atic, structured framework to achieve a balance between resistance development and transmission and the need to provide treatment in resourceconstrained settings; and (4) an assessment of current research on ARV resistance and toxicity, and the likely effects on the malnourished individuals with high disease burden found in resource-poor settings.

In response to this charge, the committee developed its findings, conclusions, and recommendations using evidence derived from the scientific literature, commissioned papers, and unpublished data drawn from workshop presentations made by individuals currently researching and implementing ART programs in resource-constrained environments. The combined weight of this evidence contributed to the committee’s formulation of strategies that require immediate attention and action, as well as recommendations regarding programs, policies, and research that must continue to evolve if efforts aimed at treating millions of individuals in need are to be improved and sustained.


ART scale-up in resource-constrained settings worldwide must proceed immediately. Although there may be no definitive single solution regarding how best to introduce ART into such settings, the committee identified a rational framework and key principles to guide the people and institutions that are providing resources for and leading ART scale-up programs worldwide. The committee undertook this effort with a keen awareness of the potential dangers of the suboptimal introduction of ARVs on a large scale, as well as the complex ethical challenges stemming from the reality that there will not be enough treatment for everyone who needs it. Recognizing these challenges, there remains an urgency to provide ART as rapidly as is feasible in order to extend the duration of as many lives as possible and reverse the course of social collapse in many countries heavily afflicted by HIV/AIDS.

Coordinating and Sustaining the Global Response

The widespread introduction of ARVs into resource-constrained settings worldwide is expected to result in exciting and life-extending successes. The much-anticipated influx of funds and resources to be made available by initiatives such as those noted earlier—including the U.S. President’s Emergency Plan for AIDS Relief; WHO’s 3-by-5 campaign; and continued efforts of the Global Fund to Fight AIDS, Tuberculosis, and Malaria—as well as the World Bank’s Multi-Country HIV/AIDS Program

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