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Assessing the impact of defining a global priority research agenda to address HIV-associated tuberculosis.
Tropical Medicine and International Health. 2016 Nov; 21(11):1420-1427.Objectives In 2010, the WHO issued 77 priority research questions (PRQs) to address HIV-associated TB. Objective of the this study was to assess the impact of defining the research agenda in stimulating and directing research around priority research questions. Methods We used number and type of scientific publications as a proxy to quantitatively assess the impact of research agenda setting. We conducted 77 single systematic reviews -one for every PRQ -building 77 different search strategies using PRQs’ keywords. Multivariate logistic regression models were applied to assess the quantity and quality of research produced over time and accounting for selected covariates. Results In 2009-2015, PRQs were addressed by 1631 publications (median: 11 studies published per PRQ, range 1-96). The most published area was ‘Intensified TB case finding’ (median: 23 studies/PRQ, range: 2-74). The majority (62.1%, n = 1013) were published as original studies, and more than half (58%, n = 585) were conducted in the African region. Original studies’ publication increased over the study period (P trend = <0.001). They focused more on the ‘Intensified TB case finding’ (OR = 2.17, 95% CI: 1.56-2.93) and ‘Drug-resistant TB and HIV infection’ (OR = 2.12, 95% CI: 1.47-3.06) areas than non-original studies. Original studies were published in journals of lower impact factor and received a smaller number of citations than non-original studies (OR = 0.54, 95% CI: 0.42-0.69). Conclusion The generation of evidence to address PRQs has increased over time particularly in selected fields. Setting a priority research agenda for HIV-associated TB might have positively influenced the direction and the conduct of research and contributed to the global response to such a major threat to health.
American Journal of Clinical Nutrition. 2011 Dec; 94(6):1683S-1689S.To establish whether there is new evidence to inform changes to WHO 2003 recommendations for micronutrient intake in persons with HIV/AIDS, we conducted a narrative review of the literature published from 2003 to 2010. Although the review focused on new randomized controlled trials of multiple micronutrients in HIV-infected adults, including pregnant and lactating women, we also considered randomized trials of single micronutrients. The review found that there are few published randomized controlled trials of micronutrients in HIV-infected persons and that most trials used high-dose multiple micronutrient supplementation. The trials were heterogeneous with respect to the composition and dose of micronutrients used and the target population studied. Despite this heterogeneity, 5 of 6 trials that used high-dose multiple micronutrients showed benefits in terms of either improved CD4 cell counts or survival. However, many of these trials were small and of short duration, and therefore the long-term risks and benefits of high-dose multiple micronutrients are not established. The current WHO recommendation for an intake of micronutrients at Recommended Dietary Allowance amounts continues to be a reasonable target for persons with clinically stable HIV infection. In light of new data that show adverse effects of high-dose vitamin A, the current recommendation for a single high dose of vitamin A in HIV-infected women within 6 wk of delivery should be reviewed.
Evidence behind the WHO guidelines: Hospital Care for Children: what is the aetiology and treatment of chronic diarrhoea in children with HIV?
Journal of Tropical Pediatrics. 2009 Dec; 55(6):349-55.This clinical review aims to address the issue of appropriate treatment for chronic diarrhea in children with HIV and evaluates the scientific evidence behind WHO's recommendations for this matter. It finds that highly active antiretroviral therapy (HAART) substantially reduces diarrhea, increases the effectiveness of antimicrobial agents, and improves weight gain.
Expert Opinion On Pharmacotherapy. 2009 Aug; 10(11):1783-91.BACKGROUND: Treating HIV-infected children remains a challenge due to a lack of treatment options, appropriate drug formulations and, in countries with limited resources, insufficient access to diagnostic tests and treatment. OBJECTIVE: To summarize current data concerning new opportunities to improve the treatment of HIV-infected children. METHODS: This review includes data from the most recently published peer-reviewed publications, guidelines or presentations at international meetings concerning new ways to treat HIV-infected children. RESULTS/CONCLUSIONS: New WHO guidelines recommend starting combination antiretroviral treatment in all infants aged < 1 year. Although this is common practice in some high-income countries, implementation of these recommendations in countries with limited resources is still a challenge. There is still an important gap between the availability of licensed drugs in children compared with adults. There remains a need for further pharmacokinetic studies, and for more pediatric formulations of antiretroviral drugs with improved palatability.
