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Prioritizing second-line antiretroviral drugs for adults and adolescents: a public health approach. Report of a WHO working group meeting, World Health Organization, HIV Department, Geneva, Switzerland, 21-22 May 2007.
Geneva, Switzerland, WHO, 2007. 43 p.Antiretroviral therapy has dramatically improved the survival of HIV infected individuals and is critically needed to save millions of lives. As resource-limited countries rapidly expand their HIV/AIDS treatment programmes, increasingly countries are faced with the need to make second-line ART regimens available. The 2006 WHO ARV treatment guidelines outline the strategic approaches that should inform updated national treatment guidelines for first- and second-line therapies, and outline which agents should be considered for use in first line and second line. National programmes, however, are requesting additional operational guidance on the composition of their 2nd line ART formularies based on programmatic efficiencies and costs. As the ARV formulary is generally limited in developing countries, there is an increasing and urgent need for principles and criteria by which to prioritize ARV options. Regulatory bodies both nationally and internationally (e.g. the WHO pre-qualification project) are also requesting guidance on how to select the most needed therapeutic ARV agents for rapid appraisal. WHO therefore convened an expert meeting to review the scientific evidence and programmatic data available, in order to develop guidance for national programmes, regulatory authorities and implementing partners on selection, prioritization and planning for second-line ARV drugs. (excerpt)
Geneva, Switzerland, WHO, 2006. 15 p. (WHO/HIV/2006.05)In August 2006, the World Health Organization (WHO) launched a coordinated global effort to address a major and often overlooked barrier to preventing and treating HIV: the severe shortage of health workers, particularly in low- and middle-income countries. Called 'Treat, Train, Retain' (TTR), the plan is an important component of WHO's overall efforts to strengthen human resources for health and to promote comprehensive national strategies for human resource development across different disease programmes. It is also part of WHO's effort to promote universal access to HIV/AIDS services. TTR will strengthen and expand the health workforce by addressing both the causes and the effects of HIV and AIDS for health workers (Box). Meeting this global commitment will depend on strong and effective health-care systems that are capable of delivering services on a scale much larger than today's. (excerpt)
Evidence behind the WHO guidelines: hospital care for children: what antiretroviral agents and regimens are effective in the prevention of mother-to-child transmission of HIV?
Journal of Tropical Pediatrics. 2006 Aug; 52(4):235-238.The World Health Organization has produced guidelines for the management of common illnesses in hospitals with limited resources. This series reviews the scientific evidence behind WHO's recommendations. This review addresses the question: 'What antiretroviral agents and regimens are effective in the prevention of mother-to-child transmission of HIV?' The WHO Pocketbook of Hospital Care for Children recommends that if an HIV infected woman becomes pregnant she should be provided with services including prophylactic antiretroviral drugs (and Antiretroviral therapy - where clinically indicated), safer obstetric practices and infant-feeding counselling and support. (excerpt)
Odessa workshop helps build capacity among Ukrainian clinicians who care for people living with HIV / AIDS.
Connections. 2004 Jan;  p..A recent Anti-retroviral Therapy Training Workshop held in Odessa, Ukraine, marked the start of an ongoing collaboration between AIHA and the Los Angeles-based AIDS Healthcare Foundation (AHF). It was the first training hosted under the aegis of the newly established World Health Organization Regional HIV/AIDS Care and Treatment Knowledge Hub for which AIHA is the primary implementing partner. This Knowledge Hub was created in response to the burgeoning HIV/AIDS pandemic in Eastern Europe and Central Asia to serve as a crucial capacity-building mechanism for reaching WHO's "3 by 5" targets for the region. (excerpt)
Lancet. 2005 Jul 9; 366(9480):169-171.How can we assure fair treatment in selecting HIV/AIDS patients for antiretroviral treatment? Who should be selected and how? I set aside older ethical and policy controversies about prevention versus treatment and address instead the urgent issue created by the WHO goal of treating 3 million by 2005. By WHO criteria, the goal means selection of only 3 of the 6 million people who would benefit. How should we pick the lucky 3 million, assuming countries develop or scale up their capacity to deliver antiretroviral treatments and patient demand for them is great? Unfortunately, we lack agreement on ethical principles that can resolve key policy decisions involved in scaling up treatments, including those relating to cost recovery, patient eligibility, siting of treatment centres, and giving priority to special groups. As a result, equality in outcomes can only be established through a fair, deliberative process that is transparent, encourages relevant stakeholders to deliberate on relevant reasons, provides room for revising decisions, and enforces adherence to the process. Of course, basic human rights considerations, such as universal access and prohibition on discrimination, act as necessary constraints on these processes and outcomes. (excerpt)
Interim WHO clinical staging of HIV / AIDS and HIV / AIDS case definitions for surveillance. African region.
