scholarly journals The Benefits of Immediate ART

2019 ◽  
Vol 18 ◽  
pp. 232595821983171 ◽  
Author(s):  
Yan Zhao ◽  
Jennifer M. McGoogan ◽  
Zunyou Wu
Keyword(s):  
World Health ◽  
Hiv Care ◽  
Hiv Diagnosis ◽  
Hiv Care Cascade ◽  
Art Initiation ◽  
Care Cascade ◽  
Nations Programme ◽  
United Nations Programme ◽  
Health Organization ◽  
Treat All

The benefits of “early” antiretroviral therapy (ART; ie, initiation when CD4 ≥500 cells/mm3) are now well accepted as reflected in the removal of the CD4-based eligibility from new ART guidelines by the World Health Organization (WHO). However, neither the “treat-all” strategy recommendations presented in the guidelines nor the HIV care cascade goals in the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 targets adequately address the issue of ART timing. Our recent study on “immediate” ART (ie, ≤30 days after HIV diagnosis) adds important evidence demonstrating the real and meaningful benefits of rapid ART initiation even among those who have CD4 ≥500 cells/mm3. We call on WHO and UNAIDS to consider this research and encourage a shift from the treat-all strategy to an “immediately-treat-all” strategy, and from a slow, fragmented, complicated, multistep HIV care cascade to a fast, easy, and simple cascade with effectiveness measures that incorporate the important aspect of time.

Multiplier method estimates of the population of men who have sex with men: the effect of privacy protection

2019 ◽  
Vol 42 (2) ◽  
pp. 429-434
Author(s):  
Liwei Jing ◽  
Yuehua Cui ◽  
Qing Lu ◽  
Hongmei Yu
Keyword(s):  
Hiv Testing ◽  
Population Size ◽  
Privacy Protection ◽  
World Health ◽  
Multiplier Method ◽  
Nations Programme ◽  
United Nations Programme ◽  
Sex With Men ◽  
Health Organization ◽  
Immunodeficiency Syndrome

Abstract Objectives The stigmatization of men who have sex with men (MSM) has led to an underestimation of their population size. To address this, the United Nations Programme on HIV/Acquired Immunodeficiency Syndrome and World Health Organization developed a multiplier method. However, nearly all multiplier method estimates of MSM population size in China are far below national estimates. This study explores how privacy protection to address and avoid MSM stigmatization can affect reliable estimates. Methods Data from an MSM website, a bar, and a peer-based HIV testing were used to produce three multiplier method estimates of the MSM population size in Taiyuan, China, in 2014. The effect of privacy protection on stigmatization was explored by comparing the peer-based HIV testing with other estimates. We used a national estimate as a reference to verify potential underestimation. Results The website and bar estimates were 5- to 10-times and 8- to 16-times lower than the Chinese national estimate range, respectively. Conversely, the peer-based HIV testing estimate was within the national estimate range. Conclusions Though the multiplier method was developed to estimate the size of stigmatized populations, it might be affected by privacy protection addressing stigmatization; this should be considered when gathering data.

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 Literasi Penyakit HIV-AIDS pada Siswa Madrasah Tsanawiah Negeri 1 Garut

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Dadang Purnama ◽  
Witdiawati W
Keyword(s):  
United Nations ◽  
Hiv And Aids ◽  
World Health ◽  
Nations Programme ◽  
United Nations Programme ◽  
Post Test ◽  
Acquired Immunodeficiency ◽  
Health Organization ◽  
Immunodeficiency Syndrome ◽  
Hiv Aids

Abstrak Penyakit AIDS (Acquired Immunodeficiency Syndrome) merupakan salah satu penyakit yang mengakibatkan kematian di dunia. Menurut UNAIDS (United Nations Programme on HIV and AIDS) dan WHO (World Health Organization), AIDS telah mengakibatkan kematian lebih dari 25 juta jiwa sejak pertama kali diakui tahun 1981, (Kent.et.al, 2010). Saat ini penularan HIV/AIDS di Kabupaten Garut telah mengalami pergeseran yang sebelumnya penyakit ini ditularkan melalui pengguna narkoba suntik sekarang berubah penularan melalui pasangan suami istri khususnya pada istri. Mengingat untuk HIV dan AIDS merupakan fenomena “gunung es” bahwa kasus yang terdata hanya cerminan sedikit kasus yang sebenarnya ada di masyarakat. Secara teori adanya 1 kasus HIV dan AIDS yang ada terdeteksi, kasus yang sebenarnya ada di masyarakat adalah 100 kasus. Metode yang digunakan dalam Kegiatan ini tujuannya adalah, memberikan informasi mengapa HIV-AIDS perlu mendapat perhatian khusus, serta bagaimana gejala-gejalanya karena HIV-AIDS adalah penyakit yang sampai saat ini belum ada obat untuk menanggulanginya dan hanya dapat dilakukan pencegahan.Tahapan selanjutnya Pelaksanaan Pre Test, Kegiatan ini dilakukan untuk menggali sejauh mana pengetahuan dan pemahaman para siswa mengenai penyakit HIV/AIDS dengan memberikan pertanyaan secara tertulis yang berhubungan dengan penyakit HIV/AIDS (soal pertanyaan pre test terlampir). Hasil yang didapat pada pre test menunjukan secara keseluruhan pertanyaan yang diajukan, para siswa hanya bisa menjawab dan memahami tentang materi penyakit HIV/AIDS sebesar 24%. Post test dilakukan setelah penyuluhan berakhir untuk mengetahui tingkat pengetahuan dan pemahaman siswa terhadap materi yang sudah diberikan. Adapun hasil post test menunjukan adanya peningkatan pemahaman tentang penyakit HIV/AIDS yang dibandingkan dengan hasil pre test yaitu sebesar 80% dari soal yang ditanyakan kepada para siswa.Penguatan keterampilan individu (Personnal Skill), dalam mewujudkan kesehatan secara keseluruhan, ketrampilan individu mutlak diperlukan, dalam hal ini siswa Madrasah Tsanawiah Negeri 1 Kabupaten Garut, untuk belajar melalui kehidupan dalam menyiapkan diri mereka untuk semua tingkatannya dan untuk menangani penyakit dan kecelakaan sangatlah penting.

