1.  Title: [Global Burden of Diseases, Injuries and Risk Factors Study] operations manual. Final draft. Author: Harvard University; University of Washington. Institute for Health Metrics and Evaluation; Johns Hopkins University; University of Queensland; World Health Organization [WHO] Source: [Cambridge, Massachusetts, Harvard University, 2009 Jan 20 142 p. Abstract: The final draft of the Global Burden of Diseases, Injuries and Risk Factors Study Operations Manual is intended to serve as a guide for the Expert Groups working on the GBD Study. There are opportunities to provide input and feedback, and instructions to do so are included in the operations manual. The new Global Burden of Diseases, Injuries, and Risk Factors Study (the GBD 2005 Study), which commenced in the spring of 2007, is led by a consortium including Harvard University, the Institute for Health Metrics and Evaluation at the University of Washington, Johns Hopkins University, the University of Queensland, and the World Health Organization WHO). It is the first major effort since the GBD 1990 Study to carry out a complete systematic assessment of the data on all diseases and injuries, and produce comprehensive and comparable estimates of the burden of diseases, injuries and risk factors for two time periods, 1990 and 2005. By November 2010 the project will produce a final set of estimates. (Excerpts) Language: English Keywords: GLOBAL | MANUAL | DATA ANALYSIS | ESTIMATION TECHNIQUES | DISABLED PERSONS AND DISABILITIES | DISEASES | ACCIDENTS AND INJURIES | MORTALITY | RISK FACTORS | EPIDEMIOLOGY | INCIDENCE | PREVALENCE | RISK ASSESSMENT | BIAS | Research Methodology | Population Characteristics | Demographic Factors | Population | Health | Population Dynamics | Public Health | Measurement | Evaluation | Error Sources Document Number: 331797 |
| 2. Peer Reviewed Title: Loss to care and death before antiretroviral therapy in Durban, South Africa. Author: Bassett IV; Wang B; Chetty S; Mazibuko M; Bearnot B; Giddy J; Lu Z; Losina E; Walensky RP; Freedberg KA Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jun 1;51(2):135-9. Abstract: OBJECTIVE: To examine the loss to care and mortality rates before starting antiretroviral therapy (ART) among ART eligible HIV-infected patients in Durban, South Africa. Design: Retrospective cohort study. METHODS: We reviewed data from ART eligible adults (> or = 18 years) at an urban HIV clinic that charges a monthly fee from July to December 2006. ART eligibility was based on CD4 count < or = 200 cells per microliter or clinical criteria and a psychosocial assessment. Patients who did not start ART and were lost within 3 months were phoned. Correlates of loss to care were evaluated using logistic regression. RESULTS: During the study period, 501 patients registered for ART training. Mean time from initial CD4 count to first ART training was 3.6 months (interquartile range 2.3-3.9 months). Four hundred eight patients (81.4%) were in care and on ART at 3-month follow-up, and 11 (2.2%) were in care but had not initiated ART. Eighty-two ART eligible patients (16.4%) were lost before ART initiation. Of these, 28 (34.1%) had died; two thirds of deaths occurred before or within 2 months after the first ART training. Despite multiple attempts, 32 patients (39%) were unreachable by phone. Lower baseline CD4 counts (< or = 100 cells/microL) and unemployment were independently associated with being lost. CONCLUSIONS: Loss to care and death occur frequently before starting ART at an HIV clinic in Durban, South Africa. This delay from CD4 count to ART training, even among those with the lowest CD4 counts, highlights the need for interventions that improve linkage to care and prioritize ART initiation for those with low baseline CD4 counts. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | CARE AND SUPPORT | PROGRAM ACCESSIBILITY | TIME FACTORS | MORTALITY | EMPLOYMENT STATUS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Health Services | Delivery of Health Care | Health | Program Evaluation | Population Dynamics | Demographic Factors | Population | Socioeconomic Status | Socioeconomic Factors | Economic Factors Document Number: 341755 |
3.  Peer Reviewed Title: Comparison of CD4 cell count, viral load, and other markers for the prediction of mortality among HIV-1-infected Kenyan pregnant women. Author: Brown ER; Otieno P; Mbori-Ngacha DA; Farquhar C; Obimbo EM; Nduati R; Overbaugh J; John-Stewart GC Source: Journal of Infectious Diseases. 2009 May 1;199(9):1292-300. Abstract: BACKGROUND: There are limited data regarding the relative merits of biomarkers as predictors of mortality or time to initiation of antiretroviral therapy (ART). METHODS: We evaluated the usefulness of the CD4 cell count, CD4 cell percentage (CD4%), human immunodeficiency virus type 1 (HIV-1) load, total lymphocyte count (TLC), body mass index (BMI), and hemoglobin measured at 32 weeks' gestation as predictors of mortality in a cohort of HIV-1-infected women in Nairobi, Kenya. Sensitivity, specificity, positive predictive value (PPV), and area under the receiver operating characteristic (ROC) curve (AUC) were determined for each biomarker separately, as well as for the CD4 cell count and the HIV-1 load combined. RESULTS: Among 489 women with 10,150 person-months of follow-up, mortality rates at 1 and 2 years postpartum were 2.1% (95% confidence interval [CI], 0.7%-3.4%) and 5.5% (95% CI, 3.0%-8.0%), respectively. CD4 cell count and CD4% had the highest AUC value (>0.9). BMI, TLC, and hemoglobin were each associated with but poorly predictive of mortality (PPV, <7%). The HIV-1 load did not predict mortality beyond the CD4 cell count. CONCLUSIONS: The CD4 cell count and CD4% measured during pregnancy were both useful predictors of mortality among pregnant women. TLC, BMI, and hemoglobin had a limited predictive value, and the HIV-1 load did not predict mortality any better than did the CD4 cell count alone. Language: English Keywords: KENYA | RESEARCH REPORT | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREGNANT WOMEN | IMMUNOLOGIC FACTORS | BODY WEIGHT | HEMOGLOBIN LEVEL | RISK FACTORS | AIDS | MORTALITY | ANTIRETROVIRAL THERAPY | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Population Characteristics | Demographic Factors | Population | Immunity | Immune System | Physiology | Biology | Hemic System | Health | Population Dynamics | HIV Document Number: 342360 |
| 4. Title: Abortion among couples in rural Bangladesh [letter] Author: Burnie R; Williams N; Robbe IJ Source: American Journal of Public Health. 2009 May;99(5):774-5; author reply 775. Abstract: Language: English Keywords: BANGLADESH | CRITIQUE | RURAL POPULATION | COUPLES | ABORTION | SAFETY | RISK FACTORS | MORTALITY | HYGIENE | Developing Countries | Asia, Southern | Asia | Population Characteristics | Demographic Factors | Population | Family Characteristics | Family and Household | Sociocultural Factors | Fertility Control, Postconception | Family Planning | Public Health | Health | Population Dynamics Document Number: 341001 |
