Rolling out HIV antiretroviral therapy in sub-Saharan Africa: 2003-2017

Multiple issues need to be addressed in order to control the HIV pandemic in sub-Saharan Africa. Combination antiretroviral therapy (cART) is key to reducing morbidity and mortality among people living with HIV and has a role in preventing HIV transmission. However, access to cART is very unevenly distributed globally, especially in sub-Saharan Africa. Although cost of cART is no longer a major barrier as effective treatment can be had for under US$100 per year, HIV management is compromised by the inadequate number of trained clinicians, the lack of clinical and laboratory infrastructure and the increased prevalence of co-morbidities (e.g., tuberculosis). To address this disparity, a number of initiatives have been undertaken. One of these was the development of the Infectious Diseases Institute (IDI) at Makerere University, Kampala, Uganda. The goals of the IDI are the clinical care of people living with HIV, clinical research relevant to Uganda (in particular) and sub-Saharan Africa, and clinical training. My initial participation was as a trainer in a program to educate large numbers of clinicians in antiretroviral therapy and other aspects of HIV/AIDS management, with the intention that they become leaders of large clinical programs in their home communities. Major progress has been made in providing access to cART, and HIV/AIDS mortality and incidence of new cases is decreasing. Nevertheless, to reach the World Health Organization 90-90-90 targets by 2020, there remains a need to expand services and develop novel approaches to HIV management. In addition to providing hands-on clinical care, Canadian health care providers can help by transferring clinical skills to local clinicians or by developing streamlined clinical paradigms or new technologies for long-term HIV management in resource-limited settings.