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.
Equity and HIV/AIDS
Integration of nutrition in the antiretroviral therapy scale up plan for Malawi
Bisika T and Mandere G: Malawi Medical Journal 20(3) 93–98, 2008
New centre in Uganda to boost paediatric HIV care
PlusNews: 10 October 2008
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.
Patient satisfaction with antiretroviral services at primary health-care facilities in the Free State, South Africa: A two-year study using four waves of cross-sectional data
Wouters E, Heunis C, van Rensburg D and Meulemans H: BMC Health Services Research 8(21) 9 October 2008
The study's first objective was to determine the levels of patient satisfaction with services at antiretroviral treatment (ART) assessment sites. Four cross-sectional waves of data were collected from a random sample of 975 patients enrolled in the Free State's public-sector ART programme. With respect to both general services and the services provided by nurses, results indicated high overall satisfaction among Free State patients receiving public-sector ART. However, the data presents a less positive picture of patient satisfaction with waiting times. Significant geographical and temporal differences were observed in these three aspects of patient satisfaction, according to the district surveyed. Patients attending facilities with high professional nurse vacancy rates reported significantly less satisfaction with nurses' services than did those attending facilities with fewer vacant nursing posts.
USAID bans contraceptive supplies to leading family planning organisation
Planetwire: October 1, 2008
The United States Agency for International Development (USAID) has instructed its staff to force governments in several African countries to discontinue the provision of US-funded contraceptive commodities to Marie Stopes International (MSI), one of the world’s leading family planning organisations. USAID claims MSI works with the Chinese Government, whom the US State Department accuses of ‘coercive abortion and involuntary sterilisations’. MSI denied that MSI supports coercive abortion or involuntary sterilisation in China or elsewhere. It said the instruction will ‘seriously disrupt’ MSI’s family planning programmes in at least six African countries – Ghana, Malawi, Sierra Leone, Tanzania, Uganda and Zimbabwe - including one where the organisation delivers 25% of all family planning services nationally. Women in these countries will be left with few options other than unsafe abortions, resulting in death or disability.
‘Antwerp in Geneva’ workshop on the AIDS response and health systems strengthening in sub-Saharan Africa, 28 May 2008
Ford N, Ooms G, Laga M, Pirard M, van Damme W and Loewenson R
On 28 May 2008 the Institute of Tropical Medicine (Antwerp, Belgium) hosted a meeting at the World Health Organization (Geneva, Switzerland) to review the evidence on the effects of AIDS programmes on Health Systems, particularly in high HIV prevalence settings, and discuss the way forward. Over 30 participants attended from a range of backgrounds (implementers, activists, academics and funders) and HIV-affected countries. The report summarizes the main issues that were discussed at the workshop, including the harms and benefits of HIV programmes for health systems and primary health care, debates around continued AIDS exceptionalism, and considerations and policy options for HIV programmes
to maximise their potential to contribute to health systems strengthening.
The report is organised around the major issues/debates that have been raised around AIDS programmes and health systems, particularly the financing, organisation and delivery of health systems. The discussions were informed by country experiences presented from a number of high-burden countries in sub-Saharan Africa and evidence and experience from
meeting delegates.
Antiretroviral therapy and early mortality in South Africa
Boulle A, Bock P, Osler M, Cohen K, Channing L, Hilderbrand K, Mothibi E, Zweigenthal V, Slingers N, Cloete K and Abdullah F: Bulletin of the World Health Organisation 86, 2008
This paper describes province-wide outcomes and temporal trends of the Western Cape Province antiretroviral treatment (ART) programme five years since inception, to demonstrate the utility of the WHO monitoring system for ART. Data on patients starting ART was prospectively captured into facility-based registers, from which monthly cross-sectional activity and quarterly cohort reports were aggregated. Retention in care, mortality, loss to follow-up and laboratory outcomes were calculated at six-monthly durations. By the end of March 2006, 16,234 patients were in care. Adults starting ART with CD4 counts less than 50 cells/μl fell from 51.3% in 2001 to 21.5% in 2005, while mortality at six months fell from 12.7% to 6.6%, offset in part by an increase in loss to follow-up (reaching 4.7% at six months in 2005). Over 85% of adults tested had viral loads below 400 copies/ml at six-monthly durations until four years on ART. The paper concludes that the location of care in primary-care sites was associated with good retention in care, while scaling-up ART provision was associated with reduced early mortality.
