Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial

via The Lancet, by Lara Fairall et al.

Background

Robust evidence of the effectiveness of task shifting of antiretroviral therapy (ART) from doctors to other health workers is scarce. We aimed to assess the effects on mortality, viral suppression, and other health outcomes and quality indicators of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) programme, which provides educational outreach training of nurses to initiate and represcribe ART, and to decentralise care.

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Changing the way HIV prevention is delivered – a roadmap

via aidsmap, by Roger Pebody

In the last few years there has been a wealth of dramatic data on the efficacy of new HIV prevention methods, including male circumcision, pre-exposure prophylaxis and treatment as prevention. While last week’s 19th International AIDS Conference (AIDS 2012) didn’t deliver similar headline-grabbing studies, there were important discussions about how policy makers can implement effective HIV prevention strategies.

“We need to start thinking about the populations who are most at risk for targeted interventions,” Nelly Mugo of the University of Nairobi told a plenary session. “Then we will need to prioritize those interventions that work within those populations, and deliver them in combination with high coverage for us to get high impact.”

Speakers at other sessions gave numerous examples of the choices and dilemmas involved at each stage, drawing upon experience in the United States and in African countries.

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Helen Epstein's wrong about SA's response to AIDS

via politicsweb, by Nathan Geffen

Helen Epstein is an influential journalist and regular contributor to one of the world's most prestigious literary journals, the New York Review of Books (NYRB). It is therefore unsettling that she has written an article on the NYRB blog that contains serious errors about the South African HIV epidemic and the important prevention benefits of antiretroviral treatment (ART) (see here).

In her first sentence Epstein writes, "When I first visited South Africa in 2000 to report on the AIDS epidemic there, one adult in five was HIV positive, and a million children had lost one or both parents to the disease." These numbers are simply wrong. UNAIDS estimates that by 2001 there were 580,000 children who had lost one or both parents to AIDS. This is a horrific figure, but substantially less than Epstein's. 2 The Actuarial Society of South Africa estimates the number of children who had lost a mother or both parents to AIDS by mid-2000 and they reach a considerably lower estimate of about 120,000. 3 Epstein also overstates the percentage of adults infected with HIV in 2000.

Epstein writes, "Although the HIV infection rate has finally begun to fall in neighboring countries like Botswana and Zimbabwe, it remains stubbornly high in South Africa. After studying the African epidemic for two decades, I've come to believe that shame and silence are the primary reasons ..."

She is wrong that South Africa's infection rate is not falling. Also wrong is her implication that shame and silence make the South African epidemic signally different from those in Botswana and Zimbabwe.

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Donor nation support for HIV stands firm but investments remain at 2008 levels

via Kaiser Family Foundation

               

U.S. continues to account for more than half of all donor government investments.

WASHINGTON, D.C., July 18, 2012— Donor nation funding in 2011 for HIV in low- and middle income countries returned to prior levels after a drop in 2010, but has been roughly flat since the recession hit world economies in 2008, according to an annual funding analysis from the Kaiser Family Foundation and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

The study found that donor governments disbursed US$ 7.6 billion in 2011 for the AIDS response in low- and middle-income countries. Overall donor government support for AIDS has been flat since 2008, which marked the end of rapid increases in donor disbursements of more than six-fold over the 2002 to 2008 period.

"International investments still account for two thirds of funding for HIV in Africa, the continent most affected by the epidemic," said Paul De Lay, Deputy Executive Director, Programme at UNAIDS. "Although more and more countries are increasing domestic investments for HIV, investments from donor governments remain an essential resource."

"The benefits of early detection and treatment have never been more clear, but countries have never been more challenged to provide needed resources. This is a critical time to keep the focus on the HIV epidemic," said Drew Altman, Kaiser Family Foundation President and CEO.

The two largest donor governments – the United States and United Kingdom – reported funding increases. The United States, the largest donor nation, reported a US$785 million increase in disbursements over 2010, but only returned to 2009 levels after reporting a delay in disbursements as the reason for last year's decline. Australia, Canada, Denmark, France, Germany, Norway and Sweden maintained or slightly increased their support, while Ireland, Italy, Japan and the Netherlands decreased funding.

Read the rest here.


