatment 30
5.75/1000/year to
program is successful, the patients will survive and the 20 3.0/1000/year; HIV-attri-
10
number of patients receiving treatment will continue to grow 0
butable deaths nearly
2001 2002 2003 2004 2005
as long as more people are getting infected. Financially, this disappeared.
increasing number of patients under treatment also means
an increase in costs. But it is important that other Indicators The already low number of days of medical absenteeism
used in human resource management are also considered. has decreased further, from 1.06 to 0.91 per yearannum per
This document examines, apart from the healthcare costs, employee; this and contributeds to an increased productivity
the mortality, absenteeism and number of hospitalizations. of the employees.
Methods Annual hospitalization episodes
(Rwanda, Burundi, DRC)
Hospitalization events
In the Heineken breweries in three Central African countries decreased from 49 to
(Burundi, RDC, Rwanda; 3300 employees in 2001) indicators 32 events per 1000
used in Human Resource Management and the financial beneficiaries per year;
information on the medical care system were collected. these cost savings help
The evolution of these indicators from 2001 to 2005 was to keep a financial balance.
monitored and related to the number of HAART patients.
Annual recurrent cost (€) of health care
per beneficiary (Rwanda, Burundi, DRC)
Results 70.0
60.0
Each year, the number of patients under HAART increased. 50.0
40.0
Yet this increase slowed down from 139% after the first year 30.0
to 25% in 2005. By the end of 2005, 139 people in the three 20.0
10.0
companies were under treatment. 0.0
2000 2001 2002 2003 2004 2005
Number of living HAART patients The total recurrent
(Rwanda, Burundi, DRC) Annual change in key indicators Heineken
healthcare costs Central Africa, 2001-2005
remained fairly stable at
an increase of €28 per
employee five years after
the start of the treatment
Annual change in number of HAART patient
program. The costs per beneficiary of the medical scheme Annual change in costs per FTE
even decreased slightly, from €45.8 to €42.7, during the Annual change in cost per beneficiary
Annual change in hospitalization events
same period. Annual change in medical absenteeism
Conclusion
The financial impact of a HAART program is only one of the indicators that should be considered when planning to
introduce such a program. Medical absenteeism, mortality and number of hospitalizations are other indicators that
could be evaluated.
6
A successful workplace program for VCT and
HAART at Heineken, Rwanda
S. Van der Borght1, S. Richards2, T.F. Rinke de Wit3, A. Collier4, M. Fox4, F. Feeley4
1
Heineken International Health Affairs, Amsterdam, the Netherlands,
2
Boston University School of Public Health, Department of International Health, Boston, USA,
3
PharmAccess Foundation, Amsterdam, the Netherlands,
4
Boston University School of Public Health, Center for International Health and Development, Boston, USA
Issues Lessons learned
What factors govern the effectiveness and acceptance of Initially, the uptake of VCT testing was slower than hoped
a workplace program for HIV treatment in a low-resource for. Inhibiting factors were concern about confidentiality at
setting? the on-site clinic and fear of losing one’s job or promotional
opportunities, partly because of coincident economic
Description redundancies. Later on, the uptake increased to a high rate
Forty months after the "Access to HAART" Program was as a result of continuous strong management support,
started at Heineken’s Rwanda subsidiary in September 2001, employee education by an HIV-positive Rwandan, and the
72.9% of employees and 61.7% of registered spouses had employee’s observation that treatment was effective and that
received voluntary counseling and testing (VCT). those receiving HAART retained their jobs.
One-hundred-and-nine HIV-positive beneficiaries had been Figure 1 demonstrates that VCT uptake can be achieved,
identified; 42 of them were receiving HAART by January but is transient and requires continuous interventions.
2005. Extrapolating from an anonymous seroprevalence test, Figure 2 demonstrates that spouses are often not reached by
87% of HIV-positive employees had entered the program workfloor-based interventions aimed at VCT. Figure 3 shows
at the time of the survey. This study examines the factors that HIV-positive people who require immediate HAART
influencing the high rate are more likely to report during the early stages of the
of uptake of VCT workplace program, which poses extra challenges to correct
and HAART in this patient management at this fragile stage of the program.
population.
