Objectives To develop projections of the resources
required (person-years of drug supply and healthcare
worker time) for universal access to antiretroviral
treatment (ART) in Zimbabwe.
Methods A stochastic mathematical model of disease
progression, diagnosis, clinical monitoring and survival in
HIV infected individuals.
Findings The number of patients receiving ART is
determined by many factors, including the strategy of
the ART programme (method of initiation, frequency of
patient monitoring, ability to include patients diagnosed
before ART became available), other healthcare services
(referral rates from antenatal clinics, uptake of HIV
testing), demographic and epidemiological conditions
(past and future trends in incidence rates and population
growth) as well as the medical impact of ART (average
survival and the relationship with CD4 count when
initiated). The variations in these factors lead to
substantial differences in long-term projections; with
universal access by 2010 and no further prevention
interventions, between 370 000 and almost 2 million
patients could be receiving treatment in 2030da fivefold
difference. Under universal access, by 2010 each doctor
will initiate ART for up to two patients every day and the
case-load for nurses will at least triple as more patients
enter care and start treatment.
Conclusions The resources required by ART
programmes are great and depend on the healthcare
systems and the demographic/epidemiological context.
This leads to considerable uncertainty in long-term
projections and large variation in the resources required
in different countries and over time. Understanding how
current practices relate to future resource requirements
can help optimise ART programmes and inform long-term
public health planning.