Access to second-line antiretroviral therapeutic regimens in low-resource settings: experiences from Cameroon

Cameroon is one of the few sub-Saharan countries engaged in the implementation of a universal public health policy on HIV/AIDS. In May 2007, second-line antiretroviral regimens were made available in the country; thanks to the joint participation of the Cameroonian government and the UNITAID/Clinton Foundation HIV/AIDS Initiative. This cooperation was achieved by means of a Memorandum of Understanding. The agreement aimed at providing free-of-charge access of 8 antiretroviral formulations. Nevertheless, only 1.9% of the estimated 16% patients that are presently in need of second-line regimens has access to these medicines. The main hindrances to achieving scaled-up access refer to the new institutional arrangements that are necessary for the demand and distribution of these medicines, the limiting conditions for the therapeutic monitoring of second-line treatments, at the national level and the governance of the Memorandum of Understanding itself.