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UNAIDS and WHO Consultation on Progress in Prevention and Care in the Context of the "3 By 5 Initiative" and the Perspective of Universal Access in the Western Pacific Region, 12-16 December 2005, Manila, Philippines. Report.
Manila, Philippines. WHO, Regional Office for the Western Pacific, .  p. ((WP)HSI/ICP/HSI/3.5/001; Report Series No. RS/2005/GE/45(PHL))The WHO Western Pacific Regional Office, in collaboration with the Joint United Programme on HIV/AIDS (UNAIDS), organized the four-day UNAIDS and WHO Consultation on Progress in Prevention and Care in the Context of the "3 by 5" Initiative and the Perspective of Universal Access in the Western Pacific Region with the general objective that, by the end of the consultation, the participants would have: (1) reviewed progress made on prevention and care scale-up in the context of the "3 by 5" Initiative; (2) shared experiences among countries on the current performance of monitoring and evaluation systems related to HIV/AIDS care, treatment and support: (3) identified ways to strengthen the integration of HIV/AIDS prevention and care: and (4) defined the conditions and terms of reference of a partners technical working group on HIV/AIDS prevention and care scale-up in the Western Pacific Region. (excerpt)
Health Policy and Development. 2004 Aug; 2(2):96-99.The World Food Programme (WFP) is the United Nations (UN) agency responding to humanitarian emergencies by delivering food aid to vulnerable populations worldwide. The protracted insurgency in northern Uganda resulted in the displacement of up to 1,619,807 people, largely women and children. The humanitarian situation among displaced persons in northern and eastern Uganda led to diminished coping abilities and increased food aid needs. Access to food through productive means varies but, on average, households can only access about 0.5 - 0.75 acres of land. Recent nutrition and health assessments conducted in Pader District, in Feb 2004 and in Gulu District, in June 2004, highlight high mortality rates of more than 1 death/10,000 people/day. While Global Acute Malnutrition (GAM) rates appear to fall within the normal range expected within African populations (<5% GAM), high mortality rates consistently highlight the severity of the health situation in the camps. The WFP Uganda Country Office currently implements a Protracted Relief and Recovery Operation (PRRO) and a Country Programme (CP). The PRRO targets Internally Displaced Persons in Northern Uganda through General Food Distribution (GFD) activities, school children, HIV/AIDS infected and affected households and other vulnerable groups. In partnership with the Government of Uganda (GOU), sister UN agencies, international and national NGOs and Community Based Organisations, WFP currently assists the 1,619,807 Internally Displaced Persons, (IDPs), including 178,741 school children in the Gulu and Kitgum, 19,900 people infected with or affected by HIV/AIDS in Gulu and Kitgum and more than 750 food insecure persons involved in asset creation. Whilst WFP and other humanitarian actors continue to provide relief support to the displaced communities of northern Uganda, it is clear that without increased security the crisis will continue. (author's)
Right to education during displacement: a resource for organizations working with refugees and internally displaced persons.
New York, New York, Women' s Commission for Refugee Women and Children, 2006.  p.This resource is the first in a series of tools that identifies everyone's right to education, with a focus on refugees, returnees and internally displaced persons (IDP). This version is designed for use by local, regional and international organizations, United Nations (UN) agencies, government agencies and education personnel working with displaced communities. Is it mean to serve as: an awareness raising tool to encourage humanitarian assistance agencies to implement education programs - and donors to found them; training and capacity-building resource for practitioners and others working with displaced populations on international rights around education; and a call to action for organizations and individuals to promote access and completion of quality education for all persons affected by emergencies. (excerpt)
Washington, D.C., World Bank, Global HIV / AIDS Program, 2005 Dec. 5 p.Many countries are working to expand access to antiretroviral (ARV) drugs for millions of people with HIV/AIDS. Uninterrupted and timely supplies of safe, effective and affordable ARV drugs are needed. They must be dispensed correctly by health workers, and consistently taken by patients. A partnership between the World Bank and World Health Organization (WHO), in collaboration with the Global Fund for AIDS, TB and Malaria (GFATM), UNICEF, UNAIDS, and the American and French Governments is helping countries build capacity to procure and manage HIV/AIDS drugs and related supplies. This effort has helped support an increase in the number of people on ARV treatment in low- and middle income countries, from 400,000 at the end of 2003, to about one million in June 2005. (author's)
Improving access to quality care in family planning: WHO's four cornerstones of evidence-based guidance.
