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Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines.
AIDS Care. 2017 Dec; 29(12):1473-1479.New strategies for HIV testing services (HTS) are needed to achieve UN 90-90-90 targets, including diagnosis of 90% of people living with HIV. Task-sharing HTS to trained lay providers may alleviate health worker shortages and better reach target groups. We conducted a systematic review of studies evaluating HTS by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. We also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomized trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%, percent difference: 30, 95% confidence interval: 27-32, p < 0.001). In Malawi, a pre/post study showed increases in HTS sites and tests after delegation to lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity (>/=98%). Values and preferences studies generally found support for lay providers conducting HTS, particularly in non-hypothetical scenarios. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.
Application opportunities of geographic information systems analysis to support achievement of the UNAIDS 90-90-90 targets in South Africa.
South African Medical Journal. 2017 Nov 27; 107(12):1065-1071.In an effort to achieve control of the HIV epidemic, 90-90-90 targets have been proposed whereby 90% of the HIV-infected population should know their status, 90% of those diagnosed should be receiving antiretroviral therapy, and 90% of those on treatment should be virologically suppressed. In this article we present approaches for using relatively simple geographic information systems (GIS) analyses of routinely available data to support HIV programme management towards achieving the 90-90-90 targets, with a focus on South Africa (SA) and other high-prevalence settings in low- and middle-income countries. We present programme-level GIS applications to map aggregated health data and individual-level applications to track distinct patients. We illustrate these applications using data from City of Johannesburg Region D, demonstrating that GIS has great potential to guide HIV programme operations and assist in achieving the 90-90-90 targets in SA.
The continuum of HIV care in South Africa: implications for achieving the second and third UNAIDS 90-90-90 targets.
AIDS. 2017 Feb 20; 31(4):545-552.BACKGROUND: We characterize engagement with HIV care in South Africa in 2012 to identify areas for improvement towards achieving global 90-90-90 targets. METHODS: Over 3.9 million CD4 cell count and 2.7 million viral load measurements reported in 2012 in the public sector were extracted from the national laboratory electronic database. The number of persons living with HIV (PLHIV), number and proportion in HIV care, on antiretroviral therapy (ART) and with viral suppression (viral load <400 copies/ml) were estimated and stratified by sex and age group. Modified Poisson regression approach was used to examine associations between sex, age group and viral suppression among persons on ART. RESULTS: We estimate that among 6511 000 PLHIV in South Africa in 2012, 3300 000 individuals (50.7%) accessed care and 32.9% received ART. Although viral suppression was 73.7% among the treated population in 2012, the overall percentage of persons with viral suppression among all PLHIV was 23.8%. Linkage to HIV care was lower among men (38.5%) than among women (57.2%). Overall, 47.1% of those aged 0-14 years and 47.0% of those aged 15-49 years were linked to care compared with 56.2% among those aged above 50 years. CONCLUSION: Around a quarter of all PLHIV have achieved viral suppression in South Africa. Men and younger persons have poorer linkage to HIV care. Expanding HIV testing, strengthening prompt linkage to care and further expansion of ART are needed for South Africa to reach the 90-90-90 target. Focus on these areas will reduce the transmission of new HIV infections and mortality in the general population.
Geneva, Switzerland, UNAIDS, 2017. 8 p.HIV testing services are an essential gateway to HIV prevention, treatment, care and support services. The World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) endorse and encourage universal access to knowledge of HIV status. Increased access to and uptake of HIV testing is central to achieving the 90–90–90 targets1 endorsed in the 2016 United Nations Political Declaration on Ending AIDS. However, at the end of 2016, approximately 30% of people living with HIV were still unaware of their HIV status. Young people aged 15–24, adult males and people from key populations (men who have sex with men, transgender people, sex workers, people who inject drugs and people in prisons and other closed settings) often have significantly lower access to HIV testing services, are less likely to be linked to treatment and care and have lower levels of viral suppression. (excerpt)
Oral Diseases. 2016 Apr; 22 Suppl 1:42-5.Four million people of the global total of 35 million with HIV infection are from South-East Asia. ART is currently utilized by 15 million people and has led to a dramatic decline in the mortality rate, including those in low- and middle-income countries. A reduction in sexually transmitted HIV and in comorbidities including tuberculosis has also followed. Current recommendations for the initiation of antiretroviral therapy in people who are HIV+ are essentially to initiate ART irrespective of CD4 cell count and clinical stage. The frequency of HIV testing should be culturally specific and based on the HIV incidence in different key populations but phasing in viral load technology in LMIC is an urgent priority and this needs resources and capacity. With the availability of simplified potent ART regimens, persons with HIV now live longer. The recent WHO treatment guidelines recommending routine HIV testing and earlier initiation of treatment should be the stepping stone for ending the AIDS epidemic and to meet the UNAIDS mission of 90*90*90. (c) 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Comparative effectiveness of congregation- versus clinic-based approach to prevention of mother-to-child HIV transmission: Study protocol for a cluster randomized controlled trial.
