Decentralizing Antiretroviral Treatment Services at Primary Health Care Facilities

A Guide to Expanding Access and Care in Resource-Limited, Generalized HIV Epidemic Settings

In recent years, many countries, particularly those addressing a generalized HI V epidemic, have begun to decentralize HIV treatment to primary health care (PHC) centers. This effort is intended not only to increase geographic coverage of HIV clinical care, including antiretroviral treatment (ART), but also to decrease the burden of providing HIV services at existing facilities while making access to care easier for people living with HI V (PLHIV). The ultimate goal of many of these nascent efforts is to further foster a public health approach that will eventually bring universal access to HIV treatment.

The information in this brief is drawn from programs in resource-limited countries that have undertaken efforts to decentralize ART services to the PHC level. The program interventions are grouped into eight major areas: 1) creating an enabling environment; 2) developing human resource capacity; 3) ensuring a continuous and secure supply of quality drugs and laboratory commodities; 4) improving the infrastructure; 5) building effective links among HIV services; 6) tapping into private- sector networks; 7) delivering quality ART services; and 8) addressing challenges that hamper service quality. Each intervention area is described in detail below, and resources are identified at the end of this brief.




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