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Surveillance of acquired immunodeficiency syndrome in Africa: an analysis of evaluations of the World Health Organization and other clinical definitions.
EPIDEMIOLOGIC REVIEWS. 1994; 16(2):403-17.In order to improve public health efforts to combat the HIV pandemic, a system for surveillance of HIV and AIDS is needed. Definitions used for case reporting are at the heart of such a system. In many parts of Africa, however, facilities for diagnosing HIV infection and its subsequent complications are unavailable, and the definition developed by the US Centers for Diseases Control and Prevention (CDC) for use in developed countries is often impractical in Africa. The World Health Organization (WHO) in early 1985 therefore proposed using a provisional case definition of AIDS based principally upon clinical criteria. Developing a clinical definition of AIDS in Africa, however, is also complicated. The nonspecific nature of many of the signs and symptoms of HIV infection as well as the clinical redundancy between HIV and other epidemic health problems make definitive identification of any single disease problematic. Evaluation of the surveillance definition of AIDS in Africa is complicated by the lack of an accepted standard for comparison. Most studies in the field have used HIV serology as the standard, while others have employed the CDC definition for AIDS, giving the evaluations a certain relativity. This paper reviews available information on the WHO definition and other clinical definitions for AIDS in Africa in order to analyze their various field evaluations and explore the use of such definitions in the African context. Sections discuss surveillance clinical case definitions for African AIDS in adult and pediatric populations, clinical case definitions of African AIDS in adult and pediatric populations, sensitivity and specificity, the WHO clinical case definition for HIV epidemiologic survey, clinical definitions for AIDS in clinical practice, and working toward the improvement of the clinical definition of AIDS.
TUBERCLE AND LUNG DISEASE. 1994 Jun; 75(3):163-7.Poor management of tuberculosis (TB) control is responsible for resistance to antituberculosis drugs. It leads to treatment failure, relapse, transmission of resistant TB, and multi-drug resistant TB. In developing countries, where resources are already limited, an epidemic of multi-drug resistant TB would jeopardize TB control. The effect of HIV infection is likely to worsen drug resistance-related problems. Specifically, streptomycin injections pose a risk of HIV transmission. It appears that withdrawal of thiacetazone from HIV infected TB patients causes resistance to more powerful drugs. If these 2 antibiotics cannot be used to treat TB patients, the armamentarium available to control TB in high HIV prevalence countries is reduced, which could foster resistance to the fewer remaining antibiotics. Good management and supervision is needed to prevent resistance to antituberculosis drugs. Surveillance of drug resistance is also needed to monitor the current level and characteristics of the drug resistance problem and to identify effective solutions. Specifically, at the national level, a TB surveillance system can assess the TB control program's performance and assess the need to modify the current treatment policy. It can identify districts or health centers with high levels of drug resistance and determine the risk factors for resistance. WHO will assist developing countries in developing their own surveillance systems. WHO and the International Union Against Tuberculosis and Lung Disease plan on setting up a network of supranational reference laboratories to determine the quality control and standardization of susceptibility testing needed for international comparison. WHO also plans on supporting national reference laboratories in developing countries.
JOURNAL OF COMMUNICABLE DISEASES. 1994 Dec; 26(4):231-2.The World Health Organization (WHO) criteria for HIV clinical disease were tested among individuals with high-risk behavior in northern India. A questionnaire, based upon history and physical examination alone, standardized by the WHO to include both major and minor signs necessary for the clinical diagnosis of AIDS in adults was applied to 165 consecutive patients attending the STD clinic of Dr. R.M.L. Hospital, New Delhi. All patients were screened for the presence of STDs by the dermatologist in charge of the clinic, with patients fulfilling two major and at least two minor WHO criteria eventually classified as having clinical AIDS based upon the WHO case definition. Each of those patients was subjected to serological confirmation of the clinical suspicion using ELISA and Western blot commercial tests. Of the 165 patients screened, a definite diagnosis of STD was possible in 85. These patients were 20-45 years old (mean age, 30.59 years). All were male and chancroid was the most common STD in the cohort. Of the 85, only one satisfied the WHO clinical criteria for AIDS. Serological investigations, ELISA, and Western blot confirmed the subject's HIV-seropositive status. These results indicate that in northern India, clinical HIV disease remains rare even among individuals with high-risk behavior. The low prevalence of clinical HIV disease in that part of the country makes it difficult to assess the specificity and sensitivity of the WHO clinical criteria for AIDS.
