Provision of antiretroviral therapy in resource-limited settings:
a review of experience up to August 2003

WHO and the UK’s Department for International Development

Authors: Kathy Attawell and Jackie Mundy

This paper was developed by HSRC on behalf of DFID and in collaboration with the World Health Organization (WHO). Special thanks are due to the following individuals and organizations for their contributions: the DFID-funded HIV/AIDS Knowledge Programme at Imperial College and the Liverpool School of Tropical Medicine; Matt Boxshall, Lighthouse Trust; Kate Butcher (JSI); Charles Lacey, Imperial College; Jos Perriens, WHO; Eric van Praag, Family Health International (FHI); Oscar Picazo, World Bank.

This background paper aims to increase understanding of the requirements for introducing and scaling up provision of antitetroviral therapy (ART) as part of comprehensive HIV/AIDS programmes in resource-poor countries. The paper provides an overview of experience and lessons learned with regard to:

  • The feasibility of ART in resource-poor settings.
  • The different approaches being taken to delivery of ART.
  • The issues to be considered in scaling up ART provision.

The review is based on published and unpublished literature, interviews with key informants, web searches and country information. It also draws on a review conducted by the Health Systems Resource Centre (HSRC) and John Snow International (JSI) for the Government of Kenya in late 2002 (under the DFID supported HAPAC Project managed by the Futures Group) and a review of the impact of HIV on health systems conducted by HSRC and JSI in early 2003.