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Retrovirology. 2018 Apr 2; 15(1):29.Pre-exposure prophylaxis (PrEP) for HIV prevention has evolved significantly over the years where clinical trials have now demonstrated the efficacy of oral PrEP, and the field is scaling-up implementation. The WHO and UNAIDS have made PrEP implementation a priority for populations at highest risk, and several countries have developed guidelines and national plans accordingly, largely based on evidence generated by demonstration projects. PrEP presents the opportunity to change the face of HIV prevention by offering a new option for protection against HIV and disrupting current HIV prevention systems. Nevertheless, as with all new technologies, both practical and social requirements for implementation must be taken into account if there is to be sustained and widespread adoption, which will also apply to forthcoming prevention technologies. Defining and building success for PrEP within the scope of scale-up requires careful consideration. This review summarises where the PrEP field is today, lessons learned from the past, the philosophy and practicalities of how successful programming may be defined, and provides perspectives of costs and affordability. We argue that a successful PrEP programme is about effective intervention integration and ultimately keeping people HIV negative.
Potential impact of multiple interventions on HIV incidence in a hyperendemic region in Western Kenya: a modelling study.
BMC Infectious Diseases. 2016 Apr 29; 16:189.BACKGROUND: Multiple prevention interventions, including early antiretroviral therapy initiation, may reduce HIV incidence in hyperendemic settings. Our aim was to predict the short-term impact of various single and combined interventions on HIV spreading in the adult population of Ndhiwa subcounty (Nyanza Province, Kenya). METHODS: A mathematical model was used with data on adults (15-59 years) from the Ndhiwa HIV Impact in Population Survey to compare the impacts on HIV prevalence, HIV incidence rate, and population viral load suppression of various interventions. These interventions included: improving the cascade of care (use of three guidelines), increasing voluntary medical male circumcision (VMMC), and implementing pre-exposure prophylaxis (PrEP) use among HIV-uninfected women. RESULTS: After four years, improving separately the cascade of care under the WHO 2013 guidelines and under the treat-all strategy would reduce the overall HIV incidence rate by 46 and 58 %, respectively, vs. the baseline rate, and by 35 and 49 %, respectively, vs. the implementation of the current Kenyan guidelines. With conservative and optimistic scenarios, VMMC and PrEP would reduce the HIV incidence rate by 15-25 % and 22-28 % vs. the baseline, respectively. Combining the WHO 2013 guidelines with VMMC would reduce the HIV incidence rate by 35-56 % and combining the treat-all strategy with VMMC would reduce it by 49-65 %. Combining the WHO 2013 guidelines, VMMC, and PrEP would reduce the HIV incidence rate by 46-67 %. CONCLUSIONS: The impacts of the WHO 2013 guidelines and the treat-all strategy were relatively close; their implementation is desirable to reduce HIV spread. Combining several strategies is promising in adult populations of hyperendemic areas but requires regular, reliable, and costly monitoring.
Uptake and performance of prevention of mother-to-child transmission and early infant diagnosis in pregnant HIV infected women and their exposed infants at seven health centres in Addis Ababa, Ethiopia.
