Integration of ART: concepts, policy and practice

Abstract

The recent implementation of ART in the South African public health sector necessitates renewed debate on the integration of key primary health care (PHC) programmes. Integration of PHC is really best understood in relation to its opposite, i e verticalisation or selective PHC. This paper discusses these approaches in international and South African contexts. Integration as it has been applied to HIV, namely the continuum of care and TB-HIV integration, is also considered, with specific reference to the Free State. We then present the “voices” of programme implementers on the theme of integration in this province. Both in the literature and in the interviews with implementers, the need for integration is supported. However, there is also recognition that the vertical and integrated approaches should not be exclusive, but should both feature in ART roll-out, particularly in the inception phases of the programme.