Scaling up antiretroviral treatment in resource-limited settings: successes and challenges
Scaling up antiretroviral treatment in resource-limited settings: successes and challenges
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DOI：
10.1097/01.aids.0000279701.93932.ef
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发表时间：
2007-07-01
期刊：
影响因子：
3.8
通讯作者：
Oelrichs, Robert B.
中科院分区：
文献类型：
--
作者：
Katabira, Elly T.;Oelrichs, Robert B.
正是在 1996 年温哥华国际艾滋病会议期间，全世界才认识到抗逆转录病毒药物的三联疗法在治疗艾滋病毒感染者方面取得了重大突破。在北美和欧洲，这些药物已经显着降低了与艾滋病毒相关的发病率和死亡率。不幸的是，当时的世界并不包括来自资源有限、艾滋病毒负担沉重的国家。然而，没过多久，其他人就注意到了这种不平衡，特别是活动人士和受影响群体，他们随后向国际社会施加压力，要求纠正这种不平衡现象。这导致联合国机构，最初是艾滋病毒和艾滋病联合规划署（UNAIDS），紧随其后的是世界卫生组织（WHO）和世界银行，建立了机制，以增加最需要的人，特别是在资源有限的环境中获得抗逆转录病毒治疗（ART）和相关护理的机会。联合国艾滋病规划署于 1996 年至 1998 年与一些制药公司合作实施了医疗准入计划，最初惠及四个国家（乌干达、科特迪瓦、智利和越南）。世界银行紧随其后，允许一些国家使用其多国艾滋病项目（MAP）资金的一部分来购买抗逆转录病毒药物。世卫组织通过“3by5”计划大力推动这项计划，该计划的目标是到 2005 年底让 300 万人接受 ART。尽管该运动未能达到 300 万人的目标，但在撒哈拉以南非洲，它能够将接受 ART 的人数从 2003 年的约 10 万人增加到 2005 年底的 81 万人。总统艾滋病紧急救援计划 (PEPFAR) 计划目前正在使 15 个受艾滋病毒流行影响最严重的国家受益，并将其预算的约 50% 用于治疗，以及全球艾滋病、结核病和疟疾基金。除了增加资金外，另一个主要推动力来自制药行业，它们降低了品牌抗逆转录病毒药物的价格，并推出了这些产品的仿制药。然而，最大的问题仍然没有得到解答。面对疫情未减和需求迅速增加的前景，如何应对
It was during the Vancouver International AIDS Conference of 1996 that the world realized that triple combination therapy with antiretroviral drugs had made a critical breakthrough in the care of HIV-infected individuals. In North America and Europe, these drugs had already reduced significantly the morbidity and mortality associated with HIV disease. Unfortunately, at that time that world did not include countries from the resource-limited settings where the HIV burden was overwhelming. It did not take long, however, for others to notice this imbalance, particularly activists and affected groups, who then put pressure on the international community, demanding that it be redressed. This led to the United Nations agencies, initially the Joint Program on HIV and AIDS (UNAIDS) and closely followed by the World Health Organization (WHO) and the World Bank, to put in place mechanisms to increase access to antiretroviral therapy (ART) and related care by those who needed it most, particularly from the resourcelimited settings. UNAIDS put in place the Medical Access Programme in 1996–1998 in collaboration with some drug companies initially to benefit four countries (Uganda, Ivory Coast, Chile and Vietnam). This was followed by the World Bank, which allowed some countries to use a portion of their Multicountry AIDS Project (MAP) funds to buy antiretroviral drugs. The big push came from WHO through their ‘3by5’programme, which aimed to put 3 million individuals on ART by the end of 2005. Although the campaign failed to reach the target of 3 million, in sub-Saharan Africa it was able to increase the number of individuals on ART from approximately 100000 in 2003 to 810000 by the end of 2005. Access was further acelerated by the introduction of the United States’ President’s Emergency Plan for AIDS Relief (PEPFAR) programme, which is now benefiting 15 countries most affected by the HIV epidemic and which contributes approximately 50% of its budget to treatment, and the Global Fund for AIDS, TB and Malaria. As well as increased funding, another major boost has come from the drug industries that have lowered the prices of brand name antiretroviral drugs as well as introducing generic versions of these products. The biggest question, however, remains starkly unanswered. How, in the face of an undiminished epidemic and the prospect of a rapidly increasing need for more