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Title: Family Health International's Site Identification and Development Initiative (SIDI).
Author: Family Health International [FHI]
Source: [Research Triangle Park, North Carolina], FHI, [2009]. [3] p. (Research Briefs on HIV Prevention)
Abstract: Successful HIV prevention research requires the participation of tens of thousands of women and men at risk for HIV infection. Ultimately, success hinges on the development of multiple international research sites. To increase the number and readiness of such sites, Family Health International (FHI) began the Site Identification and Development Initiative (SIDI) in July 2006.
Language: English
Keywords:
AFRICA | ASIA | PROGRESS REPORT | CLINICAL RESEARCH | HIV PREVENTION | INCIDENCE | NEEDS | USAID | GOALS | STANDARDS | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Measurement | Economic Factors | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Planning | Organization and Administration
Document Number: 331712

Title: Integrating multiple gender strategies to improve HIV and AIDS interventions: a compendium of programs in Africa.
Author: John Snow [JSI]. AIDS Support and Technical Resources [AIDSTAR-One]
Source: Washington, D.C., International Center for Research on Women [ICRW], 2009 May. [220] p. (USAID Contract No. GHH-I-00-07-00059-00)
Abstract: The United States Agency for International Development (USAID) AIDSTAR-One project created this compendium of selected HIV programs in sub-Saharan Africa that integrate multiple gender strategies. Featured programs address at least two of the following gender strategies: 1) reducing violence and sexual coercion; 2) addressing male norms and behaviors; 3) increasing women's legal protection; and 4) increasing women's access to income and productive resources. The compendium describes each of the 31 selected programs, and synthesizes trends and findings to provide initial insights on using multiple gender strategies in HIV programming, including how strategies are employed together, where gaps exist, and what lessons and experiences are common across programs. Though not meant to be exhaustive, the compendium represents the depth and breadth of current HIV programming that includes multiple gender strategies. Overall, we found that many innovative programs exist in sub-Saharan Africa and that implementers are successfully integrating multiple gender approaches into HIV programs. Program implementers report numerous benefits of combining gender strategies, including ensuring project salience and relevance, extending project reach, and reflecting the multiple, interrelated needs of beneficiaries. (Excerpts)
Language: English
Keywords:
AFRICA | SUMMARY REPORT | CASE STUDIES | RECOMMENDATIONS | HIV PREVENTION | INCOME GENERATION PROGRAMS | TREATMENT | CARE AND SUPPORT | FINANCIAL ACTIVITIES | VIOLENCE AGAINST WOMEN | GENDER ISSUES | PROGRAM ACTIVITIES | PROGRAM DESIGN | INTEGRATED PROGRAMS | POLICY | Developing Countries | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Domestic Violence | Crime | Social Problems | Sociocultural Factors | Programs | Organization and Administration | Political Factors
Document Number: 331479

6.
Peer Reviewed

Title: Spousal violence and potentially preventable single and recurrent spontaneous fetal loss in an African setting: cross-sectional study.
Author: Alio A; Nana PN; Salihu HM
Source: Lancet. 2009;373:318-324.
Abstract: Background Spousal violence is a global issue, with ramifications for the reproductive health of women. We aimed to investigate the effect of physical, sexual, and emotional violence on potentially preventable single and recurrent spontaneous fetal loss. Methods We analysed data from the Cameroon Demographic Health Survey. In the violence module of this survey, women were questioned about their experience of physical, emotional, and sexual violence inflicted by their spouses. Respondents were also asked about any stillbirths and spontaneous abortions. We measured risk for single and recurrent fetal loss with odds ratios, with adjustment for intracluster correlations as appropriate. We also estimated the proportion of preventable excess fetal loss at various levels of violence reduction. Findings 2562 women responded to the violence module. Those exposed to spousal violence (n=1307) were 50% more likely to experience at least one episode of fetal loss compared with women not exposed to abuse (odds ratio 1-5; 95% CI 1-3-1-8). Recurrent fetal mortality was associated with all forms of spousal violence, but emotional violence had the strongest association (1-7; 1-2-2-3). If the prevalence of spousal abuse could be reduced to 50%, 25%, or entirely eliminated, preventable excess recurrent fetal demise would be 17%, 25%, and 33%, respectively. Interpretation Spousal violence increases the likelihood of single and repeated fetal loss. A large proportion of risk for recurrent fetal mortality is attributable to spousal violence and, therefore, is potentially preventable. Our findings support the idea of routine prenatal screening for spousal violence in the African setting, a region with the highest rate of fetal death in the world.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | CROSS SECTIONAL ANALYSIS | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN | ABORTION, SPONTANEOUS | DOMESTIC VIOLENCE | PHYSICAL ABUSE | IMPACT | Developing Countries | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Pregnancy Complications | Diseases | Crime | Social Problems | Sociocultural Factors | Violence | Behavior | Communication
Document Number: 340220

