Missing the Target #5: Improving AIDS Drug Access ... - CD8 T cells

Remaining work for asuccessful programBy Eugene Schiff and Felix ReyesOverview of HIV treatment and careOne thousand people have been able to newly access ART over the past six monthsin the Dominican Republic. According to government statistics, by August 31, therewere now close to 7,300 people receiving ART at approximately 60 sites throughoutthe country. The Global Fund is currently fully subsidizing the purchase of all ARVsdistributed at these sites, in coordination with the MoH’s HIV/AIDS Program.Despite these significant improvements, major gaps and challenges remain.In particular, many public hospitals are still poorly equipped to provide qualitycare for PLWHA. Our field research revealed inefficient logistics systems, stiflingbureaucracy, and a lack of urgency to resolve problems and ensure universal accessto quality care. A recent report by the Pan American Health Organization calculatedthat 49.3 percent of all PLWHA needing treatment in the Dominican Republic werereceiving antiretroviral medicines at the end of 2006. However, the same reportestimated 19,190 PLWHA had died of AIDS between 2004 and 2006. Relativecoverage may soon get even worse, since even using the lowest current estimateof HIV prevalence for the country (1.1 percent), as many as 7,000 additional HIVpositivepeople in the country now need ART in 2007, and at least a similar numbermay require medicines each additional year in the future.Findings in the fieldIn preparing this report, the authors interviewed more than 25 individuals, includingdoctors, PLWHA, counselors, government officials, NGO staff, and representatives ofinternational agencies. They also visited a dozen clinics and hospitals in Septemberand October 2007 1 .As observed during site visits, ARV medicines, particularly for first-line drugs, aremore widely and consistently available than ever before. Except for two hospitals,which needed but still lacked ARV drugs as of late September 2007 (Boca Chica andSan Pedro de Marcoris), health workers reported ARV drugs were available without1 The facilities visited included Hospital Luis Aybar, Hospital Robert Reid, IDEV, Centro Sanitario,Hospital de San Cristobal, Hospital de Puerto Plata, CEPROSH, Hospital MUSA de San Pedro deMarcoris, Maternidad de San Andres Boca Chica, and Maternidad de Los Mina.15