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Submitted by Miriam Schneidman on
If we look at the countries which have made major strides in expanding access to antiretroviral therapy (ART) there are several key measures they have taken: (i) mobilized political support at the highest levels of government; (ii) decentralized service delivery and adopted a nurse-driven model of care, gradually integrating AIDS treatment into chronic care; (iii) introduced a policy of providing highly subsidized or free ARV drugs, which are primarily funded by donors (e.g. GFATM, USG PEPFAR program); and (iv) supported actions to ensure adherence to care, minimizing the risk of drop out (e.g. buddy system, peer educators, community worker support). Let me be a bit provocative in addressing the questions you raise. In my view, the debate of the early 2000s about whether countries should or should not initiate AIDS treatment programs is over, as many have demonstrated it is feasible, doable, and desirable. There are large socio-economic and health benefits for individuals, households and communities which have been well documented over the past decade. Two main challenges remain today. The first relates to the need to ensure that efforts to scale up access to ART are accompanied by measures to curtail new infections, so that we do not win the battle and lose the war against AIDS. Virtually all countries need to redouble efforts to strengthen prevention using a combination of proven strategies. The second and probably biggest challenge which remains is how to sustain the financing of AIDS treatment programs, because even though the cost of drugs has dropped dramatically since the early 2000s they still remain well out of reach of the majority of the poor in Africa. While most countries in sub-Saharan Africa remain highly dependent on donor funding there is a growing effort by governments to assume some financial responsibility. Turning to the questions you raise, Tanzania has the capacity to do more to contain the HIV/AIDS epidemic. First, as a country and a society, a decision needs to be taken that the provision of AIDS treatment is a priority. Leadership on this issue at the highest level is important but not sufficient. Second, the Ministry of Health and Social Welfare needs to develop a scale up plan with a clear strategy for how to address technical, operational and financing issues. The government will not be in a position to finance ART therapy for all who may need it but should consider a combination of financing strategies, including some subsidies from the national budget. The issue of counterfeit drugs and the capacity of the Tanzania Foods and Drugs Authority are being partly addressed through a regional drug harmonization initiative which Tanzania belongs to that aims to put in place policies and measures to minimize these risks. More needs to be done in this area but these are manageable issues. Finally, there needs to be a continuing emphasis on cost effective, high impact prevention strategies and individual responsibility in limiting the spread of HIV/AIDS.