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8.
Title: HIV-infected African parents living in Stockholm, Sweden: disclosure and planning for their children's future.
Author: Asander AS; Bjorkman A; Belfrage E; Faxelid E
Source: Health and Social Work. 2009 May;34(2):107-15.
Abstract: In Sweden, most HIV-infected parents are of African origin. The present study explored the frequency of HIV-infected African parents' disclosure of their status to their children and custody planning for their children's future to identify support needs among these families. Semistructured interviews were conducted with 47 parents (41 families). The study population included first-generation immigrants, with a total of 87 children less than 18 years of age. Only women had disclosed their HIV status, and only to eight of 59 children older than six. Half of the parents had talked to someone about future custody arrangements. These parents had more contact with a social worker at the social welfare office and with a medical social worker at the HIV clinic. Most parents (30) wanted their children to be cared for by a relative in Sweden or by their HIV-negative partner. Neither disclosure nor custody planning was associated with clinical status or antiretroviral treatment. This study highlights the low HIV-disclosure rate to children of HIV-infected African immigrant parents and the importance of support from social workers.
Language: English
Keywords:
SWEDEN | AFRICA | RESEARCH REPORT | PARENTS | PERSONS LIVING WITH HIV/AIDS | IMMIGRANTS | CHILD CUSTODY | PLANNING | INTERPERSONAL COMMUNICATION | INTERVIEWS | Developed Countries | Europe, Northern | Europe | Developing Countries | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Migrants | Migration | Population Dynamics | Demographic Factors | Population | Child Rearing | Behavior | Organization and Administration | Communication | Data Collection | Research Methodology
Document Number: 341675

10.
Title: Circumcision's place in the vicious cycle involving herpes simplex virus type 2 and HIV [editorial]
Author: Bailey RC; Mehta SD
Source: Journal of Infectious Diseases. 2009 Apr 1;199(7):923-5.
Abstract: HSV-2 as a biological cofactor in HIV acquisition and transmission has likely contributed substantially to the HIV epidemic. Although it remains possible that HSV-2 suppressive therapy will be efficacious in reducing HIV transmission, it is not clear how and whether a twice daily regimen of acyclovir will be manageable and effective at a population level. Research is needed to develop and test a prophylactic vaccine that, even if only partially protective against HSV-2 acquisition, is likely to be effective in both concentrated epidemics and in generalized epidemics in which a large proportion of HIV transmission occurs in stable partnerships. (excerpt)
Language: English
Keywords:
AFRICA | EUROPE | SUMMARY REPORT | INCIDENCE | HERPES GENITALIS | HIV INFECTIONS | MALE CIRCUMCISION | SEX BEHAVIOR | HIV TESTING | LABORATORY PROCEDURES | Developing Countries | Developed Countries | Measurement | Research Methodology | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Viral Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Laboratory Examinations and Diagnoses | Examinations and Diagnoses
Document Number: 341208

11.

Peer Reviewed

Title: The intergenerational impact of the African orphans crisis: a cohort study from an HIV/AIDS affected area.
Author: Beegle K; De Weerdt J; Dercon S
Source: International Journal of Epidemiology. 2009 Apr;38(2):561-8.
Abstract: BACKGROUND: In sub-Saharan Africa, the prevalence of orphanhood among children has been greatly exacerbated by the HIV/AIDS pandemic. If orphanhood harms a child's development and these effects perpetuate into adult life, then the African orphan crisis could seriously jeopardize the continent's future generations. Whether or not there exists an adverse, causal and intergenerational effect of HIV/AIDS on development is of crucial importance for setting medical priorities. This study is the first to empirically investigate the impact of orphanhood on health and schooling using long-term longitudinal data following children into adulthood. METHODS: We examined a cohort of 718 children interviewed in the early 1990s and again in 2004. Detailed survey questionnaires and anthropometric measurements were administered at baseline and during a follow-up survey. Final attained height and education (at adulthood) between children who lost a parent before the age of 15 and those who did not were compared. RESULTS: On average, children who lose their mother before the age of 15 suffer a deficit of around 2 cm in final attained height (mean 1.96; 95% CI 0.06-3.77) and 1 year of final attained schooling (mean 1.01; 95% CI 0.39-1.81). This effect is permanent and the hypothesis that it is causal cannot be rejected by our study. Although father's death is a predictor of lower height and schooling as well, we reject the hypothesis of a causal link. CONCLUSIONS: The African orphan crisis, exacerbated by the HIV/AIDS epidemic will have important negative intergenerational effects.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | COHORT ANALYSIS | PREVALENCE | ORPHANS AND VULNERABLE CHILDREN | CHILD HEALTH | CHILD DEVELOPMENT | HIV | AIDS | HUMAN CAPITAL | IMPACT | Developing Countries | Research Methodology | Measurement | Family and Household | Sociocultural Factors | Health | Biology | HIV Infections | Viral Diseases | Diseases | Human Resources | Economic Factors | Communication
Document Number: 341016

