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Low levels of antiretroviral-resistant HIV infection in a routine clinic in Cameroon that uses the World Health Organization (WHO) public health approach to monitor antiretroviral treatment and adequacy with the WHO recommendation for second-line treatment.
Clinical Infectious Diseases. 2009 May 1; 48(9):1318-22.A cross-sectional study, performed at a routine human immunodeficiency virus (HIV)/AIDS clinic in Cameroon that uses the World Health Organization public health approach, showed low rates of virological failure and drug resistance at 12 and 24 months after initiation of antiretroviral therapy. Importantly, the cross-sectional study also showed that the World Health Organization recommendation for second-line treatment would be effective in almost all patients with HIV drug resistance mutations.
Eastern Mediterranean Health Journal. 2008; 14 Suppl:S90-6.Now, 28 years after acquired immune deficiency syndrome (AIDS) was first recognised, it has become a global pandemic affecting almost all countries. WHO/UNAIDS (Joint United Nations Programme on HIV/AIDS) estimate the number of people living with human immunodeficiency virus (HIV) worldwide in 2007 at 33.2 million. Every day 68 000 become infected and over 5700 die from AIDS; 95% of these infections and deaths have occurred in developing countries. The HIV pandemic remains the most serious of infectious disease challenges to public health. Sub-Saharan Africa remains the most seriously affected region, with AIDS the leading cause of death there. Although percentage prevalence has stabilized, continuing new infections (even at a reduced Estimated number of people living with HIV globally, 1990-2007, data from UNAIDS rate) contribute to the estimated number of persons living with HIV, 33.2 million (30.6-36.1 million). A defining feature of the pandemic in the current decade is the increasing burden of HIV infection in women, which has additional implications for mother-to-child transmission. In sub-Saharan Africa, almost 61% of adults living with HIV in 2007 were women. The impact of HIV mortality is greatest on people in their 20s and 30s; this severely distorts the shape of the population pyramid in affected societies. Globally, the number of children living with HIV increased from 1.5 million in 2001 to 2.5 million in 2007, 90% of them in sub-Saharan Africa. HIV/AIDS also poses a threat to economic growth in many countries already in distress. According to the World Bank analysis of 80 developing countries, as the prevalence of HIV infection increases from 15% to 30%, the per capita gross domestic product decreases 1.0%-1.5% per year. The powerful negative impact of AIDS on households, productive enterprises and countries stems partly from the high cost of treatment, which diverts resources from productive investments, but mostly from the fact that AIDS affects people during their economically productive adult years, when they are responsible for the support and care of others. This crisis has necessitated a unique and truly global response to meld the resources, political power, and technical capacity of all UN organizations, developing countries and others in a concerted manner to curb the pandemic. AIDS often engenders stigma, discrimination, and denial, because of its association with marginalized groups, sexual transmission and lethality, hence it requires a more comprehensive and holistic approach. During the past 10 years, many developments have occurred in response to this pandemic. WHO has played an important role in this response. This article reviews the major developments in treatment and prevention and the role of WHO in response to these developments.
Improving maternal health to achieve the Millennium Development Goals in the Eastern Mediterranean Region: a youth lens.
Eastern Mediterranean Health Journal. 2008; 14 Suppl:S97-106.The fifth Millennium Development Goal (MDG) aims to improve maternal health. The 2 targets set for this goal are to "reduce by three-quarters, between 1990 and 2015, the maternal mortality ratio" and "achieve, by 2015, universal access to reproductive health". Six indicators have been selected to help track progress towards these targets: maternal mortality ratio; proportion of births attended by skilled health personnel; contraceptive prevalence rate; adolescent birth rate; antenatal care coverage (at least 1 visit and at least 4 visits); and unmet need for family planning. This paper briefly outlines the general situation in relation to maternal health in the Eastern Mediterranean Region of the World Health Organization (WHO) and goes on to focus on the perspective of adolescent pregnancy and reproductive health.