Journal of Reproduction and Contraception. 2007 Jun; 18(2):63-71.The four cornerstones of guidance in technique service of family planning are established by WHO based on high quality evidences. They have been updated according to the appearing new evidences, and the consensuses were reached by the international experts in this field. The four documents include Medical Eligibility Criteria for Contraceptive Use, Selected Practice Recommendations for Contraceptive Use, Decision-making Tool for Family Planning Clients and Providers and The Global Handbook for Family Planning Providers. The first two documents mainly face to the policy-makers and programme managers and were treated as the important references for creating the local guideline. The other two documents were developed for the front-line health-care and family planning providers at different levels, which include plenty of essential technical information to help providers improve their ability in service delivery and counselling. China paid great attention to the introduction and application of WHO guidelines. As soon as the newer editions of these documents were available, the Chinese version would be followed. WHO guidelines have been primarily adapted with the newly issued national guideline, The Clinical Practical Skill Guidelines- Family Planning Part, which was established by China Medical Association. At the same time, the WHO guidelines have been introduced to some of the clinicians and family planning providers at different levels. In the future, more special training courses will be introduced to the township level based on the needs of grass-root providers. (author's)
Long-acting and permanent contraception: An international development, service delivery perspective.
Journal of Midwifery and Women's Health. 2007 Jul-Aug; 52(4):361-367.Recent scientific findings about long-acting and permanent methods of contraception underscore their safety, effectiveness, and wide eligibility for individuals who desire them. This has led to new guidance from the World Health Organization to inform national policies, guidelines, and standards for service delivery. Although developing countries have made much progress in expanding the availability and use of family planning services, the need for effective contraception in general (and long-acting and permanent methods in particular) is large and growing because the largest cohorts in human history are entering their reproductive years. More than half a billion people will use contraception in developing countries (excluding China) by 2015, an increase of 200 million over levels of use in 2000. The health, development, and equity rationales that historically have underpinned and energized the international family planning effort remain valid and relevant today. Despite the other compelling challenges faced by the international health community, the need to make family planning services more widely available is pressing and should remain a priority. (author's)
Journal of Tropical Pediatrics. 2007 Jun; 53(3):147-149.Tuberculosis (TB) kills about 2 million adults and around 100 000 children every year. One-third of the world's population are currently infected with Mycobacterium tuberculosis and many have active disease. In Europe TB emerged as a major disease in the latter part of the 14th century. The industrial revolution saw rapid growth of urban centres where overcrowding with poor living conditions provided ideal circumstances for the spread of the disease. Great impact was made by streptomycin and isoniazid, so that by the 1970s TB was no longer being considered a problem in the developed world. But beginning in the 1980s the number of new cases of TB in USA and across Europe rose sharply. The pattern was repeated in many countries and worldwide throughout the 1990s and into the new millennium. The incidence of TB climbed to over 9 million cases every year. In 1993 the World Health Organization (WHO) declared TB as a global emergency. During the 1990s multidrug resistant tuberculosis (MDR-TB), defined as resistance to at least isoniazid and rifampicin, emerged as a threat to TB control. MDR-TB requires the use of second line drugs that are less effective, more toxic and costlier. In a global survey of 17 690 TB isolates during 2000-04, 20% were MDR and 2% were extremely drug resistant (XDR). XDR-TB is defined as MDR plus resistance to any fluoroquinolones and at least one of three injectable second line drugs kanamycin and amikacin, or capreomycin or both. Currently one in ten new infections is resistant to at least one antituberculosis drug. (excerpt)
International Journal of Gynecology and Obstetrics. 2007 Jun; 97(3):227-228.The Alliance for Women's Health is a FIGO-based interagency consortium, comprising the World Health Organization, United Nations Population Fund, World Bank, UNICEF, International Planned Parenthood Federation, International Confederation of Midwives and International Pediatric Association. In conjunction with the XVIII World Congress of Gynecology and Obstetrics in Kuala Lumpur in November 2006, the Alliance held a precongress workshop examining access in five priority emerging issues: human papillomavirus vaccine/cervical cancer screening, emergency contraception, adolescent reproductive health, emergency obstetric care and sexually transmitted infections. Reports from the five working groups, published in this and subsequent issues of the International Journal of Gynecology and Obstetrics, provide current evidence-based recommendations on improving access to sexual and reproductive health services supported by applicable rights. The World Bank presented a framework for the discussion during theopening plenary session. The importance of sexual and reproductive health services is well recognized and was articulated in the Programme of Action of the International Conference on Population and Development which was held in Cairo in 1994. However, the inclusion of universal access to reproductive health as a target for the Millennium Development Goals (MDGs) only occurred in October 2006 after prolonged negotiations reflecting the reluctance, in circles of influence, to provide support where there are certain sociopolitical sensitivities. (excerpt)
Targeting access to reproductive health: Giving contraception more prominence and using indicators to monitor progress.
