ARV TREATMENT IN POOR SETTINGS: THE STATE OF THE ART

Universal access to antiretroviral drugs (ARVs) has created enormous debate and controversy in developing countries. But it seems to be a more feasible prospect by the day. Prices of ARVs have dramatically come down, and there is an unprecedented commitment by the international community to make universal access to ARVs happen, under WHO's initiative of 3 by 5. However there are a number of issues to address. First, the criteria for selection of those to be on treatment have not been agreed upon, especially using clinical methods. Second, the compliance to ARVs has been found to be problematic in Africa. It would require a Directly Observed Treatment Strategy (DOTS) approach to improve on compliance. Third, universal access to ARVs will require integration into national health systems, and strengthening these systems. Fourth, monitoring ARV treatment for safety, effectiveness and acceptability will be critical. This will require investment in laboratory services as well as in information management systems. Fifth, sustainable financing of ARVs will require Governments to commit, for a long time to come, substantial funding for ARVs, and to the health systems into which ARVs are to be integrated. Lastly, there are risks that need to be expected and prepared for up front. These include increasing the infectitious periods of people on ARVs by prolonging their lives; leakage and misuse of ARVs and the consequent drug resistance that may occur; and a possible disabling or even collapse of health systems because resources are shunted to universal ARV provision. Nevertheless, the treatment of AIDS that was denied to poor countries on grounds of cost, lack of infrastructure, and other excuses is now more than ever possible to the people of these countries