HLT/044 - July 2007

AIDS 21, N°12; July 2007

Phillips, E. et al. Determinants of nevirapine hypersensitivity and its effect on the association between hepatitis C status and mortality in antiretroviral drug-naive HIV-positive patients. Pp 1561-1568
To assess risks factors and outcomes associated with nevirapine hypersensitivity reactions, and to determine the effect of hypersensitivity as a modifier of the association between hepatitis C virus (HCV) infection and mortality among antiretroviral drug-naive patients. Results of this study suggest that the hypersensitivity reaction behaves as an effect modifier of the association between HCV infection and mortality in this cohort of antiretroviral drug-naive HIV-positive patients. These results support the current recommendation against the use of nevirapine in HIV/HCV-coinfected patients... study   more in HTML

AIDS 21, N°11; July 2007

Welz; T. et al. Continued very high prevalence of HIV infection in rural KwaZulu-Natal, South Africa: a population-based longitudinal study. Pp 1467-1472
The objective of this study is to estimate the prevalence of HIV and associated sociodemographic factors including mobility and migration in a rural population in KwaZulu-Natal, South Africa. The extremely high prevalence of HIV suggests an urgent need to allocate adequate resources for HIV prevention and treatment in rural areas. Effective monitoring of the epidemic in Africa needs to include efforts to strengthen sentinel surveillance in rural areas and strategies for the surveillance of migrants and mobile individuals…  more in HTML

Wanyama; J. et al. Belief in divine healing can be a barrier to antiretroviral therapy adherence in Uganda. Pp 1486-1487
Although recent data suggest high levels of adherence to expanding antiretroviral therapy (ART) programmes in resource-limited settings, the culture-specific barriers to adherence are poorly understood. In a prospective observational study, we found that 1.2% of patients discontinued ART because of a belief in spiritual healing. Spiritual beliefs should be an important part of ART adherence counselling in resource-limited settings, requiring close collaboration between HIV care programmes and religious leaders to identify common goals and ensure successful treatment.  more in HTML

AIDS 21 Suppl 4, July 2007

                                
Achmat, Z.; Simcock, J. Combining prevention, treatment and care: lessons from South Africa. Pp S11-S20
Over one million people in sub-Saharan Africa now access HIV treatment, and as the prognosis of life expectancy on antiretroviral therapy (ART) improves, the central question that arises for governments, civil society and the private sector must be: how will we pay for the healthcare costs? This paper critically evaluates the need to provide effective treatment, prevention and care for HIV over the long term. Compelling evidence and moral argument suggest that the right combination of treatment and prevention policies, bolstered by grassroots mobilization and effective treatment literacy campaigns, can prevent new infections, save lives and mitigate the impact of HIV/AIDS…  more in HTML

Boyd, M. A.; Cooper, D. A Second-line combination antiretroviral therapy in resource-limited settings: facing the challenges through clinical research. Pp S55-S63
Combination antiretroviral therapy (ART) has dramatically altered the prognosis of individuals infected with HIV. In the past 5 years there has been a concerted effort to increase access to ART in the developing world. The evidence to date suggests that adherence to therapy and clinical outcomes in developing world programmes are at least the equal of those observed in developed countries. Although access to first-line therapy is reasonably well established, there is a substantial and unacceptable mortality rate in the first 6 months after initiation of ART, particularly in those with low CD4 cell counts and late-stage disease...  more in HTML

Palombi, L. et al. Treatment acceleration program and the experience of the DREAM program in prevention of mother-to-child transmission of HIV. Pp S65-S71
The Drug Resource Enhancement against AIDS and Malnutrition (DREAM) program is a large antiretroviral therapy treatment program financed by the Treatment Acceleration Program (TAP) of the World Bank. In addition to provision of antiretroviral treatment to individuals infected with human immunodeficiency virus (HIV) in sub-Saharan Africa, one major aspect of the DREAM program is nutritional supplementation and prevention of mother-to-child transmission (PMTCT) of HIV…

