HIV in Resource-Limited Settings

2019 ◽  
pp. 263-298
Author(s):  
John G. Bartlett ◽  
Robert R. Redfield ◽  
Paul A. Pham
Keyword(s):  
Diagnostic Tests ◽  
Opportunistic Infections ◽  
World Health ◽  
Hiv Care ◽  
Current Status ◽  
Who Guidelines ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
Health Organization ◽  
Delivery Models

Abstract: This chapter reviews the diagnosis, assessment, testing, and treatment of HIV in resource-limited settings around the world. The chapter covers the current status of the HIV pandemic, diagnosis of HIV (i.e., who to test), HIV testing, HIV diagnostic tests, World Health Organization (WHO) guidelines and treatment recommendations, monitoring ART efficacy and toxicity, treatment and prophylaxis of opportunistic infections and other comorbid conditions, treatment of tuberculosis and cryptococcal meningitis, co-trimoxazole prophylaxis, HIV vaccines, differentiated service delivery models of HIV care, important global trials, and further recommended reading.

scholarly journals Factors Associated with Outcomes of Pre-ART HIV Care

2018 ◽  
Vol 17 ◽  
pp. 232595821875960
Author(s):  
Kristen A. Stafford ◽  
Lucy W. Nganga ◽  
Tuhuma Tulli ◽  
Karen G. Fleischman Foreit
Keyword(s):  
Disease Progression ◽  
Opportunistic Infections ◽  
World Health ◽  
Hiv Care ◽  
Cox Models ◽  
Factors Associated ◽  
Art Initiation ◽  
Resource Limited ◽  
Health Organization ◽  
Lost To Follow Up

The World Health Organization recommended removing all CD4 requirements for initiation of antiretroviral therapy (ART) in resource-limited settings. We examined the pre-ART period to identify and assess factors associated with outcomes of pre-ART care. Four modes of transition out of pre-ART care were considered. Beta estimates from the competing risks Cox models were used to investigate whether the effects of covariates differed by mode of transition. Median CD4 counts at entry showed no meaningful change over time. Advanced disease progression and presence of opportunistic infections were significant predictors of pre-ART mortality. Men were more likely to die before initiating ART, transfer to another facility, or be lost to follow-up than were women. Removing CD4 thresholds is not likely to substantially reduce program mortality prior to ART initiation unless and until patients enroll earlier in disease progression. Care programs should focus on diagnosis and treatment of opportunistic infections to reduce pre-ART mortality.

scholarly journals Cancer Pain Management in Resource-Limited Settings: A Practice Review

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Elizabeth Namukwaya ◽  
Mhoira Leng ◽  
Julia Downing ◽  
Elly Katabira
Keyword(s):  
Pain Management ◽  
Negative Impact ◽  
World Health ◽  
Resource Limited Settings ◽  
Use Of Resources ◽  
Resource Limited ◽  
Significant Negative Impact ◽  
Practice Review ◽  
Barriers And Challenges ◽  
Health Organization

Pain in cancer is a common and burdensome symptom with different causes but in a significant number of cases it is undiagnosed and undertreated because of lack of skills for its assessment. Pain has significant negative impact on the patient and, therefore, it needs to be managed urgently and appropriately. In resource-limited settings, there are several barriers and challenges to pain management but even in these circumstances pain can be well managed with planned and innovative use of resources and if the World Health Organization public health system approach is used to ensure opioid availability.

scholarly journals Scaling Up the 2010 World Health Organization HIV Treatment Guidelines in Resource-Limited Settings: A Model-Based Analysis

PLoS Medicine ◽  
2010 ◽  
Vol 7 (12) ◽  
pp. e1000382 ◽  
Author(s):  
Rochelle P. Walensky ◽  
Robin Wood ◽  
Andrea L. Ciaranello ◽  
A. David Paltiel ◽  
Sarah B. Lorenzana ◽  
...  
Keyword(s):  
World Health Organization ◽  
Treatment Guidelines ◽  
Scaling Up ◽  
Hiv Treatment ◽  
World Health ◽  
Resource Limited Settings ◽  
Model Based ◽  
Resource Limited ◽  
Health Organization ◽  
Model Based Analysis

scholarly journals Vitamin C and COVID-19: should clinical trials be prioritised for low income settings and vitamin C-deficient populations?

