A Public Health Approach to Rapid Scale-Up of Antiretroviral Treatment in Malawi During 2004-2006

Lowrance, David; Makombe, Simon D; Harries, Anthony; Shiraishi, Ray W.; Hochgesang, Mindy; Aberle‐Grasse, John; Libamba, Edwin; Schouten, Erik J; Ellerbrock, Tedd V.; Kamoto, Kelita

doi:10.1097/qai.0b013e3181893ef0

Cited by 47 publications

(48 citation statements)

References 25 publications

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“…Importantly, NGO advocacy can exert eff ective pressure on policy makers to act on the evidence quickly. 15,[58][59][60] Health outcomes are often dependent on communitybased support systems, particularly for diseases such as tuberculosis and HIV. Thus, engaging with communities, including civil society organisations, 61 and where possible establishing community advisory boards to provide a link between researchers and the community, will probably help with research implementation as well as adoption of the results.…”

Section: Translation Of Research Results Into Actionmentioning

confidence: 99%

Is operational research delivering the goods? The journey to success in low-income countries

Zachariah

Ford

Maher

et al. 2012

The Lancet Infectious Diseases

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Section: Translation Of Research Results Into Actionmentioning

confidence: 99%

Is operational research delivering the goods? The journey to success in low-income countries

Zachariah

Ford

Maher

et al. 2012

The Lancet Infectious Diseases

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“…National programs [10–13] have reported large-scale data of HIV treatment in both urban and rural populations [14–17]; however, delivery of HIV treatment in some settings presents unique challenges and current ART delivery models may significantly limit the accessibility of ART. To have the greatest impact on public health, HIV treatment programs will have to be decentralized and integrated into the existing health care system.…”

Section: Introductionmentioning

confidence: 99%

Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

Okonkwo

Sagay

Agaba

et al. 2014

AIDS Research and Treatment

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Background. Decentralization of antiretroviral therapy (ART) services is a key strategy to achieving universal access to treatment for people living with HIV/AIDS. Our objective was to assess clinical and laboratory outcomes within a decentralized program in Nigeria. Methods. Using a tiered hub-and-spoke model to decentralize services, a tertiary hospital scaled down services to 13 secondary-level hospitals using national and program guidelines. We obtained sociodemographic, clinical, and immunovirologic data on previously antiretroviral drug naïve patients aged ≥15 years that received HAART for at least 6 months and compared treatment outcomes between the prime and satellite sites. Results. Out of 7,747 patients, 3729 (48.1%) were enrolled at the satellites while on HAART, prime site patients achieved better immune reconstitution based on CD4+ cell counts at 12 (P < 0.001) and 24 weeks (P < 0.001) with similar responses at 48 weeks (P = 0.11) and higher rates of viral suppression (<400 c/mL) at 12 (P < 0.001) and 48 weeks (P = 0.03), but similar responses at 24 weeks (P = 0.21). Mortality was 2.3% versus 5.0% (P < 0.001) at prime and satellite sites, while transfer rate was 8.7% versus 5.5% (P = 0.001) at prime and satellites. Conclusion. ART decentralization is feasible in resource-limited settings, but efforts have to be intensified to maintain good quality of care.

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“…Both observational and randomized controlled trials conducted in sub-Saharan Africa have shown that this simple intervention is associated with a substantial reduction in mortality among patients with HIV-associated TB (range, 19% to 46%) [40-44] (Table 4). This beneficial effect was observed in a range of settings with high or low rates of bacterial resistance to the drug and is additive in reducing early mortality when combined with ART [45]. …”

Section: Introductionmentioning

confidence: 99%

Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review

Lawn

Meintjes

McIlleron

et al. 2013

BMC Med

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The HIV-associated tuberculosis (TB) epidemic remains a huge challenge to public health in resource-limited settings. Reducing the nearly 0.5 million deaths that result each year has been identified as a key priority. Major progress has been made over the past 10 years in defining appropriate strategies and policy guidelines for early diagnosis and effective case management. Ascertainment of cases has been improved through a twofold strategy of provider-initiated HIV testing and counseling in TB patients and intensified TB case finding among those living with HIV. Outcomes of rifampicin-based TB treatment are greatly enhanced by concurrent co-trimoxazole prophylaxis and antiretroviral therapy (ART). ART reduces mortality across a spectrum of CD4 counts and randomized controlled trials have defined the optimum time to start ART. Good outcomes can be achieved when combining TB treatment with first-line ART, but use with second-line ART remains challenging due to pharmacokinetic drug interactions and cotoxicity. We review the frequency and spectrum of adverse drug reactions and immune reconstitution inflammatory syndrome (IRIS) resulting from combined treatment, and highlight the challenges of managing HIV-associated drug-resistant TB.

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A Public Health Approach to Rapid Scale-Up of Antiretroviral Treatment in Malawi During 2004-2006

Cited by 47 publications

References 25 publications

Is operational research delivering the goods? The journey to success in low-income countries

Is operational research delivering the goods? The journey to success in low-income countries

Treatment Outcomes in a Decentralized Antiretroviral Therapy Program: A Comparison of Two Levels of Care in North Central Nigeria

Management of HIV-associated tuberculosis in resource-limited settings: a state-of-the-art review

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