HIV This Week

Articles Tagged as 'Universal Access'

March
3
2009

Universal access

Calmy A, Pizzocolo C, Pizarro L, Brücker G, Murphy R, Katlama C; Strategies in Resource-Limited Settings Working Group. The marriage of science and optimized HIV care in resource-limited settings. AIDS. 2008;22(17):2227-30.

Large-scale HIV management in resource-limited settings has been remarkably successful in a relatively short time frame. Once combination antiretroviral therapy became more universally available, national treatment programs were able to provide much of the needed therapy, originally prioritized towards patients with the most advanced and symptomatic disease. The current worldwide expansion of antiretroviral therapy is due to a large broad-based international effort in financing the antiretroviral drugs and infrastructure required for delivering treatment and care. The fears that HIV treatment would detract from other healthcare concerns or lead to widespread drug resistance have been unfounded but important treatment-related issues remain to be addressed immediately by relevant scientific communities. The fundamental scientific concerns fall into two categories: the comprehensive approach to care and treatment management in settings in which resources are limited, and the diversity of a variety of populations who are predominantly women, have heterogeneous viral subtypes and have exposure to different environmental co-pathogens. There is an urgent need to link science and clinical practice wherever it is taking place. We need to learn more about optimal treatment choices and monitoring schemes appropriate in diverse resource-limited settings. Relevant clinical data that are urgently needed include drug efficacy in genetically diverse populations, the most cost-effective and efficient monitoring of therapy, and interactions with drugs to treat common co-infections and diseases. Transfer of competencies must be done as this is essential for operational research. In addition, we must promote and strengthen national reference centres and develop high level skills for the next generation of scientists and clinicians. The international scientific community must address this urgent need with academic, social, scientific, and economic support for the necessary critical research and training so desperately needed.

Editors’ note: This is an urgent call for more science, more science capacity-building, and more operational research competencies transfer to enable clinical data collection, monitoring, analysis, and evaluation at the service of improved care. Key questions to address include how to improve adherence, when to switch therapies, optimal treatment for pregnant women, and important drug-drug interactions with anti-tuberculosis and anti-malarial agents.

Add a Comment

Filed under Issue #65 - March 1, 2009, Universal Access

March
3
2009

Universal access

Perez F, Aung KD, Ndoro T, Engelsmann B, Dabis F. Participation of traditional birth attendants in prevention of mother-to-child transmission of HIV services in two rural districts in Zimbabwe: a feasibility study. BMC Public Health. 2008;8(1):401. [Epub ahead of print]

Prevention of mother-to-child transmission of HIV is among the key HIV prevention strategies in Zimbabwe. A decrease in use of antenatal care services with an increase in home deliveries is affecting the coverage of prevention of mother-to-child transmission interventions in a context of accelerated economic crisis. The main objective was to evaluate acceptability and feasibility of reinforcing the role of traditional birth attendants in family and child health services through their participation in prevention of mother-to-child transmission programmes in Zimbabwe. A community based cross-sectional survey was undertaken using multistage cluster sampling in two rural districts through interviews and focus group discussions among women who delivered at home with a traditional birth attendant, those who had an institutional delivery and traditional birth attendants. 45% of traditional birth attendants interviewed knew the principles of prevention of mother-to-child transmission and 8% delivered a woman with known HIV-positive status in previous year. Of the complete package of prevention of mother-to-child transmission services, more than 75% of traditional birth attendants agreed to participate in most activities with the exception of performing a blood test (17%), accompanying new-borns to closest health centre to receive medication (15%), and assisting health centres in documentation of the link between antenatal care and prevention of mother-to-child transmission services (18%). Women who delivered at home were less likely to have received more than one antenatal care service or have had contact with a health centre compared to women who delivered in a health centre (91.0% vs 72.6%; P<0.001). Also, 63.6% of the women who delivered in a health centre had the opportunity to choose the place of delivery compared to 39.4% of women who delivered at home (P<0.001). More than 85% of women agreed that traditional birth attendants could participate in all activities related to a prevention of mother-to-child transmission programme with the exception of performing a blood test for HIV. Concerns were highlighted regarding confidentiality of the HIV-serostatus of women. Although the long-term goal of antenatal care service delivery in Zimbabwe remains the provision of skilled delivery attendance, prevention of mother-to-child transmission programmes will benefit from complementary approaches to prevent missed opportunities. Traditional birth attendants are willing to expand their scope of work regarding activities related to prevention of mother-to-child transmission. There is a need to reinforce their knowledge on mother-to-child transmission prevention measures and better integrate them into the health system.