improving access to medical care as an essential element of national policy. In those nations with strong publicly financed health systems, government-supported hospitals were generally able to assume major responsibilities for the initial roll-out of ART, while in others, the process was more dependent on nongovernmental organizations, often faith-based organizations, which provide the majority of health care services in many of the focus countries (GHC, 2005). Integration of those organizations into the national system also varies considerably from country to country.

Diagnosis and Evaluation

As seen among the ART programs the Committee visited, patients diagnosed as HIV-positive are usually scheduled to receive clinical and laboratory evaluation by a health care worker to determine whether they require initiation of ART. Clinical evaluation is uniformly based on the WHO clinical criteria; availability of appropriate laboratory evaluation is variable, however.

Eligibility for ART

Eligibility for ART is determined by country treatment guidelines, which are generally based on the WHO 2006 Recommendations for Antiretroviral Therapy in Adults and Adolescents in Resource-Limited Settings. As recommended by WHO, focus country guidelines utilize WHO clinical staging and, when available, CD4 cell count to determine eligibility for ART. Patients with severe HIV-associated clinical disease (WHO clinical stage 4) and those with WHO clinical stage 3 disease with associated tuberculosis or severe bacterial infections are eligible for ART, as are all patients with CD4 counts below 200 cells/mm3, regardless of WHO clinical stage. In all focus countries visited, the great majority of patients receiving ART have WHO clinical stage 4 disease or clinical stage 3 complicated by major opportunistic infections (usually tuberculosis or severe bacterial disease) or unexplained severe malnutrition. Eligibility criteria for infants and young children are different and are discussed in the section below on treatment of HIV/AIDS in children.

Preparation for ART

Most of the focus countries have developed readiness programs to enhance adherence of eligible patients to ART. Although these programs vary, many are based on the “buddy” concept, by which each patient is required to bring a friend (a family member if possible) to one or more meetings with an adherence counselor prior to the initiation of ART. An essential part of such programs is discussing with the patient and buddy what side



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