Reproductive Health Matters. 2007 May; 15(29):186-191.Unmet need for contraception represents a major failure in the provision of reproductive health services and reflects the extent of access to services for spacing and limiting births, which are also affected by personal, partner, community and health system factors. In the context of the Millennium Development Goals, family planning has been given insufficient attention compared to maternal health and the control of sexually transmitted infections. As this omission is being redressed, efforts should be directed towards ensuring that an indicator of unmet need is used as a measure of access to services. The availability of data on unmet need must also be increased to enable national comparisons and facilitate resource mobilisation. Unmet need is a vital component in monitoring the proportion of women able to space and limit births. Unmet need for contraception is a measure conditioned by people's preferences and choices and therefore firmly introduces a rights perspective into development discourseand serves as an important instrument to improve the sensitivity of policy dialogue. The new reproductive health target and the opportunity it offers to give appropriate attention to unmet need for contraception will allow the entry of other considerations vital to ensuring universal access to reproductive health. (author's)
Public choices, private decisions: sexual and reproductive health and the Millennium Development Goals.
[New York, New York], United Nations Development Programme, UN Millennium Project, 2006.  p.Sexual and reproductive health (SRH) was given an international consensus definition at the International Conference on Population and Development (ICPD) in 1994. At its core is the promotion of healthy, voluntary and safe sexual and reproductive choices for individuals and couples, including decisions on family size and timing of marriage, that are fundamental to human well-being. Sexuality and reproduction are vital aspects of personal identity and key to creating fulfilling personal and social relationships within diverse cultural contexts. SRH does not only involve the reproductive years but emphasizes the need for a life-cycle approach to health. It touches on sensitive, yet important, issues for individuals, couples and communities, such as sexuality, gender discrimination and male/female power relations. Attainment of SRH depends vitally on the protection of reproductive rights, a set of long-standing accepted norms found in various internationally agreed human rights instruments. The ICPD adopted the goal of ensuring universal access to reproductive health by 2015 as part of its framework for a broad set of development objectives. The Millennium Declaration and the subsequent Millennium Development Goals (MDGs) set priorities closely related to these objectives. Progress towards the MDGs depends on attaining the ICPD reproductive health goals. The leaders of the world ratified that understanding in the 2005 World Summit Outcome Document. (excerpt)
London, England, International Community of Women Living with HIV / AIDS, 2006.  p.WHO supported ICW to map positive women's experiences of access to care and treatment in three countries - Namibia, Kenya and Tanzania. The findings will contribute to advocacy for increased political support and resources to address gendered barriers to care, treatment and support. The project complements a mapping and database of civil society organizations (CSOs) providing treatment by the French consortium - SIDACTION. This mapping presents results from three focus group discussions with HIV positive women conducted in two districts of Tanzania - Arusha and Moshi (2006). Women who participated in these focus group discussions were aged between 30 to 45. Most of them came from villages Munduli (Arusha) and Seliani (Moshi). Three focus groups were also conducted with men only in Arusha. A mixed-sex focus group was conducted in Chalinze in the Bagamoyo district (Dar es Salaam coastal area) with men and women aged between 35 and 42. There were between 12 - 15 participants in each group in Arusha and Mosh. However, in Chalinze there were only 8 people. Results from the mixed sex and men only focus groups are presented here but the main emphasis is on the results from the women only focus groups. Medical personnel were also interviewed and their experiences are included. (excerpt)
London, England, International Community of Women Living with HIV / AIDS, 2006.  p.Namibia, Kenya and Tanzania. The findings will contribute to advocacy for increased political support and resources to address gendered barriers to care, treatment and support. The project complements a mapping and database of civil society organizations (CSOs) providing treatment by the French consortium - SIDACTION. The research was carried out in Homabay (rural) and Kibera community (urban) involving women and men living with HIV and AIDS (13th December 2005 - 31st January 2006). Data was gathered through questionnaires and focus group discussions (FGDs). Women who participated in the focus group discussions were aged between 22 - 45 years old and in total 100 people took part in the project, including questionnaire respondents. The service providers in both sites were of varied age group (28-45 years) and both female and male service providers participated in the focus group discussions. Results from the mixed sex and service provider focus groups are presented here but the main emphasis is onthe results from the women only focus groups. (excerpt)
