Providing Antiretroviral Treatment in Southern Africa - A Literature Review

This report outlines experience with ART in a number of sub-Saharan countries. ART is provided through a number of different avenues, which include the public sector, the non-profit sector, the corporate sector and the private sector. ART programmes may involve collaboration between two or more sectors with such partnerships being encouraged in recognition that the magnitude of the task may exceed the capacity of any one sector. Particular attention is paid to Botswana, the first sub-Saharan country to provide ART on a wide-scale through the public sector.

EXECUTIVE SUMMARY

The AIDS epidemic, which is estimated to have resulted in the death of more than 2.3 million people in sub-Saharan Africa in 2003, has the potential to cause profound negative social, economic and individual effects and has placed a particularly heavy toll on existing health care systems, particularly those already facing severe resource constraints. Research has shown that the vast majority of the over 38 million people living with HIV/AIDS in low and middle-income countries at the end of 2001 did not have access to even basic medications for treating HIV-related illnesses and for relieving pain.

In high-income countries, where combination antiretroviral treatment (ART) became widely available from 1996 onwards, AIDS related mortality declined markedly for two or three years and has since stabilized. The World Health Organization reported that in sub-Saharan Africa, in 2002, more than 4 million people needed treatment, but that only 50 000 (less than 1.5%) had access to it. Where ART has been provided, it has been credited with having a significant positive effect on the lives of people living with HIV/AIDS. It has been held responsible for emptying HIV/AIDS wards, for dramatic falls in AIDS related mortality and morbidity and for people returning to their homes, families and jobs.

Due to a variety of ongoing advocacy and lobbying initiatives, the prices of antiretroviral (ARV) drugs are now low enough to contemplate scaled-up treatment programmes in resource-constrained settings. A number of pilot programmes in developing countries have produced clinical results comparable to those in high-resource settings, with acceptable cost-effectiveness. This report outlines experience with ART in a number of sub-Saharan countries. ART is provided through a number of different avenues, which include the public sector, the non-profit sector, the corporate sector and the private sector. ART programmes may involve collaboration between two or more sectors with such partnerships being encouraged in recognition that the magnitude of the task may exceed the capacity of any one sector. Particular attention is paid to Botswana, the first sub-Saharan country to provide ART on a wide-scale through the public sector.