Cohen, G. M. Access to diagnostics in support of HIV/AIDS and tuberculosis treatment in developing countries. Pp S81-S87
Access to necessary diagnostic tests in support of HIV/AIDS and tuberculosis treatment, such as CD4 cell counts, viral load, tuberculosis culture, and susceptibility testing, has significantly lagged the provision of drug therapy in developing countries. This is an outcome of the fundamental limitations in overall access to basic health services in the developing world, particularly in sub-Saharan Africa. Among health services, laboratory capacity and access are particularly deficient, and often non-existent in rural settings. As such, treatment is commonly administered in the absence of diagnostic testing, potentially accelerating the incidence of drug-related toxicity and the onset of drug resistance if therapy results in incomplete viral suppression…  more in HTML  

Renaud-Thery, F. et al. Use of antiretroviral therapy in resource-limited countries in 2006: distribution and uptake of first- and second-line regimens. Pp S89-S95
The objective of this study is to address the information gap on current use of antiretroviral drugs (ARTs) in developing countries. This survey has provided valuable information on the uptake of ARTs in developing countries and will help forecast future demand. Reporting for second-line and pediatric antiretroviral therapy should improve as national programs gain more experience. The current availability of active pharmaceutical ingredients appears to be sufficient to meet current demand. Further work is needed for an understanding of switching rates...  more in HTML

American Journal of Tropical Medicine and Hygiene Vol. 77, N°1; July 2007

Onwujekwe, O. et al. Inequities in Valuation of Benefits, Choice of Drugs, and Mode of Payment for Malaria Treatment Services Provided by Community Health Workers in Nigeria. Pp 16-21
This study determined inequities of using community health workers (CHWs) for timely and appropriate treatment of malaria in terms of: 1) valuation of benefits; 2) actual purchase of drugs; and 3) payment modality in southeast Nigeria. Socioeconomic status (SES) influenced the valuation of benefits. Also, the poorest households consumed more of the cheaper drug and less of the more expensive drug (P < 0.05). The least poor households mostly paid in full, whereas the poorest households paid mostly through installments (P < 0.05). The use of CHWs improved overall geographic but not socioeconomic equity to the drugs...  more in HTML

Zhou, G. Spatial Relationship between Adult Malaria Vector Abundance and Environmental Factors in Western Kenya Highlands.Pp 29-35
Information on the spatial relationships between disease vectors and environmental factors is fundamental to vector-borne disease control. Although it is well known that mosquito abundance is associated with the amount of rainfall and thus the number of larval breeding sites, the spatial relationship between larval habitat availability and adult mosquito abundance is not clear. We investigated the impact of environmental heterogeneity and larval habitats on the spatial distribution of Anopheles gambiae s. s. and An. funestus adult mosquitoes, the most important malaria vectors in the highlands of western Kenya…  more in HTML

Tolentino, K.; Friedman, J. F. An Update on Anemia in Less Developed Countries.Pp 44-51
 The highest prevalence of anemia exists in the developing world where its causes are multi-factorial. Anemia is responsible for significant morbidity and mortality, particularly in less developed countries (LDCs). Understanding causes of anemia and potential mechanisms are crucial to our ability to intervene to reduce this burden. In the past decade, our understanding of the etiology and mechanisms of anemia in LDCs has advanced significantly. This review will focus on recent advances in our understanding of the burden of anemia in specific sub-groups, the causes and mechanisms of anemia, and consequences of anemia for the human host...  more in HTML

Sogoba, N. et al.  Monitoring of Larval Habitats and Mosquito Densities in the Sudan Savanna of Mali: Implications for Malaria Vector Control.Pp 82-88
In Mali, anopheline mosquito populations increase sharply during the rainy season, but are barely detectable in the dry season. This study attempted to identify the dry season mosquito breeding population in and near the village of Bancoumana, Mali, and in a fishing hamlet 5 km from this village and adjacent to the Niger River. In Bancoumana, most larval habitats were human made, and dried out in January–February. In contrast, in the fishing hamlet, productive larval habitats were numerous and found mainly during the dry season (January–May) as the natural result of drying riverbeds. Adult mosquitoes were abundant during the dry season in the fishermen hamlet and rare in Bancoumana…  more in HTML    

