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Do countries rely on the World Health Organization for translating research findings into clinical guidelines? A case study.
Globalization and Health. 2016 Oct 6; 12(1):58.BACKGROUND: The World Health Organization's (WHO) antiretroviral therapy (ART) guidelines have generally been adopted rapidly and with high fidelity by countries in sub-Saharan Africa. Thus far, however, WHO has not published specific guidance on nutritional care and support for (non-pregnant) adults living with HIV despite a solid evidence base for some interventions. This offers an opportunity for a case study on whether national clinical guidelines in sub-Saharan Africa provide concrete recommendations in the face of limited guidance by WHO. This study, therefore, aims to determine if national HIV treatment guidelines in sub-Saharan Africa contain specific guidance on nutritional care and support for non-pregnant adults living with HIV. METHODS: We identified the most recent national HIV treatment guidelines in sub-Saharan African countries with English as an official language. Using pre-specified criteria, we determined for each guideline whether it provides guidance to clinicians on each of five components of nutritional care and support for adults living with HIV: assessment of nutritional status, dietary counseling, micronutrient supplementation, ready-to-use therapeutic or supplementary foods, and food subsidies. RESULTS: We found that national HIV treatment guidelines in sub-Saharan Africa generally do not contain concrete recommendations on nutritional care and support for non-pregnant adults living with HIV. CONCLUSIONS: Given that decisions on nutritional care and support are inevitably being made at the clinician-patient level, and that clinicians have a relative disadvantage in systematically identifying, summarizing, and weighing up research evidence compared to WHO and national governments, there is a need for more specific clinical guidance. In our view, such guidance should at a minimum recommend daily micronutrient supplements for adults living with HIV who are in pre-ART stages, regular dietary counseling, periodic assessment of anthropometric status, and additional nutritional management of undernourished patients. More broadly, our findings suggest that countries in sub-Saharan Africa look to WHO for guidance in translating evidence into clinical guidelines. It is, thus, likely that the development of concrete recommendations by WHO on nutritional interventions for people living with HIV would lead to more specific guidelines at the country-level and, ultimately, better clinical decisions and treatment outcomes.
Positive learning: Meeting the needs of young people living with HIV (YPLHIV) in the education sector.
Paris, France, UNESCO, 2012.  p.This document outlines roles and responsibilities for the education sector in supporting young people living with HIV to realize their personal, social and educational potential. It provides practical recommendations for all those involved in the education sector, and further suggested actions for those in the health sector and for civil society. It is a tool for networks of people living with HIV and specifically young people living with HIV to advocate for more appropriate, conducive and supportive education systems.
Lancet. 2007 Dec 1; 370(9602):1821.One Sunday morning last year, an elderly Zambian woman, four grandchildren in tow, showed up at Elizabeth Mataka's door. "I'm looking for Mrs Mataka-people said she will help me. She's the one who helps grandmothers", the woman said. She had found exactly the right person. Mataka, herself a grandmother of three, heads the Zambia National AIDS Network (ZNAN) and helps coordinate funds fl owing in from donors. And earlier this year she was elevated to the highest levels of the global response to the pandemic. In April, 61-year-old Mataka was elected Vice Chair of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The next month, she got a surprise midnight call from New York with the news that she had been chosen to replace the outgoing United Nations Special Envoy for HIV/AIDS in Africa, Canadian diplomat Stephen Lewis. (excerpt)
Towards universal access by 2010. How WHO is working with countries to scale-up HIV prevention, treatment, care and support.
Geneva, Switzerland, WHO, Department of HIV / AIDS, 2006. 32 p.In 2005, leaders of the G8 countries agreed to «work with WHO, UNAIDS and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010». This goal was endorsed by United Nations Member States at the High-Level Plenary Meeting of the 60th Session of the United Nations General Assembly in September 2005. At the June 2006 General Assembly High Level Meeting on AIDS, United Nations Member States agreed to work towards the broad goal of "universal access to comprehensive prevention programmes, treatment, care and support" by 2010. Working towards universal access is a very ambitious challenge for the international community, and will require the commitment and involvement of all stakeholders, including governments, donors, international agencies, researchers and affected communities. Among the most important priorities is the strengthening of health services so that they are able to provide a comprehensive range of HIV/AIDS services to all those who need them. This document describes the contribution that the World Health Organization (WHO) will make, as the United Nations agency responsible for health, in working towards universal access to HIV prevention, treatment, care and support in the period 2006-2010. It proposes an evidence-based Model Essential Package of integrated health sector interventions for HIV/AIDS that WHO recommends be scaled up in countries, using a public health approach, and provides an overview of the strategic directions and priority intervention areas that will guide WHO's technical work and support to its Member States as they work towards universal access over the next four years. (excerpt)
Journal of the Association of Nurses in AIDS Care. 2007 Jan-Feb; 18(1):60-62.The XVI International AIDS Conference had its own essence that differentiated it from previous meetings. This meeting was characterized by the presence of well-known individuals from foundations, international organizations, the media, pharmaceutical companies, nongovernmental organizations, activists, HIV-positive persons, health care professionals, researchers, and others concerned with HIV/ AIDS. Absent as notable exceptions were politicians currently in office. Melinda Gates and the two Bills (Gates and Clinton) and United Nations envoy Stephen Lewis gave stirring speeches. The impact of HIV/AIDS on women was recognized, with more than 100 sessions devoted to women. And although the conference organizers are to be congratulated for so much that was right about the conference, there are some areas requiring further attention. In the conference summaries, one never saw addressed issues of primary concern to nurses. For example, symptom management is given short shrift. Truth in advertising requires that I mention that this is an area of my research. I am not saying that my research should have been mentioned. I am stating that none of the studies in this area seemed on the radar screen of those completing the summaries. This contributes to the invisibility of nursing. (excerpt)
SAfAIDS News. 2005 Sep; 11(3):11-12.The AIDS epidemic has become a genuine global emergency with rising numbers of new infections, increasing numbers of deaths and the impact of the epidemic increasingly being felt particularly by the rising numbers of children made orphans or vulnerable by AIDS. The scale of the emergency has resulted in an unprecedented response by African countries, civil society and the international community. Today, there are more resources for HIV prevention, care, support and treatment than ever before. This increase in resources is coupled with an increasing number of actors becoming involved in the AIDS response, often leading to unclear roles and leadership and dispersed authority that may undermine national plans and priorities. Furthermore, resources are often dissipated and scattered, transaction costs have increased, capacities are distracted and weakened while monitoring and evaluation remains fragmented. The result has been that a substantial amount of available resources are not being used effectively and not getting to the people that need them most. (excerpt)
Development and testing of the South African National Nutrition Guidelines for People Living with HIV / AIDS.
