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Performance of Risk Charts to Guide Targeted HIV Viral Load Monitoring of ART: Applying the Method on the Data From a Multicenter Study in Rural Lesotho.
Journal of Acquired Immune Deficiency Syndromes. 2016 May 1; 72(1):e22-5.Add to my documents.
Geneva, Switzerland, UNAIDS, Joint United Nations Programme on HIV/AIDS, 2014 Oct. 40 p.In December 2013, the UNAIDS Programme Coordinating Board called on UNAIDS to support country- and region-led efforts to establish new targets for HIV treatment scale-up beyond 2015. In response, stakeholder consultations on new targets have been held in all regions of the world. At the global level, stakeholders assembled in a variety of thematic consultations focused on civil society, laboratory medicine, paediatric HIV treatment, adolescents and other key issues. The 90-90-90 UNAIDS target seeks to: 1) By 2020, 90% of all people living with HIV will know their HIV status; 2) By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 3) By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression. Key points: 1) Governments, health experts and civil society must take advantage of the next five-year window to meet the 90-90-90 target to tackle AIDS; 2) Early treatment can reduce infection rates by 90 %; 3) A paradigm shift in HIV/AIDS treatment has seen average drug prices fall from an average of US$15 000 to US$ 80; and 4) Health systems will improve as a result of investment in HIV/AIDS treatment; financing from the international community is indispensable.
Global Public Health. 2016 Aug 6; 1-15.The drive for universal health coverage (UHC) now has a great deal of normative impetus, and in combination with the inauguration of the sustainable development goals, has come to be regarded as a means of ensuring the financial basis for the struggle against HIV and AIDS. The argument of this paper is that such thinking is a case of ‘the right thing at the wrong time’: it seriously underestimates the scale of the work against HIV and AIDS, and the speed with which we need to undertake it, if we are to consolidate the gains we have made to date, let alone reduce it to manageable proportions. The looming ‘fiscal crunch’ makes the challenges all the more daunting; even in the best circumstances, the time required to establish UHCs capable of providing both essential health services and a very rapid scale-up of the fight against HIV and AIDS is insufficient when set against the urgency of ensuring that AIDS does not eventuate as a global health catastrophe.
Indian Pediatrics. 2015 Apr; 52(4):293-5.Add to my documents.
Antiviral therapy. 2014; 19 Suppl 3:1.Add to my documents.
Simplification of antiretroviral therapy: a necessary step in the public health response to HIV/AIDS in resource-limited settings.
Antiviral therapy. 2014; 19 Suppl 3:31-7.The global scale-up of antiretroviral therapy (ART) over the past decade represents one of the great public health and human rights achievements of recent times. Moving from an individualized treatment approach to a simplified and standardized public health approach has been critical to ART scale-up, simplifying both prescribing practices and supply chain management. In terms of the latter, the risk of stock-outs can be reduced and simplified prescribing practices support task shifting of care to nursing and other non-physician clinicians; this strategy is critical to increase access to ART care in settings where physicians are limited in number. In order to support such simplification, successive World Health Organization guidelines for ART in resource-limited settings have aimed to reduce the number of recommended options for first-line ART in such settings. Future drug and regimen choices for resource-limited settings will likely be guided by the same principles that have led to the recommendation of a single preferred regimen and will favour drugs that have the following characteristics: minimal risk of failure, efficacy and tolerability, robustness and forgiveness, no overlapping resistance in treatment sequencing, convenience, affordability, and compatibility with anti-TB and anti-hepatitis treatments.
New York, New York, World Youth Alliance, .  p.The World Youth Alliance’s White Paper on HIV / AIDS proposes evidence-based and person-centered treatment, such as the provision of antiretroviral drugs, and prevention strategies, such as a reduction in concurrent partners and a delay in sexual debut. These strategies reflect the capacity of the person to make responsible decisions and to stop the high-risk behavior that exposes him or her to HIV. The paper ends with an evaluation of UNAIDS' harm reduction strategies and a call for UNAIDS to start emphasizing a person-centered response that reflects science and culture.
High prevalence of antiretroviral drug resistance mutations in HIV-1 non-B subtype strains from African children receiving antiretroviral therapy regimen according to the 2006 revised WHO recommendations [letter]
Journal of Acquired Immune Deficiency Syndromes. 2008 Dec 15; 49(5):566-9.Add to my documents.
