When to start antiretroviral therapy in resource-limited settings: a human rights analysis

BMC International Health and Human Rights

Debate

Samia Hurst¹  Alexandra Calmy²  Nathan Ford³ 

[1] Institute for Biomedical Ethics, Geneva, Switzerland;Médecins Sans Frontières, Campaign for Access to Essential Medicines, Geneva, Switzerland;Geneva University Hospital, Geneva, Switzerland;Médecins Sans Frontières, Cape Town, South Africa;Centre for Infectious Disease Epidemiology and Research, Cape Town, South Africa;

关键词: Tenofovir;    Oseltamivir;    Early Initiation;    Essential Medicine;    Public Health Benefit;   

DOI  :  10.1186/1472-698X-10-6

 received in 2009-09-14, accepted in 2010-03-31,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundRecent evidence from developed and developing countries shows clear clinical and public health benefit to starting antiretroviral therapy (ART) earlier. While discussions about when to start ART have often focused on the clinical risks and benefits, the main issue is one of fair limit-setting. We applied a human rights framework to assess a policy of early treatment initiation according to the following criteria: public-health purpose; likely effectiveness; specificity; human rights burdens and benefits; potential for less restrictive approaches; and fair administration.DiscussionAccording to our analysis, a policy of earlier ART initiation would better serve both public health and human rights objectives. We highlight a number of policy approaches that could be taken to help meet this aim, including increased international financial support, alternative models of care, and policies to secure the most affordable sources of appropriate antiretroviral drugs.SummaryWidespread implementation of earlier ART initiation is challenging in resource-limited settings. Nevertheless, rationing of essential medicines is a restriction of human rights, and the principle of least restriction serves to focus attention on alternative measures such as adapting health service models to increase capacity, decreasing costs, and seeking additional international funding. Progressive realisation using well-defined steps will be necessary to allow for a phased implementation as part of a framework of short-term targets towards nationwide policy adoption, and will require international technical and financial support.

【 授权许可】

CC BY   
© Ford et al; licensee BioMed Central Ltd. 2010