Human immunodeficiency virus funding and access to treatment in sub-Saharan Africa

2021 ◽  
pp. 095646242110422
Author(s):  
Reuben Granich ◽  
Somya Gupta ◽  
Brian Williams
Keyword(s):  
Human Immunodeficiency Virus ◽  
Viral Suppression ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Access To Treatment ◽  
Immunodeficiency Virus ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Funding

Human immunodeficiency virus (HIV) treatment prevents illness, death, and transmission. The 90-90-90 disease control target is only 73% of people living with HIV virally suppressed. For 2010 to 2019, we abstracted HIV funding data for 40 countries in sub-Saharan Africa (70% of global HIV burden and >99% of HIV burden in the region in 2018). During 2010–2019, there was ∼$52 billion funding for 40 countries (99% Africa HIV burden). Domestic funding ranged from $0 to $3.2 billion. PEPFAR funding was $32 billion (average $1.4 billion; range $0.089–4.3 billion) among 22 countries. Global Fund averaged $306 million ($1.9 million to $1.1 billion) for 40 countries. Among PLHIV, known HIV status averaged 80% (11% to 94%). ART coverage averaged 64% (9% to 90%). Viral suppression among PLHIV ranged from 8% to 87%. Of the 40 countries, 21 reported under 60% of PLHIV to be on treatment and 13 did not report viral suppression for 2018. Achieving 90-90-90 is feasible in challenging settings if resources are used efficiently. Despite the significant investment in the HIV response, many countries have not reached the 90-90-90 target. Greater attention to efficiency and prioritizing important targets will be required to end AIDS in Africa.

scholarly journals Human immunodeficiency virus infection and inflammatory arthritis: A review of clinical and imaging features

2017 ◽  
Vol 21 (2) ◽  
Author(s):  
Farhana E. Suleman ◽  
Mahmood M.T.M. Ally
Keyword(s):  
Human Immunodeficiency Virus ◽  
Pain Syndrome ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Imaging Features ◽  
The People ◽  
Immunodeficiency Virus ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Articular Pain

The reported prevalence of articular manifestations of human immunodeficiency virus (HIV) varies, but with sub-Saharan Africa accounting for almost 70% of the people living with HIV, this results in a considerable burden of disease in the region. The spectrum of clinical presentation described, includes articular pain syndrome, HIV-associated arthropathy and seronegative spondyloarthropathies, among others. This brief review serves to create awareness of the clinical and imaging presentation of this spectrum of disease as there is significant morbidity associated with these conditions if treatment is delayed.

scholarly journals Management of TB/HIV co-infection: the state of the evidence

2020 ◽  
Vol 54 (3) ◽  
pp. 186-196
Author(s):  
Kwasi Torpey ◽  
Adwoa Agyei-Nkansah ◽  
Lily Ogyiri ◽  
Audrey Forson ◽  
Margaret Lartey ◽  
...  
Keyword(s):  
National Level ◽  
Hiv Treatment ◽  
The State ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Increased Risk ◽  
Mdr Tb ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Hiv Negative

Tuberculosis (TB) and HIV are strongly linked. There is a 19 times increased risk of developing active TB in people living with HIV than in HIV-negative people with Sub-Saharan Africa being the hardest hit region. According to the WHO, 1.3 million people died from TB, and an additional 300,000 TB-related deaths among people living with HIV. Although some progress has been made in reducing TB-related deaths among people living with HIV due to the evolution of diagnostics, treatment and antiretroviral HIV treatment, multi drug resistant TB is becoming a source of worry. Though significant progress has been made at the national level, understanding the state of the evidence and the challenges will better inform the national response of the opportunities for improved patient outcomes.Keywords: Tuberculosis, management, HIV, MDR TB, GhanaFunding: None

MDG 6—What about Disabled People?

2009 ◽  
Vol 11 (1) ◽  
pp. 109-126 ◽  
Author(s):  
Simon Godziek
Keyword(s):  
International Development ◽  
Implementation Strategies ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Disabled People ◽  
Access To Treatment ◽  
Sub Saharan ◽  
Living With Hiv ◽  
Relationship Of

The 2008 UNAIDS Global Update estimated that there were 33 million people living with HIV and that, of these, 67 per cent of adults and 90 per cent of children live in sub-Saharan Africa. There were 2.7 million new infections during 2007 and 2.1 million AIDS deaths, 76 per cent in sub-Saharan Africa. The aims of Millennium Development Goal (MDG) 6 are to arrest the spread of HIV and to promote access to treatment. However, the vulnerability to HIV of people with disabilities, their need for HIV & AIDS information and the constraints they face in accessing treatment have largely been ignored by international development academics and practitioners when disabled people may account for 10 per cent of the world's population and 80 million Africans are estimated to be disabled. Why, then, are disabled people not mentioned anywhere in descriptions of or implementation strategies for MDG 6? This article will use the case study of the relationship of disabled people in Mozambique to HIV & AIDS to draw out the reasons for disabled people being ignored throughout HIV & AIDS policy and services and then provide recommendations to bring about disabled people's inclusion.

scholarly journals HIV Treatment in sub-Saharan Africa: Did bureaucratic headwinds delay access to dolutegravir?

