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Pretreatment HIV-1 drug resistance in Argentina: results from a surveillance study performed according to WHO-proposed new methodology in 2014-15.
Journal of Antimicrobial Chemotherapy. 2017 Feb; 72(2):504-510.BACKGROUND: In Argentina, current national guidelines recommend starting with NNRTI-based regimens. Recently, there have been some local reports regarding concerning levels of NNRTI-transmitted resistance, but surveillance has never been carried out at a national level. OBJECTIVES: To determine the prevalence of HIV drug resistance in people starting ART in Argentina using a WHO-proposed methodology. METHODS: This was a cross-sectional, nationally representative study. Twenty-five antiretroviral-dispensing sites throughout the country were randomly chosen to enrol at least 330 persons starting ART, to generate a point prevalence estimate of resistance-associated mutations (RAMs) with a 5% CI (for the total population and for those without antiretroviral exposure). All consecutive patients older than 18 years starting or restarting ART in the chosen clinics were eligible. Samples were processed with Trugene and analysed using the Stanford algorithm. RESULTS: Between August 2014 and March 2015, we obtained 330 samples from people starting ART. The mean +/- SD age was 35 +/- 11 years, 63.4% were male, 16.6% had prior antiretroviral exposure and the median (IQR) CD4 count was 275 cells/mm3 (106-461). The prevalence of RAMs found was 14% (+/-4%) for the whole population (3% NRTI-RAMs; 11% NNRTI-RAMs and 2% PI-RAMs) and 13% (+/-4%) for those without prior antiretroviral exposure (3%, 10% and 2%, respectively). The most common mutation was K103N. CONCLUSIONS: This surveillance study showed concerning levels of HIV drug resistance in Argentina, especially to NNRTIs. Due to this finding, Argentina's Ministry of Health guidelines will change, recommending performing a resistance test for everyone before starting ART. If this is taken up properly, it also might function as a continuing surveillance tool. (c) The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: email@example.com.
Journal of Health Care Finance. 2010; 36(4):75-79.When the United Nations declared "health care for all" (at the conferences at Alma-Ata in 1978 and the Ottawa Charter in 1986),(1) the declarations were largely premature to impact the upcoming HIV/AIDS epidemic. These UN declarations still apply today, as multitudes of humanity continue to die from what amounts now to be a treatable chronic disease. Can the wealthier, industrialized countries stand by and watch the decimation of the populations of the developing world by HIV / AIDS? The global "health 9/10 gap," relates that only 10 percent of global heath resources go to developing countries - i.e., those having 90 percent of the poorest world populations. (2) The World Bank/World Health Organization has been at the forefront of providing resources for the global HIV/AIDS epidemic, (3) but for many countries of the developing world (especially Sub-Saharan Africa) it may be too little, too late. This work explores the application of an ecological model to global policy against HIV/AIDS, highlighting access to antiretroviral drugs (ARV). ARV distribution is constrained by patents and laws protecting the intellectual property rights of the international pharmaceutical corporations. In response to this situation, more questions arise. Will governments in the developing world invoke compulsory licensing (patent-breaking) in their negotiations with the international pharmaceutical corporations to provide medications against HIV/AIDS in their countries? Can international political and financial negotiations with these pharmaceutical corporations speed the growing push for a solution to this solvable crisis? The answers may lie in the "Brazilian model," that is a developing world government using all means available to provide ARV drugs for all its citizens with HIV/AIDS. The basis of this model includes negotiating with the pharmaceutical corporations over patent rights and importation of copied drugs from the Far East.
The sexual and reproductive health of young people in Latin America: Evidence from WHO case studies.
Salud Publica de Mexico. 2008 Jan-Feb; 50(1):10-16.This original article addresses the sexual and reproductive health needs of young people aged 15 to 24 in Latin America. It introduces five articles from original research projects in three countries: Argentina, Brazil, and Peru. These projects were funded by the World Health Organization. This article explains the importance of studies that address the sexual and reproductive health of young people in developing countries. It provides an overview of sexual and reproductive health issues in Latin America and a discussion these issues in the three study countries. The five articles deal with difficult and challenging issues, including: knowledge of STIs and HIV/ AIDS; pregnancy related practices; quality of care; the role of young men in couple formation, pregnancy and adoption of contraceptive practice; and, the role of obstetricians and gynecologists in public policy debate about family planning and abortion. The four articles in this special section help to improve our understanding of the factors that contribute to risky sexual behavior and negative reproductive health outcomes among youth in Latin America. The findings are useful to help inform and improve health care interventions in various contexts. (author's)
MEMORIAS DO INSTITUTO OSWALDO CRUZ. 1996 May-Jun; 91(3):335-8.The World Health Organization (WHO) Global Program on AIDS (GPA) organized the WHO Network for HIV-1 Isolation and Characterization to monitor HIV-1 variability. Brazil is one of the HIV vaccine trial sites selected by WHO-GPA. HIV-1 subtypes B, F, and C have thus far been found in the country. A study involving 235 Brazilian isolates found subtype B to prevail in 88.5% of cases, subtype F in 8.9%, and subtype C in 1.7%. 2 samples (0.9%) were variants resulting from a recombination between subtypes B and F. Further studies have found that Brazilian HIV-1 strains have genetic and antigenic differences compared to North American/European prototype strains, potentially affecting the success of immunoprophylactic programs based upon HIV-1 vaccine candidates currently proposed for testing in Brazil. A Brazilian Network for HIV-1 Isolation and Characterization (BNHIC) was thus established in March 1993, as part of the National Program of HIV/AIDS Vaccine Development and Evaluation. The BNHIC was organized upon a 3-tier basis including primary site, central reference laboratory, and secondary laboratories. The authors discuss efforts made to achieve network goals in Brazil.
Issues related to scientific, technical, population, and behavioral preparation in WHO-selected sites.
In: International Symposium on Biomedical Research Issues of HIV Infection in Thailand. Bangkok, Thailand, January 31 - February 2, 1994. Sponsors: Thailand Health Research Institute, Harvard AIDS Institute, Ministry of Public Health of Thailand, Center for Vaccine Development, Mahidol University. Cambridge, Massachusetts, Harvard AIDS Institute, 1994. 23-4.For the past three years, the World Health Organization (WHO) has been working with national authorities and scientists from the four countries which have been identified as appropriate for the establishment of WHO-sponsored sites for HIV vaccine evaluation: Brazil, Rwanda, Thailand, and Uganda. National plans for HIV vaccine development and evaluation have been prepared by the countries and endorsed by the WHO. The plans detail the national policy and nationally acceptable guidelines for the approval and initiation of HIV vaccine-related activities. They provide specific recommendations for the selection of participating institutions, for interactions with other national and international AIDS research programs, for infrastructure strengthening, and for training and specific research activities. In preparation for phase III vaccine efficacy trials, the following priority research areas have been identified: virologic, clinical, epidemiologic, and sociobehavioral research. Research in these areas is discussed. It is also important to develop a comprehensive public information strategy to help maintain community support and political commitment. Finally, trials must be conducted with only the highest ethical standards.