Addressing knowledge gaps in the public health approach to delivering antiretroviral therapy and care
The World Health Organization (WHO) convened a two-day consultation in Geneva in March 2008 to identify knowledge gaps in the public health approach to delivering ART and care in low- and middle-income countries, the obstacles that exist to addressing those gaps, and ways to overcome those obstacles. The meeting was co-sponsored by the International AIDS Society (IAS), the World Bank and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Participants included leading clinicians, community advocates, programme managers, researchers, donors and normative agency representatives.
The public health approach to delivering ART and care has been advocated by WHO since 2006 as the most effective way to scale up HIV care and treatment, and it has been broadly accepted by the health care field in low- and middle-income countries. In this approach, standardised, simplified treatment protocols and decentralised service delivery enable treatment to be delivered to large numbers of HIV-positive adults, adolescents and children, and alleviate the need for specialist physician management and advanced laboratory monitoring which is not feasible in resource-poor settings. Increasing experience has confirmed the need to precisely identify and address important uncertainties and knowledge gaps in the use of the public health approach to evaluate and improve its effectiveness and efficiency.