Browsing by Subject "HIV/AIDS treatment programmes"

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    Open Access
    Antiretroviral treatment outcomes from a nurse-driven, community-supported HIV/AIDS treatment programme in rural Lesotho: observational cohort assessment at two years
    (BioMed Central Ltd, 2009) Cohen, Rachel; Lynch, Sharonann; Bygrave, Helen; Eggers, Evi; Vlahakis, Natalie; Hilderbrand, Katherine; Knight, Louise; Pillay, Prinitha; Saranchuk, Peter; Goemaere, Eric; Makakole, Lipontso; Ford, Nathan
    INTRODUCTION:Lesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level.PROGRAMME APPROACH:We describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Medecins Sans Frontieres, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008.DISCUSSION AND EVALUATION:Overall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care. CONCLUSION: Despite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor-supported testing and counselling, adherence and case management.
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    Availability of HIV prevention and treatment services for people who inject drugs: findings from 21 countries
    (BioMed Central Ltd, 2013) Petersen, Zaino; Myers, Bronwyn; van Hout, Marie-Claire; Pluddemann, Andreas; Parry, Charles
    BACKGROUND:About a third of the global HIV infections outside sub-Saharan Africa are related to injecting drug use (IDU), and this accounts for a growing proportion of persons living with HIV. This paper is a response to the need to monitor the state of the HIV epidemic as it relates to IDU and the availability of HIV treatment and harm reduction services in 21 high epidemic countries. METHODS: A data collection form was designed to cover questions on rates of IDU, prevalence and incidence of HIV and information on HIV treatment and harm reduction services available to people who inject drugs (PWID). National and regional data on HIV infection, IDU in the form of reports and journal articles were sought from key informants in conjunction with a systematic search of the literature. RESULTS: Completed data collection forms were received for 11 countries. Additional country-specific information was sourced via the literature search. The overall proportion of HIV positive PWID in the selected countries ranged from 3% in Kazakhstan to 58% in Vietnam. While IDU is relatively rare in sub-Saharan Africa, it is the main driver of HIV in Mauritius and Kenya, with roughly 47% and 36% of PWID respectively being HIV positive. All countries had antiretroviral treatment (ART) available to PWID, but data on service coverage were mainly missing. By the end of 2010, uptake of needle and syringe programmes (NSP) in Bangladesh, India and Slovakia reached the internationally recommended target of 200 syringes per person, while uptake in Kazakhstan, Vietnam and Tajikistan reached between 100-200 syringes per person. The proportion of PWID receiving opioid substitution therapy (OST) ranged from 0.1% in Kazakhstan to 32.8% in Mauritius, with coverage of less than 3% for most countries. CONCLUSIONS: In order to be able to monitor the impact of HIV treatment and harm reduction services for PWID on the epidemic, epidemiological data on IDU and harm reduction service provision to PWID needs to be regularly collected using standardised indicators.
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    A comparative study of South African and Brazilian HIV and AIDS rates and policies
    (2010) Noronha, Rafael; Smit, Andre de V
    HIV and AIDS are still affecting many people in Brazil, South Africa and across the world, even though much has been done to mitigate against its further spread. Often Brazil and South Africa are compared to each other because of their economic position in the world and also because of their similar political histories. This research compares the Brazilian and the South African HIV and AIDS National Strategic prevention policies and it also aims to find out why the HIV and AIDS prevalence rates took significantly different patterns in the respective countries. The study includes a policy comparison and qualitative in-depth interviews with 14 organisation directors whose main focus is HIV prevention in Brazil and South Africa. The mains findings revealed that one of the main reasons for the different prevalence rate in both countries was because the civil society in Brazil played a major role in pressurizing the government to respond to the pandemic, while in South African the civil society did not play a major role. The Brazilian government thus started responding to HIV at least 9 years before the South African government did. Also, the Brazilian National HIV and AIDS prevention policy has an action plan for each goal, while the South African Policy does not have action plans for their goals. The Brazilian policy is also decentralized to municipal level, while the South African policy is decentralized only to Provincial level. Another finding was that in Brazil the NGO sector was directly involved in formulating the policy while in South Africa the NGO sector was not. In Brazil the respondents had a good knowledge and understanding of the policy, while in South Africa the respondents did not have a good knowledge of the policy. In Brazil NGOs have formed partnerships between themselves in order to deliver better services and to make their voices stronger when pressurising the government. Respondents in Brazil also knew what other organisations were doing. In South Africa organisations did not know what other organisations were doing and the NGOs did not have strong partnerships between themselves.