Tropical Medicine and International Health. 2017 Jun; 22(6):765-775.Objective To assess the uptake of WHO-recommended PMTCT procedures in Ethiopia's health services. Methods Prospective observational study of HIV-positive pregnant mothers and their newborns attending PMTCT services at seven health centers in Addis Ababa. Women were recruited during antenatal care and followed-up with their newborns at delivery, day 6 and week 6 postpartum. Retention to PMCTC procedures, self-reported ART adherence, and HIV infant outcome were assessed. Turnaround times of HIV early infant diagnosis (EID) procedures were extracted from health registers. Results Of 494 women enrolled 4.9% did not complete PMTCT procedures due to active denial or loss to follow-up. HIV was first diagnosed in 223 (45.1%) and ART initiated in 321 (65.0%) women during pregnancy. ART was initiated in a median of 1.3 weeks (IQR 0-4.3) after HIV diagnosis. Poor self-reported treatment adherence was higher post-partum than during pregnancy (12.5% versus 7.0%, p=0.002), and significantly associated with divorced/separated marital status (RR 2.2, 95% CI 1.3-3.8), low family income (RR 2.1, 95% CI 1.1-4.1), low CD4-count (RR 1.7, 95% CI 1.0-3.0), and ART initiation during delivery (RR 2.5, 95% CI 1.1-5.6). Of 435 infants born alive 98.6% received nevirapine prophylaxis. The mother-to-child HIV transmission rate was 0.7% after a median of 6.7 weeks (IQR 6.4-10.4), but EID results were received for only 46.6% within 3 months of birth. Conclusion High retention in PMTCT services, triple maternal ART and high infant nevirapine prophylaxis coverage were associated with low mother-to-child HIV transmission. Declining post-partum ART adherence and challenges of EID linkage require attention.
[Quality of life and its related factors among HIV/AIDS patients from HIV serodiscordant couples in Zhoukou of Henan province].
Zhonghua Yu Fang Yi Xue Za Zhi [Chinese Journal of Preventive Medicine]. 2016 Apr; 50(4):339-45.OBJECTIVE: To investigate the quality of life and its related factors among HIV/AIDS patients from HIV serodiscordant couples in Zhoukou city of Henan province. METHODS: During January to May in 2015, by the convenience sample, World Health Organization Quality of Life Questionnaire for Brief Version (WHOQOL-BREF) (Chinese version) and a self-edited questionnaire were used to investigate 1 251 HIV/AIDS patients who were confirmed with HIV positive by local CDC, registered in"HIV serodiscordant family" and agreed to participate in a face-to-face interview with above 18 year-old based on the local CDC , township hospitals and village clinics of 9 counties and 1 district of Zhoukou city, excluding the HIV/AIDS patients who were in divorce, death by one side, unknowing about his HIV status, with mental illness and disturbance of consciousness, incorrectly understanding the content of the questionnaire, and reluctant to participate in this study. The scores of quality of life of physical, psychological, social relations, and environmental domain were calculated. The related factors of the scores of different domains were analyzed by Multiple Two Classification Unconditioned Logistic Regression. RESULTS: The scores of investigation objects in the physical, psychological, social relations, and environmental domain were 12.00+/- 2.02, 12.07 +/- 2.07, 11.87 +/- 1.99, and 11.09 +/- 1.84, respectively. The multiple Unconditioned Logistic Regression analysis indicated that age <40 years, on ART and no other sickness in last two weeks were beneficial factors associated with physical domain with OR (95%CI): 0.61 (0.35-1.06), 0.52 (0.30-0.90), and 1.66 (1.09-2.52), respectively. The possibility of no poverty and no other sickness in last two weeks increased to 0.15(0.09-0.26) and 1.57(1.06-2.33) times of those who was in poverty and with other sickness in last two weeks in physical domain. The possibility of participants who were below 40 years old and with children increased to 0.58 (0.34-0.98) and 0.37 (0.23-0.57) times of who were above 40 years old and without children in psychological domain. The factors of with AIDS related symptoms, no children and with other sickness in last two week were found to be significantly associated with environmental domain with OR (95%CI): 0.65 (0.48-0.88), 0.66 (0.51-0.85), and 0.65 (0.51-0.84), respectively . CONCLUSION: The scores of every domain of quality of life in HIV serodiscordant couples of Zhoukou city were good. Age, whether having AIDS related symptoms, whether to accept ART , children, status of poverty, and whether suffering from other diseases in last two weeks were the main factors associated with the quality of life.
Breastmilk Output in a Disadvantaged Community with High HIV Prevalence as Determined by the Deuterium Oxide Dose-to-Mother Technique.
