Health systems' responses to the roll-out of antiretroviral therapy (ART) in India: a comparison of two HIV high-prevalence settings
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Date
2010-07Author
Kudale, A.
Salve, A.
Rangan, S.
Kielmann, Karina
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Kudale, A., Salve, A., Rangan, S. & Kielmann, K. (2010-07) Health systems' responses to the roll-out of
antiretroviral therapy (ART) in India: a comparison of
two HIV high-prevalence settings, AIDS Care, vol. 22, pp. 85-92.
Abstract
The government of India launched the free anti-retroviral therapy (ART) initiative in 2004 and the programme
has since scaled up expansion in a phased manner. Programme authorities acknowledge problems in scale-up, yet
discussions have been restricted to operational constraints, with little consideration for how local health system
responses to HIV/AIDS influence the delivery of ART. This paper draws on the perspectives of key informants
and people living with HIV (PLHIV) to compare delivery of ART in two ART centres in the States of
Maharashtra and Andhra Pradesh at two distinct points of time. In 2005, data were collected through key
informant interviews (KIIs) using interview guides and a survey of PLHIV using a semi-structured interview
schedule. Differences were observed in the functioning and resources of the two centres, indicating different levels
of preparedness which in turn influenced PLHIV's pathways in accessing ART. We examine these differences in
the light of programme leadership, ownership and the roles of public, private and non-governmental organisation
actors in HIV care. KIIs conducted during a follow-up visit in 2009 focused on changes in ART delivery. Many
operational problems had been resolved; however, new challenges were emerging as a result of the increased
patient load. An understanding of how ART programmes evolve within local health systems has bearing on
future developments of the ART programme and must include a consideration of the wider socio-political
environment within which HIV programmes are embedded.