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Conflict and Health

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Open Access 01-12-2018 | Case study

Provision and continuation of antiretroviral therapy during acute conflict: the experience of MSF in Central African Republic and Yemen

Authors: Cecilia Ferreyra, Daniel O’Brien, Beatriz Alonso, Abdulbasset Al-Zomour, Nathan Ford

Published in: Conflict and Health | Issue 1/2018

Abstract

Background

Unstable settings present challenges for the effective provision of antiretroviral treatment (ART). In this paper, we summarize the experience and results of providing ART and implementing contingency plans during acute instability in the Central African Republic (CAR) and Yemen.

Case presentation

In CAR, MSF has provided HIV care in three conflict-affected rural regions; these were put on hold throughout the acute phase of violence. “Run-away bags” containing 3 or 4 months of ART were distributed to patients at MSF facilities. Among 1820 HIV patients enrolled into care, 1440 (79%) initiated ART. By December 2016, 782 (54%) patients were still under ART, 354 (25%) have been lost to follow up and 182 (13%) had died. In 2013, when violence disrupted services, 683 patients were receiving ART. Between September–December 2013, 594 (87%) patients received runaway bags and by February 2014, 313 (53%) of these patients returned to the clinic.

In Yemen, when violence erupted, patients received a health card that included a helpline to call in case of drug shortages in admission to emergency stocks; this was not possible in CAR due to lack of a functioning telephone network. One thousand six hundred fifty-five PLWHA have been enrolled in care and 1470 (89%) initiated ART; 1056 (72%) are still followed on ART, 126 (9%) were lost to follow up, and 288 (20%) died. In January 2011 clashes began and by April 2011 MSF medical activities were interrupted. Of the 363 patients receiving ART, 363 (100%) received emergency bags to cover 9 months and by February 2012, 354 (98%) patients returned to care. In March 2015 a new wave of conflict affected Yemen, forcing HIV activities to revert to contingency planning.

Conclusions

This experience provides further evidence that provision of HIV treatment and emergency drug stocks can be successfully provided to most patients in both conflict-affected settings.

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Title: Provision and continuation of antiretroviral therapy during acute conflict: the experience of MSF in Central African Republic and Yemen
Authors: Cecilia Ferreyra
Daniel O’Brien
Beatriz Alonso
Abdulbasset Al-Zomour
Nathan Ford
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: Conflict and Health / Issue 1/2018
Electronic ISSN: 1752-1505
DOI: https://doi.org/10.1186/s13031-018-0161-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Provision and continuation of antiretroviral therapy during acute conflict: the experience of MSF in Central African Republic and Yemen

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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