1.  Peer Reviewed Title: A new agenda for children affected by HIV/AIDS [editorial] Source: Lancet. 2009 Feb 14;373(9663):517. Abstract: As is so often the case in the provision of health care and deciding research agendas, children have been sidelined in the fight against HIV/AIDS. According to the latest UNAIDS figures, nearly 2 million children live with HIV worldwide, two-thirds in sub-Saharan Africa. In addition, 12 million children in sub-Saharan Africa have lost one or two parents due to HIV/AIDS. Many more live with a parent or carer with HIV. A very small proportion of infected children receive antiretroviral treatment, and prevention of mother-to-child transmission is only given to a third of women. Diagnosis in infancy is difficult and therefore often delayed. Child-friendly medication is lacking. 60% of children in southern Africa live in poverty. Now that HIV/AIDS is evolving from an acute emergency into a chronic epidemic, the way to deliver treatment and achieve prevention needs to change radically from an individualistic approach to a broader strategic one. Children and families need to take centre stage. In an excellent report, based on 2 years of research and analyses, the Joint Learning Initiative on Children and HIV/AIDS-an independent alliance of researchers, implementers, activists, policy makers, and people living with HIV-has presented recommendations for such a change in direction. Home Truths: Facing the Facts on Children, AIDS, and Poverty, released on Feb 10, points out three broad policies that will make an immediate and long lasting difference to children: support children through immediate or extended families and deliver integrated family-centred services; strengthen community action to support families; and address family poverty through national social protection. Such policies are AIDS-sensitive but not AIDS-directed. The family is the most important support structure for children. The report argues that the way orphans have been defined (as having lost one or both parents) and have become the centre of attention for many HIV/AIDS policies has been unhelpful, if not damaging. 88% of children labelled as orphans have a surviving parent and overall 95% continue to live with extended families. Additionally, children who live with HIV-positive parents have needs long before their parents die. Children need to stay within a family or kinship structure. Infected children usually live with others who are infected with the virus. The whole family, not the individual, needs to become the unit for support and treatment. The report advocates home health visiting and early childhood development interventions together with strategies to encourage children's education. The use of schools as intervention platforms misses the opportunity to reach children early and to reach those who are not in education-the majority in some countries. Economic strengthening of families has to be the basis to allow many of these programmes to fully succeed. The best immediate support for families is given by com munity groups. International donors need to work with these groups in partnership to avoid duplication, confusion, and waste of time and money. The authors suggest that coordination could be strengthened with a district committee that maintains an active register of community activities and devises a system of accountability that is understood by all and serves the com munity. All activities should be delivered within a framework that is based on best practice. Communities also have a crucial role to act as a backstop when families break down or when children live in an abusive environment. Family poverty and undernutrition can be addressed through income-transfer programmes, such as Mexico's Oportunidades programme or South Africa's child support grants. These projects are efficient and simple, empower women, and can act as a springboard for other more complex schemes, such as microfinance loans. Such economic support increases school attendance, reduces illnesses, improves growth, and encourages uptake of health services. The largest portion of money is usually used to purchase food. Extreme poverty, rather than HIV infection, should be used as a criterion to avoid stigma and resentment. The report argues that "any developing country, no matter how poor, can afford social protection packages for children". The positive effect of this policy is now established beyond doubt and no further pilot studies are needed. To integrate all these strategies, governments need to take the lead with national plans and frameworks to scale-up programmes for children and families. With this approach, society as a whole will be strengthened with intergenerational effects that will go a long way towards, but also go well beyond, tackling the effects of HIV/AIDS. Putting children and families at the centre will show long-term vision with guaranteed future benefits. (fulll-text) Language: English Keywords: AFRICA, SUB SAHARAN | SUMMARY REPORT | CHILDREN | HIV INFECTIONS | AIDS | POVERTY | MALNUTRITION | CHILD HEALTH | HEALTH SERVICES | DELIVERY OF HEALTH CARE | TREATMENT | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Socioeconomic Factors | Economic Factors | Nutrition Disorders | Health | Medical Procedures | Medicine Document Number: 341049 |
2.  Title: Starting with the classroom: updating family planning knowledge in East Africa. Author: IntraHealth International. Capacity Project Source: Chapel Hill, North Carolina, IntraHealth International, Capacity Project, 2009 Feb. [2] p. (Voices No. 28) Abstract: In Kenya, a dedicated midwifery tutor is working hard to train students at Aga Khan University but worries that he isn't teaching them the latest information and techniques. Many of his fellow instructors are in the same situation. "We had our last refresher training ten years ago," he laments. In Tanzania, a midwifery tutor from Tumaini University Faculty of Nursing observes, "Many nurses who are providing service have never been updated on new issues [in family planning]. It will be our responsibility to see how we can help as a training institution because we will send our students to some of these clinics." To build instructors' capacity and address the knowledge gaps, the Capacity Project partnered with East, Central and Southern Africa (ECSA) Health Community and Africa's Health in 2010 to deliver a week-long workshop on Contemporary Issues in Family Planning for midwifery tutors in Kenya, Tanzania and Uganda. Held in Dar es Salaam in April 2008, the workshop updated the knowledge of 22 tutors and enabled them to teach their students more effectively. A quantitative and qualitative evaluation showed the workshop to be highly successful. Average scores climbed from 58% on the pre-test to 81% on the post-test. Additionally, 94% reported that they have used the workshop information and resources to update their colleagues. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | PROGRESS REPORT | EVALUATION | MIDWIVES AND MIDWIFERY | NURSE-MIDWIVES | FAMILY PLANNING EDUCATION | SEX EDUCATION | USAID | CAPACITY BUILDING | WORKSHOPS | CONTRACEPTION | MATERNAL-CHILD HEALTH SERVICES | PERFORMANCE IMPROVEMENT | AUDIOVISUAL AIDS | Africa | Developing Countries | Health Personnel | Delivery of Health Care | Health | Education | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Program Sustainability | Programs | Organization and Administration | Family Planning | Primary Health Care | Health Services | Management | Educational Methods | Educational Activities Document Number: 325236 |
