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In 2003, Family Health International (FHI) and its donor and country partners launched antiretroviral therapy (ART) "learning sites" in Ghana, Kenya and Rwanda, hoping to demonstrate that ART services could be provided safely and effectively in resource-constrained settings. At each site, ART was introduced as an integral component of comprehensive care and support for HIV-infected patients and their families. The sites are part of closely linked referral networks within defined geographic areas, such as districts or municipalities. In the two years since the initial sites were launched, FHI and its partners have learned valuable lessons that can guide development and expansion of ART services in Africa and other regions. Delivering Antiretroviral Therapy in Resource-Constrained Settings: Lessons from Ghana, Kenya and Rwanda presents many of these, along with strategies, challenges and key recommendations. Comments by national and community leaders, providers and patients appear throughout the text to give readers a sense of the programs as they progressed. The document is intended for governments, development partners and public and private health facilities seeking to integrate ART into existing HIV services. The lessons may not have direct relevance to all health facilities providing or planning to provide ART; it should be used or adapted depending on the epidemiological, political, social, cultural and economic context of each setting. The document is divided into nine chapters, each addressing an essential element of an effective ART program: Chapter 1. Country Preparedness Chapter 2. Community Preparedness Chapter 3. Site Preparedness Chapter 4. Referral Systems and Linkages Chapter 5. Patient Preparation and Adherence Chapter 6. Health Management Information Systems Chapter 7. Scale-Up Chapter 8. Patient Response to ART Chapter 9. Operations Research FHI staff hope this document will contribute in a meaningful way as national programs and global initiativessuch as the President's Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the World Health Organization 3 by 5 Initiativemake new resources available for HIV treatment.
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