Table 1 Challenges for the implementation of antiretroviral therapy for all HIV-infected people regardless of CD4 cell count in Africa

Challenges for health systems in Africa

 • Lack of required financial resources for HIV programs

 • Increase in healthcare workers’ workload without corresponding increase in manpower

 • Inadequate stocks of antiretroviral therapy

 • Limited supportive health system infrastructures in resource limited settings

Challenges for universal HIV testing

 • Fear of being HIV positive, fear of stigma and discrimination during home-based HIV testing

 • Thoughts of not being at risk for HIV infection

 • Fear of lack of privacy and confidentiality during home-based HIV testing

 • Need of spouses’ for HIV home testing

 • Lack of proposition of HIV testing in some health facilities

 • Lack of mobile HIV testing in some settings

Challenges for linkage to care and early/immediate initiation of antiretroviral therapy

 • Weak relation between mobile and home based HIV testing and health facility based antiretroviral initiation

 • True refusal and false acceptance of ART initiation after HIV positive testing at home or by mobile units

 • Absence of specific guidance on actual “real-life” implementation of screening, diagnosis, and initiation of antiretroviral therapy in all HIV-infected persons in resource-limited settings

Challenges for retention in care and adherence to antiretroviral treatment

 • Absence of proven methods to ensure long time adherence to ART and retention in care for all HIV-infected persons in resource limited setting

 • Weak early warning indicators for HIV drug resistance