Scaling up ARV treatment in resource-poor settings

01 May 2004

In May 2004, the Alliance hosted a five-day event in Cape Town, bringing together partners and key staff to share learning about scaling up ARV treatment, develop plans of action to increase scaling up efforts in the 25 countries where the Alliance works and to consider the implications of this on policy and programme work across the Alliance.

The Alliance’s strengths have traditionally been in the areas of community-based HIV prevention, care and impact mitigation. ARV treatment is an expanding area for the Alliance, and one that has been building steadily. The Alliance’s partners are working with people who are sick and dying of AIDS, as well as people who are coming forward for HIV testing and testing HIV positive. This brings a great sense of urgency to the Alliance’s efforts in scaling up ARV treatment.

Responding to that urgency, several Alliance partners are already actively involved in ARV treatment programmes. Project Orange, a project of Association African Solidarité, is a community-based ARV delivery programme, run by HIV positive people and their supporters, in Ouagadougou, Burkina Faso, providing ARV treatment and treatment support to 300 adults and children. In Ukraine, as the principal recipient of the Global Fund for the Fight against AIDS, Tuberculosis and Malaria, Alliance Ukraine is preparing for the large-scale ARV treatment programme in partnership with the Ukrainian Ministry of Health and the All Ukrainian Network of People with HIV/AIDS. 2100 people will be treated in 6 oblasts (administrative divisions) over a period of one year. In Zambia, the Alliance is working in partnership with the Network of People Living with HIV/AIDS in Zambia, the Central Board of Health, the Archdiocese of Lusaka, the Catholic Diocese of Ndola, Africa Directions and a traditional healers association to develop a series of community-based interventions and referral systems in two sites to promote community education on ARV treatment, treatment support, adherence support and protective behaviour.

At the workshop, a range of experts presented on a variety of topics pertinent to delivering ARV treatment in resource-poor settings: the global policy context for ARV treatment, preventing mother-to-child transmission, the role of people with HIV in ARV programmes, managing supplies and human resources, private sector responses to ARV programmes, models for delivering ARV programmes, prevention for people living with HIV/AIDS, supporting adherence, treating children, clinical issues, legal and ethical issues and treating TB/HIV co-infection.

After the presentations, two days were spent in in-depth discussion about the implications of the learning on the Alliance’s work. Different country and regional programmes are now planning an expanded role in community-based ARV treatment programmes, both treatment delivery programmes as well as programmes that support delivery by others, namely public health providers or other clinical specialists.

The workshop culminated in a site visit to the Khayelitsha clinic, jointly run by Médecins Sans Frontières and the Treatment Action Campaign, South Africa. The visit to Khayelitsha was an opportunity for participants to see how clinical regimes and monitoring systems can be simplified and scaled up. It was also to observe how community-based treatment activists and treatment educators can successfully work alongside clinical staff to deliver quality treatment and care. Many of the workshop participants were inspired to see how well clinical services and community mobilisation can work together to provide a comprehensive range of health services to the people of Khayelitsha township. As was seen in Khayelitsha, providing ARV treatment in resource-poor settings is possible, and that waiting and hesitating because ARV treatment is deemed 'too complex' or 'too specialist' is no longer ethically acceptable.