Figure 1 VCT-uptake determining events
Figure 2 Spouses were not reached by Figure 3
launch or advocacy HIV+ person Cumulative HIV+ and patients on HAART
Recommendations
1. Offer HAART as part of a comprehensive employer AIDS program.
2. Use PLWHA from the beginning in a worker education program.
3. Attempt to decouple program milestones from any redundancy.
4. Ensure strong support from local management.
5. Ensure couple testing and target outreach to spouses.
6. Design the program to ensure confidentiality and the perception of confidentiality.
7
Determinants of VCT Uptake in a five-year
Heineken HAART program in Africa
T.F. Rinke de Wit1, S. Van der Borght2, M.F. Schim van der Loeff3, P. Clevenbergh1,
K. van Cranenburgh2, H. Rijckborst2
1
PharmAccess Foundation, Amsterdam, the Netherlands,
2
Heineken International Health Affairs, Amsterdam, the Netherlands,
3
IATEC, Amsterdam, the Netherlands
Background Results (1)
Uptake of Voluntary Counseling and Testing (VCT) services Between January 2001 and December 2005, 7383 VCT visits
in workplace AIDS programs is typically low. Efforts to led to HIV testing in 15 company sites in Africa. Four-hundred-
increase VCT uptake can improve timely access to preven- and-five (5.5%) tested persons were HIV-infected; 268 of
tion, care and highly active antiretroviral therapy (HAART), them had started HAART by January 2006. Factors indepen-
thus reducing morbidity, mortality, and loss of productivity dently associated with a positive HIV result were: age younger
due to AIDS. than 15 or 25 and older; male gender; being widowed or
divorced; being a spouse or child rather than an employee;
Methods living in the Central African region rather than the West
In 2001 Heineken Africa introduced a comprehensive HIV African region; having been tested in the first twelve months
prevention and treatment program for employees and their after the roll-out of the program. VCT uptake increased
dependents of the African subsidiaries. Confidential VCT was gradually over the years. In the first 12 months 1,097 tests
part of this program. VCT visits to company clinics and HIV were performed, compared to 6,286 in the subsequent four
test results were anonymously registered into a database. years. Three factors were independently associated with early
Testing uptake was analyzed with respect to gender, age, HIV uptake of VCT: age 15-24 years; being an employee rather
status, African region (West Africa, with six sites, or Central than a spouse or child; and being HIV-infected. The median
Africa, with nine sites), beneficiary status (employee, spouse, CD4 count of HIV-infected persons was 274 cells/µl
or child), marital status, and period (within first 12 months of (interquartile range 140-451). In a multivariate analysis a
the VCT program or after that). lower CD4 count was associated with having been tested in
the first 12 months, being divorced or widowed, and having
First 12 months After 12 months P
been tested at the West African sites. Gender, age and
n 1,097 (14.9%) 6,286 (85.2%)
beneficiary status were not independently associated with
Median age [IQR] in years 35.0 (27.9-42.2) 34.4 (28.1 - 41.6) 0.82
Age categories CD4 count.
