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.
Equity and HIV/AIDS
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.
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.
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.
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).
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%.
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'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.
A key feature of South Africa’s HIV epidemic, where 5.7 million people are positive, is that among the 15-24 year olds infected, women and girls account for more than 90% of new infections. This needs a special focus on this group when designing prevention programmes, says UNAIDS. The HIV and AIDS epidemic in South Africa is stabilising, according to a report released last week by the Joint United Nations’ Programme on HIV and AIDS. This means that there has not been a recognisable increase in the rate of new infections over the last few years. Instead, the infection rate has remained relatively constant. This, however, does not mean that the epidemic is declining, as the country still holds the unenviable world number one position in the stakes of the total number of people living with HIV. The fact that women and girls continue to be disproportionately infected points to a failure of HIV programmes in addressing the issues that place females at risk of HIV infection, says the United Nations’ Special Envoy on AIDS in Africa, Elisabeth Mataka.
Over 22,000 of the world’s key HIV and AIDS scientists, academics and activists attended 17th international AIDS conference in Mexico City. The HIV/AIDS sector has been under attack recently by some health practitioners who argue that too much money is being spent on HIV and AIDS to the detriment of other diseases. However, Craig McClure, the executive director of International AIDS Society (IAS) says it is unfortunate that the criticism that HIV is distorting health systems comes at a time ‘when success is finally in our hands’. ‘There is no doubt that in order for us to achieve the 2010 Universal Access targets, health systems must be further strengthened,’ said Cahn. ‘This will require an increase in resources, including additional resources for commodities like drugs and diagnostic tools, basic health care infrastructure and the training and retaining of the health care workforce. With the life-long interventions brought by antiretroviral therapy, the success of HIV and AIDS programmes around the world is dependent on health systems strengthening.’