ART in the public and private sectors in Malawi: Results up to 31st March 2008
HIV Unit, Malawi Ministry of Health; MBCA; MSF; Area 18 Health Centre; QECH; KCH, Lilongwe; Lighthouse, Lilongwe; Mlambe Mission Hospital; SUCOMA Clinic: 2008
This report presents data on the number of patients accessing ART in both the public and private sectors in Malawi. By the end of March 2008, there were 157 free-standing facilities in Malawi in the public health sector delivering ART free of charge to HIV-positive eligible patients. In the first quarter of 2008 (January to March), there were 17,642 new patients started on ART (39% male, 61% female; 91% adults and 9% children. By the end of March 2008, there were 159,111 patients who had ever started on ART (39% male, 61% female; 92% adults and 8 % children). By the end of March 2008, there were 45 facilities in Malawi in the private health sector delivering ART at a subsidised rate to HIV-positive eligible patients. In the first quarter of 2008 (January to March), there were 669 new patients started on ART (44% male, 56% female, 95% adult, 5% children). By the end of March 2008, there were 6,076 patients who had ever started on ART (51% male, 49% female, 95% adults, 5% children).
Declining HIV prevalence among young pregnant women in Lusaka, Zambia
Stringer EM, Chintu NT, Levy JW, Sinkala M, Chi J, Muyanga BH, Bulterys M, Bweupe M, Megazzini K and Stringer JSA: WHO Bulletin 86, 2008
HIV prevention has been ongoing in Lusaka for many years. Recent reports suggest a possible decline in HIV sero-incidence in Zambia and some neighbouring countries. This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006. It analysed HIV seroprevalence trends from two Lusaka sources: antenatal data from a city-wide programme to prevent mother-to-child HIV transmission and delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and again in 2005–2006. For the antenatal data, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006. For the cord-blood surveillances, overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005–2006. Among women ≤ 17 years of age, seroprevalence declined from 12.1% to 7.7%.
Scaling-up antiretroviral treatment in southern African countries with human resource shortages: How will health systems adapt?
van Damme W: Social Science & Medicine 66(10): 2108-2121, 2008
Current anti-retroviral therapy models are doctor-based and labour-intensive, requiring many qualified staff. Yet countries such as Mozambique, Malawi, Zambia, Rwanda and Tanzania lack sufficient skilled health workers to scale up ART according to these models. This paper considers the kind of model needed for effective scale up of ART programmes in countries which lack skilled health workers. They find that ART delivery involves several types of function requiring different approaches. Good organisation of logistics, supplies and distribution calls for a standardised, centrally controlled or bureaucratic approach. However, a more society-based approach is needed when providing community support to patients. The management of patients who do not fit standardised procedures requires a more professional approach. Finally, care of the individual patient requires a combination of the social and professional approaches.
Uganda: Using mobile phones to fight HIV
PlusNews, 18 September 2008
Uganda's rising HIV prevalence is forcing policy makers to look for inventive ways of educating people about the virus. Their latest tool is mobile phone technology, whose rapid growth has provided an avenue that could potentially reach millions with messages. Text to Change (TTC) , an NGO that uses a bulk short message service (SMS) platform for HIV/AIDS education, recently partnered with the AIDS Information Centre in Uganda and Celtel, a local mobile phone network, to pilot a project in western Uganda aimed at communicating knowledge about the disease and encouraging subscribers to volunteer for HIV testing. The Uganda Communications Commission expects the number of mobile phone users to hit the six million mark by the end of 2008 – however, in urban areas, as many as 50% of people have mobile phones, compared to only 10% in rural areas.