45 years 168 (15.6%) 995
(16.2%) 0.02 Results (2)
Number of women (%) 421 (38.5%) 2,660 (42.7%) 0.009
Uptake of VCT was not evenly distributed over the 60
Marital status
single 214 (20.3%) 1,185 (20.4%) months, but went in leaps and bounds. Interventions that
married 809 (76.6%) 4,506 (77.5%) positively influenced VCT uptake included the official
divorced/widowed/union libre 33 (3.1%) 123 (2.1%) 0.13 Heineken HAART program launch, advocacy presentations
Group
by HIV-positive individuals or by senior company manage-
employee 696 (63.5%) 3,655 (58.2%)
spouse 310 (28.3%) 1,999 (31.8%) ment, the introduction of antenatal clinic services, targeted
child 91 (8.3%) 632 (10.1%) 0.004 vaccination campaigns and introduction of an annual medical
Region checkup, including an opt-out HIV test. Figure 1 demonstrates
Central African site 673 (61.4%) 3,741 (59.5%)
West African site 424 (38.7%) 2,545 (40.5%) 0.25 the frequency of VCT visits in the Nigerian Breweries, Lagos
Number HIV-infected (%) 131 (11.9%) 274 (4.4%)
hepatitis B vaccination campaign specifically targeted at demonstrates a different intervention: an awareness activity spouses of Nigerian Breweries’ employees. The occasion of by an HIV-positive policewoman at the brewery compound. delivering a vaccine was used to make spouses aware of the This intervention motivated Bralirwa employees to opt benefits of the Heineken AIDS treatment program. Figure 2 for VCT, while their spouses were not reached (p
Making 2005 AIDS Day profitable in the fight
against HIV at Bralima, a member of the
Heineken brewery group
L. Kitenge1, A. Kajemba1, T. Tchissambou1, H. Rijckborst2, P. Clevenbergh3,
S. Van der Borght2
1
Bralima, Kinshasa, the Democratic Republic of the Congo,
2
Heineken International Health Affairs, Amsterdam, the Netherlands,
3
PharmAccess Foundation, Amsterdam, the Netherlands
Background Results
Avoiding new HIV infections in youth is the hope for the This study demonstrates that children and young adults 14-25
future. This can only be achieved by acquiring good know- years of age have good knowledge of the use of condoms:
ledge about HIV transmission and modes of prevention. 82%; of symptoms and HIV transmission modes: 73%; of
HIV awareness and prevention programs rarely focus on the abstinence and delaying the first sexual encounter in order to
children of employees in workplace settings. Since 1998, avoid infection: 46%. Knowledge of PEP and PMCT was poor:
Bralima Company, member 45%. Seventy-eight drawings from 200 targeted children age
of the Heineken group, has 5-12 were assessed by the jury; the following main themes
implemented a comprehensive were encountered: impact of HIV/AIDS (death, cemetery,
program against HIV/AIDS. sick people): 27.0%; modes of transmission (needles, syringe,
And since four years, the blades): 52.5%; prevention methods (condom, faithfulness):
Bralima management has used 10.2%; miscellaneous (ribbon, national HIV symbol): 10.2%.
World AIDS Day as an
opportunity to increase awareness about HIV/AIDS among
its beneficiaries. In 2005 the main objective of the World
AIDS Day campaign was involving teenagers and young adults
in the fight against HIV/AIDS.
Methods
The target population of the 2005 World AIDS Day campaign
included all the workers’ children attending the Family Day
Party on 01/12/2005: 451 children, 14 to 25 years of age,
representing 57% of the targeted population. A self-
administered questionnaire was handed out to this group and
the results were reported according to theme. In addition,
children of 5 to 13 years of age were asked to compete by
drawing images about their views on HIV/AIDS. These
drawings were collected during one week and classified by
the Bralima HIV/AIDS task force into categories according
to theme. A quotation framework depending on the main
idea expressed in each picture was designed to assess the
children’s HIV/AIDS perception.
Conclusion
Discussion about HIV/AIDS is threatening for Congolese parents. The current activity has demonstrated that it is
possible to discuss HIV prevention with teenagers and young adults. Usually their knowledge comes from peers and
other sources, rarely from their parents. Despite the relatively low participation rates, children appeared to be
aware of HIV/AIDS and its major routes of transmission. It is recommended that parents have frank discussions with
their children about preventing HIV infection. Companies organizing social events should use these opportunities to
involve all families in health issues, especially in HIV/AIDS.