| 4. Title: Post-traumatic stress disorder (PTSD) after stigma related events in HIV infected individuals in Nigeria. Author: Adewuya AO; Afolabi MO; Ola BA; Ogundele OA; Ajibare AO; Oladipo BF; Fakande I Source: Social Psychiatry and Psychiatric Epidemiology. 2009 Sep;44(9):761-6. Abstract: BACKGROUND: One of the most distressing concerns of many people living with HIV in sub-Saharan Africa is the stigma. Intense stigma may be traumatic. This study aimed to investigate the probability and correlates of Posttraumatic stress disorder (PTSD) following intense stigmatizing events and situations in HIV infected individuals in Nigeria. METHODS: Adult sero-positive attendees of an HIV care centre (N = 190) completed questionnaires regarding sociodemographic and clinical details; the 12-item General Health Questionnaire (GHQ-12) and the Rosenberg's Self-Esteem Scale. The clients were then interviewed for the presence of stigma related PTSD with a modified version of the mini international neuropsychiatry interview (MINI). RESULTS: About 2/3 of the participants had experienced at least an intense HIV-related stigmatizing event or situation. The rate of HIV-stigma related PTSD was 27.4%. Independent predictors of HIV stigma-related PTSD included past history of traumatic events (Single event, OR 2.28, 95% CI 1.08-4.73; Multiple events, OR 9.47, 95% CI 2.97-32.20), low self esteem (OR 6.52, 95% CI 2.59-16.55), poor level of social support (OR 3.33, 95% CI 1.24-9.79) and presence of general psychopathology (OR 2.18, 95% CI 1.07-4.44). CONCLUSION: PTSD may not be specific to traumatic events alone. There is a possibility of PTSD after an intense stigmatizing event or situation. While the validity for the validity of HIV-stigma related PTSD warrants further investigation, stigma needs to be considered when planning rehabilitation strategies for HIV infected individuals in sub-Saharan Africa. A closer attention to self esteem, level of social support and presence of psychopathology is needed in these individuals. Language: English Keywords: AFRICA, SUB SAHARAN | NIGERIA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | STRESS | STIGMA | ANXIETY DISORDERS | HIV INFECTIONS | Africa | Developing Countries | Africa, Western | Viral Diseases | Diseases | Psychological Factors | Behavior | Social Problems | Sociocultural Factors Document Number: 342917 |
| 5. Title: Intimate partner violence and contraception use among women in Sub-Saharan Africa. Author: Alio AP; Daley EM; Nana PN; Duan J; Salihu HM Source: International Journal of Gynaecology and Obstetrics. 2009 May 28; Abstract: OBJECTIVE: To determine the association between contraceptive use and intimate partner violence (IPV) in Sub-Saharan African women. METHOD: The data analyzed were from national Demographic Health Surveys conducted between 2003 and 2006 in 6 Sub-Saharan African countries: Cameroon, Kenya, Malawi, Rwanda, Uganda, and Zimbabwe. Women of childbearing age completed surveys regarding the use of contraception and about their experience of physical, emotional, and sexual violence inflicted by their partners. Analyses were conducted using logistic regression. RESULTS: Of the 24311 women who responded to the violence modules, 39.8% reported that they had experienced IPV. Women who had experienced IPV were significantly more likely to report that they had used contraception compared with women who had not experienced IPV (odds ratio 1.30; 95% confidence interval, 1.22-1.38). CONCLUSION: Intimate partner violence appears to be associated with increased contraception use in the African setting. Among women who have experienced IPV, modern contraception is used more commonly than traditional and folkloric contraceptive methods. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | WOMEN | DOMESTIC VIOLENCE | CONTRACEPTIVE USAGE | INTERVIEWS | PHYSICAL ABUSE | PSYCHOLOGICAL ABUSE | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Crime | Social Problems | Sociocultural Factors | Contraception | Family Planning | Data Collection | Research Methodology | Violence | Behavior | Aggression Document Number: 341449 |
| 6. Peer Reviewed Title: Increasing the acceptability of HIV counseling and testing with three C's: convenience, confidentiality and credibility. Author: Angotti N; Bula A; Gaydosh L; Kimchi EZ; Thornton RL; Yeatman SE Source: Social Science and Medicine. 2009 Jun;68(12):2263-70. Abstract: Agencies engaged in humanitarian efforts to prevent the further spread of HIV have emphasized the importance of voluntary counseling and testing (VCT), and most high-prevalence countries now have facilities that offer testing free of charge. The utilization of these services is disappointingly low, however, despite high numbers reporting that they would like to be tested. Explanations of this discrepancy typically rely on responses to hypothetical questions posed in terms of psychological or social barriers; often, the explanation is that people fear learning that they are infected with a disease that they understand to be fatal and stigmatizing. Yet when we offered door-to-door rapid blood testing for HIV as part of a longitudinal study in rural Malawi, the overwhelming majority agreed to be tested and to receive their results immediately. Thus, in this paper, we ask: why are more people not getting tested? Using an explanatory research design, we find that rural Malawians are responsive to door-to-door HIV testing for the following reasons: it is convenient, confidential, and the rapid blood test is credible. Our study suggests that attention to these factors in VCT strategies may mitigate the fear of HIV testing, and ultimately increase uptake in rural African settings. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | PREVALENCE | LONGITUDINAL STUDIES | RURAL POPULATION | HIV TESTING | VOLUNTARY COUNSELING AND TESTING | FEAR | Africa | Developing Countries | Measurement | Research Methodology | Studies | Population Characteristics | Demographic Factors | Population | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Emotions | Psychological Factors | Behavior Document Number: 342741 |