MEMORIAS DO INSTITUTO OSWALDO CRUZ. 1996 May-Jun; 91(3):335-8.The World Health Organization (WHO) Global Program on AIDS (GPA) organized the WHO Network for HIV-1 Isolation and Characterization to monitor HIV-1 variability. Brazil is one of the HIV vaccine trial sites selected by WHO-GPA. HIV-1 subtypes B, F, and C have thus far been found in the country. A study involving 235 Brazilian isolates found subtype B to prevail in 88.5% of cases, subtype F in 8.9%, and subtype C in 1.7%. 2 samples (0.9%) were variants resulting from a recombination between subtypes B and F. Further studies have found that Brazilian HIV-1 strains have genetic and antigenic differences compared to North American/European prototype strains, potentially affecting the success of immunoprophylactic programs based upon HIV-1 vaccine candidates currently proposed for testing in Brazil. A Brazilian Network for HIV-1 Isolation and Characterization (BNHIC) was thus established in March 1993, as part of the National Program of HIV/AIDS Vaccine Development and Evaluation. The BNHIC was organized upon a 3-tier basis including primary site, central reference laboratory, and secondary laboratories. The authors discuss efforts made to achieve network goals in Brazil.
Impact of the 1994 expanded World Health Organization AIDS case definition on AIDS surveillance in university hospitals and tuberculosis centers in Cote d'Ivoire.
AIDS. 1997 Dec; 11(15):1867-72.To assess the impact of the 1994 expanded World Health Organization (WHO) AIDS case definition upon AIDS surveillance in Cote d'Ivoire, passive AIDS case surveillance was conducted from March 1994 through December 1996 at the 3 university hospitals in Abidjan, while active AIDS case surveillance was conducted at the 8 large tuberculosis (TB) centers throughout Cote d'Ivoire. Standardized questionnaires were administered and blood samples for HIV testing were collected from patients evaluated. 3658 of the 8648 hospital patients met the clinical and/or expanded case definition: 744 HIV-seropositive individuals met only the expanded definition, 44 HIV-seropositive individuals met only the clinical definition, 2334 HIV-seropositive individuals met both definitions, and 536 HIV-seronegative persons met only the clinical definition. Of 18,661 TB center patients, 9664 met the clinical and/or expanded case definition: 5685 HIV-seropositive individuals met only the expanded definition, none of the HIV-seropositive individuals met only the clinical definition, 2625 HIV-seropositive individuals met both definitions, and 1354 HIV-seronegative persons met only the clinical definition. The use of the 1994 expanded definition for surveillance purposes should be encouraged in areas of the developing world where HIV serologic testing is available.
Meeting report on Fourth Regional Workshop on HIV / STD Surveillance, Cairo, Egypt, 7-10 October 1996.
Alexandria, Egypt, WHO, Regional Office for the Eastern Mediterranean, 1997. , 28 p. (WHO/EM/STD/2/E/L)The Eastern Mediterranean Regional Office of the World Health Organization is working to develop and strengthen surveillance for HIV, AIDS, and sexually transmitted diseases (STDs). Progress in the implementation of such strategies was discussed at the Fourth Regional Workshop on HIV/STD Surveillance held in Cairo, Egypt, in October 1996. The main objectives of HIV surveillance are 1) to monitor trends in HIV infection over time and place, and 2) provide information for program planning, advocacy, and program implementation. By the end of June 1996, a cumulative total of 3979 AIDS cases had been reported by 21 Member States in the region; however, the actual number is considered to be well over 12,000 and an estimated 220,000 persons are HIV-infected. HIV surveillance has focused primarily on STD patients. Obstacles to this approach include low attendance of STD patients (especially women) at public sector clinics, the unacceptability of unlinked anonymous testing in many countries, and insufficient coordination between sentinel sites and testing laboratories. Options for improving HIV surveillance include orientation of policy-makers on the importance of using unlinked anonymous testing to reduce participation bias, involvement of private doctors and nongovernmental organizations in surveillance of high-risk groups, introduction of tests for syphilis and hepatitis B in sentinel sites before surveillance begins, proper selection of sentinel sites to ensure adequate sample size, and preparation of an operations manual for staff at surveillance sites. The AIDS case definition needs to be reviewed and revised to suit the prevailing situation in the region. For STD surveillance, reports should be obtained from both private and public health facilities, with an etiology-based rather than syndromic approach to diagnosis.
