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Trends in Antiretroviral Therapy Eligibility and Coverage Among Children Aged <15 Years with HIV Infection - 20 PEPFAR-Supported Sub-Saharan African Countries, 2012-2016.
MMWR. Morbidity and Mortality Weekly Report. 2018 May 18; 67(19):552-555.Rapid disease progression and associated opportunistic infections contribute to high mortality rates among children aged <15 years with human immunodeficiency virus (HIV) infection (1). Antiretroviral therapy (ART) has decreased childhood HIV-associated morbidity and mortality rates over the past decade (2). As accumulating evidence revealed lower HIV-associated mortality with early ART initiation, the World Health Organization (WHO) guidelines broadened ART eligibility for children with HIV infection (2). Age at ART initiation for children with HIV infection expanded sequentially in the 2010, 2013, and 2016 WHO guidelines to include children aged <2, <5, and <15 years, respectively, regardless of clinical or immunologic status (3-5). The United States President's Emergency Plan for AIDS Relief (PEPFAR) has supported ART for children with HIV infection since 2003 and, informed by the WHO guidelines and a growing evidence base, PEPFAR-supported countries have adjusted their national pediatric guidelines. To understand the lag between guideline development and implementation, as well as the ART coverage gap, CDC assessed national pediatric HIV guidelines and analyzed Joint United Nations Programme on HIV and AIDS (acquired immunodeficiency syndrome; UNAIDS) data on children aged <15 years with HIV infection and the numbers of these children on ART. Timeliness of WHO pediatric ART guideline adoption varied by country; >50% of children with HIV infection are not receiving ART, underscoring the importance of strengthening case finding and linkage to HIV treatment in pediatric ART programs.
A growth reference for mid upper arm circumference for age among school age children and adolescents, and validation for mortality: growth curve construction and longitudinal cohort study.
BMJ. 2017 Aug 03; 358:j3423.Objectives To construct growth curves for mid-upper-arm circumference (MUAC)-for-age z score for 5-19 year olds that accord with the World Health Organization growth standards, and to evaluate their discriminatory performance for subsequent mortality.Design Growth curve construction and longitudinal cohort study.Setting United States and international growth data, and cohorts in Kenya, Uganda, and Zimbabwe.Participants The Health Examination Survey (HES)/National Health and Nutrition Examination Survey (NHANES) US population datasets (age 5-25 years), which were used to construct the 2007 WHO growth reference for body mass index in this age group, were merged with an imputed dataset matching the distribution of the WHO 2006 growth standards age 2-6 years. Validation data were from 685 HIV infected children aged 5-17 years participating in the Antiretroviral Research for Watoto (ARROW) trial in Uganda and Zimbabwe; and 1741 children aged 5-13 years discharged from a rural Kenyan hospital (3.8% HIV infected). Both cohorts were followed-up for survival during one year.Main outcome measures Concordance with WHO 2006 growth standards at age 60 months and survival during one year according to MUAC-for-age and body mass index-for-age z scores.Results The new growth curves transitioned smoothly with WHO growth standards at age 5 years. MUAC-for-age z scores of -2 to -3 and less than-3, compared with -2 or more, was associated with hazard ratios for death within one year of 3.63 (95% confidence interval 0.90 to 14.7; P=0.07) and 11.1 (3.40 to 36.0; P<0.001), respectively, among ARROW trial participants; and 2.22 (1.01 to 4.9; P=0.04) and 5.15 (2.49 to 10.7; P<0.001), respectively, among Kenyan children after discharge from hospital. The AUCs for MUAC-for-age and body mass index-for-age z scores for discriminating subsequent mortality were 0.81 (95% confidence interval 0.70 to 0.92) and 0.75 (0.63 to 0.86) in the ARROW trial (absolute difference 0.06, 95% confidence interval -0.032 to 0.16; P=0.2) and 0.73 (0.65 to 0.80) and 0.58 (0.49 to 0.67), respectively, in Kenya (absolute difference in AUC 0.15, 0.07 to 0.23; P=0.0002).Conclusions The MUAC-for-age z score is at least as effective as the body mass index-for-age z score for assessing mortality risks associated with undernutrition among African school aged children and adolescents. MUAC can provide simplified screening and diagnosis within nutrition and HIV programmes, and in research. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Get on the fast-track. The life-cycle approach to HIV. Finding solutions for everyone at every stage of life.
Geneva, Switzerland, UNAIDS, 2016. 140 p.In this report, UNAIDS is announcing that 18.2 million people now have access to HIV treatment. The Fast-Track response is working. Increasing treatment coverage is reducing AIDS-related deaths among adults and children. But the life-cycle approach has to include more than just treatment. Tuberculosis (TB) remains among the commonest causes of illness and death among people living with HIV of all ages, causing about one third of AIDS-related deaths in 2015. These deaths could and should have been prevented. TB, like cervical cancer, hepatitis C and other major causes of illness and death among people living with HIV, is not always detected in HIV services. It is vital that we collaborate closely with other health programmes to prevent unnecessary deaths. The impact of better treatment coverage means that a growing number of people will be living with HIV into old age, while there has also been an increase in new HIV infections among older people. The consequences of long-term antiretroviral therapy, combined with the diseases of ageing, will be new territory for many HIV programmes. Drug resistance is a major threat to the AIDS response, not just for antiretroviral medicines but also for the antibiotic and antituberculous medicines that people living with HIV frequently need to remain healthy. More people than ever before are in need of second- and third-line medicines for HIV and TB. The human burden of drug resistance is already unacceptable; the financial costs will soon be unsustainable. We need to make sure the medicines we have today are put to best use, and accelerate and expand the search for new treatments, diagnostics, vaccines and an HIV cure. As we build on science and innovation we will need fresh thinking to get us over the remaining obstacles. The cliché is true -- what got us here, won’t get us there. We face persistent inequalities, the threat of fewer resources and a growing conspiracy of complacency. (Excerpt)
Lancet. 2011 Aug 27; 378(9793):768.Add to my documents.
AIDS. 2008 Jul; 22 Suppl 1:S51-7.Because full funding for HIV/AIDS prevention interventions is unlikely to occur in the near future, it is essential that the resources available are spent in the most effective way possible. This paper presents a matrix of effectiveness coefficients for HIV/AIDS-related prevention interventions that can be used as an integral part of the coordinated strategic planning process currently underway by the World Bank and UNAIDS, as the interventions in the matrix are harmonized with the interventions in that process. Coefficients for four types of sexual behavior change (condom use, partner reduction, sexually transmitted infection treatment-seeking behavior, age at first sex) across three different risk groups (high, medium, low) are presented, along with their interquartile ranges. Results indicate that: (1) impacts seem greater when an intervention includes interpersonal contact, rather than targeting a more general audience; (2) although significant impacts are observed in the columns measuring changing condom use, other impacts are lower, and sometimes are actually (measured) zero; and (3) additional studies have evaluations of the number of sexual partners and have found a greater impact than previous studies. Although progress has been made in increasing the number of evaluation studies that can be utilized in this impact matrix, particularly in the area of youth interventions, there are still empty cells in which no studies report impacts. Finally, it is important to note that issues such as quality differences and synergies between programmes could have an effect on the impacts calculated for a particular strategic plan.
Anti-tuberculosis drug resistance in the world. Fourth global report. The WHO / IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance, 2002-2007.
Geneva, Switzerland, World Health Organization [WHO], 2008.  p. (WHO/HTM/TB/2008.394)This is the fourth report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance. The three previous reports were published in 1997, 2000 and 2004 and included data from 35, 58 and 77 countries, respectively. This report includes drug susceptibility test (DST) results from 91,577 patients from 93 settings in 81 countries and 2 Special Administrative Regions (SARs) of China collected between 2002 and 2006, and representing over 35% of the global total of notified new smear-positive TB cases. It includes data from 33 countries that have never previously reported. New data are available from the following high TB burden countries: India, China, Russian Federation, Indonesia, Ethiopia, Philippines, Viet Nam, Tanzania, Thailand, and Myanmar. Between 1994 and 2007 a total of 138 settings in 114 countries and 2 SARs of China had reported data to the Global Project. Trend data (three or more data points) are available from 48 countries. The majority of trend data are reported from low TB prevalence settings; however this report includes data from three Baltic countries and 2 Russian Oblasts. Trend data were also available from 6 countries conducting periodic or sentinel surveys (Cuba, Republic of Korea, Nepal, Peru, Thailand, and Uruguay). (excerpt)
