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Lancet. HIV. 2016 Sep; 3(9):e409.Add to my documents.
AIDS and Behavior. 2017 Jul; 21(Suppl 1):62-71.BACKGROUND: Nigeria accounts for 9% of the global HIV burden and is a signatory to Millennium Development Goals as well as the post-2015 Sustainable Development Goals. This paper reviews maturation of her HIV M&E system and preparedness for monitoring of the post-2015 agenda. METHODS: Using the UNAIDS criteria for assessing a functional M&E system, a mixed-methods approach of desk review and expert consultations, was employed. RESULTS: Following adoption of a multi-sectoral M&E system, Nigeria experienced improved HIV coordination at the National and State levels, capacity building for epidemic appraisals, spectrum estimation and routine data quality assessments. National data and systems audit processes were instituted which informed harmonization of tools and indicators. The M&E achievements of the HIV response enhanced performance of the National Health Management Information System (NHMIS) using DHIS2 platform following its re-introduction by the Federal Ministry of Health, and also enabled decentralization of data management to the periphery. CONCLUSION: A decade of implementing National HIV M&E framework in Nigeria and the recent adoption of the DHIS2 provides a strong base for monitoring the Post 2015 agenda. There is however a need to strengthen inter-sectoral data linkages and reduce the rising burden of data collection at the global level.
Projected Uptake of New Antiretroviral (ARV) Medicines in Adults in Low- and Middle-Income Countries: A Forecast Analysis 2015-2025.
PloS One. 2016; 11(10):e0164619.With anti-retroviral treatment (ART) scale-up set to continue over the next few years it is of key importance that manufacturers and planners in low- and middle-income countries (LMICs) hardest hit by the HIV/AIDS pandemic are able to anticipate and respond to future changes to treatment regimens, generics pipeline and demand, in order to secure continued access to all ARV medicines required. We did a forecast analysis, using secondary WHO and UNAIDS data sources, to estimate the number of people living with HIV (PLHIV) and the market share and demand for a range of new and existing ARV drugs in LMICs up to 2025. UNAIDS estimates 24.7 million person-years of ART in 2020 and 28.5 million person-years of ART in 2025 (24.3 million on first-line treatment, 3.5 million on second-line treatment, and 0.6 million on third-line treatment). Our analysis showed that TAF and DTG will be major players in the ART regimen by 2025, with 8 million and 15 million patients using these ARVs respectively. However, as safety and efficacy of dolutegravir (DTG) and tenofovir alafenamide (TAF) during pregnancy and among TB/HIV co-infected patients using rifampicin is still under debate, and ART scale-up is predicted to increase considerably, there also remains a clear need for continuous supplies of existing ARVs including TDF and EFV, which 16 million and 10 million patients-respectively-are predicted to be using in 2025. It will be important to ensure that the existing capacities of generics manufacturers, which are geared towards ARVs of higher doses (such as TDF 300mg and EFV 600mg), will not be adversely impacted due to the introduction of lower dose ARVs such as TAF 25mg and DTG 50mg. With increased access to viral load testing, more patients would be using protease inhibitors containing regimens in second-line, with 1 million patients on LPV/r and 2.3 million on ATV/r by 2025. However, it will remain important to continue monitoring the evolution of ARV market in LMICs to guarantee the availability of these medicines.
[Prevalence of HIV infection and associated factors in the Central African Republic in 2010] Prévalence de l’infection VIH et facteurs associés en République Centrafricaine en 2010.
