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Cited by 42HIV/AIDS Research and InterventionsHIV/AIDS Impact and ResponsesHIV/AIDS drug development and treatment

HIV treatment and care in resource‐constrained environments: challenges for the next decade

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Eholié, Serge‐Paul, Aoussi, François Eba, Ouattara, Ismael Songda, Bissagnéné, Emmanuel, Anglaret, Xavier·2012·Journal of the International AIDS Society
DOI 10.7448/ias.15.2.17334PMC PMC3494167
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Abstract

Many successes have been achieved in HIV care in low‐ and middle‐income countries (LMIC): increased number of HIV‐infected individuals receiving antiretroviral treatment (ART), wide decentralization, reduction in morbidity and mortality and accessibility to cheapest drugs. However, these successes should not hide existing failures and difficulties. In this paper, we underline several key challenges. First, ensure long‐term financing, increase available resources, in order to meet the increasing needs, and redistribute the overall budget in a concerted way amongst donors. Second, increase ART coverage and treat the many eligible patients who have not yet started ART. Competition amongst countries is expected to become a strong driving force in encouraging the least efficient to join better performing countries. Third, decrease early mortality on ART, by improving access to prevention, case‐finding and treatment of tuberculosis and invasive bacterial diseases and by getting people to start ART much earlier. Fourth, move on from WHO 2006 to WHO 2010 guidelines. Raising the cut‐off point for starting ART to 350 CD4/mm 3 needs changing paradigm, adopting opt‐out approach, facilitating pro‐active testing, facilitating task shifting and increasing staff recruitments. Phasing out stavudine needs acting for a drastic reduction in the costs of other drugs. Scaling up routine viral load needs a mobilization for lower prices of reagents and equipments, as well as efforts in relation to point‐of‐care automation and to maintenance. The latter is a key step to boost the utilization of second‐line regimens, which are currently dramatically under prescribed. Finally, other challenges are to reduce lost‐to‐follow‐up rates; manage lifelong treatment and care for long‐term morbidity, including drug toxicity, residual AIDS and HIV‐non‐AIDS morbidity and aging‐related morbidity; and be able to face unforeseen events such as socio‐political and military crisis. An old African proverb states that the growth of a deep‐rooted tree cannot be stopped. Our tree is well rooted in existing field experience and is, therefore, expected to grow. In order for us to let it grow, long‐term cost‐effectiveness approach and life‐saving evidence‐based programming should replace short‐term budgeting approach.

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  • In HIV/AIDS, task shifting has been deemed imperative with evidence that nurses can prescribe antiretroviral treatments just as effectively as physicians.

    “In the field of HIV/AIDS, task shifting has been deemed imperative with evidence that nurses can prescribe antiretroviral treatments just as effectively as physicians”

    From Global Burden of Skin Disease: Inequities and Innovations (2017) · cites this paper as [50]

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Research works printed but not linked: 2

  1. [28]WHO Antiretroviral therapy for HIV infection in adolescents and adults: recommendations for a public health approach 2010 Geneva World Health Organization accessed 2012 June 1. Available from: http://whqlibdoc.who.int/publications/2010/9789241599764_eng.pdf. 23741771
  2. [71]Sigaloff KC Hamers RL Wallis CL Kityo C Siwale M Ive P Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa J Acquir Immune Defic Syndr 2011 58 23 31 21694603

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Authors
Eholié, S., Aoussi, F. E., Ouattara, I. S., Bissagnéné, E., & Anglaret, X.
Affiliations
  • Programme PAC-CI (CI)
  • University Hospital Medical Center at Treichville (CI)
  • Université de Bordeaux (FR)
Corresponding author
Eholié, Serge‐Paul
ORCID
Anglaret, Xavier
Venue
Journal of the International AIDS Society
Publisher
Wiley
Published
2012-04
Volume
15
Issue
2
Pages
17334-17334
ISSN
1758-2652 (ISSN-L)
DOI
10.7448/ias.15.2.17334
PMC
PMC3494167
OpenAlex
W2051492999
Cited by
42
References
93
Citations by year
2026: 1 · 2025: 1 · 2024: 4 · 2023: 3 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 1 · 2017: 3 · 2016: 8 · 2015: 3 · 2014: 11 · 2013: 2
FWCI
0.63
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the International AIDS Society (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › HIV/AIDS Impact and Responses
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
Keywords
HIV antiretroviral therapy, HIV care, resource-limited settings, low- and middle-income countries, ART coverage, viral load monitoring, second-line antiretroviral therapy, stavudine, loss to follow-up, tuberculosis co-infection, HIV prevention, WHO treatment guidelines, cost-effectiveness
MeSH terms
Delivery of Health Care, Developing Countries, Health Policy, Health Services Accessibility, Humans, Tuberculosis, World Health Organization, HIV Infections, Guidelines as Topic, CD4 Lymphocyte Count, Anti-HIV Agents, Viral Load

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