| 5. Peer Reviewed Title: Adherence to first-line antiretroviral therapy affects non-virologic outcomes among patients on treatment for more than 12 months in Lusaka, Zambia. Author: Chi BH; Cantrell RA; Zulu I; Mulenga LB; Levy JW; Tambatamba BC; Reid S; Mwango A; Mwinga A; Bulterys M; Saag MS; Stringer JS Source: International Journal of Epidemiology. 2009 Jun;38(3):746-56. Abstract: BACKGROUND: High-level adherence to antiretroviral therapy (ART) is associated with favourable patient outcomes. In resource-constrained settings, however, there are few validated measures. We examined the correlation between clinical outcomes and the medication possession ratio (MPR), a pharmacy-based measure of adherence. METHODS: We analysed data from a large programmatic cohort across 18 primary care centres providing ART in Lusaka, Zambia. Patients were stratified into three categories based on MPR-calculated adherence over the first 12 months: optimal (> or =95%), suboptimal (80-94%) and poor (<80%). RESULTS: Overall, 27 115 treatment-naive adults initiated and continued ART for > or =12 months: 17 060 (62.9%) demonstrated optimal adherence, 7682 (28.3%) had suboptimal adherence and 2373 (8.8%) had poor adherence. When compared with those with optimal adherence, post-12-month mortality risk was similar among patients with sub-optimal adherence [adjusted hazard ratio (AHR) = 1.0; 95% CI: 0.9-1.2] but higher in patients with poor adherence (AHR = 1.7; 95% CI: 1.4-2.2). Those <80% MPR also appeared to have an attenuated CD4 response at 18 months (185 cells/microl vs 217 cells/microl; P < 0.001), 24 months (213 cells/microl vs 246 cells/microl; P < 0.001), 30 months (226 cells/microl vs 261 cells/microl; P < 0.001) and 36 months (245 cells/microl vs 275 cells/microl; P < 0.01) when compared with those above this threshold. CONCLUSIONS: MPR was predictive of clinical outcomes and immunologic response in this large public sector antiretroviral treatment program. This marker may have a role in guiding programmatic monitoring and clinical care in resource-constrained settings. Language: English Keywords: ZAMBIA | RESEARCH REPORT | CLINICAL RESEARCH | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | ANTIRETROVIRAL THERAPY | USER COMPLIANCE | IMMUNOLOGICAL EFFECTS | PHARMACY DISTRIBUTION | MORTALITY | HEMOGLOBIN LEVEL | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | HIV | Behavior | Immunity | Immune System | Physiology | Biology | Nonclinical Distribution | Distributional Activities | Population Dynamics | Demographic Factors | Population | Hemic System Document Number: 342460 |
| 6. Peer Reviewed Title: CD4+ response and subsequent risk of death among patients on antiretroviral therapy in Lusaka, Zambia. Author: Chi BH; Giganti M; Mulenga PL; Limbada M; Reid SE; Mutale W; Stringer JS Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):125-31. Abstract: INTRODUCTION: Where virologic monitoring is not routinely available, immunologic criteria are commonly used to determine treatment failure while on antiretroviral therapy (ART). However, few have studied CD4+ response and its relationship to subsequent clinical outcomes in a programmatic setting. METHODS: We analyzed cohort data from Zambia to investigate whether 6- and 12-month CD4+ response after ART initiation was associated with later mortality. We used Cox proportional hazards models that accounted for different strata of baseline CD4 counts and adjusted for age, sex, clinical stage, tuberculosis coinfection, baseline hemoglobin, initial ART regimen, and adherence behavior. RESULTS: We analyzed data from 2 cohorts, from 6 months onward (n = 24,366; median follow-up = 467 days, interquartile range 222-791) and from 12 months onward (n = 17,920; median follow-up = 423 days, interquartile range 191-689). In the post-6-month analysis, hazard for death was significantly higher when absolute CD4+ response was <100 cells per microliter [adjusted hazard ratio (AHR) = 2.25, 95% confidence interval (CI): 1.91 to 2.64], relative response was <10% above baseline (AHR = 2.60, 95% CI: 2.12 to 3.19), and absolute CD4+ count was <100 per microliter (AHR = 2.79, 95% CI: 2.26 to 3.45). In the post-12 month analysis, mortality was associated with rise in absolute CD4+ cell count <200 per microliter (AHR = 2.41, 95% CI: 1.83 to 3.17), relative rise in CD4+ cell count of <10% above baseline (AHR = 3.41, 95% CI: 2.51 to 4.64), and absolute CD4+ count at 12 months <100 per microliter (AHR = 4.11, 95% CI: 2.96 to 5.68). CONCLUSION: Commonly used definitions for immunologic treatment failure are associated with elevated mortality risk among patients on ART. Language: English Keywords: ZAMBIA | RESEARCH REPORT | COHORT ANALYSIS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | DEATH RATE | HIV | MORTALITY | TREATMENT | ANTIRETROVIRAL THERAPY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | Population Dynamics | Demographic Factors | Population | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 342891 |
| 7. Peer Reviewed Title: The impact of gender and income on survival and retention in a South African antiretroviral therapy programme. Author: Cornell M; Myer L; Kaplan R; Bekker LG; Wood R Source: Tropical Medicine and International Health. 2009 Jul;14(7):722-31. Abstract: OBJECTIVES: Despite the rapid expansion of antiretroviral therapy (ART) services in Africa, there are few data on whether outcomes differ for women and men and what factors may drive such variation. We investigated the association of gender and income with survival and retention in a South African ART programme. METHODS: A total of 2196 treatment-naive adults were followed for 1 year on ART. Proportional hazards regression was used to explore associations between baseline characteristics and survival and loss-to-follow-up (LTFU). RESULTS: Patients were predominantly female (67%). Men presented at an older age and with more advanced HIV disease, and during early ART the crude death rate was higher among men than women (22.8 vs 12.5/100 person-years; P = 0.002). However in multivariate analysis, gender was not significantly associated with survival after adjusting for baseline clinical and immunovirological status (HR = 1.46, 95% CI = 0.96-2.22; P = 0.076). In late ART (4-12 months), there was no gender difference in mortality rates (3.5 vs 3.8/100 person-years; P = 0.817). In multivariate analysis, survival was strongly associated with age (HR = 1.05, 95% CI = 1.02-1.09; P < 0.001), CD4 count >150 vs <50 cells/microl (HR = 0.35, 95% CI = 0.14-0.87; P = 0.023) and any monthly income vs none (HR = 0.47, 95% CI = 0.25-0.88; P = 0.018). Having some monthly income was protective against LTFU at 1 year on ART (adjusted HR = 0.56, 95% CI = 0.39-0.82; P = 0.002). CONCLUSION: Men's high early mortality on ART appears due largely to their presentation with more advanced HIV disease. Efforts are needed to enroll men into care earlier in HIV disease and to reduce socio-economic inequalities in ART programme outcomes. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | MORTALITY | INEQUALITIES | INCOME | SEX FACTORS | IMMUNOLOGIC FACTORS | SOCIOECONOMIC STATUS | AGE FACTORS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | HIV Infections | Viral Diseases | Diseases | HIV | Population Dynamics | Demographic Factors | Population | Socioeconomic Factors | Economic Factors | Population Characteristics | Immunity | Immune System | Physiology | Biology Document Number: 342641 |