| 7. Title: Condom use for preventing STI/HIV and unintended pregnancy among young men in sub-saharan Africa. Author: Bankhole A; Singh S; Hussain R; Oestreicher G Source: American Journal of Men's Health. 2009 Mar;3(1):60-78. Abstract: The condom is the only known method that provides simultaneous protection against unplanned pregnancy and some sexually transmitted infections (STIs), including HIV, among sexually active people. Using data from the Demographic and Health Surveys from 18 Sub-Saharan African countries, this study examined condom use and reasons for using the method at last intercourse among sexually active young men aged 15 to 29. Most young men were aware of the condom (73%-98%), but its use at last intercourse was quite variable, ranging from 6% in Madagascar to 74% in Namibia. In 10 countries, more young men reportedly used condoms for preventing STIs alone than they did for preventing pregnancy alone. In 6 countries, at least one third of the users used the method for both purposes. Use of the condom at last intercourse was associated with union status, education, residence, and exposure to television in at least two thirds of the countries. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | KAP SURVEYS | DEMOGRAPHIC AND HEALTH SURVEYS | CROSS-CULTURAL COMPARISONS | YOUTH | MEN | CONDOM USE | SEXUALLY TRANSMITTED DISEASE PREVENTION | HIV PREVENTION | PREGNANCY, UNPLANNED | KNOWLEDGE | CONTRACEPTIVE PREVALENCE | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Comparative Studies | Age Factors | Population Characteristics | Risk Reduction Behavior | Behavior | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | HIV Infections | Viral Diseases | Reproductive Behavior | Fertility | Sociocultural Factors | Contraceptive Usage | Contraception | Family Planning Document Number: 329249 |
| 8. Peer Reviewed Title: "Conditional scholarships" for HIV/AIDS health workers: educating and retaining the workforce to provide antiretroviral treatment in sub-Saharan Africa. Author: Barnighausen T; Bloom DE Source: Social Science and Medicine. 2009 Feb;68(3):544-51. Abstract: Without large increases in the number of health workers to treat HIV/AIDS (HAHW) many countries in sub-Saharan Africa will be unable to achieve universal coverage with antiretroviral treatment (ART), leading to large numbers of avoidable deaths among people living with HIV/AIDS. We conduct a cost-benefit analysis of a health care education scholarship that is conditional on the recipient committing to work for several years after graduation delivering ART in sub-Saharan Africa. Such a scholarship could address two of the main reasons for the low numbers of health workers in sub-Saharan Africa: low education rates and high emigration rates. We use Markov Monte Carlo microsimulation to estimate the expected net present value (eNPV) of "conditional scholarships" in sub-Saharan Africa. The scholarships are highly eNPV-positive under a wide range of assumptions. Conditional scholarships for a HAHW team sufficient to provide ART for 500 patients have an eNPV of 1.24 million year-2000 US dollars, assuming that the scholarship recipients are in addition to the health workers who would have been educated without scholarships and that the scholarships reduce annual HAHW emigration probabilities from 15% to 5% for five years. The eNPV of the education effect of the scholarships is larger than eNPV of the migration effect. Policy makers should consider implementing "conditional scholarships" for HAHW, especially in countries where health worker education capacity is currently underutilized or can be rapidly expanded. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | MARKOV CHAIN | LABOR FORCE | HEALTH PERSONNEL | HUMAN RESOURCES | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | AIDS | COST BENEFIT ANALYSIS | MANAGEMENT | Africa | Developing Countries | Probability | Statistical Studies | Studies | Research Methodology | Economic Factors | Delivery of Health Care | Health | HIV | Viral Diseases | Diseases | Quantitative Evaluation | Evaluation | Organization and Administration Document Number: 330870 |
| 9. Peer Reviewed Title: Behavioral mechanisms in HIV epidemiology and prevention: past, present, and future roles. Author: Bingenheimer JB; Geronimus AT Source: Studies in Family Planning. 2009 Sep;40(3):187-204. Abstract: In the 1980’s behavioral variations across geographically and socially defined populations were the central focus of AIDS research, and behavior change was seen as the primary means of controlling HIV epidemics. Today, biological mechanisms-especially other sexually transmitted infections, antiretroviral therapy, and male circumcision-predominate in HIV epidemiology and prevention. We describe several reasons for this shift in emphasis. Although the shift is understandable, we argue for a sustained focus on behavioral mechanisms in HIV research in order to realize the theoretical promise of interventions targeting the biological aspects of HIV risk. We also provide evidence to suggest that large reductions in HIV prevalence may be accomplished by small changes in behavior. Moreover, we contend that behavioral mechanisms will find their proper place in HIV epidemiology and prevention only when investigators adopt a conceptual model that treats prevalence as a determinant as well as an outcome of behavior and that explicitly recognizes the dynamic interdependence between behavior and other epidemiological and demographic parameters. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | CROSS-CULTURAL COMPARISONS | EPIDEMIOLOGY | BEHAVIOR CHANGE | HIV INFECTIONS | RISK REDUCTION BEHAVIOR | HIV PREVENTION | ANTIRETROVIRAL THERAPY | MALE CIRCUMCISION | Africa | Developing Countries | Comparative Studies | Studies | Research Methodology | Public Health | Health | Behavior | Viral Diseases | Diseases | HIV | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 339701 |
| 10. Peer Reviewed Title: Polygyny and women's health in sub-Saharan Africa. Author: Bove R; Valeggia C Source: Social Science and Medicine. 2009 Jan;68(1):21-9. Abstract: In this paper we review the literature on the association between polygyny and women's health in sub-Saharan Africa. We argue that polygyny is an example of "co-operative conflict" within households, with likely implications for the vulnerability of polygynous women to illness, and for their access to treatment. We begin with a review of polygyny and then examine vulnerability to sexually transmitted infections (STIs, including HIV) and differential reproductive outcomes. Polygyny is associated with an accelerated transmission of STIs, both because it permits a multiplication of sexual partners and because it correlates with low rates of condom use, poor communication between spouses, and age and power imbalances among other factors. Female fertility is affected by the interplay between marital rank, household status, and cultural norms in polygynous marriages. Finally, we present areas which have received only cursory attention: mental health and a premature, "social" menopause. Although data are scarce, polygyny seems to be associated with higher levels of anxiety and depression, particularly around stressful life events. It is our hope that the examples reviewed here will help build a framework for mixed method quality research, which in turn can inform decision makers on more appropriate, context-dependent health policies. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | WOMEN | WOMEN'S HEALTH | MENTAL HEALTH | FERTILITY | POLYGYNY | HIV INFECTIONS | SEXUALLY TRANSMITTED DISEASES | Africa | Developing Countries | Demographic Factors | Population | Health | Population Dynamics | Marriage Patterns | Marriage | Nuptiality | Viral Diseases | Diseases | Reproductive Tract Infections | Infections Document Number: 331194 |
