How it began
Partners In Health, known in Haiti as Zanmi Lasante, opened a clinic in 1985 in Cange, a settlement on the Central Plateau of people displaced by a hydroelectric dam. Its first patient with AIDS came in 1986, and free testing, counseling and inpatient care followed. In 1998 the group launched the HIV Equity Initiative, which it describes as one of the first programs to give free, comprehensive HIV treatment in a poor setting. Newly trained community health workers delivered the drugs and stayed with patients through treatment.
Before it existed
A 2010 review in HIV Therapy states that at the time it was widely assumed that antiretroviral therapy was too complex and too costly for use in resource-poor settings. The Central Plateau was among the poorest parts of Haiti, without potable water, paved roads or electricity, and most people lived in scattered houses and small villages far from a clinic.
How it works
Community health workers called accompagnateurs live in the same villages as their patients and are paid a modest stipend. They visit each day, watch the patient take the medication, and give social support. Drugs and follow-up care are free. Patients can also receive food support and help with transport costs.
Who pushed back
Partners In Health records that its co-founder Paul Farmer argued in 1999 against prevailing ideas about cost-effective treatment and patient non-compliance, which he said blamed patients for their illness. In 2001 patients treated at Cange issued the Cange Declaration, calling for wider access to the drugs.
What changed first
The review reports a favorable clinical response in 59 of the first 60 patients. Of 21 patients whose viral load was measured, 18 had no detectable virus in the blood. Among patients who started therapy between October 2002 and December 2005 and survived the first two months, 94 percent were alive at 12 months and 5.4 percent were lost to follow-up.
What lasted
The review states that this model was one of the main success stories used to argue for expanding treatment in poor countries through the Global Fund and the United States program PEPFAR, both of which funded Haiti from 2003. Partners In Health later applied the approach in Peru, Rwanda, Lesotho, Malawi and Liberia. By 2008 it followed 13,647 people with HIV in Haiti, 3,562 of them on therapy.