Implementation Science. 2013 Jun 8; 8(62):p.Background: A total of 22 priority countries have been identified by the WHO that account for 90% of pregnant women living with HIV. Nigeria is one of only 4 countries among the 22 with an HIV testing rate for pregnant women of less than 20%. Currently, most pregnant women must access a healthcare facility (HF) to be screened and receive available prevention of mother-to-child HIV transmission (PMTCT) interventions. Finding new approaches to increase HIV testing among pregnant women is necessary to realize the WHO/ President's Emergency Plan for AIDS Relief (PEPFAR) goal of eliminating new pediatric infections by 2015. Methods: This cluster randomized trial tests the comparative effectiveness of a congregation-based Healthy Beginning Initiative (HBI) versus a clinic-based approach on the rates of HIV testing and PMTCT completion among a cohort of church attending pregnant women. Recruitment occurs at the level of the churches and participants (in that order), while randomization occurs only at the church level. The trial is unblinded, and the churches are informed of their randomization group. Eligible participants, pregnant women attending study churches, are recruited during prayer sessions. HBI is delivered by trained community health nurses and church-based health advisors and provides free, integrated on-site laboratory tests (HIV plus hemoglobin, malaria, hepatitis B, sickle cell gene, syphilis) during a church-organized 'baby shower.' The baby shower includes refreshments, gifts exchange, and an educational game show testing participants' knowledge of healthy pregnancy habits in addition to HIV acquisition modes, and effective PMTCT interventions. Baby receptions provide a contact point for follow-up after delivery. This approach was designed to reduce barriers to screening including knowledge, access, cost and stigma. The primary aim is to evaluate the effect of HBI on the HIV testing rate among pregnant women. The secondary aims are to evaluate the effect of HBI on the rate of HIV testing among male partners of pregnant women and the rate of PMTCT completion among HIV-infected pregnant women. Discussion: Results of this study will provide further understanding of the most effective strategies for increasing HIV testing among pregnant women in hard-to-reach communities.
Antiretroviral resistance patterns and HIV-1 subtype in mother-infant pairs after the administration of combination short-course zidovudine plus single-dose nevirapine for the prevention of mother-to-child transmission of HIV.
Clinical Infectious Diseases. 2009 Jul 15; 49(2):299-305.BACKGROUND: World Health Organization guidelines for prevention of mother-to-child transmission of human immunodeficiency virus type 1 (HIV-1) recommend administration of zidovudine and single-dose nevirapine (NVP) for HIV-1-infected women who are not receiving treatment for their own health or if complex regimens are not available. This study assessed antiretroviral resistance patterns among HIV-infected women and infants receiving single-dose NVP in Thailand, where the predominant circulating HIV-1 strains are CRF01_AE recombinants and where the minority are subtype B. METHODS: Venous blood samples were obtained from (1) HIV-infected women who received zidovudine from 34 weeks' gestation and single-dose NVP plus oral zidovudine during labor and (2) HIV-infected infants who received single-dose NVP after birth plus zidovudine for 4 weeks after delivery. HIV-1 drug resistance testing was performed using the TruGene assay (Bayer HealthCare). RESULTS: Most mothers and infants were infected with CRF01_AE. NVP resistance was detected in 34 (18%) of 190 women and 2 (20%) of 10 infants. There was a significantly higher proportion of NVP mutations in women with delivery viral loads of >50,000 copies/mL (adjusted odds ratio, 8.5; 95% confidence interval, 2.2-32.8, [Formula: see text] for linear trend) and in those with subtype B rather than CRF01_AE infections (38% vs. 16%; adjusted odds ratio, 3.6; 95% confidence interval, 1.1-11.8; P = .038). CONCLUSIONS: The lower frequency of NVP mutations among mothers infected with subtype CRF01_AE, compared with mothers infected with subtype B, suggests that individuals infected with subtype CRF01_AE may be less susceptible to the induction of NVP resistance than are individuals infected with subtype B.
