title: Free care at the point of service delivery: a key component for reaching universal access to HIV/AIDS treatment in developing countries.
abstract: BACKGROUND
  User fees are a common feature of health system financing in low and middle-income countries. In the context of universal access to HIV/AIDS treatment and care, the advantages of user fees for funding at country and local level should be balanced with their clinical and public health impact.
  
  
  METHODS
  We reviewed the literature on user fees and the impact of user fees on HIV/AIDS service delivery.
  
  
  RESULTS
  Empirical evidence gathered since the 1980s shows that sustainability, efficiency and equity challenges faced by health systems have persisted with and have often been exacerbated by the introduction of user fees. The evidence on HIV/AIDS suggests that free care at the point of service fosters uptake and helps to extend access for the poorest users. User fees are currently the main barrier to adherence to antiretroviral therapy (ART). Their abolition is associated with better virological results and increased survival. Such abolition should be carried out in parallel with the implementation of financing mechanisms, such as prepayment and risk pooling, which are able to gather funds from the sectors of the population who are able to pay for healthcare and to promote equity towards the poorest.
  
  
  CONCLUSIONS
  WHO has included free access to HIV/AIDS treatment at the point of service delivery as a component of its public health approach for reaching universal access. Implementation of free HIV/AIDS care should, however, be linked to efforts to strengthen healthcare systems, ensure long-term sustainability of funding and monitor equity of access to care.
authors.affiliation: HIV/AIDS Department, World Health Organization, Geneva, Switzerland. souteyrandy@who.int
authors.forename: Yves P
authors.initials: YP
authors.lastname: Souteyrand
authors.forename: Veronique
authors.initials: V
authors.lastname: Collard
authors.forename: Jean Paul
authors.initials: JP
authors.lastname: Moatti
authors.forename: Ian
authors.initials: I
authors.lastname: Grubb
authors.forename: Teguest
authors.initials: T
authors.lastname: Guerma
mesh_terms: D044966:Anti-Retroviral Agents / Q000191:economics* / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003906:Developing Countries; D005251:Fees, Medical; D005380:Financing, Government; D015658:HIV Infections / Q000188:drug therapy*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D011203:Poverty; D013222:State Medicine / Q000191:economics
chemical_list: D044966:Anti-Retroviral Agents