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reports of increase in ART uptake in Tanzania

27 July 2007
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allAfrica.com posted an article from The East African on the remarkable increase of HIV-positive Tanzanians enrolling on anti-retroviral therapy (ART). The article attributes the increase to the introduction of “Mkapa Fellows,” a program jointly initiated by former presidents of TZ and the US to increase the number of AIDS treatment and care professionals in Tanzania.

With the global push for scale-up of HIV testing and distribution of anti-retroviral therapy, increasing the group of specialists capable of providing treatment and care is incredibly important. I’m currently writing a report on research (in the wrapping up stage) in Malawi that proposed to look at the local realities of this globally endorsed scale-up.

The main question of my research was what determines ART uptake. On that, I have no clear answers – but here’s what I can tell you from an analysis of a third of the interview transcripts: In the district I study, only one hospital has a machine which can provide HIV-positive patients with their CD4 count. [NB: The cost to do so is prohibitive – one CD4 count is roughly USD6.50.] The other hospital and all ART clinics in the district use a patient’s clinical presentation to determine eligibility. [NB: In limited-resource settings, the WHO recommends using clinical staging guidelines to decide who should receive drugs – giving priority to those who are the most sick. See this recent study for why that might be a poor strategy.]

What I’m really trying to get at is whether ART eligibility is equitably determined. [A better question is why can’t everyone who is HIV-positive have access to life-lengthening drug therapy?] Do the clinicians at the local level honor the guidelines set forth by the powers-that-be in Geneva? [A better question might be why are the powers-that-be with respect to determining ART eligibility in Geneva and not in rural Malawi?] Because we see HIV-positive patients reliant on clinical presentation, there is a great deal of power in the hands of local clinicians. That might not be a bad thing, but still…

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