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An AIDS-Free Generation?

via Science, by Salim S. Abdool Karim

The HIV pandemic remains a great global health challenge.  With an estimated 3.3 million people living with HIV today, is there really hope of achieving the vision of an AIDS-free generation? Optimists argue that strong political will and generous funding are the essential elements. But skeptics point to the deep-seated structural inadequacies in many health care systems, especially in Africa, where the need is greatest.

However, both sides agree that a potential combination of therapeutic and prophylactic antiretroviral strategies brings the prospect of HIV control within reach. And this month, the International AIDS Conference in Washington, DC, “Turning the Tide Together,” will attempt to galvanize concerted global action to focus the world’s attention on this challenge.

Knowledge of HIV status is the common gateway to both treatment and prevention. But many people remain unaware of their HIV status. Denial, stigma, and a lack of understanding of vulnerability and risk lead to low rates of HIV testing, suboptimal condom use, and poor rates of circumcision. In addition to wider HIV testing, scale-up of ART therapy, both for the patient’s benefit and for the prevention benefi t to partners,will be key to reducing HIV transmission and to reaching zero new HIV infections.

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Investigating the Impact of Treatment on New HIV Infections

via PLoS Collections

The HIV Modelling Consortium aims to strengthen the support that mathematical modelling and related quantitative disciplines can provide to global decision-making in HIV. In November 2011 the HIV Modelling Consortium held a meeting in South Africa to focus on the cross-cutting issues of the impact of new scientific findings about HIV treatment preventing new infections. The group considered the feasibility of interventions, potential epidemiological impact, affordability, and new scientific observational studies and community trials. The nine reviews and one research article which comprise this collection arose from that meeting and provide insights into the factors which will support evidence-based decision-making in HIV prevention, with a focus on the use of antiretroviral treatment to prevent HIV transmission.

Read the rest here.


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Botswana's 'Stunning Achievement' Against AIDS

via NPR, by Jason Beaubien

The southern African nation of Botswana has one of the highest rates of HIV in the world. Nearly 25 percent of all adults in the country are infected with the virus. Only the nearby kingdom of Swaziland has a higher rate.

But Botswana is also remarkable for its response to the epidemic. It has one of the most comprehensive and effective HIV treatment programs in Africa. Transmission of HIV from infected mothers to their fetuses and newborn babies has been brought down to just 4 percent.

A decade ago, Botswana was facing a national crisis as AIDS appeared on the verge of decimating the country's adult population. Now, Botswana provides free, life-saving AIDS drugs to almost all of its citizens who need them.

"From the beginning of the epidemic, there's been tremendous leadership on the part of the government of Botswana to address the epidemic head on."

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State doctors: their real, everyday world

via Daily Maverick, by Karen Milford

I am a doctor working in the state sector, and this is my response to the article entitled ‘Baragwanath’s Shame: A good man dies’.

Firstly, I want to give you an idea of what a typical weekend morning is like in the trauma unit of a South African tertiary hospital. It’s 8am on a Sunday, and the morning handover round is just starting in the unit. The weekend’s carnage is plain for all to see. The resuscitation unit is over-full, serving as temporary home to seven ventilated patients. These are people so critically ill that they need what lay-people call ‘life support machines’ to keep them breathing: ventilators that push breaths in and out of their bodies because they can’t take those breaths themselves. In the passage is an eighth patient on a stretcher, being manually ventilated by a paramedic. They have been there for three hours, waiting patiently for a space to open up in the resus area for them.

Down the passage are more patients, wedged as closely together as possible. They’ve all suffered some sort of trauma: they’ve been stabbed or shot, hit by cars or thumped by thugs, throttled by their boyfriends or beaten by community members. Some of them are elderly people who fell and broke their hips whilst on the way to the bathroom, others are teenaged boys who broke their legs playing soccer. They’ve filled up all the stretchers in the unit, and have flowed over to the chairs, wheelchairs and benches. One has made a nest of blankets on the floor. They’re asking for water and bedpans and receivers to vomit into. They’re asking for help and pain medication.