Geneva, Switzerland, WHO, 2005.  p. (WHO/HIV/2005.02)With a view to facilitating the scale-up of access to antiretroviral therapy (ART) in the African Region the present document outlines recent revisions made by WHO to the clinical staging of HIV/AIDS and to case definitions for HIV/AIDS disease surveillance. These interim guidelines are based on an international drafting meeting held in Saas Fee in June 2004 and on recommendations made by experts from African countries at a meeting held in Nairobi in December of the same year. The revisions to the clinical staging target professionals ranging from senior consultants in teaching and referral hospitals to surveillance officers and first-level health care providers, all of whom have important roles in caring for people living with HIV and AIDS (PLWHA), including children. It is proposed that countries review, adapt and repackage the guidelines as appropriate for specific tasks at different levels of health service delivery. It is hoped that national HIV/ AIDS programmes in African countries will thus be assisted to develop, revise or strengthen their ART guidelines, patient monitoring and surveillance efforts. The interim clinical staging and revised definitions for surveillance are currently being reviewed in the other WHO regions and will be finalized at a global meeting to be held in September 2005. (excerpt)
Tropical Medicine and International Health. 2005 Apr; 10(4):300-304.In scaling up antiretroviral treatment (ART), financing is fast becoming less of a constraint than the human resources to ensure the implementation of the programmes. In the countries hardest affected by the acquired immunodeficiency syndrome (AIDS) pandemic, AIDS increases workloads, professional frustration and burn-out. It affects health workers also directly, contributing to rising sick leave and attrition rates. This burden is shouldered by a health workforce weakened already by chronic deficiencies in training, distribution and retention. In these countries, health workforce issues can no longer be analysed from the traditional perspective of human resource development, but should start from the position that entire societies are in a process of social involution of a scale unprecedented in human history. Strategies that proved to be effective and correct in past conditions need be reviewed, particularly in the domains of human resource management and policy-making, education and international aid. True paradigm shifts are thus required, without which the fundamental changes required to effectively strengthen the health workforce are unlikely to be initiated. (author's)
Geneva, Switzerland, WHO, 2004 Jan. 70 p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 2; WHO/CDS/IMAI/2004.2)The IMAI guidelines are aimed at first-level facility health workers and lay providers in low-resource settings. These health workers and lay providers may be working in a health centre or as part of a clinical team at the district clinic. The clinical guidelines have been simplified and systematized so that they can be used by nurses, clinical aids, and other multi-purpose health workers, working in good communication with a supervising MD/MO at the district clinic. The adherence, education and psychosocial support guidelines are aimed at delivery by lay providers or health workers after training in counselling skills. This module is designed to be used both as learning aid (during training) and as a job aid. This module cross-references the IMAI Acute Care guidelines (which includes management of opportunistic infections and when to suspect TB and HIV) and Palliative Care: Symptom Management and End-of-Life Care. If these are not available, national guidelines for the acute care of adults and palliative care can be substituted. (excerpt)
Journal of Advanced Nursing. 2004 Jun; 46(5):567-570.Speaking out on World AIDS Day the organization representing the world nurses, pharmacists and physicians has expressed solid support for the World Health Organization's initiative to provide life-saving antiretroviral treatment to 3 million people in developing countries by the end of 2005. 'We are relieved to see this action plan and broad commitment to tackle the AIDS treatment emergency', explained Delon Human, General Secretary of the World Medical Association. 'Access to treatment can relieve the terrible tragedy of illness, inability to work and look after one's family and eventual death.' The World Health Professions Alliance (WHPA) went on to emphasize the key importance of available skilled human health resources in achieving the 3 by 5 goals. 'Rapidly extending the capacity and rerooling the health world force currently in place now has to be a priority if we are to succeed in testing, treating and caring for the people who require therapy', stated Judith Oulton, Chief Executive Officer of the International Council of Nurses speaking on behalf of the World Health Professions Alliance. (excerpt)
