Reducing Deaths among those who seek HIV treatment late. The REALITY Trial
The REALITY trial was set up to look at different strategies to buy time for people like Moses. It tried giving extra ARVs for a short period to bring down the levels of HIV very quickly. It tried giving extra food to build up weight fast in the first months. But if found that the most significant improvement came from a package of easily available anti-microbial drugs, taken in the first three months to give prophylaxis against opportunistic infections. Researchers are now recommending this “enhanced prophylaxis” package be rolled out to late presenters.
The research also looked into why so many people still seek treatment late. Many did not realise that they were putting themselves in danger by doing this, thinking the right time to get treatment is when you are already sick. Researchers also found that the message of the huge benefits of early ART is not understood at a community level and that there is still a great deal of fear of side effects, and fear of being identified as HIV positive.
This film presents the results of the trial through the story of Moses, who arrives in hospital after months of suffering terrible headaches. He has a CD4 count of only 11, showing his defence system has been almost completely destroyed by HIV. Almost a quarter of patients in Africa, like Moses, start HIV treatment late. Of those one in ten will die in the first six months on treatment, as their immune system recovers, making this the highest risk HIV group. So what can be done to give them a better chance?