Some voices in the health care debate are claiming that the response to HIV and AIDS is weakening primary care in many countries, diverting funding and health care personnel and distorting health systems. The new Missing the Target report provides some of the first research to inform this debate, with on the ground studies in Argentina, Brazil, Dominican Republic, Uganda, Zambia and Zimbabwe. The results were distinct in each country but point to several broad conclusions: the response to HIV and AIDS has had far-reaching positive impacts on health care in many settings: building infrastructure and systems, raising the bar on quality, extending the reach of health care to socially marginalised groups, and engaging consumers; significant new investments in HIV and AIDS services have revealed existing fragilities in health systems, and in some cases have placed increasing burdens on these systems by expanding demand and stretching already overextended human resources. The push for treatment access has not been just about the money although these efforts have brought considerable new financing. The mobilisation of activists and health care consumers themselves has also forced global and national leaders toward a more vigorous sense of accountability and urgency. If the UN’s health-related Millennium Development Goals (MDGs) are to have any chance of being realised, we need to do for health systems what we have done for AIDS while increasing the momentum of AIDS service scale-up.
Equity and HIV/AIDS
Most prevention of mother-to-child transmission (PMTCT) programmes in Africa are still not following a comprehensive approach around the four pillars as recommended by the UN strategy, according to this paper, despite the evidence on how critical interventions such as improving access to family planning and HIV prevention knowledge and tools support the goal of ending vertical transmission of HIV. Many women in the developing world continue to receive sub-optimal drugs and confusing messages about infant feeding, undermining even the slow ‘progress’ made on pillar three. And far too many women and infants in need of treatment are leaving prevention of vertical transmission programmes without any follow-up treatment, care and support. Research conducted in a number of African countries has revealed several barriers to care, such as lack of involvement of men in PMTCT services, lack of implementation of WHO guidelines on prevention of vertical transmission and infant feeding, prohibitive costs of ANC, delivery, diagnostic tests, OI and STI treatment, and transportation to distant clinics, and stigma, combined with a shortage of trained health care workers, long waiting times and lack of integrated services under one roof.
The latest version of the Missing the Target report on AIDS treatment scale up offers a "no spin" assessment on treatment access -- the successes, challenges, and what needs to change at the national and global levels. The report points out that AIDS treatment delivery represents the best hope to build broader health systems -- but that we are in a new phase of treatment scale up where critical issues beyond simple delivery of ARVs require urgent attention. Governments and global institutions must act on the recommendations in our report to accelerate treatment delivery and address critical challenges in scale up. Without improved efforts, the world will fall short of new G8 AIDS commitments to deliver lifesaving HIV treatment and prevention services.
Global AIDS treatment efforts will fall far short of the G8 goal to reach five million Africans and provide global universal access to AIDS drugs in the next few years unless the pace of treatment scale up accelerates and the effort expands to address key barriers, according to this report. The report provides a 17-country overview of AIDS treatment successes and setbacks and offers an in-depth review of treatment delivery in six countries not covered in the group’s previous reports – Cambodia, China, Malawi, Uganda, Zambia and Zimbabwe.
This study strategised a way to integrate mobile telephony into the health management of subjects receiving anti-retroviral (ARV) medications. It took the form of a randomised controlled trial to assess health, social, and economic outcomes, involving two sub-studies in Nairobi, Kenya, and two surrounding districts. Significant time and cost are often incurred for patients to personally attend the clinics. However, the majority of subjects screened reported being comfortable with using cell phones for communicating their health issues. Note that the average travel cost to attend the clinic was US$3 (return). The current cost of an SMS is US$0.08 and a one-minute voice call is US$0.23. The most positive feedback from early enrollees in the SMS-protocol is that the participants feel 'like someone cares'. Many participants suggested that they would prefer more frequent SMS reminders. However the most common barrier to responding to the clinic SMS on time is lack of network credit at the time they are intended to respond. Overall, the once weekly protocol appears agreeable to most. Several instances of health problems have already been identified by the protocol and hence triaged by the nurse.
The report uses pre-existing information and indicators from different stakeholders, analysis of sentinel data from Thyolo district, consultations with key informants, participation in meetings and insights from qualitative studies at the Lighthouse (a high burden ART service provision site in the capital Lilongwe) and in Thyolo district.
With assistance from the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), Malawi is scaling-up the delivery of antiretroviral (ARV) therapy to HIV-positive eligible patients. The country has developed National ARV Treatment Guidelines, which emphasize a structured and standardized approach for all aspects of ARV delivery, including monitoring and evaluation. This paper describes the standardized ARV treatment regimens and the treatment outcomes to assess the impact of treatment, the registration and monitoring systems and how the cohort analyses are carried out.
In June 2001, the United Nations General Assembly Special Session (UNGASS) set a target of reducing HIV prevalence among young women and men, aged 15 to 24 years, by 25% in the worst-affected countries by 2005, and by 25% globally by 2010. In this study, researchers assessed progress toward this UNGASS target in Manicaland, Zimbabwe, using repeated household-based population sero-survey data. Progress towards the target was measured by calculating the proportional change in HIV prevalence among youth and young ANC attendees over three survey periods (rounds 1 to 3). The researchers found that HIV prevalence among youth in the general population declined by 50.7% from round 1 to 3. Among young ante-natal care (ANC) attendees, the proportional decline in prevalence of 43.5% was similar to that in the population, although ANC data significantly underestimated the population prevalence decline from round 1 to 2 and underestimated the increase from round 2 to 3. Reductions in risk behaviour between rounds 1 and 2 may have been responsible for general population prevalence declines. In Manicaland, Zimbabwe, the 2005 UNGASS target to reduce HIV prevalence by 25% was achieved. However, most prevention gains occurred before 2003. ANC surveillance trends overall were an adequate indicator of trends in the population, although lags were observed. Behaviour data and socio-demographic characteristics of participants are needed to interpret ANC trends.
AIDS drugs can dramatically increase survival for patients in poor countries but further drug price cuts are needed for patients who develop a resistance to the initial therapy, Medecins Sans Frontieres says. The independent humanitarian relief organization treats 13,000 patients in 25 countries. It says patients receiving antiretroviral (ARV) drugs have an 85 percent chance of being alive two years later.
Worldwide some 15.2 million children under 18 have lost one or both parents to AIDS. By 2010, more than 20 million children will have been orphaned by AIDS. The figures reflect the ‘tragically insufficient’ global response to protect and support HIV-infected and AIDS-affected children. However, this is set to change according to a report by UNICEF, the UN children’s agency.