Delivery of Antiretroviral Therapy in Sub-Saharan Africa

By the end of 2005 it was estimated that globally 40.3 million adults and children (range 36.7--45.3 million) were living with HIV infection 25.8 million of whom were in sub-Saharan Africa. On World AIDS Day (1 December 2003) the World Health Organization/Joint United Nations Programme on HIV/AIDS (WHO/UNAIDS) initiative "3 by 5" was launched. Its ambitious objective was to deliver antiretroviral therapy (ART) to 3 million people in low- and middle-income countries-- from a baseline of ~4--by the end of 2005. However the effort fell short of its target. Treatment coverage in certain middle-income countries exceeded 80% but in the poorer countries of Latin America the Caribbean Eastern Europe and most of Asia there is a long way to go. Similarly by the end of 2005 only ~810000 people in sub-Saharan Africa were receiving ART; 17% of those in need of therapy (i.e. those with WHO stage 4 disease or with CD4 cell counts < 200 cells/mL). Global expenditure on AIDS has increased from $4.7 billion (in US dollars) in 2003 to $8.3 billion in 2005 much of which has come from the US Presidents Emergency Plan For AIDS Relief; from the Global Fund to Fight AIDS TB and Malaria; and from the World Bank. A further goal of universal access to ART by 2010 has been set by G8 leaders and has been endorsed by United Nations member states. (excerpt)