Sexual and reproductive health of women living with HIV / AIDS. Guidelines on care, treatment and support for women living with HIV / AIDS and their children in resource-constrained settings.
Geneva, Switzerland, WHO, 2006.  p.The sexual and reproductive health of women living with HIV/AIDS is fundamental to their well-being and that of their partners and children. This publication addresses the specific sexual and reproductive health needs of women living with HIV/AIDS and contains recommendations for counselling, antiretroviral therapy, care and other interventions. Improving women's sexual and reproductive health, treating HIV infections and preventing new ones are important factors in reducing poverty and promoting the social and economic development of communities and countries. Sexual and reproductive health services are uniquely positioned to address each of these factors. (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)
Scaling up HIV / AIDS prevention, treatment and care: a report on WHO support to countries in implementing the “3 by 5” Initiative, 2004-2005.
Geneva, Switzerland, WHO, 2006. 143 p.In September 2003, LEE Jong-wook, Director-General of WHO, and Peter Piot, Executive Director of UNAIDS, declared the lack of access to antiretroviral therapy for HIV/AIDS in low- and middle-income countries to be a global health emergency. Shortly after this declaration, WHO and its partners launched a global initiative to scale up antiretroviral therapy with the objective of having 3 million people receiving antiretroviral therapy - representing half the total number of those globally in need - by the end of 2005 ("3 by 5"). Although the actual target of putting 3 million people on antiretroviral therapy was not reached by the end of 2005, countries have made significant progress in the past two years in expanding treatment coverage, strengthening prevention and building the capacity of health systems to deliver long-term, chronic care. Overall, in the two-year period, antiretroviral therapy coverage in low- and middle-income countries increased from 7% of those in need at the end of 2003 (400 000 people) to 20% of those in need at the end of 2005 (1.3 million people). Eighteen countries managed to increase antiretroviral therapy coverage to half or more of the people who needed it, consistent with the "3 by 5" target. (excerpt)
Towards universal access: scaling up priority HIV / AIDS interventions in the health sector. Progress report, April 2007.
Geneva, Switzerland, WHO, 2007 Apr. 88 p.Drawing on lessons from the scale-up of HIV interventions over the last few years, WHO, as the UNAIDS cosponsor responsible for the health sector response to HIV/AIDS, has established priorities for its technical work and support to countries on the basis of the following five Strategic Directions, each of which represents a critical area where the health sector must invest if significant progress is to be made towards achieving universal access. Enabling people to know their HIV status; Maximizing the health sector's contribution to HIV prevention; Accelerating the scale-up of HIV/AIDS treatment and care; Strengthening and expanding health systems; Investing in strategic information to guide a more effective response. In this context, WHO undertook at the World Health Assembly in May 2006 to monitor and evaluate the global health sector response in scaling up towards universal access and to produce annual reports. This first report addresses progress in scaling up the following health sector interventions. Antiretroviral therapy; Prevention of mother-to-child transmission of HIV (PMTCT); HIV testing and counseling; Interventions for injecting drug users (IDUs); Control of sexually transmitted infections (STIs) to prevent HIV transmission; Surveillance of the HIV/AIDS epidemic. (excerpt)
Washington, D.C., World Bank, Knowledge and Learning Center, 2005 Nov.  p. (Findings Infobriefs No. 118; Good Practice Infobrief)The Mali Multi-sectoral AIDS Project (MAP) began implementation in late 2004 and is in the preliminary phases of the project cycle. This project has been commended by the World Bank's Board for its innovation and the involvement of the private sector to address HIV/AIDS. Mali is one of the poorest countries in the world due to factors such as its limited resource base, land-locked status and poor infrastructure. According to the 2001 Demographic and Health Survey (DHS) published by the Ministry of Health, Mali's HIV/AIDS prevalence rate is estimated at 1.7% in 2001. The project objective is to support the Government of Malis efforts to control the spread of the HIV/AIDS epidemic and provide sustainable access to treatment and care to those infected with or affected by HIV/AIDS. While Mali currently has a low HIV prevalence rate by Sub-Saharan African standards, it runs a high risk of experiencing an increase in prevalence rates. (excerpt)