New York Times on the Web. 2002 Jun 28;  p..The United Nations today issued a stinging public criticism of China's lackluster efforts to face its rapidly accelerating epidemic of H.I.V. infection and AIDS, saying the country is "on the verge of a catastrophe." In a new report, "H.I.V./AIDS: China's Titanic Peril," the Joint United Nations Program on H.I.V./AIDS criticized Chinese officials on many fronts, from the lack of adequate education programs to the absence of treatment for people infected with H.I.V. "We are now witnessing the unfolding of an H.I.V./AIDS epidemic of proportions beyond belief, an epidemic that calls for an urgent and proper but as yet unanswered quintessential response," the report said, noting that the lack of action meant China could have the largest number of people infected with H.I.V. in the world within a few years. While much of the report circulated as an internal document among United Nations agencies late last year, its very public release today at a large news conference in Beijing signaled a new willingness by the United Nations to press China into action. (excerpt)
Scaling up antiretroviral therapy in resource-limited settings: treatment guidelines for a public health approach. Rev. ed.
Geneva, Switzerland, WHO, 2003. 67 p.Currently, fewer than 5% of people in developing countries who need ART can access the medicines in question. WHO believes that at least 3 million people needing care should be able to get the medicines by 2005. This represents almost a tenfold increase. These treatment guidelines are intended to support and facilitate the proper management and scale-up of ART in the years to come by proposing a public health approach to achieve the goals. The key tenets of this approach are as follows. 1) Scaling-up of antiretroviral treatment programmes with a view to universal access, i.e. all persons requiring treatment as indicated by medical criteria should have access to it. 2) Standardization and simplification of ARV regimens so as to support the efficient implementation of treatment programmes in resource-limited settings. 3) Ensuring that ARV treatment programmes are based on scientific evidence in order to avoid the use of substandard protocols that compromise the outcomes of individual patients and create a potential for the emergence of drug-resistant virus. However, it is also important to consider the realities with respect to the availability of human resources, health system infrastructures and socioeconomic contexts so that clear and realistic recommendations can be made. (excerpt)
Geneva, Switzerland, WHO, 2003.  p. (WHO/HIV/2003.11)The main strategy foreseen in order to implement a global M&E is to simplify and standardize tools for tracking the performance of antiretroviral therapy programmes, including surveillance of drug resistance, with the following steps: develop simple, standard, easy-to-use monitoring and evaluation indicators for ART programmes, promote the universal adoption and use of the core indicators for ART programmes, develop guidelines and networks for surveillance of antiretroviral drug resistance, develop guidelines and networks for monitoring risk behaviour, establishment of a Strategic Information Centre to collect data analyse and present the information on progresses made towards 3 by 5 for all to use. (excerpt)
Emerging Infectious Diseases. 2004 Nov; 10(11):1979-1983.The mechanisms, techniques, and data sources used to monitor and evaluate global AIDS prevention and treatment services may vary according to gender. The Joint United Nations Programme on HIV/AIDS has been charged with tracking the response to the pandemic by using a set of indicators developed as part of the Declaration of Commitment endorsed at the U.N. General Assembly Special Session on AIDS in 2001. Statistics on prevalence and incidence indicate that the pandemic has increasingly affected women during the past decade. Women’s biologic, cultural, economic, and social status can increase their likelihood of becoming infected with HIV. Since 2000, global financial resources have increased to allow expansion of both prevention and treatment services through a number of new initiatives, such as the Global Fund to Fight AIDS, TB and Malaria; the U.S. President’s Emergency Plan for AIDS Relief; and the World Bank MAP program. Programs should be monitored and evaluated to ensure these investments are used to maximum effect. Different types of data should be included when assessing the status of the HIV/AIDS epidemic and effectiveness of the response. Each of these “data streams” provides information to enhance program planning and implementation. (excerpt)
Reaching regional consensus on improved behavioural and serosurveillance for HIV: report from a regional conference in East Africa.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 1998. 12 p. (UNAIDS Best Practice Collection. Key Material; UNAIDS/98.9)This report documents a regional workshop on surveillance systems for HIV held in Nairobi, Kenya, on 10.13 February 1997. The UNAIDS-funded workshop gathered government epidemiologists, AIDS programme managers, and social scientists from Kenya, Malawi, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe as well as specialists from UNAIDS and other partner institutions. The group aimed to present current data and to work together to suggest practical guidelines for improving HIV surveillance systems in a maturing epidemic. (excerpt)