| 11. Peer Reviewed Title: Putting mental health on the agenda for HIV+ women: a review of evidence from sub-Saharan Africa. Author: Brandt R Source: Women and Health. 2009 Mar-May;49(2-3):215-28. Abstract: This article reviews the scientific literature regarding mental health services for poor HIV-infected women in sub-Saharan Africa and argues that they should constitute part of the healthcare agenda for these women. Key evidence points to the growing feminization of the HIV epidemic, as well as the differential social and economic impact of HIV on women. Further, HIV and poverty, both disproportionately affecting women, contribute independently and cumulatively to the risk for poor mental health. The limited empirical evidence regarding the mental health of this population is discussed. Multi-level psychosocial services, integrated within general health provision, are required to ensure long-term psychological benefits for HIV-infected women in the region. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | LITERATURE REVIEW | WOMEN | LOW INCOME POPULATION | PERSONS LIVING WITH HIV/AIDS | MENTAL HEALTH | HEALTH SERVICES | POVERTY | PROGRAM ACCESSIBILITY | Africa | Developing Countries | Demographic Factors | Population | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | HIV Infections | Viral Diseases | Diseases | Health | Delivery of Health Care | Program Evaluation | Programs | Organization and Administration Document Number: 342427 |
| 12. Title: Placental malaria, maternal HIV infection and infant morbidity. Author: Briand V; Badaut C; Cot M Source: Annals of Tropical Paediatrics. 2009 Jun;29(2):71-83. Abstract: Co-infection with malaria and HIV in pregnant women is particularly common in sub-Saharan Africa and has serious consequences for both mother and newborn child. Numerous studies have been published on the effects in pregnancy of HIV on malaria infection and on the effects of malaria on HIV infection. The increased prevalence and intensity of parasitaemia (placental and peripheral infection and parasite density) in HIV-infected women is well established. Similarly, malaria infection seems to be associated with higher viral loads. However, there is still uncertainty as to the influence of malaria on the clinical course of HIV infection, mother-to-child transmission of HIV, and the consequences of co-infection on post-neonatal infant morbidity and mortality. These questions require further investigation. In terms of prevention, intermittent preventive treatment with two doses of sulfadoxine-pyrimethamine (SP) has been found less effective in preventing malaria in HIV-infected than uninfected women, and a higher dosage (such as monthly SP) has been recommended. Regarding malaria, there is also a lack of clear recommendations for women taking daily cotrimoxazole prophylaxis, and anti-malarial-anti-retroviral interactions are not well understood. Multi-centre clinical trials should be undertaken to investigate effective, coherent and well-tolerated strategies to prevent malaria in HIV-infected women. Safe alternatives to SP should be identified and evaluated rapidly. Finally, a central pharmaco-vigilance network should be instituted to report adverse effects. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | PREVALENCE | PREGNANT WOMEN | MALARIA | HIV INFECTIONS | MALARIA PREVENTION | RESEARCH AND DEVELOPMENT | NEEDS | MATERNAL HEALTH | MORBIDITY | Africa | Developing Countries | Measurement | Research Methodology | Population Characteristics | Demographic Factors | Population | Parasitic Diseases | Diseases | Viral Diseases | Technology | Economic Factors | Health Document Number: 342065 |
| 13. Peer Reviewed Title: Mortality of HIV-infected patients starting antiretroviral therapy in sub-Saharan Africa: comparison with HIV-unrelated mortality. Author: Brinkhof MW; Boulle A; Weigel R; Messou E; Mathers C; Orrell C; Dabis F; Pascoe M; Egger M Author: International Epidemiological Databases to Evaluate AIDS (IeDEA) Source: PLoS Medicine. 2009 Apr 28;6(4):e1000066. Abstract: BACKGROUND: Mortality in HIV-infected patients who have access to highly active antiretroviral therapy (ART) has declined in sub-Saharan Africa, but it is unclear how mortality compares to the non-HIV-infected population. We compared mortality rates observed in HIV-1-infected patients starting ART with non-HIV-related background mortality in four countries in sub-Saharan Africa. METHODS AND FINDINGS: Patients enrolled in antiretroviral treatment programmes in Cote d'Ivoire, Malawi, South Africa, and Zimbabwe were included. We calculated excess mortality rates and standardised mortality ratios (SMRs) with 95% confidence intervals (CIs). Expected numbers of deaths were obtained using estimates of age-, sex-, and country-specific, HIV-unrelated, mortality rates from the Global Burden of Disease project. Among 13,249 eligible patients 1,177 deaths were recorded during 14,695 person-years of follow-up. The median age was 34 y, 8,831 (67%) patients were female, and 10,811 of 12,720 patients (85%) with information on clinical stage had advanced disease when starting ART. The excess mortality rate was 17.5 (95% CI 14.5-21.1) per 100 person-years SMR in patients who started ART with a CD4 cell count of less than 25 cells/microl and World Health Organization (WHO) stage III/IV, compared to 1.00 (0.55-1.81) per 100 person-years in patients who started with 200 cells/microl or above with WHO stage I/II. The corresponding SMRs were 47.1 (39.1-56.6) and 3.44 (1.91-6.17). Among patients who started ART with 200 cells/microl or above in WHO stage I/II and survived the first year of ART, the excess mortality rate was 0.27 (0.08-0.94) per 100 person-years and the SMR was 1.14 (0.47-2.77). CONCLUSIONS: Mortality of HIV-infected patients treated with combination ART in sub-Saharan Africa continues to be higher than in the general population, but for some patients excess mortality is moderate and reaches that of the general population in the second year of ART. Much of the excess mortality might be prevented by timely initiation of ART. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | COMPARATIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | DEATH RATE | EXCESS MORTALITY | RISK FACTORS | Africa | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Mortality | Population Dynamics | Demographic Factors | Population | Health Document Number: 341677 |
