title: Changing Donor Funding and the Challenges of Integrated HIV Treatment.
abstract: Donor financing for HIV prevention and treatment has shifted from supporting disease-specific ("vertical") programs to health systems strengthening ("horizontal") programs intended to integrate all aspects of care. We examine the consequences of shifting resources from three perspectives: first, through a broad analysis of the changing policy context of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of some clinical consequences that the authors observed in a research study examining adherence to antiretroviral therapy (ART) and sexual health among adolescents. We note that AIDS responses are neither completely vertical nor horizontal but rather increasingly diagonal, as disease-specific protocols operate alongside integrated supply chain management, human resource development, and preventive screening. We conclude that health care programs are better conceived of as networks of policies requiring different degrees of integration into communities.
authors.affiliation: Professor in the Centre for Social Science Research and the School of Economics at the University of Cape Town in South Africa.
authors.forename: Nicoli
authors.initials: N
authors.lastname: Nattrass
authors.affiliation: Director of the AIDS and Society Research Unit in the Centre for Social Science Research at the University of Cape Town in South Africa, and co-principal investigator of the Mzantsi Wakho study about adolescents' adherence to antiretroviral therapy and sexual health in the Eastern Cape.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hodes
authors.affiliation: Professor of child and family social work at the University of Oxford in England and in the Department of Psychiatry and Mental Health at the University of Cape Town in South Africa, and co-primary investigator of the Mzantsi Wakho study of adolescents on antiretroviral therapy in the Eastern Cape.
authors.forename: Lucie
authors.initials: L
authors.lastname: Cluver
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy; D000293:Adolescent; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002985:Clinical Protocols; D003191:Comprehensive Health Care / Q000191:economics; D003695:Delivery of Health Care / Q000191:economics / Q000379:methods*; D015658:HIV Infections / Q000175:diagnosis / Q000191:economics / Q000628:therapy; D018166:Health Care Reform; D006291:Health Policy; D006292:Health Priorities / Q000191:economics; D006295:Health Resources; D061889:Healthcare Financing; D006801:Humans; D008403:Mass Screening; D055118:Medication Adherence; D060728:Reproductive Health; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents