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The evolving cost of HIV in South Africa: Changes in health care cost with duration on antiretroviral therapy for public sector patients.
Journal of Acquired Immune Deficiency Syndromes. 2007 Jul; 45(3):348-354.A retrospective costing study of 212 patients enrolled in a nongovernmental organization-supported public sector antiretroviral treatment (ART) program near Cape Town, South Africa was performed from a health care system perspective. t-Regression was used to analyze total costs in 3 periods: Pre-ART (median length = 30 days), first 48 weeks on ART (Year One), and 49 to 112 weeks on ART (Year Two). Average cost per patient Pre-ART was $404. Average cost per patient-year of observation was $2502 in Year One and $1372 in Year Two. The proportion of costs attributable to hospital care fell from 70% Pre-ART to 24% by Year Two; the proportion attributable to ART rose from 31% in Year One to 55% in Year Two. In multivariate analysis, Pre-ART and Year One costs were significantly lower for asymptomatic patients compared with those with AIDS. Costs were significantly higher for those who died Pre-ART or in Year One. In Year Two, only week 48 CD4 cell count and being male were significantly associated with lower costs. This analysis suggests that the total cost of treatment for patients on ART falls by almost half after 1 year, largely attributable to a reduction in hospital costs. (author's)
Malaria treatment policy: technical support needs assessment. Malaria Action Coalition (MAC) Senegal Mission report, March 14-21, 2005.
Arlington, Virginia, Management Sciences for Health [MSH], Rational Pharmaceutical Management Plus, 2005. 18 p. (USAID Cooperative Agreement No. HRN-A-00-00-00016-00; USAID Development Experience Clearinghouse DocID / Order No. PN-ADF-437)African countries are undergoing a period of dramatic change in their national malaria treatment policies as more of these countries adopt artemisinin-based combination therapy (ACT). Successful implementation of the new ACT policies presents many challenges and most countries will require technical assistance from a variety of sources, both internal and external. The Malaria Action Coalition (MAC) partnership brings together three partners that have considerable expertise in many of the areas related to ACT implementation, which complements expertise brought by other Roll Back Malaria (RBM) partners. The U.S. Agency for International Development (USAID) has made a commitment to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) to provide technical assistance through MAC. This mission was therefore designed to assess the progress of Senegal toward implementing the new ACT policy and to determine what, if any, additional technical support it may need to successfully complete the implementation. It is expected that the successful implementation of the ACT policy will contribute to the attainment of the RBM goals for the prevention, treatment, and control of malaria in sub-Saharan Africa through coordinated technical support. (excerpt)
Dialectical Anthropology. 2004; 28(3-4):261-287.It is now impossible to view the AIDS pandemic solely from the vantage point of its health ramifications. Like a tornado wreaking havoc to everything in its path, AIDS has also torn the social, economic and political fabric of several societies to shreds. In January, 2000, while speaking at the UN Security Council Session, James Wolfensohn, President of the World Bank, stated: "Many of us used to think of AIDS as a health issue. We were wrong... nothing we have seen is a greater challenge to the peace and stability of African societies (and much of the world) than the epidemic of AIDS... we face a major development crisis, and more than that, a security crisis." Four years and more than eight million deaths later, an equally passionate and resolute Kofi Annan, the UN Secretary General, spoke to the BBC and describe AIDS as "a real weapon of mass destruction" and bemoaned the world's relative inaction to combat this pandemic as "callousness that one would not have expected in the 21st century"... for which history would judge us all "harshly, very harshly.". (excerpt)
Dialectical Anthropology. 2004; 28(3-4):245-259.In the past quarter century HIV/AIDS has intensified poverty and suffering world wide, more so in underdeveloped countries and poor neighborhoods of cities within industrial nations. UNAIDS and WHO estimate that 40-60 million people are living with the disease worldwide. The poorest nations in Africa and the Caribbean in which HIV/AIDS have spread most rapidly also live under political, social and economic insecurity. For example, Haiti has experienced a brief civil war and a hurricane disaster in 2004; however, AIDS is the leading cause of death for adults, accounting for 5.9% of deaths and 20% of deaths among adult women. Many of the poorest African countries have also suffered concomitantly from civil wars and high HIV/AIDS prevalence. In the 1980s when Uganda had a civil war, this country was the epicenter of the pandemic world-wide, with an adult HIV prevalence of 30%. Liberia ended her civil war in 2003 and currently records an HIV prevalence of 8.2%. Sierra Leone also had a civil war which ended officially in 2002 with HIV/AIDS prevalence among the army of 46% and a rise in prevalence among the general population. Finally Rwanda emerged from civil war, genocide and mass dislocation in the 1990s and records 11.2% of adult prevalence. The economic crises from poor countries arose from "weak agricultural growth, a decline in industrial output, poor export production, high debt and deteriorating social indicators and institutions." Botswana with 35% prevalence and South Africa with 25% prevalence, though relatively more prosperous, continue to be weighed down by the legacy of apartheid in the form of a high migrant labor system and disruption of family life. (excerpt)
Keeping the promise: summary of the Declaration of Commitment on HIV / AIDS, United Nations General Assembly, Special Session on HIV / AIDS, 25-27 June 2001, New York.