London, United Kingdom, ACF International Network, . 80 p. (Hunger Watch Publication)This report documents the findings of Local Voices, a six month qualitative research project that provided HIV orphans, vulnerable children and their carers with the opportunity to discuss and document the difficulties they face providing food, water and healthcare for their families. Through meetings, detailed interviews and discussions the project initiated and developed an ongoing dialogue with 20 families in four areas of the Kitwe district in the Copperbelt province of Zambia: Chimwemwe, Kwacha, Chipata and Zamtan. The discourse that developed over the course of the project has given Action Against Hunger (ACF-UK) and CINDI insight in two key areas. Firstly, the research has added a household perspective to existing ideas and analysis of food security in an HIV/AIDS context. Secondly, the project highlights the knowledge and learning that can be gained when people living with a positive HIV diagnosis are seen as 'experts' and their experiences are used to help identify and address the problems they face. Through the voices of the project's participants, the testimonies and images that are the core of this document explore the social and economic impact HIV/AIDS has on families affected by the disease. ACF-UK and CINDI pioneered this work because we believe HIV/AIDS can no longer be seen as just a medical issue. Within this report we demonstrate that HIV/AIDS has a direct impact on the economic and social well-being of both households and communities; and as such it must be tackled using an integrated approach where food, livelihoods and social protection are highlighted as solutions alongside access to medical care. This report opens with statistics that outline current rates of HIV/AIDS and poverty in Zambia, focusing specifically on the Copperbelt province and the Kitwe district. The testimonies that form the centrepiece of this report are introduced by a summary of the key social and economic issues that HIV orphans, vulnerable children and their carers face, together with a synopsis of government and community based organisation (CBO) responses. These topics have been selected as they cover the core issues that were raised during the Local Voices project. The document ends with a brief conclusion and the report recommendations.
[Bangkok, Thailand], ITPC, 2007 Dec.  p.In the first section of the report, nine country teams provide first-hand reports on central issues related to AIDS service scale-up in their countries. Each demonstrates that increasing access to AIDS treatment brings not only better life and new hope, but also shines light on challenges and effective approaches to a spectrum of health, poverty, and human rights issues. In part two of this report, 14 national teams review drug access issues, and find that global and national processes for AIDS drug registration are burdened by inefficiencies, duplications, delay, and, in some instances, corruption. In many cases key ARVs, particularly newer and second-line therapies, are not yet registered in high impact countries - an administrative roadblock that puts lifesaving care out of reach for hundreds of thousands of people. The report makes a number of concrete recommendations to the key players who are responsible for making near universal access to AIDS treatment a reality by 2010. (excerpt)
Lancet Infectious Diseases. 2008 Jan; 8(1):14.A report from the International Treatment Preparedness Coalition (ITPC) warns that meeting the "near universal access target" to AIDS drugs access by the 2010 deadline will require an enormous effort by governments, global agencies, and drug companies. According to the report, which looked at AIDS treatment access in 14 countries, "scale-up is working but high prices, patent and registration barriers, and ongoing stock-outs are core issues impeding AIDS drug delivery". "The issues highlighted in this report are real and widespread", said Nathan Ford of Médecins Sans Frontières (MSF; Johannesburg, South Africa). The HIV programmes run by MSF across the developing world are struggling against user fees, high drug costs, lack of human resources, and poor health infrastructure, he told TLID. The ITPC, a group of 1000 treatment activists from more than 125 countries, highlights that the high cost of antiretroviral drugs is a particular barrier in Argentina, China, and Belize. (excerpt)
Lancet Infectious Diseases. 2007 Nov; 7(11):705.An expert advisory group, convened by the European Centre for Disease Prevention and Control (ECDC), has concluded that it would be inadvisable to embark on a widespread pre-pandemic H5N1 vaccination programme in European countries at the present time. Pre-pandemic vaccines, currently being developed by several pharmaceutical companies, can be made ahead of the emergence of pandemic influenza virus, unlike "true" pandemic vaccines. However, experts have concluded that there remains too much uncertainty as to whether the H5N1 avian influenza virus, on which pre-pandemic vaccines currently under development are based, will ever be responsible for a pandemic. According to Johan Giesecke (ECDC, Stockholm, Sweden), "If there is an H5N1-based pandemic, the strategy of having stockpiled pre-pandemic H5N1 vaccines, even if the vaccines incompletely match the pandemic virus, may prevent more infections and deaths than waiting for specific "true" pandemic vaccines...however, there is no guarantee that the next human influenza pandemic will evolve from the current H5N1 avian influenza virus". (excerpt)
