The Zimbabwe Minister of Health and Child Welfare, Dr Henry Madzorera is reported to have announced plans to increase the number of people on anteretrovirals from the current 180,000 to 300,000 (or 60% of the 500,000 adults estimated to need treatment) using resouces from the Global Fund, the United States President's Emergency Plan for AIDS Relief (PEPFAR), and a basket funding mechanism to which donors contribute for various HIV and AIDS interventions, known as the Expanded Support Programme on HIV/AIDS (ESP).
Equity and HIV/AIDS
Zimbabwean government to double number of people on HIV treatment
Plus News: 22 January 2010
'Less noisy' female condom proves a hit in Uganda
Plus News: 22 December 2009
Ten months after being re-launched, a new brand of female condom has proven popular among Ugandan women. FC2 was launched in February; the government stopped distributing the original female condom, FC1, in 2007 on the grounds that women had complained it was smelly and noisy during sex. 'The new condom has improved features and will enable women to have a procedure within their control to give them more choices for prevention [of HIV and unwanted pregnancies],' said Vashta Kibirige, the coordinator of the condom unit at the Ministry of Health. The UN Population Fund and the NGO, Programme for Accessible health Communication and Education, are spearheading the re-launch of the female condom, which is still in the sensitisation stage and will become available to the public in 2010. The women questioned said the new condom was less noisy, more comfortable and well lubricated, increasing their sexual pleasure. It also has no smell and can be inserted in the vagina at least eight hours before sex, which the women liked a lot.
Breast is always best, even for HIV-positive mothers
Langa L: Bulletin of the World Health Organization 88:9–10, January 2010
Despite emerging evidence that HIV-positive mothers should breastfeed to maximise their babies’ health prospects, South African health workers face a battle to change attitudes and habits. The 2003 South African Demographic Health Survey found that fewer than 12% of infants are exclusively breastfed during their first three months and this drops to 1.5% for infants aged between three and six months. Some health workers themselves have yet to be convinced of the benefits of breastfeeding, even for mothers who aren’t HIV positive. 'There exists the general idea that it is not important, that there is no critical reason to breastfeed, especially when you can formula feed,' says Linda Glynn, breastfeeding consultant at Mowbray Maternity Hospital in Cape Town. 'Some [health workers] think breastfeeding is a waste of time and an inconvenience.' Yet, the risks of not breastfeeding often go unrecognised. Most children born to HIV-positive mothers and raised on formula do not die of AIDS but of under-nourishment, diarrhoea, pneumonia and other causes not related to HIV. The World Health Organization recommends that all new mothers, regardless of their HIV status, practise exclusive breastfeeding for a minimum of six months.
Breastfeeding, mother-to-child HIV transmission, and mortality among infants born to HIV-infected women on highly active antiretroviral therapy in rural Uganda
Homsy J, Moore D, Barasa A, Were W, Likicho C, Waiswa B, Downing R, Malamba S, Tappero J and Mermin J: Journal of Acquired Immune Deficiency Syndromes 53(1): 28-35, January 2010
Highly active antiretroviral therapy (HAART) drastically reduces mother-to-child transmission of HIV, but where breastfeeding is the only safe infant feeding option, HAART for the prevention of mother-to-child transmission needs to be evaluated in relation to both HIV transmission and infant mortality. One hundred-and-two >=18-year old women on HAART in rural Uganda who delivered one or more live infants between 1 March 2003 and 1 January 2007 were enrolled in a prospective study to assess HIV transmission and infant survival. Of 118 infants born during follow-up, 109 were breastfed. In total, 23 infants died during follow-up at a median age of 3.7 months; 15 of whom with severe diarrhoea and/or vomiting in the week preceding their death. The study concludes that, in resource-constrained settings, HIV-infected pregnant women should be assessed for HAART eligibility and treated as needed without delay, and should be encouraged to breastfeed their infants for at least six months.
Enhancing global control of alcohol to reduce unsafe sex and HIV in sub-Saharan Africa
Chersich MF, Rees HV, Scorgie F and Martin G: Globalization and Health 5(16), 17 November 2009
Sub-Saharan Africa carries a massive dual burden of HIV and alcohol disease, and these pandemics are inextricably linked, says this study. Conflation of HIV and alcohol disease in these setting is not surprising given patterns of heavy-episodic drinking and that drinking contexts are often coterminous with opportunities for sexual encounters. HIV and alcohol also share common ground with sexual violence. Both perpetrators and victims of sexual violence have a high likelihood of having drunk alcohol prior to the incident, as with most forms of violence and injury in sub-Saharan Africa. According to this study, reducing alcohol harms necessitates multi-level interventions and should be considered a key component of structural interventions to alleviate the burden of HIV and sexual violence. It recommends that brief interventions for people with problem drinking must incorporate specific discussion of links between alcohol and unsafe sex, and consequences thereof. Additionally, implementation of known effective interventions could alleviate a large portion of the alcohol-attributable burden of disease, including its effects on unsafe sex, unintended pregnancy and HIV transmission.
