This study aimed to improve the Zambia Prisons Service’s implementation of tuberculosis screening and human immunodeficiency virus (HIV) testing. For both tuberculosis and HIV, the authors implemented mass screening of inmates and community-based screening of those residing in encampments adjacent to prisons. They also established routine systems – with inmates as peer educators – for the screening of newly entered or symptomatic inmates. We improved infection control measures, increased diagnostic capacity and promoted awareness of tuberculosis in Zambia’s prisons. In a period of 9 months, the authors screened 7638 individuals and diagnosed 409 new patients with tuberculosis. They tested 4879 individuals for HIV and diagnosed 564 cases of infection. An additional 625 individuals had previously been found to be HIV-positive. Including those already on tuberculosis treatment at the time of screening, the prevalence of tuberculosis recorded in the prisons and adjacent encampments was 18 times the national prevalence estimate of 0.35%. Overall, 22.9% of the inmates and 13.8% of the encampment residents were HIV-positive. Both tuberculosis and HIV infection are common within Zambian prisons. The authors enhanced tuberculosis screening and improved the detection of tuberculosis and HIV in this setting. These observations should be useful in the development of prison-based programmes for tuberculosis and HIV elsewhere.
Equity and HIV/AIDS
In the management of HIV infection, tenofovir (TDF) is preferred to its predecessors based on its safety profile, despite some adverse reactions which warrant its substitution for some patients. This review measured the rate of TDF’s substitution from January 1 2008 to November 30 2011, and compared the gender difference in these rates of substitution using dispensing records from the national antiretroviral dispensing database. No gender difference was observed and the authors indicate that further investigation is required to determine the clinical reasons for TDF’s withdrawal.
African ministers of finance and key partners in the AIDS response meeting in Addis Ababa, Ethiopia, have called for increased national investment to end the AIDS epidemic as a public health threat by 2030. The international community has committed to meeting the 90–90–90 treatment targets, under which 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression. If the 90–90–90 targets are met by 2020, ending the AIDS epidemic a decade later is achievable.
Hopes that a South African-developed vaginal gel containing tenofovir would protect women against HIV were dashed after a major new study found that it did not work. Scientists had been optimistic that the microbicide would protect millions of women from HIV, after a phase 2 study of 900 women in KwaZulu-Natal found it reduced the risk of getting the virus by 39%. The development was hailed as a breakthrough, though the scientists who led the work were careful to emphasise that further research was needed to replicate the findings. At that stage, 11 other trials testing six other products had failed. The findings had a wide margin of error, with the efficacy of HIV protection estimated to lie between 6% and 60%. A much larger Follow-on African Consortium for Tenofovir Studies (FACTS) 001 trial was launched in 2011 to confirm its findings. The consortium scientists announced at the annual Conference on Retroviruses and Opportunistic Infections in Seattle, however, that the tenofovir-containing microbicide provided to 2,059 women aged between 18 years and 30 years did not protect them from HIV.
Nearly US$1.3 billion spent on US-funded programmes to promote abstinence and faithfulness in sub-Saharan Africa is argued by the author of this paper to have had no significant impact on sexual behaviour in 14 countries in sub-Saharan Africa, as shown from an analysis of sexual behaviour data. The preliminary findings were presented by Nathan Lo of Stanford University School of Medicine at the Conference on Retroviruses and Opportunistic Infections (CROI 2015) in Seattle, USA. The Pepfar programmes aimed to delay sexual debut in order to reduce the period of high risk during adolescence, especially for girls, and to reduce partner numbers. The study investigated trends in sexual behaviour derived from national Demographic and Health Surveys in 14 PEPFAR focus countries before and after the beginning of PEPFAR funding in 2004, and compared these to a counterfactual: trends in eight other African countries – largely in West Africa – where PEPFAR funding was not determining the content of prevention campaigns. They found no significant change in PEPFAR countries relative to non-PEPFAR countries over time for any of the measures assessed, for men or women, although there was a trend towards a lower number of reported sexual partners for men in both PEPFAR and non-PEPFAR countries.