Lancet. 2007 Jul 7; 370(9581):15-16.A new spirit of cooperation and coordination between the key global players in the fight against HIV/AIDS was cemented at a meeting for programme implementers in Kigali, Rwanda, in mid-June. The partnership comes amidst concerns about rising infection rates in some countries where infections had slowed, as well as worries about the unpredictability of funding for HIV/AIDS activities. The collaboration is expected to curb duplication of efforts and wastage of resources, and to ultimately scale-up AIDS prevention and treatment. The meeting-usually an annual gathering for the US President's Emergency Plan for AIDS Relief (PEPFAR) and its grantees-opened up for the first time to include the Global Fund to Fight AIDS, Tuberculosis and Malaria, UNAIDS, the World Bank, UNICEF, WHO, and the Global Network of People Living with HIV/AIDS (GNP+), who were all co-sponsors of the conference. (excerpt)
AIDS. 2007 May; 21(9):1205-1209.Thanks to the leadership of the World Health Organisation (WHO), and massive financial support from programmes such as the Global Fund and the US President's Emergency Plan for AIDS Relief (PEPFAR), the number of HIV-infected individuals accessing antiretroviral therapy (ART) in resource-limited settings has tripled from 2001 to 2005. An estimated 1.3 million HIV-infected individuals were on ART in 2005, representing 20% of those in need of treatment. Contrary to initial fears, numerous reports have now been published describing successful early outcomes in many ART patient populations. This is as a result of a number of factors including the fact that the majority of patients are treatment naive, that a low prevalence of primary drug resistance still prevails, and that adherence is better than expected, particularly in patients receiving treatment free of charge. (excerpt)
Lancet. 2007 Apr 21; 369(9570):1320.In June, 2006, UN member states at the High Level Meeting on AIDS committed themselves to provide universal access to comprehensive prevention pro grammes, treatment, care, and support by 2010. This week WHO, UNAIDS, and UNICEF publish the first report about progress towards this goal. Sadly, there is little for the international community to be pleased about. Although 2 million people had access to antiretroviral therapy at the end of 2006, 5 million were still in need of treatment. Some progress has been made in reducing the costs of first-line antiretrovirals. In low-income and middle-income countries the prices of most first-line drugs decreased by between 37% and 53% from 2003 to 2006, contributing substantially to the wider availability of treatment. But more patients put on treatment will inevitably be accompanied by increasing HIV-drug resistance. Second-line drugs, and new types of antiretroviral drugs in the future, such as the integrase inhibitors, have the potential to offer new treatment options for patients whose disease no longer responds to first-line drugs. But unless prices for second-line regimens fall substantially, budgetary constraints mean treatment programmes will be put at risk. (excerpt)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:52-59.This study evaluates the targets of the United Nations Declaration on HIV/AIDS Resource Targets, the attainment of which are premised on promoting three fronts: reduction of material and services costs, increased efficiency in access to and management of funds, and the channeling of new funds. Data were derived from studies of National Accounts of HIV/AIDS in Latin America and the Caribbean and from the recent available literature on the global dynamics of HIV/AIDS resources. The economic concept of global public good occurs throughout the text. The article discusses factors that constrain funding, and thus compel the adoption of new strategies in Brazil. The issues addressed include: difficulties in maintaining the downward tendency in the cost of items related to the HIV/AIDS epidemic, the incorporation each year of thousands of persons needing antiviral therapy, the rise in patient survival and increased diagnosis for the control of HIV/AIDS transmission. It is concluded that, in order to guarantee additional resources to combat the epidemic, the discussion on funding must necessarily focus on both the share of AIDS support for the Brazilian Ministry of Health, and, more importantly, on an increase in health funding as a whole. The recognition that HIV/AIDS control contributes to the global public good should facilitate increases in development assistance from international funding sources. (author's)
Are a past history of tuberculosis and WHO clinical stage associated with incident tuberculosis in adults receiving antiretroviral therapy? [letter [reply]