Geneva, Switzerland, UNAIDS, 2002 Jun. 33 p. (UNAIDS/02.31E; PN-ACP-799)At the meeting, Heads of State and Representatives of Governments issued the Declaration of Commitment on HIV/AIDS. This Declaration describes in its preamble (paragraphs 1–36), the extent of the epidemic, the effects it has had, and the ways to combat it. The Declaration then states what governments have pledged to do—themselves, with others in international and regional partnerships, and with the support of civil society— to reverse the epidemic. The Declaration is not a legally binding document. However, it is a clear statement by governments concerning that which they have agreed should be done to fight HIV/AIDS and that which they have committed to doing, often with specific deadlines. As such, the Declaration is a powerful tool with which to guide and secure action, commitment, support and resources for all those fighting the epidemic, both within and outside government. This booklet simplifies and summarizes the text of the Declaration in an effort to make it more accessible to all and to encourage everyone to do his or her part to put it into action. Where possible, it pairs relevant paragraphs from the preamble with relevant sections from the body of the Declaration. The bold text in quotes is taken directly from the Declaration. Also included are quotes from some of the statements made by speakers at the meeting, as well as from people affected by HIV/AIDS. It should be stressed that the paragraphs in this booklet are simplified versions of those found in the Declaration. They should not be substituted for the full, original text when formal reference to the Declaration is needed. The original text is attached as an annex for easy reference. (excerpt)
BMJ. British Medical Journal. 2004 Apr 24; 328(7446): p..The Chinese government is to offer free HIV tests and treatments to those who cannot afford to pay. The policy includes free antiretroviral drugs, testing, prevention of mother to child transmission, and schooling of orphans. Joel Rehnstrom, country coordinator of UNAIDS China, said he was “very encouraged by the commitment of central government in China to provide free testing and treatment.” He added, however, that there would no doubt be setbacks: “I believe it will be an enormous challenge to provide free testing and treatment across China. My sense is that every country in the world should probably have woken up earlier to HIV/AIDS. China is no exception.” UNAIDS (the Joint United Nations Programme on HIV/AIDS) has been involved with the scheme, including the development of guidelines for testing, voluntary counselling, and antiretroviral treatment. According to the state controlled Chinese media, the central government will fund the scheme in areas with a high prevalence of HIV—for example, Yunnan and Sichuan in the south west. Areas not covered by central government will be funded by local governments. (excerpt)
Journal of the Indian Medical Association. 2003 Mar; 101(3):150-151.Tuberculosis (TB) remains a serious public health problem in spite of DOTS programme recommended by WHO. One person dies from TB in India every minute. Revised National TB Control Programme (RNTCP) is playing a major role in global DOTS expansion. DOTS coverage has expanded from 2% of the population in mid-1998 to 57% by the end of January, 2003. RNTCP has made a significant contribution to public health capacity. The programme has saved the people of India hundreds of millions of dollars. Monitoring the clinical course using smear microscopy and accurately reporting treatment outcomes is essential in well-functioning DOTS programme. RNTCP has invested heavily and made significant strides in maintaining and improving quality DOTS. State and district level programme reviews are a key component of the process. RNTCP has established guidelines for the involvement of the private sector and medical colleges. A member by ongoing technical activities will improve RNTCP’s surveillance and monitoring systems. However a challenge lies with the programme and a collective effort is welcome. (excerpt)
In: AIDS in Africa: Help the victims or ignore them?, edited by V. Lovell. New York, New York, Novinka Books, 2002. 1-21.Sub-Saharan Africa has been far more severely affected by AIDS than any other part of the world. According to a December 1, 2001 report issued by the Joint United Nations Program on HIV/AIDS (UNAIDS), some 28.1 million adults and children are infected with the HIV virus in the region, which has about 10% of the world's population but 70% of the worldwide total of infected people. The overall rate of infection among adults is about 8.4%, compared with 1.2% worldwide. UNAIDS projects that half or more of all 15 year-olds will eventually die of AIDS in some of the worst-affected countries, such as Zambia, South Africa, and Botswana, unless the risk of contracting the disease is sharply reduced. An estimated 19.3 million Africans have lost their lives to AIDS, including an estimated 2.3 million who died in 2001. UNAIDS estimates that 3.4 million new HIV infections occurred in 2001, down from the estimated 3.8 million new infections in 2000. Experts are cautious in suggesting that this decline might represent some success in prevention efforts, particularly since the adult infection rates continue to increase in a number of countries, including Nigeria, Africa's most populous nation. Moreover, they point out that 3.4 million new infections still represents a very fast and highly destructive rate of spread. AIDS has surpassed malaria as the leading cause of death in sub-Saharan Africa, and it kills many times more people than Africa's armed conflicts. (excerpt)
