Life-saving Antiretroviral Treatment Research Articles

Impact of the coronavirus disease 2019-related global recession on the financing of the global HIV response.

Impact of the coronavirus disease 2019-related global recession on the financing of the global HIV response.

National HIV testing and diagnosis coverage in sub-Saharan Africa: a new modeling tool for estimating the 'first 90' from program and survey data.

HIV testing services (HTS) are a crucial component of national HIV responses. Learning one's HIV diagnosis is the entry point to accessing life-saving antiretroviral treatment and care. Recognizing the critical role of HTS, the Joint United Nations Programme on HIV/AIDS (UNAIDS) launched the 90-90-90 targets stipulating that by 2020, 90% of people living with HIV know their status, 90% of those who know their status receive antiretroviral therapy, and 90% of those on treatment have a suppressed viral load. Countries will need to regularly monitor progress on these three indicators. Estimating the proportion of people living with HIV who know their status (i.e. the 'first 90'), however, is difficult. We developed a mathematical model (henceforth referred to as 'Shiny90') that formally synthesizes population-based survey and HTS program data to estimate HIV status awareness over time. The proposed model uses country-specific HIV epidemic parameters from the standard UNAIDS Spectrum model to produce outputs that are consistent with other national HIV estimates. Shiny90 provides estimates of HIV testing history, diagnosis rates, and knowledge of HIV status by age and sex. We validate Shiny90 using both in-sample comparisons and out-of-sample predictions using data from three countries: Côte d'Ivoire, Malawi, and Mozambique. In-sample comparisons suggest that Shiny90 can accurately reproduce longitudinal sex-specific trends in HIV testing. Out-of-sample predictions of the fraction of people living with HIV ever tested over a 4-to-6-year time horizon are also in good agreement with empirical survey estimates. Importantly, out-of-sample predictions of HIV knowledge of status are consistent (i.e. within 4% points) with those of the fully calibrated model in the three countries when HTS program data are included. The model's predictions of knowledge of status are higher than available self-reported HIV awareness estimates, however, suggesting - in line with previous studies - that these self-reports could be affected by nondisclosure of HIV status awareness. Knowledge of HIV status is a key indicator to monitor progress, identify bottlenecks, and target HIV responses. Shiny90 can help countries track progress towards their 'first 90' by leveraging surveys of HIV testing behaviors and annual HTS program data.

90-90-90--Charting a steady course to end the paediatric HIV epidemic.

IntroductionThe new “90-90-90” UNAIDS agenda proposes that 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression by 2020. By focusing on children, the global community is in the unique position of realizing an end to the paediatric HIV epidemic.DiscussionDespite vast scientific advances in the prevention and treatment of paediatric HIV infection over the last two decades, in 2014 there were an estimated 220,000 new paediatric infections attributed to mother-to-child HIV transmission (MTCT) and 150,000 HIV-related paediatric deaths. Furthermore, adolescents remain at particularly high risk for acquisition of new HIV infections, and HIV/AIDS remains the second leading cause of death in this age group. Among the estimated 2.6 million children less than 15 years of age living with HIV infection, only 32% were receiving life-saving antiretroviral treatment. After decades of languishing, good progress is now being made to prevent MTCT. Unfortunately, efforts to scale up HIV treatment services have been less robust for children and adolescents compared with adult populations. These discrepancies reflect substantial gaps in essential services and numerous missed opportunities to prevent HIV transmission and provide effective life-saving antiretroviral treatment to children, adolescents and families. The road to an AIDS-free generation will require bridging the gaps in HIV services and addressing the particular needs of children across the developmental spectrum from infancy through adolescence. To reach the ambitious new targets, innovations and service improvements will need to be rapidly escalated at each step along the prevention-treatment cascade.ConclusionsCharting a successful course to reach the 90-90-90 targets will require sustained political and financial commitment as well as the rapid implementation of a broad set of systematic improvements in service delivery. The prospect of a world where HIV no longer threatens the lives of infants, children and adolescents may finally be within reach.

Getting to 90-90-90 in paediatric HIV: What is needed?

Introduction The new “90-90-90” UNAIDS agenda proposes that 90% of all people living with HIV will know their HIV status, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy and 90% of all people receiving antiretroviral therapy will have viral suppression by 2020. By focusing on children, the global community is in the unique position of realizing an end to the paediatric HIV epidemic. Discussion Despite vast scientific advances in the prevention and treatment of paediatric HIV infection over the last two decades, in 2014 there were an estimated 220,000 new paediatric infections attributed to mother-to-child HIV transmission (MTCT) and 150,000 HIV-related paediatric deaths. Furthermore, adolescents remain at particularly high risk for acquisition of new HIV infections, and HIV/AIDS remains the second leading cause of death in this age group. Among the estimated 2.6 million children less than 15 years of age living with HIV infection, only 32% were receiving life-saving antiretroviral treatment. After decades of languishing, good progress is now being made to prevent MTCT. Unfortunately, efforts to scale up HIV treatment services have been less robust for children and adolescents compared with adult populations. These discrepancies reflect substantial gaps in essential services and numerous missed opportunities to prevent HIV transmission and provide effective life-saving antiretroviral treatment to children, adolescents and families. The road to an AIDS-free generation will require bridging the gaps in HIV services and addressing the particular needs of children across the developmental spectrum from infancy through adolescence. To reach the ambitious new targets, innovations and service improvements will need to be rapidly escalated at each step along the prevention-treatment cascade. Conclusions Charting a successful course to reach the 90-90-90 targets will require sustained political and financial commitment as well as the rapid implementation of a broad set of systematic improvements in service delivery. The prospect of a world where HIV no longer threatens the lives of infants, children and adolescents may finally be within reach. 10.7448/IAS.18.7.20296 © 2015 Abrams E J et al; licensee International AIDS Society Received 9 May 2015; Revised 25 August 2015; Accepted 2 September 2015; Published 2 December 2015 Corresponding author: Elaine J Abrams, ICAP, Mailman School of Public Health, Columbia University, 722 W168th Street, New York, NY 10032, USA. Tel: +1 212 342 0543. (eja1@cumc.columbia.edu)

