Scaling Up Treatment for the Global AIDS Pandemic Challenges and Opportunities (2005) / Chapter Skim
Currently Skimming:
1 Introduction
1 Introduction
Pages 19-31
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From page 19... ...
Today, ARV-treated patients can generally anticipate leading a good-quality life for many years. The provision of safe, effective ART to the millions of individuals in need in resource-constrained settings is likewise expected to dramatically reduce HIV/AIDS-related morbidity and mortality, improve quality of life, and increase social and political stability.
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20 000 18 & Zealand Australia 000 New 12 Asia million Pacific Asia & 1.3 East million Central Asia & million 000 8.2 South 1.8 East 700 & 4.6 Europe 1.2 South 2003. Eastern of 000 end 000 Europe 680 the East 730 Africa at 000 & million Western 520 North Middle 000 Saharan Africa 28.2 470 Sub 25.0 HIV/AIDS with living be 000 million to 590 America 1.9 Caribbean 000 Latin 1.3 million estimated 350 1.2 America 000 children North 790 and 2003.
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From page 21... ...
As a result, there are a multitude of unanswered questions regarding how best to introduce ARVs on a broad scale in resource-constrained settings, where the public health and drug delivery infrastructures are often weak or nonexistent and operational capacity is largely lacking. Although several pilot initiatives worldwide have garnered early success and proven the feasibility of implementing ART programs in resource-poor settings, we have yet to determine how these pilot initiatives can be scaled up to meet larger needs.
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From page 22... ...
While avoiding delays in delivering treatment, the international and national communities of donors, planners, and providers must remain vigilant in seeking continued improvements and necessary course corrections to maximize treatment benefits and extend as many lives as possible. Failed programs using first-line regimens, regardless of the reasons for failure, necessitate much more costly and less-sustainable second-line regimens or result in the termination of ART for affected patients; they also limit treatment opportunities for others afflicted today and for the tens of millions of additional HIV-infected persons anticipated over the next decade or so.
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From page 23... ...
and Gabon (Vergne et al., 2002) , for example, has led to high levels of drug resistance in treated patients, as well as treatment failure due to unsustainable drug supplies (and consequent inadequate dosing)
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. Long-term sustainability aside, even a successful short-term response requires addressing social and behavioral aspects of HIV/AIDS that lie outside the traditional realm of epidemiological and biomedical modeling of infectious disease transmission.
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The Committee on Examining the Probable Consequences of Alternative Patterns of Widespread Antiretroviral Drug Use in Resource-Constrained Settings was charged to provide (1) an examination and evaluation of current ART implementation programs, efficacy studies, infrastructure costing models, existing guide
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From page 26... ...
STUDY APPROACH The committee formed to conduct this study encompassed broad international expertise in the clinical and basic research aspects of HIV/AIDS, epidemiology, virology, pathology, ethics, behavioral science, community medicine, health care financing and policy, and public health. The members of the committee were also chosen for their first-hand experience with HIV/ AIDS in a wide range of middle- and low-income countries.
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From page 27... ...
In highlighting these efforts, the committee describes issues that will require further resolution as ART programs evolve, such as the need for global and national coordination of financial, technical, and human resource investments; ethical considerations at the international, national, and local levels; and, the importance of ensuring the long-term fiscal sustainability of these programs to avert the dire medical consequences of treatment interruption or termination. (Additional ethical issues for consideration are presented in Appendix D.)
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From page 28... ...
Strategies are included for selecting treatment regimens; for using laboratories to diagnose, initiate, and monitor therapies; and for meeting the treatment needs of special populations, such as pregnant women, children, and those suffering also from opportunistic infections, especially tuberculosis. Emphasis is placed on the benefits of treatment programs that are synergized with prevention efforts, and on the critical importance of adherence to treatment to ensure the life-sustaining effects of the therapy and prevent the emergence of drug-resistant virus that not only would result in individual treatment failure, but also might jeopardize the long-term durability of select drug regimens at the population level.
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From page 29... ...
The report concludes with a sobering call to the many decision makers, researchers, and practitioners who will take up arms against this deadly plague to heed the crucial lesson learned from ongoing investigations: that within the imperative to act now, it will also be important to act well. Defining a Country's Wealth Low income = a country having an annual gross national income (GNI)
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2003b. Resolving international debt crises fairly.
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From page 31... ...
2002. Assessment of a pilot antiretroviral drug therapy programme in Uganda: Patients' response, survival, and drug resistance.
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