THE CRUCIAL NEED FOR BETTER ANTIRETROVIRAL THERAPY, ESPECIALLY FOR HIGH-BURDEN COUNTRIES
The current and projected need for HIV treatment is simply stunning. Already, among the estimated 35 million people living with HIV, 13.6 million are receiving antiretrovirals (ARVs),1 with about 3 of every 4 people on antiretroviral therapy (ART) residing in sub-Saharan Africa.2 However, achieving expanded 2013 treatment guidelines from the World Health Organization (WHO) would require ART provision to about twice the current number. And many have recommended that all people living with HIV infection should receive ARVs. Moreover, over time as survival improves substantially, the number of people living with HIV will increase markedly. Additional special demands are ARVs for people for whom first-line therapy has failed, people with tuberculosis (TB), pregnant and lactating women, and children.
At almost US$10 billion per year,2 international funding for HIV is the lion's share of all global health funding, and within that, support for HIV treatment is also the lion's share. That level of support seems to have plateaued, and indeed pressure is mounting for resource-constrained countries affected by HIV to take over more of the burden. Actually, more of the site-level costs of providing treatment comes from service delivery costs than from costs of the ARVs themselves; provision of services for established patients (excluding …