AIDS. 2007 Jan; 21(3):389-390.In two recent excellent articles, Lawn and colleagues [1,2] reported the incidence and risk factors for active tuberculosis among HIV-infected adults receiving antiretroviral therapy (ART) in South Africa. In both studies, they found contradictory results regarding the association between the baseline World Health Organization (WHO) clinical stage and the occurrence of incident tuberculosis during follow-up, and contradictory trends towards an association between a past history of tuberculosis at enrolment and a lower (first study) or higher (second study) incidence of tuberculosis during follow-up. (excerpt)
Past history of tuberculosis is not a risk factor for incident tuberculosis during antiretroviral treatment in South Africa [letter] [reply]
AIDS. 2007 Jan 30; 21(3):388-389.We thank Ouattara and colleagues for their letter concerning risk factors for incident tuberculosis during antiretroviral treatment (ART) in sub-Saharan Africa. In a study from Abidjan that included 12 cases, Seyler et al. identified a past history of tuberculosis as the sole risk factor for incident tuberculosis. We reported a larger number of cases (n = 27) within a hospital-based study cohort in Cape Town and, in contrast, a low baseline CD4 cell count and advanced World Health Organization (WHO) stage of disease were the principal risk factors. In a second, much larger community-based study, we found that the current CD4 cell count was the sole independent risk factor for incident tuberculosis (n = 81). In both our studies, a history of previous tuberculosis was consistently found not to be a significant risk factor, agreeing with other unpublished studies from South Africa, Uganda and Senegal; a further study from Uganda reported a strong but statistically nonsignificant trend towards an association. (excerpt)
National adult antiretroviral therapy guidelines in South Africa: concordance with 2003 WHO guidelines?
AIDS. 2007 Jan 2; 21(1):121-122.We read with interest the article by Beck and colleagues who examined the adult antiretroviral therapy (ART) guidelines in 43 World Health Organization (WHO) '3 by 5' focus countries. The authors found that the national guidelines of a majority of countries had a good degree of concordance with the WHO 2003 guidelines. Although concordance was noted to be inversely related to health expenditure per capita, the authors did not further explore the reasons why some countries have adopted guidelines that differ from the current WHO recommendations. One such country is South Africa, which has among the highest per capita income of countries in sub-Saharan Africa and also has much better healthcare infrastructure than most. Despite these resources, the South African national ART programme currently bases its treatment guidelines on the former WHO 2002 guidelines that recommend ART only for patients with WHO stage 4 disease (AIDS) or a blood CD4 cell count of less than 200 cells/ml. We believe these guidelines advocate treatment at too late a stage of disease and that they represent a compromise that may substantially undermine the effectiveness of the programme in the long term. (excerpt)
SAfAIDS News. 2005 Sep; 11(3):2.Most people living with HIV and AIDS (PLWHA) are found in severely resource-constrained settings, where the pandemic continues to grow at an alarming rate, throwing into disarray the already enormous treatment challenge. High AIDS mortality rates are mainly experienced in sub-Saharan Africa, particularly in the southern Africa region. Yet recent events paint a gloomy picture regarding financial support for international remedial efforts against HIV and AIDS. There is uncertainty over continued funding of AIDS programmes in the future, forcing us to ask tough questions such as whether the aim of providing antiretroviral therapy (ART) to individuals clinically qualified to receive these medicines will be feasible and whether it will be possible to retain those already on treatment in the future. (excerpt)
The 10-year struggle to provide antiretroviral treatment to people with HIV in the developing world.
Lancet. 2006 Aug 5; 368(9534):541-546.In March, 2006, the WHO took stock of the 3 by 5 initiative, which had been formally launched with UNAIDS 2 years earlier. With 1.3 million people on antiretroviral treatment in developing countries by the end of 2005, the world had not reached the target of treating 3 million people living with HIV/AIDS. In terms of numbers, at least, some said that the campaign failed. But the initiative did show that with the right vision and a determined effort by all relevant parties, development achievements that seem unthinkable are indeed possible. The apparent failure to achieve what was always an aspirational goal should not overshadow the fact that the progress on access to antiretroviral treatment might have no precedent in global public health. For no other life-threatening disease has the world moved from the first scientific breakthroughs to a commitment to achieve universal access to treatment in less than a decade. But we should not forget that the number of new HIV infections still outpaces the expansion of access to treatment, and that progress remains slow in view of the millions still dying from AIDS every year. (excerpt)
The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings.
