Abstract:
Background: International targets for access to antiretroviral therapy (ART) have over-estimated the capacity of health
systems in low-income countries in Sub-Saharan Africa. The WHO target for number on treatment by end 2005 for Tanzania
was 10 times higher than actually achieved. The target of the national Care and Treatment Plan (CTP) was also not reached.
We aimed at estimating the capacity for ART provision and created five scenarios for ART production given existing resource
limitations.
Methods: A situation analysis including scrutiny of staff factors, such as available data on staff and patient factors including
access to ART and patient losses, made us conclude that the lack of clinical staff is the main limiting factor for ART scale-up,
assuming that sufficient drugs and supplies are provided by donors. We created a simple formula to estimate the number of
patients on ART based on availability and productivity of clinical staff, time needed to initiate vs maintain a patient on ART
and patient losses using five different scenarios with varying levels of these parameters.
Findings: Our scenario assuming medium productivity (40% higher than that observed in 2002) and medium loss of
patients (20% in addition to 15% first-year mortality) coincides with the actual reported number of patients initiated on ART
up to 2008, but is considerably below the national CTP target of 90% coverage for 2009, corresponding to 420,000 on ART
and 710,000 life-years saved (LY’s). Our analysis suggests that a coverage of 40% or 175,000 on treatment and 350,000 LY’s
saved is more achievable.
Conclusion: A comparison of our scenario estimations and actual output 2006–2008 indicates that a simple user-friendly
dynamic model can estimate the capacity for ART scale-up in resource-poor settings based on identification of a limiting
staff factor and information on availability of this staff and patient losses. Thus, it is possible to set more achievable targets.