12.
Title: The President's Emergency Plan for AIDS Relief in Africa: an evaluation of outcomes.
Author: Bendavid E; Bhattacharya J
Source: Annals of Internal Medicine. 2009 May 19;150(10):688-95.
Abstract: BACKGROUND: Since 2003, the President's Emergency Plan for AIDS Relief (PEPFAR) has been the most ambitious initiative to address the global HIV epidemic. However, the effect of PEPFAR on HIV-related outcomes is unknown. OBJECTIVE: To assess the effect of PEPFAR on HIV-related deaths, the number of people living with HIV, and HIV prevalence in sub-Saharan Africa. DESIGN: Comparison of trends before and after the initiation of PEPFAR's activities. SETTING: 12 African focus countries and 29 control countries with a generalized HIV epidemic from 1997 to 2007 (451 country-year observations). INTERVENTION: A 5-year, $15 billion program for HIV treatment, prevention, and care that started in late 2003. MEASUREMENTS: HIV-related deaths, the number of people living with HIV, and HIV prevalence. RESULTS: Between 2004 and 2007, the difference in the annual change in the number of HIV-related deaths was 10.5% lower in the focus countries than in the control countries (P = 0.001). The difference in trends between the groups before 2003 was not significant. The annual growth in the number of people living with HIV was 3.7% slower in the focus countries than in the control countries from 1997 to 2002 (P = 0.05), but during PEPFAR's activities, the difference was no longer significant. The difference in the change in HIV prevalence did not significantly differ throughout the study period. These estimates were stable after sensitivity analysis. LIMITATION: The selection of the focus countries was not random, which limits the generalizability of the results. CONCLUSION: After 4 years of PEPFAR activity, HIV-related deaths decreased in sub-Saharan African focus countries compared with control countries, but trends in adult prevalence did not differ. Assessment of epidemiologic effectiveness should be part of PEPFAR's evaluation programs. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | COMPARATIVE STUDIES | PREVALENCE | PERSONS LIVING WITH HIV/AIDS | CAUSES OF DEATH | HIV INFECTIONS | AIDS | PROGRAM EFFECTIVENESS | PROGRAM EVALUATION | Developing Countries | Studies | Research Methodology | Measurement | Viral Diseases | Diseases | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration
Document Number: 341612

13.

Title: Three-year outcome data of second-line antiretroviral therapy in Ugandan adults: good virological response but high rate of toxicity.
Author: Castelnuovo B; John L; Lutwama F; Ronald A; Spacek LA
Source: Journal of the International Association of Physicians in AIDS Care. 2009 Jan-Feb;8(1):52-59.
Abstract: Objective: To evaluate the safety and virological response to lopinavir/ritonavir containing second-line therapy after failing a first line nonnucleoside reverse transcriptase inhibitor NNRTI) based regimen. Design. Prospective 36 months cohort study of patients switched to zidovudine/stavudine plusdidanosine plus lopinavir/ritonavir capsules as second-line regimen. Methodology. Structured interview, medical examination and laboratory assessment performed every 6 months. Results. We enrolled 40 patients; 1 died and 3 were lost to follow-up. Median CD4+count at baseline was 108cell/microL, median log viral load was 4.8 copies/mL. Sixteen (40%) patients had baseline genotypic resistant test, 14 (87%) had lamivudine resistance mutations, and all had NNRTIs resistance mutations. At month 36, 82% of the patients achieved viral suppression (<400copies/mL) and the median increase in CD4+count was 214 cell/microL, (interquartile range: 128-295). Twenty-five patients (62%) experienced at least one adverse event. Conclusions. Our study confirms lopinavir/ritonavir-based second-line regimen but with a high rate of toxicities.
Language: English
Keywords:
AFRICA | UGANDA | RESEARCH REPORT | ADULTS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | TOXICITY | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Age Factors | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | Physiology | Biology
Document Number: 331330

14.

Title: HIV stigma and nurse job satisfaction in five African countries.
Author: Chirwa ML; Greeff M; Kohi TW; Naidoo JR; Makoae LN; Dlamini PS; Kaszubski C; Cuca YP; Uys LR; Holzemer WL
Source: Journal of the Association of Nurses in AIDS Care. 2009 Jan-Feb;20(1):14-21.
Abstract: This study explored the demographic and social factors, including perceived HIV stigma, that influence job satisfaction in nurses from 5 African countries. A cross-sectional survey was conducted of nurses (n = 1,384) caring for patients living with HIV infection in Lesotho, Malawi, South Africa, Swaziland, and Tanzania. Total job satisfaction in this sample was lower than 2 comparable studies in South Africa and the United Kingdom. The Personal Satisfaction subscale was the highest in this sample, as in the other 2. Job satisfaction scores differed significantly among the 5 countries, and these differences were consistent across all subscales. A hierarchical regression showed that mental and physical health, marital status, education level, urban/rural setting, and perceived HIV stigma had significant influence on job satisfaction. Perceived HIV stigma was the strongest predictor of job dissatisfaction. These results provide new areas for intervention strategies that might enhance the work environment for nurses in these countries.
Language: English
Keywords:
AFRICA | CROSS SECTIONAL ANALYSIS | SURVEYS | NURSES AND NURSING | PERSONS LIVING WITH HIV/AIDS | SATISFACTION | MANAGEMENT | STIGMA | Developing Countries | Research Methodology | Sampling Studies | Studies | Health Personnel | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Psychological Factors | Behavior | Organization and Administration | Social Problems | Sociocultural Factors
Document Number: 330878

15.

Peer Reviewed

Title: Contraception in historical and global perspective.
Author: Cleland J
Source: Best Practice and Research. Clinical Obstetrics and Gynaecology. 2009 Apr;23(2):165-176.
Abstract: This chapter describes the rise in contraceptive practice and fall in fertility from around 1880 to the present day. Two main phases are identified: the first confined to European populations and involving methods of low efficacy, and the second embracing the whole planet involving modern methods. Today, sub-Saharan Africa is the only region where low levels of contraceptive use and high fertility persist. Nevertheless, nearly half of pregnancies worldwide are still unintended, and much scope remains for improvement in contraceptive protection. The main international priority is Africa, where demographic factors jeopardize the goals of reducing poverty and hunger.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE | SOCIAL MARKETING | POPULATION GROWTH | CONTRACEPTIVE METHODS CHOSEN | PREGNANCY, UNPLANNED | COMMUNITY-BASED DISTRIBUTION | CONTRACEPTION | FAMILY PLANNING PROGRAMS | Developing Countries | Contraceptive Usage | Family Planning | Marketing | Economic Factors | Population Dynamics | Demographic Factors | Population | Reproductive Behavior | Fertility | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration
Document Number: 329659

16.