Mandy de Waal’s article made me angry, not because I don’t want the horrors of state hospitals reported on, but because of her failure to put the opportunity she was given to good use. She scratched the surface and told us one thing: that doctors sometimes act without compassion and don’t properly communicate to patients and families what is happening. But she could have dug deeper and pulled out the evil root at the base of this ugly tree to show us. The public healthcare system is appalling. It is not equipped to deal with the burden of disease in this country. Whether this is due to a lack of funds or simply mismanagement and wasting of available funds is a question worth asking. Whether or not it can be fixed by changing the people running the system is another.

Read the rest.

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Reasons to Use Biomedical Prevention to Fight HIV/AIDS

via thewarning.info

In France, the controversy between HIV organizations about PrEP appear in the media and social networks, from moral considerations disguised in ethical objections to classic behavioral speculations (as there was on the TasP or PEP) [4].

So, to clarify and defuse the situation, it should be noted some points :

The biomedical prevention is a revolution in terms of sexual and mental health for serodifferent couples (especially those who want to have children) and poz sex workers (under pressure from their customers to have condomless sex), removing the risk and visceral fear of contamination. It is essential for fighting the demonization of people living with HIV/Aids (PLWHA) in our poz-phobic society : they are no longer considered as « viral bombs ».

 The biomedical prevention is a need expressed by all PLWHAs and peoples concerned by HIV [5].

 The biomedical prevention is an additional argument for the battle for universal access to treatment in poor countries and in prisons.

 The biomedical prevention is an important argument against the criminalization of HIV transmission, which beyond our respective countries, is increasing in Africa (since women are the first victims).

 The biomedical prevention must be done within the strict framework of informed consent and needs (therapeutic, psychological, sexual and social) of the concerned person(s). In no circumstances it may force the initiation of treatment to anyone, even if early treatment appears to have benefits, and although some mathematical models abound for the establishment of a general strategy of Test&Treat. Warning has long been positioned on the subject [6].

These reasons alone are sufficient to promote biomedical prevention [7] in a responsible manner and combined [8] to other tools in the fight against AIDS : condoms, HIV testing [9], Counseling, and struggles against serophobia and criminalization of sexual transmission of HIV.

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Inching Towards a Cure

via allafrica.com, by Ruby Leo

Almost a decade ago since the HIV/AIDS virus was discovered, no cure seems to be at the horizons, despite billions of dollars spent and pumped into research to stop the transmission of the disease which has claimed millions of lives across board.

It was nothing short of joy when scientists announced that a new drug, Truvada, can actually prevent the transmission of the virus.

It stipulates that once the person is taking the drug and has intercourse with an infected person, it would not jeopardize his immune system as he or she will be immune to the virus.

Gloria Funsho (Not real name) told Health Insight that there is hope for those of them that are living with the virus because their chances of marrying is now ascertained since the fear of infecting their partners has been eliminated.

The Director General of National Agency for the Control of AIDS (NACA), Professor John Idoko, speaking on the discovery said the drug which is just like the malaria drug, will prevent one from getting infected even if he or she has intercourse with a positive person.

Prof John Idoko, explaining the new prevention treatment drug, pre- exposure Prophylaxis, said "if we give the drugs to somebody who doesn't have HIV, and the person has sexual relationship with an HIV positive partner, it can prevent transmission from the positive person to the person. That is why it's called a pre- exposure prophylaxis because before exposure, the person has taken the drugs and because he has the drugs in him, the virus cannot infect him or her."

Also, Idoko says: "If you take this sero-discordant couples; one is positive and the other is negative, instead of giving the drug to the negative person before the sexual relationship, just put the positive one on drug as soon as you know. It doesn't matter what his CD-4 count is, even if it's 500, just give him the drugs. It has shown clearly one of the best study results that we have seen, as 96 per cent chance of the person transmitting HIV is blocked. So we call that treatment as prevention.

"So you can now imagine that if you go to a community, and they are using this method, your chances of blocking transmission are very high. We believe that these are the two things we need to put together as part of our combination prevention method."

Read the rest.


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Uganda Dismisses Truvada as an HIV Vaccine

via observer.ug, by Shifa Mwesigye

Scientists in Uganda have dismissed reports that an HIV vaccine has been found.

The reports follow the US-based Food and Drug Administration’s approval of the anti-retroviral drug Truvada as a preventive measure against the transmission of HIV. Prof Pontiano Kaleebu, director of the Uganda Virus Research Institute in Entebbe, says Truvada is not an HIV vaccine but an anti-retroviral drug.