scholarly journals Impact of Traditional Healers on the HIV Care Cascade in Senegal, West Africa: A Longitudinal Study

2021 ◽  
Author(s):  
Noelle A. Benzekri ◽  
Jacques F. Sambou ◽  
Sanou Ndong ◽  
Mouhamadou Baïla Diallo ◽  
Ibrahima Tito Tamba ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Traditional Healers ◽  
Cd4 Count ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Care Cascade ◽  
Art Initiation ◽  
Care Cascade ◽  
Prospective Longitudinal

Consultation with traditional healers (THs) is common among people living with HIV in sub-Saharan Africa. We conducted a prospective longitudinal study to determine the association between consultation with THs and HIV outcomes following 12 months of antiretroviral therapy (ART). HIV-infected individuals presenting for care and initiation of ART in Dakar and Ziguinchor, Senegal were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart reviews at enrollment, 6 months after ART initiation, and 12 months after ART initiation. Among the 186 participants, 35.5% consulted a TH. The most common reason for consulting a TH was “mystical” concerns (18%). Those who consulted a TH before ART initiation were more likely to present with a CD4 count < 200 cells/mm3 (44% versus 28%; P = 0.04) and WHO stage 3 or 4 disease (64% versus 46%; P = 0.03), and they were less likely to disclose their HIV status (44% versus 65%; P = 0.04). Those who consulted a TH more than 6 months after ART initiation were more likely to report poor adherence to ART (57% versus 4%; P < 0.01). The strongest predictor of virologic failure was consulting a TH more than 6 months after ART initiation (odd ratio [OR], 7.43; 95% CI, 1.22–45.24). The strongest predictors of mortality were consulting a TH before ART initiation (OR, 3.53; 95% CI, 1.25–9.94) and baseline CD4 count < 200 cells/mm3 (OR, 3.15; 95% CI, 1.12–8.89). Our findings reveal multiple opportunities to strengthen the HIV care cascade through partnerships between THs and biomedical providers. Future studies to evaluate the impact of these strategies on HIV outcomes are warranted.

HIV care cascade among cisgender men who have sex with men in a key population-led community center in the Philippines

2021 ◽  
pp. 095646242098743
Author(s):  
Patrick C Eustaquio ◽  
Steffen S Docken ◽  
Katerina T Leyritana ◽  
Luh Putu Lila Wulandari
Keyword(s):  
The Philippines ◽  
Hiv Care ◽  
Sexually Transmitted ◽  
Effective Strategies ◽  
Hiv Care Cascade ◽  
Art Initiation ◽  
Care Cascade ◽  
Key Population ◽  
Hiv Test ◽  
Sex With Men

The HIV epidemic in the Philippines is the fastest growing globally, and disproportionately affects cisgender men who have sex with men (cis-MSM) demanding effective strategies for this key population (KP) group. KP-specific and community-based (CB) interventions have improved the HIV response elsewhere, but these have yet to be evaluated locally. We analyzed the HIV care cascade outcomes in a KP-led, CB HIV test-and-treat center and determined factors that affect these by performing a retrospective study of medical records of 3137 patients diagnosed from January 2016 to March 2019 in LoveYourself in Manila, Philippines. Multivariate logistic regression was performed to determine predictors affecting the likelihood of antiretroviral therapy (ART) initiation and viral load (VL) suppression. As to UNAIDS 90–90–90 targets, LoveYourself had higher rates than national outcomes with 78% initiated ART and 84% achieved VL suppression. Such satisfactory performance is consistent with other studies exploring CB, KP-led approaches among cis-MSM. Patients who presented with WHO Stages 2–4 and those with sexually transmitted infections were less likely to initiate ART. Patients who presented with WHO Stages 2–4 and those whose ART was started late were less likely to be virally suppressed. These findings suggest the need to develop responsive interventions to reach the UNAIDS targets.