Calverton, Maryland, ICF International, 2012 Apr.  p.Nearly 68 percent of all HIV-positive individuals worldwide live in Sub-Saharan Africa. The region remains the most severely affected in the world, even though only 12 percent of the world's population lives there. Central Africa, which is less afflicted than Southern and Eastern Africa, nevertheless has a high enough level of infection for it to be characterized as a generalized epidemic. This is the case in the Central African Republic. The Central African Republic has long lacked reliable data on the epidemic, which has slowed the national response that otherwise would have occurred with more factual data. In response to the perceived need, the United Nations Population Fund (UNFPA), World Bank, World Health Organization (WHO), and Joint United Nations Program on HIV/AIDS (UNAIDS) have financed HIV testing in two multiple indicator cluster surveys--the 2006 MICS and 2010 MICS. This partnership has led to collection of reliable data to monitor trends in HIV prevalence and distribution among the population age 15 to 49. Also monitored are distribution of the epidemic by geographic region and population group. Because the decrease in HIV prevalence between 2006 and 2010 will be interpreted as an encouraging sign of progress, it is important to remain vigilant. The disaggregated results show that the epidemic continues to grow in scope and provokes disastrous consequences in certain groups. For the first time since 2006, the Central African Republic has reliable data to inform decision-making and intervention planning. These data have permitted the pandemic areas in the Central African Republic to emerge from the shadows. For the future, we wish to put in place systematic HIV testing similar to that of the Demographic and Health Surveys (DHS) and the Multiple Indicator Cluster Surveys (MICS). The UNFPA office in the Central African Republic is committed to improving knowledge about HIV and reinforcing the availability of information for planning, implementation, and follow-up of the country's National Strategic Plan for the Fight against AIDS.
Geneva, Switzerland, UNAIDS, 2011 Oct.  p.These guidelines to UNAIDS’ preferred terminology have been developed for use by staff members, colleagues in the Programme’s 10 Cosponsoring organisations, and other partners working in the global response to HIV. Language shapes beliefs and may influence behaviours. Considered use of appropriate language has the power to strengthen the global response to the epidemic. UNAIDS is pleased to make these guidelines to preferred terminology freely available. It is a living, evolving document that is reviewed on a regular basis. Comments and suggestions for additions, deletions, or modifications should be sent to email@example.com.
Turning gender and HIV commitments into action for results: an update on United Nations interagency activities on women, girls, gender equality and HIV.
[Geneva, Switzerland], UNAIDS, 2009 Dec. 4 p.In September 2000, 189 UN Member States committed to achieving the Millennium Development Goals (MDGs) by 2015. Among these goals is a commitment to promoting gender equality and empowering women and combating HIV, malaria, and other diseases. Today, almost 10 years on, addressing gender inequality and AIDS remains the most significant challenge to achieving the MDGs, as well as broader health, human rights, and development goals. This update highlights key 2009 interagency initiatives, all of which operate at the intersection of gender equality, women's empowerment, and HIV.
Lancet. 2010 Dec 4; 376(9756):1874.This editorial argues that despite the report by UNAIDS that the trajectory of the HIV epidemic has been broken, a US Institute of Medicine (IOM) report paints a bleaker picture for the immediate future of HIV/AIDS in Africa. The IOM report states that sub-Saharan Africa bears 68% of the worldwide burden of HIV infection and the gap is growing between the number of people needing treatment and the availability of resources.
New York, New York, UNICEF, 2008 Apr. 48 p.This report will focus on three major themes. First, strengthening communities and families is crucial to every aspect of a child-centred approach to AIDS. Support by governments, NGOs and other actors should therefore be complementary to and supportive of these family and community efforts, through, for example, ensuring access to basic services. Second, interventions to support children affected by HIV and AIDS are most effective when they form part of strong health, education and social welfare systems. Unfortunately, because maternal and child health programmes are weak in many countries, millions of children, HIV-positive and -negative alike, go without immunization, mosquito nets and other interventions that contribute to the overall goal of HIV-free child survival. A final theme of this report is the challenge of measurement. Documenting advances and shortfalls strengthens commitment and guides progress. A number of countries have data available on the 'Four Ps', and targeted studies are being developed to assess the situation of the marginalized young people who are most at risk but often missed in routine surveys. (excerpt)
International guidelines on HIV / AIDS and human rights. 2006 consolidated version. Second International Consultation on HIV / AIDS and Human Rights, Geneva, 23-25 September 1996. Third International Consultation on HIV / AIDS and Human Rights, Geneva, 25-26 July 2002. Organized jointly by the Office of the United Nations High Commissioner for Human Rights and the Joint United Nations Programme on HIV / AIDS.