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)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:94-100.The objective of this study was to analyze, on the national level, the process of monitoring the proposed UNGASS indicators through the use of the Brazilian National Program for STD/AIDS's indicators. Two groups of proposed indicators were analyzed in 2002 and 2005 respectively, as part of the monitoring of the progress of the UNGASS Declaration of Commitment. The availability of information and limitations in calculating the proposed indicators in Brazil were analyzed and the appropriateness of the indicators for monitoring the epidemic in Brazil was discussed. Of the 13 quantitative indicators originally proposed by UNGASS, five were not included in the National Program. One was not included due to its qualitative nature. Two of the indicators were considered to be of little use and two were not included due to the lack of available data needed for their calculation. As the epidemic in Brazil is characterized as being concentrated, within the second group of proposed UNGASS indicators those that refer to the accompaniment of epidemic among high-risk population groups were prioritized. The study highlights that the National Program concentrates its efforts in the development, adaptation, and sharing of sampling methodologies for hard to reach populations. Such activities are geared towards estimating the size of vulnerable population groups, as well as obtaining more information regarding their knowledge, attitudes, and practices. The study concludes that by creating the possibility of international comparisons between advances achieved, the proposal of supranational indicators stimulates countries to discuss and make their construction viable. In a complementary way, the national monitoring systems should focus on program improvement by covering areas that permit the evaluation of specific control and intervention actions. (author's)
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:80-87.The paper critically analyzes, from the gender standpoint, official results presented in the Brazilian government report to the Joint United Nations Programme on HIV/ AIDS (UNAIDS). Specifically, the fulfillment of 2003 targets set forth in the United Nations Declaration of Commitment on HIV/AIDS, under the category of Human Rights and Reduction of the Economic and Social Impact of AIDS, are evaluated. Key concepts are highlighted, including indicators and strategies that may help civilian society better monitor these targets until 2010. (author's)
Findings Infobriefs. 2007 May; (136): p.The specific objectives of this project - financed through an IDA credit of $28.7 million (2002-05) - were to : (i) provide resources that would enable the government to implement a balanced, diversified multi-sector response, engaging all relevant government sectors, non-governmental organizations (NGOs) and grassroots initiatives; (ii) to expand contributions made by the Ministry of Health ( MOH ) engage civil society in the fight against AIDS; and (iii) finance eligible activities conducted by civil society organizations, including NGOs, community-based organizations (CBOs), faith-based organizations (FBOs), trade and professional associations, associations of people living with HIV/AIDS (PLWHAs), districts, and line ministries to ensure a rapid multisector scaling-up of HIV prevention and care activities in all regions and at all administrative levels. (excerpt)
Lancet Infectious Diseases. 2007 Aug; 7(8):508.New guidance has been issued to ensure that patient confidentiality is not compromised in the process of collecting and storing information on HIV/AIDS. "Ensuring that HIV information is securely stored and confidentiality is maintained will avoid potential stigmatisation and discrimination of individuals and communities as countries are scaling up HIV prevention, treatment, care, and support services", Eduard Beck (UNAIDS, Geneva, Switzerland) told TLID. "The development of these guidelines is part of the standards work that UNAIDS has been involved in, together with the US-funded President's Emergency Plan for AIDS Relief (PEPFAR) and WHO...it is aimed at those who provide and use HIV services, and managers who need to monitor and evaluate the services provided." (excerpt)