Evidence behind the WHO guidelines: hospital care for children: what is the aetiology of pneumonia in HIV-infected children in developing countries?
Journal of Tropical Pediatrics. 2009 Aug; 55(4):219-24.This clinical review discusses the most common cause of pneumonia in HIV-infected children--bacterial pathogens and includes recommendations for the management of pneumonia in HIV-infected children from World Health Organization (WHO).
AIDS Reader. 2009 Apr; 19(4):131-9, 148-52.This article reviews the medical literature for information about lipodystrophy in Africa and Asia. These 2 regions were selected because both are of particular interest to the declaration for universal access. Africa represents the epidemic's epicenter. Asia, especially India and China, will soon have HIV / AIDS prevalence rates that will outstrip those seen in the rest of the world combined. The methodology is summarized first: how articles were selected, the inclusion and exclusion criteria used, and how information was synthesized. The results and discussion focus on 3 specific areas: how lipodystrophy is defined and measured, the study populations, and the persons excluded from these studies. A summary of what is and what is not yet known about lipodystrophy in Africa and Asia is also included.
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)
Orphans and vulnerable children affected by HIV / AIDS in Brazil: where do we stand and where are we heading?
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:23-30.This study aimed at identifying human rights' status and situation, as expressed in the United Nations General Assembly Special Session on HIV/AIDS, of children and adolescents living with HIV/AIDS, non-orphans and orphans affected by AIDS, based on local and international literature review. The main study findings did not allow to accurately estimating those children and adolescents living with HIV and non-orphans affected by HIV/AIDS but data was available on those living with AIDS and orphans. The limitations and possibilities of these estimates obtained from surveillance systems, mathematical models and surveys are discussed. Though studies in literature are still quite scarce, there is indication of compromise of several rights such as health, education, housing, nutrition, nondiscrimination, and physical and mental integrity. Brazil still needs to advance to meet further needs of those orphaned and vulnerable children. Its response so far has been limited to providing health care to those children and adolescents living with HIV/AIDS, preventing mother-to-child HIV transmission and financing the implementation and maintenance of support homes (shelters according to Child and Adolescent Bill of Rights) for those infected and affected by HIV/AIDS, either orphans or not. These actions are not enough to ensure a supportive environment for children and adolescents orphaned, infected or affected by HIV/AIDS. It is proposed ways for Brazil to develop and improve databases to respond to these challenges. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:31-41.The focus of the present study is the Brazilian response within science, technology and innovation to the targets formulated in the UNGASS document. An analysis was made of items 70-73 of the UNGASS Draft Declaration of Commitment on HIV/ AIDS (2001), which defined science, technology and innovation targets relating to HIV/AIDS. The main topics listed in these items were put into operation in the form of keywords, in order to guide systematic searches within the standard biomedicine databases, also including the subdivisions of the Web of Science relating to natural and social sciences. The success of Brazilian research within the field of characterization and isolation of HIV-1 is undeniable. Phase II/III vaccine studies have been developed in Rio de Janeiro, Belo Horizonte and São Paulo. Empirical studies on the monitoring of primary resistance have been developed in specific populations, through the Brazilian HIV Resistance Monitoring Network. Within the field of monitoring secondary resistance, initiatives such as the National Genotyping Network have been highlighted. Two national systems - the Mortality Information System and the Notifiable Diseases Information System-AIDS - and some studies with wider coverage have given rise to work on trends within the epidemic. The production of high-quality generic medications and their free distribution to patients have been highlighted. Brazil has implemented a consistent and diversified response within the field of HIV/AIDS, with studies relating to the development of vaccines, new medications and monitoring of the epidemic. (author's)
Antiretroviral treatment for injecting drug users in developing and transitional countries 1 year before the end of the "Treating 3 million by 2005. Making it happen. The WHO strategy" (‘3 by 5').