2021 ◽  
Vol 23 (1) ◽  
pp. 119-120
Author(s):  
Anitra C Carr ◽  
◽  
Sam Rowe ◽  
◽  
Keyword(s):  
Vitamin C ◽  
Low Income ◽  
Low Cost ◽  
World Health ◽  
Biological Plausibility ◽  
Resource Limited Settings ◽  
Resource Limited ◽  
The World ◽  
Adjunctive Intervention ◽  
Health Organization

TO THE EDITOR: Managing coronavirus disease 2019 (COVID-19) in resource-limited settings requires a number of considerations, including reducing or preventing requirements for respiratory support.1 Vitamin C is a low cost, readily available therapy that the World Health Organization has highlighted for further research as an adjunctive intervention with biological plausibility for improving the clinical outcome of patients with COVID-19

scholarly journals Evaluation of Two Techniques for Viral Load Monitoring Using Dried Blood Spot in Routine Practice in Vietnam (French National Agency for AIDS and Hepatitis Research 12338)

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Fabien Taieb ◽  
Tran Hong Tram ◽  
Hien Thi Ho ◽  
Van Anh Pham ◽  
Huong Lan Nguyen ◽  
...  
Keyword(s):  
Viral Load ◽  
Dried Blood Spot ◽  
World Health ◽  
Hiv Care ◽  
Routine Practice ◽  
National Agency ◽  
Resource Limited ◽  
Load Monitoring ◽  
Health Organization ◽  
Blood Spot

Abstract Background.  Although it is the best method to detect early therapeutic failure, viral load (VL) monitoring is still not widely available in many resource-limited settings because of difficulties in specimen transfer, personnel shortage, and insufficient laboratory infrastructures. Dried blood spot (DBS) use, which was introduced in the latest World Health Organization recommendations, can overcome these difficulties. This evaluation aimed at validating VL measurement in DBS, in a laboratory without previous DBS experience and in routine testing conditions. Methods.  Human immunodeficiency virus (HIV)-infected adults were observed in a HIV care site in Hanoi, and each patient provided 2 DBS cards with whole blood spots and 2 plasma samples. Viral load was measured in DBS and in plasma using the COBAS Ampliprep/TaqMan and the Abbott RealTime assays. To correctly identify those with VL ≥ 1000 copies/mL, sensitivity and specificity were estimated. Results.  A total of 198 patients were enrolled. With the Roche technique, 51 plasma VL were ≥1000 copies/mL; among these, 28 presented a VL in DBS that was also ≥1000 copies/mL (sensitivity, 54.9; 95% confidence interval [CI], 40.3–68.9). On the other hand, all plasma VL < 1000 copies/mL were also <1000 copies/mL in DBS (specificity, 100; 95% CI, 97.5–100). With the Abbott technique, 45 plasma VL were ≥1000 copies/mL; among these, 42 VL in DBS were also ≥1000 copies/mL (sensitivity, 93.3%; 95% CI, 81.7–98.6); specificity was 94.8 (95% CI, 90.0–97.7). Conclusions.  The Abbott RealTime polymerase chain reaction assay provided adequate VL results in DBS, thus allowing DBS use for VL monitoring.

Heterocycles in the Treatment of Neglected Tropical Diseases

2020 ◽  
Vol 27 ◽  
Author(s):  
Kush K. Maheshwari ◽  
Debasish Bandyopadhyay
Keyword(s):  
Developing Countries ◽  
Heterocyclic Compounds ◽  
Neglected Tropical Diseases ◽  
World Health ◽  
Current Status ◽  
Poor People ◽  
Tropical Diseases ◽  
Concise Review ◽  
The World ◽  
Health Organization

Background: Neglected tropical diseases (NTDs) affect a huge population of the world and majority of the victims belong to the poor community of the developing countries. Until now, the World Health Organization (WHO) has identified 20 tropical diseases as NTDs that must be addressed with high priority. However, many heterocyclic scaffolds have demonstrated potent therapeutic activity against several NTDs. Objective: There are three major objectives: (1) To discuss the causes, symptoms, and current status of all the 20 NTDs; (2) To explore the available heterocyclic drugs, and their mechanism of actions (if known) that are being used to treat NTDs; (3) To develop general awareness on NTDs among the medicinal/health research community and beyond. Methods: The 20 NTDs have been discussed according to their alphabetic orders along with the possible heterocyclic remedies. Current status of treatment with an emphasis on the heterocyclic drugs (commercially available and investigational) has been outlined. In addition, brief discussion of the impacts of NTDs on socio-economic condition is included. Results: NTDs are often difficult to diagnose and the problem is worsened by the unhealthy hygiene, improper awareness, and inadequate healthcare in the developing countries where these diseases primarily affect poor people. The statistics include duration of suffering, numbers affected, and access to healthcare and medication. The mechanism of actions of various heterocyclic drugs, if reported, have been briefly summarized. Conclusion: Scientists and pharmaceutical corporations should allocate more resources to reveal the in-depth mechanism of actions of many heterocyclic drugs that are currently being used for the treatment of NTDs. Analysis of current heterocyclic compounds and development of new medications can help in the fight to reduce/remove the devastating effects of NTDs. An opinion-based concise review has been presented. Based on available literature, this is the first effect to present all the 20 NTDs and related heterocyclic compounds under the same umbrella.

