A very important meta-analysis of patient retention rates in HAART programs in subsaharan Africa was published today in PLOS. Information about these retention rates are of utmost importance. Burried underneath all the rhetoric of human rights to health (and as a corollary access to health care), there's a serious public health issue. It is known that, for instance among people with chronic serious illnesses in developed countries, adherence to strict treatment regimes is only around 50%. So, the mentioned meta-analysis notes that in the average about 40% of patients with HIV infection enrolled in subsaharan AIDS treatment programs cannot be retained. Many are lost due to death (for instance because they got started on treatments too late), others are lost for other reasons. A positive spin on this would probably note that at least in some subsaharan AIDS treatment programs adherence to treatment regimes is better than in some developed countries (while, predictably, it's worse in others).
The negative spin would say that the findings of this meta-analysis are significant, because many of these people, while they will eventually die on AIDS, will have enough time to do two things: 1) develop drug resistant mutations of the AIDS virus, and 2) infect others with their drug resistant variant of the AIDS virus. In short: treatment programs of this sort run the very serious risk of contributing to a public health threat that is larger than the magnitude of the problem it tries to tackle.
Quite an ethical challenge for health policy makers in subsahara Africa, be they government, NGOs or civil society.
