Antiretroviral therapy in sub-Saharan Africa: myth or reality?

somewhat lax. Treatment access programmes will have to determine at what level within the health system ART should be made available. Pilot programmes like the UNAIDS DAI demonstrated that by strengthening existing facilities, an effective central system for drug procurement, distribution and accountability could be implemented and ensure an uninterrupted supply of drugs to support sustainable management of AIDS patients. It is thus likely that in the implemen- tation phase, expanded access to ART in sub-Saharan Africa will start with utilizing and strengthening existing central health infra- structures. However, because provision of ART on an expanded scale involves more than distributing antiretroviral drugs, other health infrastructure requirements will need to be addressed. These are likely to include reviewing best practices, developing standard operating procedures for all components involved, establishing quality assurance programmes, training of health care personnel and planning for staff retention, and renovating physical structures. Of paramount importance will be the need to strengthen drug control mechanisms so as to provide a means of supervision, especially for the informal sector. Although an emotive issue, there will eventually be a need to control unregulated access to antiretroviral drugs and discourage practices such as making antiretroviral drugs available 'on the street' and the selling to patients of single pills, even without prescription.