MEASURE Evaluation Bulletin. 2001; (2):1-27.This issue of the MEASURE Evaluation Bulletin includes articles in a number of areas of monitoring and evaluation of AIDS programs. The first four articles are based on a field test of indicators on knowledge, sexual behavior and stigma that was carried out as part of a large international effort to improve monitoring and evaluation of national programs. The field test resulted in revisions of standard indicators for AIDS programs, which were eventually published by UNAIDS, and revisions of the survey tools that are now used to collect AIDS information in many countries. Three subsequent articles deal with different aspects of monitoring and evaluation. The first of these explores estimation of the size of core groups, such as commercial sex workers or bar workers, which is essential but difficult. Capture-recapture techniques can be used to make such estimates, although there are multiple pitfalls. The next article focuses on monitoring trends in HIV prevalence among young antenatal women, which is the most feasible method of monitoring HIV incidence. Modelling shows that using prevalence trends to extrapolate incidence trends has to be done very carefully, but can be done if one takes measures to minimize the various biases. The last article of the Bulletin discusses the use of newspaper clippings as a source of indicators on political will and commitment and stigma. Although newspaper clippings have been cited as an easily accessible source for these indicators, the analysis suggests that an analysis of newspaper clippings may be more suitable for a cross-sectional situation analysis or in-depth qualitative research than for monitoring purposes. (excerpt)
Indian Journal of Medical Ethics. 2007 Jul-Sep; 4(3):109-10; discussion 111-2.In the last several months, there have been discussions in the media, including in this journal (1), about issues related to how AIDS vaccine trials are conducted in India. The International AIDS Vaccine Initiative (IAVI) has partnered with the ministry of health and family welfare in India through the National AIDS Control Organisation (NACO) and the Indian Council of Medical Research (ICMR) since 2002 to implement the AIDS vaccine research and development programme. With our partners, we strongly support transparency and the highest ethical standards in our joint efforts to find and deliver an AIDS vaccine that the world so desperately needs. In fact, IAVI's intellectual property agreements are also used as a mechanism to avoid any delay in the introduction of vaccines to developing countries (delays of more than 10 years or so in the past) by insisting that any vaccine will be made simultaneously available in developed and developing countries (2). (excerpt)
Low levels of antiretroviral-resistant HIV infection in a routine clinic in Cameroon that uses the World Health Organization (WHO) public health approach to monitor antiretroviral treatment and adequacy with the WHO recommendation for second-line treatment.
Clinical Infectious Diseases. 2009 May 1; 48(9):1318-22.A cross-sectional study, performed at a routine human immunodeficiency virus (HIV)/AIDS clinic in Cameroon that uses the World Health Organization public health approach, showed low rates of virological failure and drug resistance at 12 and 24 months after initiation of antiretroviral therapy. Importantly, the cross-sectional study also showed that the World Health Organization recommendation for second-line treatment would be effective in almost all patients with HIV drug resistance mutations.
Getting in line: Coordinating responses for children affected by HIV and AIDS in sub-Saharan Africa.
Vulnerable Children and Youth Studies. 2010 Jun; 5(Suppl 1):92-100.Only one in every eight households containing orphans and vulnerable children (OVC) in African countries received any support from an external source (UNICEF, 2008). This is a reflection of how governments, both rich and poor, have ignored obligations ratified in conventions to ensure the social protection of vulnerable children (United Nations, 1989). Consequently, a disproportionate proportion of the financial burden of care of vulnerable children is borne by affected families and communities. It is deplorable that vulnerable children are forced to rely on the charity of income poor relatives and community members (Wilkinson-Maposa et al., 2005; Foster, 2005b). This situation is likely to continue until governments adequately assume their responsibilities. In countries such as Botswana, governments have responded to the crisis of children and AIDS and consequently most households containing vulnerable children now receive external support (UNAIDS et al., 2006). The movement to establish national social protection schemes for vulnerable households is gaining momentum. If cash transfers become established nationally, they may alleviate suffering on a wide scale (JLICA, 2009). In that case, community groups and non-governmental organizations (NGOs) that are currently responsible for implementing responses to support children affected by HIV and AIDS will still be needed to administer psychosocial and other services that are complementary to those provided by these schemes. It is vital that governments develop a central role in coordinating civil society responses and ensure that resources for vulnerable children are used more effectively. But most African governments have limited capacity to coordinate responses and have only recently engaged in this area that involves a few well-resourced international organisations, many local NGOs and innumerable community initiatives. This article reviews the responses of different sectors responding to the impacts of HIV/AIDS on children, and discusses how these may be better funded, coordinated and monitored, utilizing the findings from a study of civil society OVC initiatives and evolving national responses.