| 8. Peer Reviewed Title: The 1991-2004 evolution in life expectancy by educational level in Belgium based on linked census and population register data. L'evolution de l'esperance de vie par niveau d'instruction en Belgique de 1991 a 2004 sur la base de donnees de recensement liees au registre de la population. Author: Deboosere P; Gadeyne S; Oyen HV Source: European Journal of Population. 2008 May;25(2):175-196. Abstract: The aim of this study is to determine trends in life expectancy by educational level in Belgium and to present elements of interpretation for the observed evolution. The analysis is based on census data providing information on educational level linked to register data on mortality for the periods 1991-1994 and 2001-2004. Using exhaustive individual linked data allows to avoid selection bias and numerator-denominator bias. The trends reveal a general increase in life expectancy together with a widening social gap. Summary indices of inequality based on life expectancies show, however, a more complex pattern and point to the importance to include the shifts in population composition by educational level in an overall assessment of the evolution of inequality by educational level. Language: English Keywords: BELGIUM | RESEARCH REPORT | DATA LINKAGE | LIFE EXPECTANCY | EDUCATIONAL STATUS | HEALTH | INEQUALITIES | MORTALITY | DEATH RECORDS | CENSUS | Europe, Western | Europe | Developed Countries | Data Collection | Research Methodology | Length of Life | Population Dynamics | Demographic Factors | Population | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Vital Statistics | Population Statistics Document Number: 340174 |
| 9. Peer Reviewed Title: Youth, unemployment, and male gender predict mortality in AIDS patients started on HAART in Nigeria. Author: DeSilva MB; Merry SP; Fischer PR; Rohrer JE; Isichei CO; Cha SS Source: AIDS Care. 2009 Jan;21(1):70-7. Abstract: This retrospective study identifies risk factors for mortality in a cohort of HIV-positive adult patients treated with highly active antiretroviral therapy (HAART) in Jos, Nigeria. We analyzed clinical data from a cohort of 1552 patients enrolled in a HIV/acquired immune deficiency syndrome treatment program and started on HAART between December 2004 and 30 April 2006. Death was our study endpoint. Patients were followed in the study until death, being lost to follow-up, or the end of data collection, 1 December 2006. Baseline patient characteristics were compared using Wilcoxon Rank Sum Test for continuous variables and Pearson Chi-Square test for categorical variables to determine if certain demographic factors were associated with more rapid progression to death. The Cox proportional hazard multivariate model analysis was used to find risk factors. As of 1 December 2006, a total of 104 cases progressed to death. In addition to the expected association of CD4 count less than 50 at initiation of therapy and active tuberculosis with mortality, the patient characteristics independently associated with a more rapid progression to death after initiation of HAART were male gender, age less than 30 years old, and unemployment or unknown occupation status. Future research is needed to identify the confounding variables that may be amenable to targeted interventions aimed at ameliorating these health disparities. Language: English Keywords: NIGERIA | RESEARCH REPORT | RETROSPECTIVE STUDIES | YOUTH | MEN | PERSONS LIVING WITH HIV/AIDS | UNEMPLOYMENT | AIDS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | MORTALITY | DEATH | GENDER ISSUES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Employment | Macroeconomic Factors | Economic Factors | HIV | Population Dynamics | Sociocultural Factors Document Number: 331211 |
| 10. Title: Advances and future directions in HIV surveillance in low- and middle-income countries. Author: Diaz T; Garcia-Calleja JM; Ghys PD; Sabin K Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):253-9. Abstract: PURPOSE OF REVIEW: To present recent advances in HIV/AIDS surveillance methods in low- and middle-income countries. RECENT FINDINGS: From 2001 to 2008, 30 low- and middle-income countries implemented national population-based surveys with HIV testing. Antenatal clinic HIV sentinel surveillance sites in sub-Saharan Africa increased from just over 1000 in 2003-2004 to almost 2500 in 2005-2006, becoming more representative of rural areas. Between 2003 and 2007, at least 122 behavioral surveys in low- and middle-income countries used respondent-driven sampling for surveillance among high-risk populations, although many countries with concentrated epidemics continue to have major sentinel surveillance gaps. Improvements have been made in modeling estimates of number of persons HIV infected, and systems are now in place to measure HIV drug resistance. However, the reliable monitoring of trends and the measuring of HIV incidence, morbidity, and mortality is still a challenge. SUMMARY: In the past 5 years, there have been substantial improvements in the quantity and quality of HIV surveillance studies, especially in the countries with high prevalence. Further efforts should be made in countries that lack fully implemented surveillance systems to improve HIV incidence, morbidity, and mortality surveillance and to use data more effectively. Language: English Keywords: GLOBAL | LITERATURE REVIEW | RECOMMENDATIONS | HIV INFECTIONS | AIDS | EPIDEMICS | MONITORING | MORTALITY | PREVALENCE | HIV TESTING | DRUG RESISTANCE | INCIDENCE | Viral Diseases | Diseases | Evaluation | Population Dynamics | Demographic Factors | Population | Measurement | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment Document Number: 342342 |
| 11. Peer Reviewed Title: High early mortality in patients with chronic acquired immunodeficiency syndrome diarrhea initiating antiretroviral therapy in Haiti: a case-control study. Author: Dillingham RA; Pinkerton R; Leger P; Severe P; Guerrant RL; Pape JW; Fitzgerald DW Source: American Journal of Tropical Medicine and Hygiene. 2009 Jun;80(6):1060-4. Abstract: This case-control study examines whether chronic diarrhea at initiation of antiretroviral therapy (ART) affects survival of human immunodefiency virus-infected patients. Cases (288) were treatment-naive, non-pregnant, adults with self report of frequent loose stool for > 3 weeks at the time ART was initiated. One-third of patients had an enteric pathogen identified including Cryptosporidium spp., Giardia spp., Isospora belli, Cyclospora cayetanensis, and Entamoeba histolytica. Control patients (400) did not have diarrhea when initiating ART. At six weeks, mortality was 10% in the patients with diarrhea and 5% in the patients without diarrhea (P = 0.009). Chronic diarrhea in patients requesting ART in Haiti is associated with increased early mortality. Language: English Keywords: HAITI | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | ADULTS | PERSONS LIVING WITH HIV/AIDS | AIDS | ANTIRETROVIRAL THERAPY | DIARRHEA | GASTROINTESTINAL EFFECTS | ANTIBIOTICS | MORTALITY | Developing Countries | Caribbean | Americas | Research Methodology | Program Activities | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Physiology | Biology | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics Document Number: 341760 |
