What is the primary function of Antiretroviral Therapy (ART) centres for individuals living with Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)?

Primary Function of ART Centres

ART centres serve as specialized healthcare facilities that provide comprehensive HIV treatment services, with their core function being the provision of antiretroviral therapy to suppress viral replication, prevent disease progression, reduce mortality, and prevent HIV transmission. 1

Core Clinical Functions

Antiretroviral Medication Provision

• ART centres dispense combination antiretroviral therapy, typically consisting of an integrase strand transfer inhibitor (InSTI) plus two nucleoside reverse transcriptase inhibitors (NRTIs) as the current standard first-line regimen. 1
• Free provision of ART medications represents the most valued support service reported by patients accessing these centres. 2
• Centres must ensure consistent availability of first-line ART drugs and ideally second-line regimens to prevent treatment interruptions. 2

Treatment Monitoring and Laboratory Services

• Regular viral load monitoring is conducted to assess treatment response, with measurements within 6 weeks of starting ART, every 3 months until viral suppression is achieved, and every 6 months thereafter once sustained suppression (<50 copies/mL) is maintained. 3
• Monthly health check-ups are provided to monitor treatment efficacy and detect complications. 2
• CD4 count monitoring helps assess immune reconstitution and guide prophylaxis decisions for opportunistic infections. 1

Management of Opportunistic Infections

• ART centres provide medicines for opportunistic infections (OIs), which patients identify as critical support alongside antiretroviral drugs themselves. 2
• Treatment of HIV-associated conditions requires maintaining ART while addressing specific complications. 1

Multidisciplinary Care Model

Case Management and Counseling Services

• HIV care sites should utilize a multidisciplinary model with an identified primary provider for each patient to support long-term patient-provider relationships. 4
• Effective counseling services are essential, though patients frequently report this as an area requiring strengthening and improvement. 2
• Case managers enhance adherence to care, identify unmet needs, and improve medication adherence. 4

Linkage to Care and Retention

• ART centres function as the critical link between HIV diagnosis and treatment initiation, with linkage to care rates around 80% reported in well-functioning programs. 5
• Retention in care is a key performance metric, with hospital-based ART centres demonstrating superior retention rates (94.1%) compared to community drug delivery facilities (84.0%). 5

Addressing Social Determinants

• Assessment and support for social and economic factors that impact adherence, including food security and safe housing, are essential functions. 4
• Educational support for children of HIV-positive parents is frequently requested. 2
• Employment assistance and nutritional supplements represent important ancillary services. 2

Prevention and Public Health Functions

Transmission Prevention

• ART centres serve a dual function: treating infected individuals while simultaneously preventing HIV transmission, as viral suppression through ART dramatically reduces transmission risk. 4, 1
• Early ART initiation regardless of CD4 count prevents disease progression and reduces transmission risk. 1

Screening and Evaluation

• All patients should be evaluated for depression and substance abuse, with management plans developed in collaboration with appropriate providers. 4
• Genotype resistance testing before initiating therapy guides optimal regimen selection. 3

Critical Operational Challenges

Access Barriers That Must Be Addressed

• Financial costs associated with accessing ART services (26% of patients), delays in receiving care (24%), and drug shortages (23%) represent the three most significant barriers even when ART is nominally "free." 6
• Transportation costs and distance to treatment centres create substantial access barriers (4.9% of patients). 6
• Stigma (8.8%) and fear of medication side effects (7.9%) require ongoing counseling interventions. 6

Quality Metrics

• Hospital-based ART centres demonstrate substantially lower mortality (0.4 deaths/100 person-years) compared to community drug delivery facilities (1.4 deaths/100 person-years), with an adjusted hazard ratio of 3.3 for mortality in non-hospital settings. 5
• Treatment termination rates are 7.5-fold higher in community delivery facilities compared to hospital-based centres. 5

Common Pitfalls to Avoid

• Inadequate drug supply management: Regular stockouts of antiretrovirals and opportunistic infection medications undermine treatment continuity and patient trust. 2
• Insufficient laboratory capacity: Lack of free or accessible laboratory investigations creates barriers to appropriate monitoring. 2
• Centralized service delivery: Overly centralized ART centres increase travel burden; decentralization improves access but requires careful implementation to maintain quality. 2
• Neglecting the "side door" phenomenon: Many patients initiate ART after presenting with advanced disease rather than through systematic pre-ART care, requiring health systems to accommodate multiple pathways to treatment. 7