Médecins Sans Frontières, Cape Town, South Africa.
BMC Int Health Hum Rights. 2010 Mar 31;10:6. doi: 10.1186/1472-698X-10-6.
Recent 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.
According 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.
Widespread 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.
来自发达国家和发展中国家的最新证据表明，尽早开始抗逆转录病毒治疗（ART）具有明显的临床和公共卫生益处。虽然关于何时开始 ART 的讨论通常集中在临床风险和益处上，但主要问题是公平的限制设定。我们应用人权框架，根据以下标准评估早期治疗启动政策：公共卫生目的；可能的效果；特异性；人权负担和益处；采用限制较少方法的可能性；以及公平管理。
根据我们的分析，早期开始 ART 的政策将更好地服务于公共卫生和人权目标。我们强调了一些可以采取的政策方法，以帮助实现这一目标，包括增加国际财政支持、护理新模式以及确保获得最负担得起的合适抗逆转录病毒药物的政策。
在资源有限的情况下，广泛实施早期 ART 启动具有挑战性。然而，基本药物的配给是对人权的限制，最小限制原则有助于关注替代措施，例如调整卫生服务模式以增加能力、降低成本和寻求额外的国际资金。需要使用明确界定的步骤逐步实现，以便作为短期目标框架的一部分分阶段实施，采用全国性政策，并需要国际技术和财政支持。