| 14. Peer Reviewed Title: Surgical task shifting in Sub-Saharan Africa. Author: Chu K; Rosseel P; Gielis P; Ford N Source: PLoS Medicine. 2009 May 19;6(5):e1000078. Abstract: Surgically treatable problems account for a significant proportion of disease burden in resourcelimited settings, but are neglected due to lack of skilled professionals, adequate infrastructure and equipment, and the perception that surgical services are complex and expensive. In the absence of trained surgeons, surgical tasks are often performed by non-specialist physicians and non-physician clinicians. While evaluations have proven the effectiveness of such task shifting, this is often done de facto, with little supervisory or training framework in place. As efforts increase to scale up surgical care in the developing world, a number of important lessons from task shifting in the field of HIV/AIDS care could serve to support task shifting in surgery. These include clearly defining the limits of task shifting, ensuring adequate training and supervision, providing adequate recognition and remuneration, developing simplified tools and guidelines, ensuring engagement with regulatory bodies, and mobilizing community health workers. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | HEALTH PERSONNEL | SURGERY | ANESTHESIA | HUMAN RESOURCES | TRAINING PROGRAMS | AIDS | HIV INFECTIONS | REFERRAL AND CONSULTATION | SUPERVISION | ETHICS | Africa | Developing Countries | Delivery of Health Care | Health | Treatment | Medical Procedures | Medicine | Health Services | Economic Factors | Education | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Management | Sociocultural Factors Document Number: 341772 |
| 15. Title: Chronic viral hepatitis may diminish the gains of HIV antiretroviral therapy in sub-Saharan Africa. Author: Cooper CL; Mills E; Wabwire BO; Ford N; Olupot-Olupot P Source: International Journal of Infectious Diseases. 2009 May;13(3):302-6. Abstract: There is a heavy burden of HIV-hepatitis B virus (HBV) and HIV-hepatitis C virus (HCV) co-infection in many regions of the developing world. An often unmentioned illness, issues of poverty, socio-economic status, nutrition, access to medical care, and mistrust of Western-style medicine conspire to reduce the opportunity to receive clinical work-up and treatment for chronic viral hepatitis. We discuss key issues specific to the treatment of viral hepatitis and obstacles to success with this endeavor in the context of HIV co-infection in Africa. We predict that provision of viral hepatitis antiviral therapy will become a more pressing issue as more HIV-infected patients receive lifesaving combination antiretroviral therapy only to succumb thereafter from viral hepatitis-induced liver disease. Given the lessons learned from combination antiretroviral rollout in sub-Saharan Africa, establishing expertise and infrastructure for viral hepatitis care and antiviral therapy is relevant. Failure to act now may diminish the milestones and the gains made with antiretroviral therapy in the developing world. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | SIDE EFFECTS | HEPATIC EFFECTS | TOXICITY | HEPATITIS | ANTIVIRAL DRUGS | OBSTACLES | SCREENING | Africa | Developing Countries | HIV | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Physiology | Biology | Drugs | Organization and Administration | Examinations and Diagnoses Document Number: 342111 |
| 16. Title: HIV in adolescents in sub-Saharan Africa. Author: Cowan F; Pettifor A Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):288-93. Abstract: The authors summarize existing evidence on the effectiveness of different intervention approaches to HIV prevention in adolescents. They focus on studies that are either from or are relevant to sub-Saharan Africa. In addition, they include a brief review of other issues relevant to HIV prevention research in adolescents. Although numerous adolescent behavioral HIV prevention interventions have been evaluated, few have assessed their impact on HIV endpoints or been undertaken in Africa. In the three trials from Africa, which had HIV endpoints, none of the interventions had an impact on HIV, although all affected some knowledge and attitudes and reported behaviors. In one of these trials, there was a borderline effect on herpes simplex virus-2 incidence. Adolescents have typically been excluded from trials of biological interventions, although they are likely to benefit from these interventions if found to be effective. Despite the regulatory difficulties, they must be considered for inclusion in these trials as an important target population. Language: English Keywords: AFRICA, SUB SAHARAN | LITERATURE REVIEW | ADOLESCENTS | HIV PREVENTION | INTERVENTIONS | PROGRAM EFFECTIVENESS | KNOWLEDGE | ATTITUDES | SEX BEHAVIOR | BEHAVIOR CHANGE | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Programs | Organization and Administration | Program Evaluation | Sociocultural Factors | Psychological Factors | Behavior Document Number: 342339 |
| 17. Peer Reviewed Title: Intensified case finding for tuberculosis in prevention of mother-to-child transmission programs: a simple and potentially vital addition for maternal and child health. Author: Deluca A; Chaisson RE; Martinson NA Source: JAIDS. Journal of Acquired Immune Deficiency Syndromes. 2009 Feb 1;50(2):196-9. Abstract: The intersection of HIV and tuberculosis (TB) poses a serious threat to HIV-infected women and their children. The majority of patients with TB in sub-Saharan Africa are infected with HIV, and together the overlapping epidemics synergistically accelerate illness and death. Escalating case rates, increased mortality, and the recent emergence of extensively drug-resistant TB highlights how catastrophic a once preventable and curable disease has become among people with HIV/AIDS. The HIV epidemic requires new strategies to control TB in high-burden areas especially as women of reproductive age are disproportionately affected by the epidemic. Intensified case finding for TB has the potential to reduce morbidity and mortality for people living with HIV, especially pregnant women, their families, and infants. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | LITERATURE REVIEW | RECOMMENDATIONS | CLINICAL RESEARCH | PERSONS LIVING WITH HIV/AIDS | TUBERCULOSIS | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | COMPLICATIONS | INTEGRATED PROGRAMS | PREVALENCE | INCIDENCE | Africa | Developing Countries | Research Methodology | Persons Living With HIV/AIDS | HIV Infections | Viral Diseases | Diseases | Infections | Disease Transmission Control | Prevention and Control | Programs | Organization and Administration | Measurement Document Number: 330367 |
| 18. Peer Reviewed Title: Preventing HIV among adolescents in Sub-Saharan Africa. Author: DiClemente RJ; Crosby RA Source: Journal of Adolescent Health. 2009 Feb;44(2):101-102. Abstract: The prospect of HIV infection remains one of the most significant public health risks facing adolescents. Twenty-five percent of all global HIV infections occur among people between the ages of 15 and 24 years, with new infections among some subgroups reaching record proportions. Sub-Saharan Africa has been disproportionately impacted by the HIV epidemic, as approximately threequarters of all youth living with HIV/AIDS reside there with HIV the leading cause of death among adolescents/ young adults 15 to 29 years old. Sub-Saharan Africa is a richly diverse mosaic of nations, cultures, traditions, customs, languages, and religions. Likewise, the HIV epidemic is fueled by concurrent epidemics of poverty, internecine conflict, deeply embedded cultural practices, and of course, other prevalent diseases. Understanding the full spectrum of issues and subsequently creating efficacious HIV risk-reduction interventions for sub-Saharan adolescents will require intensified research efforts. The articles in this issue of the Journal of Adolescent Health shed light on factors that drive the HIV epidemic, and offer promise for designing prevention programs. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | ADOLESCENTS | HIV PREVENTION | NEEDS ASSESSMENT | COUNSELING | HIV TESTING | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Evaluation | Clinic Activities | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330165 |