10Evaluation of an expanded program for
Prevention of Mother-to-Child Transmission
of HIV (PMTCT+) in the private sector
J.P. Kabarega1, D. Biteziminsi2, E. Kamo3, S. Van der Borght4, K. Kitenge5, N. Onyia6,
P. Nsalou7, P. Sianard8, H. Rijckborst4, T. Rinke de Wit9, P. Clevenbergh9
1
BRALIRWA, Health Services, Kigali, Rwanda, Republic of the Congo,
2 6
BRALIRWA, Health Services Dept., Gisenyi, Rwanda, Nigerian Breweries, Health Services Dept., Lagos, Nigeria,
3 7
BRARUDI, Health Services Dept., Bujumbura, Burundi, BRASCO, Health Services Dept., Pointe Noire, Congo,
4 8
Heineken International Health Affairs, Amsterdam, the BRASCO, Health Services Dept., Brazzaville, Congo,
9
Netherlands, PharmAccess Foundation, Amsterdam, the Netherland
5
BRALIMA, Health Services Dept., Kinshasa, the Democratic
Introduction Results
The epidemic of pediatric HIV infection, nearly always acquired Forty HIV-infected mothers completed 47 pregnancies and
through mother-to-child transmission, mirrors the HIV delivered 48 babies in 45 deliveries. One woman miscarried
epidemic among women of child-bearing age. Currently, 90% and one was lost to follow-up before delivery. Pregnancy was
of HIV infections in newborns and children worldwide occur the reason for an HIV test in 22/40 mothers. 37/40 (92%)
in sub-Saharan Africa and is responsible for over 500,000 partners accepted HIV VCCT and accessed comprehensive
deaths annually in children below the age of 15 years. HIV care. Mothers presented at a mean age of 23 [5-38]
In 2001, Heineken International (Heineken) decided to offer weeks of pregnancy. The mean CD4 count at pregnancy
voluntary confidential HIV counseling and testing (VCCT) to diagnosis was 335 [39-937] cells/µl. Eleven mothers already
all pregnant spouses of workers in Heineken’s African received ART at the time of pregnancy diagnosis. The mean
operating companies (OPCOs), and provide prevention of HIV RNA was 3.53 [1.69-4.9] log10 copies/ml with 5/21
mother-to-child transmission (PMTCT) of HIV to those available samples below level of quantification. Antiretroviral
diagnosed with HIV. This PMTCT intervention takes place in therapy for PMTCT was started at a mean 30 [15-40] weeks
the broader context of access to comprehensive HIV of pregnancy. Mothers’ ART consisted of: triple therapy:
diagnosis and care for all workers and their families. 38 cases; AZT or NVP monotherapy: 6 cases; no ARV:
1 case. At delivery, the mean CD4 count available for 23
Aim of the study mothers was 451 [200-937] cells/µl, and HIV RNA available
We assessed the implementation of the PMTCT guidelines for 14 mothers was 2.51 [1.69-3.8] log10 copies/ml. Delivery
and their efficacy in preventing MTCT in the African OPCOs. was vaginal in 27 mothers, by caesarean section in 14
mothers, unreported in 4 mothers, at a mean of 38 [30-42]
Methods weeks of pregnancy (1 lost to follow-up, 1 miscarriage).
All pregnancies in HIV-infected spouses recorded in the Mean Apgar score was 9 [0-10] and mean newborn’s weight
database up to February 2006 were reviewed and data were was 3.1 [1.4-4.7] kg. Newborn’s ART consisted of: none: 10
collected on baseline clinical and immunological status of the babies; nevirapine single-dose: 22 babies; AZT monotherapy:
mother, characteristics of pregnancy and delivery, PMTCT 7 babies; AZT + NVP bitherapy: 5 babies; other: 1 baby;
provided to the mothers and the newborns, and final unknown: 3 babies. Three babies were breastfed.
outcome of the mothers and the newborns. Antiretroviral The present outcome of the mothers is: 36 mothers alive
treatment guidelines with a specific chapter on PMTCT were and clinically well, 1 mother at end-stage disease, 1 mother
provided to the company physicians. Guidelines recommended transferred out, 2 mothers lost to follow-up. The mean
the start of antiretroviral therapy during the last trimester length of follow-up of the mothers is 29 [0-83] months.
of pregnancy, or earlier if requested by the mother’s clinical Eighteen infants aged over 18 months have been tested HIV-
and/or immunologic conditions; provision of single-dose antibody-negative, 19 children are younger than 18 months
nevirapine or six weeks zidovudine for the newborn; of age and have no definitive diagnosis yet, and 5 children
cotrimoxazole preventive therapy, starting at week 6 of the aged over 18 months are still awaiting their final diagnosis.
newborn’s life, until exclusion of HIV infection; exclusive The present outcome of the infants is: alive: 42 babies, dead:
formula feeding. HIV infection in the child was excluded by 5 babies, lost to follow-up: 1 baby. The child mortality rate is
negative HIV antibody testing after the age of 18 months. 102/1000 (5/48), or 125/1000 (6/48) if we consider the baby
lost to follow-up as dead.
