As countries approach the UNAIDS 95-95-95 targets, there is a need for innovative and cost-saving HIV testing approaches that can increase testing coverage in hard-to-reach populations. The HIV Self-Testing Africa-Initiative distributed HIV self-test (HIVST) kits using unincentivised HIV testing counsellors across 31 public facilities in Malawi, South Africa, Zambia and Zimbabwe. HIVST was distributed either through secondary (partner’s use) distribution alone or primary (own use) and secondary distribution approaches. The authors evaluated the costs of adding HIVST to existing HIV testing from the providers’ perspective in the 31 public health facilities across the four countries between 2018 and 2019 using expenditure analysis and bottom-up costing approaches. They found that costs of integrating HIV self-testing in the public health facilities ranged from US$4.27-US$13.42 per kit distributed. Personnel and cost of test kits were important cost drivers.
Equity and HIV/AIDS
More quickly than they could have anticipated, people living with (PLWH) and those at-risk for HIV felt the impact of the COVID-19 pandemic, as they were asked to shelter in place and distance themselves from others. In March and April 2020, community-based organizations (CBOs) closed, medical offices cut hours, and medical personnel shifted from primary care to COVID-19 hospital units, affecting the HIV Continuum of Care and Prevention—that is, testing, pre-exposure prophylaxis (PrEP), and primary care. The authors call for further research, review and monitoring to provide evidence on referral practices and links that could help clients access the HIV services to which they are referred (“referral completion”).
Recent data has shown that the COVID-19 pandemic has had an impact on HIV testing services, but the impact on HIV treatment is less than originally feared. As of August 2020, the UNAIDS, World Health Organization and United Nations Children's Fund data collection exercise to identify national, regional and global disruptions of routine HIV services caused by COVID-19 had collected treatment data from 85 countries. Of these, 22 countries reported data over a sufficient number of months to enable the identification of trends. Only five countries reported monthly declines in the number of people on treatment after April—these include Zimbabwe in June, Peru and Guyana in July, the Dominican Republic in April, and Sierra Leone in May through to July. The remaining 18 countries did not show a decline and some countries showed a steady increase (e.g. Kenya, Ukraine, Togo and Tajikistan). However, among the 22 countries with trend data on numbers newly initiating treatment, all countries except Jamaica showed declines for at least one month or more relative to January. Only around eight of those countries showed a rebound in the number of people newly initiating treatment between January and July.
This paper looks at anecdotal evidence that unproven AIDS 'cures' are widely used, and promoted by some countries' governments, instead of evidence based antiretroviral therapy (ART). Ot focuses on reasons why these 'cures' are used, including the high cost of conventional medicine and stigma associated with accessing healthcare systems. The authors discuss case studies from Gambia, South Africa and Iran where governments have promoted unproven treatment creating confusion over the legitimacy of AIDS medicines. Governments appear reluctant to dismiss these 'cures' for fear of being seen to criticise traditional medicine. The authors conclude that the full extent of the availability and use of unproven 'cures' and counterfeit antiretrovirals (ARVs) has not been fully documented, and that more research, as well as scaling up of ARV programmes, is needed.
Twenty-five years of knowingly living with HIV, the global community is still falling behind the virus in its alarming, complex and often hidden progress. Despite many diverse and creative successes in committed peoples' responses and many lessons drawn along the way, few have been widely adopted. Civil society groups have often led the way. A passionate - sometimes desperate - drive to respond to HIV and AIDS, and their own diversity unites them. This issue of id21 insights features examples of such real-life responses and asks: how can we move forward to catch up with the virus?
Over the past several years, the HIV virus has spread in an alarming, complex and often hidden manner. Ordinary people, local and global communities and various organisations have responded to the epidemic in various ways. They offer many lessons but few have been widely adopted. The latest issue of id21 insights asks: “What can we learn from this diversity of response? Can we find better ways to help scale up the coverage, quality and impact of civil society action?" Guest editor Jerker Edstrom from the Institute of Development Studies says that it is important for health systems to involve clients, communities and affected groups in planning and negotiating HIV testing, treatment, care and social protection arrangements.
PRESIDENT Yoweri Museveni of Uganda has called for death penalty for people who knowingly spread HIV. He also called for the outlawing of primitive methods used by the Bagishu and Sebei in eastern Uganda of using knives for circumcision that are likely to spread the virus. Speaking at the commemoration of 25 years since the first case was identified at Kasensero landing site in Rakai District on Friday, the President lauded the parliamentary committee on HIV/AIDS for coming up with the draft Bill.
In March 2012, the World Bank issued a report: ‘The fiscal dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda’. The report, the author of this article argues, is not new because it represents a recurrent theme in the World Bank approach from the earliest days of the global AIDS pandemic – it’s not fiscally sustainable to treat people living with HIV in high-impact, low-resource countries – instead the world must focus on prevention measures. The author disagrees, and points out a number of significant flaws in the report. First, the report is already out of date since it relies almost exclusively on pre-2009 data and fails to take into account increased efficiencies in AIDS programming, which have been significant in the past several years. The World Bank has also ignored the exciting new research that shows that suppressive anti-retroviral therapy reduces the risk of onward transmission of HIV by at least 96%. Second, there is growing evidence, again ignored by the Bank, that even a moderate expansion of investments now in treatment scale-up and in diffusion of scaleable prevention methods like condoms and needle-exchange can have significant impacts on new infections and thus future treatment costs. Third, the Bank fails to use evidence to rally support for (unspecified) “prevention” activities and does not call for innovative global financing, like a financial transaction tax. Fourth, the report appears to neglect the economic and social benefits of a healthier population and to ignore some of the costs of premature deaths by focusing on fiscal costs of treatment, while ignoring the huge social and economic benefits of the survival of the vital age 25-45 cohort.
"We, economists, public health experts and policy makers involved in the fight against AIDS are committed to scaling up access to health care including ARVs for HIV positive people. We consider it a rational economic decision and an absolute priority. The goal set by WHO is to have 3 million people on treatment by the end of 2005. What it will cost, who will do it and how it will be done is still being debated and we have much to learn. There are, of course, major concerns around the scaling up of access to treatment; how can these programs improve the uptake? How can they reach the most vulnerable and poor populations? How can they achieve a high level of adherence to ARV treatments in order to avoid the spread of resistance? This declaration sets out a principle we all should subscribe to and apply: the principle of a comprehensive minimum package of treatment provided for free to all the people living with HIV / AIDS."
HIV prevention has been ongoing in Lusaka for many years. Recent reports suggest a possible decline in HIV sero-incidence in Zambia and some neighbouring countries. This study aimed to examine trends in HIV seroprevalence among pregnant and parturient women between 2002 and 2006. It analysed HIV seroprevalence trends from two Lusaka sources: antenatal data from a city-wide programme to prevent mother-to-child HIV transmission and delivery data from two anonymous unlinked cord-blood surveillances performed in 2003 and again in 2005–2006. For the antenatal data, the HIV seroprevalence among antenatal attendees who were tested declined steadily from 24.5% in the third quarter of 2002 to 21.4% in the last quarter of 2006. For the cord-blood surveillances, overall HIV seroprevalence declined from 25.7% in 2003 to 21.8% in 2005–2006. Among women ≤ 17 years of age, seroprevalence declined from 12.1% to 7.7%.