Antiretroviral therapy in resource-poor settings: decreasing barriers to access and promoting adherence

Antiretroviral therapy in resource-poor settings: decreasing barriers to access and promoting adherence

Poverty, primary healthcare and adherance support are key to successfully scaling up access to HIV treatment

This article from the Journal of Acquired Immune Deficiency Syndromes (JAIDS) argues that the scale up of HIV testing and treatment cannot be done without improving access to primary healthcare. It also argues that food security is the greatest threat to the scale-up of antiretroviral (ARV) treatment provision in some of the countries most heavily affected by HIV. The article outlines a HIV Equity Initiative project in rural Haiti that improved access to HIV treatment for the poor by waiving clinic fees for all HIV and tuberculosis (TB) patients and by integrating routine HIV testing into primary health services.

The Haitian project created a network of health workers who provide adherence support to those on ARV treatment, and nutritional support to those who need this. The low rate of treatment failure in the Haitian project shows the effectiveness of such adherence support. The initial cost of providing the support network is offset in the longer term because there is less requirement for more costly second line ARV treatments. The authors call for greater advocacy of funding for initiatives that improve treatment adherence, particularly among those who are poor. HIV diagnosis, treatment and monitoring should be provided free of charge in poor communities to ensure that drugs are taken properly and not shared with family members or sold.

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