2019 ◽  
Author(s):  
Reuben Granich ◽  
Somya Gupta
Keyword(s):  
Service Delivery ◽  
National Level ◽  
Essential Element ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
World Health ◽  
Critical Element ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv

IntroductionThe World Health Organization now recommends dolutegravir (DTG) as part of the preferred first-line treatment for all adults living with HIV including women who may become pregnant. The new regimen with its high barrier to resistance, shortened time to suppression, superior side effects profile, and lower health sector and individual costs, represents a significant improvement. The recommendation removes an important obstacle to accessing dolutegravir as an essential element in controlling the epidemic. DiscussionTranslating science to policy to HIV service delivery is complex and vulnerable to significant delays. WHO, assuming a regulatory role, used preliminary Botswana Tsepamo study information regarding neural tube defects to issue a “safety signal” regarding DTG in May 2018. Regulatory evaluations of rare adverse reactions are complex, take time, and require considerable subject area specific expertise. After over a year, the WHO reversed its initial findings and issued revised treatment recommendations. However, the mixed messaging and confusion around dolutegravir’s safety profile has delayed national level adoption. The pace of national adoption of new WHO recommendations is measurable through published national guidelines and/or circulars available in the public domain. After 2015, published guidelines for 22 of 46 sub-Saharan countries (94% of 2018 regional HIV burden) showed that only three countries representing 4% of regional burden have adopted the new WHO preferred 1st line recommendations. ConclusionsMonitoring and evaluating the translation of science to service delivery is a critical element of successful disease control and elimination. The DTG false alarm and ongoing delayed access provides an opportunity to learn valuable lessons and implement corrective actions. However, lessons can only be learned by accurately describing and examining the timeline, processes, and impact of policy decisions that can adversely impact millions of people living with HIV. As with any successful global disease elimination effort or major project, it is important to establish a critical pathway for translation of science to service delivery and hold people and agencies accountable for their roles in accelerating and/or delaying progress.

Online and offline information seeking behaviours of people living with HIV in a clinic-based setting

2019 ◽  
Vol 68 (6/7) ◽  
pp. 517-533
Author(s):  
Edda Tandi Lwoga
Keyword(s):  
Human Immunodeficiency Virus ◽  
Information Seeking ◽  
Health Knowledge ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Online Information ◽  
Content Type ◽  
Immunodeficiency Virus ◽  
Health Promoting ◽  
Sub Saharan

Purpose The purpose of this study sought to determine the characteristics that distinguish online from offline information seekers among people living with human immunodeficiency virus (PLHIV) in selected regional hospitals of Tanzania. Design/methodology/approach Questionnaire-based survey was conducted among 341 adults with human immunodeficiency virus (HIV) infection attending the HIV clinics in the regional referral hospitals in Mwanza, Mbeya and Dar es Salaam, Tanzania. The study used multivariate logistic regressions to determine factors that distinguish online HIV information seekers from offline HIV information seekers. Findings One in every five survey participants sought online HIV information (19.6 per cent, n = 67). Both higher level of education (odds ratio (OR) = 1.765, 95 per cent confidence interval (CI) = 1.208-2.58) and intention to use internet in future (OR = 1.566, 95 per cent CI 1.148-2.136) were predictors of online HIV information seeking behaviour at multivariate analysis. Respondents who sought online information reported to have gained knowledge such as; to understand their conditions better (77.4 per cent, n = 41) and understand information received from health care workers (66 per cent, n = 35), as well as acquisition of health promoting behaviour such as; asking questions during doctor’s visit (55 per cent, n = 35) and consulting a clinician when they have problems (64.3 per cent, n = 33). The offline HIV information seekers (n = 274) did not use internet due to lack of information seeking skills (44.3 per cent, n = 113) and lack of access to internet connectivity (30.2 per cent, n = 77). Originality/value This is a comprehensive study that differentiates online from offline HIV information seekers in the context of sub-Saharan Africa. The results suggest that interventions to improve online access information will empower patients and probably positively affect their health knowledge and health promoting behaviours.

scholarly journals HIV Treatment in sub-Saharan Africa: Did bureaucratic headwinds delay access to dolutegravir?

2019 ◽  
Author(s):  
Reuben Granich ◽  
Somya Gupta
Keyword(s):  
Service Delivery ◽  
National Level ◽  
Essential Element ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
World Health ◽  
Critical Element ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv

IntroductionThe World Health Organization now recommends dolutegravir (DTG) as part of the preferred first-line treatment for all adults living with HIV including women who may become pregnant. The new regimen with its high barrier to resistance, shortened time to suppression, superior side effects profile, and lower health sector and individual costs, represents a significant improvement. The recommendation removes an important obstacle to accessing dolutegravir as an essential element in controlling the epidemic. DiscussionTranslating science to policy to HIV service delivery is complex and vulnerable to significant delays. WHO, assuming a regulatory role, used preliminary Botswana Tsepamo study information regarding neural tube defects to issue a “safety signal” regarding DTG in May 2018. Regulatory evaluations of rare adverse reactions are complex, take time, and require considerable subject area specific expertise. After over a year, the WHO reversed its initial findings and issued revised treatment recommendations. However, the mixed messaging and confusion around dolutegravir’s safety profile has delayed national level adoption. The pace of national adoption of new WHO recommendations is measurable through published national guidelines and/or circulars available in the public domain. After 2015, published guidelines for 22 of 46 sub-Saharan countries (94% of 2018 regional HIV burden) showed that only three countries representing 4% of regional burden have adopted the new WHO preferred 1st line recommendations. ConclusionsMonitoring and evaluating the translation of science to service delivery is a critical element of successful disease control and elimination. The DTG false alarm and ongoing delayed access provides an opportunity to learn valuable lessons and implement corrective actions. However, lessons can only be learned by accurately describing and examining the timeline, processes, and impact of policy decisions that can adversely impact millions of people living with HIV. As with any successful global disease elimination effort or major project, it is important to establish a critical pathway for translation of science to service delivery and hold people and agencies accountable for their roles in accelerating and/or delaying progress.

scholarly journals Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

2017 ◽  
Vol 31 (1) ◽  
pp. 109-138 ◽  
Author(s):  
Mark J. Siedner
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Care Delivery ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

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