TRIPS, Public Health Systems and Free Access
Edited by Benjamin Coriat
Chapter 12: The Public Health Approach to Antitretroviral Treatment: The Case of Cameroon
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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