Teddington, United Kingdom, Tearfund, 2008 Jul. 44 p.This report provides an overview of PMTCT and is an attempt to explore what is working, and why, in scaling up access. The report captures innovative examples of successful programming and partnerships, while identifying challenges and bottlenecks that must be overcome if these countries are to meet their nationally set universal access targets by 2010. The research methodology used for this report was based on a desk review, interviews with key global informants (see Acknowledgements) and country case studies in Malawi, Nigeria and Zambia in early 2008. The in-country study included semi-structured interviews with representatives of government and nongovernmental organisations as well as focus group discussions with community representatives, participatory and observational methodologies. The main objectives of the research were to: 1) identify and conduct interviews with the key international and national stakeholders and explore the structure, components, implementation, co-ordination, financing, policies, and guidelines and monitoring system of the PMTCT programmes; 2) determine what was working well and why; and 3) identify specific bottlenecks, challenges and recommendations for progress. This report provides an overview of the perceptions of key experts and communities on PMTCT interventions and approaches, current global action and country progress.
World Health and Population. 2008; 10(2):25-39.Our study examines factors influencing demand for contraception for spacing as well as for limiting births in India. Data on socio-economic, demographic and program factors affecting demand for contraception in India are from the National Family Health Survey, 1998--99. The recent document from the National Rural Health Mission has completely ignored the use of contraception in controlling fertility in India. Empirical results of our study suggest giving priority to and focusing attention on supply-side factors such as a regular and sustained supply of quality contraceptive methods to improve accessibility and affordability. Further, strengthening the information, education and communication (IEC) component of the reproductive and child health (RCH) package would allay misapprehensions about the side effects and health risks of contraception. Focusing attention on demand-side factors such as women's empowerment through education, gainful employment and exposure to mass-media would help reduce the unmet demand for family planning. The resulting reduction in fertility would hasten the process of demographic transition and population stabilization in India.
Reproductive health surveillance in the US-Mexico border region: beyond the border (and into the future) [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A109.This editorial examines reproductive health surveillance in the US- Mexico border region. It offers improvements for reproductive health data system methods and recommendations for sustainability of the project. It also proposes revisions to the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP) in the following areas: maternal birthing experiences, women’s health over the life course, migration history, acculturation/cultural identity/border region identity, Latina reproductive health, and MCH policy relevance.
The past, present, and future of reproductive health surveillance in the US-Mexico border region [editorial]
Preventing Chronic Disease. 2008 Oct; 5(4):A110.This editorial discusses reproductive health surveillance in the US- Mexico border region. It touches on past, present and future projects for that area including the United States- Mexico Border Health Commission (USMBHC) and the Brownsville-Matamoros Sister City Project for Women’s Health (BMSCP).
Journal of Pediatric Gastroenterology and Nutrition. 2008 Aug; 47 Suppl 1:S10-4.In Latin America and the Caribbean, malnutrition still represents a health concern expressed mainly as stunting and micronutrient deficiencies, lessening the attention given to acute malnutrition (moderate and severe); however, the latter has a high fatality rate. Ending these avoidable deaths represents a major health and ethical challenge in the region. Acute malnutrition plus infections (mainly diarrhea and pneumonia) determine an important fraction of the fatality rate due to malnutrition in most regions, especially those with higher poverty and social instability. Application of the World Health Organization guidelines for the treatment of children with acute severe malnutrition reduces the fatality rate significantly. Among the many possibilities for treatment, systems based on day care centers and at home should be promoted. Training in the application of the World Health Organization guidelines should be incorporated into the curricula of health-related professions in countries where malnutrition is prevalent.
Sexually Transmitted Infections. 2008; 84(Suppl 1):i1-i4.This introductory article refers to the journal supplement that assembles important new data relating to several assumptions used for the new HIV and AIDS estimates. The collection of methodological papers in the supplement, aim to provide easy access to the scientific basis underlying the latest HIV and AIDS estimates for 2007.
