Rolling out antiretrovirals in Africa: there are still challenges ahead.

Received 11 April 2005; accepted 22 April 2005; electronically published 30 June 2005. Reprints or correspondence: Dr. A. Ronald, Section of Infectious Diseases, St. Boniface General Hospital, 409 Tache Ave., Rm. C5124, Winnipeg, Manitoba R2H 2A6, Canada ([email protected]). Clinical Infectious Diseases 2005; 41:386–9 2005 by the Infectious Diseases Society of America. All rights reserved. 1058-4838/2005/4103-0018$15.00 In their article “Lessons Learned from Highly Active Antiretroviral Therapy in Africa,” Akileswaran et al. [1] review the effectiveness of HAART programs in Africa. They report positive health outcomes, including high levels of treatment adherence and virological suppression that are comparable to those of industrialized countries [1]. Most of these studies, however, were performed in settings with significant external financial support, and the duration of patient follow-up was relatively short. Also, many of the studies are only currently available as abstracts, and as a result, a critical analysis of the strengths and weaknesses of the various programs is not possible. There is no doubt that the availability of antiretroviral drugs in Africa from the President’s Emergency Plan for AIDS Relief; the Global Fund for AIDS, Tuberculosis, and Malaria; and other donor programs is an extremely important life-saving initiative, especially when it is strategically linked to well-organized, community-based HIV-prevention programs. However, the challenge to roll out antiretrovirals in Africa to all those who need them and to obtain achievable long-term results is daunting. In this commentary, we detail some of these challenges.