Delivering Antiretroviral therapy in Resource-constrained Settings: lessons from Ghana, Kenya and Rwanda

Robert Ritzenthaler
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Tragically, only a small fraction of the estimated 40 million people living with HIV worldwide has access to the full range of services, including treatment. In Africa, home to approximately 26 million HIV-infected people, only 8 percent of the more than 4 million people clinically eligible for ART (ages 1549) has access to it. Delivering ART in these settings presents significant challenges related to drug supply, health infrastructure, provider availability and capacity, equitable service provision, and drug adherence, toxicity and resistance. To address these challenges, FHI, USAID and their partners developed ART learning sites in Ghana, Kenya and Rwanda. These countries were identified because of their strong government commitment to provide and sustain HIV treatment, their well-established national AIDS programs and the presence of ongoing IMPACT prevention and care interventions. 

The objectives were to: Improve the capacity of clinics, laboratories and pharmacies in selected health facilities to provide comprehensive HIV services, including treatment Strengthen referral networks to link ART delivery with other care and support services across a continuum of care between health facilities and communities Joint United Nations Programme on HIV/AIDS (UNAIDS). AIDS EEpidemic Update, December 2004. Educate communities, including people living with HIV/AIDS (PLHA), about HIV disease, the need for prevention and treatment of opportunistic infections, when to seek care and the benefits and limitations of ART Provide ART to an initial cadre of patients, ensuring drug adherence, proper management of side effects and toxicity, and regular monitoring and follow-up strengthen commodity management, including the drug supply chain Explore selected operations research questions, particularly related to adherence and cost. Gather and distill lessons to guide service expansion.

Delivering Antiretroviral Therapy1.72 MB