British Medical Journal Vol. 335, N° 7612; July 2007

Gray, R. H. et al. Limitations of rapid HIV-1 tests during screening for trials in Uganda: diagnostic test accuracy study. Pp 188-191
The objective of this article is to evaluate the limitations of rapid tests for HIV-1. Weak positive bands on rapid tests for HIV should be confirmed by enzyme immunoassay and western blotting before disclosing the diagnosis. Programmes using rapid tests routinely should use standard serological assays for quality control...   more in HTML

BMC Health Services Research Vol.7, N°108; July 2007

Marseille, E. et al. Planning prevention programs for HIV. 
Economic theory and limited empirical data suggest that costs per unit of HIV prevention program output (unit costs) will initially decrease as small programs expand. Unit costs may then reach a nadir and start to increase if expansion continues beyond the economically optimal size. Information on the relationship between scale and unit costs is critical to project the cost of global HIV prevention efforts and to allocate prevention resources efficiently… more in PDF    

Bulletin of the World Health Organization Vol. 85, N°7, July 2007

Kwong-Leung Yu, J. et al. True outcomes for patients on antiretroviral therapy who are “lost to follow-up” in Malawi. Pp 550-554
In many resource-poor countries that are scaling up antiretroviral therapy (ART), 5–25% of patients are reported as “lost to follow-up”. This figure is 9% in Malawi. There is no published information about the true outcome status of these patients. ART clinics in resource-poor countries should ensure that patients’ addresses are correct and comprehensive. Clinics should also undertake contact tracing as soon as possible in the event of non-attendance, consider facilitating access to ART clinics and take loss to follow-up into consideration when assessing death rates…  more in PDF  

Miles, K. et al. Antiretroviral treatment roll-out in a resource-constrained setting: capitalizing on nursing resources in Botswana. Pp 555-560
As programmes to deliver antiretroviral therapy (ART) are implemented in resource-constrained settings, the problem becomes not how these programmes are going to be financed but who will be responsible for delivering and sustaining them. Practicalities involved in scaling up nurse-led models of ART delivery include overcoming political and professional barriers, identifying educational requirements, agreeing on the limitations of nursing practice, developing clear referral pathways between medical and nursing personnel, and developing mechanisms to monitor and supervise practice. Operational research is required to demonstrate that such models are safe, effective and sustainable…  more in PDF

Lancet Vol. 370, N°9584, 7 July 2007

McCarthy, M. The Global Fund: 5 years on. Pp 307-308
This spring the Global Fund to Fight  AIDS, Tuberculosis and Malaria announced that its programmes had treated nearly 3 million tuberculosis patients, distributed more than 30 million insecticide-treated bednets, and were providing antiretroviral drugs to more than 1 million people infected with HIV. After nearly 5 years of operation “Global Fund programmes are saving 3000 lives a day”...   more in HTML

Lancet Vol. 370, N°9581, 7 July 2007

Zeitz, P. Lessons from South Africa's experience of HIV/AIDS. Pp 19-20
During the late 1990s while living in Zambia, I saw the devastating effect HIV/AIDS was having on individuals, families, and communities. On a trip to the northern province, I met some young Zambians and was stunned when one man emphatically declared, “Mbeki says HIV doesn’t cause AIDS, so why should I wear a condom anyway?” Until that moment, I hadn’t understood the ripple effect of South Africa’s policy on individual behaviour elsewhere, and since then I’ve been seeking to understand this failure of the South African people to use their intelligence and relative wealth to more effectively respond to the HIV/AIDS crisis...  more in HTML

Killeen, G.F. et al. Preventing Childhood Malaria in Africa by Protecting Adults from Mosquitoes with Insecticide-Treated Nets. Pp e229
Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. Insecticide-treated nets (ITNs) represent a practical means to prevent malaria in Africa, so scaling up coverage to at least 80% of young children and pregnant women by 2010 is integral to the Millennium Development Goals (MDG). Targeting individual protection to vulnerable groups is an accepted priority, but community-level impacts of broader population coverage are largely ignored even though they may be just as important…  more in PDF

