Expanding Access to Antiretroviral Therapy in Sub-Saharan Africa: Avoiding the Pitfalls and Dangers, Capitalizing on the Opportunities

Abstract

We describe a number of pitfalls that may occur with the push to rapidly expand access to antiretroviral therapy in sub-Saharan Africa. These include undesirable opportunity costs, the fragmentation of health systems, worsening health care inequities, and poor and unsustained treatment outcomes. On the other hand, AIDS "treatment activism" provides an opportunity to catalyze comprehensive health systems development and reduce health care inequities.However, these positive benefits will only happen if we explicitly set out to achieve them. We call for a greater commitment toward health activism that tackles the broader political and economic constraints to human and health systems development in Africa, as well as toward the resuscitation of inclusive and equitable public health systems.

Living with death in a time of AIDS: A rural South African case study

“…AIDS presents health professionals with a growing challenge to establish therapeutic partnerships with patients (and their families). Recent studies on medicine-taking behaviour suggest that patient/family-centred therapeutic regimes that incorporate social and cultural understandings of illness and treatment are effective in the management of chronic conditions [25][26][27].…”

Health Systems and Access to Antiretroviral Drugs for HIV in Southern Africa: Service Delivery and Human Resources Challenges

“…Although global funding for HIV/AIDS has increased significantly over the last years, the resources mobilised for treatment still fall far short of need, 14 let alone for rebuilding health systems. 8 Much of the new funds also bypass and are in danger of overshadowing established national mechanisms for managing external health sector assistance, such as the sector-wide approaches (SWAps). 15 However, even if adequate funds were made available through integrated systems, years of under-investment in the resource base of health systems -in particular people and infrastructure -have established difficulties that cannot be reversed in the short term.…”

“…3 Health systems failures are seen as being at the root of the disappointing outcomes of tuberculosis (TB) control strategies (DOTS), 4 Integrated Management of Childhood Illness (IMCI) 5 and the integration of reproductive health services. 6 Several authors [7][8][9] have warned of increasing fragmentation and health systems chaos in the wake of the global proliferation of public-private partnerships attempting to tackle HIV in one way or another. The tendency to bypass health systems by creating vertical structures that drain resources from a ''crumbling core'' 10 may address short-term needs but cannot form the basis for universal access.…”

Sustainability of long-term treatment in a rural district: The Lusikisiki model of decentralised HIV/AIDS care

“…Our experience in Lusikisiki shows that far from being to the detriment of health care services as some have suggested 13 the provision of ART is having a positive effect on the general quality of primary health care. Improvements in drug supply, diagnostic services, monitoring, staff training, and infrastructural improvements all contribute to improving general primary health care.…”