Journal of Health, Population, and Nutrition. 2008 Sep; 26(3):280-94.Bangladesh is on its way to achieving the MDG 5 target of reducing the maternal mortality ratio by three-quarters between 1990 and 2015, but the annual rate of decline needs to triple. Although the use of skilled birth attendants has improved over the past 15 years, it remains less than 20% as of 2007 and is especially low among poor, uneducated rural women. Increasing the numbers of skilled birth attendants, deploying them in teams in facilities, and improving access to them through messages on antenatal care to women, have the potential to increase such use. The use of caesarean sections is increasing although not among poor, uneducated rural women. Strengthening appropriate quality emergency obstetric care in rural areas remains the major challenge. Strengthening other supportive services, including family planning and delayed first birth, menstrual regulation, and education of women, are also important for achieving MDG 5.
MEASURE Evaluation Bulletin. 2001; (2):1-27.This issue of the MEASURE Evaluation Bulletin includes articles in a number of areas of monitoring and evaluation of AIDS programs. The first four articles are based on a field test of indicators on knowledge, sexual behavior and stigma that was carried out as part of a large international effort to improve monitoring and evaluation of national programs. The field test resulted in revisions of standard indicators for AIDS programs, which were eventually published by UNAIDS, and revisions of the survey tools that are now used to collect AIDS information in many countries. Three subsequent articles deal with different aspects of monitoring and evaluation. The first of these explores estimation of the size of core groups, such as commercial sex workers or bar workers, which is essential but difficult. Capture-recapture techniques can be used to make such estimates, although there are multiple pitfalls. The next article focuses on monitoring trends in HIV prevalence among young antenatal women, which is the most feasible method of monitoring HIV incidence. Modelling shows that using prevalence trends to extrapolate incidence trends has to be done very carefully, but can be done if one takes measures to minimize the various biases. The last article of the Bulletin discusses the use of newspaper clippings as a source of indicators on political will and commitment and stigma. Although newspaper clippings have been cited as an easily accessible source for these indicators, the analysis suggests that an analysis of newspaper clippings may be more suitable for a cross-sectional situation analysis or in-depth qualitative research than for monitoring purposes. (excerpt)
Washington, D.C., World Bank, 2008.  p.The World Bank is committed to support Sub-Saharan Africa in responding to the HIV/AIDS epidemic. This Agenda for Action (AFA) is a road map for the next five years to guide Bank management and staff in fulfilling that commitment. It underscores the lessons learned and outlines a line of action. HIV/AIDS remains - and will remain for the foreseeable future - an enormous economic, social, and human challenge to Sub-Saharan Africa. This region is the global epicenter of the disease. About 22.5 million Africans are HIV positive, and AIDS is the leading cause of premature death on the continent. HIV/AIDS affects young people and women disproportionately. Some 61 percent of those who are HIV positive are women, and young women are three times as likely to be HIV positive than are young men. As a result of the epidemic, an estimated 11.4 million children under age 18 have lost at least one parent. Its impact on households, human capital, the private sector, and the public sector undermines the alleviation of poverty, the Bank's overarching mandate. In sum, HIV/AIDS threatens the development goals in the region unlike anywhere else in the world. (excerpt)
Paris, France, UNESCO, 2008.  p. (Advocacy Briefing Note; ED/UNP/HIV/2008/IATT-ABN4)Teachers play a key custodian role within the educational system. They serve as role models, mentors and guardians. They are also central to efforts to achieve the Education for All (EFA) and Millennium Development Goals (MGDs), as educational is seen both as a right and as a central pillar of efforts to eradicate poverty. Like all members of the population, however, teachers are susceptible to HIV. In countries with high HIV infection rates, most notable in sun-Saharan Africa, this susceptibly is increasingly noticeable. As more and more teachers die, an already weakened educational system is left with the dual challenge of increasing numbers of pupils and decreasing numbers of teachers. (excerpt)
Paris, France, UNESCO, 2008.  p. (Advocacy Briefing Note; ED/UNP/HIV/2008/IATT-ABN2)Education and HIV & AIDS are inextricably linked. On the one hand, the chances of achieving crucial education goals set by the international community are severely threatened by HIV and AIDS. On the other hand, global commitments to strategies, policies and programs that reduce the vulnerability of children and young people to HIV will not be met without the full contribution of the education sector. Preventing and mitigating the impact of the AIDS epidemic through the education sector is critical, yet all too often responsibility for education and HIV has fallen under different spheres of authority. HIV and AIDS is frequently an add-on to the existing education system, rather than an integral part of education planning. A comprehensive sector-wide approach which mainstreams HIV and AIDS into existing education sector programs - taking account of the underlying causes of vulnerability to HIV infection and the longer term consequences of AIDS - is a crucial step towards addressing the epidemic. In addition, early mainstreaming actions in low prevalence countries may help to stem the surge of AIDS epidemics and reduce the likelihood that concentrated epidemics become more generalized. (excerpt)
Anti-tuberculosis drug resistance in the world. Fourth global report. The WHO / IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance, 2002-2007.