scholarly journals How early is too early? Challenges in ART initiation and engaging in HIV care under Treat All in Rwanda—A qualitative study

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251645
Author(s):  
Jonathan Ross ◽  
Charles Ingabire ◽  
Francine Umwiza ◽  
Josephine Gasana ◽  
Athanase Munyaneza ◽  
...  
Keyword(s):  
Treatment Guidelines ◽  
Qualitative Interviews ◽  
Hiv Treatment ◽  
Sub Saharan Africa ◽  
Hiv Care ◽  
People Living With Hiv ◽  
Hiv Status ◽  
Hiv Diagnosis ◽  
Art Initiation ◽  
Treat All

Introduction HIV treatment guidelines recommend that all people living with HIV (PLWH) initiate antiretroviral therapy (ART) as soon as possible after diagnosis (Treat All). As Treat All is more widely implemented, an increasing proportion of PLWH are likely to initiate ART when they are asymptomatic, and they may view the relative benefits and risks of ART differently than those initiating at more advanced disease stages. To date, patient perspectives of initiating care under Treat All in sub-Saharan Africa have not been well described. Methods From September 2018 to March 2019, we conducted individual, semi-structured, qualitative interviews with 37 patients receiving HIV care in two health centers in Kigali, Rwanda. Data were analyzed using a mixed deductive and inductive thematic analysis approach to describe perceived barriers to, facilitators of and acceptability of initiating and adhering to ART rapidly under Treat All. Results Of 37 participants, 27 were women and the median age was 31 years. Participants described feeling traumatized and overwhelmed by their HIV diagnosis, resulting in difficulty accepting their HIV status. Most were prescribed ART soon after diagnosis, yet fear of lifelong medication and severe side effects in the immediate period after initiating ART led to challenges adhering to therapy. Moreover, because many PLWH initiated ART while healthy, taking medications and attending appointments were visible signals of HIV status and highly stigmatizing. Nonetheless, many participants expressed enthusiasm for Treat All as a program that improved health as well as health equity. Conclusion For newly-diagnosed PLWH in Rwanda, initiating ART rapidly under Treat All presents logistical and emotional challenges despite the perceived benefits. Our findings suggest that optimizing early engagement in HIV care under Treat All requires early and ongoing intervention to reduce trauma and stigma, and promote both individual and community benefits of ART.

Data, Principles and Strategies: How Do Global Control Mechanisms on the HIV Epidemic Work?

2021 ◽  
Vol 31 (1) ◽  
pp. 143-176
Keyword(s):  
United Nations ◽  
World Health ◽  
Control Mechanisms ◽  
Global Epidemic ◽  
Aids Epidemic ◽  
Nations Programme ◽  
United Nations Programme ◽  
Health Organization ◽  
National Governments ◽  
Hiv Aids

The article discusses the activities of two United Nations bodies - the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS(UNAIDS) - which are engaged in developing measures to counteract the global HIV/AIDS epidemic. An important component of this activity is gathering information and producing strategic documents. Their almost unclassifiable diversity, however, can be managed by a rigorous algorithm that incorporates data collection, formulation of principles and development of strategies. An analysis of materials such as “reports,” “fact sheets,” and “global strategies” reveals how the main global mechanisms work as they coordinate the efforts of national governments and attempt to control the epidemic globally; analysis also indicates what kind of language is used and what goals are set. In 2020 the ambitious goal of eliminating the HIV/AIDS epidemic by 2030 that is declared in WHO and UNAIDS documents unexpectedly became problematic once more due to the spread of another global epidemic - COVID-19. The publication of new materials on how to continue the fight against HIV/AIDS in the context of the coronavirus pandemic suggests that WHO and UNAIDS are already losing faith in the effectiveness of the measures so far developed in order to eliminate HIV/AIDS. The ongoing crisis caused by the COVID pandemic has also revealed a new trend by converting these UN bodies mostly into tools for producing global information while making other aspects of their activities less visible.

scholarly journals Eastern Europe and Central Asia still home to world's fastest-growing HIV/AIDS epidemic

2002 ◽  
Vol 6 (48) ◽  
Author(s):  
L Pritchard
Keyword(s):  
United Nations ◽  
Eastern Europe ◽  
Central Asia ◽  
World Health ◽  
Aids Epidemic ◽  
Nations Programme ◽  
United Nations Programme ◽  
The World ◽  
Health Organization ◽  
Hiv Aids

The unfortunate distinction of having the world's fastest-growing HIV/AIDS epidemic still belongs to eastern Europe and Central Asia, according to the report, AIDS epidemic update 2002, released this week (1). In southern Africa, the HIV/AIDS epidemic has greatly decreased the capacity of farm communities to survive famine (2). The update on the global HIV/AIDS epidemic was issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization, in advance of World AIDS day on 1 December.

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