Prioritizing Investment in Medical Education 英文参考文献.docVIP

Correspondence Rational Choices for Allocating Antiretrovirals in Africa: Treatment Equity, Epidemiological Ef?ciency, and Feasibility methodology, that it is possible to use mathematics to decide how to achieve treatment equity [3]. Thus, it is possible to devise a mathematically ethical solution to decide how to allocate a scarce supply of antiretrovirals if the objective is to achieve treatment equity [3]. We have shown that treatment equity is only possible in some areas of South Africa if each of the available health-care facilities treat individuals with HIV in David P. Wilson, Sally M. Blower a large catchment area (radius of approximately 40–60 km ) 2 We agree with the thesis of Rosen et al. [1] that, despite initiatives such as the World Health Organization’s “3 by 5” program, rationing of HIV/AIDS antiretroviral therapy (ART) will be necessary in the majority of African countries. Dif?cult choices will need to be made, and choices will be constrained due to the limited health infrastructure and lack of quali?ed health personnel in many African countries. Rosen et al. outlined a number of useful rationing systems and selection criteria [1]. [3]. Hence, in some African countries, it may be impossible to achieve treatment equity even if it is possible to achieve a rationing strategy that would ensure the maximum reduction of the epidemic. Therefore, government of?cials and health policy experts in each African country will have to decide the relative weight that they wish to place on treatment equity versus epidemiological ef?ciency when they decide how to ration their scarce supply of antiretrovirals. We also stress that when using mathematical models to evaluate any rationing strategy, single scenarios should not be used to make complex decisions. There is a large degree of variability in the parameters that de?ne each strategy and a great deal of heterogeneity in how a given strategy will be implemented. Accordingly, we recommend that time-dependent unce