The severity of the situation prompted our initiative to integrate community-based
prevention and care efforts once effective drugs became available. In 1995-1996,
we introduced zidovudine to our prenatal-clinic formulary. Prior to this,
a majority of young women who came to this clinic declined free VCT services;
however, once this effective method of preventing mother-to-child transmission
became available, more than 90% of women offered these services accepted them.
In 1998, we launched the "HIV Equity Initiative" in order to complement prevention
efforts with ARV treatment for infected individuals who would have died, in
our opinion, without these drugs. Because measurement of CD4 cell counts and
viral loads is not available in rural Haiti, a clinical algorithm—based
on criteria that include the nature and frequency of opportunistic infections,
weight, neurologic status, and severe hematologic abnormalities— is
used to identify those patients in greatest need. Currently, some 200 of the
more than 2100 HIV-positive patients followed in our clinic receive ARV therapy.
To ensure adherence, use of ARVs is supervised by community-based health workers,
called accompagnateurs, who visit patients daily
(this strategy is termed directly observed therapy [DOT]-HAART).17 The
program also provides a modicum of financial and social support to ensure
adequate nutritional intake for both the patients and their families.