| 19. Title: [Czech model for decrease of maternal mortality in Uganda] Cesky model pro snizeni materske umrtnosti v Ugande. Author: Donat J Source: Casopis Lekaru Ceskych. 2009;148(7):338-41. Abstract: High maternal and perinatal mortality is the leading problem of the health care in developing countries of Sub-Saharan Africa, including Uganda. The main condition for decrease of maternal mortality is availability of an emergency obstetrical care in hospital accompanied by skilled team of specialists (gynaecologist, anaesthesiologist, paediatrician), which are able to treat all obstetrical complications and provide an intensive care to risk newborns. The Czech Hospital and School for midwives in Uganda was founded and build with the aim to accomplish a grant project for the decrease of maternal, perinatal and child mortality. Our project to connect emergency obstetrical care in hospital to villages and traditional delivery attendants by mobile phones shows a simple and original model, which can help to decrease maternal mortality in Uganda and in the other countries of Sub-Saharan Africa as well. The Czech-Uganda Hospital started its work on 19th February 2007 with a team of Slovak doctors; however, till now, after 2 years of work, it doesn't fulfil its role of a specialised obstetrical department, which would be able to join its partners in villages and start the grant project for decrease of maternal and perinatal mortality. Language: Czech Keywords: UGANDA | AFRICA, SUB SAHARAN | RESEARCH REPORT | MATERNAL MORTALITY | PERINATAL MORTALITY | EMERGENCY SERVICES | PREGNANCY COMPLICATIONS | MIDWIVES AND MIDWIFERY | PREVENTION AND CONTROL | Africa, Eastern | Africa | Developing Countries | Mortality | Population Dynamics | Demographic Factors | Population | Health Services | Delivery of Health Care | Health | Diseases | Health Personnel Document Number: 342652 |
| 20. Title: Women's rights and women's health during HIV/AIDS epidemics: the experience of women in sub-Saharan Africa. Author: Dugassa BF Source: Health Care For Women International. 2009 Aug;30(8):690-706. Abstract: Twenty-five years have passed since HIV/AIDS was recognized as a major public health problem. Although billions of dollars are spent in research and development, we still have no medical cure or vaccination. In the early days of the epidemic, public health slogans suggested that HIV/AIDS does not discriminate. Now it is becoming clear that HIV/AIDS spreads most rapidly among poor, marginalized, women, colonized, and disempowered groups of people more than others. The HIV/AIDS epidemic is exacerbated by the social, economic, political, and cultural conditions of societies such as gender, racial, class, and other forms of inequalities. Sub-Saharan African countries are severely hit by HIV/AIDS. For these countries the pandemic of HIV/AIDS demands the need to travel extra miles. My objective in this article is to promote the need to go beyond the biomedical model of "technical fixes" and the traditional public health education tools, and come up with innovative ideas and strategic thinking to contain the epidemic. In this article, I argue that containing the HIV/AIDS epidemic and improving family and community health requires giving appropriate attention to the social illnesses that are responsible for exacerbating biological disorders. Language: English Keywords: AFRICA, SUB SAHARAN | CRITIQUE | HIV INFECTIONS | AIDS | EPIDEMICS | WOMEN'S HEALTH | WOMEN'S RIGHTS | PUBLIC HEALTH | SOCIOECONOMIC FACTORS | HIV TRANSMISSION | MALNUTRITION | SOCIOCULTURAL FACTORS | Africa | Developing Countries | Viral Diseases | Diseases | Health | Human Rights | Political Factors | Economic Factors | Nutrition Disorders Document Number: 342818 |
| 21. Peer Reviewed Title: Population-level effect of potential HSV2 prophylactic vaccines on HIV incidence in sub-Saharan Africa. Author: Freeman EE; White RG; Bakker R; Orroth KK; Weiss HA; Buve A; Hayes RJ; Glynn JR Source: Vaccine. 2009 Feb 5;27(6):940-6. Abstract: Herpes simplex virus type-2 (HSV2) infection increases HIV transmission. We explore the impact of a potential prophylactic HSV2 vaccination on HIV incidence in Africa using STDSIM an individual-based model. A campaign that achieved 70% coverage over 5 years with a vaccine that reduced susceptibility to HSV2 acquisition and HSV2 reactivation by 75% for 10 years, reduced HIV incidence by 30-40% after 20 years (range 4-66%). Over 20 years, in most scenarios fewer than 100 vaccinations were required to avert one HIV infection. HSV2 vaccines could have a substantial impact on HIV incidence. Intensified efforts are needed to develop an effective HSV2 vaccine. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | INCIDENCE | HIV | HIV INFECTIONS | HIV PREVENTION | VACCINES | Africa | Developing Countries | Measurement | Research Methodology | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330823 |
| 22. Title: Early motherhood, high mortality, and HIV/AIDS rates in Sub-Saharan Africa. Author: Gant L; Heath KM; Ejikeme GG Source: Social Work In Public Health. 2009 Jan-Apr;24(1-2):39-46. Abstract: Despite billions of dollars devoted to HIV/AIDS prevention since 1990, rates of infection continue to climb worldwide, primarily through heterosexual contact, and Sub-Saharan Africa is the worst case scenario (UNAIDS, 2004). Traditional intervention programs based on the ABCs (abstinence, being faithful, and condom use) of safe sex practices have shown mixed success. Engaging in risky sexual behavior (behaviors not adhering to the ABCs of safe sex practices) continues to escalate the HIV/AIDS epidemic. Although research abounds with correlates to HIV/AIDS rates, few studies have addressed the basis of sexual behavior. Here we show that not only are HIV/AIDS rates significantly higher in Sub-Saharan Africa than in the rest of the world but also infant mortality rates and teenage birth rates are higher as well. Based on these findings, we argue that engaging in risky sexual behavior, in many circumstances associated with deplorable living conditions and high mortality, is the only viable option for avoiding reproductive failure: dying without leaving surviving descendents. We suggest that initiatives that improve overall health and living conditions in the at-risk populations are necessary before traditional intervention programs can effectively combat the spread of HIV/AIDS in Sub-Saharan Africa. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | STATISTICAL STUDIES | HIV INFECTIONS | AIDS | PREVALENCE | MORTALITY | LIFE EXPECTANCY | INFANT MORTALITY | AGE SPECIFIC FERTILITY RATE | ADOLESCENT PREGNANCY | SEX BEHAVIOR | Africa | Developing Countries | Studies | Research Methodology | Viral Diseases | Diseases | Measurement | Population Dynamics | Demographic Factors | Population | Length of Life | Fertility Rate | Birth Rate | Fertility Measurements | Fertility | Reproductive Behavior | Behavior Document Number: 341955 |
