These findings highlight shortcomings in LF management, including diagnostic and treatment delays. More research and development efforts should be devoted to this 'neglected disease'.

Financial access to HIV care and treatment can be difficult for many people in China, where the government provides free antiretroviral drugs but does not cover the cost of other medically necessary components, such as lab tests and drugs for opportunistic infections. This article estimates out-of-pocket costs for treatment and care that a person living with HIV/AIDS in China might face over the course of one year. Data comes from two treatment projects run by Médecins Sans Frontières in Nanning, Guangxi Province and Xiangfan, Hubei Province. Based on the national treatment guidelines, we estimated costs for seven different patient profiles ranging from WHO Clinical Stages I through IV. We found that patients face significant financial barriers to even qualify for the free ARV program. For those who do, HIV care and treatment can be a catastrophic health expenditure, with cumulative patient contributions ranging from approximately US$200-3939/year in Nanning and US$13-1179/year in Xiangfan, depending on the patient's clinical stage of HIV infection. In Nanning, these expenses translate as up to 340% of an urban resident's annual income or 1200% for rural residents; in Xiangfan, expenses rise to 116% of annual income for city dwellers and 295% in rural areas. While providing ARV drugs free of charge is an important step, the costs of other components of care constitute important financial barriers that may exclude patients from accessing appropriate care. Such barriers can also lead to undesirable outcomes in the future, such as impoverishment of AIDS-affected households, higher ARV drug-resistance rates and greater need for complex, expensive second-line antiretroviral drugs.

with a community-based nutrition programme that has been using PPN for the management of acute malnutrition among children in a slum setting in Dhaka, Bangladesh. Bangladesh has one of the highest prevalence rates of childhood malnutrition in the world: 6,7 almost 46% of children aged <5 years are stunted (low height for age) and 15% are wasted (low weight for height). 8 During the implementation of this nutrition programme, several care givers of children complained of diffi culties in feeding their children with PPN and attributed it to the taste and smell of PPN. The programme also faced challenges in terms of a high lossto-follow-up rate (15-17%) and relatively low nutritional recovery rates (59-65%) compared to those reported in the literature. 9 A relatively long average length of stay in the programme (60-63 days) has also been observed. We are concerned that these fi ndings might be related to the overall acceptability of PPN, which is a key determinant in ensuring favourable outcomes of nutritional rehabilitation. While some studies in Africa have shown that peanut-based RUTF has good acceptability and compliance among severely malnourished children, 10-12 other studies have demonstrated barriers to its use and inadequate compliance, mainly due to sharing within the households. 13,14 There is, however, limited published literature on PPN acceptability in South Asia.In the present study, we assessed the acceptability of PPN among 1) care givers of malnourished children and 2) community health workers (CHWs), in Kamrangirchar slum, Dhaka, Bangladesh. METHODS DesignThis was a cross-sectional semi-structured questionnaire survey. Study setting and study populationThe study was conducted between April and June 2011 in Kamrangirchar, an urban slum setting in Dhaka, Bangladesh, with about 400 000 inhabitants living in an area of 3.1 km 2 . It is not offi cially considered as part of Dhaka City, and all health services are outsourced to non-governmental organisations, who are the main providers.MSF started its nutrition programme for children in May 2010. All services are provided free of charge . It is to be noted that 47% of children needed encouragement or were forced to eat PPN, while 5% completely rejected it after 3 weeks. Of the 29 CHWs interviewed, 48% were dissatisfied with PPN's taste and consistency, and 55% with its smell. However, 91% of the care givers and all CHWs still perceived a therapeutic benefit of PPN for malnourished children. Conclusion: Despite a therapeutic benefit, only 4 in 10 care givers perceived PPN as being acceptable as a food product, which is of concern. Interna onal Union Against Tuberculosis and Lung Disease

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