1140 HIV-infected 37 Partners
mothers tested
- Mean CD4 count at pregnancy:
335 cells/µl
- Mean VL at
pregnancy: 1 Miscarriage
3.53 log10 copies/ml 40 Pregnancies 1 LTF
Triple ART: 38 pts
AZT or NVP mono: 6 pts
None: 1pt developed AIDS or death within the first year of life and an
additional 40% progressed to AIDS or death by 6 years of
age. In Africa, rate of progression could be even higher in the
context of malnutrition and exposure to multiple infectious
- Mean CD4 count at delivery: 45 Deliveries
organisms. In addition, maternal health status has been shown
451 cells /µl to influence survival of HIV-infected as well as HIV-uninfected
Vaginal: 27
C section: 14 children. This suggests that adequate care for the HIV-infected
- Mean VL at delivery:
2.51 log10 copies /ml Unknown: 4 mother will affect survival of her child(ren), whether HIV-
infected or not.
In our series the child mortality rate was 114/1000, which is
close to the general children’s mortality rate in Central
48 Babies Africa. The two-year mortality rate was 547/1000, 166/1000
- Mean term: 38 weeks NVP mono: 22 pts and 128/1000, respectively, in infected children of infected
AZT mono: 7 pts mothers, in uninfected children of infected mothers, and in
- Mean APGAR score: 9 AZT + NVP: 5 pts control children in a series in Uganda. The average maternal
None: 10 pts mortality rate was 5% per year in the first two years after
- Mean weight: 3.1 kg Other: 1 Pt
delivery. CD4 count less than 200 and HIV RNA higher
Unknown: 3 pts
Discussion than 100,000 copies/ml were the principal determinants of
maternal mortality. In our series, 90% of the mothers were
clinically and immunologically well after a follow-up of about
Mother-to-child HIV transmission (MTCT) can occur before, two years.
during and after delivery through breastfeeding. Without
specific interventions the MTCT rate ranges between 15 and
45%. In developed countries, vertical transmission of HIV
infection has virtually been eradicated by using antiretroviral
therapy during pregnancy and delivery and in the newborn,
by elective caesarean section and by avoiding breastfeeding.
Multiple studies have shown that application of some or all
of these interventions are effective in reducing MTCT in the
African setting.
In this series, there is no documented vertical transmission
of HIV, although this cannot be completely excluded as some
infants died before the age of 18 months.
Vertically HIV-infected children are at high risk of short-term
mortality. In industrialized settings, before the antiretroviral
therapy era, approximately 20% of HIV-infected children
Conclusion
The Heineken PMTCT+ program has proven effective in preventing HIV transmission in children, in improving survival of children
from HIV-infected mothers, and in providing comprehensive HIV diagnosis and care to the mothers and their partners.
12Adverse reactions to Antiretrovirals
in a Workplace treatment center
F.N. Onyia+*, S. Van der Borght*
+*
Nigerian Breweries Plc, Lagos,
*
Heineken International Health Affairs, Amsterdam, the Netherlands
Background Results
In 2001, Heineken International started a comprehensive There were 574 complaints of adverse effects by 185/248
HIV/AIDS workplace program in its African operating (74.6%) patients, all in the first 24 weeks of treatment.
companies for employees and their spouses living with AIDS Several patients complained of more than one adverse effect.
(PLWA), which included the provision of free Antiretrovirals The predominant adverse effects were nausea (186 (32.4%)),
(ARVs). The first-line regimen used consisted of zidovudine, fatigue (137 (23.9%)), and headache (79 (13.8%)).
lamivudine and nevirapine/efavirenz. This paper reports Of all adverse effects, 54.5% were described as mild, 27.2%
on the frequency of the occurrence of adverse reactions to as moderate, and 5.8% as severe; 12.8% were not graded.