| 12. Peer Reviewed Title: Combined antiretroviral treatment initiation during hospitalization: outcomes in South African adults [letter] Author: Eshun-Wilson I; Plas HV; Prozesky HW; Zeier MD; Nachega J; Taljaard JJ Source: Journal of Acquired Immune Deficiency Syndromes. 2009 May 1;51(1):105-6. Abstract: Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | CONTROL GROUPS | CLIENTS | ADULTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | HOSPITALS | AIDS | MORTALITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Program Activities | Programs | Organization and Administration | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Health Facilities | Delivery of Health Care | Health | Population Dynamics Document Number: 342349 |
| 13. Peer Reviewed Title: Monitoring HIV treatment in resource-limited settings: reassuring news on the usefulness of CD4(+) cell counts. Author: Fowler MG; Owor M Source: Journal of Infectious Diseases. 2009 May 1;199(9):1255-7. Abstract: Language: English Keywords: DEVELOPING COUNTRIES | CRITIQUE | PERSONS LIVING WITH HIV/AIDS | IMMUNOLOGIC FACTORS | BODY WEIGHT | HEMOGLOBIN LEVEL | RISK FACTORS | AIDS | MORTALITY | ANTIRETROVIRAL THERAPY | MONITORING | TIME FACTORS | HIV Infections | Viral Diseases | Diseases | Immunity | Immune System | Physiology | Biology | Hemic System | Health | Population Dynamics | Demographic Factors | Population | HIV | Evaluation Document Number: 342361 |
| 14. 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 |
| 15. Peer Reviewed Title: Opportunity for natural selection among the Indian population: secular trend, covariates and implications. Author: Gautam RK Source: Journal of Biosocial Science. 2009 Jul 23;:1-41. Abstract: Crow's index is widely used for indirect quantitative estimation of natural selection using birth and death rates. The present investigation is based on 179 studies among 144 different endogamous communities belonging to nineteen states and six geographical regions of India, categorized into six social groups. These studies appeared in 33 different years over six decades (1956 to 2007). The secular trend in Crow's index (It) and its mortality and fertility components (Im and If) shows a gradual decline in It and radical shift in the relative contributions of Im and If. Before 1990 the opportunity for natural selection was mainly determined by differential pre-reproductive mortality (Im), whereas after 1990 it has been determined by differential fertility (If). To find out the covariates of It, Im and If sixteen socio-demographic variables were considered, and nine were found to be significantly correlated with It: total dependency ratio, decadal growth rate 1991-2001, young age dependency ratio, crude death rate, total fertility rate, child mortality rate, under-5 mortality rate, old age dependency ratio and decadal growth rate 1981-1991. On the basis of multivariate stepwise regression analysis, female literacy emerged as one of the most important predictors of It. The declining trend of It, Im and If shows that the Indian population is passing through the demographic transition. Language: English Keywords: INDIA | ADMINISTRATIVE DISTRICTS | RESEARCH REPORT | DATA COLLECTION | STATISTICAL REGRESSION | TRIBES | MOTHERS | CASTE | POPULATION GENETICS | FERTILITY | MORTALITY | DEPENDENCY BURDEN | SOCIOCULTURAL FACTORS | DEMOGRAPHIC TRANSITION | Asia, Southern | Asia | Developing Countries | Geographic Factors | Population | Research Methodology | Data Analysis | Cultural Background | Population Characteristics | Demographic Factors | Parents | Family Relationships | Family Characteristics | Family and Household | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Genetics | Biology | Population Dynamics | Microeconomic Factors Document Number: 342293 |
| 16. Title: Latin America: Cash transfers to support better household decisions. Author: Glassman A; Todd J; Gaarder M Source: In: Performance incentives for global health: potential and pitfalls, [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :89-121. Abstract: Conditional cash transfers (CCTs) in Latin America have been effective at increasing the use of preventive health services, increasing knowledge, improving attitudes and practices, enhancing nutritional status, and reducing morbidity, mortality, and fertility. Rigorous impact evaluations suggest that improved health results can be attributed to demand-side performance incentives. Better choice of health conditionalities in future CCT programs could strengthen the impact on health. Language: English Keywords: LATIN AMERICA | SUMMARY REPORT | EVALUATION | LOW INCOME POPULATION | POVERTY | HEALTH EDUCATION | HEALTH SERVICES | QUALITY OF HEALTH CARE | VACCINES | CHILD HEALTH | MATERNAL HEALTH | MORBIDITY | MORTALITY | KNOWLEDGE | ATTITUDES | BEHAVIOR | PREVENTIVE MEDICINE | PROGRAM ACCESSIBILITY | Americas | Developing Countries | Social Class | Socioeconomic Status | Socioeconomic Factors | Economic Factors | Education | Delivery of Health Care | Health | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Medical Procedures | Medicine | Diseases | Population Dynamics | Demographic Factors | Population | Sociocultural Factors | Psychological Factors Document Number: 331454 |
| 17. Title: Paediatric antiretroviral therapy outcomes under HIV hospice care in South Africa. Author: Harding R; Brits H; Penfold S Source: International Journal of Palliative Nursing. 2009 Mar;15(3):142-5. Abstract: AIM: This study aims to evaluate outcomes of children with advanced HIV disease who are initiated on antiretroviral therapy under multiprofessional specialist paediatric hospice care. DESIGN: A retrospective cohort file review methodology was undertaken in a specialist paediatric hospice in South Africa. METHODS: Antiretroviral therapy was initiated for children with a CD4% of less than 15% (for children under 6 years of age) or a CD4 count under 200 for children over 6 years of age. According to the World Health Organization Europe (2007) staging criteria, all children were stage 3/4 HIV disease. Multiprofessional staff provided daily tailored assessment and care. Each child was followed for 6 months. Data on mortality, CD4 count, CD4 percentage, body weight, and viral load were measured at initiation and a follow-up after 6 months. FINDINGS: Of the 37 children initiated on ART therapy, 31 I survived at 6 months. From a baseline of mean body weight 13.3 kg, there was an average of 3.2 kg increase (P < 0.001). Mean CD4 counts more than doubled (P < 0.001), with a mean increase of 467 cells per mm3 blood. Mean CD4 percentages increased from 13.6-19.4% (P < 0.001).Viral load decreased significantly from a median 271000 copies per mm3 blood to a median of 25 (imputed value for undetectable viral load) (P < 0.001). Twenty-three children had an undetectable viral load. CONCLUSION: For children with advanced HIV disease, who are least likely to access or respond to treatment, this study demonstrates a novel approach to managing care successfully. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | COHORT ANALYSIS | CHILDREN | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | CARE AND SUPPORT | BODY WEIGHT | IMMUNOLOGIC FACTORS | MORTALITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Health Services | Delivery of Health Care | Health | Physiology | Biology | Immunity | Immune System | Population Dynamics Document Number: 342153 |