Valiadation of a new clinical case definition for paediatric HIV infection, Bloemfontein, South Africa [letter]
Journal of Tropical Pediatrics. 2005 Dec; 51(6):387.In 2003 a study was published, evaluating the WHO clinical case definition for paediatric HIV infection in Bloemfontein, South Africa. It was found that the WHO case definition could only detect 14.5 per cent of children who were in fact symptomatic and HIV positive on age-appropriate serology testing. Following logistic regression analysis, a new case definition was proposed, namely that HIV is suspected in a child who has at least two of the following four signs: marasmus, hepatosplenomegaly, oropharyngeal candidiasis, and generalized lymphadenopathy. This new case definition had a sensitivity of 63.2 per cent and a specificity of 96.0 per cent. (excerpt)
UN Chronicle. 2005 Jun-Aug; 42(2): p..The battle against tuberculosis (TB) is being successfully fought in most areas of the world, but in Africa the disease has reached alarming proportions with an increasing number of cases and deaths linked to HIV, said the World Health Organization in its WHO Report 2005, Global Tuberculosis Control: Surveillance, Planning, Financing, released on 24 March to coincide with World TB Day. The WHO Report focuses on five principal indicators: incidence, prevalence, deaths, case detection and treatment success. It finds that its prevalence has declined worldwide by more than 20 per cent since 1990 and that incidence rates are falling or stable in all regions except in Africa, where TB rates have tripled since 1990 in countries with high HIV prevalence and continue to rise at 3 to 4 per cent annually. (excerpt)
Listen, Learn, Live! World AIDS Campaign with Children and Young People. Facts and figures. 1999 World AIDS Campaign.
Geneva, Switzerland, UNAIDS, 1999 Feb. 4 p.This paper presents data and information from the 1999 World AIDS Campaign with Children and Young People by age range.
ETHIOPIAN MIDWIVES MAGAZINE. 1995; (10):13.The Global Program on Acquired Immunodeficiency Syndrome (AIDS), known as GPA, has established a new organization composed of several UN agencies (i.e., WHO, UNICEF, UNDP, UNESCO, UNDFP, and the World Bank). GPA estimates for human immunodeficiency infection (HIV) indicate an increase of 3 million over the last year. Over half of the new infections occurred in women. The sharpest rise has been in the number of AIDS cases; during the last 6 months, the estimated cumulative number has risen from 1 million to 4 million globally. Since the beginning of the pandemic, over 16 million men, women, and children have become infected with HIV. One in every 15 people infected is a child. Almost one-fourth of the total, about 4 million, have developed AIDS. The GPA Management Committee Meeting (GMC) in May released the following information: 1) every day 5000 more people are infected with HIV; 2) sub-Saharan Africa remains the most heavily affected with two-thirds of the total infections; 3) the epidemic is spreading most rapidly in India, Thailand, Vietnam, and Cambodia; 4) there has been an increase, from 30,000 to 250,000, in the number of AIDS cases in the past year in south and southeast Asia; and 5) prevalence rates as high as 25% among military recruits, and 8% among pregnant women, are being reported in parts of northern Thailand. Once the epidemics in African countries have matured, over two-thirds of the new infections occur in persons under 24 years of age; almost half of the new adult cases are women. Unless action is taken at least 30-40 million people will be infected by the end of the decade.
AIDS. 1988 Jun; 2(3):219-21.In many areas of Africa where AIDS is endemic, facilities for laboratory diagnosis are too limited to reliably diagnose opportunistic infections. Therefore, the World Health Organization defined a clinical case definition of AIDS in which 2 major signs and at least 1 minor sign must be present to diagnose AIDS. The major signs are: weight loss greater than 10%, diarrhea for more than 1 month, and prolonged fever for more than 1 month. The minor signs are: persistent cough for more than 1 month, generalized pruritic dermatitis, recurrent herpes zoster, oropharyngeal candidiasis, chronic disseminated herpes simplex, and generalized lymphadenopathy. (The presence of Kaposi's sarcoma or cryptococcal meningitis are sufficient by themselves for a diagnosis of AIDS.) 72 patients in 4 hospitals in Equateur Province of Zaire were used to test the reliability of the clinical case definition. 21 (29%) of the patients were HIV seropositive, and 22 (32%) fulfilled the clinical criteria. From these data the sensitivity of the case definition was 52%, specificity was 78%, positive predictive value was 50%, and negative predictive value was 80%. Since positive predictive value rises with prevalence and HIV infection is maximal in the 20-40 age group, restricting the case definition to this age group would increase its predictive value. Exclusion of patients with tuberculosis would reduce the number of false positive results.