AIDS Response Research Articles

A SICA compartmental model in epidemiology with application to HIV/AIDS in Cape Verde

We propose a new mathematical model for the transmission dynamics of the human immunodeficiency virus (HIV). Global stability of the unique endemic equilibrium is proved. Then, based on data provided by the “Progress Report on the AIDS response in Cape Verde 2015”, we calibrate our model to the cumulative cases of infection by HIV and AIDS from 1987 to 2014 and we show that our model predicts well such reality. Finally, a sensitivity analysis is done for the case study in Cape Verde. We conclude that the goal of the United Nations to end the AIDS epidemic by 2030 is a nontrivial task.

English

HIV-1 genetic diversity in sub-Saharan Africa is broad and the AIDS epidemic is driven predominantly by recombinants in Central and West Africa. The classification of HIV-1 strains is therefore necessary to understand diagnostic efficiency, individual treatment responses as well as options for designing vaccines and antiretroviral (ARV) treatment guidelines. More so, accurate subtyping of a partial or full genome would represent the population dynamics of HIV and provide evidence for designing surveillance strategies within a geographic region. Evaluating the performance of rapid subtyping tools with options that incorporate phylogeny could be fast, more user-friendly and of high performance. A total of 570 HIV-1 partial sequences from Cameroon, Angola, Democratic Republic of Congo, Gabon and Senegal were obtained from the Los Alamos National Library (LANL) HIV Sequence Database. Phylogeny was performed using MEGA v6 and the results were used to evaluate the performance of eleven different rapid HIV-1 subtyping tools: REGA v2, REGA v3, NCBI, Stanford HIVDB, SUDI, Geno2Pheno, Euresist, STAR, jpHMM, COMET and SCUEAL. The performance of these subtyping tools differed among HIV-1 clades and across different viral genes. NCBI and SUDI showed the highest performance in subtyping. The discordance observed between the rapid subtyping tools and phylogeny implies that phylogenetic analysis is still the more suitable method for HIV-1 classification. However, the need to update the reference datasets of the subtyping tools, and validate algorithms for rapid subtyping and quality control is imperative as this information is relevant for clinical use and policy-making to the AIDS response.   Key words: HIV, phylogeny, performance, subtyping tools, algorithm.

Investing for Impact: The Global Fund Approach to Measurement of AIDS Response

The Global Fund raises and invests nearly US$4 billion a year to support programs run in more than 140 countries. The Global Fund strategy 2012–2016 is focused on “Investing for Impact”. In order to accomplish this, timely and accurate data are needed to inform strategies and prioritize activities to achieve greater coverage with quality services. Monitoring and evaluation is intrinsic to the Global Fund’s system of performance-based funding. The Global Fund invests in strengthening measurement and reporting of results at all stages of the grant cycle. The Global Fund approach to measurement is based on three key principles—(1) simplified reporting: the Global Fund has updated its measurement guidance to focus on impact, coverage and quality with the use of a harmonized set of indicators. (2) Supporting data systems—based on a common framework developed and supported by partners, it promotes investment in five common data systems: routine reporting including HMIS; Surveys—population based and risk group surveys; Analysis, reviews and transparency; Administrative and financial data sources; and, Vital registration systems. (3) Strengthen data use: the Global Fund funding encourages use of data at all levels—national, subnational and site level. Countries do not automatically prioritize M&E but when guidance, tools and investments are available, there is high level utilization of M&E systems in program design, planning, implementation, and results reporting. An in-depth analysis of the available data helps the Global Fund and countries to direct investments towards interventions where impact could be achieved and focus on target population groups and geographic areas that are most affected.

The Role of Civil Society Organizations in Monitoring the Global AIDS Response.

Civil society organizations (CSOs) are recognized as playing an exceptional role in the global AIDS response. However, there is little detailed research to date on how they contribute to specific governance functions. This article uses Haas' framework on global governance functions to map CSO's participation in the monitoring of global commitments to the AIDS response by institutions and states. Drawing on key informant interviews and primary documents, it focuses specifically on CSO participation in Global AIDS Response Progress Reporting and in Global Fund to Fight AIDS, Tuberculosis and Malaria processes. It argues that the AIDS response is unique within global health governance, in that CSOs fulfill both formal and informal monitoring functions, and considers the strengths and weaknesses of these contributions. It concludes that future global health governance arrangements should include provisions and resources for monitoring by CSOs because their participation creates more inclusive global health governance and contributes to strengthening commitments to human rights.

