Antiretroviral therapy in countries with low health expenditure

Abstract

Olaf Muller et al. argue against making public investments in triple-combination antiretroviral therapy against HIV-1 infection in sub-Saharan Africa on the basis that such countries few resources should be used to improve existing health services and provide for the care of a growing burden of tuberculosis pneumonia and other opportunistic infections in the population. Moreover the lack of laboratory facilities to assess HIV RNA or CD4 lymphocyte counts poor client compliance with drug regimens and severe side effects would cause the rapid development of drug resistance in communities. This argument is also valid for some Asian countries including Vietnam Laos Bangladesh and Nepal. In some countries which spend little upon health a larger proportion of funds is spent in the private rather than the public health sector. The levels of health expenditure per person per year and as a percent of gross domestic product are presented for the public and private sectors in countries which spend less than US$10/person/year on health. Poor quality black-market antiretroviral drugs against HIV are commonly used in many countries including Sierra Leone and India. Clinicians in developing countries could however help prevent the emergence of multidrug-resistant strains of HIV by refusing to provide their more affluent HIV/AIDS patients with drugs obtained on the black market.