Current HIV/AIDS Reports

, Volume 3, Issue 4, pp 182–186 | Cite as

Extending HIV care in resource-limited settings

Abstract

Despite the clear benefits of antiretroviral therapy (ART), only three countries in sub-Saharan Africa have achieved the "3 by 5" goal of treating at least half of the persons living with HIV/AIDS who need it. A major obstacle faced by many lower income countries is the establishment of treatment programs in rural areas where there is a scarcity of trained health care providers and infrastructure. This paper reviews published data on rural ART programs in lower income countries to identify necessary components of such a program. No clearly superior model for rural ART delivery has emerged. All programs document the need for expanded physical infrastructure, laboratory development, recruitment/ training of additional health care providers, and/or the introduction of new technologies in order to effectively support the needs of ART roll-out.

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References and Recommended Reading

  1. 1.
    Joint United Nations Programme on HIV/AIDS/World Health Organization: Report on the Global AIDS Epidemic: May 2006. Geneva: World Health Organization; 2006.Google Scholar
  2. 2.
    Population Reference Bureau. http://www.prb.org. Accessed June 20, 2006.Google Scholar
  3. 3.
    Wools-Kaloustian K, Kimaiyo S, Diero L, et al.: Viability and effectiveness of large-scale HIV treatment initiatives in sub-Saharan Africa: experience from western Kenya. AIDS 2006, 20:41–48.PubMedCrossRefGoogle Scholar
  4. 4.
    Braitstein P, Brinkhof MWG, Dabis F, et al.: Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 2006, 367:817–824. A study comparing patient level outcomes of ART between sites in low-income countries with those in high-income countries.PubMedCrossRefGoogle Scholar
  5. 5.
    Severe P, Leger P, Charles M, et al.: Antiretroviral therapy in a thousand patients with AIDS in Haiti. New Engl J Med 2005, 353:2325–2334.PubMedCrossRefGoogle Scholar
  6. 6.
    Coetzee D, Hildebrand K, Boulle A, et al.: Outcomes after two years of providing antiretroviral treatment in Khaylitsha, South Africa. AIDS 2004, 18:887–895.PubMedCrossRefGoogle Scholar
  7. 7.
    Joint United Nations Programme on HIV/AIDS/World Health Organization: Progress on Global Access to HIV Antiretroviral Therapy: An Update on "3 by 5." Geneva: World Health Organization; 2005.Google Scholar
  8. 8.
    Kober K, Damme WV: Scaling up access to antiretroviral treatment in southern Africa: who will do the job? Lancet 2004, 364:103–107.PubMedCrossRefGoogle Scholar
  9. 9.
    Gates Foundation: Working with Botswana to Confront Its Devastating AIDS Crisis. http://www.gatesfoundation.org. Accessed June 21, 2006.Google Scholar
  10. 10.
    Kim JY, Gilkes C: Scaling up treatment — why we can‘t wait. New Engl J Med 2005, 353:2392–2394.PubMedCrossRefGoogle Scholar
  11. 11.
    AIDS Health Care Foundation Global Immunity: Consensus Recommendations from the International Workshop on Strategies for Scaling Up HIV/AIDS Treatment in Resource-poor Settings. AIDS Health Care Foundation: Los Angeles; 2003.Google Scholar
  12. 12.
    Meng X, Anderson AF, Hou X, et al.: A pilot project for the effective delivery of HAART in rural China. AIDS Patient Care STDS 2006, 20:213–219.PubMedCrossRefGoogle Scholar
  13. 13.
    Mamlin J, Kimaiyo S, Nyandiko W, Tierney W: Academic Institutions Linking Access to Treatment and Prevention: Case Study. Geneva: World Health Organization; 2004.Google Scholar
  14. 14.
    Partners in Health: The PIH Guide to: the Communitybased Treatment of HIV in Resource Poor Settings, XV International AIDS Conference Bangkok Edition. Boston: Partners in Health; 2004. Outline of the HIV Equity Initiative including history, structure, and guidelines.Google Scholar
  15. 15.
    Koenig SP, Leandre F, Farmer PE.: Scaling-up HIV treatment programmes in resource-limited settings: the rural Haiti experience. AIDS 2004, 18(Suppl 3):S21–25.PubMedCrossRefGoogle Scholar
  16. 16.
    Fraser HSF, Jazayeri D, Nevil P, et al.: An information system and medical record to support HIV treatment in rural Haiti. BMJ 2004, 329:1142–1146.PubMedCrossRefGoogle Scholar
  17. 17.
    Ferrandini L, Jeannin A, Pinoges L, et al.: Scaling up of highly active antiretroviral therapy in a rural district of Malawi: an effectiveness assessment. Lancet 2006, 367:1335–1342.CrossRefGoogle Scholar