PEPFAR Scale-up of Pediatric HIV Services

HIV/AIDS has had a profound impact on children around the world since the start of the epidemic. There are currently 3.4 million children under the age of 15 years living with HIV globally, and more than 450,000 children currently receiving lifesaving antiretroviral treatment. This article describes efforts supported by the President's Emergency Plan for AIDS Relief (PEPFAR) to expand access to treatment for children living with HIV in high-burden countries. The article also highlights a series of case studies that illustrate the impact that the PEPFAR initiative has had on the pediatric HIV epidemic. Through its support of host governments and partner organizations, the PEPFAR initiative has expanded HIV testing and treatment for pregnant women to reduce vertical transmission of HIV, increased access to early infant diagnosis for HIV-exposed infants, improved training and resources for clinicians who provide pediatric care and antiretroviral treatment, and, through public-private partnerships with pharmaceutical manufacturers, helped increase the number of medications available for the treatment of HIV-infected children in resource-limited settings.

Orphans in Sub-Saharan Africa: The Crisis, the Interventions, and the Anthropologist

Response to the orphan crisis in sub-Saharan Africa has focused mainly on mobilizing and distributing material resources to households with orphans. Only a few anthropologists have interrogated the frameworks and values on which the projects for orphans are based. In this paper, I analyze the trends in foster-care research in Africa and suggest that current ethnographic data on foster-care practices do not adequately reflect the changing context of fostering in Africa. There is a need for fresh anthropological evidence on fostering because of death. It is only when new data are generated that effective and culturally sensitive programs for orphans and the people who are directly responsible for their well-being can be developed. With fourteen million children orphaned because of AIDS, sub-Saharan Africa is facing an unprecedented crisis, which could be exacerbated because many more of the 22.4 million people living with HIV—60 percent women—will become ill and die for lack of life-saving antiretroviral treatment, to which only 45 percent of pregnant women have access to prevent transmission of HIV to their babies. Also, armed conflicts are causing more children to be orphaned. The responsibility for orphans is mostly borne by older women, who depend upon support from external partners comprising international

NEXT STEPS FOR UKRAINE ABOLITION OF HIV REGISTRIES, IMPLEMENTATION OF ROUTINE HUMAN IMMUNODEFICIENCY VIRUS TESTING AND EXPANSION OF SERVICES

Booth et al. should be congratulated on a rigorously conducted study with a challenging population. Their work demonstrated that compared to an indigenous leader outreach model, a less-expensive, briefer counseling intervention was equally effective at reducing sexual and injection risk-taking [1]. The data also confirm that learning one's own HIV+ status significantly reduces sexual HIV risk-taking, independently from each intervention. These data are consistent with findings elsewhere where an HIV+ diagnosis alone reduces sexual risk [2]. Knowing one's HIV+ status is essential for accessing life-saving antiretroviral treatment, itself an intervention associated with decreased HIV transmission [3]. On a population level, widespread treatment with antiretroviral medications is a powerful tool in controlling the HIV epidemic among all affected groups [4]. Why then has Ukraine not embarked upon incredibly cost-effective strategies [5] to increase HIV identification through deployment of routine testing? Routine testing would be most effective if multiple barriers were removed, including name-based registration programs (e.g. HIV and drug dependence) and pre-test counseling. HIV registries and voluntary testing programs stigmatize patients and discourage testing of high-risk individuals, particularly when risk-behaviors are assessed. Moreover, HIV registries and pre-test counseling add significant costs that detract from treatment and prevention, especially in the current global economic climate. In particular, implementation of routine testing could effectively be conducted at existing settings, including where patients are treated for substance abuse, tuberculosis, inpatient services and in newly-created integrated care settings [6]. The criminal justice system would also greatly benefit from routine HIV testing [7] in ways that Booth et al elegantly demonstrated for community outreach and harm reduction programs. These latter sites may serve as sentinel sites for initiating care for HIV and opioid substitution therapy (OST) and greatly contribute to controlling the HIV epidemic. Though stimulants exist in Ukraine, opioids remain the mainstay of drug dependence. Therefore, wider implementation of OST is urgently needed. While identifying HIV+ status reduces sexual risk-behaviors, OST dramatically reduces injection risk-behaviors [8]. Indeed, since Booth's study, both buprenorphine and methadone have been introduced, but not at a sufficient magnitude to curb the HIV epidemic [9]. Though progress has been made since 2005, considerable legal, political, economic and social barriers continue to impede HIV prevention and treatment efforts. Laws regulating the transportation, storage, and dispensing of opioid treatment therapies currently hamper widespread access. Hospitals rarely offer OST, forcing hospitalized IDUs into agonizing forced-abstinence. Regulations requiring observed, daily OST dosing create a disincentive for patients wanting to return to the workforce. Requirements that physicians dispense OST create unneeded expense and distract them from attending to more complex cases. Laws that ban driver's licenses for OST patients are similarly ill-advised, limiting uptake of OST and further endangering society by encouraging active drug users to remain out of treatment and to drive under the influence of illicit drugs. In the political and economic arena, ideology and stigma regarding HIV prevention and treatment must be set aside to counter the explosive spread of HIV in Ukraine. Though seemingly daunting, effective HIV containment strategies now exist that will facilitate better health for all Ukrainians. The time to implement them is now.

