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Access to antiretroviral treatment in the developing world: a framework, review and health systems research agenda

Till Barnighausen

Of the estimated 7 million people who needed antiretroviral treatment (ART) in developing countries in December 2006, 2 million were receiving it. International organizations are committed to achieving universal access to ART. This article develops a conceptual framework to analyze access to ART – need is translated into latent demand by knowledge and willingness to access ART; latent demand is translated into expressed demand by ability to access; and expressed demand results in ART use, if it can be satisfied with ART supply. The article reviews evidence and ideas, and identifies future research needs, on a number of key issues in access to ART: ART need (how to measure and predict it), latent demand (how to achieve universal knowledge of HIV status and ART; how to ensure that ART services are acceptable and accommodating), expressed demand (how to ensure that ART services are accessible and affordable) and ART supply (how to achieve equitable access to ART in the short term and universal access in the long term).