Breastfeeding Medicine. 2016 Mar; 11(2):64-9.INTRODUCTION: World Health Organization breastfeeding guidelines for HIV-infected mothers are exclusive breastfeeding for 6 months and then continued breastfeeding for 12 months, provided the mother is receiving antiretroviral prophylaxis. Many African women perceive that breastmilk alone is not sufficient for their infant's nutritional requirements for the first 6 months of life, and mixed feeding is a common practice. METHODOLOGY: A stable isotope technique was used to determine breastmilk output volumes and maternal body composition objectively at five different time points in the first year of the infant's life. RESULTS: Breastmilk output volumes were high for HIV-infected mothers: 831 +/- 185 g/day at 6 weeks; 899 +/- 188 g/day at 3 months; 871 +/- 293 g/day at 6 months; 679 +/- 281 g/day at 9 months; and 755 +/- 287 g/day at 12 months. These high output volumes had no negative impact on the mother's fat-free mass. The breastmilk output volumes for HIV-uninfected mothers were not significantly different to the outputs for HIV-infected mothers at any of the time points (p > 0.05): 948 +/- 223 g/day at 6 weeks; 925 +/- 227 g/day at 3 months; 902 +/- 286 g/day at 6 months; 746 +/- 263 g/day at 9 months; and 713 +/- 264 g/day at 12 months. CONCLUSION: This study using objective methodology shows that breastmilk outputs of HIV-infected mothers were relatively high (and within published reference ranges), and mothers are able to provide sufficient breastmilk for their infants without compromising their own fat-free mass.
Challenges and priorities in the management of HIV/HBV and HIV/HCV coinfection in resource-limited settings.
Seminars In Liver Disease. 2012 May; 32(2):147-57.Liver disease due to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is now emerging as an increasing cause of morbidity and mortality in human immunodeficiency virus- (HIV-) infected persons in resource-limited settings (RLS). Existing management guidelines have generally focused on care in tertiary level facilities in developed countries. Less than half of low-income countries have guidance, and in those that do, there are important omissions or disparities in recommendations. There are multiple challenges to delivery of effective hepatitis care in RLS, but the most important remains the limited access to antiviral drugs and diagnostic tests. In 2010, the World Health Assembly adopted a resolution calling for a comprehensive approach for the prevention, control, and management of viral hepatitis. We describe activities at the World Health Organization (WHO) in three key areas: the establishment of a global hepatitis Program and interim strategy; steps toward the development of global guidance on management of coinfection for RLS; and the WHO prequalification program of HBV and HCV diagnostic assays. We highlight key research gaps and the importance of applying the lessons learned from the public health scale-up of ART to hepatitis care. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Impact of cotrimoxazole prophylaxis on the health of breast-fed, HIV-exposed, HIV-negative infants in a resource-limited setting.
AIDS. 2011 Sep 10; 25(14):1797-9.WHO guidelines recommend cotrimoxazole prophylaxis (CTXP) in all HIV-exposed negative infants who are still breastfeeding. This is based on the evidence of efficacy in HIV-infected infants, but there is no evidence of benefit in HIV-negative, breast-fed infants. We assessed the impact of CTXP on diarrhoeal and respiratory morbidity in breast-fed, HIV-exposed negative infants in a community programme. CTXP for more than 60 days showed no consistent evidence of benefit for incidence of lower respiratory tract infection [incidence rate ratio (IRR) 0.71, 95% confidence interval (CI) 0.39-1.26; P = 0.241] but an increased incidence of diarrhoea (IRR = 1.38, 95% CI 0.98-1.94; P = 0.065). The guidelines should be reconsidered by conducting a randomized control trial.
Progress in development and use of antiviral drugs and interferon. Report of an informal consultation, Geneva, Switzerland, 13-15 March 1995.