Lancet. 2007 Jul 21; 370(9583):202-203.After a series of meetings, open internet-based reviews, and consultations over a year, WHO and UNAIDS recently released guidance on HIV testing and counselling initiated by health providers. Those not engaged in this exercise might not fully appreciate the evolution of thinking represented by this final document, nor the role played by active debate between constituencies with diverging views on key issues. Among these issues was whether HIV testing should be included in the panoply of routine tests given in health settings on the initiative of the clinician, unless the patient specifically opted-in by asking to be tested for HIV or opted-out by refusing the test, despite not having been prompted to consent to it. Many found the ideas confusing and questioned the underlying assumption of this approach-ie, that patients who signed off on admission forms when consulting or being admitted to a care facility de-facto agree to any diagnostic test found necessary by the treating doctor. Concerns were raised that, unlike other tests, in view of prevailing stigma, discrimination, and risks of violence attached to an HIV-positive result in many settings, particularly for women, specific individual agreement to the test remained necessary. (excerpt)
Lancet Infectious Diseases. 2007 Jul; 7(7):446.WHO and UNAIDS have issued new guidance on scaling up informed voluntary HIV testing and counselling in health facilities globally. The guidance promotes provider-initiated HIV testing, alongside existing patient-initiated HIV testing, with a view to ensuring earlier diagnosis, reducing transmission, and maximising the benefits of treatment. At a press conference in London, UK, Kevin De Cock (WHO, Geneva, Switzerland) told journalists: "WHO now recommends that in countries with generalised epidemics, all patients - with or without symptoms -who present to health services for whatever reason, should be offered testing". In countries with low-level HIV epidemics, the testing of all patients is now recommended at specific health services catering for at-risk groups. Additionally, all patients presenting to a health service with symptoms suggestive of HIV infection should be encouraged by health professionals to undergo testing. According to WHO, too many opportunities to diagnose HIV infection are being missed. (excerpt)
WHO HIV clinical staging or CD4 cell counts for antiretroviral therapy eligibility assessment? An evaluation in rural Rakai district, Uganda [letter]
AIDS. 2007 May 31; 21(9):1208-1210.The ability of WHO clinical staging to predict CD4 cell counts of 200 cells/µl or less was evaluated among 1221 patients screened for antiretroviral therapy (ART). Sensitivity was 51% and specificity was 88%. The positive predictive value was 64% and the negative predictive value was 81%. Clinical criteria missed half the patients with CD4 cell counts of 200 cells/µl or less, highlighting the importance of CD4 cell measurements for the scale-up of ART provision in resource-limited settings. (author's)
Progression to WHO criteria for antiretroviral therapy in a 7-year cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire.
Bulletin of the World Health Organization. 2007 Feb; 85(2):116-123.The objective was to estimate the probability of reaching the criteria for starting highly active antiretroviral therapy (HAART) in a prospective cohort of adult HIV-1 seroconverters in Abidjan, Côte d'Ivoire. We recruited participants from HIV-positive donors at the blood bank of Abidjan for whom the delay since the estimated date of seroconversion (midpoint between last negative and first positive HIV-1 test) was = 36 months. Participants were offered early trimethoprim-sulfamethoxazole (cotrimoxazole) prophylaxis, twice-yearly measurement of CD4 count and we made standardized records of morbidity. We used the Kaplan-Meier method to estimate the probability of reaching the criteria for starting HAART according to WHO 2006 guidelines. 217 adults (77 women (35%)) were followed up during 668 person-years (PY). The most frequent diseases recorded were mild bacterial diseases (6.0 per 100 PY), malaria (3.6/100 PY), herpes zoster (3.4/100 PY), severe bacterial diseases (3.1/100 PY) and tuberculosis (2.1/100 PY). The probability of reaching the WHO 2006 criteria for HAART initiation was estimated at 0.09, 0.16, 0.24, 0.36 and 0.44 at 1, 2, 3, 4 and 5 years, respectively. Our data underline the incidence of the early HIV morbidity in an Ivorian adult population and provide support for HIV testing to be made more readily available and for early follow-up of HIV-infected adults in West Africa. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:42-51.Items from the UNGASS Draft Declaration of Commitment on HIV/AIDS (2001) are analyzed. The Brazilian experience of new methods for testing and counseling among vulnerable populations, preventive methods controlled by women, prevention, psychosocial support for people living with HIV/AIDS, and mother-child transmission, is discussed. These items were put into operation in the form of keywords, in systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The Brazilian experience relating to testing and counseling strategies has been consolidated through the utilization of algorithms aimed at estimating incidence rates and identifying recently infected individuals, testing and counseling for pregnant women, and application of quick tests. The introduction of alternative methods and new technologies for collecting data from vulnerable populations has been allowing speedy monitoring of the epidemic. Psychosocial support assessments for people living with HIV/AIDS have gained impetus in Brazil, probably as a result of increased survival and quality of life among these individuals. Substantial advances in controlling mother-child transmission have been observed. This is one of the most important victories within the field of HIV/ AIDS in Brazil, but deficiencies in prenatal care still constitute a challenge. With regard to prevention methods for women, Brazil has only shown a shy response. Widespread implementation of new technologies for data gathering and management depends on investments in infrastructure and professional skills acquisition. (author's)
Geneva, Switzerland, World Health Organization [WHO], 2006 Mar 30.  p.This independent formative evaluation was conducted by a team of six international consultants between August 2005 and January 2006 to appraise WHO's contributions and roles in implementing the "3 by 5" Initiative. Funded by the Canadian Government, and as a requirement for its grant to WHO, the evaluation investigated all three levels at which WHO operates (headquarters, regional offices and country offices), placing particular emphasis on Africa. This included seven country assessments and an extensive consultation of international and country-level partners and stakeholders. A number of focused technical studies were also commissioned. The evaluation reviewed how effectively WHO provided technical, managerial and administrative guidance and support pursuant to the "3 by 5" goals and target. An assessment was also made of the extent to which WHO has mobilized, sustained and contributed to this major global partnership through improving harmonization between United Nations agencies and working with other stakeholders and partners. Key lessons from "3 by 5" have been documented, including those on how the initiative contributed to health systems strengthening and HIV prevention, as well as the ways with which equity and gender concerns were dealt. Potential opportunities for future collaboration between WHO, main donors and partners were identified and recommendations have been provided for future plans and the way forward for WHO and its partners. (excerpt)
Geneva, Switzerland, UNAIDS, 1996 Jan. 35 p. (UNAIDS/96.5)These guidelines are destined for policy makers and programme planners wishing to introduce national external quality assessment schemes (NEQAS) for serological testing for human immunodeficiency viruses (HIV). They describe some important basic principles and the main practical aspects of NEQAS. The objectives of external quality assessment schemes are briefly discussed below and elsewhere (References 1 and 2 in bibliography, Annex 2). It is now widely accepted that quality assurance, quality control and quality assessment constitute an essential part of HIV testing and of diagnostic testing in general. Quality assessment is one component of a total quality assurance programme. The availability of excellent HIV tests does not automatically guarantee reliable laboratory results. Many steps are involved between the moment when a specimen enters the laboratory and the moment when the result of the test is reported to the physician, and at each step something can go wrong. Therefore each government should ensure that sufficient support is made available for a National Reference Laboratory to provide a suitable programme to monitor and if necessary improve the quality of HIV testing in the country. A well-functioning national programme is an important step towards achieving high-quality laboratory performance nationwide. (excerpt)
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2002 Jul. 226 p. (UNAIDS/02.26E)In the past two years, the sense of common purpose in the worldwide struggle against HIV/AIDS has intensified. More than at any other time in the short history of the epidemic, the need to translate local and national examples of success into a global movement has become manifest. The political momentum to tackle AIDS has grown. Public opinion in many countries has been mobilized by the media, nongovernmental organizations, activists, doctors, economists, and people living with HIV/AIDS. Communities and nations are progressively taking the lead in responding to the epidemic with increased political commitment, resources and institutional initiatives. But this new political resolve is not universal. An unacceptable number of governments and civil society institutions are still in a state of denial about the HIV/AIDS epidemic, and are failing to act to prevent its further spread or alleviate its impact. By failing to act, governments and civil society are turning their backs on the possibility of success against AIDS. Where the moment of action has been seized, there is mounting evidence of inroads being made against the epidemic. Alongside the familiar achievements of Senegal, Thailand and Uganda, there are new successes on every continent. Despite emerging from genocide and conflict, Cambodia responded to the threat of HIV in the mid-1990s and has achieved marked declines in both the levels of HIV and the high-risk behaviours associated with its transmission. The infection rate among pregnant women in Cambodia declined by almost a third between 1997 and 2000. The Philippines has acted early to forestall the epidemic, keeping HIV rates low with strong prevention efforts and the mobilization of community and business organizations. (excerpt)
WHO consultation on technical and operational recommendations for scale-up of laboratory services and monitoring HIV antiretroviral therapy in resource-limited settings.
