title: What are the essential components of HIV treatment and care services in low and middle-income countries:  an overview by settings and levels of the health system?
abstract: OBJECTIVE
  To review and summarize the essential components of HIV treatment and care services in low and middle-income countries (LMICs).
  
  
  METHODS
  Literature review and reflection on programmatic experience.
  
  
  RESULTS
  There is increasing recognition that the essential 'package' of HIV care must include early identification of HIV-positive people in need of care, appropriate initial and continued counselling, assessment of HIV disease stage, treatment with HAART for those who need it, monitoring while on treatment for efficacy, adherence and side-effects, detection and management of other complications of HIV infection, provision of sexual and reproductive health services as well as careful record-keeping. The impressive scale-up of HIV treatment and care services has required decentralization of service provision linked to task-shifting. But the future holds even greater challenges, as the number of people in need of HIV care continues to rise at a time when many traditional donors and governments in the most-affected regions have reduced budgets.
  
  
  CONCLUSIONS
  In the long-term, the increased demand for HIV-care services can only be satisfied through increased decentralisation to peripheral health units, with the role of each type of unit being appropriate to the human and material resources available to it.HIV-care services can also naturally integrate with the care of chronic noncommunicable diseases and with closely related services like mother and child health, and thus should promote a shift from vertical to integrated programming. Staff training and support around a set of evidence-based policies and guidelines and a reliable supply of essential medicines and supplies are further essential components for a successful programme.
authors.affiliation: MRC/UVRI Research Unit on AIDS in Uganda, Uganda Virus Research Institute, Entebbe, Uganda. Paula.Munderi@mrcuganda.org
authors.forename: Paula
authors.initials: P
authors.lastname: Munderi
authors.forename: Heiner
authors.initials: H
authors.lastname: Grosskurth
authors.forename: Benson
authors.initials: B
authors.lastname: Droti
authors.forename: David A
authors.initials: DA
authors.lastname: Ross
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003906:Developing Countries; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy*; D006679:HIV Seropositivity / Q000175:diagnosis / Q000188:drug therapy*; D006291:Health Policy; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D010342:Patient Acceptance of Health Care; D034121:Reproductive Health Services / Q000458:organization & administration
chemical_list: D019380:Anti-HIV Agents