We assess here the potential effect of expanded HIV treatment for the prevention of AIDS-related deaths. We analyzed the available UNAIDS data to describe AIDS-related deaths, ART coverage and new HIV infections in 30 countries with the highest AIDS mortality burden and compared it with data from eight high-income countries. For illustrative purposes, we also explored the potential impact of reaching international treatment expansion targets in South Africa and Nigeria- two countries with the largest HIV epidemics, but with different trends of AIDS-related deaths over time – through the examination of four treatment expansion scenarios.
As coverage of paediatric ART increases and guidelines for ART initiation change, it will be necessary to determine how best to monitor ART. Routine monitoring of HIV viral load is common practice in ART programmes in high-income countries, but, in sub-Saharan Africa, most ART programmes rely on CD4 cell measurements or clinical monitoring to detect treatment failure. We conducted a computer simulation of HIV-positive children to predict the effect of different ART monitoring strategies.
While in the past antiretroviral treatment (ART) for children aged 2-5 years was started only when the CD4 count or CD4% fell below a critical threshold, or a clinically severe event occurred, the new WHO 2013 guidelines recommend immediate treatment initiation regardless of the child’s immune status. Scientific evidence which can guide policies is sparse and conducting trials on the optimal timing of ART initiation is lengthy, costly, and ethically difficult. Instead, routinely captured observational data can be used to answer this question if the statistical analysis makes use of methods which allow a causal interpretation. One of these methods which allows causal interpretations is called “g-computation”.
Expanding ART coverage to healthier HIV patients is widely regarded as a potential strategy for addressing the rampant TB epidemic in high HIV-TB burden settings. Estimating the population-level impact of ART expansion on TB disease has proven challenging. We set out to estimate the potential effects of changing HIV treatment policy on TB outcomes in South Africa, comparing the results of three independent TB models. This project was part of a broader effort to shed light on the consequences of HIV policy changes, through model comparison and consensus building, a process pioneered in the HIV modelling field by the HIV Modelling Consortium.
On the occasion of AIDS 2014, the twentieth International AIDS Conference in Melbourne, SACEMA released a policy brief on the ongoing debate about appropriate initiation of antiretroviral therapy for HIV positive people.
In 2011, the Ministry of Health in Swaziland joined forces with the WHO, the Global Fund and SACEMA to do the first in depth health programmes progress evaluation using triangulation from key empirical data sources. The focus was on key questions like: Given increasing coverage of ART, has ART reduced adult and/or infant mortality?; Can TB trends be related to trends in HIV prevalence, ART coverage and combined TB/HIV interventions?; Can trends in infant mortality be related to uptake of PMTCT?
Eastern and southern Africa remains the region most affected by the HIV epidemic in the world and accounts for more than 50% of the global burden of HIV. Significant progress has been made in recent years in the response to the epidemic in the region: new HIV infections and AIDS deaths have fallen while prevention and treatment services for HIV have increased substantially. While several challenges still remain, there is renewed optimism that the elimination of HIV and AIDS is not an impossible goal.
The history of tenofovir exemplifies the success of international procurement agencies in securing a rock bottom price while at the same time making a profit.
Antiretroviral treatment should be a patient-doctor choice available to all upon diagnosis.
The contributions in this issue of the SACEMA Quarterly focus on different aspects related to TB and incidence of HIV. This editorial focuses on HIV treatment as prevention by presenting the MaxART project (Maximizing ART for Better Health and Zero New HIV Infections). This project pursues the dream of reaching all people in Swaziland who are in need of treatment with an ultimate goal of preparing the country for the possibility of ending the HIV epidemic. SACEMA is one of the members of the MaxART consortium and is involved in various modelling and analysis activities that are presented here.