Geneva, Switzerland, World Health Organization [WHO], 2008.  p. (WHO/HTM/TB/2008.394)This is the fourth report of the WHO/IUATLD Global Project on Anti-Tuberculosis Drug Resistance Surveillance. The three previous reports were published in 1997, 2000 and 2004 and included data from 35, 58 and 77 countries, respectively. This report includes drug susceptibility test (DST) results from 91,577 patients from 93 settings in 81 countries and 2 Special Administrative Regions (SARs) of China collected between 2002 and 2006, and representing over 35% of the global total of notified new smear-positive TB cases. It includes data from 33 countries that have never previously reported. New data are available from the following high TB burden countries: India, China, Russian Federation, Indonesia, Ethiopia, Philippines, Viet Nam, Tanzania, Thailand, and Myanmar. Between 1994 and 2007 a total of 138 settings in 114 countries and 2 SARs of China had reported data to the Global Project. Trend data (three or more data points) are available from 48 countries. The majority of trend data are reported from low TB prevalence settings; however this report includes data from three Baltic countries and 2 Russian Oblasts. Trend data were also available from 6 countries conducting periodic or sentinel surveys (Cuba, Republic of Korea, Nepal, Peru, Thailand, and Uruguay). (excerpt)
In: Disease control priorities in developing countries. 2nd ed., edited by Dean T. Jamison, Joel G. Breman, Anthony R. Measham, George Alleyne, Mariam Claeson et al. Washington, D.C., World Bank, 2006. 531-549.This chapter provides an overview of neonatal deaths, presenting the epidemiology as a basis for program priorities and summarizing the evidence for interventions within a health systems framework, providing cost and impact estimates for packages that are feasible for universal scale-up. The focus of the chapter is restricted to interventions during the neonatal period. The priority interventions identified here are largely well known, yet global coverage is extremely low. The chapter concludes with a discussion of implementation in country programs with examples of scaling up, highlighting gaps in knowledge. (excerpt)
In: Disease control priorities in developing countries. 2nd ed., edited by Dean T. Jamison, Joel G. Breman, Anthony R. Measham, George Alleyne, Mariam Claeson et al. Washington, D.C., World Bank, 2006. 499-529.The Millennium Declaration includes two goals directly relevant to maternal and perinatal conditions: reducing child mortality and improving maternal health. The fact that two out of the eight Millennium Development Goals (MDGs) are exclusively targeted at mothers and children is testament to the significant proportion of the global burden of disease they suffer and to the huge inequities within and between countries in the magnitude of their burden. Achieving these goals is inextricably linked at the biological, intervention, and service delivery levels. Maternal and child health services have long been seen as inseparable partners, although over the past 20 years the relative emphasis within each, particularly at a policy level, has varied. The launch of the Safe Motherhood Initiative in the late 1980s, for example, brought heightened attention to maternal mortality, whereas the International Conference on Population and Development (ICPD) broadened the focus to reproductive health and, more recently, to reproductive rights. Those shifts can be linked with international programmatic responses and terminology-with the preventive emphasis of, for instance, prenatal care being lowered as a priority relative to the treatment focus of emergency obstetric care. For the child, integrated management of childhood illnesses has brought renewed emphasis to maintaining a balance between preventive and curative care. The particular needs of the newborn, however, have only started to receive significant attention in the past three or four years. (excerpt)
Washington, D.C., World Bank, Human Development Network, Health, Nutrition and Population Team, 2007 Aug. 51 p. (Policy Research Working Paper No. 4295)Tuberculosis is the most important infectious cause of adult deaths after HIV/AIDS in low- and middle-income countries. This paper evaluates the economic benefits of extending the World Health Organization's DOTS Strategy (a multi-component approach that includes directly observed treatment, short course chemotherapy and several other components) as proposed in the Global Plan to Stop TB, 2006-2015. The authors use a model-based approach that combines epidemiological projections of averted mortality and economic benefits measured using value of statistical life for the Sub-Saharan Africa region and the 22 high-burden, tuberculosis-endemic countries in the world. The analysis finds that the economic benefits between 2006 and 2015 of sustaining DOTS at current levels relative to having no DOTS coverage are significantly greater than the costs in the 22 high-burden, tuberculosis-endemic countries and the Africa region. The marginal benefits of implementing the Global Plan to Stop TB relative to a no-DOTS scenario exceed the marginal costs by a factor of 15 in the 22 high-burden endemic countries, a factor of 9 (95% CI, 8-9) in the Africa region, and a factor of 9 (95% CI, 9-10) in the nine high-burden African countries. Uncertainty analysis shows that benefit-cost ratios of the Global Plan strategy relative to sustained DOTS were unambiguously greater than one in all nine high-burden countries in Africa and in Afghanistan, Pakistan, and Russia. Although HIV curtails the effect of the tuberculosis programs by lowering the life expectancy of those receiving treatment, the benefits of the Global Plan are greatest in African countries with high levels of HIV. (author's)