Evolution of Monitoring and Evaluation of AIDS Response in Ukraine: Laying the Groundwork for Evidence-Based Health Care.

Once facing the most severe HIV epidemic in Eastern Europe, Ukraine has built an elaborate Monitoring and Evaluation (M&E) system to track the response to AIDS. This system was developed using recommendations and input from multiple international expert organizations and donors and, at the current stage, serves as a best practice model in many areas. The present paper aims to provide a comprehensive overview of the evolution of the M&E system in Ukraine since its inception. Notable achievements and challenges are described and illustrated by epidemiological data and the recommendations for future development are discussed. Unique experiences and advances in M&E in Ukraine may be useful to other countries facing similar epidemiological, structural or methodological issues.

Population health and individualized care in the global AIDS response: synergy or conflict?

Population health and individualized care in the global AIDS response: synergy or conflict?

Changing HIV treatment eligibility under health system constraints in sub-Saharan Africa: investment needs, population health gains, and cost-effectiveness.

We estimated the investment needs, population health gains, and cost-effectiveness of different policy options for scaling-up prevention and treatment of HIV in the 10 countries that currently comprise 80% of all people living with HIV in sub-Saharan Africa (Ethiopia, Kenya, Malawi, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe). We adapted the established STDSIM model to capture the health system dynamics: demand-side and supply-side constraints in the delivery of antiretroviral treatment (ART). We compared different scenarios of supply-side (i.e. health system capacity) and demand-side (i.e. health seeking behavior) constraints, and determined the impact of changing guidelines to ART eligibility at any CD4 cell count within these constraints. Continuing current scale-up would require US$178 billion by 2050. Changing guidelines to ART at any CD4 cell count is cost-effective under all constraints tested in the model, especially in demand-side constrained health systems because earlier initiation prevents loss-to-follow-up of patients not yet eligible. Changing guidelines under current demand-side constraints would avert 1.8 million infections at US$208 per life-year saved. Treatment eligibility at any CD4 cell count would be cost-effective, even under health system constraints. Excessive loss-to-follow-up and mortality in patients not eligible for treatment can be avoided by changing guidelines in demand-side constrained systems. The financial obligation for sustaining the AIDS response in sub-Saharan Africa over the next 35 years is substantial and requires strong, long-term commitment of policy-makers and donors to continue to allocate substantial parts of their budgets.

Investing in the health workforce to increase access to and use of HIV and AIDS services in Uganda.

Despite progress over the last decade, Uganda's achievement of key health indicators, including for HIV and AIDS, remains unsatisfactory and continues to represent leading causes of morbidity and mortality [1]. As the Government of Uganda works to improve healthcare across all service delivery areas, HIV and AIDS receives heightened attention because of the country's ranking in terms of the number of new HIV infections, people living with HIV (PLHIV), AIDS-related deaths, and adult HIV prevalence rate [2]. Intensive efforts in HIV prevention, care, and treatment led to a decrease in HIV prevalence from a high of 18% in the 1990s to 6.4% in 2002. After persisting at this level from 2002 to 2007, HIV prevalence rose to a national average of 7.3% (2011) [3,4]. Many regions experience an even higher burden of HIV, especially in central and mid-northern Uganda, with prevalence ranging from 8.3 to 10.6% [4]. Health workforce challenges undermine HIV service delivery Uganda's aim to strengthen and scale up its HIV and AIDS response to reduce new infections and achieve ‘a population free of HIV and its effects’ [5] is undermined by low utilization of health services and perceived low quality of healthcare [6]. A key element of quality service delivery and demand is a well performing and well trained health workforce [7]. Uganda's absolute shortage and inadequate geographic distribution of health workers with appropriate skill mix to provide services across the continuum hinders achievement of epidemic control. A national staff audit conducted by the Ministry of Health in 2009 found that 47% of established positions in government health facilities were vacant [8]. In addition, about 71% of doctors and 41% of nurses and midwives were working in urban areas, although 85% of the population reside in rural areas [9,10]. Factors contributing to high health worker vacancy and low retention include weak leadership and management, inadequate planning and human resources management systems, low levels of motivation, and poor working and living conditions in rural areas [6]. To address health workforce challenges affecting quality of care for HIV and AIDS, the United States Agency for International Development (USAID) and U.S. President's Emergency Plan for AIDS Relief-funded global CapacityPlus project and bilateral Uganda Capacity Program (UCP), both led by IntraHealth International, worked in close collaboration with the Ministry of Health to strengthen health workforce management to enable improved delivery of quality HIV and AIDS services. They also provided family planning, reproductive health and other health services with funding from PEPFAR and USAID's Population and Reproductive Health, Maternal and Child Health, and other programs. This field note describes selected interventions from a more comprehensive package of human resources management support provided to the Ministry of Health, to improve the utilization of data for evidence-based planning, deployment, and management of the health workforce. It also provides an example of how health workforce data can be analyzed alongside country-level HIV service statistics to ensure an adequate supply of human resources for health (HRH) where increased accessibility and scale-up of HIV services is needed to achieve 90–90–90 goals [11–13].