Geneva, Switzerland, WHO, Division of Emerging and Other Communicable Diseases Surveillance and Control, 1995. 30 p. (WHO/EMC/LTS/95.1)Considerable progress has been made in the development of antiviral agents. Several new compounds have become available to physicians over the past few years and many more are under development. Many of the recently developed agents represent incremental improvements related to improved pharmacokinetic and/or tolerance profiles. One of the reasons behind this progress has been the fight against the epidemic of HIV infection and its sequelae, with a resulting expansion in antiviral drug research. Other viral diseases have benefited from this increased interest, but with these successes problems of toxicity and viral resistance have also been encountered. Although there has been significant progress in the field, much still needs to be done to control and treat viral infections. There is a need to develop more effective vaccines and antiviral agents, to be alert in monitoring resistance and in devising strategies to overcome this problem, and to develop a better understanding of the epidemiology and pathogenesis of many viral infections. An international group of experts met at WHO to assess today's state of the art in this field and to offer recommendations for the future. (excerpt)
Hopkins HIV Report. 2002 Jul;  p..The WHO guidelines are based on rigorous evaluation of data collected almost exclusively in developed countries. Of concern is whether guidelines created for HIV-infected populations of developed nations are adaptable to HIV-infected populations worldwide. Specifics regarding the presence of different HIV subtypes, endemic infections such as tuberculosis, genetic determinants, and other health measures such as nutritional status may introduce factors that alter response to treatment. Developing nations that have successfully implemented HAART include Brazil, Thailand, Senegal, and Uganda. Studies are needed to examine responses to HAART and whether changes to the guidelines would better serve populations in different regions around the world. For example, initiation of HAART earlier in the course of HIV disease may have an impact on disease outcomes due to endemic mycobacterial infections such as tuberculosis. With initiation of HAART on a population-wide scale, continuous surveillance of drug-resistant HIV will be needed to update treatment guidelines. A recent study conducted in Gabon demonstrated resistance to antiretroviral therapy. Of great concern is that antiviral drug resistance due to suboptimal therapies could limit the potency of available treatments. (excerpt)
Geneva, Switzerland, WHO, 2004.  p.Influenza vaccines and antiviral drugs for influenza are essential components of a comprehensive pandemic response, which also includes planning for antibiotic supplies and other health care resources. However, the current reality is that most countries have no or very limited supplies. Such a situation would force national authorities to make difficult decisions concerning which citizens should receive first call on limited vaccines and drugs. This document provides guidance to health policy-makers and national authorities on planning principles and options for the prioritization of vaccine and antiviral use during an influenza pandemic. It includes recommendations on actions that can improve future supply for the many countries that currently have no national vaccine or antiviral production. (excerpt)
BMJ. British Medical Journal. 2004 Jan 3; 328:10.Dr Lee Jong-wook, director general of the World Health Organization, has said that the organisation’s goal of getting lifesaving antiretroviral drugs to three million patients with HIV or AIDS in the developing world by 2005 presents a golden opportunity to put in place desperately needed basic healthcare systems. In the preface to WHO’s annual report on global health Dr Lee said that funds for tackling the AIDS crisis could in turn establish lasting health systems for the future treatment and prevention of disease in the developing world. (excerpt)
Bulletin of the World Health Organization. 2003 Oct; 81(10):776.At a special session of the United Nations General Assembly in New York on 22 September, WHO declared the failure to expand access to antiretrovirals in the developing world a global health emergency. The announcement was made together with UNAIDS and the Global Fund to Fight AIDS, Tuberculosis & Malaria. (excerpt)
Bulletin of the World Health Organization. 2003 Oct; 81(10):699.WHO’s new Director-General has just declared AIDS to be a global health emergency. This move is not unprecedented but does signal a welcome departure from business as usual. Can declarations change the world? They can if they lead to action commensurate with the problem. (excerpt)
