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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.
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)
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)
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)
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)