Scaling Up Treatment For The Global Aids Pandemic

An estimated forty million people carry the human immunodeficiency virus (HIV), and five million more become newly infected annually. In recent years, many HIV-infected patients in wealthy nations have enjoyed significantly longer, good-quality lives as a result of antiretroviral therapy (ART). However, most infected individuals live in the poorest regions of the world, where ART is virtually nonexistent. The consequent death toll in these regionsâ€"especially sub-Saharan Africaâ€"is begetting economic and social collapse. To inform the multiple efforts underway to deploy antiretroviral drugs in resource-poor settings, the Institute of Medicine committee was asked to conduct an independent review and assessment of rapid scale-up ART programs. It was also asked to identify the components of effective implementation programs. At the heart of the committee's report lie five imperatives: Immediately introduce and scale up ART programs in resource-poor settings. Devise strategies to ensure high levels of patient adherence to complicated treatment regimens. Rapidly address human-resource shortages to avoid the failure of program implementation. Continuously monitor and evaluate the programs to form the most effective guidelines and treatment regimens for each population. Prepare to sustain ART for decades.

An estimated forty million people carry the human immunodeficiency virus (HIV), and five million more become newly infected annually. In recent years, many HIV-infected patients in wealthy nations have enjoyed significantly longer, good-quality lives as a result of antiretroviral therapy (ART). However, most infected individuals live in the poorest regions of the world, where ART is virtually nonexistent. The consequent death toll in these regionsâ€"especially sub-Saharan Africaâ€"is begetting economic and social collapse. To inform the multiple efforts underway to deploy antiretroviral drugs in resource-poor settings, the Institute of Medicine committee was asked to conduct an independent review and assessment of rapid scale-up ART programs. It was also asked to identify the components of effective implementation programs. At the heart of the committee's report lie five imperatives: Immediately introduce and scale up ART programs in resource-poor settings. Devise strategies to ensure high levels of patient adherence to complicated treatment regimens. Rapidly address human-resource shortages to avoid the failure of program implementation. Continuously monitor and evaluate the programs to form the most effective guidelines and treatment regimens for each population. Prepare to sustain ART for decades.

As we approach the 25th anniversary of the first recognition of HIV/AIDS in 1981, this book reflects on the international impact of the disease. It has persistently remained a global issue, with more than 50 million people worldwide estimated to have been infected since that date. This ambitious book, written by 165 authors from 30 countries, offers a multi-country comparative study that examines how the response to the common, global threat of HIV is shaped by the history, culture, institutions and health systems of the individual countries affected. Increasingly the shift of health systems has been from prevention only as the main containment strategy, to a strategy that includes scaling up HIV treatment, and care and prevention services, including antiretroviral therapy. Thus, all parts of the health system must be involved; policy makers, healthcare professionals and users of the services have been forced to think differently about how services are financed, how resources are allocated, how systems are structured and organized, how services are delivered to patients, and how the resulting activity is monitored and evaluated in order to improve the effectiveness, efficiency, equity and acceptability of the response. This book is unique in attempting to describe and assess a range of responses across the globe by situating them within the characteristics of each country and its health system. Most chapters combine a health policy expert with an HIV specialist, allowing both a 'top down' health system approach and a 'bottom up' HIV-specific perspective. There are thematic and analytical sections, which provide an overview and some suggestions for solutions to the most serious outstanding issues, and chapters which analyse specific country and organisational responses. There is no perfect health system, but the evidence provided here allows the sharing of knowledge, and a opportunity to assess the impact and reactions, to an epidemic that must be considered a long term issue.

The global expansion of HIV programming (HIV "scale-up") and the growth of global health in the past decade reshaped politics, power, civic relations, and citizen subjectivities in countries across the globe. This book draws on interdisciplinary research from numerous sites in the Global South to examine the political dimensions of HIV and global health programming. The chapters reflect extensive methodological diversity and geographic range, yet exhibit striking resonance with the book’s core themes. Collectively, the authors paint a complex global portrait of a unique period in the social history of HIV, as the pandemic enters its fourth decade, and the global response reaches its peak. The book contemplates "scale-up" (and, subsequently, "scale-down") as an object of analysis and an historical shift in the politics of response to global crisis. Ultimately, HIV/AIDS campaigns provide a template for the broader expansion of global health projects and institutions. These transnational shifts and expansions necessitate further critical evaluations across social science and public health disciplines. By collecting diverse perspectives on the political legacies of HIV and global health, this book provides a unique history of the present, cataloguing emerging practices and policies that will have long-term social impacts. This book was originally published as a special issue of Global Public Health.

HIV/AIDS is a catastrophe globally but nowhere more so than in sub-Saharan Africa, which in 2008 accounted for 67 percent of cases worldwide and 91 percent of new infections. The Institute of Medicine recommends that the United States and African nations move toward a strategy of shared responsibility such that these nations are empowered to take ownership of their HIV/AIDS problem and work to solve it.

Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

The AIDS epidemic in Sub-Saharan Africa continues to affect all facets of life throughout the subcontinent. Deaths related to AIDS have driven down the life expectancy rate of residents in Zambia, Kenya, and Uganda with far-reaching implications. This book details the current state of the AIDS epidemic in Africa and what is known about the behaviors that contribute to the transmission of the HIV infection. It lays out what research is needed and what is necessary to design more effective prevention programs.

A people-centered approach to global health When People Come First critically assesses the expanding field of global health. It brings together an international and interdisciplinary group of scholars to address the medical, social, political, and economic dimensions of the global health enterprise through vivid case studies and bold conceptual work. The book demonstrates the crucial role of ethnography as an empirical lantern in global health, arguing for a more comprehensive, people-centered approach. Topics include the limits of technological quick fixes in disease control, the moral economy of global health science, the unexpected effects of massive treatment rollouts in resource-poor contexts, and how right-to-health activism coalesces with the increased influence of the pharmaceutical industry on health care. The contributors explore the altered landscapes left behind after programs scale up, break down, or move on. We learn that disease is really never just one thing, technology delivery does not equate with care, and biology and technology interact in ways we cannot always predict. The most effective solutions may well be found in people themselves, who consistently exceed the projections of experts and the medical-scientific, political, and humanitarian frameworks in which they are cast. When People Come First sets a new research agenda in global health and social theory and challenges us to rethink the relationships between care, rights, health, and economic futures.