To Pee, or Not to Pee: A Review on Envenomation and Treatment in European Jellyfish Species.

There is a growing cause for concern on envenoming European species because of jellyfish blooms, climate change and globalization displacing species. Treatment of envenomation involves the prevention of further nematocyst release and relieving local and systemic symptoms. Many anecdotal treatments are available but species-specific first aid response is essential for effective treatment. However, species identification is difficult in most cases. There is evidence that oral analgesics, seawater, baking soda slurry and 42–45 °C hot water are effective against nematocyst inhibition and giving pain relief. The application of topical vinegar for 30 s is effective on stings of specific species. Treatments, which produce osmotic or pressure changes can exacerbate the initial sting and aggravate symptoms, common among many anecdotal treatments. Most available therapies are based on weak evidence and thus it is strongly recommended that randomized clinical trials are undertaken. We recommend a vital increase in directed research on the effect of environmental factors on envenoming mechanisms and to establish a species-specific treatment. Adequate signage on jellyfish stings and standardized first aid protocols with emphasis on protective equipment and avoidance of jellyfish to minimize cases should be implemented in areas at risk.

Innovative Faith-Community Responses to HIV and AIDS: Summative lessons from Over Two Decades of Work

It has been acknowledged for decades that “communities” are key to all levels of HIV and AIDS response. However, for a long time community-level responses have been poorly assessed or documented, a...

Changing Donor Funding and the Challenges of Integrated HIV Treatment.

Donor financing for HIV prevention and treatment has shifted from supporting disease-specific ("vertical") programs to health systems strengthening ("horizontal") programs intended to integrate all aspects of care. We examine the consequences of shifting resources from three perspectives: first, through a broad analysis of the changing policy context of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of some clinical consequences that the authors observed in a research study examining adherence to antiretroviral therapy (ART) and sexual health among adolescents. We note that AIDS responses are neither completely vertical nor horizontal but rather increasingly diagonal, as disease-specific protocols operate alongside integrated supply chain management, human resource development, and preventive screening. We conclude that health care programs are better conceived of as networks of policies requiring different degrees of integration into communities.

Putting the t in tools: a roadmap for implementation of new global and regional transgender guidance.

Transgender (trans) activists and global health partners have collaborated to develop new tools and guidance for assessing and addressing HIV and other health needs within trans populations. Trans women experience a heavy burden of HIV and other sexually transmitted infections (STIs), high incidence of violence and difficulties accessing gender-affirming services. At the same time, little has been published on trans men's health, HIV issues, needs and experiences. Young trans people are especially marginalized and vulnerable, with few programmes and services specifically tailored to their needs. Trans-specific data and guidance are needed to adapt the global response to HIV to meet the needs of the trans population. While the needs of this group have only recently received attention, global, regional and other technical guidance documents are being developed to address these gaps. Regional blueprints for comprehensive care for trans people in Latin America, the Caribbean, and Asia and the Pacific are now available. These tools – supported by the Pan American Health Organization, World Health Organization, US President's Emergency Plan for AIDS Relief and the United Nations Development Programme, in collaboration with regional trans groups – provide a contextual map, indicating opportunities for interventions in health, HIV, violence, stigma and discrimination, social protection and human rights. Global guidance includes the World Health Organization's Policy Brief: Transgender People and HIV, and the interagency publication, Implementing Comprehensive HIV and STI Programmes with Transgender People. Community empowerment and capacity building are the focus of the new tools for global and regional transgender guidance. The goal is to strengthen and ensure community-led responses to the HIV challenge in trans populations. This article describes the new tools and guidance and considers the steps needed to use them to appropriately support and engage transgender populations within national AIDS, STI, and sexual and reproductive health responses and programmes. The time to use these tools and guidance for advocacy, strategic planning, capacity building, programme design and training is now.

HIV prevention among transgender women in Latin America: implementation, gaps and challenges.

