This study of six countries, including Zimbabwe, Kenya and Uganda, indicates that new investment in AIDS services has exposed existing fragilities in health systems. In some cases it has placed increasing burdens on these systems by expanding demand and stretchied already overextended human resources. The report, which provides some of the first on-the-ground research documenting the impacts of the AIDS service scale up, shows that the AIDS response has attracted the biggest share of health financing, increased the number of trained medical personnel, improved the management of people living with the virus, and supported the establishment of HIV clinics that treat TB and other opportunistic infections.
Equity and HIV/AIDS
Missing the Target 6: The HIV/AIDS response and health systems
International Treatment Preparedness Coalition: July 2008
Reuse of single-dose nevirapine in subsequent pregnancies for the prevention of mother-to-child HIV transmission in Lusaka, Zambia: A cohort study
Walter J, Kuhn L, Kankasa C, Semrau K, Sinkala M, Thea DM and Aldrovandi GM: BMC Infectious Diseases, 30 December 2008
This study compared risks of perinatal HIV transmission between multiparous women who had previously received a dose of single-dose nevirapine (SDNVP) (exposed) and those that had not (unexposed) and who were given SDNVP for the index pregnancy within a prevention of mother-to-child HIV transmission (PMTCT) clinical study. We also compared transmission risks among exposed and unexposed women who had two consecutive pregnancies within the trial. Transmission risks did not differ between 59 SDNVP-exposed and 782 unexposed women in unadjusted analysis or after adjustment for viral load and disease stage. Transmission risks for women who had two consecutive pregnancies were 7% at both the first (unexposed) and second (exposed) delivery, suggesting that the efficacy of SDNVP may not be diminished when reused in subsequent pregnancies.
The symptom experience of people living with HIV and AIDS in the Eastern Cape, South Africa
Peltzer K and Phaswana-Mafuya N: Health Services Research, 22 December 2008
Limited information about symptom prevalence exists about HIV infected persons in South Africa, in particular in the context of antiretroviral treatment (ART). The aim of this study was to assess HIV symptoms and demographic, social and disease variables of people living with HIV in South Africa. In 2007, 607 people living with HIV or AIDS (PLWHAs), sampled by all districts in the Eastern Cape Province and recruited through convenience sampling, were interviewed by PLWHAs at health facilities, key informants in the community and support groups. Symptom assessment provided information that may be valuable in evaluating AIDS treatment regimens and defining strategies to improve quality of life. Because of the high levels of symptoms reported (26.1 symptoms out of a possible 64), the results imply an urgent need for effective health care, home- and community-based and self-care symptom management.
Training programme for nurses and other health professionals in rural-based settings on screening and clinical management of HIV and other sexually transmitted infections
Lifson AR, Rybicki SL, Hadsall C, Dickinson S, van Zyl A and Carr P: Journal of the Association of Nurses in AIDS Care 20(1): 77-85, January 2009
Populations at risk for HIV and other sexually transmitted infections (STIs) include those living in rural areas. The authors describe a statewide training programme that targeted rural-based health professionals. This program focused on HIV, STIs, and viral hepatitis and was designed to enhance participants’ ability to conduct sexual histories and risk assessments, educate clients about risk reduction and prevention, screen for and diagnose these infections, clinically manage clients with positive screening test results, access prevention and other educational materials, and conduct other clinical and public health activities. A total of 122 participants reflecting a wide variety of practice settings attended trainings at five sites throughout Minnesota; 74% of participants were nurses and 81% characterised employment settings as rural. Nurses and other health professionals in rural settings are an important training priority and can play an important role in education, prevention, screening, and clinical care for HIV and other STIs.
‘SADC, put your money where your mouth is’
SATAMo: December 2008
The Treatment Barometer, a survey by SATAMo on access to AIDS treatment within Southern African Development Community (SADC) countries, calls on regional leaders to keep the promises they made towards the provision of HIV treatment by committing much-needed resources. It’s the first regional treatment monitoring research to be carried out by community-based treatment activists, who noted that more than 80% of SADC governments have not honoured the Abuja Declaration more than seven years after the commitment, barriers to treatment still exist, reports of stigma and discrimination by health care workers remain high, stock-outs of drugs are common in more than 80% of the countries surveyed and most countries are struggling to provide first-line treatment to those who need it, with eight countries in SADC below 35% coverage and only two exceeding 75% coverage.
