February 2002 Insights Health
Issue #2
Delivering the goods:
HIV treatment for the poor
HIV has spread like
wildfire, causing untold suffering and death and creating profound development
challenges. Antiretroviral drugs (ARVs) are standard treatment for HIV
in wealthy countries and should be included in a package of care for
all infected people. Increasing access to HIV care and treatment requires
immediate action. This should involve innovative use of existing health
infrastructure with simplified approaches to treatment, long-term development
of the health sector, greatly increased donor investment and government
commitment. More...
Other articles in this issue
Testing
times: opportunities and challenges for voluntary counselling and testing
Voluntary
counselling and testing (VCT) are essential components of HIV prevention
and care programmes. But many people are reluctant to be tested if care
and treatment are not on offer. As antiretroviral (ARV) therapy becomes
increasingly available, more people may want to access VCT. How can
health services ensure that VCT facilities offer the maximum benefits
to users?
Quantity
with quality: scaling-up VCT in rural Kenya
The Kenyan government
is committed to the large-scale introduction of voluntary counselling
and testing for HIV (VCT) in its primary healthcare centres. At least
250 sites are expected to open during 2002. VCT can stimulate behaviour
change and provide an entry point to care and support services, but
it must be client-centred, rapid, reliable and fully confidential. Will
the proposed scale-up of VCT compromise the quality of the service?
Providing
care in South Africa: lessons from TB/HIV pilot districts
South Africa
is facing a dual epidemic of tuberculosis (TB) and HIV. An estimated
4.7 million South Africans are infected with HIV; 1.6 million of these
will develop TB. How can the country tackle this enormous problem?
DOTS
on the spot: lessons for access to HIV care
People with
HIV/AIDS in developing countries become stigmatised and impoverished
by their disease. How can health systems deliver effective care to the
most vulnerable people? Tuberculosis (TB) is another impoverishing disease
requiring complex long-term care. What can we learn from a well-functioning
DOTS programme for TB?
Economies
of scale-up? The cost of expanding access
The Commission
on Macroeconomics and Health was established in January 2000 under the
direction of the WHO Director-General. It is examining interrelations
between investment in health, economic growth and poverty reduction.
As part of the background analysis, researchers investigated the likely
costs of scaling-up antiretroviral (ARV) treatment for HIV/AIDS.
Local
solutions: the role of district hospitals
Antiretroviral
drugs (ARVs) are available for people with HIV/AIDS at certain specialist
centres in developing countries. In Thailand, generic drug production
is growing rapidly and prices have fallen by 80 percent over two years.
But most patients are poor and cannot get to specialist centres. For
wider access, district hospitals must play a role.
Model
of success: universal access to treatment in Brazil
In the mid-1990s,
the Brazilian Ministry of Health (MoH) adopted a policy of universal
free access to antiretroviral (ARV) drugs for people with HIV. 113,000
patients now receive ARVs through the public health system. The scheme
has improved patients' quality of life, produced a six-fold reduction
in hospitalisation rates and is cost-effective - saving the government
around US$ 1 billion over five years. How has it achieved this success?
Could this be repeated in other countries?
Community
action: mobilising NGOs and CBOs
Health systems
are under-funded and overburdened in many developing countries. Non-governmental
and community-based organisations (NGOs/CBOs), individuals and families
are key providers of HIV treatment and care. The need for treatment
is rising as increasing numbers of people become infected. What support
will NGOs, CBOs and groups of people living with HIV/AIDS need to address
this growing demand?
Demanding
control: HIV treatment in Haiti
A growing
number of people in poor countries need effective HIV therapy. Despite
the potential problems of cost and drug resistance, this demand will
not go away. Falling drug prices mean that patients will have increasing
access to antiretroviral drugs (ARVs). The degree to which we control
their use is a key challenge for public health policy.
Sites
for sore eyes
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