title: Adult combination antiretroviral therapy in sub-Saharan Africa: lessons from Botswana and future challenges.
abstract: Numerous national public initiatives offering first-line combination antiretroviral therapy (cART) for HIV infection have commenced in sub-Saharan Africa since 2002. Presently, 2.1 million of an estimated seven million Africans in need of cART are receiving treatment. Analyses from the region report favorable clinical/treatment outcomes and impressive declines in AIDS-related mortality among HIV-1-infected adults and children receiving cART. While immunologic recovery, virologic suppression and cART adherence rates are on par with resource-rich settings, loss to follow-up and high mortality rates, especially within the first 6 months of treatment, remain a significant problem. Over the next decade, cART coverage rates are expected to improve across the region, with attendant increases in healthcare utilization for HIV- and non-HIV-related complications and the need for expanded laboratory and clinical services. Planned and in-progress trials will evaluate the use of cART to prevent primary HIV-1 infection with so-called 'test and treat' expansions of coverage and treatment. Education and training programs as well as patient-retention strategies will need to be strengthened as national cART programs are expanded and more people require lifelong monitoring and care.
authors.affiliation: Botswana-Harvard School of Public Health AIDS Initiative Partnership for HIV Research & Education (BHP), Gaborone, Botswana.
authors.forename: C William
authors.initials: CW
authors.lastname: Wester
authors.forename: Hermann
authors.initials: H
authors.lastname: Bussmann
authors.forename: John
authors.initials: J
authors.lastname: Koethe
authors.forename: Claire
authors.initials: C
authors.lastname: Moffat
authors.forename: Sten
authors.initials: S
authors.lastname: Vermund
authors.forename: Max
authors.initials: M
authors.lastname: Essex
authors.forename: Richard G
authors.initials: RG
authors.lastname: Marlink