HIV treatment

Published on June 15, 2017 by

The role of cities in ending the AIDS epidemic

City leaders across the world are showing commitment and are providing political and technical leadership in dealing with local issues and barriers to delivering health and social services where they are needed. Cities are taking action, through their networks and by involving affected communities, to achieving the HIV Fast-Track targets by 2020. Ending the AIDS epidemic in cities will have profound, long-lasting benefits for urban communities and for countries and the global community.

Published on March 15, 2017 by

VL testing as an HIV treatment monitoring strategy based on the latest WHO guidelines

This study attempted to evaluate several HIV treatment monitoring strategies based on the 2013 and 2016 WHO Guidelines by developing a mathematical model that mimics the natural history of people on ART in South Africa. The results indicate that, from both a public health and an economic perspective, the replacement of HIV monitoring from the current CD4 count testing to only viral load (VL) testing, is not supported. The best economic results were achieved in the hybrid strategies combining CD4 and VL tests. More cost modelling studies are required to evaluate the cost-benefit of the 2016 WHO Guidelines.

Short item Published on March 15, 2017

The devil in the details: A comparison of demographics and behaviours of female sex workers in Johannesburg and Pretoria

This study clearly shows the diversity of sex workers (SWs) and their varying HIV treatment needs in the workplace and at home. Standard treatment guidelines could therefore fall short of their intention to reduce vulnerability to poor health outcomes if a non-differentiated approach to care is followed. Trained staff who are sensitised to the local medical, emotional and legal needs of SWs are able to create user friendly services that encourage these vulnerable women to utilise services.

Published on September 14, 2016 by

The declining value of CD4 counts for antiretroviral therapy eligibility

The World Health Organization’s most recent guideline for the treatment of HIV recommends ART for all individuals living with HIV. Although this new recommendation is gaining traction among wealthier countries, many countries have not yet adopted this guideline. Instead, those countries follow a strategy of providing ART only to people with low CD4+ T-cell counts, which was necessary early in the HIV epidemic, but it is unclear whether the use of CD4 counts was based on sound science and logic.

Published on September 14, 2016 by

Ending AIDS in South Africa: progress and prospects

World-wide South Africa has the largest epidemic of HIV and the biggest anti-retroviral programme. But reaching the UNAIDS 90-90-90 target by 2020 and ending AIDS by 2030 will require an expansion of surveillance and strengthening patient monitoring. Both are needed to monitor progress, identify and correct problems and to demonstrate success. Here we outline the current state of the epidemic and discuss important issues that should inform the National Strategic Plan to be launched on World AIDS Day in December.

Published on June 15, 2016 by

Future needs for characterising the care cascade

With the release of the WHO Consolidated Strategic Information Guidelines , countries are provided with a template, in the form of a depiction of the “Care Cascade”, permitting them to quantify the state of care as it currently stands. The Care Cascade begins by characterising all infected individuals in a population, before illustrating the cascading loss of patients at each stage of care between diagnosis and viral suppression. Countries are now beginning to produce estimates of their national cascades in order to evaluate the efficiency of current care programmes. This article discusses data issues related to cascade reporting and suggests ways to improve reporting.

Published on June 15, 2016 by

Pattern, determinants, and impact of HIV spending on care and treatment in 38 high-burden low- and middle-income countries

To fast-track the HIV response and end AIDS by 2030, the Joint United Nations Programme on HIV/AIDS (UNAIDS) called for 90-90-90 targets for 2020. Achieving these targets has resource implications – it will require increase in spending and efficient utilization of HIV funding and lead to savings by preventing illness, deaths, and new HIV infections. Thus, how countries decide to allocate and prioritize their HIV funding will directly impact whether end of AIDS is achieved. This article examines the pattern, source, determinants, and impact of HIV spending on care and treatment from 2009 to 2013 in 38 LMICs, which are home to 73% of PLHIV.

Short item Published on June 15, 2016

The impact and cost of Botswana’s progress toward achieving the 2020 UNAIDS 90-90-90 antiretroviral therapy and virological suppression goals

Botswana has made substantial progress towards meeting the UNAIDS 90-90-90 target by 2020 under which 90% of people living with HIV will know their status, 90% of these will be on anti-retroviral therapy (ART), and 90% of these will have viral loads below 400/µL. In this paper we use a previously published model for Botswana to assess the future impact of their HIV control programme on new HIV infections, AIDS related mortality and the costs of doing this. We show that while treatment will have a major impact on incidence and mortality and will lead to net cost savings, prevention will lead to further small reductions in incidence and mortality, but will entail significant cost increases.

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