The Lancet Infectious Diseases Vol.7, N° 7, July 2007

Cassell,  M. M. ;  Surdo, A. Testing the limits of case finding for HIV prevention. Pp 491-495
HIV testing technologies have been available for two decades, but concerns about stigma and discrimination have historically tempered the application of case finding—a cornerstone of public-health practice—to combat the HIV/AIDS pandemic. The recent expansion of access to HIV treatment has resulted in a shift of emphasis from pairing testing with rigorous risk-reduction prevention counselling, to applying testing to find infected individuals, address their care and treatment needs, and prevent them from infecting others. However, the effi- cacy of case finding for infectious disease prevention is contingent on two basic principles: the ability to identify infected individuals before further transmission occurs, and the availability of effective strategies to prevent such transmission from taking place.  more in HTML  
                                                                                           
Hargreaves, S. New guidelines launched to boost HIV testing globally. Pp 446
WHO and UNAIDS have issued new guidance on scaling up informed voluntary HIV testing and counselling in health facilities globally. The guidance promotes provider-initiated HIV testing, alongside existing patient-initiated HIV testing, with a view to ensuring earlier diagnosis, reducing transmission, and maximising the benefi ts of treatment. At a press conference in London, UK, Kevin De Cock (WHO, Geneva, Switzerland) told journalists: “WHO now recommends that in countries with generalised epidemics, all patients— with or without symp toms—who present to health services for whatever reason, should be offered testing”...  more in HTML

Wakabi, W. The aftermath of civil war in Burundi. Pp 445
Burundi is one of two countries in east and west Africa where the HIV infection rate has remained stagnant or has risen in the past decade, the other being Mali. Elsewhere on the continent, with the exception of southern Africa where the epidemic emerged later, behaviour change resulting from increased AIDS awareness has helped cut prevalence rates...  more in HTML

Plos Medicine Vol. 4, No. 7; July 2007

Lewin, S.A. et al. Patient Adherence to Tuberculosis Treatment: A Systematic Review of Qualitative Research Munro, e238

Tuberculosis (TB) is a major contributor to the global burden of disease and has received considerable attention in recent years, particularly in low- and middle-income countries where it is closely associated with HIV/AIDS. Poor adherence to treatment is common despite various interventions aimed at improving treatment completion. Lack of a comprehensive and holistic understanding of barriers to and facilitators of, treatment adherence is currently a major obstacle to finding effective solutions. The aim of this systematic review of qualitative studies was to understand the factors considered important by patients, caregivers and health care providers in contributing to TB medication adherence…  more in PDF

Sexual  Transmitted Infections Vol. 83 ; N°3, June 2007

Morris,  C. N. ;  Ferguson, A. G. Sexual and treatment-seeking behaviour for sexually transmitted infection in long-distance transport workers of East Africa Pp 242-245
The aim of this study is to investigate the sexual and treatment-seeking behaviour for sexually transmitted infection (STI) in long-distance transport workers of East Africa. Truck drivers and their assistants in East Africa have high rates of reported STIs and many continue to exhibit high-risk sexual behaviour. The transport workers studied here favoured private health facilities because of convenience and shorter waiting times...  more in HTML

Social Science & Medicine Vol. 65, N° 2, July 2007

Cooper, D. et al. “Life is still going on”: Reproductive intentions among HIV-positive women and men in South Africa. Pp 274-283
This article reports on qualitative research investigating HIV positive individuals’ reproductive intentions and their influencing factors in Cape Town, South Africa. In-depth interviews were held with 61 HIV positive women and men; at the time of interview, half had been receiving antiretroviral treatment (ART) for over 6 months and half were not receiving ART. Being HIV positive modified but did not remove reproductive desires, and diversity existed in reproductive intentions. Some HIV positive individuals wished to avoid pregnancy. Fears of partner and infant infection and having a previously infected baby were important factors deterring some individuals from considering having children. There was also strongly perceived community disapproval associated with HIV and reproduction…  more in HTML   