Early antiretroviral therapy and mortality among HIV-infected infants
Violari A, Cotton MF, Gibb DM, Babiker AG, Steyn J, Madhi SA, Patrick JP and McIntyre JA: New England Journal of Medicine (359)21, 2008
This paper investigated antiretroviral-treatment strategies in the Children with HIV Early Antiretroviral Therapy (CHER) trial. HIV-infected infants 6 to 12 weeks of age with a CD4 percentage of 25% or more were randomly assigned to receive antiretroviral therapy until the CD4 percentage decreased to less than 20% (or 25% if the child was younger than 1 year), specific clinical criteria were met or the child needed to immediately start on limited antiretroviral therapy. The children were followed up after 40 weeks and, after a review by the data and safety monitoring board, some of the infants were reassessed for the initiation of antiretroviral therapy. The paper concluded that early HIV diagnosis and early antiretroviral therapy reduced early infant mortality by 76% and HIV progression by 75%.
One-Million-to-Test Campaign logs first victory in Uganda
PlusNews: 27 November 2008
Between 26 November and 1 December (World AIDS Day) the AIDS Healthcare Foundation (AHF), a US-based NGO, set a goal of testing one million people around the world. More than 1,000 people were tested for HIV at a busy marketplace in the Ugandan capital, Kampala, kicking off a nationwide drive that aims to help at least 20,000 people across the country know their status. HIV prevalence is around 6%, but only 21% of Ugandans know their HIV status. The large turnout for the testing event proved that many people wanted to know their status but hadn't had the opportunity to get tested. The campaign sees AHF partnering with 972 organisations in 72 countries around the world. A standard model is used at all sites, involving pre-test counselling, a one-minute test, post-test counselling and treatment referral.
South Africa flunks when it comes to AIDS spending
AIDS Accountability International: 2008
South Africa has flunked with an E-symbol (0-20%) when it come to the amount of money spent on HIV/AIDS, but attained an overall B-symbol for its response to the epidemic on the AIDS Reporting Index, an AIDS Accountability International (AAI) scorecard. South Africa scored a D for data collection, which the AAI said was largely due to poor reporting, with no improvement since the last time the country was assessed. The country showed an improvement in antiretroviral coverage (2% in 2004 to 28% in 2008), but the AAI noted overall performance remained poor (D-symbol) with only just over a quarter of those needing treatment getting it. The overall low score is due to poor performance rather than poor reporting, it added.
South African Health MEC wants traditional medicine in hospice
Kerry Cullinan: Health-e, 23 November 2008
KwaZulu-Natal Health MEC, Peggy Nkonyeni, is attempting to introduce traditional medicine for AIDS patients at a hospice with the help of traditional healers. The Treatment Action Campaign said African traditional healers have a role in combating HIV but they are concerned that disreputable stakeholders are included, especially those who are not traditional healers and who have caused harm with so-called ‘alternative’ remedies.
Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: A mathematical model
Granich RM, Gilks CF, Dye C, de Cock KM and Williams BG: The Lancet, 26 November 2008
This study investigated a theoretical strategy of universal voluntary HIV testing and immediate treatment with ART, and examined the conditions under which the HIV epidemic could be driven towards elimination. Data from South Africa was used as the test case for a generalised epidemic, and it was assumed that all HIV transmission was heterosexual. The study found that the strategy could greatly accelerate the transition from the present endemic phase, in which most adults living with HIV are not receiving ART, to an elimination phase, in which most are on ART, within five years. It could reduce HIV incidence and mortality to less than one case per 1,000 people per year by 2016. Universal voluntary HIV testing and immediate ART, combined with present prevention approaches, could have a major effect on severe generalised HIV/AIDS epidemics.