Rapid Scale-Up of Antiretroviral Treatment in Ethiopia Successes and System-Wide Effects 英文参考文献.docVIP

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Rapid Scale-Up of Antiretroviral Treatment in Ethiopia Successes and System-Wide Effects 英文参考文献.doc

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Rapid Scale-Up of Antiretroviral Treatment in Ethiopia Successes and System-Wide Effects 英文参考文献

HealthinAction RapidScale-UpofAntiretroviralTreatmentinEthiopia: SuccessesandSystem-WideEffects YibeltalAssefa1*,DeguJerene1,SileshiLulseged2,GorikOoms3,WimVanDamme3 1HealthProgramsDepartment,NationalHIV/AIDSPreventionandControlOffice,AddisAbaba,Ethiopia,2InternationalCenterforAIDSCareandTreatmentPrograms, ColumbiaUniversity,NewYork,NewYork,UnitedStatesofAmerica,3DepartmentofPublicHealth,InstituteofTropicalMedicine,Antwerp,Belgium Introduction overall health system and the HIV epi- demicwithinindividualcountries. SummaryPoints Theprovisionofantiretroviraltreatment (ART) has decreased morbidity and mor- tality in people living with HIV/AIDS [1,2]. However, introducing ART to sub- Saharan Africa was a topic of hot debate just a few years ago. Concerns about adherenceandsubsequentdevelopmentof drugresistance,poorinfrastructure,logistic andhumancapacity,andcost-effectiveness were the major issues [3]. Once pilot projects indicated the feasibility of ART delivery in resource-limited settings, the World Health Organization catalyzed the globaleffortbydeclaringlackofaccessto effectiveHIVtreatmentaglobalemergen- cy.Thisresultedinthe‘‘3by5’’initiative, whichaimedtoprovide3millionpeoplein developingcountrieswithARTbytheend of 2005 [4]—a 10-fold increase in two years, as in 2003, only 100,000 people N In this paper, we present Ethiopia’s experience in expanding access to ART using the public health approach and highlightthesystem-wideeffectsassociated with the rapid scale-up of the ART program. Our analysis is based on sec- ondary data sources, mainly (1) official documentsfromtheEthiopianMinistryof Health, including annual health service coverage reports on health and health- related indicators such as HIV/AIDS, tuberculosis, maternal and child health, and human resources for health (HRH); (2) the national ART treatment and implementation guidelines and proceed- ingsofHIV/AIDSprogramreviewmeet- ings; and (3) monthly ART reports avail- able on the National AIDS Resou