Transactions of the Royal Society of Tropical Medicine and Hygiene Vol. 101, N°7; July 2007

Dondorp, A. M. ; Day, N.P.J. The treatment of severe malaria. Pp 633-634
In the SEAQUAMAT trial, parenteral artesunate was shown to be associated with a considerably lower mortality than quinine, and is now the recommended treatment for severe malaria in low-transmission areas and in the second and third trimesters of pregnancy. A trial is underway to establish its role in African children. The development of artesunate suppositories may provide the means to treat patients with severe disease in remote rural settings, potentially buying the time needed to reach a health care facility. The increasing availability of basic intensive care facilities in developing countries also has the potential to further reduce mortality…  more in HTML

Wichmann, O. et al. High residual chloroquine blood levels in African children with severe malaria seeking healthcare. Pp 637-642
Despite widespread resistance, chloroquine remains widely used in West Africa, particularly in home treatment. We examined chloroquine blood levels on admission to a referral hospital with respect to the manifestation of severe malaria in 290 Ghanaian children. Of the patients, 78% exhibited chloroquine concentrations (subtherapeutic, 35%; therapeutic, 37%; supratherapeutic, 6%) and 11% died. Most parasites (78%) carried the pfcrt-T76 chloroquine resistance mutation. High drug concentrations correlated with reduced parasitaemia but also with selection of resistant parasites, lower respiratory and heart rates, increased plasma lactate levels and impaired consciousness. Geometric mean chloroquine concentrations tended to be higher in children who died than in survivors…  more in HTML

Roestenberg, M. et al. Complement activation in experimental human malaria infection. Pp 643-649
The objective of this study was to investigate complement activation in uncomplicated, early phases of human malaria. Fifteen healthy volunteers were experimentally infected with Plasmodium falciparum malaria. Parasitemia and complement activation products were assessed. During blood stage parasitemia, volunteers showed a significant increase in soluble terminal complement complex (TCC) formation. After start of a curative regimen of artemether/lumefantrine, TCC further increased due to activation of both the classical and the alternative pathway…  more in HTML

Lapika Dimomfu, B. et al. African Programme for Onchocerciasis Control (APOC): sociological study in three foci of central Africa before the implementation of treatments with ivermectin (Mectizan®). Pp 674-679
The African Programme for Onchocerciasis Control (APOC) has put in place a study to assess the long-term impact of the community-directed treatments with ivermectin on various clinical and entomological indicators of onchocerciasis. As the results obtained would depend on community participation in the treatments, surveys were also conducted at the study sites to assess the people's knowledge, attitudes and practices regarding onchocerciasis and its treatment. This article presents the anthropological observations made before the implementation of the treatments in three sites: one in the Central African Republic, and two in the Democratic Republic of Congo. The information collected shows that the populations have a relatively poor knowledge of the manifestations and mode of transmission of onchocerciasis. The communities’ attitudes towards those individuals afflicted with the disease vary from one site to another…  more in HTML

Trends in Parasitology Vol. 23, N° 7; July 2007

Lefèvre, T. et al. Virulence and resistance in malaria: who drives the outcome of the infection? Pp 299-302
Theoretical and experimental studies have established the dynamic nature of virulence and that, like all traits, it has evolved. Understanding parasite evolution offers a conceptual framework for diverse fields and can contribute greatly to decision-making in disease control. Recently, Grech et al. investigated the effects of host genotype-by-parasite genotype interactions on the expression of virulence in an artificial rodent-malaria system. They found that both parasite and host effects explained most of the variance in the virulence, resistance and transmission potential. These findings are a major contribution to the emerging debate on the pros and cons of a coevolutionary approach of virulence evolution; they also hold great potential for more effective control strategies.  more in HTML

Tuberculosis Vol. 87, N° 4, July 2007

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