Overcoming barriers to antiretroviral therapy in resource-limited settings

The provision of antiretroviral therapy in resource-limited settings has been one of the most ambitious global health projects to date, leading to a significant reframing of global trade rules, the establishment of new international funding mechanisms, and challenging medical and public health models. This thesis provides a summary of these major challenges. The first chapter provides an analysis of the drug policy challenges, examining the effectiveness of policy approaches to reducing the price of antiretrovirals and analyzing the role played by civil society in this struggle to increase access to treatment. Chapter two assesses efforts to overcome human resource shortage, in particular the effectiveness of task shifting. Chapter three examines the related issue of decentralization of care. Chapter four begins with an analysis of data from a treatment programme in South Africa to assess adherence to treatment over time as a prelude to a summary of emerging concerns around the quality of treatment provided to resource-limited settings. Finally, the thesis concludes with a reflection on future challenges for maintaining and sustaining access to effective treatment.