Antiretroviral Treatment

The Cost of Antiretroviral Therapy in Haiti

This study details the costs and personnel requirements for the provision of antiretroviral therapy (ART) to patients with AIDS in Haiti. [from abstract]

Introducing Family Planning Services into Antiretroviral Program in Ghana: an Evaluation of a Pilot Intervention

This report documents the assessment of a family planning training program for providers to enable them to offer family planning counseling and methods, and make referrals where needed as part of antiretroviral therapy services in Ghana. [from summary]

What if We Decided to Take Care of Everyone Who Needed Treatment? Workforce Planning in Mozambique Using Simulation of Demand for HIV/AIDS Care

One of the most significant challenges in fighting the AIDS epidemic in Southern Africa is securing the health care workforce to deliver care in settings where the manpower is already in short supply. The authors produced a demand-driven staffing model based on treatment protocols for HIV-positive patients that adhere to Mozambican guidelines.

Human Resources Requirements for Highly Active Antiretroviral Therapy (HAART) Scale-up in Malawi

Twelve percent of the adult population in Malawi is estimated to be HIV infected and 15% to 20% of these are in need of life saving antiretroviral therapy. Using data on the total number of patients on highly active antiretroviral treatment (HAART) and estimates of the number of health professionals required to deliver HAART, researchers set out to determine the human resources requirements for HAART scale-up in Malawi. Results show that the human resources requirements are significant and that Malawi is using far fewer human resources than would be expected based on past studies. [adapted

Human Resources for Treating HIV/AIDS: Needs, Capacities, and Gaps

Limited human resources to treat HIV/AIDS (HRHA) are one of the main constraints to achieving universal ART coverage. We model the gap between needed and available HRHA to quantify the challenge of achieving and sustaining universal ART coverage by 2017. [from abstract]

Integrating Family Planning with Antiretroviral Therapy Services in Uganda

As strides are made in the prevention and treatment of HIV, it is important to take advantage of opportunities to expand and integrate reproductive health services. Integration is an approach that uses a client visit as an opportunity to address other health and social needs beyond those that prompted the current health visit.

Guideline for Outsourcing Human Resources Services to Make Antiretroviral Therapy Rapidly Available in Underserved Areas

This is a guideline to replicate and scale-up a human resources promising practice documented by the Capacity Project for outsourcing human resources services (HRS) to obtain a rapid increase and deployment of the health workforce, making HIV services available in a short period of time, especially in underserved areas.

Guideline for Incorporating New Cadres of Health Workers to Increase Accessibility and Adherence to Antiretroviral Therapy

This guideline is for human resources planners and managers in the health sector and sets out the steps required to extend the health workforce by incorporating lay workers (field officers), especially in the delivery of antiretroviral therapy (ART) to home-based clients.

Community-Based Approaches to HIV Treatment in Resource-Poor Settings

The main objections to the use of [antiretroviral therapies] in less-developed countries have been their high cost and the lack of health infrastructure necessary to use them. We have shown that it is possible to carry out an HIV treatment programme in a poor community in rural Haiti, the poorest country in the western hemisphere.

Uganda: Use of Traditional Medicine Interfering with ART Adherence

This news article presents a study in Uganda that found HIV-positive Ugandans are twice as likely to quit antiretroviral therapy (ART) if they also use traditional herbal medicine. It suggests that the integration of traditional healers into modern medical practice needs to be handled more cautiously and that rather than shunning traditional healers, the solution is to work closely with them. [adapted from author]

Evaluation of the Nigerian National Antiretroviral (ARV) Treatment Training Programme

The Nigerian national ARV treatment training programme was conceived to meet the human resource needs in hospitals providing ARV therapy. This paper reports on the evaluation of the training programme. It examines knowledge and skills gained, and utilization thereof. Recommendations are made for improved training effectiveness and for specific national policy on training, to meet the demand for scaling up therapy to the thousands who need ARV. [from abstract]

How Labour Intensive is a Doctor-Based Delivery Model for Antiretroviral Treatment (ART)? Evidence from an Observational Study in Siem Reap, Cambodia

Funding for scaling-up antiretroviral treatment (ART) in low-income countries has increased substantially, but the lack of human resources for health (HRH) is increasingly being identified as an important constraint for scaling-up ART. ART is labour intensive. Important reductions in doctor-time per patient can be realized during scaling-up. The doctor-based ART delivery model analysed seems adequate for Cambodia. However, for many districts in sub-Saharan Africa a doctor-based ART delivery model may be incompatible with their HRH constraints. [from abstract]

Capacity Building: What Does It Mean? Millennium Development Goal 6: Malaria, HIV

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It provides an excellent overview of the challenges of Malaria and HIV/AIDS ; discusses the human resource needs in light of these challenges; and how to build and maintain capacity. [from author’s description]

Strategy for the Rapid Start-Up of the HIV/AIDS Program in Namibia: Outsourcing the Recruitment and Management of Human Resources for Health

In response to the HIV/AIDS crisis, Namibia’s public health sector is carrying out a comprehensive strategy to rapidly hire and deploy professional and non-professional health workers with the aim of providing comprehensive care, counseling and testing, as well as antiretroviral therapy (ART) and prevention of mother-to-child transmission (PMTCT). [from executive summary]

Incorporating Lay Human Resources to Increase Accessibility to Antiretroviral Therapy: a Home-Based Approach in Uganda

The AIDS Support Organization (TASO) administers a home-based program in Uganda that gives people in poor and rural settings access to antiretroviral therapy (ART) and services. The program’s innovation lies in shifting delivery of most clients’ follow-up activities at home to field officers, a new cadre of degree and diploma holders from the social sciences and education. Field officers ensure adherence to ART, refill clients’ medications and perform various activities, from voluntary counseling and testing to education to promoting family and community support. [from executive summary]

Using Nurses to Identify HAART Eligible Patients in the Republic of Mozambique: results of a Time Series Analysis

The most pressing challenge to achieving universal access to highly active anti-retroviral therapy (HAART) in sub-Saharan Africa is the shortage of trained personnel to handle the increased service requirements of rapid roll-out. Overcoming the human resource challenge requires developing innovative models of care provision that improve efficiency of service delivery and rationalize use of limited resources. We conducted a time-series intervention trial in two HIV clinics in central Mozambique to discern whether expanding the role of basic-level nurses to stage HIV-positive patients using CD4 counts and WHO-defined criteria would lead to more rapid information on patient status (including identification of HAART eligible patients), increased efficiency in the use of higher-level clinical staff, and increased capacity to start HAART-eligible patients on treatment.

Integrating FP Services in VCT and PMTCT Sites: the Experience of Pathfinder International-Ethiopia in the Amhara Region

To maximize program impact with current resources, integration of Family Planning into existing HIV/AIDS programs is a very cost effective and an excellent point of entry. This is a study of an intervention program focused on initiating and also strengthening existing integration of FP into functional VCT, ART and PMTCT sites. The intervention encompassed an orientation on integration benefits to heads of health facilities; identification of challenges of integration and drawing of plan of action on how to overcome the challenges and improve integration.

Rwanda Human Resources Assessment for HIV/AIDS Services Scale-up

These reports review Rwanda’s healthcare staffing, documents practices and levels of effort in providing HIV/AIDS services, and calculates staffing needs for scale-up. It also discusses such issues as training, management, supervision, job satisfaction, and staff motivation and incentives. [publisher’s description]

Integrating Pediatric Palliative Care into Home-Based Care: an Evaluation of 3 Home-Based Care Projects

In order to identify potentially effective models of home-based care (HBC) within which paediatric palliative care could be integrated, and to identify critical aspects requiring strengthening, the NMCF commissioned an in-depth evaluation of three NGOs that have been supported through the Goelama Program. The objectives of the evaluation were: to evaluate the current capacity of the three HBC projects to provide paediatric palliative care as a component of overall HBC - this focused on the overall management of the projects, as well as the competencies of carers to provide both general HBC and palliative care to children; To explore the possibilities for strengthening the provision of paediatric palliative care as an integrated component of HBC; and to explore the role of home-based carers and HBC projects in the provision of ART to children. [author’s description]

Scaling Up Antiretroviral Treatment in the Public Sector in Nigeria: A Comprehensive Analysis of Resource Requirements

This report presents estimates of the total cost of providing comprehensive antiretroviral (ARV) treatment in the public sector in Nigeria, using the AIDSTREATCOST model to estimate the cost of providing Highly Active Antiretroviral Therapy (HAART), Voluntary Counseling and Testing (VDT), and Opportunistic Infection (OI) treatment, and other resource requirements for implementing the national antiretroviral (ARV) treatment program

