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Evidence for scaling up HIV treatment in sub-Saharan Africa: A call for incorporating health system constraints

Evidence for scaling up HIV treatment in sub-Saharan Africa: A call for incorporating health system constraints

PLOS/Medicine - "The scale-up of antiretroviral therapy (ART) for HIV-infected people in sub-Saharan Africa (SSA) over the past 15 years is one of the most remarkable achievements in public health. With approximately 12 million people on treatment in 2015, life expectancy on the subcontinent has vastly improved. Nevertheless, ART coverage in SSA is still suboptimal, HIV incidence remains high], and improved survival due to ART implies ever increasing numbers of people on treatment.

Substantial additional resources are needed to further scale up ART, yet funding has levelled off over the recent years, increasing the need for optimizing the allocation of limited resources. (...)

Many of these strategies, e.g., universal testing and immediate treatment for all HIV-infected people, require substantial investments, yet most of the models implicitly assumed a well-functioning health system with unlimited resources by modelling immediate and sustainable implementation. In reality, most health systems experience constraints on the supply side (i.e., the capacity of the health system) and on the demand side (i.e., demand of HIV-infected people to receive care)." (Photo: Commonwealth Secretariat/flickr)

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