Lancet. 2007 Apr 21; 369(9570):1320.In June, 2006, UN member states at the High Level Meeting on AIDS committed themselves to provide universal access to comprehensive prevention pro grammes, treatment, care, and support by 2010. This week WHO, UNAIDS, and UNICEF publish the first report about progress towards this goal. Sadly, there is little for the international community to be pleased about. Although 2 million people had access to antiretroviral therapy at the end of 2006, 5 million were still in need of treatment. Some progress has been made in reducing the costs of first-line antiretrovirals. In low-income and middle-income countries the prices of most first-line drugs decreased by between 37% and 53% from 2003 to 2006, contributing substantially to the wider availability of treatment. But more patients put on treatment will inevitably be accompanied by increasing HIV-drug resistance. Second-line drugs, and new types of antiretroviral drugs in the future, such as the integrase inhibitors, have the potential to offer new treatment options for patients whose disease no longer responds to first-line drugs. But unless prices for second-line regimens fall substantially, budgetary constraints mean treatment programmes will be put at risk. (excerpt)
Political Declaration on HIV / AIDS. Draft resolution submitted by the President of the General Assembly.
New York, New York, United Nations, General Assembly, 2006 Jun 2. 8 p. (A/60/L.57)We, Heads of State and Government and representatives of States and Governments participating in the comprehensive review of the progress achieved in realizing the targets set out in the Declaration of Commitment on HIV/AIDS, held on 31 May and 1 June 2006, and the High-Level Meeting, held on 2 June 2006. Note with alarm that we are facing an unprecedented human catastrophe; that a quarter of a century into the pandemic, AIDS has inflicted immense suffering on countries and communities throughout the world; and that more than 65 million people have been infected with HIV, more than 25 million people have died of AIDS, 15 million children have been orphaned by AIDS and millions more made vulnerable, and 40 million people are currently living with HIV, more than 95 per cent of whom live in developing countries. Recognize that HIV/AIDS constitutes a global emergency and poses one of the most formidable challenges to the development, progress and stability of our respective societies and the world at large, and requires an exceptional and comprehensive global response. (excerpt)
New York, New York, UNFPA, .  p.Each year, more people are living with HIV than the year before. And each year, more people die of AIDS. This growing global tragedy has many faces: The desperation of a teenage orphan struggling to care for her younger siblings by trading sexual favours for food; The sorrow of a young mother who learns she is HIV-positive at a prenatal clinic; The anguish of an unemployed youth who fears he has acquired HIV, but has no access to counselling, testing or condoms. In the absence of a cure, HIV prevention offers the best hope of reversing the epidemic. Prevention works. Sustained political commitment through intensive programmes in diverse settings has reduced HIV incidence. Advances in treatment are reinforcing prevention efforts by encouraging voluntary testing and reducing the stigma associated with AIDS. Nevertheless, the pandemic is outstripping efforts to contain it and is gaining ground globally. (excerpt)
Paris, France, UNESCO, 2006 Mar. 37 p. (Good Policy and Practice in HIV and AIDS and Education Booklet No. 3; ED-2006/WS/4; cld 26006)UNESCO recognizes the significant impact of HIV and AIDS on international development, and in particular on progress towards achieving Education For All (EFA). As the UN agency with a mandate in education and a co-sponsor of the Joint United Nations Programme on HIV and AIDS (UNAIDS), UNESCO takes a comprehensive approach to HIV and AIDS. It recognizes that education can play a critical role in preventing future HIV infections and that one of its primary roles is to help learners and educators in formal and non-formal education systems to avoid infection. It also recognizes its responsibility to address and respond to the impact of the epidemic on formal and non-formal education systems, and the need to expand efforts to address issues related to care, treatment and support of those infected and affected by HIV. UNESCO's