Lancet. 2006 Aug 5; 368(9534):505-510.WHO has proposed a public-health approach to antiretroviral therapy (ART) to enable scaling-up access to treatment for HIV-positive people in developing countries, recognising that the western model of specialist physician management and advanced laboratory monitoring is not feasible in resource-poor settings. In this approach, standardised simplified treatment protocols and decentralised service delivery enable treatment to be delivered to large numbers of HIV-positive adults and children through the public and private sector. Simplified tools and approaches to clinical decision-making, centred on the "four Ss"--when to: start drug treatment; substitute for toxicity; switch after treatment failure; and stop--enable lower level health-care workers to deliver care. Simple limited formularies have driven large-scale production of fixed-dose combinations for first-line treatment for adults and lowered prices, but to ensure access to ART in the poorest countries, the care and drugs should be given free at point of service delivery. Population-based surveillance for acquired and transmitted resistance is needed to address concerns that switching regimens on the basis of clinical criteria for failure alone could lead to widespread emergence of drug-resistant virus strains. The integrated management of adult or childhood illness (IMAI/IMCI) facilitates decentralised implementation that is integrated within existing health systems. Simplified operational guidelines, tools, and training materials enable clinical teams in primary-care and second-level facilities to deliver HIV prevention, HIV care, and ART, and to use a standardised patient-tracking system. (author's)
BMJ. British Medical Journal. 2006 Aug 19; 333(7564):367.The world's richest nations are failing to ensure that people living with HIV/AIDS in the developing world have universal access to antiretroviral drugs, delegates at the 16th international AIDS conference in Toronto were told this week. In an opening address, Microsoft founder Bill Gates said that he was making AIDS the top priority of his foundation, at which resources doubled last month to $62bn (£33bn; €49bn), after a donation by US investor Warren Buffett. Bill Gates, who with his wife Melinda pledged $500m to the Global Fund to Fight AIDS, Tuberculosis, and Malaria last week, emphasised the importance of seeking more funds, creating cheaper drugs with fewer side effects, and achieving more widespread treatment for the world's most vulnerable people with HIV/AIDS. (excerpt)
Bulletin of the World Health Organization. 2006 Jul; 84(7):506.June 2006 marks the 25th anniversary of a report of five cases of Pneumocystis carinii (now jirovecii) pneumonia in men who have sex with men, heralding the acquired immunodeficiency syndrome (AIDS). Over 65 million infections with the causative agent, human immunodeficiency virus (HIV), have now caused at least 25 million deaths. Following recognition at the XI International Conference on AIDS in 1996, that combination antiretroviral therapy (ART) dramatically improves survival, various initiatives have helped to bring treatment to people with HIV/AIDS in developing countries. Although the target of treating 3 m people by the end of 2005 (WHO's "3 by 5" initiative) was not reached, about 1.3 m people now receive ART in low- and middle-income countries. Major lessons from the initiative include the utility of country-owned targets in mobilizing efforts and promoting accountability, the need for extensive partnerships to scale up activities, the importance of identifying and resolving health systems constraints, the challenges of ensuring equity, and the synergy between treatment initiatives and a simultaneous scaling-up of HIV prevention. (excerpt)
Choices. 2001 Dec; 4.We are facing the most devastating global epidemic in modern history. Over 60 million people have been infected. In the worst affected countries one in four adults are now living with HIV/AIDS, a disproportionate number of younger women and girls. More than 80 percent are in their twenties. The result is a devastating hollowing out of communities, leaving only the very young and the very old and thrusting millions of families deeper into poverty. Meeting this challenge means progress on three fronts: first, preventing new infections and reversing the spread of the epidemic; second, expanding equitable access to new HIV treatments; third, alleviating the disastrous impact of AIDS on human development. Effectively responding to HIV/AIDS requires a wide range of initiatives under strong national political leadership, including sex education in schools, public awareness campaigns, programmes in the workplace, mobilization of religious and community leaders, action to mitigate the impact on poverty and essential social services, support for orphans and tough policy decisions in ministries of finance to ensure optimal allocation of resources to cope with the crisis. (excerpt)