title: Costing human rights and community support interventions as a part of universal access to HIV treatment and care in a Southern African setting.
abstract: Expanding access to antiretroviral therapy (ART) has both individual health benefits and potential to decrease HIV incidence. Ensuring access to HIV services is a significant human rights issue and successful programmes require adequate human rights protections and community support. However, the cost of specific human rights and community support interventions for equitable, sustainable and non-discriminatory access to ART are not well described. Human rights and community support interventions were identified using the literature and through consultations with experts. Specific costs were then determined for these health sector interventions. Population and epidemic data were provided through the Statistics South Africa 2009 national mid-year estimates. Costs of scale up of HIV prevention and treatment were taken from recently published estimates. Interventions addressed access to services, minimising stigma and discrimination against people living with HIV, confidentiality, informed consent and counselling quality. Integrated HIV programme interventions included training for counsellors, 'Know Your Rights' information desks, outreach campaigns for most at risk populations, and adherence support. Complementary measures included post-service interviews, human rights abuse monitoring, transportation costs, legal assistance, and funding for human rights and community support organisations. Other essential non-health sector interventions were identified but not included in the costing framework. The annual costs for the human rights and community support interventions are United States (US) $63.8 million (US $1.22 per capita), representing 1.5% of total health sector HIV programme costs. Respect for human rights and community engagement can be understood both as an obligation of expanded ART programmes and as a critically important factor in their success. Basic rights-based and community support interventions constitute only a small percentage of overall programmes costs. ART programs should consider measuring the cost and impact of human rights and community support interventions as key aspects of successful programme expansion.
authors: World Health Organization, Geneva, Switzerland.
authors: Louisa
authors: L
authors: Jones
authors: Paula
authors: P
authors: Akugizibwe
authors: Michaela
authors: M
authors: Clayton
authors: Joseph J
authors: JJ
authors: Amon
authors: Miriam Lewis
authors: ML
authors: Sabin
authors: Rod
authors: R
authors: Bennett
authors: Christine
authors: C
authors: Stegling
authors: Rachel
authors: R
authors: Baggaley
authors: James G
authors: JG
authors: Kahn
authors: Charles B
authors: CB
authors: Holmes
authors: Navneet
authors: N
authors: Garg
authors: Carla Makhlouf
authors: CM
authors: Obermeyer
authors: Christina DeFilippo
authors: CD
authors: Mack
authors: Phoebe
authors: P
authors: Williams
authors: Caoimhe
authors: C
authors: Smyth
authors: Marco
authors: M
authors: Vitoria
authors: Siobhan
authors: S
authors: Crowley
authors: Brian
authors: B
authors: Williams
authors: Craig
authors: C
authors: McClure
authors: Reuben
authors: R
authors: Granich
authors: Gottfried
authors: G
authors: Hirnschall
mesh_terms: D023241:Antiretroviral Therapy, Highly Active / Q000191:economics*; D003153:Community Health Services / Q000191:economics*; D003365:Costs and Cost Analysis; D019033:Delivery of Health Care, Integrated / Q000191:economics; D015658:HIV Infections / Q000191:economics* / Q000628:therapy*; D006297:Health Services Accessibility / Q000191:economics*; D006806:Human Rights; D006801:Humans; D012944:Social Support; D013019:South Africa