Geneva, Switzerland, UNAIDS, . 13 p.For over 25 years, our world has been living with HIV. And in just this short time, AIDS has become one of the make-or-break global crises of our age, undermining not just the health prospects of entire societies but also their ability to reduce poverty, promote development, and maintain national security. And in too many regions AIDS continues to expand - every single day 11 000 people are newly infected with HIV, and nearly 8 000 people die from AIDS-related illnesses. Yet, despite the magnitude of the AIDS crisis, today we are at a time of great hope and great opportunity to get ahead of the epidemic. Our crisis-response tactics have led to real progress against AIDS. Funding for efforts against AIDS has risen from 'millions' to 'billions' in just a decade. Political commitment and leadership on AIDS is higher than ever before. In more and more countries - including some of the world's poorest - we are seeing real results in terms of lives saved because effective HIV prevention and treatment programmes are being made widely available. Leaders of both developing and rich countries have now committed themselves to working together so as to get close to universal access to HIV prevention, treatment, care and support by 2010 - a critical stepping stone to halting the epidemic by 2015, as set out in the Millennium Development Goals. (excerpt)
Lancet. 2007 Sep 22; 370(9592):1032-1033.Cost-effectiveness analysis, as referenced by Davide Mauri and Nikolaos Polyzos, constitutes one of several sources of information considered by policymakers in developing and developed worlds in making decisions about the optimum efficient use of health-care resources. The WHO Commission on Macroeconomics and Health has suggested that interventions costing less than three times a country's per capita gross domestic product per disability-adjusted life year gained can be regarded as good value, and analysts have equivalently applied this threshold to analyses that use quality-adjusted life years (QALYs). Preliminary results from a cost-effectiveness analysis of vaccination with quadrivalent HPV 6/11/16/18 vaccine in Mexico suggest a cost/QALY ratio well below this threshold in that country. Previous analyses in developed world settings have consistently shown that vaccination of girls and young women has a cost-effectiveness ratio within the range typically regarded as cost-effective. In countrieswith the fewest resources, direct assistance and public-private partnerships can help deliver needed medicines to the population at or below development costs-eg, the ivermectin donation for river blindness. Marc Arbyn states that if the cases of vaccine-type-related disease are subtracted from disease due to all types, there are a larger number of cases in women who received vaccine than in those who received placebo. This subtraction assumes that the subset of disease cases due to vaccine HPV types and the subset of cases due to non-vaccine HPV types are mutually exclusive, which is not the case. Coinfections with vaccine and non-vaccine types are common. In the presence of coinfection, the effect of such a subtraction is to ignore the presence of non-vaccine HPV types in disease where a vaccine-type HPV has also been detected. The effect of the subtraction is to preferentially attribute co-infected disease cases only to the vaccine HPV types. Individuals in the placebo group are more likely to have their non-vaccine type-related disease discounted in this way. Owing to the high efficacy of the vaccine, individuals in the vaccine group have less vaccine-type-related disease, and so those in the vaccine group have fewer such coinfection cases. To illustrate this point, an analysis of the numbers of individuals with disease due to vaccine and non-vaccine HPV types in the intention-to-treat population of protocols 013 and 015 is presented in the figure. The parts shaded blue would be the result of subtraction, similar to Arbyn's subtraction. However, the total numbers of cases of disease related to non-vaccine HPV types are 226+56=282 cases in the vaccine group and 193+106=299 cases in the placebo group. There is not an excess of cases caused by non-vaccine HPV types in the vaccine group. (full text)
Deaths and disease burden by cause: global burden of disease estimates for 2001 by World Bank country groups. Revised.