PloS One. 2010; 5(1):e8796.BACKGROUND: The tight epidemiological coupling between HIV and its associated opportunistic infections leads to challenges and opportunities for disease surveillance. METHODOLOGY/PRINCIPAL FINDINGS: We review efforts of WHO and collaborating agencies to track and fight the TB/HIV co-epidemic, and discuss modeling--via mathematical, statistical, and computational approaches--as a means to identify disease indicators designed to integrate data from linked diseases in order to characterize how co-epidemics change in time and space. We present R(TB/HIV), an index comparing changes in TB incidence relative to HIV prevalence, and use it to identify those sub-Saharan African countries with outlier TB/HIV dynamics. R(TB/HIV) can also be used to predict epidemiological trends, investigate the coherency of reported trends, and cross-check the anticipated impact of public health interventions. Identifying the cause(s) responsible for anomalous R(TB/HIV) values can reveal information crucial to the management of public health. CONCLUSIONS/SIGNIFICANCE: We frame our suggestions for integrating and analyzing co-epidemic data within the context of global disease monitoring. Used routinely, joint disease indicators such as R(TB/HIV) could greatly enhance the monitoring and evaluation of public health programs.
Alternative antiretroviral monitoring strategies for HIV-infected patients in east Africa: opportunities to save more lives?
Journal of the International AIDS Society. 2011; 14:38.BACKGROUND: Updated World Health Organization guidelines have amplified debate about how resource constraints should impact monitoring strategies for HIV-infected persons on combination antiretroviral therapy (cART). We estimated the incremental benefit and cost effectiveness of alternative monitoring strategies for east Africans with known HIV infection. METHODS: Using a validated HIV computer simulation based on resource-limited data (USAID and AMPATH) and circumstances (east Africa), we compared alternative monitoring strategies for HIV-infected persons newly started on cART. We evaluated clinical, immunologic and virologic monitoring strategies, including combinations and conditional logic (e.g., only perform virologic testing if immunologic testing is positive). We calculated incremental cost-effectiveness ratios (ICER) in units of cost per quality-adjusted life year (QALY), using a societal perspective and a lifetime horizon. Costs were measured in 2008 US dollars, and costs and benefits were discounted at 3%. We compared the ICER of monitoring strategies with those of other resource-constrained decisions, in particular earlier cART initiation (at CD4 counts of 350 cells/mm3 rather than 200 cells/mm3). RESULTS: Monitoring strategies employing routine CD4 testing without virologic testing never maximized health benefits, regardless of budget or societal willingness to pay for additional health benefits. Monitoring strategies employing virologic testing conditional upon particular CD4 results delivered the most benefit at willingness-to-pay levels similar to the cost of earlier cART initiation (approximately $2600/QALY). Monitoring strategies employing routine virologic testing alone only maximized health benefits at willingness-to-pay levels (> $4400/QALY) that greatly exceeded the ICER of earlier cART initiation. CONCLUSIONS: CD4 testing alone never maximized health benefits regardless of resource limitations. Programmes routinely performing virologic testing but deferring cART initiation may increase health benefits by reallocating monitoring resources towards earlier cART initiation.
UNAIDS ‘multiple sexual partners’ core indicator: Promoting sexual networks to reduce potential biases.