“No HIV vaccine has yet been discovered. There are, however, ongoing studies and efforts to discover a vaccine,” Kaleebu said.

Truvada has been shown to reduce risk of infection by up to 42% in gay and bisexual men and 75% in heterosexual couples according to the AIDS Research Alliance. Dr Patrick Ndase, the Ugandan HIV prevention research expert at the University of Washington, says Truvada is an anti-retroviral agent that has been in use for HIV treatment since 2004. It is one of the first line of drugs for HIV treatment in several countries in Africa.

“It most certainly is not a vaccine. The concept studied is the use of an anti-retroviral drug for HIV prevention similar to the approach used for prevention of mother-to-child transmission,” he said.

“There is no vaccine and clearly no clear timeframe can even be put to hopes of ever getting a vaccine against HIV, but the hope is alive.”

The scientists say that Truvada does not offer 100% protection against HIV and may encourage risky behaviour. For Truvada to give some measure of protection, an HIV negative person would have to take it daily, something that is difficult even for people who take part in vaccine and drug trials.

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ARM-ing Africa for Rectal Microbicides

Original content from the Mapping Pathways blog team

These are exciting times in the HIV-prevention landscape.  In an earlier Mapping Pathways post, we covered our colleague, Jim Pickett’s experiences at the Microbicides 2012 (M2012) conference in Sydney in April.  At M2012, advocates discussed a number of important issues, including the importance of adherence in clinical trials. 

A major development at M2012 was a report released by the International Rectal Microbicide Advocates (IRMA), a global network that Jim leads, as a cornerstone of their Project ARM (Africa for Rectal Microbicides). The report, titled “On the Map: Ensuring Africa’s place in Rectal Microbicide Research and Advocacy” outlines priority actions to ensure Africa is involved in rectal microbicide research and advocacy activities.

On The Map is the result of a two-day consultation that took place before the ICASA conference in Addis Ababa in December with African and international stakeholders. Says Pickett, “The central question of the consultation was ‘How can we be more strategic and proactive to make sure Africa is on the map when it comes to rectal microbicide research and advocacy?’”

The Project ARM report lays out seven key action areas specific to rectal microbicide research and advocacy in the African context:

Knowledge, Attitudes and Behaviors (KAB) studies on anal health and anal sex to generate data that can be analyzed across countries and populations

Rectal microbicide acceptability studies

Mapping of sex education curricula to determine what content on anal health is included

Advocacy for lubricant access through the “And Lube” campaign of the Global Lube Advocacy Mobilisation (GLAM)

Documentation of best practices for integrating anal health, anal intercourse and rectal microbicides into sexual health and HIV prevention education

Capacity-building activities for community leaders, advocates, and researchers

Awareness raising and education about anal health, anal intercourse, and rectal microbicides, including development of educational materials and other communications efforts specific to the African context

According to Pickett, members of the Project ARM working group further prioritized the key activities. While the members agreed that all the activities are important, the top three are the KAB studies, awareness raising and education on anal health and anal intercourse, and improving access to condom-compatible lubricants, which are in very short supply across most of Africa.

Pickett explained that the HIV epidemic in Africa is often wrongly considered as solely heterosexual, with sexual transmission driven entirely by unprotected vaginal sex between men and women. “There has been little to no official recognition of the fact that there are gay men and other men who have sex with men in Africa who are enduring high rates of HIV, and that plenty of heterosexuals also have anal sex. Unprotected anal intercourse is 10 to 20 times more likely to result in an HIV infection compared to unprotected vaginal intercourse,” says Pickett.

As mentioned, increasing access to condom-compatible lubricant is a key goal of Project ARM. Access to appropriate lubricants on the continent is quite abysmal. “In the absence of appropriate, safe lubricants, people use things like shampoo, cooking oil, hand lotion, antibiotic creams – even motor oil – that break down the latex in the condom, erasing the protective benefits.. People also use saliva, which dries out quickly – and can cause tears in the condom as well as harm the fragile rectal environment. For safer anal sex, lubrication that is condom-compatible is absolutely necessary,” says Pickett.

