Institute for Health and Human Development

Health and Development

Project: Impact of scale up of antiretroviral drug therapy for HIV/AIDS in Ghana and South Africa

Project Lead: Patrick Tobi

Partners:

• Imperial College, London
• Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi Ghana (George Badu-Addo, Alex Owusu-Ofori)
• Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, South Africa (Gavin George, Alan Whiteside, Nina Veenstra, Tim Quinlan)

Description

This innovative multicountry study is part of a collaborative research project funded by the UK Department for International Development under a multi-institutional Knowledge Programme on HIV/AIDS and Sexually Transmitted Infections. The project concept relies on a systems approach to assessing HIV/AIDS epidemics and response known as Whole Systems Assessment and Response.

The study involves a systematic investigation of the effects of antiretroviral drug treatment (ART) scale up programmes on the wider health system in developing and transitional countries in sub-Saharan Africa (SSA) following the 2003 roll out of the Joint United Nations Programme on HIV/AIDS and World Health Organisation’s “3 by 5” initiative to widen access to drug treatment for HIV/AIDS. Three key areas of the health system are the focus of attention:

• human resources for health
• health expenditure, and
• service provision and utilisation.

The aim is to understand the mechanisms by which health system impacts are effected and to identify strategies for implementing scale-up in ways that optimise intended positive impacts and mitigate unintended negative impacts on the health system.

SSA is home to well over half the people on ART in the developing world and 20 of the world’s 25 poorest countries. It suffers a shortage of some 1 million professional health workers further compounded by an annual health sector brain drain of 20,000 trained staff. The initial two country sites selected were Ghana and South Africa. The countries, among the top 20 with the highest unmet need for antiretroviral treatment, are in the early stages of scaling-up with current ART coverage of 4-5% (Ghana)and 10-14% (South Africa). Both plan rapid expansion over the next 4 years within the scope of the “3 by 5” programme. South Africa has a high HIV prevalence of 21.5% and Ghana a low prevalence of 3.1%. The differing contexts in the two countries will allow an understanding of scale up effects in different epidemic, treatment coverage, health system and socio-economic settings.

References:

Field work in the country sites has recently been competed and the data analysed. Click on the links for further details of the Ghana scoping visit, study protocol and post-study report. Papers in progress around key issues emerging from the studies are listed below.

• Patrick Tobi, Adrian Renton, Elena Tkatchenko-Schmidt, Rifat Atun Starving in the midst of plenty: what HIV toolkits reveal about HIV responses.
• Patrick Tobi, Adrian Renton, Elena Tkatchenko-Schmidt. Beyond content and context: a systems approach to HIV/AIDS programme evaluation.
• Patrick Tobi, Adrian Renton, Elena Tkatchenko-Schmidt, Martin Wall. Implementing ‘3 by 5’ in Ghana: a multimethods investigation of the impact of early phase antiretroviral treatment scale-up on human resources for health.

Published papers:

• Patrick Tobi, Gavin George, Elena Schmidt, Adrian Renton. Antiretroviral treatment and the workforce in south africa: have ART workers been affected by scaling up? (click here to download the abstract)

For further details contact Patrick Tobi

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© 2010