Geneva, Switzerland, WHO, 2005. 42 p.The aim of the consultation was to obtain clear and realistic guidelines as to which diagnostic and monitoring schedules were optimal and how they could be delivered in order to assist decision-making on treatment and facilitate the implementation of strategies and necessary actions for scaling up diagnosis and monitoring at the local, regional and global levels, with particular emphasis on resource-constrained settings. It was required that the resulting recommendations would provide useful tools for the rational implementation of scaling-up processes, taking into consideration variations between developing countries in human resources, health structures and socioeconomic contexts. (excerpt)
Geneva, Switzerland, WHO, 2005.  p.AIDS Medicines and Diagnostics Service is a network that aims to increase access to good quality and effective treatments for HIV/AIDS by improving supply of antiretroviral medicines and diagnostics in developing countries. Goals: To ensure that the supply of quality commodities is never an obstacle to expanding treatment, care and support; To use improved commodity supply to catalyze rapid expansion of treatment, to promote equity, and to support prevention. (excerpt)
Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. Overview of findings.
New York, New York, UNICEF, 2003. 47 p. (HIV / AIDS Working Paper)This overview report presents key findings from an evaluation of UN- supported pilot PMTCT projects in eleven countries, including: Botswana, Burundi, Cote d'Ivoire, Honduras, India, Kenya, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe. Key findings discuss: feasibility and coverage; factors contributing to programme coverage; programme challenges; scaling-up; the special case of low prevalence countries; and recommendations. Recommendations include: To increase coverage and improve infant feeding counseling: supplement clinic staff with lay counselors; introduce rapid HIV tests so women can receive same day counseling, HIV testing, and test results; improve the quality of HIV and infant feeding counseling by providing job aids and active supervision; offer support to PMTCT providers including material support and peer psychosocial support; partner with community groups to offer community education and outreach; and expand the vision of PMTCT to encompass an active role for fathers and male partners. To strengthen postnatal support and follow up of HIV- infected women and their infant to assist them with infant feeding, getting care for themselves and their families, and to evaluate the program: establish national infant feeding guidelines; establish postnatal follow-up protocols; forge partnerships between the PMTCT program and NGO care and support groups; Enhance referral links between PMTCT programs and HIV care; New measurement tools and systems should be developed. To scale up PMTCT programs the findings suggest: expand to new sites but enlarge the scope of activities within existing sites to reach more women; and provide a comprehensive package of HIV prevention and care. The pilot experience has shown that introducing PMTCT programs into antenatal care in a wide variety of settings is feasible and acceptable to a significant proportion of antenatal care clients who have a demand for HIV information, counseling, and testing. As they go to scale, PMTCT programs have much to learn from the pilot phase, during which they successfully reached hundreds of thousands of clients. (author's)
Geneva, Switzerland, WHO, 2003 Jun.  p.This report sets out to provide market information that can be used to help procurement agencies make informed decisions on the source of medicines and serve as the basis for negotiating affordable prices. The aim is to help increase access to medicines for people living with HIV/ AIDS in developing countries. The data provided by the manufacturers serves to highlight the multiplicity of suppliers and the variation in price of some essential HIV/AIDS-related medicines on the international market. Without this information, there is a risk that low-income countries may be paying more than needed to obtain essential medicines. Price variations are highlighted through the tables and graphs included. Provision of price information addresses only one barrier to access to medicines in countries with limited resources and, it is appreciated that many other factors will affect the availability of medicines. Some of the other issues that must be considered in relation to the purchase of medicines for HIV/AIDS and related conditions are health infrastructure, human resources, and supply and distribution systems. (excerpt)
London, England, Christian Aid, 2004 Jul. 17 p.The World Health Organisation (WHO) hopes to treat three million people with antiretroviral drugs by 2005. If ‘3 by 5’, as it is known, is achieved it would represent a ten-fold increase in the number of people in poor countries receiving antiretroviral treatment (ART). This would be a hugely important step – prolonging the lives of the most productive generation and allowing parents to survive long enough to put their children through school. Christian Aid applauds this commitment but warns that this is a highly complex situation. HIV/AIDS is the biggest threat to the developing world. Today’s productive generation is dying and the workforce of tomorrow is being left without parents; the economic future of the developing world is bleak. But, as Drugs alone are not enough shows, without the appropriate infrastructure the drugs themselves may actually become counter-productive. Community organisations and networks must provide recipients of drug treatment with backup. Home-based care and other community-support programmes, the backbone of much of Christian Aid’s HIV work, are ideally placed to provide these services. (excerpt)