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Optimizing Hiv Treatment In Resource Limited Settings
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Book Synopsis Optimizing HIV Treatment in Resource-Limited Settings by : Gordon Amed Akudibillah
Download or read book Optimizing HIV Treatment in Resource-Limited Settings written by Gordon Amed Akudibillah and published by . This book was released on 2016 with total page 99 pages. Available in PDF, EPUB and Kindle. Book excerpt: Apart from the traditional role of preventing progression from HIV to AIDS, antiretroviral drug therapy (ART) has an additional benefit of substantially reducing infectiousness, making them potentially an important strategy in the fight against HIV. Recent advances in drug therapy have also seen the use of antiretroviral drugs as a prophylaxis, administered either as post-exposure prophylaxis (PEP) after high-risk exposure or as pre-exposure prophylaxis (PrEP) in those with ongoing HIV exposure. In this dissertation I developed two models for HIV transmission and parameterized them with data from South Africa to study governmental-level intervention programs in which antiretroviral drugs are given as treatment and prophylaxis. The first model is based on the dynamics of HIV in heterosexual population in Sub- Saharan Africa. The model classifies the male and female adult populations by HIV risk into three categories (low, medium and high) according to their sexual preferences. I used a non-linear optimization method to determine the optimal population-level allocation of ART and PrEP allocations required to minimize four objectives: new infections, infection-years, deaths and cost. I considered several strategies for allocating ART and PrEP. I found that generally for low treatment availability, prevention through PrEP to the general population or PrEP and ART to high-risk females is key to optimize all objectives, while for higher drug availability, an all-ART treatment is optimal. At South Africa’s current level of treatment availability, using prevention is most effective at reducing new infections, infection-years, and cost, while using the treatment as ART to the general population best reduces deaths. At treatment levels that meet the UNAIDS's ambitious new 90-90-90 target in South Africa, using all or almost all treatment as ART to the general population best reduces all four objectives considered. The second model is based on the WHO's five-stage classification of HIV/AIDS disease progression. This models stratified the population by disease status, whether diagnosed and whether on treatment. I used optimal control methods to determine the best time-dependent treatment allocation required to minimize new infections, infection-years, deaths and cost. My results indicated that the treatment strategy to minimize infection-years and new infections is to place emphasis on early treatment (i.e. treatment in Stage II & III) while to minimize cost and death, the emphasis should be on late treatment (i.e. Stage III & IV). Applying the optimal treatment strategy also leads to a substantial reduction in disease incidence and prevalence. The results of this study will hopefully provides some guidance for policymakers in determining how to allocate antiretroviral drugs in order to maximize the benefit of treatment.
Book Synopsis Scaling Up Antiretroviral Therapy in Resource-limited Settings by : Alamo Stella-Talisuna
Download or read book Scaling Up Antiretroviral Therapy in Resource-limited Settings written by Alamo Stella-Talisuna and published by . This book was released on 2012 with total page 186 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Scaling Up Treatment for the Global AIDS Pandemic by : Institute of Medicine
Download or read book Scaling Up Treatment for the Global AIDS Pandemic written by Institute of Medicine and published by National Academies Press. This book was released on 2004-11-24 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: An estimated forty million people carry the human immunodeficiency virus (HIV), and five million more become newly infected annually. In recent years, many HIV-infected patients in wealthy nations have enjoyed significantly longer, good-quality lives as a result of antiretroviral therapy (ART). However, most infected individuals live in the poorest regions of the world, where ART is virtually nonexistent. The consequent death toll in these regionsâ€"especially sub-Saharan Africaâ€"is begetting economic and social collapse. To inform the multiple efforts underway to deploy antiretroviral drugs in resource-poor settings, the Institute of Medicine committee was asked to conduct an independent review and assessment of rapid scale-up ART programs. It was also asked to identify the components of effective implementation programs. At the heart of the committee's report lie five imperatives: Immediately introduce and scale up ART programs in resource-poor settings. Devise strategies to ensure high levels of patient adherence to complicated treatment regimens. Rapidly address human-resource shortages to avoid the failure of program implementation. Continuously monitor and evaluate the programs to form the most effective guidelines and treatment regimens for each population. Prepare to sustain ART for decades.