Addiction. 2006 Sep; 101(9):1246-1253.The objective was to describe and estimate the availability of antiretroviral treatment (ART) to injecting drug users (IDUs) in developing and transitional countries. Literature review of grey and published literature and key informants' communications on the estimated number of current/former injecting drug users (IDUs) receiving ART and the proportion of human immunodeficiency virus (HIV) attributed to injecting drug use (IDU), the number of people in ART and in need of ART, the number of people living with HIV/acquired immunodeficiency syndrome (AIDS) (PLWHA) and the main source of ART. Data on former/current IDUs on ART were available from 50 countries (in 19 countries: nil IDUs in treatment) suggesting that ~34 000 IDUs were receiving ART by the end of 2004, of whom 30 000 were in Brazil. In these 50 countries IDUs represent ~15% of the people in ART. In Eastern European and Central Asia IDU are associated with > 80% of HIV cases but only ~2000 (14%) of the people in ART. In South and South-East Asia there were ~1700 former/current IDUs receiving ART (~1.8% of the people in ART), whereas the proportion of HIV cases associated to IDU is > 20% in five countries (and regionally ranges from 4% to 75%). There is evidence that the coverage of ART among current/former IDUs is proportionally substantially less than other exposure categories. Ongoing monitoring of ART by exposure and population subgroups is critical to ensuring that scale-up is equitable, and that the distribution of ART is, at the very least, transparent. (author's)
A cultural approach to HIV / AIDS prevention and care, UNESCO / UNAIDS research project. Uganda's experience: country report.
Paris, France, UNESCO, Cultural Policies for Development Unit, 1999. 61 p. (Studies and Reports, Special Series, Issue No. 1)Nearly two decades since a new syndrome, the acquired immune deficiency syndrome (AIDS) was first recognised in 1981, and its aetiological agent the human immunodeficiency virus [HIV] identified in 1983, there is still no cure nor is a vaccine against the disease available. Interventions intended to bring about changes in behaviour remain the principal means of preventing further spread and counselling is the main avenue for alleviating the adverse impact of the disease. Uganda, in common with other countries of Eastern and Central Africa, is one of the worst hit. By the end of 1997, UNAIDS estimated that between 400,000 - 500,000 Ugandans had already died of AIDS - related illnesses, out of a population of 20 million. Currently, HIV/AIDS is the leading cause of deaths among adults aged 25 - 44 and ranks only second to malaria in the general population, (Ministry of Health). It is estimated that about 1.8 million Ugandans, or 9 per cent of the population are infected with HIV, the virus that causes AIDS. (excerpt)
HIV-infected women and their families: psychosocial support and related issues. A literature review.
Geneva, Switzerland, World Health Organization [WHO], Department of Reproductive Health and Research, 2003. vi, 57 p. (Occasional Paper; WHO/RHR/03.07; WHO/HIV/2003.07)This review is divided into three sections. Section one provides a synthesis of the reviewed literature on prevention of mother-to-child transmission (PMTCT) of HIV, voluntary HIV testing and counselling (VCT), and other issues that impact on the care, psychosocial support and counselling needs of HIV-infected women and their families in the perinatal period. Section two provides examples from around the world of projects that focus on the care and support of women and families, with a focus on MTCT. The fi nal section contains recommendations on psychosocial support and counselling for HIV-infected women and families. (excerpt)
Immunization of children at risk of infection with human immunodeficiency virus. [Immunisation des enfants courant le risque d'infection par le virus d'immunodéficience humain]
Bulletin of the World Health Organization. 2003; 81(1):61-70.This paper reviews the English language literature on the safety, immunogenicity and effectiveness in children infected with the human immunodeficiency virus (HIV) of vaccines currently recommended by WHO for use in national immunization programmes. Immunization is generally safe and beneficial for children infected with HIV, although HIV-induced immune suppression reduces the benefit compared with that obtained in HIV-uninfected children. However, serious complications can occur following immunization of severely immunocompromised children with bacillus Calmette–Guérin (BCG) vaccine. The risk of serious complications attributable to yellow fever vaccine in HIV-infected persons has not been determined. WHO guidelines for immunizing children with HIV infection and infants born to HIV-infected women differ only slightly from the general guidelines. BCG and yellow fever vaccines should be withheld from symptomatic HIV-infected children. Only one serious complication (fatal pneumonia) has been attributed to measles vaccine administered to a severely immunocompromised adult. Although two HIV-infected infants have developed vaccine-associated paralytic poliomyelitis, several million infected children have been vaccinated and the evidence does not suggest that there is an increased risk. The benefits of measles and poliovirus vaccines far outweigh the potential risks in HIV-infected children. The policy of administering routine vaccines to all children, regardless of possible HIV exposure, has been very effective in obtaining high immunization coverage and control of preventable diseases. Any changes in this policy would have to be carefully examined for a potential negative impact on disease control programmes in many countries. (author's)