Active tuberculosis (TB) is common among HIV-infected persons living in tuberculosis endemic countries, and screening for tuberculosis (TB) is recommended routinely. The study sought to determine the role of chest x-ray and sputum culture in the decision to treat for presumptive TB using active case finding in a large cohort of HIV-infected patients. Many ambulatory HIV-infected patients with CD4 counts >200/mm3 are treated for presumptive TB. Data suggests that optimal detection requires comprehensive evaluation, including CXR and sputum culture on both symptomatic and asymptomatic subjects.
Equity and HIV/AIDS
Basis for treatment of tuberculosis among HIV-infected patients in Tanzania: the role of chest x-ray and sputum culture
Bakari M, Arbeit RD, Mtei L, Lyimo J, Waddell RD, Matee M, Cole BF, Tvaroha S, Horsburgh CR, Soini H, Pallangyo K and von Reyn CF: BMC Infectious Diseases 8(32), 6 March 2008
Behavioural interventions for HIV positive prevention in developing countries: A systematic review and meta-analysis
Kennedy CE, Medley AM, Sweat MD and O’Reilly KR: Bulletin of the World Health Organization 88: 615–623, August 2010
This study’s aim was to assess the evidence for a differential effect of positive prevention interventions among individuals infected and not infected with human immunodeficiency virus (HIV) in developing countries, and to assess the effectiveness of interventions targeted specifically at people living with HIV. The researchers conducted a systematic review and meta-analysis of papers on positive prevention behavioural interventions in developing countries published between January 1990 and December 2006. Nineteen studies met the inclusion criteria. The meta-analysis showed that behavioural interventions had a stronger impact on condom use among HIV-positive (HIV+) individuals than among HIV-negative individuals. Interventions specifically targeting HIV+ individuals also showed a positive effect on condom use. However, interventions included in this review were limited both in scope (most were HIV counselling and testing interventions) and in target populations (most were conducted among heterosexual adults or HIV-serodiscordant couples). Current evidence suggests that interventions targeting people living with HIV in developing countries increase condom use, especially among HIV-serodiscordant couples. Comprehensive positive prevention interventions targeting diverse populations and covering a range of intervention modalities are needed to keep HIV+ individuals physically and mentally healthy, prevent transmission of HIV infection and increase the agency and involvement of people living with HIV.
Better antiretroviral therapy outcomes at primary healthcare facilities: An evaluation of three tiers of ART services in four South African provinces
Fatti G, Grimwood A and Bock P PLoS ONE 5(9), 21 September 2010
This study compares effectiveness of antiretroviral therapy (ART) services between primary healthcare (PHC) facilities and hospitals in low-income settings. A retrospective cohort study was conducted including ART-naïve adults from 59 facilities in four provinces in South Africa, enrolled between 2004 and 2007. A total of 29,203 adults from 47 PHC facilities, nine district hospitals and three regional hospitals were included. Patients at PHC facilities had more advanced WHO stage disease when starting ART. Retention in care was 80.1%, 71.5% and 68.7% at PHC, district and regional hospitals respectively, after 24 months of treatment. The study concludes that ART outcomes were superior at PHC facilities, despite PHC patients having more advanced clinical stage disease when starting ART, suggesting that ART can be adequately provided at this level and supporting the South African government's call for rapid up-scaling of ART at the primary level of care. Further prospective research is required to determine the degree to which outcome differences are attributable to either facility level characteristics or patient co-morbidity at hospital level.
Beyond Toronto: Prospects for universal access to HIV/AIDS care
Foster JW: The North-South Institute 2006 Winter Review, January 2007
"We have the goal: universal access to prevention, care,treatment and support by 2010. We have the means: the United Nations review session on HIV/AIDS in June declared that the drugs and the resources exist. Do we have the will? The 16th International Conference on AIDS in Toronto, August 13–18, was a testing ground and the jury is very definitely still out. The Toronto conference was the largest and perhaps the best publicized of its kind. It had significant African, HIV-positive and youth participation, but remained predominantly Northern (and North American), professional and male. It needed much more extensive representation from countries facing growing threats in Eastern Europe, Central, Eastern and Southern Asia."