| 18. Title: Early treatment of HIV: implications for resource-limited settings. Author: Hobbs CV; Essajee SM Source: Current Opinion In HIV and AIDS. 2009 May;4(3):222-31. Abstract: PURPOSE OF REVIEW: We review the current literature supporting adoption of higher CD4 thresholds for initiation of antiretroviral treatment and survey progress in adoption of early treatment policies in resource-limited settings. We highlight some of the challenges and opportunities implementation of early treatment will bring. RECENT FINDINGS: The initial success of combination antiretroviral treatment resulted in the recommendation to treat early all individuals with HIV. However, the gradual realization that antiretroviral treatment was associated with toxicity led to a more tempered approach. Recent cohort studies and some clinical trials have shown that delaying treatment is associated with increased morbidity and mortality. SUMMARY: Early treatment is routinely practiced in developed countries. Now, early treatment is being adopted as a strategy in many resource-limited settings. The implications of this policy shift are not known, but we predict early treatment will have important consequences for the health system, the individual, and the community. Whereas these consequences will bring significant challenges, the increased numbers of HIV-infected individuals on treatment will result in many new opportunities - antiretroviral treatment will become less expensive, systems to deliver chronic care will be strengthened, and the policy shift will focus greater attention on pregnant women and children. Finally, some authors postulate that early treatment may impact HIV transmission. Language: English Keywords: DEVELOPING COUNTRIES | LITERATURE REVIEW | HIV INFECTIONS | AIDS | ANTIRETROVIRAL THERAPY | IMPLEMENTATION | OBSTACLES | TIME FACTORS | MORTALITY | IMMUNOLOGICAL EFFECTS | HEALTH POLICY | WHO | Viral Diseases | Diseases | HIV | Programs | Organization and Administration | Population Dynamics | Demographic Factors | Population | Immunity | Immune System | Physiology | Biology | Policy | Political Factors | Sociocultural Factors | UN | International Agencies | Organizations Document Number: 342344 |
| 19. Peer Reviewed Title: Mortality profiles in a country facing epidemiological transition: An analysis of registered data. Author: Huicho L; Trelles M; Gonzales F; Mendoza W; Miranda J Source: BMC Public Health. 2009 Feb 2;9(47):39 p. Abstract: Sub-national analyses of causes of death and time-trends help to define public health policy priorities. They are particularly important in countries undergoing epidemiological transition like Peru. There are no studies exploring Peruvian national and regional characteristics of such epidemiological transition. We aimed to describe Peru's national and regional mortality profiles between 1996 and 2000. Registered mortality data for the study period were corrected for underregistration following standardized methods. Main causes of death by age group and by geographical region were determined. Departmental mortality profiles were constructed to evaluate mortality transition, using 1996 data as baseline. Annual cumulative slopes for the period 1996-2000 were estimated for each department and region. For the study period non-communicable diseases explained more than half of all causes of death, communicable diseases more than one third, and injuries 10.8% of all deaths. Lima accounted for 32% of total population and 20% of total deaths. The Andean region, with 38% of Peru´s population, accounted for half of all country deaths. Departmental mortality predominance shifted from communicable diseases in 1996 towards non-communicable diseases and injuries in 2000. Maternal and perinatal conditions, and nutritional deficiencies and nutritional anaemia declined markedly in all departments and regions. Infectious diseases decreased in all regions except Lima. In all regions acute respiratory infections are a leading cause of death, but their proportion ranged from 9.3% in Lima and Callao to 15.3% in the Andean region. Tuberculosis and injuries ranked high in Lima and the Andean region. Peruvian mortality shows a double burden of communicable and noncommunicable, with increasing importance of non-communicable diseases and injuries. This challenges national and sub-national health system performance and policy making. Language: English Keywords: PERU | RESEARCH REPORT | DEMOGRAPHIC TRANSITION | CAUSES OF DEATH | DEATH RATE | MORTALITY | AGE FACTORS | DISEASES | DEFICIENCY DISEASES | TUBERCULOSIS | ACCIDENTS AND INJURIES | South America, Western | South America | Latin America | Americas | Developing Countries | Population Dynamics | Demographic Factors | Population | Population Characteristics | Nutrition Disorders | Infections | Health Document Number: 329534 |
| 20. Peer Reviewed Title: Probiotics and prebiotics for severe acute malnutrition (PRONUT study): a double-blind efficacy randomised controlled trial in Malawi. Author: Kerac M; Bunn J; Seal A; Thindwa M; Tomkins A; Sadler K; Bahwere P; Collins S Source: Lancet. 2009 Jul 11;374(9684):136-44. Abstract: BACKGROUND: Severe acute malnutrition affects 13 million children worldwide and causes 1-2 million deaths every year. Our aim was to assess the clinical and nutritional efficacy of a probiotic and prebiotic functional food for the treatment of severe acute malnutrition in a HIV-prevalent setting. METHODS: We recruited 795 Malawian children (age range 5 to 168 months [median 22, IQR 15 to 32]) from July 12, 2006, to March 7, 2007, into a double-blind, randomised, placebo-controlled efficacy trial. For generalisability, all admissions for severe acute malnutrition treatment were eligible for recruitment. After stabilisation with milk feeds, children were randomly assigned to ready-to-use therapeutic food either with (n=399) or without (n=396) Synbiotic2000 Forte. Average prescribed Synbiotic dose was 10(10) colony-forming units or more of lactic acid bacteria per day for the duration of treatment (median 33 days). Primary outcome was nutritional cure (weight-for-height >80% of National Center for Health Statistics median on two consecutive outpatient visits). Secondary outcomes included death, weight gain, time to cure, and prevalence of clinical symptoms (diarrhoea, fever, and respiratory problems). Analysis was on an intention-to-treat basis. This trial is registered as an International Standard Randomised Controlled Trial, number ISRCTN19364765. FINDINGS: Nutritional cure was similar in both Synbiotic and control groups (53.9% [215 of 399] and 51.3% [203 of 396]; p=0.40). Secondary outcomes were also similar between groups. HIV seropositivity was associated with worse outcomes overall, but did not modify or confound the negative results. Subgroup analyses showed possible trends towards reduced outpatient mortality in the Synbiotic group (p=0.06). INTERPRETATION: In Malawi, Synbiotic2000 Forte did not improve severe acute malnutrition outcomes. The observation of reduced outpatient mortality might be caused by bias, confounding, or chance, but is biologically plausible, has potential for public health impact, and should be explored in future studies. FUNDING: Department for International Development (DfID). Language: English Keywords: MALAWI | RESEARCH REPORT | DOUBLE-BLIND STUDIES | CHILDREN | MALNUTRITION | NUTRITION PROGRAMS | FOOD AND BEVERAGE | ANTHROPOMETRY | HIV INFECTIONS | ANTIBIOTICS | INFECTIONS | MORTALITY | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Nutrition Disorders | Diseases | Primary Health Care | Health Services | Delivery of Health Care | Health | Nutrition | Measurement | Viral Diseases | Drugs | Treatment | Medical Procedures | Medicine | Population Dynamics Document Number: 342331 |
