<qa>  What is the most significant barrier to universal access to ART in sub-SaharanTremendous efforts and resources have been expended by the global community to ensure that antiretroviral therapy ART is available and accessible to all that need it. Despite these, less than a half of Human Immunodeficiency Virus HIV-infected patients requiring ART in sub-Saharan Africa SSA are receiving it. Some of the most significant barriers to attaining universal access to ART in this region include large distances that patients have to travel to clinic, time spent in accessing care and a significant shortage of human resources. In order to address these challenges the World Health Organization WHO advocates alternative care models especially those that incorporate task-shifting to lower cadre health care workers and lay persons. Unfortunately, few such alternative care models have been identified and very little data exist on their long-term outcomes. 