Hindawi Publishing Corporation AIDS Research and Treatment Volume 2012, Article ID 749718, 8 pages doi:10.1155/2012/749718 Review Article Are Expert Patients an Untapped Resource for ART Provision in Sub-Saharan Africa? Tom Decroo,1 Wim Van Damme,2 Guy Kegels,2 Daniel Remartinez,3 and Freya Rasschaert2 1 M´edecins Sans Fronti`eres, Avenue Eduardo Mondlane 38, Tete, Mozambique 2 Department of Public Health, Institute of Tropical Medicine, Antwerp, Nationalestraat 155, 2000 Antwerpen, Belgium 3 M´edecins Sans Fronti`eres, Maputo, Mozambique Correspondence should be addressed to Tom Decroo, tomdecroo2@gmail.com Received 29 November 2011; Revised 23 January 2012; Accepted 24 January 2012 Academic Editor: Ann Duerr Copyright © 2012 Tom Decroo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Since the introduction of antiretroviral treatment, HIV/AIDS can be framed as a chronic lifelong condition, requiring lifelong ad- herence to medication. Reinforcement of self-management through information, acquisition of problem solving skills, motivation, and peer support is expected to allow PLWHA to become involved as expert patients in the care management and to decrease the dependency on scarce skilled medical staﬀ. We developed a conceptual framework to analyse how PLWHA can become expert pa- tients and performed a literature review on involvement of PLWHA as expert patients in ART provision in Sub-Saharan Africa. This paper revealed two published examples: one on trained PLWHA in Kenya and another on self-formed peer groups in Mozambique. Both programs ﬁt the concept of the expert patient and describe how community-embedded ART programs can be eﬀective and improve the accessibility and aﬀordability of ART. Using their day-to-day experience of living with HIV, expert patients are able to provide better ﬁtting solutions to practical and psychosocial barriers to adherence. There is a need for careful design of models in which expert patients are involved in essential care functions, capacitated, and empowered to manage their condition and support fellow peers, as an untapped resource to control HIV/AIDS. 1. Introduction By the end of 2010, approximately 5,1 million people were receiving antiretroviral therapy (ART) in sub-Saharan Africa (SSA) representing only 49% of people in need of treatment [1]. For those fortunate enough to access ART, HIV infection became a chronic disease requiring lifelong treatment. However, retention in ART is a huge challenge. In 2010, a systematic review reported 80.2% (CI 78.0–82.4%), 76.1% (CI 72.4–79.7%), and 72.3% (67.4–76.9%) retention in ART at 12, 24, and 36 months of treatment, respectively, [2]. Frequently mentioned barriers to adherence in SSA are stigma, forgetfulness, lack of awareness, and loss of employ- ment due to frequent absences from work. Shortage of human resources results in inaccessible staﬀ, long waiting times, and poor quality of health services. Moreover, long distances to health facilities, scarce availability and high cost of transport limit access [3, 4]. Although barriers to retention in ART are well studied, they remain in place as a large number of patients keep on defaulting. We postulate that the dominant provider-centred ART delivery model needs to be challenged, taking into account supporting factors for adherence such as adequate information, sense of self-worth, acquisition of problem solving skills, community support, and self-management [4– 7]. When PLWHA use their insider’s knowledge about their condition, develop self-management skills, have worked out what services exist and when and how to access them, and make day-to-day decisions to enhance their well-being, they can be considered expert patients, exerting a signiﬁcant con- trol over their own lives. This perception can be accelerated by involving actively PLWHA as expert patients in medical ART care [8]. ART care is a combination of several types of functions such as complicated clinical decision making, routine clin- ical checkups, ART provision, adherence counselling, social