UNAIDS HIV Drug Access Initiative: Providing Wider Access to HIV-related Drugs in Developing Countries, Pilot Phase

support and in supporting patients outside the treatment centres. This
could include home visits to patients with special needs or who fail to
come for treatment, or home care assistance when individuals are sick.
* Another barrier may be the lack of formal mechanisms for collaboration
among NGOs. Without such mechanisms it is difficult for NGOs to make
coordinated proposals for funding or collaboration with the public sector.
Scaling Up
Countries are no longer waiting for the Initiative in order to starttheir own
treatment access programmes. Whatever the rational of using ARVs, it is
clear that the decision to make ARVs available will not wait for the results of
the Initiative. Therefore, the scaling up should concentrate on providing
guidance and assistance to the countries willing to introduce or optimize ARV
management. Such assistance will focus on the model of the initiative as
adapted to the specific context as well as the experience from the pilot
countries.
Approaches to creating such adapted models for expanding access to AIDS
drugs should include:
* An adequate situation analysis, conducted before the model is created.
Without a thorough understanding of the local situation, the sustainability
and adequacy of the programme is in jeopardy.
* Clear qualification criteria for the referral centres, including the ability to
adequately diagnose and manage the most common opportunistic
infections.
* A commitment to provide sophisticated drugs for Ols and STDs in parallel
to ARVs.
Improving the coverage of basic 01 drugs in rural areas often poses very
difficult challenges because of the malfunctioning of distribution systems and
wider systemic issues such as inadequate salaries in the public sector, lack of
local managerial capacity, etc. HIV- specific solutions should not be sought in
this context. Instead, any action or programme to improve the availability of
basic O and STD drugs should be integrated into existing essential drug
programmes as part of the basic health package.

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