  18. 18.
    Ramiah I, Reich MR.: Public-private partnerships and antiretroviral drugs for HIV/AIDS: lessons from Botswana. Health Affairs 2005, 24:545–551.PubMedCrossRefGoogle Scholar
  19. 19.
    Teixeira PR, Vitoria MA, Barcarolo J.: Antiretroviral treatment in resource-poor settings: the Brazilian experience. AIDS 2004, 18(Suppl 3):S5-S7.PubMedCrossRefGoogle Scholar
  20. 20.
    Phanuphak P: Antiretroviral treatment in resource-poor settings: what can we learn from the existing programmes in Thailand? AIDS 2004, 18(Suppl 3):S33–38.PubMedCrossRefGoogle Scholar
  21. 21.
    Cohen J, Kimaiyo S, Nyandiko W, et al.: Addressing the educational void during the antiretroviral therapy rollout. AIDS 2004, 18:2105–2106.PubMedCrossRefGoogle Scholar
  22. 22.
    Farmer P, Leandre F, Mukherjee J, et al.: Communitybased treatment of advanced HIV disease: introducing DOT-HAART (directly observed therapy with highly active antiretroviral therapy) [see comment]. Bull World Health Organ 2001, 79:1145–1151.PubMedGoogle Scholar
  23. 23.
    Farmer P, Leandre F, Mukherjee JS, et al.: Communitybased approaches to HIV treatment in resource-poor settings. Lancet 2001, 358:404–409.PubMedCrossRefGoogle Scholar
  24. 24.
    Mitty JA, Macalino G, Taylor L, et al.: Directly observed therapy (DOT) for individuals with HIV: successes and challenges. Med Gen Med 2003, 5:30.CrossRefGoogle Scholar
  25. 25.
    Maher D, Chaulet P, Spinaci S, Harres A: Treatment of Tuberculosis: Guidelines for National Programmes, edn 2. Geneva: World Health Organization; 1997.Google Scholar
  26. 26.
    Global Tuberculosis Program: WHO Report on the Tuberculosis Epidemic. Geneva: World Health Organization; 1997.Google Scholar
  27. 27.
    Harries AD, Nyangulu DS, Hargreaves NJ, et al.: Preventing antiretroviral anarchy in sub-Saharan Africa. Lancet 2001, 358:410–414.PubMedCrossRefGoogle Scholar
  28. 28.
    Harries AD, Libamba E, Schouten EJ, et al.: Expanding antiretroviral therapy in Malawi: drawing on the country‘s experience with tuberculosis. BMJ 2004, 329:1163–1166.PubMedCrossRefGoogle Scholar
  29. 29.
    Salaniponi F: Using lessons learned in the control of tuberculosis to design a structured framework for providing antiretroviral therapy in Malawi. Adv Studies Med 2001, 1:480–482.Google Scholar
  30. 30.
    Wagner EH, Austin BT, Davis C, et al.: Improving chronic Illness care: translating evidence into action. Health Affairs 2000, 20:64–78.CrossRefGoogle Scholar
  31. 31.
    Castro A, Farmer P: Understanding and addressing AIDSrelated stigma: from anthropological theory to clinical practice in Haiti. Am J Public Health 2005, 95:53–59.PubMedCrossRefGoogle Scholar
  32. 32.
    Liechty CA, Bangsberg DR: Doubts about DOT: antiretroviral therapy for resource-poor countries. AIDS 2003, 17:1383–1387.PubMedCrossRefGoogle Scholar
  33. 33.
    Pawinski R, Lalloo U, Jinabhai C, Bobat R. Community -based approach to HIV treatment. Lancet 2002, 359(9306):624.PubMedCrossRefGoogle Scholar
  34. 34.
    Kagay CR, Porco TC, Liechty CA, et al.: Modeling the impact of modified directly observed antiretroviral therapy on HIV suppression and resistance, disease progression, and death. Clin Infect Dis 2004, 38(Suppl 5):S414–420.PubMedCrossRefGoogle Scholar
  35. 35.
    Orrell C: Antiretroviral adherence in a resource-poor setting. Curr HIV/AIDS Rep 2005, 2:171–176. This review paper examines the data on antiretroviral adherence in resource-poor settings.PubMedCrossRefGoogle Scholar
  36. 36.
    Volmink J, Garner P: Directly observed therapy for treating tuberculosis. Cochrane Database Syst Rev 2006, 2:CD003343.PubMedGoogle Scholar
  37. 37.
    Siika AM, Rotich J, Simiyu C, et al.: An electronic medical record system for ambulatory care of HIV-infected patients in Kenya. Int J Med Informat 2005, 74:345–355.CrossRefGoogle Scholar
  38. 38.
    Reach Out Mbuya: Quarterly Report January-March 2006. http://reachoutmbuya.org. Accessed July 1, 2006.Google Scholar
  39. 39.
    Marazzi MC, Bartolo M, Emberti Gialloreti L, et al.: Improving adherence to highly active anti-retroviral therapy in Africa: the DREAM programme in Mozambique. Health Educ Res 2006, 21:34–42.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2006

Authors and Affiliations

  1. 1.Division of Infectious DiseasesIndiana University School of Medicine, Wishard Memorial Hospital (Room OPW 430)IndianapolisUSA

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