While clinical care providers, programme managers and other stakeholders increasingly recognise the critical importance of nutrition for the treatment of HIV and AIDS, interventions that link nutritional support to treatment are relatively new. The Academic Model for Prevention and Treatment of HIV/AIDS (AMPATH) initiated one such intervention in 2002 in western Kenya with a large-scale expansion currently underway with the support of World Food Programme commodity donations and fresh food grown on AMPATH production farms. The intervention is designed to bolster nutrition security of the most vulnerable patients on antiretroviral regimens over a short period of time by providing supplemental household food rations. Weaning or transitioning clients off food supplementation is the major programmatic challenge facing this and similar nutrition interventions - especially given its critical importance in sustaining nutritional, health and productivity gains. The growing global interest in linking nutrition care to ARV treatment must not overlook the parallel need for long-term strategies to ensure nutrition security. In resource-poor settings, a high proportion of people living with HIV will be chronically food-insecure.
Equity and HIV/AIDS
Is high level HIV and AIDS policy cut off from the reality on the ground? Ingrid Young, editor of the Eldis HIV and AIDS Resource Guide, argues that policymakers need to listen to and learn from each other as well as from communities who are experiencing and responding to the crisis. "The development community needs to focus on what communities and organisations are already doing, not only in their response to HIV and AIDS, but also in terms of how they share their information and experiences and how they collectively identify challenges and solutions," she writes.
In this study, researchers explored the lessons learnt by health workers involved in the provision of prevention of mother-to-child transmission (PMTCT) services in eastern Uganda to better understand what more needs to be done to strengthen the PMTCT programme. A qualitative study was conducted at Mbale Regional Referral Hospital, The AIDS Support Organisation (TASO) Mbale and at eight neighbouring health centres in eastern Uganda, between January and May 2010. Data were collected through 24 individual interviews with the health workers involved in the PMTCT programme and four key informants (two district officials and two officials from TASO). Study themes and sub-themes were identified following multiple reading of interview transcripts. The key lessons for programme improvement were: ensuring constant availability of critical PMTCT supplies, such as HIV testing kits, antiretroviral drugs (ARVs) for mothers and their babies, regular in-service training of health workers to keep them abreast with the rapidly changing knowledge and guidelines for PMTCT, ensuring that lower level health centres provide maternity services and ARVs for women in the PMTCT programme and provision of adequate facilities for effective follow-up and support for mothers.
More and more HIV-positive pregnant women are testing for the virus and seeking out prevention of mother-to-child transmission (PMTCT) services in Sofala Province, in central Mozambique, but local health officials say much work remains to be done. During the first three months of 2008, HIV tests were offered to 34,200 women during pre-natal checkups; of the 31,303 who agreed to be tested, 16% were HIV-positive, and 70% of these women were given nevirapine to prevent the virus being passed to their babies. During the same period in 2007, HIV tests were only offered to 60% of the women attending pre-natal clinics, and only 19% of them accepted. The increase in uptake of PMTCT is particularly significant in Sofala, which has one of the highest HIV infection rates in the country - 25% - compared to the national average of 16%.
The objective of this paper was to describe the long-term virological, immunological and mortality outcomes of providing highly active antiretroviral therapy (HAART) with strong adherence support to African HIV-infected female sex workers (FSWs) and contrast outcomes with those obtained in a cohort of regular HIV-infected women. FSWs and non-FSWs initiated on HAART between August 2004 and October 2007 were included in the study. Patients were followed monthly for drug adherence (interview and pill count), and at six-monthly intervals for monitoring CD4 counts and HIV-1 plasma viral loads (PVLs) and clinical events. Results showed no statistical differences between outcomes of FSWs and non-FSWs. The authors conclude that clinical and biological benefits of HAART can be maintained over the long term among FSWs in Africa and could also lead to important public health benefits.
Patients who do not return for follow-up at clinics providing comprehensive HIV/AIDS care require special attention. This is particularly true where resources are limited and clinic loads are high. Data on a sample of patients who failed to return for follow-up were analysed to identify the causes and to plan strategies to overcome the problem.
Four years after world leaders at the UN General Assembly Special Session (UNGASS) on AIDS pledged to scale up their fight against the disease, many countries are falling short of their targets, a new report has found. Under the Declaration of Commitment on HIV/AIDS of July 2001, UN member governments set time-bound goals for reversing the spread of the pandemic by scaling up treatment, prevention and care in their countries. Much still has to be done before the people directly affected realise the benefits of these commitments.
The island nation of Madagascar, off the coast of Southern Africa, has so far been spared an HIV/AIDS epidemic, unlike its continental neighbours, but health officials have warned that the country cannot afford to be complacent. The next decade presents a window of opportunity; a chance for the government to take action to prevent HIV prevalence from climbing. Madagascar's National Committee for the Fight Against AIDS (CNLS) has estimated that the country rate in 2005 was 0.95 percent, considerably lower than other countries in the region, where rates hover around 20 percent.
Health experts and scientists have accused the world's wealthiest countries of abandoning the goal of universal access to HIV prevention, care and treatment by 2010. ‘We must hold the G8 leaders accountable for their failure to deliver on their promises,’ said Julio Montaner, president of the International Aids Society (IAS), on opening the Fifth IAS Conference on Pathogenesis, Diagnosis and Treatment in Cape Town on 19 July. Montaner, who is also director of the British Columbia Centre for Excellence in HIV/AIDS, was sharply critical of the world's most powerful industrialised countries, who in 2005 committed to developing a comprehensive response to the AIDS pandemic that would achieve universal access to treatment by next year, yet have failed to renew these promises at the G8 summit held from 8–10 July. ‘HIV/AIDS was indeed the elephant in the room,’ he said. ‘In 2009, the eight most powerful economies in the world left HIV off their priority agenda.’
Pharmaceutical giant GlaxoSmithKline has announced plans to invest up to US$97 million over 10 years in improving antiretroviral (ARV) treatment for children and adults in sub-Saharan Africa. The world's second largest drug manufacturer has already pledged US$16 million in seed funding to a public-private partnership that will develop new paediatric formulations of ARV drugs. Less than 10 percent of patients on ARVs in Africa are children and, although thirteen ARV formulations specifically for children are available, they are not adapted for use in resource-poor settings. Most are in liquid form, and come as three, often unpalatable, separate drugs that children find difficult to take. The company has also launched a new ‘Positive Action for Children’ fund of US$80 million over 10 years to help prevent mother-to-child transmission of HIV, and to support orphans and vulnerable children. It made the announcement after activists and governments put pressure on drug companies to do more to make life-saving medicines available in developing countries.