Free care at the point of service delivery: a key component for reaching universal access to HIV/AIDS treatment in developing countries.

BACKGROUND: User fees are a common feature of health system financing in low and middle-income countries. In the context of universal access to HIV/AIDS treatment and care, the advantages of user fees for funding at country and local level should be balanced with their clinical and public health impact. METHODS: We reviewed the literature on user fees and the impact of user fees on HIV/AIDS service delivery. RESULTS: Empirical evidence gathered since the 1980s shows that sustainability, efficiency and equity challenges faced by health systems have persisted with and have often been exacerbated by the introduction of user fees. The evidence on HIV/AIDS suggests that free care at the point of service fosters uptake and helps to extend access for the poorest users. User fees are currently the main barrier to adherence to antiretroviral therapy (ART). Their abolition is associated with better virological results and increased survival. Such abolition should be carried out in parallel with the implementation of financing mechanisms, such as prepayment and risk pooling, which are able to gather funds from the sectors of the population who are able to pay for healthcare and to promote equity towards the poorest. CONCLUSION: WHO has included free access to HIV/AIDS treatment at the point of service delivery as a component of its public health approach for reaching universal access. Implementation of free HIV/AIDS care should, however, be linked to efforts to strengthen healthcare systems, ensure long-term sustainability of funding and monitor equity of access to care.

[Ethical aspects of clinical trials and patient informed-consent sheet: HIV/AIDS]. / Infection à VIH/sida: aspects éthiques des essais cliniques et du consentement éclairé.

The TRT-5 (Treatment and Therapeutic Research) group, created in 1992, is a coalition of eight advocacy and service-providing HIV/AIDS nongovernmental organisations (NGOs) [originally five NGOs] working together on treatment and research issues in the field of HIV/AIDS in France. After 11 years of work in the defending and advocating for the rights and the welfare of HIV+ individuals in the area of drug development and clinical research, we felt authorised to make comments and propose changes to the currently ongoing reform of the French Law (Loi Huriet) defining the legal framework of clinical research in France. Several of our proposals aiming to include into the new law solutions to many of the ethical problems we regularly face in clinical research have been incorporated into amendments submitted to Parliament during the first reading in the lower Chamber last October. Some of these amendments have been approved by the majority of deputies.