Peer Reviewed

Title: On the origin of South America HIV-1 C epidemic [letter]
Author: de Macedo Brigido LF
Source: AIDS. 2009 Feb 20;23(4):543-4.
Abstract: In a recent AIDS issue, two articles present sequence analysis to trace the origin of HIV-1 clade C in South America. The authors correctly point out that the density of clade C infection in south Brazil and its phylogenetic relationship to most isolates observed elsewhere in South America places south Brazil as its probable origin. When tracing the origin of the C viruses circulating in Brazil, both groups focused on phylogenic relationships of available/analyzable material. Although reported in the Epidemiology/Social sector, the authors disconnect their findings to potential social and cultural determinants of HIV dissemination, factors that may actually have played a major role in the introduction of HIV-1 clade C in Brazil. Although the precise African origin of the variant is not known, it was first observed in Ethiopia, but it is observed, along with other variants, in many countries of central and east Africa. It is conceivable that the variant migrated southwards through highland areas (including Burundi and Kenya, the putative origin, ascribed by each group, to the South America and Brazilian clade C epidemic) to dominate the epidemic in the south of the continent. Mozambique is one of the countries in the south of Africa where clade C is predominant. In 1975, Mozambique declared its independence from Portugal and Frelimo, a left-oriented liberation movement, took hold of the government. Its support to liberation movements at South Africa and Rhodesia (now Zimbabwe) resulted in an armed rebel movement supported by the white-ruled neighboring countries, causing a civil war that was associated with an exodus of most of the Portuguese community and Mozambicans of Portuguese heritage. Brazil, a former Portuguese colony, has a large community of Portuguese descendants, a fact that may have facilitate a temporary or permanent destiny for some of these emigrants. According to the official Brazilian demographic data center (IBGE), the number of conceded residency for Portuguese nationals surged five-fold in 1975, returning to 1974 levels by 1981. In some areas of the south of Brazil, as in the coast of the state of Santa Catarina, Portuguese descendents are specially noted. Coincidentally, this area includes cities with the highest proportions of clade C infection. Available molecular data may not provide sufficient support for a direct link of the two epidemics and, apart from a threonine at codon 12, most amino acid signatures listed by Bello et al. [1] are not commonly observed among Mozambique sequences available at GenBank. However, these isolates are recent (1999-2004) and may not reflect the variants circulating in late 1970s. An evolving virus in distinct ethnic groups may make the task of tracing its origins and evolution difficult, especially when based exclusively on available, most of the time fragmental, sequence information. The relationship of Mozambique to Brazil, through a 'Portuguese connection', placed the area as the most feasible origin for the Brazilian clade C epidemic. Social and cultural determinants and tangibility of potential routes of dissemination should be incorporated into these studies to allow a more precise picture of HIV epidemic dynamics. (full-text)
Language: English
Keywords:
SOUTH AMERICA | BRAZIL | AFRICA | CRITIQUE | HISTORICAL REVIEW | EPIDEMIOLOGIC METHODS | GENETIC TECHNIQUES | PERSONS LIVING WITH HIV/AIDS | HIV TRANSMISSION | EPIDEMIOLOGY | HUMAN GEOGRAPHY | CULTURE | GENETICS | Latin America | Americas | Developing Countries | South America, Eastern | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV Infections | Viral Diseases | Diseases | Public Health | Geography | Social Sciences | Science | Sociocultural Factors | Biology
Document Number: 341168

17.

Peer Reviewed

Title: HIV prevalence and mortality among children undergoing treatment for severe acute malnutrition in sub-Saharan Africa: a systematic review and meta-analysis.
Author: Fergusson P; Tomkins A
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):541-8.
Abstract: This systematic review and meta-analysis explored HIV prevalence and mortality in children undergoing treatment for severe acute malnutrition (SAM) in sub-Saharan Africa. It included all studies reporting on HIV infection within a sample of children with SAM where HIV status was assessed using a blood test and SAM was defined using the WHO, Gomez, Wellcome or Waterlow definitions. Children from 17 studies were included in the analysis (n=4891), of whom 29.2% were HIV-infected. HIV-infected children were significantly more likely to die than HIV-uninfected children (30.4% vs. 8.4%; P<0.001; relative risk=2.81, 95% CI 2.04-3.87). HIV-negative children treated within community-based therapeutic care (CTC) programmes had lower mortality (4.3%) than those treated within an inpatient nutrition rehabilitation unit (NRU) (15.1%). There was no significant difference in mortality for HIV-infected children with SAM treated in the CTC (30.0%) or NRU (31.3%) settings. HIV prevalence is high in children with SAM in sub-Saharan Africa, and HIV-infected children are at significantly increased risk of mortality. There is an urgent need to integrate HIV testing and treatment into care for children with SAM in regions of high HIV prevalence.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | PREVALENCE | CHILD | CHILD MORTALITY | MALNUTRITION | HIV INFECTIONS | HIV TESTING | TESTING | HIV | RISK FACTORS | TREATMENT | Developing Countries | Measurement | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Nutrition Disorders | Diseases | Viral Diseases | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342751

18.