 “There is an immediate need for appropriate lubricants for people who have anal intercourse in Africa. If we can’t get lubricant to people now, how will we be able to deliver rectal microbicides to them when they become available? Increasing access to appropriate lube is absolutely critical, and paves the way for access to rectal microbicides down the line. We can’t have campaigns and programs that deliver condoms without also delivering condom-compatible lubes. Period.”

Stay tuned to the blog as we bring you more information on this exciting project. Until then, read a vivid snapshot of advocacy in Africa through the eyes of Brian Kanyemba here. Brian has been very involved with IRMA's Project ARM, and is an integral member of the Project ARM video working group, which is trying to produce an African-focused video on anal health and anal intercourse.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position. Please look for us on Facebook here www.facebook.com/MappingPathways and you can follow us on Twitter @mappingpathways as well.]

South African Clinicians Outline Best Treatment for Prevention Practices

via mg.co.za, by Mia Malan

South African guidelines for the preventative use of HIV medication by men who have sex with men who are not infected with the virus are to be published in the peer-reviewed academic publication, Southern African Journal of HIV Medicine, this month.

The treatment, pre-exposure prophylaxis (Prep), consists of an antiretroviral (ARV) pill that is taken daily by HIV-negative people to lower their chances of becoming infected with the virus.

The guidelines were developed by a panel of microbiologists, clinicians, virologists, pharmacists and community representatives affiliated to the South African HIV Clinicians’ Society. 

Several recent studies have revealed that, if Truvada pills, which contain the ARVs tenofovir and emtricitabine, are taken regularly, they can reduce the risk of men who have sex with men of acquiring HIV by up to 72.8%.

Prep is part of a movement based on the use of ARVs to protect vulnerable groups who are consistently exposed to HIV. In “discordant” couples, where one partner is HIV positive and the other negative, the uninfected person is at a high risk of contracting HIV if condoms are not always used, particularly if the ­positive partner has a large amount of the virus in his or her blood or sexual fluids because he or she is not yet on ARVs.

HIV-infected people’s chances of infecting their sexual partners with HIV are significantly lower if they are using ARVs, as the medication reduces the amount of virus in their bodies. Men who have sex with men are particularly vulnerable, and HIV infections are on the increase in this group, despite awareness of the effectiveness of condoms.

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Hospital Fails to Make ARV Order for the Month of June

via allafrica.com, by Jennifer Dube

SCORES of people receiving anti-retroviral (ARV) drugs from Harare Central Hospital were early last week told to buy their own drugs as the hospital allegedly "forgot" to order the life-prolonging drugs.

A beneficiary of the government-free ARV programme showed The Standard his health card where "out of stock" had been written against the second line drug alluvia which is used together with tenolam.

"They said they do not have the drugs," the beneficiary said. "I was advised to buy the drugs but I currently do not have the money to do so. This will affect me as I may take long to get the money for the drugs."

Vice-president of Zimbabwe HIV and Aids Activists Union, Stanley Takaona said his organisation had been told the hospital did not make an order for the month of June.

"We have made a follow-up with the hospital together with the ministry and we were told the drugs are there at the national pharmacy but the hospital did not make an order for this month," Takaona said.

"Those are the most expensive ARV drugs, costing US$120 for a month's supply and most people who are on the government programme cannot afford them."

Takaona said such alleged negligence on the part of the hospital was disturbing as those on ARVs were supposed to take the tablets consistently, without skipping any days, for effectiveness.

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HIV Drug Trial in South Africa Draws Concerns

via allafrica.com, by Anso Thom

AIDS activists and researchers are at loggerheads over the planned South African trial of a lower dose version of the controversial antiretroviral stavudine, which has in the past been responsible for debilitating side-effects in HIV patients.

The main adverse effect is peripheral neuropathy, which can be corrected by reducing dosage.

The symptoms of peripheral neuropathy include burning, stiffness, prickling, tingling, and numbness or a loss of feeling in the toes and soles of the feet. Sometimes the nerves in the fingers, hands, and wrists are also affected.

Stavudine is also one of the most likely ARVs to cause lipodystrophy, and for this reason it is no longer considered an appropriate treatment for most patients in developed countries and is no longer recommended by the World Health Organisation.

However, due to its low price, it is still widely used in the developing world.