Lancet. 2003 Oct 4; 362(9390):1152-1153.By AIDS day 2002, HIV/AIDS in Africa had killed 20.4 million and infected 29.4 million people. This number of deaths is seven times that in the Nazi holocaust, and it approaches the death toll associated with transatlantic slave trading. Treatment for AIDS includes monitoring of disease progression, psychosocial support, provision of adequate nutrition, teaching healthy living and survival skills, prophylaxis and treatment of opportunistic infections, and antiretroviral treatment. Such holistic treatment can now be provided at an all-inclusive cost of about US$600 dollars per year. Yet most African countries and donors still judge this amount to be too costly. The cost of not treating a person with AIDS includes the loss of output of each patient; loss of income of care-givers; cost of treatment in homes, clinics, and hospitals; funeral costs; death and survivor benefits; and the cost of orphan care and support. These costs are met by patients, families, employers, governments, and society at large. On economic grounds alone treatment should be provided for all those for whom the present value of expenses exceeds the cost of not giving treatment. Results of several studies show that this situation is now true for many classes of people and workers. The issue has become not whether we can afford to treat, but whether we can afford not to. Here, I review imagined obstacles and faulty arguments against large-scale treatment programmes, and show that unwillingness to pay is the main reason for inaction. (excerpt)
Lancet. 2003 Oct 4; 362(9390):1157.Sir—In your July 19 Editorial (p 179), you write: “. . . no international organisation has so far stepped forward to assume responsibility for controlling HIV at the country level.” This statement is incorrect. (excerpt)
Lancet. 2003 Sep 27; 362(9389):1045.A high-level panel attended by heads of state, ministers, and civil society members at United Nations (UN) headquarters in New York on Sept 22 called HIV/AIDS “the greatest leadership challenge of our time”, and one that requires “drastic action”. Progress reports from the UN Secretary-General and the Joint United Nations Programme on HIV/AIDS (UNAIDS) stated that global and national efforts are falling far short of meeting basic goals for prevention and care. (excerpt)
Lancet. 2003 Sep 20; 362(9388):993-994.Should volunteers who become HIV- 1 infected during the course of HIV-1 vaccine trials in developing countries be provided with antiretroviral therapy by investigators? Despite emotionally charged debate, consensus on this issue has not been reached. For example, UNAIDS ethics guidelines for HIV vaccine research do not set one standard of care, but rather provide an acceptable range between a minimum and the ideal. (excerpt)
Lancet. 2003 Sep 13; 362(9387):918.The table shows our rough calculations for the inputs that will be needed to reach the 3 million target. We have used statistics relevant to the most heavily affected region, sub-Saharan Africa, although other lower-prevalence regions may have better health infrastructure to implement interventions more rapidly. Our estimates only refer to interventions that lead to start of therapy, not to those needed for maintenance. We have done this rough calculation because there is a dearth of published experience about the large-scale effectiveness of interventions that move people through a process from awareness to action—i.e., for services to be in demand (WHO aims to ensure rates of 60% and 90% for accessibility of voluntary counselling and HIV testing and for AIDS education and services for youths by 2005). (excerpt)
AIDS Reader. 2003 Jan; 13(1):5-6.In a special session of the United Nations, held from June 25 to 27, 2001, access to medications was recognized as one of the fundamental elements ensuring the innate right of all persons to enjoy the highest attainable standard of health. The prevention and treatment of HIV/AIDS were emphasized as "mutually reinforcing elements" of an effective health response. Yet, of the 43 million people currently living with HIV/AIDS, fewer than 1 million have access to and are treated with antiretrovirals. That fact has become part of a new public service campaign to increase awareness of this issue in the United States. (author's)
Perspectives in Health. 2003; 8(2):23-25.Today the Pedro Kourí Institute for Tropical Medicine comprises 52,000 square meters and 700 employees and is Cuba's leading research and training center in infectious diseases, as well as a major player in international efforts to control tropical diseases. Many of the national laboratories of Cuba are housed at the institute, along with the island's only tertiary AIDS clinic and research center. It continues to receive support from TDR as well as Canada, France, Spain, Belgium, the European Union and the Wellcome Trust, among others. (excerpt)
Prophylactic use of cotrimoxazole against opportunistic infections in HIV-positive patients: knowledge and practices of health care providers in Cote d'Ivoire.