Sub-Saharan Africa alone contributes more than 90 % of global Mother-to-Child Transmission (MTCT) burden. As part of efforts to address this, African countries were earmarked in 2009 for rapid Preventing Mother to child HIV Transmissions (PMTCT) interventions scale-up within their primary care system for maternal and child health. In this study, the authors reviewed records in Ghana, on ANC registrants eligible for PMTCT services to describe regional disparities and national trends in key PMTCT indicators. They also assessed distribution of missed opportunities for testing pregnant women and treating those who are HIV positive across the country. Although there was a decline in HIV prevalence among pregnant women, untested ANC registrants increased from 17 % in 2011 to 25 % in 2013. There were varying levels of missed opportunities for testing across the ten regions of Ghana. Overall, HIV positive pregnant women initiated onto ARVs remarkably increased from 57% (2011) to 82 % (2013). Missed opportunities to test pregnant women for HIV and also initiate those who are positive on ARVs across all the regions pose challenges to the quest to eliminate mother-to-child transmission of HIV in Ghana. For some regions these missed opportunities mimic previously observed gaps in continuous use of primary care for maternal and child health in those areas. The authors contend that increased national and regional efforts aimed at improving maternal and child healthcare delivery, as well as HIV-related care, is paramount for ensuring equitable access across the country.
The 24th Summit of the African Union and related events reaffirmed that Africa is committed and will remain committed to women’s empowerment and to ending the AIDS epidemic by 2030. The Summit took place in Addis Ababa, Ethiopia, from 23 to 31 January 2015 under 2015 annual African Union theme of “Women empowerment and development towards Africa’s Agenda 2063”. This report outlines the importance of ending AIDS was particularly articulated during the gender pre-summit meeting, at which the participants noted that member states should ensure that ending the AIDS epidemic by 2030 is part of Agenda 2063 and that it has an inclusive human rights approach that leaves no one behind, including children, adolescents, women of child-bearing age and women and girls in conflict and post-conflict settings.
In Mozambique, pulmonary tuberculosis is primarily diagnosed with sputum smear microscopy. However this method has low sensitivity, especially in people infected with human immunodeficiency virus (HIV). Patients are seldom tested for drug-resistant tuberculosis. The national tuberculosis programme and Health Alliance International introduced rapid testing of smear-negative sputum samples. Four machines were deployed in four public hospitals along with a sputum transportation system to transfer samples from selected health centres. Laboratory technicians were trained to operate the machines and clinicians taught to interpret the results. The results indicated that using rapid tests to diagnose tuberculosis is promising but logistically challenging. More affordable and durable platforms are needed. All patients diagnosed with tuberculosis need to start and complete treatment, including those who have drug resistant strains.
Escalation of non-communicable diseases (NCDs) among urban South African populations disproportionately afflicted by HIV/AIDS presents not only medical challenges but also new ways in which people understand and experience sickness. In Soweto, the psychological imprints of political violence of the Apartheid era and structural violence of HIV/AIDS have shaped social and health discourses. Yet, as NCDs increasingly become part of social and biomedical discussions in South African townships, new frames for elucidating sickness are emerging. This article employs the concept of syndemic suffering to critically examine how 27 women living with Type 2 diabetes in Soweto, a township adjacent to Johannesburg known for socio-economic mobility as well as inequality, experience and understand syndemic social and health problems. For example, women described how reconstructing families and raising grandchildren after losing children to AIDS was not only socially challenging but also affected how they ate, and how they accepted and managed their diabetes. Although previously diagnosed with diabetes, women illustrated how a myriad of social and health concerns shaped sickness. Many related diabetes treatment to shared AIDS nosologies, referring to diabetes as ‘the same’ or ‘worse’. These narratives demonstrate how suffering weaves a social history where HIV becomes ordinary, and diabetes new.
Alcohol consumption is a recognised risk factor for HIV infection. Alcohol serving establishments have been identified as appropriate venues in which to deliver HIV prevention interventions. This paper describes experiences and lessons learnt from implementing a combined HIV prevention intervention in bar settings in one city- and one township-based bar in Tshwane, South Africa. The intervention consisted of peer-led and brief intervention counselling sub-components. Thirty-nine bar patrons were recruited and trained, and delivered HIV and alcohol risk reduction activities to their peers as peer interventionists. At the same time, nine counselors received training and visited the bars weekly to provide brief motivational interviewing counselling, advice, and referrals to the patrons of the bars. The intervention was overall well received and suggests that bar patrons and servers can accept a myriad of intervention activities to reduce sexual risk behaviour within their drinking settings. However, HIV- and AIDS-related stigma hindered participation in certain intervention activities. The buy-in received from the relevant stakeholders (i.e. bar owners/managers and patrons, and the community at large) was an important contributor to the feasibility and acceptability of the intervention.