| 21. Title: Combination antiretroviral therapy in population affected by conflict: outcomes from large cohort in northern Uganda. Author: Kiboneka A; Nyatia RJ; Nabiryo C; Anema A; Cooper CL; Fernandes KA; Montaner JS; Mills EJ Source: BMJ. 2009;338:b201. Abstract: OBJECTIVE: To measure the clinical and immunological outcomes of HIV positive adult patients receiving combination antiretroviral therapy in conflict affected northern Uganda. DESIGN: Prospective cohort study. SETTING: Gulu District, northern Uganda. PARTICIPANTS: 1625 adults (aged over 14 years) receiving combination antiretroviral therapy. MAIN OUTCOME MEASURES: Primary outcome: all cause mortality. Secondary outcomes: impact of covariates (sex, age, CD4 count at start, adherence, tuberculosis at start, duration of treatment, and internally displaced person status) on mortality. RESULTS: Sixty nine (4.2%) patients died during follow-up. The mortality incidence rate was 3.48 (95% confidence interval 2.66 to 4.31) per 100 person years. Patients started treatment with a median CD4 count of 157 (interquartile range 90-220) cells/mul; most (1009; 63%) had World Health Organization stage 2 defined illness. Sixty two patients had pulmonary tuberculosis at the start of treatment. Of the 1521 patients with adherence data, 118 (7.8%) had adherence of less than 95% and 1403 (92.2%) had adherence of 95% or above. CONCLUSION: Patients receiving combination antiretroviral therapy in conflict affected northern Uganda had a mortality comparable to that of patients in peaceful, low income settings and better adherence than patients in higher income settings. These favourable findings highlight the need to expand access to combination antiretroviral therapy in populations affected by armed conflict. Language: English Keywords: UGANDA | RESEARCH REPORT | PROSPECTIVE STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | INTERNALLY DISPLACED PERSONS | HIV INFECTIONS | ANTIRETROVIRAL THERAPY | WAR | MORTALITY | TREATMENT | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Settlement and Resettlement | Migration | Population Dynamics | Demographic Factors | Population | HIV | Political Factors | Sociocultural Factors | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health Document Number: 330593 |
| 22. Title: Global epidemiology of HIV. Author: Kilmarx PH Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):240-6. Abstract: PURPOSE OF REVIEW: To provide an update on the epidemiology of HIV worldwide and by region, along with an overview of recent HIV epidemiological research. RECENT FINDINGS: The global prevalence of HIV-1 has stabilized at 0.8%, with 33 million people living with HIV/AIDS, 2.7 million new infections, and 2.0 million AIDS deaths in 2007. Heterosexual spread in the general population is the main mode of transmission in sub-Saharan Africa, which remains the most heavily affected region, with 67% of the global burden. Male-male sex, injection drug use, and sex work are the predominant risk factors in most other regions. Infection rates are declining in some regions, including some of the most heavily affected countries in Africa, but climbing elsewhere such as in eastern Europe and central Asia. Recent HIV epidemiologic research findings include new insights into the role of HIV viral load, co-infection with sexually transmitted infections, male circumcision, antiretroviral treatment, serosorting, and superinfection in HIV transmission and prevention. SUMMARY: The global prevalence of HIV has stabilized in this decade, but with important regional differences in trends and modes of transmission. Prevention and treatment programs have an expanding impact in preventing HIV infection and AIDS deaths. Language: English Keywords: GLOBAL | LITERATURE REVIEW | EPIDEMIOLOGY | HIV INFECTIONS | AIDS | PREVALENCE | MORTALITY | HIV TRANSMISSION | INCIDENCE | ANTIRETROVIRAL THERAPY | SEXUALLY TRANSMITTED DISEASES | HIV PREVENTION | MALE CIRCUMCISION | Public Health | Health | Viral Diseases | Diseases | Measurement | Research Methodology | Population Dynamics | Demographic Factors | Population | HIV | Reproductive Tract Infections | Infections | Medical Procedures | Medicine | Health Services | Delivery of Health Care Document Number: 342343 |
| 23. Peer Reviewed Title: Mortality and virologic outcomes after access to antiretroviral therapy among a cohort of HIV-infected women who received single-dose nevirapine in Lusaka, Zambia. Author: Kuhn L; Semrau K; Ramachandran S; Sinkala M; Scott N; Kasonde P; Mwiya M; Kankasa C; Decker D; Thea DM; Aldrovandi GM Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):132-6. Abstract: OBJECTIVES: Single-dose nevirapine (SDNVP) for prevention of mother-to-child HIV transmission selects mutations conferring resistance to nonnucleoside reverse transcriptase inhibitor (NNRTI)-based therapy. We investigated mortality and virologic and clinical outcomes after introduction of antiretroviral treatment (ART) among a cohort of women given SDNVP. METHODS: When ART programs were introduced in 2004 in Lusaka, Zambia, we were completing a trial of infant feeding, which involved following HIV-infected women who received SDNVP between 2001 and 2005. Women still in follow-up or who could be contacted were evaluated for eligibility for ART (CD4 count <200 or <350 and World Health Organization stage >or=3) and started on NNRTI-based therapy if eligible. We compared mortality in the cohort of women before and after ART access, and examined, among women initiating ART, whether virologic response was better allowing a longer time to elapse between SDNVP and treatment initiation. RESULTS: In the cohort of 872 women, mortality more than halved after ART became available (relative hazard = 0.46, 95% confidence interval: 0.23 to 0.91, P = 0.03). Of 161 SDNVP-exposed women followed on NNRTI-based ART, 70.8% suppressed (viral load <400 copies/mL). Only 3 of 8 SDNVP-exposed women (37.5%) <6 months of starting therapy suppressed compared with 13 of 22 (59.1%) who started 6-12 months, 44 of 61 (72.1%) 12-24 months, and 54 of 70 (77.1%) >24 months after exposure (chi2 trend P = 0.01). CONCLUSIONS: Most SDNVP-exposed women respond well to NNRTI-based therapy, but there was an attenuation of therapy efficacy that persisted to 12 months after exposure. Women should be screened for ART eligibility during pregnancy and started on effective regimens before delivery. Language: English Keywords: ZAMBIA | RESEARCH REPORT | COHORT ANALYSIS | WOMEN | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | ANTIRETROVIRAL DRUGS | MORTALITY | TREATMENT | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | HIV | Disease Transmission Control | Prevention and Control | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics Document Number: 342901 |
