Human resources for treating HIV/AIDS: needs, capacities, and gaps.

Area of Science:

• Global Health
• Health Workforce Studies
• Epidemiology

Background:

• Despite global efforts, over 5 million individuals in low- and middle-income countries (LMIC) needing antiretroviral treatment (ART) do not receive it.
• A critical barrier to universal ART coverage is the shortage of human resources for HIV/AIDS (HRHA).

Purpose of the Study:

• To model the gap between required and available HRHA in LMIC.
• To quantify the challenge of achieving and sustaining universal ART coverage by 2017.
• To analyze the impact of various factors on HRHA needs and ART coverage.

Main Methods:

• Utilized recent estimates of ART coverage, HIV incidence, health worker emigration, and mortality rates.
• Employed a discrete-time model projecting HRHA needs over 10 years (to 2017).
• Assessed regional variations (sub-Saharan Africa, other LMIC, South Africa) and analyzed sensitivity to HRHA inflows/outflows and HIV pandemic evolution.

Main Results:

• Current ART coverage in LMIC is 28%-32%; without intervention, it could drop to 16%-19% by 2017.
• Achieving universal ART coverage by 2017 requires adding significant numbers of HRHA annually: 2x current in sub-Saharan Africa, 1.5x in other LMIC, and >3x in South Africa.
• Sustaining coverage necessitates continued HRHA increases and is highly sensitive to HRHA inflow/outflow rates and HIV incidence.

Conclusions:

• Universal ART coverage is unlikely to be achieved solely by increasing HRHA; strategies must include reducing HRHA emigration, lowering HIV incidence, and optimizing care delivery.
• Policy interventions should consider conditional scholarships, training non-mobile health workers, and modifying recruitment policies.
• Organizational changes to reduce HRHA required per patient are crucial, ensuring ART workforce growth doesn't compromise other essential health services.