Adherence to Antiretroviral Therapy in a Home-Based AIDS Care Programme in Rural Uganda

Poverty and limited health services in rural Africa present barriers to adherence to antiretroviral therapy that necessitate innovative options other than facility-based methods for delivery and monitoring of such therapy. We assessed adherence to antiretroviral therapy in a cohort of HIV-infected people in a home-based AIDS care programme that provides the therapy and other AIDS care, prevention, and support services in rural Uganda. [author’s description]

Private Sector Response to HIV and AIDS in Lesotho

This study attempted to determine the feasibility of a private sector led long-term intervention to reduce the HIV-infection rate among apparel workers and to provide care and support for those already infected. [author’s description]

Financial and Economic Costs of Scaling Up the Provision of HAART to HIV-Infected Health Care Workers in KwaZulu-Natal

This study provides evidence on the cost of providing HAART to health care workers and suggests that this strategy could reduce absenteeism and alleviate future staff shortages at moderate cost to hospitals. This is crucial, given the impending human resources crisis in health care in South Africa and the growing burden of HIV/AIDS. These cost estimates should be good indicators of the costs of extending antiretroviral therapy to health care workers in public-sector hospitals in KwaZulu-Natal. [author’s description]

DREAM: An Integrated Faith-Based Initiative to Treat HIV/AIDS in Mozambique

[This case study evaluates the] Drug Resources Enhancement against AIDS and Malnutrition (DREAM) program, created by the Community of Sant’Egidio to fight AIDS in sub-Saharan Africa. The project takes a holistic approach, combining Highly Active Anti- Retroviral Therapy (HAART) with the treatment of malnutrition, tuberculosis, malaria, and sexually transmitted diseases. It also strongly emphasizes health education at all levels. DREAM aims to achieve its goals in line with the gold standard for HIV treatment and care. [author’s description]

HIV Antiretroviral Therapy: Can Franchising Expand Coverage?

This paper reviews the experiences of franchising and discusses the opportunities and implications for governments and donors of franchising for HIV and AIDS services. [from author]

Progress on Global Access to HIV Antiretroviral Therapy: A Report on "3 by 5" and Beyond

This report describes global progress on the “3 by 5” (Treating 3 million by 2005: making it happen) project in scaling up access to [HIV/AIDS] antiretroviral therapy and outlines the areas in which important progress has been made and lessons learned. It also outlines the remaining challenges and roadblocks to treatment access. [author’s description]

Chapter 2 (Strengthening Health Systems) provides an overview of HRH related approaches and progress.

Guidelines for Establishing Community-Led Antiretroviral Treatment through a Human Capacity Development Approach

The following guidelines have been developed by a working group of practitioners drawn from clinics, hospitals, congregations and communities. They are intended for use by practitioners from the congregation, community, clinic, and other partners in local responses which are incorporating ART. [Description from preface]

Public Sector Nurses in Swaziland: Can the Downturn be Reversed?

The lack of human resources for health (HRH) is increasingly being recognized as a major bottleneck to scaling up antiretroviral treatment (ART), particularly in sub-Saharan Africa, whose societies and health systems are hardest hit by HIV/AIDS. In this case study of Swaziland, we describe the current HRH situation in the public sector. We identify major factors that contribute to the crisis, describe policy initiatives to tackle it and base on these a number of projections for the future. Finally, we suggest some areas for further research that may contribute to tackling the HRH crisis in Swaziland.

Estimating Health Workforce Needs for Antiretroviral Therapy in Resource-Limited Settings

Efforts to increase access to life-saving treatment, including antiretroviral therapy (ART), for people living with HIV/AIDS in resource-limited settings has been the growing focus of international efforts. One of the greatest challenges to scaling up will be the limited supply of adequately trained human resources for health, including doctors, nurses, pharmacists and other skilled providers.

Expert Patients and AIDS Care: A Literature Review on Expert Patient Programmes in High-Income Countries, and an Exploration of Their Relevance for HIV/AIDS Care in Low-Income Countries with Severe Human Resource Shortages

A number of ART projects are trying to tackle the HRH problematic by delegating certain tasks from medical doctors to other cadres. While this task-shifting is certainly an important step, we contend that it will not be enough for scaling up ART in the high HIV-prevalence countries with the most severe HRH shortages. In the present report we argue that an altogether different approach to HIV/AIDS care and treatment might be required for overcoming the HRH bottleneck. [from summary]