South African Medical Journal. 2004 Jan; 94(1):20.The Global Fund to fight AIDS, TB and malaria is providing support to initiatives in South Africa in the form of grants for specific projects, including: Enhancing the Care of HIV/AIDS-infected and -affected patients in resource-constrained settings in KwaZulu-Natal. The goals of this project include complementing and expanding the strategies that prevent the further spread of HIV/AIDS in KwaZulu-Natal and improving the quality of life for those with HIV/AIDS through the provision of a continuum of care, treatment and support. Strengthening national capacity for treatment, care and support related to HIV and TB, building on successful behaviour change initiatives in South Africa (Soul City). The Institute for Health and Development Communication (Soul City:IHDC) is a non-governmental organisation which was established 11 years ago in South Africa. It is a social change project which aims to make an impact on individuals and communities through edutainment. The goal is to decrease the incidence of HIV/AIDS in South Africa, as well as to decrease stigma and to improve the standards of care and support for those infected or affected by HIV/AIDS. (excerpt)
Geneva, Switzerland, WHO, 2003.  p. (WHO/HIV/2003.16)Scaling up access to antiretroviral treatment (ART) must build on existing clinical or public health services and extend their coverage. It also means making the most of synergies between prevention and care, recognizing that people are more likely to follow prevention advice when they receive comprehensive services. To accomplish this, it will be necessary to exploit opportunities—or entry points—for identifying people who could benefit from treatment. Entry points must provide, or facilitate the link to, HIV testing and counselling, the gateway to treatment services. (excerpt)
Geneva, Switzerland, WHO, Department of HIV / AIDS, . 19 p.Globally, up to 100 000 people need to be trained for their contribution to achieving the 3 by 5 target– including those involved in managing and delivering antiretroviral treatment services, those working on testing and counselling and other entry points to antiretroviral treatment and the many community treatment supporters assisting people living with HIV/AIDS who are receiving medication. The challenge is enormous, and the impact of HIV/AIDS on the workforce is exacerbating the already difficult situation. This document outlines a strategic plan for WHO to support the development, strengthening and sustaining of the workforce necessary to radically scale up and maintain antiretroviral treatment. The strategic approach is based on the understanding that achieving this goal critically depends on joint efforts between communities, countries and international organizations. It builds on the experience of successful capacity-building efforts and harnesses existing expertise to strengthen training capacity at the regional and country level in the context of an emergency response. (excerpt)
Geneva, Switzerland, WHO, 2003.  p. (WHO/HIV/2003.14)Globally up to 100 000 people need to be trained for their contribution to making 3 by 5 possible—including those involved in the management and delivery of anti-retroviral treatment (ART) services, those working on testing and counselling and other entry points to ART, and the many community treatment supporters assisting people living with HIV/AIDS who are receiving medication. The challenge is enormous, and the impact of HIV/AIDS on the workforce is exacerbating the already difficult situation. The World Health Organization (WHO) has developed a ‘Human Capacity-Building Plan' that proposes a set of unprecedented steps by which WHO, together with partners, will help countries to develop and sustain the workforce necessary to achieve 3 by 5. It addresses five critical elements for building and sustaining human capacity at the country level. (excerpt)