Lipodystrophy is the redistribution of fat in the body, which manifests as excess, or lack of, fat in various regions of the body. People can have sunken cheeks and/or "humps" on the back or back of the neck (also referred to as buffalo hump).

In the one camp, the Treatment Action Campaign, Medecins Sans Frontieres (Doctors without borders) and the Treatment Action Group have serious concerns about the proposed trial.

They are concerned that stavudine is more toxic than tenofovir (the drug which replaced stavudine in the government treatment programme), making it an inferior treatment.

Patients' poor tolerance means that they are more likely to not adhere to treatment and will have to be switched to more expensive second-line treatment when they fail first line treatment.

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Tanzania Considers Compulsory HIV Testing for All Citizens

via AllAfrica.com, by Alvar Mwakyusa

People living with HIV/AIDS (PLHAs) and a section of lawmakers have proposed that every person living in the country be subjected to compulsory HIV testing in a bid to promote the fight against the disease.

However, not everyone supports the idea. Some of the people interviewed by the 'Daily News' are against the idea. Many point out that it is against human rights to compel someone to undergo a HIV test or any other medical tests.

Speaking in Dar es Salaam recently, the board chairperson of the National Council of People Living with HIV/AIDS (NACOPHA), Mr Vitalis Makayula, was of a view that if the fight against the disease was to be won, then all people must be aware of their HIV status.

He also said that those found to be positive must disclose their status. Mr Makayula made these remarks at a seminar organized by the Association of Journalists Against AIDS in Tanzania (AJAAT), to sensitize journalists on the HIV and AIDS Prevention and Control Act (HAPCA) of 2008.

"Tackling HIV/AIDS would be more effective if everyone tested for HIV and disclose his/her status. Otherwise it is like fighting an enemy you don't know," he stressed.

Mr Makayula was also optimistic that if everyone knew their HIV status stigma against those found to be positive would be reduced.When contacted for comment, the Deputy Minister for Health and Social Welfare, Dr Seif Suleiman Rashid, said that there are factors that must be considered before deciding if testing should be compulsory or not.

"Before deciding on the matter we should consider revising the current legislation, human rights and availability of resources, among others. It is an issue which requires discussion among experts and stakeholders," he explained in a telephone interview.

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PrEP Provides Hope to HIV Prevention in Nigeria

via Leadership Newspapers, by Winifred Ogbebo

Like a breath of fresh air, the news that a combination prevention drug would soon hit the Nigerian market is definitely something to cheer about, given Nigeria’s high prevalence of HIV rate, which is said to be second only to South Africa in the African continent. WINIFRED OGBEBO reports.

It is like Sunday-Sunday malaria drugs. But in this case, you take HIV drug to prevent HIV and HIV negative people, says the Director-General, National Agency for the Control of AIDS (NACA), Prof John Idoko, explaining the new prevention treatment drug, pre- exposure Prophylaxis.

“From what we learnt from malaria for example,  he explains further, “if we give the drugs  to somebody who doesn’t have HIV, and the person has  sexual relationship with an HIV positive partner, it can prevent transmission from the positive person to the person. That is why it’s called a pre- exposure prophylaxis because before exposure, the person has taken the drugs and because he has the drugs in him, the virus cannot infect him or her.”

Also, Idoko says, “  If you take this sero-discordant couples; one is positive and the other is negative, instead of giving the drug to the negative person before the sexual relationship, just put the positive one on drug as soon as you know. It doesn’t matter what his CD-4 count is even if it’s 500, just give him the drugs. It has shown clearly one of the best study results that we have seen, as 96 per cent chance of the person transmitting HIV is blocked. So we call that treatment as prevention. So you can now imagine that if you go to a community, and they are using this method, your chances of blocking transmission are very high. We believe that these are the two things we need to put together as part of our combination prevention method.”

The pre-exposure prophylaxis is the newest HIV prevention tool that has been developed.    It involves the use of Truvada, an antiretroviral to prevent HIV infection. A few studies have shown the ability of this drug to prevent HIV infection in sero-discordant couples, MSMs, transgenders and in men and women.


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AIDSmeds: Adherence Challenges in Intermittent HIV PrEP Study

via AIDSmeds.com

Intermittent use of Truvada (tenofovir plus emtricitabine) as pre-exposure prophylaxis was associated with poor adherence, compared with daily use of the tablet to prevent HIV infection, according to results of a small clinical trial published in the online scientific journal PLoS ONE.