Geneva, Switzerland, Office of the United Nations High Commissioner for Human Rights, 2006. 115 p. (HR/PUB/06/9)The International Guidelines on HIV/AIDS and Human Rights arose because of various calls for their development in light of the need for guidance for Governments and others on how to best promote, protect and fulfill human rights in the context of the HIV epidemic. During the first International Consultation on AIDS and Human Rights, organized by the United Nations Centre for Human Rights, in cooperation with the World Health Organization, in Geneva, from 26 to 28 July 1989, participants discussed the possible elaboration of guidelines to assist policymakers and others in complying with international human rights standards regarding law, administrative practice and policy. Several years later, in his report to the Commission at its fifty-first session (E/CN.4/1995/45, para.135), the United Nations Secretary-General stated that "the development of such guidelines or principles could provide an international framework for discussion of human rights considerations at the national, regional and international levels in order to arrive at a more comprehensive understanding of the complex relationship between the public health rationale and the human rights rationale of HIV/AIDS. In particular, Governments could benefit from guidelines that outline clearly how human rights standards apply in the area of HIV/AIDS and indicate concrete and specific measures, both in terms of legislation and practice, that should be undertaken". (excerpt)
Geneva, Switzerland, UNAIDS, 2007 Dec. 50 p. (UNAIDS/07.27E; JC1322E)Every day, over 6800 persons become infected with HIV and over 5700 persons die from AIDS, mostly because of inadequate access to HIV prevention and treatment services. The HIV pandemic remains the most serious of infectious disease challenges to public health. Nonetheless, the current epidemiologic assessment has encouraging elements since it suggests: the global prevalence of HIV infection (percentage of persons infected with HIV) is remaining at the same level, although the global number of persons living with HIV is increasing because of ongoing accumulation of new infections with longer survival times, measured over a continuously growing general population; there are localized reductions in prevalence in specific countries; a reduction in HIV-associated deaths, partly attributable to the recent scaling up of treatment access; and a reduction in the number of annual new HIV infections globally. Examination of global and regional trends suggests the pandemic has formed two broad patterns: generalized epidemics sustained in the general populations of many sub-Saharan African countries, especially in the southern part of the continent; and epidemics in the rest of the world that are primarily concentrated among populations most at risk, such as men who have sex with men, injecting drug users, sex workers and their sexual partners. (excerpt)
Global progress in PMTCT and paediatric HIV care and treatment in low- and middle-income countries in 2004 -- 2005.
Reproductive Health Matters. 2007 Sep; 15(30):179-189.A growing number of countries are moving to scale up interventions for prevention of mother-to-child transmission (PMTCT) of HIV in maternal and child health services. Similarly, many are working to improve access to paediatric HIV treatment. This paper reviews national programme data for 2004-2005 from low- and middle-income countries to track progress in these programmes. The attainment of the UNGASS target of reducing HIV infections by 50% by 2010 necessitates that 80% of all pregnant women accessing antenatal care receive PMTCT services. In 2005, only seven of the 71 countries were on track to meet this target. However PMTCT coverage increased from 7% in 2004 (58 countries) to 11% in 2005 (71 countries). In 2005, 8% of all infants born to HIV positive mothers received antiretroviral prophylaxis for PMTCT, up from 5% in 2004, though only 4% received cotrimoxazole. 11% of HIV positive children in need received antiretroviral treatment in 2005. In 31 countries that had data, 28% of women who received an antiretroviral for PMTCT also reported receiving antiretroviral treatment for their own health. Achieving the UNGASS target is possible but will require substantial investments and commitment to strengthen maternal and child health services, the health workforce and health systems to move from pilot projects to a decentralised, integrated approach. (author's)
Civil society involvement in rapid assessment, analysis and action planning (RAAAP) for orphans and vulnerable children. An independent review.