IntroductionTransgender women are the population most vulnerable to HIV in Latin America, with prevalence between 18 and 38%. Although the region has improved antiretroviral coverage, there is an urgent need to strengthen HIV prevention for key populations to meet regional targets set by governments. We conducted an assessment on the state of HIV prevention among transgender women in Latin America.MethodsWe conducted a desk review of Global AIDS Response Progress Reports, national strategic plans, technical reports and peer-reviewed articles from 17 Latin American countries published through January 2015. The review was preceded by 12 semi-structured interviews with UNAIDS and Pan American Health Organization officers and a discussion group with transgender women regional leaders, to guide the identification of documents. We assessed access to, implementation and coverage of programmes; legal frameworks; community participation; inclusion of new strategies; and alignment with international recommendations.Results and discussionOverall, prevention activities in the region focus on condom distribution, diagnosis of sexually transmitted infections and peer education, mostly delivered at health facilities, with limited community involvement. Argentina and Uruguay have implemented structural interventions to address social inclusion. Argentina, Brazil and Mexico have adopted early initiation of antiretroviral therapy and treatment as prevention strategies. The other countries do not have substantial tailored interventions and consider the trans population a sub-population of men who have sex with men in data collection and programme implementation. Limited coverage of services, discrimination and a deep-seated mistrust of the health system among transgender women are the main barriers to accessing HIV prevention services. Promising interventions include health services adapted to transgender women in Mexico; LGBT-friendly clinics in Argentina that incorporate community and health workers in mixed teams; task-shifting to community-based organizations; mobile HIV testing; and gender identity laws.ConclusionsTransgender women in Latin America continue to have limited access to HIV prevention services, which presents a bottleneck for reaching prevention goals and incorporating new prevention interventions. Prevention programmes should be rights-based; offer tailored, holistic interventions; and involve transgender women in their design and implementation.

The evolution of Earth Observation satellites in Europe and its impact on the performance of emergency response services

The paper reviews the evolution of Earth Observation systems in Europe and Worldwide and analyses the potential impact of their performance in support of emergency response services. Earth Observation satellites play already a significant role in supporting the action of first responders in case of major disasters. The main principle is the coordinated use of satellites in order to ensure a rapid response and the timely delivery of images and geospatial information of the area affected by the event.The first part of the paper reviews the main instruments and evaluates their current performance. The International Charter “Space and Major Disasters”, signed in October 2000, was the first international initiative aimed at establishing a unified system for the acquisition of space data. The charter is a cooperation agreement between space agencies and operators of space systems. At regional level, a similar instrument exists in Asia: Sentinel-Asia. In the frame of the European programme Copernicus, the emergency management service was launched in 2009. Geo-information products derived from space imagery are delivered during all phases of the emergency management cycle, in either rush or non-rush mode, free of charge for the users. In both cases, the capacities were historically drawn from national missions, funded with public money and directly operated by the space agencies or by national operators.The paper focuses on the performance of the space infrastructure (satellites and ground segments). Several trends may have a significant impact on the current performance:–The increasing number of space systems which are privately-owned and managed by commercial operators.–The emergence in Europe of shared-ownership or community-owned systems. Copernicus Sentinel missions (Copernicus) or Eumetsat satellites are two typical examples.–The development of dual-use capacities and the sovereignty dimension of these systems.–The development of unmanned airborne vehicles (UAVs) for civil applications.–The development of social media and crowd-based initiatives for humanitarian aid and emergency response.–Possible disruptions, such as large LEO constellations or GEO infrastructures enabling persistent observation.A common feature is the increased number of information sources and the higher real time dimension.Typical scenarios for the future are described and their likelihood is discussed, including political acceptance and the international dimension. Aside from rapid technological evolutions, two main driving factors are the capacity of national and international stakeholders to agree on governance and the sustainability of the economic models.

Grassroots responses to violence against women and girls in post-earthquake Nepal: lessons from the field

ABSTRACTViolence against women and girls (VAWG), including sexual violence, can increase after natural disasters. This article provides evidence from Nepal, a country where progress has been made on gender equality but VAWG remains an endemic problem. Research since the earthquakes involving women activists and non-government organisations indicates the continuing challenges facing disaster response efforts to prevent VAWG and protect women. Women and girls in camps and temporary shelters feel threatened and insecure due to the risk of violence and lack of privacy. Humanitarian aid, health care, and disaster responses can challenge VAWG, and offer safe spaces for women and girls to be established. This article draws on the views of grassroots women’s activists in Nepal and shares lessons for development and humanitarian workers about steps to be taken to challenge and minimise VAWG in emergency situations.