Book Synopsis Scaling Up Antiretroviral Therapy in Resource-limited Settings by :
Download or read book Scaling Up Antiretroviral Therapy in Resource-limited Settings written by and published by . This book was released on 2002 with total page 31 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring by : World Health Organization
Download or read book Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring written by World Health Organization and published by World Health Organization. This book was released on 2021-07-16 with total page 592 pages. Available in PDF, EPUB and Kindle. Book excerpt: These consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring bring together existing and new clinical and programmatic recommendations across different ages, populations and settings, bringing together all relevant WHO guidance on HIV produced since 2016. It serves as an update to the previous edition of the consolidated guidelines on HIV. These guidelines continue to be structured along the continuum of HIV care. Information on new combination prevention approaches, HIV testing, ARV regimens and treatment monitoring are included. There is a new chapter on advanced HIV disease that integrates updated guidance on the management of important HIV comorbidities, including cryptococcal disease, histoplasmosis and tuberculosis. The chapter on general HIV care, contains a new section on palliative care and pain management, and up to date information on treatment of several neglected tropical diseases, such as visceral leishmaniasis and Buruli ulcer. New recommendations for screening and treating of cervical pre-cancer lesions in women living with HIV are also addressed in this chapter. Guidance on service delivery was expanded to help the implementation and strengthening the HIV care cascade. Importantly, this guidance emphasizes the need for differentiated approaches to care for people who are established on ART, such as reduced frequency of clinic visits, use of multi-month drug dispensing and implementation of community ART distribution. The adoption of these efficiencies is essential to improve the quality of care of people receiving treatment and reduce the burden on health facilities, particularly in resource limited settings.
Book Synopsis Disease Control Priorities, Third Edition (Volume 6) by : King K. Holmes
Download or read book Disease Control Priorities, Third Edition (Volume 6) written by King K. Holmes and published by World Bank Publications. This book was released on 2017-11-06 with total page 1027 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.
Book Synopsis Scaling Up Antiretroviral Therapy in Resource-limited Settings by : WHO (Geneva).
Download or read book Scaling Up Antiretroviral Therapy in Resource-limited Settings written by WHO (Geneva). and published by . This book was released on 2004 with total page 67 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection by : World Health Organization
Download or read book Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection written by World Health Organization and published by . This book was released on 2016 with total page 429 pages. Available in PDF, EPUB and Kindle. Book excerpt: These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.
Book Synopsis Guidelines for Diagnosing and Managing Disseminated Histoplasmosis Among People Living with HIV by : Pan American Pan American Health Organization
Download or read book Guidelines for Diagnosing and Managing Disseminated Histoplasmosis Among People Living with HIV written by Pan American Pan American Health Organization and published by . This book was released on 2020-06-18 with total page 56 pages. Available in PDF, EPUB and Kindle. Book excerpt: Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. This disease is highly endemic in some regions of North America, Central America, and South America and is also reported in certain countries of Asia and Africa. It often affects people with impaired immunity, including people living with HIV, among whom the most frequent clinical presentation is disseminated histoplasmosis. The symptoms of disseminated histoplasmosis are non-specific and may be indistinguishable from those of other infectious diseases, especially disseminated tuberculosis (TB), thus complicating diagnosis and treatment. Histoplasmosis is one of the most frequent opportunistic infections caused by fungal pathogens among people living with HIV in the Americas and may be responsible for 5-15% of AIDS-related deaths every year in this Region. These guidelines aim to provide recommendations for the diagnosis, treatment, and management of disseminated histoplasmosis in persons living with HIV. Although the burden of disease is concentrated in the Americas, the recommendations presented within these guidelines are applicable globally. These guidelines were produced in accordance with the World Health Organization (WHO) handbook for guideline development. The Guideline Development Group elaborated the final recommendations based on a systematic review of scientific literature and critical evaluation of the evidence available using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. These guidelines are intended for health-care providers, HIV program managers, policy-makers, national treatment advisory boards, researchers, and other professionals involved in caring for people who either have or may be at risk of developing disseminated histoplasmosis.
