Gains in access to antiretroviral treatment come with some costs

In this week's PLoS Medicine magazine, Yibeltal Assefa, from the National HIV/AIDS Prevention and Control Office in Addis Ababa, and colleagues describe the successes and challenges of the scale-up of antiretroviral treatment (ART) across Ethiopia.

They report remarkable achievements in expansion of access to ART and to HIV counseling and testing (HCT), while managing to maintain the performance of other health programs such as tuberculosis and maternal and child health services. Task shifting to the health officers and health extension workers is thought to be responsible for these successes, say the authors.

At the same time, however, HIV prevention interventions and the management of chronic care patients are lagging behind now in Ethiopia. The authors say this may be due to lack of attention to these health care areas and to physicians leaving the public sector for non-governmental organizations (NGOs), including AIDS-related NGOs. They say urgent attention is needed in the areas of HIV prevention, management of chronic care patients, and retention of doctors in the public sector to ensure an effective and sustainable health system in Ethiopia.