of tdr being 6.6% as of 2015. in addition, studies that were conducted within these regions revealed a correlation between the length of time art was implemented as a method of treatment and the likelihood of the establishment of tdr. the studies concluded that the likelihood of tdr in lmics is 1.7 times greater if art is implemented for equal to or more than five years. necessity for adherence antiretroviral therapy requires hiv-positive individuals to abide by strict adherence and thrives when countries have the necessary hiv services available for infected individuals to access. management of hiv/aids includes services such as hiv testing and diagnosing, consistent hiv care and treatment, education lessons regarding how to use art effectively and distribution methods to ensure individuals receive their medications. in lmics, hiv testing has expanded, which, in turn, creates the opportunity for the initiation of treatment as a preventative method as an increasing number of infected individuals are aware of their hiv status. short-term and long-term solutions global fund in 2002, the global fund to fight aids, tuberculosis and malaria (global fund) was a financial initiative developed to raise and provide funding to the developing world in an attempt to enhance their care and treatment programs for individuals who are living with hiv/aids, tb and malaria. for the international organization to be successful, developed countries must work in conjunction with third-world countries, private organizations, civil society and affected communities to ease the impact of the epidemics. in an attempt to prevent the misuse of funding provided by the global fund, a system has been set in place for countries to apply for funding through submission of proposals and implementation plans. as a result of the impact of the global fund, seventeen and a half million people are being treated with antiretroviral therapy as of 2017. pepfar in 2003, in an attempt to promote the importance of hiv research and funding, george w. bush enacted the president's emergency plan for aids relief (pepfar/emergency plan), committing the united states government to authorize $15 billion to support hiv/aids, tuberculosis (tb) and malaria over a five-year period in third-world countries. with the improvement of art treatment as a result of pepfar, the number of new infections has declined by 51-76% worldwide since the enactment of the emergency plan. in addition, the funding received from pepfar has allowed developing countries to treat millions, prevent millions of new infections and provide other care services to millions of already infected individuals. generic drugs antiretroviral generic drugs are medications that are identical to brand names drugs. pharmaceutical companies in brazil and india like cipla and farmanguinhos have dedicated their efforts to reduce the prices of art drugs. for example, cipla has reduced prices of antiretroviral drugs for poor third-world countries to practically zero. through their initiatives in combination with pharmaceutical companies in brazil, individuals in third-world countries are being provided access to antiretroviral treatment regimens that they could not afford before. today, art drug combinations cost $75 dollars in africa. with the providing of generic drugs at such low costs in the developing world brings about turmoil regarding the current expensive prices of antiretroviral drugs in the united states. antiretroviral drug regimens in the united states range in price from $10,000 to $40,000 as a result of pharmaceutical companies having control of price regulation. with this, the future of price reduction in the united states depends on pharmaceutical competition and negotiation to make antiretroviral drugs available to all low- and middle-income individuals despite where they may live in the world. community-based care "community-based care" refers to communities with high rates of hiv transmission and infected individuals taking the initiative to end the spread of aids within their own community. community based care services include access to: hiv testing directly observed therapy with haart (dot-haart) dot-haart refers to the administration and delivery of antiretroviral drugs by community members to ensure individuals adhere to drug regimens. such community members observe the taking of medications to provide guidance and clarify any questions infected individuals may have. educational services regarding hiv transmission and prevention methods condoms and other barrier methods maternal-child transmission packages social services for families and orphaned children other services to ensure suppression of hiv transmission the utilization of community-based care assists in the efforts in diminishing hiv transmission to reduce the number of new infections annually. there have been studies of key populations in communities like cape town, south africa that assert the benefits of community-based approaches, like adherence "clubs", where participants meet every two months for group counseling and the distribution of their arv treatments. cost-effectiveness in south africa and india, a clinical trial was completed to determine the cost-effectiveness of administering antiretroviral drugs early to treat hiv. sero-discordant couples were used in the study and each couple was provided either early or delayed antiretroviral treatment. over a five-year period, researchers concluded that early art was cost-saving in south africa and cost-effective in india. over a lifetime, early art was determined to be very cost-effective in both countries. after the release of such results, other countries have concluded that it is cost-effective to utilize combination therapy resources especially when implementing them early into practice. single-tablet regimens when doctors prescribe antiretroviral drugs to patients, the initial prescriptions consist of drug regimens that contain multiple pills of different classes that must be taken daily. although triple therapy is most commonly used, there are single-tablet regimens (strs) that exist to treat aids. strs are created through combining three antiretroviral drugs into one pill. single-tablet regimens are only available at specific clinics around the world—meaning there is limited access to these regimens—and are only prescribed if a doctor feels a patient will struggle with the treatment schedule of antiretroviral therapy. the implementation of strs worldwide could serve as a replacement for the triple-drug antiretroviral therapy and allow patients to have a less strict art schedule to abide by. injectable hiv-1 treatment the greatest struggle faced by hiv-positive individuals is maintaining compliance of taking the art pills every day. the lack of compliance can lead to drug failure or drug resistance. in july 2017, the lancet released an article revealing the results of a study conducted involving an injectable hiv-1 treatment to serve as a future replacement for the three-drug oral combination therapy. this new treatment would consist of two drugs: cabotegravir and rilpivirine, and injections would occur every four to eight weeks for each patient. thus far, the treatment has passed phase ii of the clinical trial and has been proven to be just as effective as the oral regimen. in august 2018, viiv healthcare, a collaboration between glaxosmithkline and pfizer revealed the findings of a study that found that receiving monthly injections of two long-acting arvs over a course of 48 weeks is just as effective as taking daily pills. however, logistical questions still remain about cost, the effect of missed shots, and side effects of taking monthly injections. the study, which is called antiretroviral therapy as long-acting suppression (atlas) is experimenting with the drugs cabotegravir—made by viiv—and rilpivrine, which is a licensed drug from janssen sciences ireland uc. atlas has a scope of 618 hiv-positive individuals from 13 countries, all of which had reached undetectability. half of the participants continued with daily pills, while the others switched to receiving an injection each month. viral suppression was the same in both groups. the results of the atlas study may also impact those who are not yet infected and are participating in prep, yet are reluctant to take daily pills. other studies are underway which are testing viral suppression in hiv-positive people who have never taken antiretrovirals, and whether the injectables are still effective when only taken once every 8 weeks. with the introduction of long-acting drugs come questions on the optimal dose and timing, and how the virus may mutate to become resistant to the new form of treatment. moving forward treatment as prevention has the ability to shift the paradigm of how hiv is received and treated. the effects of universal testing and treatment, and connecting people with resources for care will allow for global effects in terms of reduced rates of new hiv infections. the success of tasp is contingent upon innovation in strategies to increase the rate of hiv testing, along with exploring other dimensions of improving adherence, such as including cognitive and emotional support in those efforts. the cost of viral load testing is another factor in tasp's longevity, and increased access to that resource will allow for greater access to the beneficial effects of treatment as prevention.