South Africa recently launched a national antiretroviral treatment programme. This has created an urgent need for nurse-training in antiretroviral treatment (ART) delivery. The PALSA PLUS programme provides guidelines and training for primary health care (PHC) nurses in the management of adult lung diseases and HIV/AIDS, including ART. A process evaluation was undertaken to document the training, explore perceptions regarding the value of the training. It found that nurse uptake of PALSA PLUS training was high. Ongoing on-site training of PHC nurses enhanced their experience of support for their work by allowing not only for ongoing experiential learning, supervision and emotional support, but also for the ongoing managerial review of all those infrastructural and system-level changes required to facilitate health provider behaviour change and guideline implementation.
Equity and HIV/AIDS
This paper looks at anecdotal evidence that unproven AIDS 'cures' are widely used, and promoted by some countries' governments, instead of evidence based antiretroviral therapy (ART). Ot focuses on reasons why these 'cures' are used, including the high cost of conventional medicine and stigma associated with accessing healthcare systems. The authors discuss case studies from Gambia, South Africa and Iran where governments have promoted unproven treatment creating confusion over the legitimacy of AIDS medicines. Governments appear reluctant to dismiss these 'cures' for fear of being seen to criticise traditional medicine. The authors conclude that the full extent of the availability and use of unproven 'cures' and counterfeit antiretrovirals (ARVs) has not been fully documented, and that more research, as well as scaling up of ARV programmes, is needed.
Data from sentinel surveillance at antenatal clinics and a national population survey were used to estimate the trend of adult HIV prevalence from 1980 to 2007 in Botswana. Prevalence has declined slowly in urban areas since 2000 and has remained stable in rural areas. The number of new adult infections has been stable for several years and number of new child infections has declined due to coverage of ART that reaches over 80% in need and nearly complete coverage of an effective program to prevent mother-to-child transmission (PMTCT). The need for ART will increase by 60% by 2016. Botswana's PMTCT and treatment programs have achieved significant results in preventing new child infections and deaths among adults and children. The number of new adult infections continues at a high level. More effective prevention efforts are urgently needed.
The South African government’s health department controversially declined to accept freely donated nevirapine and grants from the Global Fund, despite the fact that it is one of the countries most severely affected by HIV and AIDS, because they claimed antiretroviral (ARV) drugs were not useful for patients. This study aimed to assess the department’s assertion. Using modeling, it compared the number of persons who received ARVs for treatment and prevention of mother-to-child HIV transmission between 2000 and 2005 with an alternative of what was reasonably feasible in the country during that period. It calculated that more than 330,000 lives were lost because a feasible and timely ARV treatment programme was not implemented in South Africa. Thirty-five thousand babies were born with HIV, resulting in 1.6 million person-years lost by not implementing a mother-to-child transmission prophylaxis programme using nevirapine. The total lost benefits of ARVs are at least 3.8 million person-years for the period 2000–2005.
This study assessed the effect of adherence to HAART on survival in The AIDS Support Organization (TASO) community HAART programme in Kampala, Uganda. It took the form of a retrospective cohort of 897 patients who initiated HAART at TASO clinic, Kampala, between May 2004 and December 2006. A total of 7,856 adherence assessments were performed on the data. The study study showed that good adherence and improved survival are feasible in community HIV/AIDS programmes such as that of TASO, Uganda. However, there is need to support community HAART programmes to overcome the challenges of funding to provide sustainable drug supplies, the provision of high quality clinical and laboratory support and achieving a balance between expansion and quality of services. Measures for the early identification and treatment of HIV infected people should be strengthened.
AIDS activists in Uganda have criticised a proposed new law that will force HIV-positive people to reveal their status to their sexual partners, and also allow medical personnel to reveal someone's status to their partner. The HIV Prevention and Control Bill (2008) is intended to provide a legal framework for the national response to HIV, as well as protect the rights of individuals affected by HIV. While activists agree that Uganda needs legislation to guide its HIV policy, they are concerned that the bill in its current form could worsen the difficulties many HIV-positive people experience, such as stigmatisation.
Anti-retroviral therapy (ART) scale up in Malawi continues to progress well. Sites are doing well, despite the increasing burden of work. The majority are taking the initiative of doing quarterly and cumulative cohort analysis, although nearly one third of sites are still not coming up with correct outcomes. This will require continued and regular vigilance and supervision. The treatment outcomes for ART are reasonable. Early death rates are still a problem, and defaults still constitute a significant proportion of the outcomes. ARV drug stocks were again assessed, and nationally drugs stocks are adequate. However, some sites are over-performing to a large extent and causing problems with drug stocks (both for starter packs and continuation packs). The quarterly drug stocktaking assists in the activity of re-distributing drugs from under- to over-performing sites. Some drugs for HIV-related diseases, particularly morphine and vincristine, are out of stock in most facilities.
This study aimed to determine important factors that affect antiretroviral drug adherence among HIV and AIDS male and female adult patients in Kenya. A cross sectional study involving 384 adult patients on ARV drugs and attending Moi Hospital, Eldoret, was conducted. Sixty-eight percent of the respondents on ARVs were females aged between 18-63, of which 52.1% had secondary and post secondary education. Results showed that only 43.2% adhered to the prescribed time of taking drugs. Only 93.5% of the respondents kept clinic appointments. It recommends patients should be educated on the importance of strict adherence to the prescribed doses of ARVs as a suitable measure of intervention. Future research should explore multiple-target interventions to resolve barriers to adherence.
Malawi is one of the countries experiencing an unprecedented HIV/AIDS epidemic in an environment where malnutrition is rampant. In 2001 Malawi started providing ARVs to HIV patients. This ARV programme is now being scaled up to cover the whole country. Since underlying malnutrition is associated with adverse ART outcomes, the Malawi government commissioned a study to design a programme for integrating nutrition in the ARV scale up plan. This study used a Participatory qualitative research methodology. The study recommends that nutritional support should include therapeutic feeding, food supplements and take home ration and proposes a clear enrolment and discharge criteria.
Children living with HIV in Uganda have been given greater access to treatment with a new paediatric HIV care centre opened at the main referral hospital in the capital, Kampala. More than 20,000 children are infected with HIV every year, and 50 percent of them die before their second birthday. There is still inadequate access to paediatric HIV care and treatment services in Uganda –out of the 330 active antiretroviral therapy centres in Uganda, only 110 are able to provide paediatric HIV care services, and most of these are located in urban centres. The centre at Mulago Hospital is the first to provide a comprehensive package of HIV care and treatment services for children and adolescents infected or exposed to HIV, including testing, treatment, counselling of children and their families, and training healthcare professionals in the management of paediatric HIV.