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. 2009 Sep 1;3(5):501-526.
doi: 10.2217/hiv.09.35.

Adult combination antiretroviral therapy in sub-Saharan Africa: lessons from Botswana and future challenges

C William Wester  1 , Hermann Bussmann, John Koethe, Claire Moffat, Sten Vermund, Max Essex, Richard G Marlink
Affiliations

Adult combination antiretroviral therapy in sub-Saharan Africa: lessons from Botswana and future challenges

C William Wester et al. HIV Ther. .

Abstract

Numerous national public initiatives offering first-line combination antiretroviral therapy (cART) for HIV infection have commenced in sub-Saharan Africa since 2002. Presently, 2.1 million of an estimated seven million Africans in need of cART are receiving treatment. Analyses from the region report favorable clinical/treatment outcomes and impressive declines in AIDS-related mortality among HIV-1-infected adults and children receiving cART. While immunologic recovery, virologic suppression and cART adherence rates are on par with resource-rich settings, loss to follow-up and high mortality rates, especially within the first 6 months of treatment, remain a significant problem. Over the next decade, cART coverage rates are expected to improve across the region, with attendant increases in healthcare utilization for HIV- and non-HIV-related complications and the need for expanded laboratory and clinical services. Planned and in-progress trials will evaluate the use of cART to prevent primary HIV-1 infection with so-called 'test and treat' expansions of coverage and treatment. Education and training programs as well as patient-retention strategies will need to be strengthened as national cART programs are expanded and more people require lifelong monitoring and care.

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