[Washington, D.C.], World Bank, Disease Control Priorities Project, 2005 Jan.  p. (Disease Control Priorities Project Working Paper No. 18)The World Health Organization has undertaken a new assessment of the GBD for the year 2000 and subsequent years. The three goals articulated for the GBD 1990 (8) remain central: to decouple epidemiological assessment of the magnitude of health problems from advocacy by interest groups of particular health policies or interventions; to include in international health policy debates information on non-fatal health outcomes along with information on mortality; and to undertake the quantification of health problems in time-based units that can also be used in economic appraisal. The specific objectives for GBD 2000 are similar to the original objectives: to quantify the burden of premature mortality and disability by age, sex, and region for 135 major causes or groups of causes; to develop internally consistent estimates of the incidence, prevalence, duration, and case-fatality for over 500 sequelae resulting from the above causes; to describe and value the health states associated with these sequelaeof diseases and injuries; to analyze the contribution to this burden of major physiological, behavioral, and social risk factors by age, sex and region; to develop alternative projection scenarios of mortality and non-fatal health outcomes over the next 30 years, disaggregated by cause, age, sex and region. (excerpt)
Joint UNFPA-UNICEF-WHO Meeting on Prevention and Control of Sexually Transmitted Infections in the Pacific, 8-11 November 2005, Nadi, Fiji.
Manila, Philippines. WHO, Regional Office for the Western Pacific, .  p. ((WP)HSI/ICP/HSI/3.5/001; Report Series No. RS/2005/GE/36(FIJ))The Joint UNFPA-UNICEF-WHO Meeting on Prevention and Control of Sexually Transmitted Infections in the Pacific was held at the Mocambo Hotel in Nadi, Fiji, from 8 to 11 November 2005 with the following objectives: to review the current sexually transmitted infection (STI) situation in the Pacific island countries and areas; to share experiences, lessons learnt and the latest developments in STI prevention and control; and to identify issues, gaps and key actions needed for effective prevention and control of STI in the Pacific island countries and areas. The programme included technical presentations, situation reports from countries and partners and open forum discussion across a broad range of issues related to the epidemiology, prevention and control of STIs: the status of STIs in countries in the Pacific region; new STI case management strategies; the role of laboratories in STI case management, screening and surveillance systems; special needs for dealing with STIs in high-risk groups like antenatal women, sex workers and their clients, and youth; the integration of STIs into reproductive health services; and Pacific STI networking, both current and planned. Meeting participants reached a number of conclusions and made recommendations. These included: recognition of the important individual and public health hazards that STIs present in the Pacific region; the special clinical and epidemiological challenges that are presented by chlamydiosis; the utility of syndromic case management in controlling STIs, the importance of STI intervention programmes targeting "core" and "bridging" groups; and the role of partnerships and STI networks in the Pacific region. Each participating country identified its immediate priority needs as well as priorities for regional support. (author's)
UNAIDS and WHO Consultation on Progress in Prevention and Care in the Context of the "3 By 5 Initiative" and the Perspective of Universal Access in the Western Pacific Region, 12-16 December 2005, Manila, Philippines. Report.