Book Synopsis Antiretroviral Therapy for HIV Infection in Adults and Adolescents by : World Health Organization
Download or read book Antiretroviral Therapy for HIV Infection in Adults and Adolescents written by World Health Organization and published by . This book was released on 2010 with total page 154 pages. Available in PDF, EPUB and Kindle. Book excerpt: The guidelines identify the most potent, effective and feasible first-line, second-line and subsequent treatment regimens, applicable to the majority of populations, the optimal timing of ART initiation and improved criteria for ART switching, and introduce the concept of third-line antiretroviral regimens. The primary audiences are national treatment advisory boards, partners implementing HIV care and treatment, and organizations providing technical and financial support to HIV care and treatment programmes in resource-limited settings. It is critical that national ART programme and public health leaders consider these recommendations in the context of countries' HIV epidemics, the strengths and weaknesses of health systems, and the availability of financial, human and other essential resources. In adapting these guidelines, care must be exercised to avoid undermining current treatment programmes, to protect access for the most at-risk populations, to achieve the greatest impact for the greatest number of people and to ensure sustainability. It is similarly important to ensure that the adaptation of these guidelines do not stifle ongoing or planned research, since the new recommendations reflect the current state of knowledge and new information for sustainability and future modifications of existing guidelines will be needed.
Book Synopsis Technical Update on Treatment Optimization by : Peter L. Havens
Download or read book Technical Update on Treatment Optimization written by Peter L. Havens and published by . This book was released on 2012 with total page 13 pages. Available in PDF, EPUB and Kindle. Book excerpt: "The aim of this update is to provide information and guidance to countries on how best to use tenofovir (TDF) for the treatment of children with HIV. It is intended to complement the World Health Organization (WHO) normative guidelines on antiretroviral therapy (ART) and also support the goal of increasing access to simpler paediatric antiretroviral (ARV) formulations, in line with Treatment 2.0. TDF is recommended by WHO for use in adults and adolescents as a preferred first-line drug for the treatment of HIV infection, in combination with other ARVs. TDF is well tolerated and is available as a co-formulation with other ARVs to make dual or triple once-daily fixed-dose combinations. In this technical update, WHO has reviewed the currently available published and unpublished data on the safety, efficacy and dosing of TDF in children and adolescents. The US Food and Drug Administration (FDA) has approved TDF for use in adolescents and children above the age of two years. The recommended dose is 8 mg/kg body weight (up to a maximum of 300 mg), administered once daily using either an oral powder formulation or low-strength tablets. There are many potential benefits to using TDF in children--especially the ability to harmonize TDF-containing paediatric regimens with adult treatment recommendations, and the possibility of developing a once-daily paediatric fixed-dose combination. However, TDF also has potential risks. TDF toxicities have been investigated better in adults but there are some recent data from studies in children and adolescents. The main toxicities are decreases in bone mineral density (BMD), and glomerular and renal tubular dysfunction resulting in phosphaturia, hypophosphataemia and increased levels of parathyroid hormone. The TDF product label calls for patients with a history of pathological fracture and those at risk for osteoporosis to undergo BMD testing. It also recommends assessment of creatinine clearance before treatment initiation with TDF. In resource-limited settings, routine monitoring of creatinine clearance is frequently not possible. However, long-term data suggest that routine biochemistry testing does not improve patient outcome compared with clinical monitoring alone. When compared with population norms, HIV-infected children have lower-than-expected bone mass for their age and gender. This may be due to delays in growth, sexual maturity, time with HIV infection and disease severity. Bone turnover is higher in young children than in adults and adolescents because of skeletal growth. TDF-associated decreases in BMD correlate with young age, but also with a decline in viral load, suggesting that young virological responders may be at greater risk for loss of BMD if taking TDF. In addition, use of other ARVs, such as stavudine and protease inhibitors, especially ritonavir, is also associated with lower bone mass measurements. It is important to note that the clinical consequences of low BMD --related to either HIV or ART--remain unclear. Although bone fracture has not been observed in children treated with TDF, the impact of lower BMD on the long-term risk of osteoporosis and fracture is unknown."--Page 1.