Title: Staged introduction of antiretroviral therapy into a family with multiple HIV-infected members.
Author: Fielder JF; Kwatampora L
Source: Journal of the International Association of Physicians in AIDS Care. 2009 Jan-Feb;8(1):68-72.
Abstract: Children and families bear a significant burden of human immunodeficiency virus disease globally, particularly in sub-Saharan Africa. Care of severely affected families can be adversely impacted by high medication burdens and overwhelmed caregivers, who themselves may be human immunodeficiency virus infected. Family-centered care involving joint clinic days, treatment preparation, adherence counseling, and community-based follow-up may improve the care of family units. We describe the successful treatment of a single family composed of 6 infected members living in a rural African setting.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | NUCLEAR FAMILY | HIV | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | Developing Countries | HIV Infections | Viral Diseases | Diseases | Family Characteristics | Family and Household | Sociocultural Factors | Behavior
Document Number: 331332

19.

Peer Reviewed

Title: The HIV-exposed, uninfected African child.
Author: Filteau S
Source: Tropical Medicine and International Health. 2009 Mar;14(3):276-87.
Abstract: The increasing success of prevention of mother-to-child HIV transmission programmes means that in Africa, very large numbers of HIV-exposed, uninfected (HIV-EU) children are being born. Any health problems that these children may have will thus be of enormous public health importance, but to date have been largely neglected. There is some evidence that HIV-EU African children are at increased risk of mortality, morbidity and slower early growth than their HIV-unexposed counterparts. A likely major cause of this impaired health is less exposure to breast milk as mothers are either less able to breastfeed or stop breastfeeding early to protect their infant from HIV infection. Other contributing factors are parental illness or death resulting in reduced care of the children, increased exposure to other infections and possibly exposure to antiretroviral drugs. A broad approach for psychosocial support of HIV-affected families is needed to improve health of HIV-EU children. High quality programmatic research is needed to determine how to deliver such care.
Language: English
Keywords:
AFRICA | CRITIQUE | LITERATURE REVIEW | EVALUATION | CHILDREN | PERSONS LIVING WITH HIV/AIDS | ORPHANS AND VULNERABLE CHILDREN | BREASTFEEDING | TIME FACTORS | CHILD HEALTH | GROWTH | DEFICIENCY DISEASES | CHILD MORTALITY | ANTIRETROVIRAL DRUGS | INFECTIONS | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Family and Household | Sociocultural Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Child Development | Biology | Nutrition Disorders | Mortality | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care
Document Number: 330961

20.

Peer Reviewed

Title: Rationing antiretroviral therapy in Africa--treating too few, too late.
Author: Ford N; Mills E; Calmy A
Source: New England Journal of Medicine. 2009 Apr 30;360(18):1808-10.
Abstract: The past 6 years have seen striking advances in access to antiretroviral therapy in Africa. From 2002 onward, the international drive to scale up antiretroviral treatment gained considerable momentum, most notably with the establishment of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, the "3 by 5" Initiative of the World Health Organization (WHO), and the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). The momentum has now begun to wane, with various groups arguing that the focus on AIDS has had its day and that health care funding should now be redirected to other areas, such as maternal and child health and primary care. But before the international community gives up on prioritizing care for patients with HIV infection, we believe that on-the-ground discussions must address not only whether enough has been done to scale up treatment but also whether the treatment that patients are receiving is good enough. The standard approach to HIV treatment in Africa is to wait until people are visibly sick, treat them with effective but poorly tolerated drugs, and then wait until they are sick again before switching regimens. There are several problems with this approach. The first is that too few people are receiving treatment. Second, we are waiting until people are symptomatic before they are treated. Another concern is that in most developing countries, patients are receiving drugs with major tolerability issues. Furthermore, not only should initial treatment begin earlier in developing countries, but when the first-line regimen fails, patients should also be switched earlier to another regimen. The drive to scale up antiretroviral treatment in Africa has encouraged a public health approach that promotes reaching the greatest number of patients with the simplest, most affordable regimens. We would argue that treating people when they are less sick with drugs that are less toxic and providing a simple tool for monitoring adherence and detecting treatment failure would be entirely consistent with this approach and would improve access to care by facilitating the decentralization of services from the hospital level to the clinic. (excerpt)
Language: English
Keywords:
AFRICA | DEVELOPING COUNTRIES | SUMMARY REPORT | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | TREATMENT | TIME FACTORS | SIGNS AND SYMPTOMS | DRUG RESISTANCE | ANTIRETROVIRAL DRUGS | SIDE EFFECTS | HIV TRANSMISSION | HEALTH POLICY | NEEDS ASSESSMENT | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population | Policy | Political Factors | Sociocultural Factors | Evaluation
Document Number: 341021

21.

Peer Reviewed

Title: Role of breastfeeding cessation in mediating the relationship between maternal HIV disease stage and increased child mortality among HIV-exposed uninfected children.
Author: Fox MP; Brooks DR; Kuhn L; Aldrovandi G; Sinkala M; Kankasa C; Horsburgh R; Thea DM
Source: International Journal of Epidemiology. 2009 Apr;38(2):569-76.
Abstract: BACKGROUND: Maternal CD4 count predicts child mortality in HIV-uninfected children born to HIV-infected women. METHODS: To explore the mediating role of breastfeeding cessation in this relationship, we compared marginal structural models of maternal CD4 count on child death with and without adjustment for breastfeeding. RESULTS: In crude analyses, children of mothers with CD4<200 during pregnancy were 3.2 times more likely to die by 18 months (CI 1.3-8.1) as children whose mothers had CD4>500. Earlier breastfeeding cessation was also associated with low CD4 (HR 1.8; CI 1.2-2.7). After adjusting for breastfeeding and low birth weight using a marginal structural model, the low CD4 count-child mortality association through 18 months was reduced 17%. The change was overestimated using a traditional Cox proportional hazards model (35% reduction in HR from 3.4 to 2.5). CONCLUSIONS: Our analysis suggests that only a small part of the effect of low vs high CD4 count on child mortality through 18 months is mediated through breastfeeding cessation. Our results must be taken into account when deciding whether or not to recommend breastfeeding for infants of HIV-infected mothers.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | DATA ANALYSIS | CHILDREN | CHILD MORTALITY | BREASTFEEDING | INFANT MORTALITY | HIV | RESEARCH METHODOLOGY | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Mortality | Population Dynamics | Infant Nutrition | Nutrition | Health | HIV Infections | Viral Diseases | Diseases
Document Number: 341015