SAJCN. South African Journal of Clinical Nutrition. 2003 Feb; 16(1):12-16.Malnutrition is a common consequence of HIV infection, and weight loss is used as a diagnostic criterion for HIV/AIDS. The relationship between HIV/AIDS and malnutrition and wasting is well described, with nutritional status compromised by reduced food intake, malabsorption caused by gastrointestinal involvement, increased nutritional needs as a result of fever and infection, and increased nutrient losses. Malnutrition contributes to the frequency and severity of opportunistic infections seen in HIV/AIDS and nutritional status is a major factor in survival. Failure to maintain body cell mass leads to death at 54% of ideal body weight. The effectiveness of nutrition intervention has been documented and dietary nutrition counselling is considered critical in the treatment of HIV/AIDS, especially in view of the fact that drug treatment is inaccessible to many people living with the virus in Africa. (excerpt)
Strategies to support the HIV-related needs of refugees and host populations. A joint publication of the Joint United Nations Programme on HIV / AIDS (UNAIDS) and the United Nations High Commissioner for Refugees (UNHCR).
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS UNAIDS], 2005 Oct. 38 p. (UNAIDS Best Practice Collection; UNAIDS/05.21E)Many countries are already overburdened by the impact of AIDS, and are often unable or unwilling to provide these populations with the HIV-related services they require. This places many refugees in a unique situation. They are no longer guaranteed the protection of their country of origin, they often do not have the assistance of the country of asylum, and they go without the HIV-related services which they need and to which they are entitled under international human rights instruments. This failure to provide HIV prevention and care to refugees not only undermines effective HIV prevention and care efforts, it also hinders effective HIV prevention and care for host country populations. Since refugee populations now remain on average in their host country for 17 years,2 the implications for both refugee and host populations are very serious. Addressing HIV-related needs in the context of refugee situations requires a change in the thinking of the authorities in many countries of asylum. It is impossible to determine the actual length of time that refugees will remain in the host country. However, it is critical that during this time both refugees and surrounding host populations receive all necessary HIV related services, including those that require long-term funding and planning. Failure to provide these interventions could be very harmful to both refugees and the surrounding host populations. In order to meet the HIV-related needs in the context of refugee situations, UNHCR and UNAIDS advocate for the implementation of the best practices described below. Both organizations believe that these practices will generate more effective, equitable and sustainable frameworks to help countries better address both the needs of refugees and their own citizens, whether they are displaced themselves or hosting refugees in their communities. (excerpt)
A report of a theological workshop focusing on HIV- and AIDS-related stigma, 8th-11th December 2003, Windhoek, Namibia. Supported by UNAIDS.
Geneva, Switzerland, UNAIDS, 2005 Feb. 62 p. (UNAIDS/05.01E)Stigma is difficult to define. Generally, though, it implies the branding or labelling of a person or a group of persons as being unworthy of inclusion in human community, resulting in discrimination and ostracization. The branding or labelling is usually related to some perceived physical, psychological or moral condition believed to render the individual unworthy of full inclusion in the community. We may stigmatize those we regard as impure, unclean or dangerous, those who are different from ourselves or live in different ways, or those who are simply strangers. In the process we construct damaging stereotypes and perpetuate injustice and discrimination. Stigma often involves a conscious or unconscious exercise of power over the vulnerable and marginalized. The purpose of this document is to identify those aspects of Christian theology that endorse or foster stigmatizing attitudes and behaviour towards people living with HIV and AIDS and those around them, and to suggest what resources exist within Christian theology that might enable churches to develop more positive and loving approaches. It is not a theological statement, but rather a framework for theological thinking, and an opportunity, for church leaders, to pursue a deeper Christian reflection on the current crisis. (excerpt)
Geneva, Switzerland, UNAIDS, 1998. 32 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/98.25)The aim of this document is to point out the most important ways in which NGOs concerned with HIV/ AIDS and with the persons who have this infection in Latin America and the Caribbean help facilitate access to HIV-related drugs. During the XIth Conference on AIDS, the slogan "No greed, access to all!" was heard. The immediate reason was that the new AIDS drugs, the protease inhibitors, had a high price. This does not, of course, mean that access to all other AIDS-related drugs was easy. It was not, and it is not, especially for persons in developing countries. Thus, although lack of access to AIDS-related drugs is an old subject in developing countries, this topic aroused renewed interest when it affected developed countries. Access to treatment has become a global issue and has given rise to a new phase of global solidarity. (excerpt)