AIDS Care. 2003 Oct; 15(5):629-637.We present here the results of a survey conducted in Côte d’Ivoire, Africa, among health care providers, on the knowledge of prophylactic use of cotrimoxazole to prevent opportunistic infections in HIV-infected persons. The survey was conducted in 15 health centres, involved or not in the ‘initiative of access to treatment for HIV infected people’. Between December 1999 and March 2000, 145 physicians and 297 other health care providers were interviewed. In the analysis, the health centres were divided into three groups: health centres implicated in the initiative of access to treatment for HIV-infected people with a great deal of caring for HIV-infected people, health centres implicated in this initiative but caring for few HIV-infected people, and health centres not specifically involved in the care of HIV-infected people. Six per cent of physicians and 50% of other health care providers had never heard of cotrimoxazole prophylaxis. The level of information about this prophylaxis is related to the level of HIV-related activities in the health centre. Among health care providers informed, knowledge on the exact terms of prescription of the cotrimoxazole is poor. In conclusion, it appears that the recommendations for primary cotrimoxazole prophylaxis of HIV-infected people did not reach the whole health care provider population. Most physicians are informed but not other health workers, even if the latter are often the only contact of the patient with the health centre. The only medical staff correctly informed are the physicians already strongly engaged in the care of HIV-infected people. (author's)
Boston Globe. 2003 Sep 3;  p..[Jong-Wook] Lee has set an ambitious goal of treating 3 million poor people with antiretroviral medicines by the year 2005; now, just 300,000 patients receive the drugs, two-thirds of them in Latin America. With an estimated 4.5 million people who have the HIV virus, South Africa had steadfastly resisted calls by activists and world leaders to begin more aggressive policies to fight AIDS. But with the government's decision last month to allow the use of antiretroviral drugs, Lee and other international health leaders now see an opportunity in South Africa. (excerpt)
Boston Globe. 2003 Jul 30; A10.The World Health Organization announced yesterday that it will create a new model to buy antiretroviral AIDS drugs in hopes of dramatically speeding distribution and reducing the cost of the life-saving medication. The plan comes from a collaboration among tuberculosis experts, foremost among them the new WHO director general, Jong-wook Lee. That program, called the TB Drug Facility, purchases drugs in bulk on behalf of countries and then oversees the distribution. (excerpt)
New York Times. 2003 Feb 8;  p..In this gritty township [Khayelitsha] near Cape Town, the relief agency Doctors Without Borders provides free triple-therapy treatment to about 330 people and reports remarkable results, Doctors treat even the sickest of the sick, patients who can barely walk or swallow. After six months of treatment, most people show dramatic improvements, gaining as much as 20 pounds and the strength to fight off killer diseases. (excerpt)
AIDS Analysis Africa. 2003 Jun-Jul; 14(1):6-8.Given that Budget 2003/4 significantly steps up the amount of funds going to the provinces for HIV/AIDS, there are now two critical questions facing us. 1. Extra money for HIV/AIDS was put into the Equitable Share in Budget 2003/4. Will provinces use the additional funds in their equitable share grant to increase their provincial health budgets and boost funding to HIV/AIDS interventions? Or will those funds be diverted to other priorities as identified by individual provinces? 2. Will provinces be able to spend the added funds? Absorption is a real problem-provincial departments are already struggling with capacity in terms of lack of financial management and programme management skills, insufficient staff, or unfilled posts. This issue is not unique to HIV/AIDS but symptomatic of other social sector programmes. In essence, analysis of Budget 2003/4 suggests that--from a public finance perspective--the main challenge for government's response to HIV/AIDS in the foreseeable future is not going to be lack of financial resources, but the capacity to spend. (excerpt)