London, England, UK Consortium on AIDS and International Development, 2005 Jul. 63 p. (Orphans and Vulnerable Children)The Rapid Assessment, Analysis, and Action Planning (RAAAP) Initiative for orphans and other vulnerable children (OVC) was launched by UNICEF, USAID, UNAIDS, and WFP in November 2003. The first round of RAAAPs were carried out in 16 countries in Sub-Saharan Africa in 2004. The purpose of the RAAAP is to undertake an analysis of the situation of OVC and the response in each country, and then, based on this analysis, to produce a national plan of action to scale up and improve the quality of the response to OVC. This plan is then ratified by the government and provides a unifying framework that brings together the activities of all the different stakeholders under a set of common objectives and strategies. This includes all interventions for OVC, including activities of national and local government, donors and civil society organisations (CSOs). The first round of the RAAAP process consisted of a desk study, additional data collection and analysis in country, and a stakeholder workshop to validate the findings and draw up the OVC National Plan of Action. The process was led and coordinated by a national steering group which consisted of the government ministry with responsibility for OVC, other relevant government ministries and departments, development partners including UNICEF, USAID, UNAIDS and WFP and representatives of civil society organisations (CSO). The involvement of different stakeholders in the analysis and planning process is critical for ensuring their ownership of the resulting action plan. (excerpt)
In: State of the art: AIDS and economics, edited by Steven Forsythe. Washington, D.C., Futures Group International, POLICY Project, 2002 Jul. 58-63.The Declaration of Commitment of the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) calls for spending on HIV/AIDS programs to increase to US$7-10 billion annually by 2005. The Declaration specifies a number of goals at the global and national level and calls for specific actions to reach those goals, but it does not specify how the funding should be allocated. The Report of the Commission on Macroeconomics and Health estimates that spending on HIV/AIDS in low- and middle-income countries should increase by US$14 billion by 2007 and suggests that US$6 billion is needed for prevention, US$3 billion for care, and US$5 billion for antiretroviral (ARV) treatment. A detailed estimate of spending requirements prepared for UNGASS calls for minimum spending of US$9.2 billion annually by 2005 in low- and middle-income countries to provide coverage of essential prevention, care, and mitigation services in an effort to reach the UNGASS goals. Details of spending needs by category of intervention are shown in Figure 1. A recent analysis shows that these coverage levels are sufficient to achieve the UNGASS goals. However no analysis has been done to show whether this is the most cost-effective approach to achieving these goals or whether the same goals could be reached with less funding and a more strategic allocation of resources. (excerpt)
In: State of the art: AIDS and economics, edited by Steven Forsythe. Washington, D.C., Futures Group International, POLICY Project, 2002 Jul. 2-8.Policymakers need a reasonably complete picture of resource flows from sources to uses that finance HIV/AIDS prevention, care, support, and treatment. Without that picture, they risk misallocation, waste, and faulty strategic planning. For now, in most parts of the developing world, the picture remains largely unpainted. Filling in the details on financing is among the key challenges to HIV/AIDS policymakers today. Limited data for Latin American and Caribbean (LAC) region countries offer virtually the only cases of adequate resource flow data outside the United States. Those countries spent a thousand dollars per person living with HIV/AIDS (PLWHA) in 2000. The U.S. federal government’s Medicaid program for indigents spent 35 times as much for each AIDS patient under its care in that same year. Low-income countries, largely dependent on donor assistance, spent far less per person and per PLWHA—as little as 31 cents per person, and eight dollars per PLWHA in sub-Saharan Africa. These enormous disparities underline a dual challenge: First, use what little money is available in poor countries very effectively; and second, demonstrate to all concerned that more resources must be forthcoming to confront the HIV/AIDS pandemic in poor countries, lest the negative effects swamp any effort to develop. (author's)
Geneva, Switzerland, UNAIDS, 2004. vii, 64 p.This report grows out of our shared belief that the world must respond to the HIV crisis confronting women. It highlights the work of the Global Coalition on Women and AIDS—a UNAIDS initiative that supports and energizes programmes that mitigate the impact of AIDS on girls and women worldwide. Through its advocacy and networking, the Coalition is drawing greater attention to the effects of HIV on women and stimulating concrete, effective action by an ever-increasing range of partners. We believe this report, with its straightforward analysis and practical responses, can be a valuable advocacy and policy tool for addressing this complex challenge. The call to empower women has never been more urgent. We must act now to strengthen their capacity, resilience and leadership. (excerpt)