Lancet. 2003 Sep 13; 362(9387):879.In a damning indictment of China’s efforts to control the spread of HIV/AIDS, an international human rights organisation has accused the country’s central and local authorities of a cover-up that fosters discrimination, prevents adequate treatment, and threatens to worsen what is already one of the world’s largest outbreaks of the disease. (excerpt)
WORLD BANK POLICY AND RESEARCH BULLETIN. 1998 Jan-Mar; 9(1):1-5.According to the 1997 World Bank Policy Research Report "Confronting AIDS: Public Priorities in a Global Epidemic," 250 million people live in countries with generalized epidemics, where the rate of infection is highest among people who have the most risky behavior and at least 5% of women attending antenatal clinics are infected with HIV. Countries in this group include most countries of eastern and southern Africa, a few West African countries, and Guyana and Haiti. 1.6 billion people live in countries with concentrated epidemics, where more than 5% of those with the riskiest behavior are infected with HIV, but the rate of infection among pregnant women is low. Most of Indochina, Latin America, and West Africa, as well as China's Yunnan Province and about half of India are in this category. Half of the population of the developing world, 2.3 billion people, live in areas with nascent epidemics. Especially governments in countries with nascent epidemics need to take immediate action to prevent the further spread of HIV. This paper explains the reasons why government action is needed and what governments should do to prevent the spread of HIV infection and help people with AIDS. Prevention must be the key strategy of AIDS policy in developing countries, focusing upon changing the behavior of those at highest risk of contracting and spreading the virus. Efforts must also be made to disseminate information on HIV/AIDS, lower the cost of condom use, and lower the cost of unsafe injecting behavior. As much as they can with constrained resources, governments need to improve access to treatment for people with AIDS and prevent discrimination against them. Donor support for national AIDS programs is often critical.
AFRICA HEALTH. 1997 Nov; 20(1):19-20.About 80,000 cases of tuberculosis (TB) are reported annually in South Africa. However, control measures have failed to check the growing numbers of TB cases and the spread of HIV is bound to exacerbate the situation. The Western Cape has almost 3 times the national notification rate (663 vs. 225 per 100,000). With only 60-70% of patients in Western Cape found to adhere to treatment, the Community Health Association of South Africa (CHASA) recommended using the DOTS strategy to control TB. The DOTS method, however, burdens both health workers and those patients who have to travel long distances to reach a health center. Such inconvenience contributes to poor treatment compliance. Any strictly medical approach to TB eradication will fail. Medical interventions must instead be set within, and supported by, a strong social and political network. A change in attitude is needed in order to ensure the success of DOTS. The creation of the Western Cape TB Alliance (TBA), TB control-related research, DOTS implementation, and project objectives and achievements are described.
AIDS CARE. 1991; 3(4):395-8.While scientists demonstrated that they have pushed ahead in developing treatment and a vaccine for AIDS, comparatively little was voiced regarding AIDS as a development issue at the 7th Conference on AIDS. In the context of socioeconomic development, President Museveni of Uganda and others spoke on AIDS, recognizing the need for behavioral change in preventing HIV infection. The family was also recognized as a basic unit of caring, important in fostering global solidarity. Topics discussed included the fusion of technology and human response in the fight against AIDS, NGO-government integration, community home care, and the need for an difficulty of measuring behavior change. In research, evidence was presented attesting to the cost-effectiveness of home care, while other types of research interventions, the effectiveness of audiovisual media in message dissemination, evaluation methods, and ethnographic methods for program design and evaluation were also explored. Where participants addressed psychosocial factors in development, little was presented on training. Informal discussions were robust, and covered the need for academic research, the process of an international conference, program principle transferability, and counseling. There was, however, an overall realization at the conference that progress is slow, AIDS challenges human nature, and coordinated international efforts may be incapable of effecting more rapid positive change. Even though sweeping solutions to AIDS did not emerge from this conference, more appropriate programs and conferences may develop in the future, with this conference opening AIDS in the arenas of community, development, hope and science.