| 24. Title: Gender, intimacy, and risky sex: a terror management account. Author: Lam SR; Morrison KR; Smeesters D Source: Personality and Social Psychology Bulletin. 2009 Aug;35(8):1046-56. Abstract: Three studies tested whether mortality salience would lead men to be more sexually risky than women. In Study 1, men reported greater intentions to engage in risky sexual behaviors than did women after a mortality prime, but not after a control prime. In Study 2, men desired more future sexual partners and had a lower need for intimacy than did women, but again, only when mortality was salient. Furthermore, need for romantic intimacy mediated the relationship between mortality salience, gender, and desired number of future partners. Using a behavioral rather than a self-reported dependent measure, Study 3 showed that men primed with mortality were less likely than women to select a package of condoms (versus a pen) as a free gift after the experiment. Implications for gender differences in responses to mortality salience, as well as for how to design effective safe-sex interventions, are discussed. Language: English Keywords: UNITED STATES OF AMERICA | RESEARCH REPORT | CONTROL GROUPS | STUDENTS | MORTALITY | SELF ESTEEM | SELF-PERCEPTION | SEX BEHAVIOR | RISK BEHAVIOR | INTERPERSONAL RELATIONS | MOTIVATION | SEX FACTORS | Developed Countries | North America | Americas | Research Methodology | Education | Population Dynamics | Demographic Factors | Population | Psychological Factors | Behavior | Perception | Population Characteristics Document Number: 342853 |
| 25. Title: Epidemiology of HIV-associated tuberculosis. Author: Lawn SD; Churchyard G Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):325-33. Abstract: PURPOSE OF REVIEW: We review literature concerning the epidemiology of HIV-associated tuberculosis (HIV-TB), focusing on articles published between 2007 and 2008. RECENT FINDINGS: An estimated 1.37 million new cases of HIV-TB occurred in 2007, representing 15% of the total global burden of TB. In addition, an estimated 456 000 HIV-TB deaths accounted for 23% of global HIV/AIDS mortality. Sub-Saharan Africa is the worst affected region with 79% of the disease burden. The epicentre of the coepidemic lies in the south of the continent, with South Africa alone accounting for over one quarter of all cases. A critical overlap between HIV and the global multidrug-resistant TB epidemics is emerging. Although it is as yet unclear whether HIV is driving a disproportionate increase in multidrug-resistant TB cases at a population level, HIV has nevertheless been a potent risk factor for institutional outbreaks, especially in South Africa and eastern Europe. Increasing data have highlighted the risk of TB among HIV-infected healthcare workers in resource-limited settings. However, many studies also show the major benefits to be derived from antiretroviral therapy in high-income and low-income countries. SUMMARY: HIV-TB remains a major challenge to global health that requires substantial increases in resource allocation and concerted international action. Language: English Keywords: GLOBAL | LITERATURE REVIEW | EPIDEMIOLOGY | HIV INFECTIONS | TUBERCULOSIS | EPIDEMICS | ANTIRETROVIRAL THERAPY | AIDS | MORTALITY | DRUG RESISTANCE | IMMUNOLOGICAL EFFECTS | Public Health | Health | Viral Diseases | Diseases | Infections | HIV | Population Dynamics | Demographic Factors | Population | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Immunity | Immune System | Physiology | Biology Document Number: 342337 |
| 26. Title: Can we reduce the number of low-birth-weight babies? The Cuban experience. Author: Lopez NB; Choonara I Source: Neonatology. 2009;95(3):193-7. Abstract: Low-birth-weight (LBW) infants have a significantly greater mortality than other babies, not only within the neonatal period but also in infancy and early childhood. Babies are LBW either because they are preterm or they have experienced intrauterine growth retardation. Reducing the prevalence of LBW babies is important in reducing child and infant mortality. Risk factors for prematurity and intrauterine growth retardation are well established. Socioeconomic conditions and nutrition during pregnancy are two key factors. Interventions to reduce the prevalence of LBW infants in developed countries have usually been unsuccessful. A few studies in developing countries have, however, achieved positive results. Cuba has managed to reduce the prevalence of LBW infants and their model of healthcare in relation to achieving this is described. Key features of the Cuban healthcare system are that it is both free and universal, and additionally there is a strong emphasis on primary healthcare. It is likely that a similar approach in both developing countries and disadvantaged communities in developed countries would reduce the prevalence of LBW babies. This would have a major impact in relation to reducing infant mortality rates. Language: English Keywords: CUBA | RESEARCH REPORT | LOW BIRTH WEIGHT | PREMATURE BIRTH | INTRAUTERINE GROWTH RETARDATION | MORTALITY | PREVENTION AND CONTROL | Caribbean | Americas | Developing Countries | Birth Weight | Body Weight | Physiology | Biology | Pregnancy Outcomes | Pregnancy | Reproduction | Congenital Abnormalities | Neonatal Diseases and Abnormalities | Diseases | Population Dynamics | Demographic Factors | Population Document Number: 341366 |
| 27. Peer Reviewed Title: Mortality and loss to follow-up among HAART initiators in rural South Africa. Author: MacPherson P; Moshabela M; Martinson N; Pronyk P Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):588-93. Abstract: A retrospective cohort study of mortality rates and potential predictors of death was conducted in public-sector patients initiating highly active antiretroviral therapy (HAART) between October 2005 and September 2007 in a rural, under-resourced region of South Africa. The aims were to determine the relative contribution of death to cohort exit and the causes and predictors of mortality among HAART initiators. A community outreach programme traced non-attenders. Patients categorised as dying at home underwent a verbal autopsy (by interviewing family members) and case-file review, and those dying in hospital a case-file review, to determine the probable cause of death. At 24 months 1131 (83.6%) patients were retained on treatment in the programme, 124 (9.2%) had died, 63 (4.7%) had transferred out, and 35 (2.6%) were lost to follow-up. The most common causes of death were tuberculosis (44.3%) and diarrhoeal diseases (24.5%). Death was the major reason for cohort exit. As experience is gained with rural HAART programmes mortality rates may decrease. These results draw attention to the need for early HIV diagnosis, increased access to HAART services with earlier treatment initiation, and routine screening and aggressive management of opportunistic infections, particularly tuberculosis. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | FOLLOW-UP STUDIES | RURAL POPULATION | CLIENTS | MORTALITY | DEATH RATE | HIV | TUBERCULOSIS | SIGNS AND SYMPTOMS | ANTIRETROVIRAL THERAPY | CAUSES OF DEATH | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Population Dynamics | HIV Infections | Viral Diseases | Diseases | Infections Document Number: 342753 |
