When to start antiretroviral therapy in resource-limited settings: a human rights analysis.
AffiliationMédecins Sans Frontières, Cape Town, South Africa. firstname.lastname@example.org.
MetadataShow full item record
AbstractABSTRACT: 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.
- [A research roadmap for complementary and alternative medicine - what we need to know by 2020].
- Authors: Fischer F, Lewith G, Witt CM, Linde K, von Ammon K, Cardini F, Falkenberg T, Fønnebø V, Johannessen H, Reiter B, Uehleke B, Weidenhammer W, Brinkhaus B
- Issue date: 2014
- How has the impact of 'care pathway technologies' on service integration in stroke care been measured and what is the strength of the evidence to support their effectiveness in this respect?
- Authors: Allen D, Rixson L
- Issue date: 2008 Mar
- Scaling up antiretroviral therapy in resource-limited settings: adapting guidance to meet the challenges.
- Authors: Vitoria M, Vella S, Ford N
- Issue date: 2013 Jan
- What strategies to boost production of affordable fixed-dose anti-retroviral drug combinations for children in the developing world?
- Authors: Dionisio D, Gass R, McDermott P, Racalbuto V, Madeo M, Braghieri G, Crowley S, Pinheiro Edos S, Graaff P, Vasan A, Eksaengsri A, Moller H, Khanna AK, Kraisintu K, Juneja S, Nicolaou S, Sengupta A, Esperti F, Messeri D
- Issue date: 2007 Mar
- Using cost-effectiveness analyses to inform policy: the case of antiretroviral therapy in Thailand.
- Authors: Tantivess S, Walt G
- Issue date: 2006 Dec 30