Community-based approaches to HIV treatment in resource-poor settings

Farmer, Paul; Léandre, Fernet; Mukherjee, Joia S.; Claude, M.S.; Nevil, Patrice; Smith-Fawzi, Mary C.; Koenig, Serena P.; Castro, Arachu; Becerra, Mercedes C.; Sachs, Jeffrey D.; Attaran, Amir; Kim, Jim Yong

doi:10.1016/s0140-6736(01)05550-7

Cited by 392 publications

(252 citation statements)

References 20 publications

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“…One of the arguments made in the rural-focused reforms is that local delivery of health services enhances their convenience and enhances the population's confidence in the health system. This has been shown to be the case for community-based HIV care in Haiti, for example (Farmer et al, 2001;Walton et al, 2004). Improving patients' experience of care and patient-provider communication was one of the objectives of the family medicine reforms in the countries of the former Soviet Union.…”

Section: Responsivenessmentioning

confidence: 99%

“…Initiatives such as IMCI have improved overall quality of care for sick children presenting in primary care facilities . The impact of rural and decentralized HIV care on health systems has been debated, but experience in Haiti suggests that a broad-based approach involving the upgrading of health centers to provide counseling, testing, and antiretrovirals can result in collateral benefits for other health services (Farmer et al, 2001;Walton et al, 2004). The implementation of primary care packages in post-conflict countries is also tightly integrated with health system development.…”

Section: Health System Strengtheningmentioning

confidence: 99%

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The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Kruk

Porignon

Rockers

et al. 2010

Social Science & Medicine

234

180

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a b s t r a c tIt has been 30 years since the Declaration of Alma Ata. During that time, primary care has been the central strategy for expanding health services in many low-and middle-income countries. The recent global calls to redouble support for primary care highlighted it as a pathway to reaching the health Millennium Development Goals. In this systematic review we described and assessed the contributions of major primary care initiatives implemented in low-and middle-income countries in the past 30 years to a broad range of health system goals. The scope of the programs reviewed was substantial, with several interventions implemented on a national scale. We found that the majority of primary care programs had multiple components from health service delivery to financing reform to building community demand for health care. Although given this integration and the variable quality of the available research it was difficult to attribute effects to the primary care component alone, we found that primary care-focused health initiatives in low-and middle-income countries have improved access to health care, including among the poor, at reasonably low cost. There is also evidence that primary care programs have reduced child mortality and, in some cases, wealth-based disparities in mortality. Lastly, primary care has proven to be an effective platform for health system strengthening in several countries. Future research should focus on understanding how to optimize the delivery of primary care to improve health and achieve other health system objectives (e.g., responsiveness, efficiency) and to what extent models of care can be exported to different settings.

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Section: Responsivenessmentioning

confidence: 99%

Section: Health System Strengtheningmentioning

confidence: 99%

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Kruk

Porignon

Rockers

et al. 2010

Social Science & Medicine

234

180

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“…Highly Active Antiretroviral Therapy (HAART) has the potential to change the perception of AIDS as a death sentence, and thereby reduce stigma (PrestonWhyte, 2003). Access to HAART is believed, for example, to have lessened HIV-related stigma in Haiti (Farmer et al, 2001), among adolescents in Brazil (Abadía-Barrero & Castro, 2005), and in villages in rural China (Cao, Sullivan, Wi, & (Nattrass, 2007, p. 131).…”

Section: Introductionmentioning

confidence: 99%

Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa

Maughan-Brown

2010

Social Science & Medicine

108

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a b s t r a c tStigma is a recognised problem for effective prevention, treatment, and care of HIV/AIDS. However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS and (2) knowing people who died of AIDS. Panel survey data collected in Cape town 2003 and 2006 for 1074 young adults aged 14-22 years were used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS; instrumental stigma; and symbolic stigma. Individual fixed effects regression models are used to evaluate factors that influence stigma over time. Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased the most, followed by instrumental stigma, while negative behavioural intentions showed a modest increase. Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma and symbolic stigma, while increased personal contact with people living with HIV/AIDS was not significantly associated with any changes in stigma. Despite interventions, such as public-sector provision of antiretroviral treatment (which some hoped would have reduced stigma), stigma increased among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate the imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.

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“…These figures are especially disturbing when juxtaposed with the fact that medications exist that dramatically decrease HIV mortality and morbidity and that, when ARVs are made available, HIV treatment in resource-poor settings has been shown to be not only possible but extremely successful 15 . Despite these facts, the international community, including governments, nongovernmental organizations, and pharmaceutical companies, are generally failing to provide ART to those who need it most, and as a result millions are dying prematurely of an otherwise treatable disease.…”

Section: Global Aids and Access To Antiretroviralsmentioning

confidence: 99%

Access to generic antiretrovirals: inequality, intellectual property law, and international trade agreements

Castro

Westerhaus

2007

Cad. Saúde Pública

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Community-based approaches to HIV treatment in resource-poor settings

Cited by 392 publications

References 20 publications

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

The contribution of primary care to health and health systems in low- and middle-income countries: A critical review of major primary care initiatives

Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa

Access to generic antiretrovirals: inequality, intellectual property law, and international trade agreements

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