The relation of HIV testing and treatment to identity formation in Zambia

Why would many Zambians be reluctant to access lifesaving antiretroviral treatment? Does the process of accessing an HIV test in Zambia promote an identity that can change individuals' livelihood strategies? What happens to individuals when people access treatment? Voluntary testing and treatment centres and the HIV-prevention programmes that support them have come to embody explicit messages about ‘health,’ ‘progress,’ ‘civilisation’ and ‘modernity,’ and through this they compel individuals to take on a particular identity. In Zambia the pursuit of HIV testing and biomedical treatment forces individuals to locate themselves somewhat differently in relation to community support structures, placing their faith in the future on an uneasy foundation of a ‘modern’ identity. This is embodied in the deep-rooted suspicion that many Zambians have toward the international HIV/AIDS-response sector from which HIV and AIDS treatment programmes are derived. Drawing upon the notion of ‘therapeutic citizenship’ I examine why the ‘AIDS industry’ continues to symbolise such tension. I explore how individuals believe their identity will shift through participation in HIV testing and treatment options and how that might impact long-term and short-term livelihood strategies.

Feasibility of Provider-Initiated HIV Testing and Counselling of Tuberculosis Patients Under the TB Control Programme in Two Districts of South India

BackgroundProvider-initiated HIV testing and counselling (PITC) is internationally recommended for tuberculosis (TB) patients, but the feasibility, effectiveness, and impact of this policy on the TB programme in India are unknown. We evaluated PITC of TB patients across two districts in India considered to have generalized HIV epidemics, Tiruchirappalli (population 2.5 million) and Mysore (population 2.8 million).Methodology/Principal FindingsStarting June 2007, healthcare providers in both districts were instructed to ascertain HIV status for all TB patients, and refer those with unknown HIV status to the nearest Integrated Counselling and Testing Centre (ICTC)—often in the same facility—for counselling and voluntary HIV testing. All TB patients registered from June 2007 to March 2008 were followed prospectively. Field investigators assessed PITC practices and abstracted data from routine TB programme records and HIV counselling registers to determine the proportion of TB patients appropriately evaluated for HIV infection. Patient records were traced to determine the efficiency of referral links to HIV care and antiretroviral treatment (ART). Between July 2007 and March 2008, 5299 TB patients were registered in both study districts. Of the 4701 with unknown HIV status at the time of TB treatment initiation, 3368 (72%) were referred to an ICTC, and 3111 (66%) were newly tested for HIV. PITC implementation resulted in the ascertainment of HIV status for 3709/5299 (70%) of TB patients, and detected 200 cases with previously undiagnosed HIV infection. Overall, 468 (8.8%) of all registered TB patients were HIV-infected; 177 (37%) were documented to have also received any ART.ConclusionsWith implementation of PITC in India, HIV status was successfully ascertained for 70% of TB patients. Previously undiagnosed HIV-infection was detected in 6.4% of those TB patients newly tested, enabling referral for life-saving anti-retroviral treatment. ART uptake, however, was poor, suggesting that PITC implementation should include measures to strengthen and support ART referral, evaluation, and initiation.

Elizabeth Mataka: UN Special Envoy for HIV/AIDS in Africa

One Sunday morning last year an elderly Zambian woman four grandchildren in tow showed up at Elizabeth Matakas door. "Im looking for Mrs Mataka-people said she will help me. Shes the one who helps grandmothers" the woman said. She had found exactly the right person. Mataka herself a grandmother of three heads the Zambia National AIDS Network (ZNAN) and helps coordinate funds fl owing in from donors. And earlier this year she was elevated to the highest levels of the global response to the pandemic. In April 61-year-old Mataka was elected Vice Chair of the Global Fund to Fight AIDS Tuberculosis and Malaria. The next month she got a surprise midnight call from New York with the news that she had been chosen to replace the outgoing United Nations Special Envoy for HIV/AIDS in Africa Canadian diplomat Stephen Lewis. (excerpt)