| 23. Peer Reviewed Title: Sex ratio at birth and family composition in sub-saharan Africa: inter-couple variations. Author: Garenne M Source: Journal of Biosocial Science. 2009 May;41(3):399-407. Abstract: In this study, sex ratios at birth (male/female births) were found to vary according to family composition. Using Demographic and Health Survey (DHS) maternity histories from sub-Saharan Africa, the study shows that the sex ratio at birth increases with the number of previous male births and decreases with the number of previous female births. For families with only males, the sex ratio increases from 1.046 for the first birth to 1.083 for the 8th birth. For families with only females, the sex ratio decreases from 1.046 for the first birth to 0.942 for the 8th birth. The differences were highly significant when tested with a linear logistic model (p=0.018 for males; p=1.85 x 10(-11) for females). The effect was not symmetrical, and was found to be significantly stronger for females. These effects could be reproduced assuming a strong heterogeneity between couples. The distribution of sex ratios was fitted with an asymmetrical log-gamma function, which revealed a wide range of variation in the sex ratio between 0.50 and 1.30, and a peak around 1.14. The results and their implications are discussed in the light of former findings in France and in the United States of America. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | STATISTICAL STUDIES | COUPLES | SEX RATIO | FAMILY CHARACTERISTICS | BIRTH HISTORY | Africa | Developing Countries | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Studies | Research Methodology | Family and Household | Sociocultural Factors | Sex Distribution | Sex Factors | Population Characteristics | Pregnancy History | Fertility Measurements | Fertility Document Number: 341403 |
| 24. 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 HIVtransmission 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, SUB SAHARAN | METHODOLOGICAL STUDIES | CLASSIFICATION | EPIDEMIOLOGIC METHODS | SEXUAL PARTNERS | MULTIPLE PARTNERS | HIV PREVENTION | RISK ASSESSMENT | BEHAVIOR CHANGE COMMUNICATION | EPIDEMIOLOGY | SEX BEHAVIOR | SAFER SEX | HUMAN GEOGRAPHY | Africa | Developing Countries | Studies | Research Methodology | Behavior | HIV Infections | Viral Diseases | Diseases | Evaluation | Communication Programs | Communication | Behavior Change | Public Health | Health | Geography | Social Sciences | Science | Sociocultural Factors Document Number: 341082 |
| 25. Peer Reviewed Title: Sexual behavior change in countries with generalised HIV epidemics? Evidence from population-based cohort studies in sub-Saharan Africa. Author: Gregson S; Todd J; Zaba B Source: Sexually Transmitted Infections. 2009 Apr;85(Suppl 1):i1-i2. Abstract: This introductory article describes the contents of the current issue which presents 10 recent analyses of sexual behaviour data from longitudinal studies in five countries-Uganda, Tanzania, Malawi, Zimbabwe and South Africa- experiencing different sizes and stages of the HIV epidemic. The results provide valuable information for use in evaluating trends in HIV epidemics and the impact of HIV prevention programmes. An underlying purpose of this is to highlight appropriate methods and to encourage better analysis and presentation of sexual behaviour data, especially as they relate to HIV and HIV prevention. Language: English Keywords: AFRICA, SUB SAHARAN | LITERATURE REVIEW | KAP SURVEYS | COHORT ANALYSIS | DEMOGRAPHIC AND HEALTH SURVEYS | LONGITUDINAL STUDIES | TARGET POPULATION | HIV TRANSMISSION | EPIDEMICS | SEX BEHAVIOR | RISK BEHAVIOR | SURVIVORSHIP | RISK FACTORS | Africa | Developing Countries | Surveys | Sampling Studies | Studies | Research Methodology | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Program Design | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Behavior | Length of Life | Mortality | Health Document Number: 340100 |
| 26. Peer Reviewed Title: Polygynous marital structure and child survivorship in sub-Saharan Africa: some empirical evidence from Ghana. Author: Gyimah SO Source: Social Science and Medicine. 2009 Jan;68(2):334-42. Abstract: Although studies have found children in married families to have better health outcomes than those in other family types, this strand of research implicitly views marriage as monolithic and, by default, monogamous as found in western industrialized societies. In polygynous cultures, there is a need to make a distinction between polygynous and monogamous families, because these marital arrangements might imply varying levels of parental support necessary for optimum child outcomes. Using pooled children's data from the 1998 and 2003 (N=4938) Ghana Demographic and Health Surveys, this study investigates the effects of polygynous marital structure on child survivorship and assesses whether the effect is uniform over the entire childhood period. In models that did not allow for age-specific effects of polygyny, children in polygynous marriages were found to have an elevated risk of death. Further analysis revealed that only older children experienced the survival disadvantages associated with polygyny. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | CHILDREN | POLYGYNY | MARRIAGE | CHILD MORTALITY | FAMILY RELATIONSHIPS | CHILD SURVIVAL | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Marriage Patterns | Nuptiality | Mortality | Population Dynamics | Family Characteristics | Family and Household | Sociocultural Factors | Survivorship | Length of Life Document Number: 331179 |
| 27. Title: Monitoring HIV epidemics: declines in prevalence do not always mean good news [editorial] Author: Hallett T Source: AIDS. 2009 Jan 2;23(1):131-2. Abstract: The future of HIV epidemic monitoring is likely to rely on HIV prevalence for many years to come. After years of intensive research, direct measurements of incidence in local cohort studies are becoming less and less representative of whole countries, and assays that discriminate recent infections in cross-sectional serosurveys have been shown to be unreliable in African countries without calibration. Antiretroviral therapy will add a further layer of complexity, as longer survival times will tend to increase HIV prevalence; so that upturns in epidemics may not indicate increased risk behaviour, and stable prevalence rates could mask substantial reductions in incidence. It will, therefore, be essential to make maximum use of mathematical modelling in the interpretation of trends in HIV prevalence. To be conservative and defensible, these modelsmust reasonably account for all other potential sources of natural changes in epidemics, so that the contribution of actual reductions in risk-if any-can be resolved. And only from that starting point, can the important investigations into the proximal and distal causes and reasons for the behaviour changes begin. (excerpt) Language: English Keywords: AFRICA, SUB SAHARAN | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | EVALUATION INDEXES | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | MONITORING | HIV INFECTIONS | EPIDEMIOLOGY | EPIDEMICS | RELIABILITY | VALIDITY | ERROR SOURCES | Africa | Developing Countries | Research Methodology | Theoretical Models | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Public Health | Health Document Number: 330256 |