global strategy for responding to HIV and AIDS is guided by four key principles, and focuses on five core tasks. The guiding principles that are the foundation of UNESCO's response to HIV and AIDS are: Work towards expanding educational opportunities and the quality of education for all; A multi-pronged approach that addresses both risk (individual awareness and behaviour) and vulnerability (contextual factors); Promotion and protection of human rights, promotion of gender equality, and elimination of violence (notably violence against women), stigma and discrimination; An approach to prevention based on providing information that is scientifically sound, culturally appropriate, and effectively communicated, and helping learners and educators to develop the skills they need to prevent HIV infection and to tackle HIV and AIDS-related discrimination. (excerpt)
Durban, South Africa, Health Systems Trust, 2004. 61 p.This case study presents an overview of the Stop TB Partnership operating in the South African context. It offers an analysis of the activities and impact of the Partnership in South Africa. Its overarching objective is to collect a set of baseline data on the functioning and operational aspects of the Partnership and to assess whether such initiatives contribute to the development of equitable health services in the public health sector. Tuberculosis is a priority disease in South Africa: the cure rate for new patients of 64% is still way below the World Health Organization (WHO) target of 85%. In some provinces, the cure rate is as low as 40%. The estimated incidence of TB per 100 000 population is 526, and an estimated 60% of adults with TB are also HIV positive. South Africa is ranked third in the WHO AFRO region by the number of TB cases, and ninth globally. Funded by WEMOS, this review is part of a multi-country study. It aims to augment the existing body of knowledge on Global Public Private Initiatives in Health (GPPIs) and to generate a body of country-based evidence relating to the effect of GPPIs on health policies and health systems. (excerpt)
Using UN process indicators assess needs in emergency obstetric services:Gabon, Guinea-Bissau, and The Gambia.
International Journal of Gynecology and Obstetrics. 2007 Mar; 96(3):233-240.We report on assessments of the needs for emergency obstetric care in 3 West African countries. All (or almost all) medical facilities were visited to determine whether there are sufficient facilities of adequate quality to manage the expected number of obstetric emergencies. Medical facilities able to provide emergency obstetric care were poorly distributed and often were unable to provide needed procedures. Too few obstetricians and other providers, lack of on-the-job training and supervision were among the challenges faced in these countries. (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)
The Maputo report. WHO support to countries for scaling up essential interventions towards universal coverage in Africa.
Brazzaville, Congo, WHO, 2006. 33 p. (WHO/CCO/06.02)The African region accounts for 10% of the world's population yet is confronted with 20% of the global burden of disease. African nations are faced with high levels of poverty, with 39% of the population below the poverty line; and slow economic growth, with annual per capita expenditure on health in most countries limited to between US$ 10 and US$ 29. Other well-documented challenges to the region include limited financial and human resources, uncoordinated and inconsistent policy action on the determinants of health, limited use of knowledge and evidence to inform policies, and frequent occurrences of natural and man-made disasters. Although much has happened, WHO requires radical new approaches for how it does business in the region. The 21st century presents extensive opportunities for improving health in the region -- building on the momentum of the Millennium Development Goals (MDGs), resolutions of the WHO World Health Assembly (WHA) and the Regional Committee, coordinated work of the African Union, and the strategic framework of the New Partnership for Africa's Development (NEPAD) -- offering opportunities for the mobilization of political, technical and other resources for the region. In addition to health investments from national, bilateral and multilateral sources, commitments are being crystallized in distinct initiatives such as the Millennium Challenge Account, the Presidential Emergency Plan for AIDS Relief (PEPFAR), the Report on the Commission for Africa, the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria (GFATM), and the Global Alliance for Vaccines and Immunizations (GAVI). These initiatives come at a time when international agreements such as the Paris Declaration reaffirm the importance of countries taking the lead in their own health agendas in regards to international development assistance. (excerpt)
Engaging all health care providers in TB control. Guidance on implementing public-private mix approaches.