Predictors of adults' helping intentions and behaviours towards a person with a mental illness: A six-month follow-up study

Little is known about the relationship between adults' intentions to assist a hypothetical person experiencing a mental illness and their subsequent first aid actions in reality. This study examines whether the quality of respondents' stated first aid intentions predicts the quality of their helping behaviour towards a person they know in real life. A convenience sample of 820 Australian adults completed two surveys six months apart which asked questions about a hypothetical person experiencing depression with suicidal thoughts, and how they had assisted someone with a similar problem in their lives. The quality of helping intentions at baseline predicted the quality of mental health first aid behaviours at follow-up, as did the quality of past behaviours. In particular, people who intended to assess and assist with the crisis situation in the vignette were five times more likely to perform the same action when helping someone they knew. The quality of past intentions and behaviour, and confidence in helping, were the most significant predictors of behaviour at follow-up. These findings suggest that adults' mental health first aid intentions can be used to predict their subsequent behaviours, therefore, educating communities about effective first aid responses may increase future rates of appropriate help.

Evolution of HIV and AIDS Programmes in an African Institution of Higher Learning: The Case of the Copperbelt University in Zambia.

Background:Universities present the foundation for socio-economic and political development. Without structures and processes to fight HIV, there is no prospect of enhancing treatment, prevention, care and support services. Copperbelt University HIV and AIDS response was initiated in 2003 with the aim of building capacity of students and employees in HIV and AIDS. Objectives:The main objective of this paper is to demonstrate how the CBU HIV response has evolved over time and provide a timeline of important milestones in the development process. Method:Peer educators and counsellors conduct sensitization campaigns through one on one discussion, workshops, and drama performances, distribution of Information, Education and Communication (IEC) materials.Results:HIV Programme has been set up with players from policy, programme and community levels. Strategic processes, collaborations, funding, medical insurance schemes, prevention, treatment, care and support services, training of peer educators and counsellors have been established.Conclusion:Copperbelt University HIV initiative has demonstrated potential to reduce new infections in the university, and is currently expanding her programme to encompass wellness and also spearhead the integration of HIV in the university curriculum.

Editorial: HIV Infection and AIDS in Africa - Issues, Lessons Learnt and Next Steps.

Editorial: HIV Infection and AIDS in Africa - Issues, Lessons Learnt and Next Steps.

Feedback on terrorist attacks on November 13, 2015. First aid response and interactions with medical teams

Les attentats de Paris du 13 novembre 2015 ont confronte les secours a de nouvelles problematiques : l'engagement des secours en zone non securisee, le tres grand nombre de victimes civiles presentant des blessures de guerre, une strategie d'evacuation adaptee a cette situation de catastrophe a effet majeur. Pour la premiere fois en France, le concept tactique du « plan rouge alpha » a ete applique : triage medical, damage control prehospitalier, medicalisation uniquement des urgences absolues le necessitant et transport rapide vers les centres hospitaliers. Ces principes de sauvetage au combat ont permis de sauver le maximum de vies.

Safety in High School Supervised Agricultural Experiences: Teachers' Training and Students' Injury Awareness.

This research study sought to gather evidence of school-based agriculture teachers' hazard perceptions, safety practices, training experiences, and awareness of student injuries related to supervised agricultural experience (SAE) programs. Teachers agreed that students should follow safety guidelines developed by the National Children's Center for Rural and Agricultural Safety and Health during SAE work. Approximately 66% (f = 153) of teachers reported having general training in first aid, CPR, and AED. Twenty participants (8.6%) indicated having no safety certifications or training. Abrasions, lacerations, bites/stings, and burns accounted for a majority of the student SAE-related injuries that were reported. There were 82 participants (35.5%) who stated that no injuries had been reported or they were not aware of any injuries that occurred. The majority of teachers (66%) had received some form offirst aid or first response training, but fewer teachers had received safety training for ATVs (f = 25, 10.8%), tractors (f = 48, 20.7%), and livestock (f = 39, 16.8%). Results indicated a disparity between required safe work habits and the types of hazardous tasks students should be allowed to complete alone while participating in SAE activities. It appears most responding teachers in this study agreed to allow students to operate equipment and machinery alone. Recommendations for teachers include attending professional development training specific to SAE safety and keeping records of any risk assessments conducted during SAE supervision. Further development of best practices for SAE supervision and safety are needed to assist agricultural education professionals in protecting and shaping our future leaders in agriculture.