Using electronic pill caps, the Kenyan study found that the adherence rate associated with daily PrEP use was 83 percent. Among those using intermittent therapy—Truvada taken on Monday, Friday and within two hours following sexual intercourse—the adherence rate was 55 percent. Among those who only took Truvada within two hours following sexual intercourse, the post-coital adherence rate was only 26 percent.

Truvada as PrEP was recently recommended for U.S. Food and Drug Administration (FDA) approval by the Antiviral Drugs Advisory Committee. The recommendation is based on data from several clinical trials, all exploring the safety and efficacy of Truvada PrEP used daily.

There has been interest in exploring alternative dosing strategies, notably scheduled and as-needed intermittent use of the drug. Experts hypothesize less frequent dosing may reduce the risk of side effects and prove easier for people to use, in light of the poor adherence that has been noted in clinical trials evaluating daily use of Truvada.

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Patients in South Africa Increase the Use of Antiretroviral Treatment

via aidsmap.com, by Carole Leach-Lemens

South Africa exceeded national targets for new patients starting antiretroviral treatment (ART) by around 50% between 2007 and 2011 – achieving treatment coverage of close to 80% of eligible adults – according to new research carried out by Dr Leigh F Johnson, actuarial scientist at the University of Cape Town, published  in the March issue of The Southern African Journal of Medicine.

From mid-2004 to mid-2011, the total numbers of people receiving ART increased from 47,500 (95% CI: 42,900 to 51,800) to 1.79 million people (95% CI: 1.65 to 1.93 million). The latter figure represents close to 80% of adult treatment coverage, according to eligibility criteria in use during this period (CD4 cell counts under 200 cells/mm3). Using current South African CD4 cell count eligibility criteria (under 350 cells/mm3), coverage achieved decreases to 52% (95% CI: 46-57%).

While the targets were still exceeded, children and men started ART at considerably lower ratios than women.

Women accounted for 61%, men 31% and children 8% of the total.
Effective HIV treatment significantly reduces illness and death resulting from HIV, as well as onward transmission of HIV. Evaluating the effectiveness of HIV treatment and prevention programmes requires monitoring access to ART.

Previous monitoring assessments have shown a dramatic increase in access to ART in South Africa. While these assessments have suggested South Africa was on track to meet the targets of its HIV & AIDS & STI National Strategic Plan 2007-2011 (the NSP), no formal assessment has been made, Dr Johnson adds.


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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]

Activists Protest Against Obama's PEPFAR Budget Cuts

via Plus News

Almost a thousand Swazi and South African HIV activists marched to the United States consulate in Johannesburg on 22 March 2012 to demand that the US continue supporting the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria, and safeguard funding of its President's Emergency Plan for AIDS Relief (PEPFAR), which US President Barack Obama's latest proposed budget will cut by 12 percent.

The march organizers - a coalition of international and regional HIV organizations, including the global medical charity, Médecins Sans Frontières (MSF), the World AIDS Campaign, and the AIDS Rights Alliance Southern Africa - also called on the British and Australian governments to join their American counterparts in kick-starting a response to solve the Global Fund's financial crisis.

Without an emergency donor meeting, the Fund - already in need of at least US$ 2 billion - will only secure additional funding at its next scheduled replenishment in 2014.

"We're not asking for charity, we are asking for social justice," said Daygan Eagar, a researcher at the South African human rights organization, Section27. "The US spends more money in one day of war than we're asking for the Global Fund."

Representatives from MSF, Section27 and the South African AIDS lobby group, Treatment Action Campaign, were to meet with consular and PEPFAR representatives to discuss their concerns.
The demonstration was also endorsed by the two million-member Congress of South African Trade Unions (COSATU). It followed similar protest action at US representative offices in Swaziland, according to Siphiwe Hlophe, a founder of the NGO, Swaziland for Positive Living (SWAPOL).

"If we are here, if we are laughing, it is because we are on drugs," she told the crowd. "Before the Global Fund we didn't have food, we didn't have pyschosocial support, we didn't disclose our HIV status - that all started when the Global Fund came. Look at how many of us are here today - that is the Global Fund."

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[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]