The International AIDS Society— Lancet Commission on the future of the HIV response and global health

Beyrer, Chris; Das, Pam; Horton, Richard; Ryan, Owen; Bekker, Linda‐Gail

doi:10.1016/s0140-6736(17)31874-3

Cited by 11 publications

(10 citation statements)

References 4 publications

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“…Human immunodeficiency virus (HIV) infection has become a manageable chronic disease with the universal use of highly active antiretroviral therapy (HAART). Mortality has been significantly reduced, but the resulting prolonged life spans have led to an increase in the number of non-fatal complications [1] , [2] , [3] , [4] , [5] , including ocular manifestations (OMs) that seriously affect the quality of patient life [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] .…”

Section: Introductionmentioning

confidence: 99%

“…Many patients with OMs are not diagnosed until a severe visual impairment has developed [ 6 , [8] , [9] , [10] , 18 , 27 ]. Methods to balance medical resources and develop appropriate ophthalmic examination procedures to ensure that patients obtain a timely ophthalmic diagnosis and necessary treatments, have been a problem for patients with HIV infection and many chronic diseases [ 3 , 5 , [28] , [29] , [30] , [31] ].…”

Section: Introductionmentioning

confidence: 99%

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The value and implementation of routine ophthalmic examination in the era of HAART

Wang

Zhao

et al. 2021

EClinicalMedicine

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Background The high prevalence of ocular manifestations (OMs) in patients with human immunodeficiency virus (HIV) infection and chronic diseases such as diabetes has become a global health issue. However, there is still a lack of an appropriate ophthalmic diagnostic procedure for the early detection of OMs in this population, leading to the risk of an irreversible visual impairment that substantially affects the quality of life of these patients. Methods The Guangzhou HIV Infection Study was a retrospective study that enrolled hospitalised HIV-infected patients in Guangzhou between January 2005 and December 2016, period corresponding to the highly active antiretroviral therapy (HAART) era in China. We collected data on OMs, systemic diseases, hospitalisation, and demographic characteristics. We classified the patients into 3 groups according to the ophthalmic examination mode they underwent: the non-ophthalmologist examination group (patients hospitalised in 2005–2011 who were only treated by infectious disease physicians), the on-demand ophthalmic examination group (patients hospitalised in 2012–2013 who were referred for a consultation with an ophthalmologist), and the routine ophthalmic examination group (patients hospitalised in 2014–2016 who routinely underwent standard ophthalmic examinations). Binary logistic regression models were used to investigate the factors related to OMs. Findings A total of 8,743 hospitalised HIV-infected patients were enrolled. The prevalence of detected OMs were 1.5% in the non-ophthalmologist examination group, 1.9% in the on-demand ophthalmic examination group, and 12.8% in the routine ophthalmic examination group. The odds of detection of OMs were highest in the routine ophthalmic examination group (adjusted odds ratio [aOR]=9.24, [95%CI, 6.51–13.12], compared to the non-ophthalmologist examination group). The detection of all types of OMs increased substantially, with keratitis, retinitis and vascular abnormalities increased the most (by 15.8–20.0 times). In the routine examination group, patients who were older than 50 years, males, with medical insurance, and were not resident in Guangzhou, had higher odds to have OMs. Several systemic diseases also increased the odds of OMs, with the highest odds among patients with a cytomegalovirus infection (aOR=5.59, [95%CI, 4.12–7.59]). Patients with retinitis, retinopathy and conjunctivitis had higher odds of having a CD4 + T cell counts less than 200 cells/μL compared to the patients that did not have these referred OMs. Interpretation The implementation of a routine ophthalmic examination has improved the odds of OM detection by approximately 9 times and increased the diagnosis rates of all types of OMs. Therefore, we encourage all HIV-infected patients to undergo regular ophthalmic examinations. Patients with OMs, especially retinopathy and retinitis, need to be evaluated for immune function (such as ...

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The value and implementation of routine ophthalmic examination in the era of HAART

Wang

Zhao

et al. 2021

EClinicalMedicine

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“…Providing for these comprehensive needs is essential to the goals of the growing movement to implement Universal Health Care (UHC), 12 and integrating some of these services into DSD platforms is a promising avenue to achieve such coverage. 13 …”

Section: Introductionmentioning

confidence: 99%

“…Similar proposals for greater integration of services have been made previously. 13 Although there has been some success with coordinating TB/HIV services in particular settings, 29 integration of other services has faced barriers to scale, including lack of resources to pay for the non-HIV services and accompanying lack of centralized support to establish a functioning large-scale public-sector program for conditions such as diabetes or hypertension. 30 With the concerns about decreasing international financial support for the HIV response and the accelerating global movement toward UHC, 31 there have been multiple calls for policies, plans, and resources to facilitate integration, including health insurance programs and civil society engagement.…”

Section: Introductionmentioning

confidence: 99%

Expanding the Vision for Differentiated Service Delivery: A Call for More Inclusive and Truly Patient-Centered Care for People Living With HIV

Ehrenkranz

Grimsrud²,

Holmes

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: Simplifying antiretroviral therapy for clinically stable people living with HIV (PLHIV) is important but insufficient to meet their health care needs, including prevention and treatment of tuberculosis and noncommunicable diseases, routine primary care, and family planning. Integrating these services into differentiated service delivery (DSD) platforms is a promising avenue to achieve such coverage. We propose a transition from an HIV-focused “DSD 1.0” to a patient-centered “DSD 2.0” that is inclusive of additional chronic care services for PLHIV. Discussion: The lack of coordination between HIV programs and these critical services puts a burden on both PLHIV and health systems. For individual patients, fractionated services increase cost and time, diminish the actual and perceived quality of care, and increase the risk that they will disengage from health care altogether. The burden on the health system is one of inefficiency and suboptimal outcomes resulting from the parallel systems required to manage multiple vertical programs. Conclusions: DSD 2.0 provides an opportunity for the HIV and Universal Health Coverage agendas—which can seem to be at odds—to achieve greater collective impact for patients and health systems by integrating strong vertical HIV, tuberculosis and family planning programs, and relatively weaker noncommunicable disease programs. Increasing coordination of care for PLHIV will increase the likelihood of achieving and sustaining UNAIDS′ goals of retention on antiretroviral therapy and viral suppression. Eventually, this shift to DSD 2.0 for PLHIV could evolve to a more person-centered vision of chronic care services that would also serve the general population.

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“…UNAIDS and the International AIDS Society have spearheaded a conversation and strategic thinking on this reconfigured relationship, capitalizing on the growing sub-discipline that aims to articulate the "learning from AIDS" to inform and promote solutions to address other public health challenges. These are characterized by complex causal networks, "combination" structures, and the need for advanced investment and governance models which coordinate a spectrum of responding actors across systems and society as a whole [7]. SDG Target 3.3 urges the global community to "By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases. "…”

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confidence: 99%

Evolution or extinction? Paediatric and adolescent HIV responses in the Agenda 2030 era

2018

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The International AIDS Society— Lancet Commission on the future of the HIV response and global health

Cited by 11 publications

References 4 publications

The value and implementation of routine ophthalmic examination in the era of HAART

The value and implementation of routine ophthalmic examination in the era of HAART

Expanding the Vision for Differentiated Service Delivery: A Call for More Inclusive and Truly Patient-Centered Care for People Living With HIV

Evolution or extinction? Paediatric and adolescent HIV responses in the Agenda 2030 era

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