The recent unprecedented investment in combating the HIV pandemic by United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria have led to the debate on whether HIV programs have strengthened or undermined national health systems in developing countries. The debate was continued by health system strengthening (HSS) … Continue reading “Health systems strengthening: The dichotomy between HIV and non-HIV services”
Finally the global community has seen the importance of involving the family & community in the fight against HIV & AIDS. After a number of research studies and project implementations, we have finally realized that HIV is a family issue, and the right way to minimize the effects of the epidemic is to utilize the power of family and community support–the closest source of support for people affected by HIV.
But, I have also seen hope. I have seen people, organizations, countries coming together, putting resources together to help Zambians. I have seen a disease which was once a death sentence become a disease that can be managed, thanks to all the resources that have gone into providing testing facilities & ART, as well as care and support programs. I have seen the disease itself change from the virulent attacks characteristic of the early textbook description of AIDS, including severe oral thrush, severe Herpes Zoster, other skin manifestations; the AIDS we see now is milder, I think.
What is the lesson learned from this new evidence? Probably, our programs will see more and more frequently the use of CD4 count tests, depending on various national policies and the different degree of compliance with the WHO guidelines. We need to be ready to incorporate this element into our activities that are related to HIV care and treatment. Additionally, we may look into possible alternative options to implement the provision of CD4 tests.
You are right, it is both clear and difficult. It is difficult because first you need funding and political will. IDUs and sex workers are rarely considered priority populations from the point of view of governments, but in concentrated HIV epidemics such as there are in Central Asia, these are exactly the populations that need to be prioritized.
Next, the populations themselves are difficult to reach. Because of stigma and discrimination, as well as the criminalization of sex work and drug use, people who engage in these activities are hidden. To reach them, we have to draw them out to drop-in centers that attract them with needed services, or find them with outreach workers who know and understand the population.
There is still something missing in the monitoring of TB/HIV activities that would be worth collecting. TB and both ART and pre-ART patients are currently being assessed in cohorts and their outcome measured according to standardized categories. However, little is known about the outcome of co-infected individuals, since their details get mixed with the overall cohort they belong to.
Main messages from the CCABA (Coalition on Children Affected by AIDS) – a two day symposium with most of the major players in the OVC sector participating.
our programs should nonetheless endeavor to gather as much data on other aspects of care as possible and to find time for elaborating and analyzing more health information. This could produce two essential results. First, by doing so we should be able to look at the broader picture of our intervention as far as health care services are concerned. Secondly, we could be more informed and authoritative in documenting our findings, supporting our views, and contributing to the design of future programs.
Continuing the conversation about more effective use of the newer medications to improve efficacy and decrease toxicity in HIV patients.
The IAS-USA Treatment Guidelines were released during the conference, supporting earlier initiation of treatment with ART recommended for all patients with CD4 counts < 500, selected clinical conditions, and all symptomatic patients (provided patients are ready to start therapy: “The patient must be ready and willing to adhere to lifelong therapy,” the document explicitly states. Additional populations for ART initiation included pregnant women, and those with acute primary infections. The document is well worth a good read for its careful review of the data behind the pendulum swinging to earlier initiation in 2010.