Background The first HIV positive case was detected back in 1989. From then 2,871 cases have been reported till December 2012. However, the estimated number of PLHIV in Bangladesh is 7,500. Most of the HIV programme for last decades has been focused on HIV prevention. In 2005, ART programme was started in NGO settings in a small scale. Under the Global Fund Round 6 project, Ministry of Health and Family Welfare (MOHFW)/National AIDS/STD Programme (NASP) as Principal Recipient (PR) and Save the children as Management Agency (MA) initiated ART programme for PLHIV (People living with HIV/AIDS).

Methods Enormous efforts of Save the Children, as PR, through active formal and informal co-ordination and advocacy with NASP, UNAIDS, UNICEF, and other relevant stakeholders, ARV drug distribution process has been taken over by the government in December 2012.

Results Before 2008, 100% of ART was managed by INGOs and their implementing partners in the country. Central Medical Stores Depot of MOHFW has started ARV procurement in 2012. Before that, Save the Children has provided ART to 911 PLHIV in past 4 years with grants from the Global Fund. Beginning of 2013, 88.28% of PLHIV were provided ARV through Public-Private Partnerships (PPP). To provide direction to the national ART programme, MOHFW developed ART guidelines (2006, updated in 2011), Management of Opportunistic Infection (2009) and also developed Standard Operating Procedures (SOP) for Services to PLHIV in 2009. Simultaneously NASP installed CD+4 counters and additional laboratory equipment in eight tertiary government health institutes for HIV management.

Conclusion Nevertheless challenges remain. Government health system is yet to be sensitised and ready to start full-scale ART. An effort is ongoing to establish an efficient ARV drug procurement, supply chain system and PLHIV-friendly distribution mechanism in government-managed health facilities.