Birth outcomes in South African women receiving highly active antiretroviral therapy: a retrospective observational study
Van der Merwe K, Hoffman R, Black V, Chersich M, Coovadia A and Rees H: Journal of the International AIDS Society 14(42), 15 August 2011
The objective of this study was to investigate whether in utero exposure to highly active antiretroviral therapy (HAART) is associated with low birth weight and/or preterm birth in a population of South African women with advanced HIV disease. A retrospective observational study was performed on women with CD4 counts ≤250 cells/mm3 attending antenatal antiretroviral clinics in Johannesburg between October 2004 and March 2007. Effects of different HAART regimen and duration were assessed. Among HAART-unexposed infants, 27% were low birth weight compared with 23% of early HAART-exposed and 19% of late HAART-exposed infants. In the early HAART group, a higher CD4 cell count was protective against low birth weight and preterm birth. HAART exposure was associated with an increased preterm birth rate, with early nevirapine and efavirenz-based regimens having the strongest associations with preterm birth. The authors conclude that in utero HAART exposure was not significantly associated with low birth weight.
Book to mobilise politicians to fight HIV/AIDS in Lesotho
In an effort to mobilise leaders to fight HIV/AIDS, the parliament of Lesotho and the UN Children's Fund (UNICEF) have launched a publication called "What Parliamentarians can do about HIV/AIDS Action for Children and Young People". The publication provides parliamentarians with guidelines for responding to the challenge of protecting children and young people through laws, policies, advocacy, education and providing these vulnerable groups with tools to empower them.
Boost for AIDS research in South Africa
PlusNews: 29 July 2009
A new government initiative to boost local HIV and AIDS research has been launched. The South African HIV/AIDS Research (and Innovation) Platform (SHARP), with backing from the Department of Science and Technology (DST), will support the development of new treatment options and prevention approaches such as microbicides, vaccines, and the role of genetics in controlling HIV infection. ‘The South African government had to revisit its expectations of HIV vaccine research in the light of growing national and international deliberations on the need to modify basic HIV/AIDS research and development strategies,’ the DST noted. So far SHARP has committed R45 million (US$5.8 million) to fund nine research projects over the next three years. One of the projects will validate a method for testing resistance to antiretroviral drugs that is cheaper and more accurate than the current method; another will investigate the role of natural ‘killer’ cells that prevent HIV transmission.
Botswana AIDS drug roll out bearing fruit
Health experts have attributed fewer AIDS-related deaths in Botswana to the government's steadily progressing rollout of anti-AIDS drugs. In a new report Botswana's health ministry and the World Health Organisation said the overall mortality of patients on treatment was less than 10 percent.
Botswana prioritises HIV prevention to cut ART costs
Afrique Avenir: 8 December 2010
Botswana has said it is prioritising the prevention of new HIV infections as its number one HIV and AIDS strategy, since the cost of keeping people alive on treatment is no longer sustainable. National AIDS Council spokesperson, Lorato Mongatane, said there is need for a comprehensive public awareness campaign to ensure the nation is made aware of the cost of the national response to HIV and AIDS and its impact on economic growth. Mongatane said with over 150,000 people on treatment and HIV and AIDS budget for 2010/2011 exceeding US$500 million, the Botswana government is prioritising the prevention of new infections to ensure that the number of people living with HIV and AIDS stabilises to help contain the cost over time. She pointed out that HIV prevention knowledge has not translated into major behaviour changes that could ultimately reduce the number of new infections.
Botswana's President discusses breaking the cycle of HIV infection for sustainable AIDS responses
Tautona Times
The following is a statement by his excellency, Mr. Festus G. Mogae, President of the Republic of Botswana, at a panel discussion on "Breaking the cycle of HIV infection for sustainable AIDS responses". The statement was made at the United Nations General Assembly High Level Session on HIV/AIDS in New York.
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