scholarly journals A 3D-printed magnetic digital microfluidic diagnostic platform for rapid colorimetric sensing of carbapenemase-producing Enterobacteriaceae

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Pojchanun Kanitthamniyom ◽  
Pei Yun Hon ◽  
Aiwu Zhou ◽  
Mohammad Yazid Abdad ◽  
Zhi Yun Leow ◽  
...  
Keyword(s):  
Point Of Care ◽  
Resistance Mechanism ◽  
Turnaround Time ◽  
World Health ◽  
Colorimetric Sensing ◽  
Resource Limited ◽  
Reaction Chambers ◽  
Technological Platform ◽  
Health Organization ◽  
Digital Microfluidic

AbstractCarbapenemase-producing Enterobacteriaceae (CPE) are a group of drug-resistant Gram-negative pathogens that are classified as a critical threat by the World Health Organization (WHO). Conventional methods of detecting antibiotic-resistant pathogens do not assess the resistance mechanism and are often time-consuming and laborious. We have developed a magnetic digital microfluidic (MDM) platform, known as MDM Carba, for the identification of CPE by measuring their ability to hydrolyze carbapenem antibiotics. MDM Carba offers the ability to rapidly test CPE and reduce the amount of reagents used compared with conventional phenotypic testing. On the MDM Carba platform, tests are performed in droplets that function as reaction chambers, and fluidic operations are accomplished by manipulating these droplets with magnetic force. The simple droplet-based magnetic fluidic operation allows easy system automation and simplified hands-on operation. Because of the unique “power-free” operation of MDM technology, the MDM Carba platform can also be operated manually, showing great potential for point-of-care testing in resource-limited settings. We tested 27 bacterial isolates on the MDM Carba platform, and the results showed sensitivity and specificity that were comparable to those of the widely used Carba NP test. MDM Carba may shorten the overall turnaround time for CPE identification, thereby enabling more timely clinical decisions for better clinical outcomes. MDM Carba is a technological platform that can be further developed to improve diagnostics for other types of antibiotic resistance with minor modifications.

scholarly journals Trends in access to anti‐malarial treatment in the formal private sector in Uganda: an assessment of availability and affordability of first‐line anti‐malarials and diagnostics between 2007 and 2018

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Denis Kibira ◽  
Anthony Ssebagereka ◽  
Hendrika A. van den Ham ◽  
Jimmy Opigo ◽  
Henry Katamba ◽  
...  
Keyword(s):  
Private Sector ◽  
Diagnostic Tests ◽  
Malaria Treatment ◽  
World Health ◽  
First Line ◽  
Cross Sectional ◽  
Malaria Rapid Diagnostic Tests ◽  
Retail Outlets ◽  
Health Action ◽  
Health Organization

Abstract Background Malaria is the single largest cause of illness in Uganda. Since the year 2008, the Global Fund has rolled out several funding streams for malaria control in Uganda. Among these are mechanisms aimed at increasing the availability and affordability of artemisinin-based combination therapy (ACT). This paper examines the availability and affordability of first-line malaria treatment and diagnostics in the private sector, which is the preferred first point of contact for 61% of households in Uganda between 2007 and 2018. Methods Cross-sectional surveys were conducted between 2007 and 2018, based on a standardized World Health Organization/Health Action International (WHO/HAI) methodology adapted to assess availability, patient prices, and affordability of ACT medicines in private retail outlets. A minimum of 30 outlets were surveyed per year as prescribed by the standardized methodology co-developed by the WHO and Health Action International. Availability, patient prices, and affordability of malaria rapid diagnostic tests (RDTs) was also tracked from 2012 following the rollout of the test and treat policy in 2010. The median patient prices for the artemisinin-based combinations and RDTs was calculated in US dollars (USD). Affordability was assessed by computing the number of days’ wages the lowest-paid government worker (LPGW) had to pay to purchase a treatment course for acute malaria. Results Availability of artemether/lumefantrine (A/L), the first-line ACT medicine, increased from 85 to100% in the private sector facilities during the study period. However, there was low availability of diagnostic tests in private sector facilities ranging between 13% (2012) and 37% (2018). There was a large reduction in patient prices for an adult treatment course of A/L from USD 8.8 in 2007 to USD 1.1 in 2018, while the price of diagnostics remained mostly stagnant at USD 0.5. The affordability of ACT medicines and RDTs was below one day’s wages for LPGW. Conclusions Availability of ACT medicines in the private sector medicines retail outlets increased to 100% while the availability of diagnostics remained low. Although malaria treatment was affordable, the price of diagnostics remained stagnant and increased the cumulative cost of malaria management. Malaria stakeholders should consolidate the gains made and consider the inclusion of diagnostic kits in the subsidy programme.

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