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More information
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| Title |
Antiretroviral Therapy in Resource-poor Settings |
| Region |
Africa & South America |
| Countries |
Kenya, Brazil,Uganda,Ivory Coast, Senegal |
| Project Information |
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| Keywords |
HIV,AIDS |
| Organisations |
Undertaken by JSI(UK) on behalf of The Department
for Internation Development (DFID) |
| Author |
Professor Charles Gilks |
| Document Type |
Technical Guidance Note |
| Date of Publication |
June 2001 |
| File Name |
View
File
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| Abstract |
1 Background and context
1.1: Antiretroviral (ARV) drugs can effectively be used to treat
HIV infection. Single drug and dual combination antiretroviral
therapy (ART) has limited potency. However triple drug therapy
(HAART - highly active ART) is highly effective. It has the
potential to prolong life expectancy and restore quality of
life; and is the only truly disease-modifying clinical intervention
available.
1.2: ARVs are costly, complex to use and potentially toxic.
HIV is only held in check — it is not cured. Virus reappears
when treatment stops and disease progresses. Therapy thus is
for life. Resistance to drugs can rapidly develop with poor
ARV use, especially with single drug therapy.
1.3: HAART is now standard of care in industrialised countries,
where HIV/AIDS has become a chronic disease over which physicians
and patients now have control. It is unquestionably seen and
accepted as part of the comprehensive response to HIV/AIDS.
1.4: Developing countries, particularly in Africa, with the
highest burden of disease, have been bypassed by these developments.
The huge disparity in outcome between those who can and cannot
access ARVs has been highlighted and is viewed universally as
unjust and unacceptable.
1.5: Quite unprecedented changes in ARV prices have been announced.
Both proprietary and generic manufacturers have been involved
in this process. The price barrier still exists but it is far
less of an obstacle. Some feel that the access problem has now
been largely been resolved.
1.6: Financing mechanisms are now being developed for Governments,
and perhaps NGOs, to take advantage of these cheaper drugs —
eg the Global Fund. Exactly how these funds are to be dispersed
is currently being worked out. Drug purchase seems the main
target of the fund.
1.7: DFID needs to respond to the challenges posed by ART through
engagement at country and international levels. Constructive
dialogue with emphasis on the main elements that need to be
in place should be developed, tempered with caution about what
can be achieved rapidly.
1.8: The field is rapidly evolving with far more problems and
dilemmas than clear answers or solutions. This technical guidance
note (the third in 15 months) aims to summarise some of the
complex issues, give up to date information, identify best practice
and the current evidence base.
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