Manila, Philippines. WHO, Regional Office for the Western Pacific, .  p. ((WP)HSI/ICP/HSI/3.5/001; Report Series No. RS/2005/GE/45(PHL))The WHO Western Pacific Regional Office, in collaboration with the Joint United Programme on HIV/AIDS (UNAIDS), organized the four-day UNAIDS and WHO Consultation on Progress in Prevention and Care in the Context of the "3 by 5" Initiative and the Perspective of Universal Access in the Western Pacific Region with the general objective that, by the end of the consultation, the participants would have: (1) reviewed progress made on prevention and care scale-up in the context of the "3 by 5" Initiative; (2) shared experiences among countries on the current performance of monitoring and evaluation systems related to HIV/AIDS care, treatment and support: (3) identified ways to strengthen the integration of HIV/AIDS prevention and care: and (4) defined the conditions and terms of reference of a partners technical working group on HIV/AIDS prevention and care scale-up in the Western Pacific Region. (excerpt)
New York, New York, United Nations, Department of Economic and Social Affairs, Population Division, 2005.  p. (ST/ESA/SER.A/247)The HIV/AIDS epidemic has been a gathering force for nearly a quarter-century, and it continues to be a major global challenge. AIDS finds its victims in both rich and poor countries. There is no region of the world where HIV/AIDS is not a potentially serious threat to the population. Sub-Saharan Africa has so far borne the brunt of the AIDS devastation, and the region continues to experience high rates of infection. About 3 million people in the region were newly infected with the virus in 2004. Countries in Eastern Europe and Asia now have the fastest-growing rates of HIV infection in the world, and the populous countries of China, India and Indonesia are of particular concern. In some more developed countries, there are signs of a resurgence of risky sex between men. (excerpt)
Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: Evaluation of a two-tiered approach.
PLoS Medicine. 2007 Aug; 4(8):e257.Highly active antiretroviral treatment (HAART) has only been recently recommended for HIV-infected pregnant women requiring treatment for their own health in resource-limited settings. However, there are few documented experiences from African countries. We evaluated the short-term (4 wk) and long-term (12 mo) effectiveness of a two-tiered strategy of prevention of mother-to-child transmission of HIV (PMTCT) in Africa: women meeting the eligibility criteria of the World Health Organization (WHO) received HAART, and women with less advanced HIV disease received short-course antiretroviral (scARV) PMTCT regimens. The MTCT-Plus Initiative is a multi-country, family-centred HIV care and treatment program for pregnant and postpartum women and their families. Pregnant women enrolled in Abidjan, Cote d'Ivoire received either HAART for their own health or short-course antiretroviral (scARV) PMTCT regimens according to their clinical and immunological status. Plasma HIV-RNA viral load (VL) was measured to diagnose peripartum infection when infants were 4 wk of age, and HIV final status was documented either by rapid antibody testing when infants were aged >/= 12 mo or by plasma VL earlier. The Kaplan-Meier method was used to estimate the rate of HIV transmission and HIV-free survival. Between August 2003 and June 2005, 107 women began HAART at a median of 30 wk of gestation, 102 of them with zidovudine (ZDV), lamivudine (3TC), and nevirapine (NVP) and they continued treatment postpartum; 143 other women received scARV for PMTCT, 103 of them with sc(ZDV+3TC) with single-dose NVP during labour. Most (75%) of the infants were breast-fed for a median of 5 mo. Overall, the rate of peripartum HIV transmission was 2.2% (95% confidence interval [CI] 0.3%-4.2%) and the cumulative rate at 12 mo was 5.7% (95% CI 2.5%-9.0%). The overall probability of infant death or infection with HIV was 4.3% (95% CI 1.7%-7.0%) at age week 4 wk and 11.7% (95% CI 7.5%-15.9%) at 12 mo. This two-tiered strategy appears to be safe and highly effective for short- and long-term PMTCT in resource-constrained settings. These results indicate a further benefit of access to HAART for pregnant women who need treatment for their own health. (author's)