Equity and efficiency in scaling up access to HIV-related interventions in resource-limited settings

Abstract

The present review focuses on empirical studies examining equity and efficiency in scaling up access to HIV treatment in resource-limited settings. Key themes from reviewed papers are extracted and future research priorities are identified. Papers were found relating to three key themes. These were equity/efficiency trade-offs in the choice of treatment intervention(s); the implications of the model of care for equitable access; and socioeconomic inequalities in use, adherence and outcomes. Key findings include the need to implement or develop more cost-effective models of care as well as the importance of improving access for the poor. Increasing and sustaining access to HIV treatment is a key challenge in resource-limited settings, particularly those with a high HIV prevalence. It is, therefore, important that more efficient models of care are developed and implemented given that these should be able to achieve equitable access more quickly and at a lower overall cost. Another challenge is to ensure that interventions are designed to take the particular access barriers of the poor into account to guard against widening socioeconomic inequalities in the health of HIV-positive people.