22.
Title: [A fixed dose anti-HIV combination for the poor? Triomune] Triom une: la tritherapie du pauvre ?
Author: Garcia MV; Mukeba-Tshialala D; Vaira D; Moutschen M
Source: Revue Medicale De Liege. 2009 Jan;64(1):32-6.
Abstract: Despite a relative global stabilization of its incidence, HIV infection remains a major threat for public health, principally in Africa where it concerns more than 22 million people and constitutes the first cause of death on the continent. To face the emergency of the HIV/AIDS epidemics on the African continent, the primary goal is to make available to all patients free and efficient antiretroviral medications. Such a goal cannot be dissociated from large scale prevention campaigns. In 2000, Triomune, one of the first fixed dose combinations of three antiretrovirals (stavudine, lamivudine & nevirapine) was launched by the Indian drug company Cipla, specialized in the production of low cost medications. Its convenient pill burden (one pill twice a day) and its very low cost (around 30 US $ per month) make Triomune an appealing solution for the treatment of HIV/AIDS in Africa. Unfortunately, Triomune presents several drawbacks (low genetic barrier, frequent side effects) and one of its constituents is not used in Europe anymore. Other first line treatments are urgently needed.
Language: French
Keywords:
AFRICA | RESEARCH REPORT | INCIDENCE | LOW INCOME POPULATION | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL DRUGS | HIV INFECTIONS | FEES | NEEDS ASSESSMENT | PREVENTION AND CONTROL | TREATMENT | PROGRAM ACCESSIBILITY | Developing Countries | Measurement | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Financial Activities | Evaluation | Program Evaluation | Programs | Organization and Administration
Document Number: 341155

23.

Peer Reviewed

Title: Loss of population levels of immunity to malaria as a result of exposure-reducing interventions: consequences for interpretation of disease trends.
Author: Ghani AC; Sutherland CJ; Riley EM; Drakeley CJ; Griffin JT; Gosling RD; Filipe JA
Source: PLoS One. 2009;4(2):e4383.
Abstract: BACKGROUND: The persistence of malaria as an endemic infection and one of the major causes of childhood death in most parts of Africa has lead to a radical new call for a global effort towards eradication. With the deployment of a highly effective vaccine still some years away, there has been an increased focus on interventions which reduce exposure to infection in the individual and -by reducing onward transmission-at the population level. The development of appropriate monitoring of these interventions requires an understanding of the timescales of their effect. METHODS & FINDINGS: Using a mathematical model for malaria transmission which incorporates the acquisition and loss of both clinical and parasite immunity, we explore the impact of the trade-off between reduction in exposure and decreased development of immunity on the dynamics of disease following a transmission-reducing intervention such as insecticide-treated nets. Our model predicts that initially rapid reductions in clinical disease incidence will be observed as transmission is reduced in a highly immune population. However, these benefits in the first 5-10 years after the intervention may be offset by a greater burden of disease decades later as immunity at the population level is gradually lost. The negative impact of having fewer immune individuals in the population can be counterbalanced either by the implementation of highly-effective transmission-reducing interventions (such as the combined use of insecticide-treated nets and insecticide residual sprays) for an indefinite period or the concurrent use of a pre-erythrocytic stage vaccine or prophylactic therapy in children to protect those at risk from disease as immunity is lost in the population. CONCLUSIONS: Effective interventions will result in rapid decreases in clinical disease across all transmission settings while population-level immunity is maintained but may subsequently result in increases in clinical disease many years later as population-level immunity is lost. A dynamic, evolving intervention programme will therefore be necessary to secure substantial, stable reductions in malaria transmission.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | MATHEMATICAL MODEL | MALARIA | TIME FACTORS | EXPOSURE | TRANSMISSION | INTERVENTIONS | MONITORING | PROGRAM EVALUATION | Developing Countries | Theoretical Models | Research Methodology | Parasitic Diseases | Diseases | Population Dynamics | Demographic Factors | Population | Risk Factors | Health | Infections | Programs | Organization and Administration | Evaluation
Document Number: 331039

24.

