Why test a clinical monitoring strategy in an African trial?
Access to antiretroviral drugs is becoming increasingly possible across Africa but it is not clear how we can safely provide ART outside a few centres of excellence in large cities where substantial resources are available.One issue in our countries is how ART can be delivered safely and effectively by health centres with limited laboratory facilities for monitoring drug toxicity and clinical response such as up-country and rural settings. In resource-rich countries the standard has become to use regular, extensive and expensive laboratory tests, yet there is little evidence as to how much (if any) benefit this is to patients over the long term. In many research-rich countries the costs of such routine testing is much higher than the cost of the provision of ARVs and it also requires expensive equipment and skilled technicians.There is reason to believe that with good clinical care many laboratory tests for possible drug toxicity would only need to be carried out if there were clinical
Access to antiretroviral drugs is becoming increasingly possible across Africa but it is not clear how we can safely provide antiretroviral therapy (ART) outside a few centres of excellence in large cities where substantial resources are available. One issue in African countries is how ART can be delivered safely and effectively by health centres with limited laboratory facilities for monitoring drug toxicity and clinical response to drugs, in up-country and rural settings for example. In resource-rich countries standard practice is to use regular, extensive and expensive laboratory tests, yet there is little evidence of how much benefit this is to patients in the long term. In many research-rich countries the costs of such routine testing is much higher than the cost of the provision of ARVs and it also requires expensive equipment and skilled technicians. There is reason to believe that with good clinical care, many laboratory tests for possible drug toxicity would only need to be ca
