HIV treatment can be delivered even in settings of armed conflict, and humanitarian health agencies should not wait until a conflict is over before launching HIV care programs, say a team from Médecins Sans Frontières (MSF) in this week’s PLoS Medicine.

Heather Culbert and colleagues report their results of three years’ experience of providing HIV care, including antiretroviral therapy (ART), to a conflict-affected population in the Democratic Republic of the Congo (DRC). The reported treatment outcomes were similar to those in HIV projects in non-conflict settings.

"Our experience has shown us that one of the keys to successful provision of ART in conflict settings is preparation for disruption," say the authors. Some of the crucial contingency measures include:

  • Providing patients with extra emergency drug supplies that can be taken in case of program interruption.
  • Stockpiling emergency supplies of ART and securing them against vandals and looters
  • Distributing clinics widely throughout the treatment area, thus reducing travel requirements and making it easier and safer for staff and patients to access the clinics in times of insecurity
  • Establishing links with HIV care programs in neighboring regions, allowing displaced patients to continue to receive care
  • Educating patients on the importance of not conserving their pills and trying to take them on time even during periods of instability.

December 2003, says:

"I heard gun fire all through the night. When I had only five pills left I lost my appetite and felt desperate…but despite the uncertainty I continued to take my treatment at the correct hour… When I had only one pill left I had the courage to go out and seek some more treatment. I went to see nurse who informed me that she would be able to distribute antiretrovirals; with that I had a month’s worth of treatment. If we have to give up this treatment we will return to how we were at the start, sick."

The authors acknowledge that their results have been achieved with the resources of an international nongovernmental organization (MSF), in an urban setting, with the episode of conflict-related disruption occurring early in the programme, and thus similar results in conflict settings may not always be possible. "Nevertheless," they say, "the key elements of contingency planning for care delivery in conflict settings are not resource-intense and we believe they can generally be applied to most care programmes."

Citation: Culbert H, Tu D, O’Brien DP, Ellman T, Mills C, et al. (2007) HIV treatment in a conflict setting: Outcomes and experiences from Bukavu, Democratic Republic of the Congo. PLoS Med 4(5): e129.