Peer Reviewed

Title: How to contain generalized HIV epidemics? A plea for better evidence to displace speculation.
Author: Gisselquist D; Potterat JJ; St Lawrence JS; Hogan M; Arora NK; Correa M; Dinsmore WW; Mehta G; Millogo J; Muth SQ; Okinyi M; Ounga T
Source: International Journal of STD and AIDS. 2009 Jul;20(7):443-6.
Abstract: In the worst generalized HIV epidemics in East and Southern Africa, from one-quarter to three-quarters of women aged 15 years can expect to be living with HIV or to have died with AIDS by age 40 years. This disaster continues in the face of massive HIV prevention programmes based on current inexact knowledge of HIV transmission pathways and risks. To stop this disaster, both the public and public health experts need better information about the specific factors that allow HIV to propagate so extensively in countries with generalized epidemics. This knowledge could be acquired by tracing HIV infections to their source - especially tracing HIV infections in women of all ages, and tracing unexplained HIV infections in children with HIV-negative mothers.
Language: English
Keywords:
AFRICA | CRITIQUE | EPIDEMIOLOGIC METHODS | HIV INFECTIONS | AIDS | EPIDEMICS | GOALS | NEEDLE PIERCING | BLOOD TRANSFUSION | HIV TRANSMISSION | HIV PREVENTION | MALE CIRCUMCISION | Developing Countries | Research Methodology | Viral Diseases | Diseases | Planning | Organization and Administration | Risk Behavior | Behavior | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 342830

25.
Peer Reviewed

Title: A framework of sexual partnerships: risks and implications for HIV prevention in Africa.
Author: Green EC; Mah TL; Ruark A; Hearst N
Source: Studies In Family Planning. 2009 Mar;40(1):63-70.
Abstract: The global diversity of HIV epidemics can be explained in part by types and patterns of sexual partnerships. We offer a typology of sexual partnerships that corresponds to varying levels of HIV-transmission risk to help guide thinking about appropriate behavioral interventions, particularly in the epidemics of sub-Saharan Africa. Declines in HIV prevalence have been associated with reductions in numbers of sex partners, whereas many other prevention strategies have not been demonstrated to reduce HIV transmission at a population level. We suggest a reorientation of current prevention efforts, based on the epidemiology of sexually transmitted HIV epidemics and trends in sexual behavior change. Concurrent sexual partnerships are likely to play a large role in transmission dynamics in the generalized epidemics of East and Southern Africa, and should be addressed through improved behavior-change interventions.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | SEXUAL PARTNERS | MULTIPLE PARTNERS | HIV TRANSMISSION | SEXUALLY TRANSMITTED DISEASES | RISK REDUCTION BEHAVIOR | BEHAVIOR CHANGE | PROGRAM EVALUATION | Developing Countries | Sex Behavior | Behavior | HIV Infections | Viral Diseases | Diseases | Reproductive Tract Infections | Infections | Programs | Organization and Administration
Document Number: 341337

26.

Title: Letter to the editor of AIDS based on a recent paper by Rollins et al. 'there is no evidence for any specific age at which HIV-positive mothers in Africa should be advised to stop breastfeeding' [letter]
Author: Greiner T
Source: AIDS. 2009 Feb 20;23(4):547-8.
Abstract: The authors attempted to convince sample mothers that they should stop breastfeeding at 6 months, implying that all had access to nutritious foods for their infants. The assumption that doing so would lead to increased rates of HIV-free survival seems to be justified by their data. However, if poorer mothers are the ones who opt to breastfeed longer, wemust be very careful in assuming that their infants will have the same outcomes as those who opt to breastfeed for shorter periods. This is especially true in South Africa where fears of stigma may be less of a factor explaining the continuation of breastfeeding beyond 6 months than poverty, at least compared with other African countries. Thus, WHO no longer recommends attempting to convince all HIV� mothers to stop breastfeeding at 6months: 'At 6months, if replacement feeding is still not acceptable, feasible, affordable, sustainable and safe, continuation of breastfeeding with additional complementary foods is recommended, while the mother and baby continue to be regularly assessed (http://whqlibdoc. who.int/publications/2007/9789241595964_eng.pdf). Finally, while both the article and editorial mention, respectively, that HAART treatment of eligible mothers and antiretroviral therapy (ART) prophylaxis are likely to reduce postnatal HIV transmission, the former is now increasingly available in Africa, making generalization from this study even more difficult. (excerpt)
Language: English
Keywords:
AFRICA | CRITIQUE | CLINICAL RESEARCH | MOTHERS | PERSONS LIVING WITH HIV/AIDS | WOMEN IN DEVELOPMENT | BREASTFEEDING | TIME FACTORS | HIV PREVENTION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | BREASTFEEDING, EXCLUSIVE | RISK ASSESSMENT | COUNSELING | SOCIOECONOMIC STATUS | POVERTY | Developing Countries | Research Methodology | Parents | Family Relationships | Family Characteristics | Family and Household | Sociocultural Factors | HIV Infections | Viral Diseases | Diseases | Economic Development | Economic Factors | Infant Nutrition | Nutrition | Health | Population Dynamics | Demographic Factors | Population | Disease Transmission Control | Prevention and Control | Evaluation | Clinic Activities | Program Activities | Programs | Organization and Administration | Socioeconomic Factors
Document Number: 341158

27.

