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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.
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)
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)
BMJ. British Medical Journal. 2003 Jun 21; 326:1389-1392.Summary points: The number of cases of AIDS in India will probably exceed 20 million by 2010. The limited resources should be used for large cost effective programmes to decrease spread of the disease. Money spent now will be much more effective than money spent later in the epidemic. Adequate supplies of condoms and antibiotics must be secured. Prevention should be given priority over antiretroviral treatment. (excerpt)
Lancet. 2002 Dec 21-28; 360(9350):2051.WHO, UNAIDS, and the World Bank joined with advocacy groups on Dec 12 to launch the International HIV Treatment Access Coalition, designed to increase global uptake of antiretrovirals. The coalition’s primary aim is not to raise money for the drugs—the Global Fund is supposed to do that—but to pool expertise, provide backup to national treatment programmes, and scale up community and family-based networks to administer antiretroviral therapy (ART). (excerpt)
AIDS Asia. 2002 Mar-Apr; 4(2):10.In a decisive move to strengthen action against AIDS in developing countries, the World Health Organization (WHO) has announced treatment guidelines for HIV/AIDS in poor settings. Parallel to that, WHO has endorsed the inclusion of AIDS medicines in its Essential Medicines List. The 41 drug formulations on the list, include II antiretroviral drugs (ARVs) and five drugs for the opportunistic infections, funguses and cancers that attack AIDS patients. Twenty six come from the major international pharmaceutical manufacturers but ten are from Cipla and three small European generic manufacturers. (excerpt)
Lancet. 2002 Mar 30; 359:1134.In an effort to improve access to HIV/AIDS drugs, the WHO published on March 20, 2002 its first list of products that meet the agency’s recommended standards and are thus classified as suitable for procurement by UN agencies. The list, which includes 40 products from eight manufacturers, features 11 antiretrovirals and five products for opportunistic infections. The Indian firm as well as the Medecins Sans Frontieres welcomed the inclusion of generic manufacturers although International Federation of Pharmaceutical Manufacturers Associations, which represents international companies with patents to defend, was more critical. However, WHO said it was satisfied that the approval process conformed with its own rigid norms. It is said that products and manufacturing sites would be assessed at regular intervals and will be removed from the list if they no longer comply with the standards.
Scientific American. 2002 Mar; 286(3):10.Worldwide, clinics have dispensed millions of free condoms and have counseled people about how to change their behavior to reduce the risk of HIV infection. Such prevention efforts have indeed helped stabilize or reduce the incidence of HIV infections in various countries. However, this editorial points out that the time has come for the developed world to acknowledge that treatment must join prevention in the battle against AIDS in developing nations. UN Secretary Koffi A. Annan included treatment as a priority in the newly established Global Fund to Fight AIDS, Tuberculosis and Malaria. In addition, the link between treatment and prevention is evident in the use of antiretroviral drugs to prevent mothers from passing on HIV to their babies. However, the high cost of most antiretroviral drugs and a dearth of doctors, clinics and hospitals block the use of AIDS drugs in many developing countries and political obstacles prevent their employment in many others.