A Web-based project aims to bring HIV treatment costs down to as little as R8 a person a month.

South Africa and Botswana will pioneer the world's largest Web-based HIV treatment and care programme that will slash the costs of HIV treatment and extend care to hundreds of thousands more people.

Using sophisticated Internet technology, the fight against Aids can go into the poorest areas of Southern Africa, bringing treatment that would have been considered unattainable a few months ago.

The non-profit programme, Right to Care (R2C), will extend Web-based patient diagnostics, treatment and care through the two countries, which will ultimately see patient care for HIV-positive patients, supervised by a doctor, cost as little as R8 a month.

The Web project is pioneered by the University of Witwatersrand's Clinical HIV Trials Unit under Dr Ian Sanne and is likely to begin its first project with Anglo American's HIV programme for staff on September 1.

R2C is also working with the Botswana government and having discussions with a multinational, medical aid schemes and a large government parastatal about extending the programme through their workforces.

Currently, anti-retroviral drug treatments cost patients between R600 and R1 500 a month with lab tests of R466 a month. Through R2C costs will drop to a total of R700 a month with administration fees of R30 a patient a month for the first 5 000 patients. Once there are 100 000 patients on the programme costs will drop to R10 a month and by the time there are 250 000 patients, the monthly cost for patient care, including lab tests and monitoring by a doctor, will be down to R8 a month.

Sanne says they are also examining reducing viral load tests from four to two a year and have successfully developed a programme that will reduce CD4 testing (to measure the strength of the immune system) by 70%.

The patient-monitoring programme, developed in the United States, has 36 researchers consistently inputting new data, whether drug-related information, research or recommendations from users. It personalises patient information, including notifying the doctor or nurse of drugs likely to induce toxicities or react against each other in a patient. This reduces drug failures and associated costs.

The US pilot study has begun at 10 sites in that country with 4 000 patients. However, the Southern African aspects have been modified to suit this environment.

The programme uses data for research and statistical information critical to drug manufacturers, epidemiologists, doctors and patients. Drugs are not limited to registered pharmaceuticals but can include generics and are tailored to what is available.

Security of data is a critical aspect of the programme with information being protected by double key encryption -- banks are protected by single key encryption. Patient records will also be encoded by the patient's fingerprint to identify blood samples sent to labs, as an example.

On Monday South African researchers, including Sanne's team, presented evidence at an international Aids conference in Buenos Aires, Argentina, of 16 clinical trials involving almost 800 HIV-positive people. The trials, of people "in resource-poor settings from three academic clinical trial units" in Johannesburg, Cape Town and Soweto, showed anti-retroviral therapy can succesfully be given to poor people.

Economist Nicoli Natrass of the University of Cape Town has shown it will cost the South African government more than R850-million a year not to give anti-retroviral treatment.

Anti-retrovirals are now cheaper than cardiac or cancer care and in line with the costs of other long-term illnesses such as diabetes.

The Three Centres study, conducted since 1995, showed that of the 763 people on the trials, only 26 (less than 3,5%) dropped out.

The average age of those on the trials was 35 and treatment discontinuation was highest among those in the 20 to 30 age group.

Sanne pointed out that although most of the research was urban or peri-urban based, more than 60% of South Africa's population is urbanised.

"However, we have done distance treatment in rural settings using IT expertise. Our research shows that with an indigent research base we get the same results as in international settings. However, we had a far better success rate with women here than internationally.

"The toxicity ranges were low, also similar to those in developed nations, but we need to get a spectrum of toxicity that reflects our population more accurately." The Three Centres research used triple therapy.

What does the programme need to begin? More than 50% of clinics and labs in South Africa are offline and the government is urging faster connectivity.

In Botswana, for example, five computers will be used to monitor 5 000 patients with a 56K dial-up connection, although Sanne says they are hoping to install a 128K line to a server.

IBM in Botswana is considering issuing palm pilots to doctors and nurses so that they can download patient information into the system daily. Johnnic is examining satellite connections for South African sites.