Expert patients and AIDS care

This paper, published by the Institute of Tropical Medicine, reviews the literature on expert patient programmes for AIDS care in high-income countries, and explores their relevance for low-income countries with severe human resources shortages. The paper identifies human resources as a major bottleneck in scaling up the provision of antiretroviral therapy (ART) for AIDS, especially in southern Africa. Present ART models are very intensive in their use of skilled medical staff and projections suggest that they can only be used in countries where the human resources situation is less severe, such as South Africa.

Reviewing the literature on self-management of chronic diseases by patients in developed countries, the paper reveals that results from early evaluations have been good, and these programmes have significantly reduced the use of health services. The authors argue that the pool of people living with HIV and AIDS in developing countries represent a huge untapped resource for scaling up ART, and yet their potential role as expert patients has not been recognised. Although such programmes would pose their own challenges for health systems, in terms of training and coordination, the paper concludes that they could make ART scale-up a reality in countries where human resources shortages would otherwise prevent this.