Mapping out a treatment programme

The World Health Organisation (WHO) presented a challenge to African countries last year by setting a target of three million HIV-positive Africans to be on antiretroviral (ARV) HIV/AIDS therapy by 2005. Almost a year later, a workshop on scaling up access to care and treatment for people living with HIV/AIDS (PWAs) in 17 East and Southern African countries has been held to assist them in reaching that goal. HIV/AIDS programme managers and health officials from the 17 countries emerged with country-specific "road maps" to guide them in expanding their treatment programmes. The road maps outline the process each country should follow in developing, updating and finalising its national plan and programme for comprehensive care and treatment for PWAs, and describe how this will be translated into action, WHO Regional Office for Africa spokesman, Sam Ajibola told PlusNews. In Malawi, plans to provide ARV treatment for up to 50,000 people were announced earlier this year after the country was awarded a grant by the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria. Up to 3,000 people were currently receiving anti-AIDS drugs in the public sector, but the process of increasing these numbers would be slow, senior HIV/AIDS officer in the National AIDS Commission, Dr Andrinah Mwasambo, admitted. Two districts are offering free ARVs in a project run by humanitarian NGO, Medicines Sans Frontieres, and two state hospitals have been dispensing the drugs through a cost-sharing scheme. "We don't have a clue of the numbers in the private sectors," she said. Malawi was only "starting the process" of developing a road map, she told PlusNews. Treatment guidelines would also be finalised "next week", she added. But some progress had been made. "We are not starting from scratch - there are a lot of activities going on, but they are all being done here and there, and we need to coordinate them," Mwasambo said. Workshop participants agreed that countries should establish or revise national ARV coverage targets. "But, in Malawi we have to be realistic. We can't aim too high, because we are aware of our shortcomings," she noted. Funding remains a problem and will determine how many HIV-positive Malawians receive treatment. As a result, the government has had to find other partners to help sustain the treatment programme. "We realised that if we limited our funding to the Global Fund, we would be doing an injustice to our country. We have to find other means," Mwasambo said. The country's biggest challenge was its health care infrastructure and this had to be considered when planning a national rollout, she warned. But experts at the workshop recommended that these challenges should not stand in the way of country treatment programmes. "We can't wait for the perfect situation, this is not possible. We need to start...people are dying. In Malawi, with the little that we have, we are saying 'let's start'," Mwasambo said. WHO's target represents just half of the six million Africans who currently require ARV treatment. With fewer than 30,000 Africans on ARVs in 2001, the urgency of implementing road maps grows stronger by the day.