Global Health Action. 2014; 7:23103.UNAIDS proposed a set of core indicators for monitoring changes in the worldwide AIDS epidemic. This paper explores the validity and effectiveness of the ‘multiple sexual partners’ core indicator, which is only partially captured with current available data. The paper also suggests an innovative approach for collecting more informative data that can be used to provide an accurate measure of the UNAIDS’s ‘multiple sexual partners’ core indicator. Specifically, the paper addresses three major limitations associated with the indicator when it is measured with respondents’ sexual behaviors. First, the indicator assumes that a person’s risk of contracting HIV / AIDS / STIs is merely a function of his / her own sexual behavior. Second, the indicator does not account for a partner’s sexual history, which is very important in assessing an individual’s risk level. Finally, the 12-month period used to define a person’s risks can be misleading, especially because HIV / AIDS theoretically has a period of latency longer than a year. The paper concludes that, programmatically, improvements in data collection are a top priority for reducing the observed bias in the ‘multiple sexual partners’ core indicator.
WHO Collaborating Centre for Acquired Immunodeficiency Syndrome for the Eastern Mediterranean Regional Office, Faculty of Medicine, Kuwait University, Kuwait.
Medical Principles and Practice. 2014; 23 Suppl 1:47-51.In the early 1980s, the World Health Organization (WHO) designated the Virology Unit of the Faculty of Medicine, Health Sciences Centre, Kuwait University, Kuwait, a collaborating centre for AIDS for the Eastern Mediterranean Regional Office (EMRO), recognizing it to be in compliance with WHO guidelines. In this centre, research integral to the efforts of WHO to combat AIDS is conducted. In addition to annual workshops and symposia, the centre is constantly updating and renewing its facilities and capabilities in keeping with current and latest advances in virology. As an example of the activities of the centre, the HIV-1 RNA viral load in plasma samples of HIV-1 patients is determined by real-time PCR using the AmpliPrep TaqMan HIV-1 test v2.0. HIV-1 drug resistance is determined by sequencing the reverse transcriptase and protease regions on the HIV-1 pol gene, using the TRUGENE HIV-1 Genotyping Assay on the OpenGene(R) DNA Sequencing System. HIV-1 subtypes are determined by sequencing the reverse transcriptase and protease regions on the HIV-1 pol gene using the genotyping assays described above. A fundamental program of Kuwait's WHO AIDS collaboration centre is the national project on the surveillance of drug resistance in human deficiency virus in Kuwait, which illustrates how the centre and its activities in Kuwait can serve the EMRO region of WHO. (c) 2014 S. Karger AG, Basel.
A decade of investments in monitoring the HIV epidemic: how far have we come? A descriptive analysis.
Health Research Policy and Systems. 2014; 12:62.BACKGROUND: The 2001 Declaration of Commitment (DoC) adopted by the General Assembly Special Session on HIV/AIDS (UNGASS) included a call to monitor national responses to the HIV epidemic. Since the DoC, efforts and investments have been made globally to strengthen countries' HIV monitoring and evaluation (M&E) capacity. This analysis aims to quantify HIV M&E investments, commitments, capacity, and performance during the last decade in order to assess the success and challenges of national and global HIV M&E systems. METHODS: M&E spending and performance was assessed using data from UNGASS country progress reports. The National Composite Policy Index (NCPI) was used to measure government commitment, government engagement, partner/civil society engagement, and data generation, as well as to generate a composite HIV M&E System Capacity Index (MESCI) score. Analyses were restricted to low and middle income countries (LMICs) who submitted NCPI reports in 2006, 2008, and 2010 (n = 78). RESULTS: Government commitment to HIV M&E increased considerably between 2006 and 2008 but decreased between 2008 and 2010. The percentage of total AIDS spending allocated to HIV M&E increased from 1.1% to 1.4%, between 2007 and 2010, in high-burden LMICs. Partner/civil society engagement and data generation capacity improved between 2006 and 2010 in the high-burden countries. The HIV MESCI increased from 2006 to 2008 in high-burden countries (78% to 94%), as well as in other LMICs (70% to 77%), and remained relatively stable in 2010 (91% in high-burden countries, 79% in other LMICs). Among high-burden countries, M&E system performance increased from 52% in 2006 to 89% in 2010. CONCLUSIONS: The last decade has seen increased commitments and spending on HIV M&E, as well as improved M&E capacity and more available data on the HIV epidemic in both high-burden and other LMICs. However, challenges remain in the global M&E of the AIDS epidemic as we approach the 2015 Millennium Development Goal targets.