Scaling-up HIV treatment programmes in resource-limited settings

Koenig, Serena P.; Léandre, Fernet; Farmer, Paul

doi:10.1097/00002030-200406003-00005

Cited by 164 publications

(116 citation statements)

References 5 publications

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“…In Haiti, antiretroviral treatment was successfully provided in the context of a comprehensive programme of HIV care, tuberculosis and STI prevention and treatment, together with women's health. 128 It was reported that integrated HIV prevention and care strengthened primary health care, and in particular regarding women's health, increased attendance for antenatal care. However, available quantitative evidence is limited, including in terms of the impact of integrated care on family planning.…”

Section: Family Planning In Pmtct Servicesmentioning

confidence: 99%

Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility

Delvaux¹,

Nöstlinger

2007

Reproductive Health Matters

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From a policy and programmatic point of view, this paper reviews the literature on the fertility-related needs of women and men living with HIV and how the entry points represented by family planning, sexually transmitted infection and HIV-related services can ensure access to contraception, abortion and fertility services for women and men living with HIV. Most contraceptive methods are safe and effective for HIV positive women and men. The existing range of contraceptive options should be available to people living with HIV, along with more information about and access to emergency contraception. Potential drug interaction must be considered between hormonal contraception and treatment for tuberculosis and certain antiretroviral drugs. Couples living with HIV who wish to use a permanent contraceptive method should have access to female sterilisation and vasectomy in an informed manner, free of coercion. How to promote condoms and dual protection and how to make them acceptable in long term-relationships remains a challenge. Both surgical and medical abortion are safe for women living with HIV. To reduce risk of vertical transmission of HIV and in cases of infertility, people with HIV should have access to sperm washing and other assisted conception methods, if these are available. Simple and cost-effective procedures to reduce risk of vertical transmission should be part of counselling for women and men living with HIV who intend to have children. Support for the reproductive rights of people with HIV is a priority. More operations research on best practices is needed. A2007 Reproductive Health Matters. All rights reserved.

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Section: Family Planning In Pmtct Servicesmentioning

confidence: 99%

Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility

Delvaux¹,

Nöstlinger

2007

Reproductive Health Matters

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“…Our predicted levels of transmitted resistance are low, because our predictions are only short term (to 2008). Relatively high levels of acquired resistance would be likely to emerge after several years on treatment (3-6); as levels of acquired resistance rise, levels of transmitted resistance will increase (16,17). For longer time periods, our model predicts higher levels of transmitted resistance.…”

Section: Resultsmentioning

confidence: 91%

Predicting the epidemiological impact of antiretroviral allocation strategies in KwaZulu-Natal: The effect of the urban–rural divide

Wilson¹,

Kahn²,

Blower³

2006

Proc. Natl. Acad. Sci. U.S.A.

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Antiretroviral therapy (ART) is becoming available in South Africa. Demand will exceed supply; thus, difficult decisions will have to be made in allocating ART. The majority of those treated for HIV are likely to be in cities, because health infrastructure and personnel are concentrated in urban centers. We predict the epidemiological impact of drug allocation strategies (DAS) by using a spatially explicit model that links urban and rural epidemics. We parameterize our model by using data from the KwaZulu-Natal province in South Africa. We model the South African government's treatment plan from 2004 -2008, and we predict the consequences of one DAS that allocates drugs only to Durban and of two DAS that allocate drugs to both urban and rural areas. All three strategies would treat 500,000 people by 2008. Not surprisingly, the Durban-only DAS would prevent the greatest number of infections (an additional 15,000 infections by 2008). However, it may have been expected that this DAS would generate the highest levels of transmitted resistance, because it concentrates ART in one location. Paradoxically, we found that this DAS would generate the lowest levels of transmitted resistance. Concentrating treatment in Durban would also avert the greatest number of AIDS-related deaths. We discuss the difference between using the principle of treatment equity versus using the principle of utilitarianism͞ efficiency to allocate ART. Decisions about allocating scarce drugs should consider treatment equity as well as epidemiological consequences. Notably, a Durban-only DAS would lead to new disparities in healthcare between urban and rural areas in KwaZulu-Natal. (Fig. 1a). This plan will result in 50% of PLWHA receiving treatment by 2008. To predict the epidemiological consequences of different drug allocation strategies (DAS), we modeled the South African government's treatment plan from 2004-2008 (2) (Fig. 1a). The World Health Organization has outlined four ethical principles that should govern the rollout of antiretrovirals in Africa; all four of these ethical principles are important for consideration in decision making by government health officials. We predict the epidemiological impact of DAS if one of these ethical principles is considered: namely, the ethical principle of utilitarianism͞efficiency. We evaluated three DAS: two urban-rural strategies (strategies 1 and 2) and an urban-only strategy that would treat only PLWHA in Durban (strategy 3). We evaluated which of the DAS would have the maximum impact on reducing the HIV epidemic by 2008 in terms of reducing the incidence rate, minimizing transmitted resistance, and decreasing the AIDS-related death rate.We modeled heterogeneity in HIV transmission dynamics by developing a spatially explicit model of KwaZulu-Natal that linked the urban epidemics with the surrounding rural epidemics (Fig. 1b); for the mathematical structure of our model and our analytical techniques, see Methods. Our spatially explicit model builds to some degree on our earlier models (3-7) but ...

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“…Accompagnateurs, or community health workers, were people chosen from the local community and trained in medication and symptom management for HIV patients. Since starting this program, patients have experienced an increase in CD4 count and reduction in viral loads, and therefore the accompagnateurs have been identified as a critical component of the clinical care provided for these patients (Koenig, Leandre, and Farmer 2004;Behforouz, Farmer, and Mukherjee 2004).…”

Section: Haitimentioning

confidence: 99%

Social Determinants of HIV Health Care: A Tale of Two Cities

Doshi¹,

Rı́o²,

Marconi³

2011

Understanding HIV/AIDS Management and Care - Pandemic Approaches in the 21st Century

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Scaling-up HIV treatment programmes in resource-limited settings

Abstract: Community-based care of AIDS has been highly effective in rural Haiti. With more international financial support for HIV/AIDS treatment in resource-limited settings, there should be no barriers to access to life-saving HAART for those who need it most.

Cited by 164 publications

References 5 publications

Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility

Reproductive Choice for Women and Men Living with HIV: Contraception, Abortion and Fertility

Predicting the epidemiological impact of antiretroviral allocation strategies in KwaZulu-Natal: The effect of the urban–rural divide

Social Determinants of HIV Health Care: A Tale of Two Cities

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