New York, New York, United Nations Population Fund [UNFPA], HIV / AIDS Branch, UNAIDS Inter-Agency Task Team on Young People, 2004. 8 p.Young people remain at the centre of the epidemic in terms of transmission, vulnerability, impact, and potential for change. Today’s young generation, the largest in history, has not known a world without AIDS. Of the over 1 billion young people worldwide, 10 million are currently living with HIV. If we are to reach the global targets set forth in international agreements, urgent action and increased investment must be made in HIV prevention, treatment and care programmes specifically for young people. (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)
Global AIDSLink. 2003 Jun-Jul; 12.A bill was drafted and finally endorsed in early 1998 stating that the vaccine candidate had a favorable safety profile from pre-clinical and clinical testing in the country of origin; that there was evidence of clear benefit to the population; that there was a Memorandum of Understanding affirming interaction between UNAIDS/WHO manufacturers/sponsoring agencies and Ugandan representatives; and that the final decision about the vaccine candidate would be made by the government of Uganda, and endorsed by the parliament. The media closely followed these processes and, in February 1998, 40 army men -- a cohort that had undergone intensive preparation for 18 months since 1994 -- became the first volunteers recruited for the study. Despite the protracted nature of the process, it paved the way for other vaccine candidates to enter Uganda with minimal resistance, in an environment with the necessary infrastructure and level of community preparedness. Uganda now has an HIV Vaccine Preparedness Plan and, while the ALVAC trial ended successfully in 2001, three other vaccine candidates have already found their way into the country. (excerpt)
Journal of the Association of Nurses in AIDS Care. 1999; 10(1):17-20.There is a need for increasing international collaboration in the search for a safe and effective HIV vaccine. In addition to the ethical issues that must be considered in conducting any clinical research, unique issues arise in vaccine research and in international research. Careful deliberation and guideline development regarding the ethics of international vaccine research was the focus of a series of recent consultations sponsored by Joint United Nations Programme on HIV/AIDS (UNAIDS) around the world. (author's)
Boston Globe. 2003 Jun 22;  p..A draft report for the UN's AIDS agency has found that even when people use condoms consistently, the failure rate for protection against HIV is an estimated 10 percent, making them a larger risk than portrayed by many advocate groups. The report, which looked at two decades of scientific literature on condoms, is likely to add fuel to a heated political battle on US policy in fighting AIDS in the developing world. (excerpt)
Journal of Acquired Immune Deficiency Syndromes. 2002 Feb 1; 29(2):184-90.The objective of this study was to estimate the global distribution and regional spread of different HIV-1 genetic subtypes and circulating recombinant forms (CRFs) in the year 2000. These estimates were made based on data derived from global HIV/AIDS surveillance and molecular virology studies. HIV-1 incidence during the year 2000 was estimated in defined geographic regions, using a country-specific model developed by WHO-Joint UN Programmes on HIV/AIDS (UNAIDS). The proportion of new infections caused by different HIV-1 subtypes in the same geographic regions was estimated by experts from the WHO-UNAIDS Network for HIV Isolation and Characterization, based on results generated by HIV molecular epidemiology studies in 1998-2000. The absolute numbers and relative proportions of new infections due to different genetic subtypes of HIV- 1 by different geographic regions were calculated using these two sets of estimated data. The results of the study demonstrated that the epidemiology of HIV-1 subtypes and CRFs is characterized by their differential distribution and varying significance as a driving cause of the pandemic on regional and global basis. The largest proportion of HIV-1 infections in the year 2000 was due to subtype C strains (47.2%). Subtype A/+CRF02_AG was estimated to be the second leading cause of the pandemic (27%), followed by subtype B strains (12.3%). The same analysis confirmed an increasing role of HIV-1 CRFs in the pandemic. The authors conclude that combined analysis of data based on the global HIV/AIDS surveillance and molecular virology studies provides for a useful model to monitor the dynamics of the global spread of HIV-1 subtypes and CRFs on regional and country levels--the information of potential importance for diagnosis and treatment of HIV/AIDS, as well as for the development globally effective HIV vaccines. (author's)
Lancet. 1999 Sep 11; 354(9182):923.This article reports on the completion of the UNAIDS document on ethical considerations in HIV-vaccine research, which is the second major attempt to draft universally acceptable ethical guidelines. The document includes 18 guidance points, followed by annotations. The guidance point stipulates that communities involved, as a trial must be a party to the research protocol. The document also presented some difficult guidance points to negotiate. To mention a few, one guidance point requires a pretrial agreement of care packages for research participants who acquire HIV infection during a vaccine trial. Another controversial guidance point is that any vaccine shown to be safe and effective should be made available to all participants and eventually to the whole population.