Current gaps in access to care and treatment in Latin America (LA)
O. Sued1, L. Martin2, B. Gomez1, M.D. Perez-Rosales1, M. Vila1, R. Mazin1, M. Alonso1, G. Hirnschall1
1Pan American Health Organization, FCH-HI, Washington, United States, 2PAHO. Carlo Schmid Program Fellow, Washington, United States
Background: Antiretroviral treatment (ART) coverage in LA ranks first among developing regions with 55% (52-60%). However scaling-up during 2008 was lower than in other regions. The identification of country-specific factors hindering universal access targets in LA is indispensable to improve national HIV responses.
Methods: Data collected by PAHO for the Universal Access Report 2009, peer-reviewed literature, national HIV reports and additional country-specific information provided by national HIV PAHO representatives were summarized to identify barriers to increase ART coverage.
Results: Insufficient integration of HIV testing activities in primary health care services remains as the main obstacle to expand ART coverage across the whole region. Number of health facilities offering HIV testing is low. Stigma and discrimination (S&D) and impaired access of MARPs and vulnerable populations continue being frequent in health services in LA.
Specific barriers impeding the expansion of HIV testing were a) limited use of rapid testing among the general population in Colombia, Argentina, Panama, Guatemala, Costa Rica, Ecuador, Paraguay; b) inconsistent supply provision (El Salvador, Paraguay, Peru, Bolivia, Nicaragua, Guatemala); c) lack of trained human resources (Peru, Paraguay, Honduras, Ecuador, Bolivia), d) missed testing opportunities (e.g. in TB patients in Argentina, Bolivia, Colombia, Ecuador, Guatemala, Mexico, Paraguay, Peru and Venezuela) e) late diagnosis resulting in higher risk of early mortality (Argentina, Chile, Mexico, Paraguay).
Further common difficulties in the access to treatment were inadequate referral systems, lack of human resources and laboratory capabilities, high inequity in the access (in particular among MARPs, young and indigenous populations).
Conclusions: Common barriers to ART persist across the region. HIV testing needs to be expanded, ideally integrated into primary care with low-cost and rapid methodologies. Adequate referral systems for timely treatment need to be established. Training of human resources and capacity building are needed to reduce S&D, allow access to key populations and increase coverage.
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