Peer Reviewed

Title: Community response to intermittent preventive treatment of malaria in infants (IPTi) delivered through the expanded programme of immunization in five African settings.
Author: Gysels M; Pell C; Mathanga DP; Adongo P; Odhiambo F; Gosling R; Akweongo P; Mwangi R; Okello G; Mangesho P; Slutsker L; Kremsner PG; Grobusch MP; Hamel MJ; Newman RD; Pool R
Source: Malaria Journal. 2009 Aug 10;8(1):191.
Abstract: ABSTRACT: BACKGROUND: IPTi delivered through EPI has been shown to reduce the incidence of clinical malaria by 20-59%. However, new health interventions can only be effective if they are also socially and culturally acceptable. It is also crucial to ensure that attitudes to IPTi do not negatively influence attitudes to and uptake of immunization, or that people do not misunderstand IPTi as immunization against malaria and neglect other preventive measures or delay treatment seeking. METHODS: These issues were studied in five African countries in the context of clinical trials and implementation studies of IPTi. Mixed methods were used, including structured questionnaires (1,296), semi-structured interviews (168), in-depth interviews (748) and focus group discussions (95) with mothers, fathers, health workers, community members, opinion leaders, and traditional healers. Participant observation was also carried out in the clinics. RESULTS: IPTi was widely acceptable because it resonated with existing traditional preventive practices and a general concern about infant health and good motherhood. It also fit neatly within already widely accepted routine vaccination. Acceptance and adherence were further facilitated by the hierarchical relationship between health staff and mothers and by the fact that clinic attendance had a social function for women beyond acquiring health care. Type of drug and regimen were important, with newer drugs being seen as more effective, but potentially also more dangerous. Single dose infant formulations delivered in the clinic seem to be the most likely to be both acceptable and adhered to. There was little evidence that IPTi per se had a negative impact on attitudes to EPI or that it had any affect on EPI adherence. There was also little evidence of IPTi having a negative impact on health seeking for infants with febrile illness or existing preventive practices. CONCLUSIONS: IPTi is generally acceptable across a wide range of settings in Africa and involving different drugs and regimens, though there is a strong preference for a single dose infant formulation. IPTi does not appear to have any negative effect on attitudes to EPI, and it is not interpreted as immunization against malaria.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | CLINICAL TRIALS | INCIDENCE | INFANT HEALTH | SAFE MOTHERHOOD | MATERNAL HEALTH | MALARIA | IMMUNIZATION | PREVENTIVE HEALTH CARE | PROGRAM ACCEPTABILITY | Developing Countries | Clinical Research | Research Methodology | Measurement | Child Health | Health | Parasitic Diseases | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration
Document Number: 342542

28.

Peer Reviewed

Title: Errors in 'BED'-derived estimates of HIV incidence will vary by place, time and age.
Author: Hallett TB; Ghys P; Barnighausen T; Yan P; Garnett GP
Source: PloS One. 2009;4(5):e5720.
Abstract: BACKGROUND: The BED Capture Enzyme Immunoassay, believed to distinguish recent HIV infections, is being used to estimate HIV incidence, although an important property of the test--how specificity changes with time since infection--has not been not measured. METHODS: We construct hypothetical scenarios for the performance of BED test, consistent with current knowledge, and explore how this could influence errors in BED estimates of incidence using a mathematical model of six African countries. The model is also used to determine the conditions and the sample sizes required for the BED test to reliably detect trends in HIV incidence. RESULTS: If the chance of misclassification by BED increases with time since infection, the overall proportion of individuals misclassified could vary widely between countries, over time, and across age-groups, in a manner determined by the historic course of the epidemic and the age-pattern of incidence. Under some circumstances, changes in BED estimates over time can approximately track actual changes in incidence, but large sample sizes (50,000+) will be required for recorded changes to be statistically significant. CONCLUSIONS: The relationship between BED test specificity and time since infection has not been fully measured, but, if it decreases, errors in estimates of incidence could vary by place, time and age-group. This means that post-assay adjustment procedures using parameters from different populations or at different times may not be valid. Further research is urgently needed into the properties of the BED test, and the rate of misclassification in a wide range of populations.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | ESTIMATION TECHNIQUES | MATHEMATICAL MODEL | HIV INFECTIONS | IMMUNOLOGICAL EFFECTS | INCIDENCE | TESTING | LABORATORY PROCEDURES | ERROR SOURCES | TIME FACTORS | Developing Countries | Research Methodology | Theoretical Models | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology | Measurement | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics | Demographic Factors | Population
Document Number: 342159

29.

Title: CULTURE AND GENETIC SCREENING IN AFRICA.
Author: Jegede AS
Source: Developing World Bioethics. 2009 Aug 3;
Abstract: Africa is a continent in transition amidst a revival of cultural practices. Over previous years the continent was robbed of the benefits of medical advances by unfounded cultural practices surrounding its cultural heritage. In a fast moving field like genetic screening, discussions of social and policy aspects frequently need to take place at an early stage to avoid the dilemma encountered by Western medicine. This paper, examines the potential challenges to genetic screening in Africa. It discusses how cultural practices may affect genetic screening. It views genomics science as a culture which is trying to diffuse into another one. It argues that understanding the existing culture will help the diffusion process. The paper emphasizes the importance of genetic screening for Africa, by assessing the current level of burden of diseases in the continent and shows its role in reducing disease prevalence. The paper identifies and discusses the cultural challenges that are likely to confront genetic screening on the continent, such as the worldview, rituals and taboos, polygyny, culture of son preference and so on. It also discusses cultural practices that may promote the science such as inheritance practices, spouse selection practices and naming patterns. Factors driving the cultural challenges are identified and discussed, such as socialization process, patriarchy, gender, belief system and so on. Finally, the paper discusses the way forward and highlights the ethical considerations of doing genetic screening on the continent. However, the paper also recognizes that African culture is not monolithic and therefore makes a case for exceptions.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | ETHICS | GENETICS | INFORMED CONSENT | RESEARCH AND DEVELOPMENT | Developing Countries | Sociocultural Factors | Biology | Health Services | Delivery of Health Care | Health | Technology | Economic Factors
Document Number: 342535

30.


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