Book Synopsis Ethics and Drug Resistance: Collective Responsibility for Global Public Health by : Euzebiusz Jamrozik
Download or read book Ethics and Drug Resistance: Collective Responsibility for Global Public Health written by Euzebiusz Jamrozik and published by Springer. This book was released on 2021-08-21 with total page 448 pages. Available in PDF, EPUB and Kindle. Book excerpt: This Open Access volume provides in-depth analysis of the wide range of ethical issues associated with drug-resistant infectious diseases. Antimicrobial resistance (AMR) is widely recognized to be one of the greatest threats to global public health in coming decades; and it has thus become a major topic of discussion among leading bioethicists and scholars from related disciplines including economics, epidemiology, law, and political theory. Topics covered in this volume include responsible use of antimicrobials; control of multi-resistant hospital-acquired infections; privacy and data collection; antibiotic use in childhood and at the end of life; agricultural and veterinary sources of resistance; resistant HIV, tuberculosis, and malaria; mandatory treatment; and trade-offs between current and future generations. As the first book focused on ethical issues associated with drug resistance, it makes a timely contribution to debates regarding practice and policy that are of crucial importance to global public health in the 21st century.
Book Synopsis Examining Critical Issues Associated with Human Immunodeficiency Virus Antiretroviral Therapy Administration in Resource-limited Settings by : Jayne Byakika Tusiime
Download or read book Examining Critical Issues Associated with Human Immunodeficiency Virus Antiretroviral Therapy Administration in Resource-limited Settings written by Jayne Byakika Tusiime and published by . This book was released on 2010 with total page 212 pages. Available in PDF, EPUB and Kindle. Book excerpt: Human Immunodeficiency Virus (HIV) infection remains a global health problem affecting many lives especially in sub-Saharan Africa (SSA). The push by the global community towards universal access to HIV prevention, treatment, care, and support has enabled millions of individuals to start on antiretroviral therapy (ART) in resource-limited settings. However, there is concern that widespread antiretroviral use could lead to widespread drug resistance. Suboptimal adherence leading to incomplete viral suppression is the primary predictor of HIV drug resistance. Concerns have been raised about the ability of patients in resource-limited settings to maintain the high level of adherence required to produce adequate viral suppression and hence prevent the emergence of resistant strains of HIV. The cost of antiretroviral medications is the most frequently cited barrier to adherence in resource-limited settings. Even with the recent substantial reductions in drug prices, many patients cannot afford to sustain their therapy over time. Generic antiretroviral medications (ARVs) today form the backbone of first-line regimens in developing countries. However, there are limited data on the bioavailability and bioequivalence of generic ARVs with branded pharmaceutical equivalents. While substantial effort has been put into increasing access to ART in resource-limited settings, less attention has been paid to the responsibilities of governments and international agencies to address the threat of substandard and counterfeit ARVs. The prevalence of counterfeit ARVs in resource-limited settings is not known. The Beck Depression Inventory (BDI) is a commonly used instrument to measure depressive symptoms in HIV-infected populations in SSA but it has never be validated in these populations This dissertation is an attempt to address some of the critical issues associated with administration of ART in resource-limited settings. I explored the issues of adherence to HIV medications and ARV drug quality using data collected from patients participating in three prospective cohort studies and one cross sectional study conducted in two different HIV-infected populations in Uganda between September 2002 and December 2006. Specifically, I assessed i) the effect of source of payment for ARVs (no cost vs. self-pay) on adherence; ii) the impact on adherence of treating all HIV-infected members in a household; iii) the psychometric properties of the Beck Depression Inventory (BDI) when used in an HIV-infected population, and iv) the bioequivalence of a fixed dose combination generic drug (Triomune®) with the brand name pharmaceutical equivalents (Zerit®/Epivir®/Viramune®). Patients receiving no cost ART had 3.8 percentage points higher adherence than those patients