Faculty of Medicine, Department of Internal Medicine, Makerere University, Kampala, Uganda.
AIDS Rev. 2009 Oct-Dec;11(4):179-89.
Although the availability of antiretroviral therapy has increased rapidly to reach over three million people in low- and middle-income countries, coverage remains low as only 31% of people in need were receiving antiretroviral therapy in sub-Saharan Africa. Antiretroviral therapy scale-up needs to continue to grow exponentially to meet the need for universal access and keep pace with or exceed the new HIV infections. This calls for strategies that will have the greatest impact on the reduction of opportunistic infections, toxicities, and early mortality after antiretroviral therapy initiation as well improve adherence, clinical, immunological, and virologic responses, patient retention in antiretroviral therapy programs, and overall quality of life of people living with HIV/AIDS. Expanding antiretroviral therapy to all those eligible requires evidence-based decisions about how, when, and where expansion should occur. In this article we highlight some of the strategies that have optimized HIV treatment outcomes within the constraints of limited resources in sub-Saharan Africa. Key strategies to optimize HIV treatment outcomes include, i) scaling up HIV testing to identify all in need of HIV treatment, ii) strengthening the links between HIV diagnosis and comprehensive HIV/AIDS care, iii) timely initiation of antiretroviral therapy, iv) optimal diagnosis and treatment of opportunistic infections and comorbidities, v) investing in laboratory tests to support clinical monitoring of patients on antiretroviral therapy, vi) maximizing adherence to antiretroviral medication and retention of patients in HIV/AIDS care, viii) improving the health infrastructure, and increasing the human resources to handle the growing numbers of people in need of HIV treatment.
尽管抗逆转录病毒疗法的可及性迅速提高，在中低收入国家已覆盖超过 300 万人，但覆盖率仍然很低，因为在撒哈拉以南非洲，仅有 31%的有需要的人正在接受抗逆转录病毒治疗。抗逆转录病毒疗法的推广需要继续呈指数级增长，以满足普及治疗的需求，并跟上或超过新的艾滋病毒感染。这需要采取策略，这些策略将对减少机会性感染、毒性和抗逆转录病毒治疗开始后的早期死亡率产生最大影响，并改善依从性、临床、免疫和病毒学反应、患者在抗逆转录病毒治疗方案中的保留率以及艾滋病毒感染者/艾滋病患者的整体生活质量。将抗逆转录病毒疗法扩大到所有符合条件的人需要根据如何、何时以及在何处扩大做出基于证据的决策。在本文中，我们强调了一些在撒哈拉以南非洲资源有限的情况下优化艾滋病毒治疗结果的策略。优化艾滋病毒治疗结果的关键策略包括：i）扩大艾滋病毒检测，以发现所有需要艾滋病毒治疗的人，ii）加强艾滋病毒诊断与全面艾滋病毒/艾滋病护理之间的联系，iii）及时开始抗逆转录病毒治疗，iv）优化机会性感染和合并症的诊断和治疗，v）投资实验室检测，以支持抗逆转录病毒治疗患者的临床监测，vi）最大限度地提高抗逆转录病毒药物的依从性并保留艾滋病毒/艾滋病患者的治疗，viii）改善卫生基础设施，并增加人力资源，以处理越来越多需要艾滋病毒治疗的人。
