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    Apr 11, 2021
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    When to start antiretroviral therapy in resource-limited settings: a human rights analysis.

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    Authors
    Ford, Nathan
    Calmy, Alexandra
    Hurst, Samia
    Affiliation
    Médecins Sans Frontières, Cape Town, South Africa. nathan.ford@joburg.msf.org.
    Issue Date
    2010-06
    
    Metadata
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    Journal
    BMC International Health and Human Rights
    Abstract
    ABSTRACT: BACKGROUND: Recent evidence from developed and developing countries shows clear clinical and public health benefit to starting antiretroviral therapy (ART) earlier. While discussions about when to start ART have often focused on the clinical risks and benefits, the main issue is one of fair limit-setting. We applied a human rights framework to assess a policy of early treatment initiation according to the following criteria: public-health purpose; likely effectiveness; specificity; human rights burdens and benefits; potential for less restrictive approaches; and fair administration. DISCUSSION: According to our analysis, a policy of earlier ART initiation would better serve both public health and human rights objectives. We highlight a number of policy approaches that could be taken to help meet this aim, including increased international financial support, alternative models of care, and policies to secure the most affordable sources of appropriate antiretroviral drugs. SUMMARY: Widespread implementation of earlier ART initiation is challenging in resource-limited settings. Nevertheless, rationing of essential medicines is a restriction of human rights, and the principle of least restriction serves to focus attention on alternative measures such as adapting health service models to increase capacity, decreasing costs, and seeking additional international funding. Progressive realisation using well-defined steps will be necessary to allow for a phased implementation as part of a framework of short-term targets towards nationwide policy adoption, and will require international technical and financial support.
    URI
    http://hdl.handle.net/10144/110033
    DOI
    10.1186/1472-698X-10-6
    PubMed ID
    20356356
    Language
    en
    ISSN
    1472-698X
    ae974a485f413a2113503eed53cd6c53
    10.1186/1472-698X-10-6
    Scopus Count
    Collections
    HIV/AIDS

    entitlement

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