ARVS in our patients and its impact on adherence. 55.8% of the adverse effects were reported two weeks after
the start of treatment (37.1% in the 4th week and 7.1% in the
Objectives 24th week). Of all patients, 72.9% were described as adherent
1. To determine the frequency of adverse reactions to our (not having missed even a single dose) to therapy in the
first-line drugs. 2nd week, 75.6% in the 4th week, and 77.7% in the 24th week.
2. To describe the severity and timing of adverse effects to
our first-line drugs.
3. To determine the impact of adverse reactions on
adherence to therapy
Methodology
The 2-week, 4-week and 24-week visit (after the start of
ARV use) sheets of our electronic database (HAART version
3.1) were reviewed to determine the frequency of the
occurrence, the severity and the timing of adverse effects to
the drugs. Results are presented with descriptive statistics.
Conclusion
The most common adverse effects to antiretroviral drugs were nausea, fatigue and headache. Most of them occurred in the first
month of treatment and were predominantly mild. More than 70% of patients were adherent to therapy despite adverse effects.
13Description of HIV-related events
according to CD4 status in a Workplace
treatment program in Africa
F.N. Onyia*, Ph. Clevenbergh°, H. Rijckborst+, S. Van der Borght+
*
Nigerian Breweries Plc, Lagos,
°
PharmAccess Foundation, Amsterdam, the Netherlands
+
Heineken International Health Affairs, Amsterdam, the Netherlands
Background HRE Number of
episodes and
CD4 count
As part of the implementation of its HIV/AIDS policy,
% of total Range Median
Heineken International started a comprehensive HIV/AIDS
workplace program in 15 African operating companies. Oropharyngeal 35 (25%) 2- 123
To date, 340 HIV-positive patients have been identified of candidiasis 768
WHO 111
whom 224 are under antiretroviral treatment (ART). Criteria CDC B
for starting ART are CD4 count below 300 or the occurrence
of CDC Group C HIV/AIDS-related events (HRE). Herpes Zoster 31 (22%) 13 - 245
WHO 11 561
CDC B
Objectives
1. To determine the frequency and nature of HIV-related Fever of 24 (17%) 2- 133
events (HRE) in HIV-infected patients included in our unknown origin 422
WHO 111
treatment program.
CDC B
2. To determine the CD4 count values at which these events
occur. Chronic 15 (11%) 5- 179
diarrhea 601
Methodology WHO 111
CDC C
The eligibility sheets of the electronic database (HAART
version 3.1) of the medical departments of 15 Heineken Pulmonary 12 (9%) 3- 86
operating companies in Africa were reviewed to extract tuberculosis 462
WHO 111
tuberculosis information on the occurrence of HRE and on CDC C
the CD4 count at the time of occurrence.
Vulvovaginal 7 (5%) 30 - 199
Results candidiasis
WHO 111
465
340 HIV-infected patients were identified, 224 of whom met CDC B
the treatment eligibility criteria. There were 140 HRE in the
total number of 71 patients. These are represented in the Esophageal 5 (3%) 3- 13
candidiasis 168
table. WHO 1V
CDC C
Others 11 (8%) 17 - 134
868
Total 140 (100%)
Conclusion
Oral candidiasis, herpes zoster and fever of unknown origin are the three most common HIV-related events seen in HIV-infected
patients. Herpes zoster occurred at the highest CD4 count values and esophageal candidiasis at the lowest. Occurrence of these
diseases should alert the clinician and trigger the performance of HIV voluntary counseling and testing. Availability of CD4 count is
necessary to decide when to start, as many patients who need antiretroviral therapy do not have any HRE.
14PharmAccess Foundation Heineken International, Health Affairs
Meibergdreef 9 T1-220(AMC) P.O. Box 28
1105 AZ Amsterdam 1000 AA Amsterdam
The Netherlands The Netherlands
Phone: (+)31 71 5456700
Phone: (+) 31 20 5667158 Fax: (+)31 71 5457788
Fax: (+) 31 20 5669440 E-mail: healthaffairs@heineken.com
E-mail: info@pharmaccess.org
Website: www.pharmaccess.org
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