Further benefits of early start of HIV treatment in low income countries: Survival estimates of early versus deferred antiretroviral therapy
Johansson K, Robberstad B and Norheim O: AIDS Research and Therapy 7:3, 16 January 2010
This study estimates mean life years gained using different treatment indications in low-income countries. It carried out a systematic search to identify relevant studies on the treatment effect of highly active antiretroviral therapy (HAART) and data was applied to a hypothetical Tanzanian HIV population. It found that providing HAART early when CD4 is 200-350 cells/μl is likely to be the best outcome strategy with an expected net benefit of 14.5 life years per patient. The model predicts diminishing treatment benefits for patients starting treatment when CD4 counts are lower. Patients starting treatment at CD4 50-199 and <50 cells/μl have expected net health benefits of 7.6 and 7.3 life years. Without treatment, HIV patients with CD4 counts 200-350; 50-199 and < 50 cells/μl can expect to live 4.8; 2 and 0.7 life years respectively. This study demonstrates that HIV patients live longer with early start strategies in low-income countries. Since low-income countries have many constraints to full coverage of HAART, this study provides input to a more transparent debate regarding where to draw explicit eligibility criteria during further scale up of HAART.
Mobilising cell phones to improve antiretroviral adherence and follow-up in Kenya
Lester R and Kariri A: World Health Organization Essential Medicines Monitor 2: 1–3, November 2009
This study strategised a way to integrate mobile telephony into the health management of subjects receiving anti-retroviral (ARV) medications. It took the form of a randomised controlled trial to assess health, social, and economic outcomes, involving two sub-studies in Nairobi, Kenya, and two surrounding districts. Significant time and cost are often incurred for patients to personally attend the clinics. However, the majority of subjects screened reported being comfortable with using cell phones for communicating their health issues. Note that the average travel cost to attend the clinic was US$3 (return). The current cost of an SMS is US$0.08 and a one-minute voice call is US$0.23. The most positive feedback from early enrollees in the SMS-protocol is that the participants feel 'like someone cares'. Many participants suggested that they would prefer more frequent SMS reminders. However the most common barrier to responding to the clinic SMS on time is lack of network credit at the time they are intended to respond. Overall, the once weekly protocol appears agreeable to most. Several instances of health problems have already been identified by the protocol and hence triaged by the nurse.
New strategy in Kenya targets most at-risk populations
Plus News: 13 January 2010
Kenya has launched an ambitious strategy to fight HIV and AIDS that aims to reduce new infections by at least 50% over the next four years and focus more on most at-risk populations (MARPs). The third Kenya National AIDS Strategic Plan, which runs from 2009/2010 till 2012/2013 and was launched in the capital, Nairobi, on 12 January, also aims to reduce AIDS-related mortality by 25%. 'We cannot achieve our target unless we close new taps of HIV infections – this involves putting most at-risk populations at the centre of our HIV programmes and prevention strategies,' said Alloys Orago, director of the National AIDS Control Council. In Kenya, female and male sex workers, injecting/intravenous drug users, and men who have sex with men (MSM) are considered primary MARPs. Speaking at the launch, UNAIDS executive director Michél Sidibé highlighted the paradox of the intention to increase HIV programming among MARPS while at the same time criminalising the activities that put them at an elevated risk of contracting and transmitting HIV. 'Criminalisation puts most at-risk populations, like commercial sex workers, injecting drug users and men who have sex with men, in the shadows,' he said. 'It is difficult to reach groups whose actions are deemed to be at odds with the law.' Sex work, homosexual acts and the use of illicit drugs are all outlawed in Kenya and are punishable by long terms in prison.
Quarterly report antiretroviral treatment programme in Malawi with results up to 30 September 2009
Malawi Department of Health: 2009
By the end of September 2009, there were 236 static ART clinics in Malawi in the public and private health sector; 22 of these static clinics provided ART at a total of 103 outreach or mobile sites, bringing the total to 339 ART service delivery points in Malawi in Q3 2009. In the third quarter of 2009 (July to September) a total of 18,292 new patients initiated ART and 3,030 ART patients transferred between clinics, resulting in a total of 21,322 ART clinic registrations (39% male, 61% female; 91% adults and 9% children). Improved integration of the supervision system for the public and private sector has led to a revision of previous M&E data in the private sector and patient outcomes in the private sector are similar to those in the public sector. The National programme has been affected by serious ARV drug supply shortage during Q3 due to the delayed release of funding and the ensuing logistical complications resulting in widespread drug re-allocations between sites. However a targeted survey revealed that patients were affected only in isolated cases, requiring regimen changes or short-term treatment interruption.
Testing campaign in Kenya surpasses one million target
Plus News: 24 December 2009
An ambitious, door-to-door voluntary counselling and testing (VCT) exercise launched in November 2009 has resulted in more than 1.5 million Kenyans being tested for HIV, according to a senior government official. 'Our preliminary data show that during the [first] three weeks… [] … we tested 1.5 million people and, as we continue putting our records together, we could go way above this number,' said Nicholas Muraguri, director of the National AIDS and Sexually transmitted infections Control Programme (NASCOP). 'Normally men do not come forward to be tested but this time round we are impressed... Our results show they formed 40% of the total number tested,' he added. 'Those above 50 also turned out in large numbers. Government research shows they are at risk because they too are sexually active.' He noted that the campaign reached out to most at-risk populations such as commercial sex workers through 'moonlight' VCT centres that opened out of regular business hours. The campaign was part of the government's initiative to have at least 80% of Kenyans tested for HIV by the end of 2010.