paying for their treatment. Excellent adherence was observed when all household members infected with HIV were treated, however adherence declined over time. Depression was associated with poor adherence. The BDI had good psychometric properties with Cronbach's alpha of 0.79 and the expected a posteriori reliability coefficient (EAP) of 0.86. Comparing generic and brandname ARVs, we found that the generic formulation was not statistically bioequivalent to the brand formulations during steady state, although exposures were comparable. Fifty percent of the total variability in maximum plasma concentration (Cmax) and the area under the plasma concentration-time curve (AUC) was due to between-subject variability. These results suggest that removing a financial barrier to treatment with ART by providing no cost HIV treatment may significantly improve adherence to ART. Our results also indicate that providing free ART to all eligible members in a household is associated with excellent adherence in both parents and children. Adherence to ART among new parents declines over time, even when patients receive treatment at no cost. Depression should be addressed as a potential adherence barrier. These findings support the use of the BDI-II in assessing depressive symptoms for HIV-infected patients in sub-Saharan Africa, especially women. Finally, these findings provide support for the use of Triomune in resource-limited settings, although identification of the sources of between-subject variability in AUC and Cmax in these populations is critical.
Book Synopsis WHO Consultation on Technical and Operational Recommendations for Scale-Up of Laboratory Services and Monitoring HIV Antiretroviral Therapy in Resource-Limited Settings by :
Download or read book WHO Consultation on Technical and Operational Recommendations for Scale-Up of Laboratory Services and Monitoring HIV Antiretroviral Therapy in Resource-Limited Settings written by and published by . This book was released on 2005 with total page 42 pages. Available in PDF, EPUB and Kindle. Book excerpt: The aim of the consultation was to obtain clear and realistic guidelines as to which diagnostic and monitoring schedules were optimal and how they could be delivered in order to assist decision-making on treatment and facilitate the implementation of strategies and necessary actions for scaling up diagnosis and monitoring at the local, regional, and global levels, with particular emphasis on resource-constrained settings.
Book Synopsis Overcoming Barriers to Antiretroviral Therapy in Resource-limited Settings by : Nathan Paul Ford
Download or read book Overcoming Barriers to Antiretroviral Therapy in Resource-limited Settings written by Nathan Paul Ford and published by . This book was released on 2010 with total page 284 pages. Available in PDF, EPUB and Kindle. Book excerpt: The provision of antiretroviral therapy in resource-limited settings has been one of the most ambitious global health projects to date, leading to a significant reframing of global trade rules, the establishment of new international funding mechanisms, and challenging medical and public health models. This thesis provides a summary of these major challenges. The first chapter provides an analysis of the drug policy challenges, examining the effectiveness of policy approaches to reducing the price of antiretrovirals and analyzing the role played by civil society in this struggle to increase access to treatment. Chapter two assesses efforts to overcome human resource shortage, in particular the effectiveness of task shifting. Chapter three examines the related issue of decentralization of care. Chapter four begins with an analysis of data from a treatment programme in South Africa to assess adherence to treatment over time as a prelude to a summary of emerging concerns around the quality of treatment provided to resource-limited settings. Finally, the thesis concludes with a reflection on future challenges for maintaining and sustaining access to effective treatment.
Book Synopsis Challenges in Rolling Out HIV Care and Antiretroviral Treatment in Resource Limited Settings by : Barbara Castelnuovo
Download or read book Challenges in Rolling Out HIV Care and Antiretroviral Treatment in Resource Limited Settings written by Barbara Castelnuovo and published by . This book was released on 2011 with total page 171 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Book Synopsis The Columbia Clinical Manual by : Miriam Rabkin
Download or read book The Columbia Clinical Manual written by Miriam Rabkin and published by . This book was released on 2005 with total page 212 pages. Available in PDF, EPUB and Kindle. Book excerpt:
