Support required for antiretroviral uptake in developing countries.

Abstract

It is evident from the current global debate on improving care and treatment for people living with HIV that antiretroviral therapy will become increasingly available in resource-poor countries. As this happens, there is an imperative to determine which factors will promote optimal use of these complex therapies to minimise the potentially serious consequences of poor adherence and the development of a worse epidemic of multidrug-resistant HIV (MDRHIV). In parallel with the process of allocating funds to purchase drugs, there needs to be a pro-active scaling up of healthcare worker training and infrastructure support systems and development of continuity of care from healthcare services into the community. The engagement of healthcare workers in the HIV epidemic has been largely ignored in favour of a focus on prevention which, understandably, works through the non-government sector as the vehicle for implementation. This upscaling and recruitment of healthcare workers needs involvement not only from our more eminent clinicians as spokespeople but also from experienced field workers, who will be caring for the majority of patients as they become ill. This article identifies the multidimensional approach necessary to implement a broad initiative for care and treatment and discusses the possible strategies and consequences of each factor.