| 28. Peer Reviewed Title: Weight gain at 3 months of antiretroviral therapy is strongly associated with survival: evidence from two developing countries. Author: Madec Y; Szumilin E; Genevier C; Ferradini L; Balkan S; Pujades M; Fontanet A Source: AIDS. 2009 Apr 27;27(7):853-61. Abstract: BACKGROUND: In developing countries, access to laboratory tests remains limited, and the use of simple tools such as weight to monitor HIV-infected patients treated with antiretroviral therapy should be evaluated. METHODS: Cohort study of 2451 Cambodian and 2618 Kenyan adults who initiated antiretroviral therapy between 2001 and 2007. The prognostic value of weight gain at 3 months of antiretroviral therapy on 3-6 months mortality, and at 6 months on 6-12 months mortality, was investigated using Poisson regression. RESULTS: Mortality rates [95% confidence interval (CI)] between 3 and 6 months of antiretroviral therapy were 9.9 (7.6-12.7) and 13.5 (11.0-16.7) per 100 person-years in Cambodia and Kenya, respectively. At 3 months, among patients with initial body mass index less than or equal to 18.5 kg/m (43% of the study population), mortality rate ratios (95% CI) were 6.3 (3.0-13.1) and 3.4 (1.4-8.3) for those with weight gain less than or equal to 5 and 5-10%, respectively, compared with those with weight gain of more than 10%. At 6 months, weight gain was also predictive of subsequent mortality: mortality rate ratio (95% CI) was 7.3 (4.0-13.3) for those with weight gain less than or equal to 5% compared with those with weight gain of more than 10%. CONCLUSION: Weight gain at 3 months is strongly associated with survival. Poor compliance or undiagnosed opportunistic infections should be investigated in patients with initial body mass index less than or equal to 18.5 and achieving weight gain less than or equal to 10%. Language: English Keywords: CAMBODIA | KENYA | RESEARCH REPORT | STATISTICAL REGRESSION | ADULTS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | ANTIRETROVIRAL THERAPY | MONITORING | BODY WEIGHT | MORTALITY | Developing Countries | Asia, Southeastern | Asia | Africa, Eastern | Africa, Sub Saharan | Africa | Data Analysis | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | HIV | Evaluation | Physiology | Biology | Population Dynamics Document Number: 341950 |
| 29. Peer Reviewed Title: Effect of HIV/AIDS-related mortality on household dependency ratios in rural South Africa, 2000-2005. Author: Madhavan S; Schatz E; Clark B Source: Population Studies. 2009 Mar;63(1):37-51. Abstract: With data from a surveillance system that uses verbal autopsies to identify cause of death in rural South Africa, we investigated whether mortality from HIV/AIDS differs from other causes of death in its effect on household dependency ratio, and to what extent the effect is mediated by the baseline dependency ratio. Findings: (i) the impact of death from HIV/AIDS on the dependency ratio in 2005 is marginally positive compared with other causes of death, but (ii) the impact is overpowered by the effect of death at working age, and (iii) the baseline dependency ratio mediates the effects on the 2005 ratio of cause of death and of the individual's sex and age at death. Migration into and out of the household--anticipating or responding to a death--seems to be a key source of change in the household dependency ratio. Language: English Keywords: SOUTH AFRICA | RESEARCH REPORT | RURAL AREAS | HOUSEHOLDS | HIV INFECTIONS | AIDS | DEPENDENCY BURDEN | MORTALITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Geographic Factors | Population | Family and Household | Sociocultural Factors | Viral Diseases | Diseases | Microeconomic Factors | Economic Factors | Population Dynamics | Demographic Factors Document Number: 341033 |
| 30. Title: Increased infant human immunodeficiency virus-type one free survival at one year of age in sub-saharan Africa with maternal use of highly active antiretroviral therapy during breast-feeding. Author: Marazzi MC; Nielsen-Saines K; Buonomo E; Scarcella P; Germano P; Majid NA; Zimba I; Ceffa S; Palombi L Source: Pediatric Infectious Disease Journal. 2009 Jun;28(6):483-7. Abstract: BACKGROUND: Reduction of HIV-1 breast-feeding transmission remains a challenge for prevention of pediatric infections in Sub-Saharan Africa. Provision of formula decreases transmission but often increases child mortality in this setting. METHODS: A prospective observational cohort study of HIV-1 exposed infants of mothers receiving pre and postnatal medical care at Drug Resource Enhancement Against AIDS and Malnutrition centers in Mozambique was conducted. Live-born infants of HIV-1-infected women receiving medical care were enrolled. HIV-1 testing was performed at 1, 6, and 12 months of age using branched DNA. Mothers were counseled to breast-feed exclusively for 6 months and were provided HAART antenatally and postnatally for the first 6 months. Women with CD4 cell counts less than 350/cmm at baseline continued HAART indefinitely. RESULTS: Of 341 infants followed from birth, 313 mother-infant pairs (92%) completed 6 months and 283 (83%) completed 12 months of follow-up. HIV-1 diagnosis was ascertained in 287 infants (84%) including 4 who died. There were 8 cases of HIV-1 transmission: 4 of 341 (1.2%) at 1 month, 2 of 313 (0.6%) at 6 months, and 2 of 276 (0.7%) at 12 months (cumulative rate: 2.8%). Two mothers (0.6%) and 11 infants (3.2%) died. Maternal and infant mortality rates were 587 of 100,000 and 33 of 1000, while country rates are 1000 of 100,000 and 101 of 1000. HIV risk reduction was 93% and HIV-free survival at 12 months was 94%. CONCLUSIONS: Late postnatal transmission of HIV-1 is significantly decreased by maternal use of HAART with high infant survival rates up to 12 months of age. Language: English Keywords: MOZAMBIQUE | RESEARCH REPORT | PROSPECTIVE STUDIES | INFANT | ANTIRETROVIRAL THERAPY | BREASTFEEDING, EXCLUSIVE | HIV TRANSMISSION | PREVALENCE | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | COUNSELING | MORTALITY | TIME FACTORS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | HIV | HIV Infections | Viral Diseases | Diseases | Breastfeeding | Infant Nutrition | Nutrition | Health | Measurement | Disease Transmission Control | Prevention and Control | Clinic Activities | Program Activities | Programs | Organization and Administration | Population Dynamics Document Number: 342638 |
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