| 28. Title: Providing HIV care for co-infected tuberculosis patients: a perspective from sub-Saharan Africa. Author: Harries AD; Zachariah R; Lawn SD Source: International Journal of Tuberculosis and Lung Disease. 2009 Jan;13(1):6-16. Abstract: Human immunodeficiency virus/acquired immune-deficiency syndrome (HIV/AIDS) and tuberculosis (TB) are overlapping epidemics that cause an immense burden of disease in sub-Saharan Africa. This region is home to the majority of the world's co-infected patents, who have higher TB case fatality and recurrence rates than patients with TB alone. A World Health Organization interim policy has been developed to reduce the joint burden of TB-HIV disease, an important component of which is provision of HIV care to co-infected patients. This review focuses on HIV testing of TB patients and, for those who are HIV-positive, the administration of adjunctive cotrimoxazole preventive treatment (CPT) and antiretroviral treatment (ART). HIV testing has moved from a voluntary, client-initiated intervention to one that is provider-initiated and a routine part of the diagnostic work-up. The efficacy and safety of CPT in HIV-infected patients is now well established, and this is an essential part of the package of HIV care. ART scale-up in Africa can substantially improve outcomes in co-infected patients. However, the clinical and programmatic challenges of combining ART with anti-tuberculosis treatment need to be resolved to realise the full potential of this benefit. These include the optimal time to start ART, how best to combine rifampicin-containing regimens with first-line and second-line ART regimens, management of immune reconstitution disease, the role of isoniazid preventive treatment with ART after TB treatment completion, and where and how to provide combined treatment to best suit the patient. Clinical and operational studies in the next few years should help to resolve some of these issues. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | TUBERCULOSIS | ANTIRETROVIRAL THERAPY | HIV TESTING | DRUGS | ADMINISTRATION AND DOSAGE | TREATMENT | Africa | Developing Countries | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Infections | HIV | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330579 |
| 29. Peer Reviewed Title: Increasing uptake of HIV testing and counseling among the poorest in sub-Saharan countries through home-based service provision. Author: Helleringer S; Kohler HP; Frimpong JA; Mkandawire J Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):185-93. Abstract: BACKGROUND: Uptake of HIV testing and counseling (HTC) is lower among members of the poorest households in sub-Saharan countries, thereby creating significant inequalities in access to HTC and possibly antiretroviral treatment. OBJECTIVES: To measure uptake of home-based HTC and estimate HIV prevalence among members of the poorest households in a sub-Saharan population. METHODS: Residents of 6 villages of Likoma Island (Malawi) aged 18-35 and their spouses were offered home-based HTC services. Socioeconomic status, HIV testing history, and HIV risk factors were assessed. Differences in HTC uptake and HIV infection rates between members of households in the lowest income quartile and the rest of the population were estimated using logistic regression. RESULTS: Members of households in the lowest income quartile were significantly less likely to have ever used facility-based HTC services than the rest of the population (odds ratio = 0.60, 95% confidence interval (CI): 0.36 to 0.97). In contrast, they were significantly more likely to use home-based HTC services provided during the study (adjusted odds ratio = 1.70, 95% CI: 1.04 to 2.79). Socioeconomic differences in uptake of home-based HTC were not due to underlying differences in socioeconomic characteristics or HIV risk factors. The prevalence of HIV was significantly lower among members of the poorest households tested during home-based HTC than among the rest of the population (adjusted odds ratio = 0.37, 95% CI: 0.14 to 0.96). CONCLUSIONS: HTC uptake was high during a home-based HTC campaign on Likoma Island, particularly among the poorest. Home-based HTC has the potential to significantly reduce existing socioeconomic gradients in HTC uptake and help mitigate the impact of AIDS on the most vulnerable households. Language: English Keywords: AFRICA, SUB SAHARAN | RESEARCH REPORT | STATISTICAL REGRESSION | LOW INCOME POPULATION | COUNSELING | HIV TESTING | HOME VISITS | UTILIZATION OF HEALTH CARE | HIV INFECTIONS | PREVALENCE | ANTIRETROVIRAL THERAPY | INEQUALITIES | Africa | Developing Countries | Data Analysis | Research Methodology | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Clinic Activities | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Communication | Viral Diseases | Diseases | Measurement | HIV Document Number: 341774 |
| 30. Title: Home truths: facing the facts on children, AIDS, and poverty. Final report of the Joint Learning Initiative on Children and HIV/AIDS. Author: Irwin A; Adams A; Winter A Source: Joint Learning Initiative on Children and HIV/AIDS, 2009. [84] p. Abstract: This report summarizes two years of research and analysis of AIDS- related policies, programs, and funding sources and their effectiveness in addressing the needs of children. It calls for greater emphasis on strengthening families and communities to enable them to give children the care and support they are uniquely suited to provide. The report also recommends new approaches to address the simultaneous impacts of HIV, poverty, food insecurity, and social inequality that many countries confront today. Language: English Keywords: AFRICA, SUB SAHARAN | SUMMARY REPORT | CHILDREN | PERSONS LIVING WITH HIV/AIDS | HUMAN CAPITAL | PRIMARY HEALTH CARE | HEALTH SERVICES | TREATMENT | COMMUNITY PARTICIPATION | FAMILY AND HOUSEHOLD | FAMILY LIFE | CARE AND SUPPORT | Africa | Developing Countries | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Human Resources | Economic Factors | Delivery of Health Care | Health | Medical Procedures | Medicine | Organization and Administration | Sociocultural Factors Document Number: 330184 |
 |
||
 |
Information & Knowledge for Optimal Health (INFO) Project 111 Market Place Suite 310, Baltimore, MD 21202 Phone: 410-659-6300 Fax: 410-659-6266 Security & Privacy Policy |  |