Geneva, Switzerland, World Health Organization [WHO], Stop TB Department, 2006. 52 p. (WHO/HTM/TB/2006.360)A great deal of progress has been made in global tuberculosis control in recent years through the large-scale implementation of DOTS. It has been acknowledged though that TB control efforts worldwide, although impressive, are not sufficient. The global TB targets -- detecting 70% of TB cases and successfully treating 85% of them, and halving the prevalence and mortality of the disease by 2015 as part of the Millennium Development Goals (MDGs) -- are likely to be met only if current efforts are intensified. Among the important interventions required to reach these goals would be a systematic involvement of all relevant health care providers in delivering effective TB services to all segments of the population. Therefore, engaging all health care providers in TB control is an essential component of WHO's new Stop TB strategy¹ and the Stop TB Partnership's Global Plan to Stop TB 2006-2015. (excerpt)
Social Science and Medicine. 2007 Jan; 64(2):287-291.This article builds on a previous study which found low numbers of patent applications for HIV antiretroviral drugs in African countries. A high level of variation was noted across individual countries, and consequently, the present study has sought to account for sources of the variation through statistical analyses. First, a correlation between the number of patents and HIV infection rate was observed (r = 0.448, p < 0.001). T-tests identified significantly higher numbers of patents in national members of two intellectual property organizations (IPOs)--African Regional Intellectual Property Orginisation (ARIPO) and the Organisation Africaine de la Proprie´ te´ Intellectualle (OAPI)--than in countries who did not belong to an intellectual property organization. The relationship between IPO membership and number of patents was also statistically significant in a multivariate Poisson regression. These findings demonstrate that higher numbers of patents are found in countries where they are more easily filed. This has important policy implications given the worldwide trend toward increased recognition of pharmaceutical patents. (author's)
Washington, D.C., Population Reference Bureau [PRB], 2006 Apr. 5 p.As if the global AIDS pandemic alone were not enough, developing countries are beset with converging epidemics of HIV and tuberculosis (TB)--increasing the likelihood of premature death in these countries. Worldwide, 14 million people are coinfected with TB and HIV--70 percent of those in sub-Saharan Africa (see figure for five countries with particularly high coinfection rates). TB is the leading cause of death for those infected with HIV and is implicated in up to one-half of all AIDS deaths. And because HIV compromises the immune system, HIV-positive people are 50 times more likely to develop active TB than those who are HIV-negative. (excerpt)
Journal of Acquired Immune Deficiency Syndromes. 2006 Dec; 43(5):618-623.The number of people on highly active antiretroviral therapy (HAART) in South Africa has risen from < 2000 in October 2003, to almost 200,000 by the end of 2005. Yet South Africa's performance in terms of HAART coverage is poor both in comparison with other countries and the targets set by the government's own Operational Plan. The public-sector HAART ''rollout'' has been uneven across South Africa's nine provinces and the role of external assistance from NGOs and funding agencies such as the Global Fund and PEPFAR has been substantial. The National Treasury seems to have allocated sufficient funding to the Department of Health for a larger HAART rollout, but the Health Minister has not mobilized it accordingly. Failure to invest sufficiently in human resources-- especially nurses--is likely to constrain the growth of HAART coverage. (author's)
National adult antiretroviral therapy guidelines in South Africa: concordance with 2003 WHO guidelines?
AIDS. 2007 Jan 2; 21(1):121-122.We read with interest the article by Beck and colleagues who examined the adult antiretroviral therapy (ART) guidelines in 43 World Health Organization (WHO) '3 by 5' focus countries. The authors found that the national guidelines of a majority of countries had a good degree of concordance with the WHO 2003 guidelines. Although concordance was noted to be inversely related to health expenditure per capita, the authors did not further explore the reasons why some countries have adopted guidelines that differ from the current WHO recommendations. One such country is South Africa, which has among the highest per capita income of countries in sub-Saharan Africa and also has much better healthcare infrastructure than most. Despite these resources, the South African national ART programme currently bases its treatment guidelines on the former WHO 2002 guidelines that recommend ART only for patients with WHO stage 4 disease (AIDS) or a blood CD4 cell count of less than 200 cells/ml. We believe these guidelines advocate treatment at too late a stage of disease and that they represent a compromise that may substantially undermine the effectiveness of the programme in the long term. (excerpt)