The Political Economy of HIV/AIDS in Developing Countries
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The Political Economy of HIV/AIDS in Developing Countries

TRIPS, Public Health Systems and Free Access

Edited by Benjamin Coriat

The book is based on original data and field studies from Brazil, Thailand, India and Sub-Saharan Africa. Focusing on the issue of universal and free access to treatment (a goal now taken to heart by the international community), it assesses the progress made and presents a rigorous diagnosis of the obstacles that remain, especially the constraints imposed by TRIPS and the poor state of most public health systems in Southern countries. In so doing, the book renews our understanding of the political economy of HIV/AIDS in these vast regions, where it continues to spread with devastating social and economic consequences.
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Chapter 12: The Public Health Approach to Antitretroviral Treatment: The Case of Cameroon

Sinata Koulla-Shiro and Eric Delaporte

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12. The public health approach to antiretroviral treatment: the case of Cameroon Sinata Koulla-Shiro and Eric Delaporte The World Health Organization (WHO, 2007a) estimates that as a result of the scaling-up of antiretroviral therapy (ART) in developing countries, two million people living with HIV/AIDS (PLWHA) receive treatment, representing 28 per cent of the estimated 7.1 million people in urgent need of treatment in these countries. If these results are far from satisfactory, they nevertheless represent a rapid increase in access to ART. To enable scaling-up access to treatment in developing countries, the WHO has proposed a public health approach based on standardized simplified treatment protocols and decentralized service delivery. The chapter starts with a brief description of the public health approach. We then describe the operational process in the implementation of this strategy in Cameroon and the evaluation tools used to accompany the process. Finally, we give a general appraisal of the lessons learnt from this strategy. THE PUBLIC HEALTH APPROACH TO ART Guidelines for industrialized countries are based on individual patient management delivery by specialist doctors prescribing the full range of antiretrovirals and using high-technology laboratories to measure the efficacy of and tolerance to the treatment. In developing countries such an approach is not feasible. The reasons are multiple: doctors are scarce (for example, in Cameroon there is only one medical doctor for 30,000 inhabitants in rural areas), the laboratory infrastructures are inadequate and procurement is fragile. Taking these realities into account, the WHO has proposed...

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