Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings

Hdl Handle:
http://hdl.handle.net/10144/120330
Title:
Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings
Authors:
Spaar, A; Graber, C; Dabis, F; Coutsoudis, A; Bachmann, L; McIntyre, J; Schechter, M; Prozesky, H W; Tuboi, S; Dickinson, D; Kumarasamy, N; Pujdades-Rodriquez, M; Sprinz, E; Schilthuis, H J; Cahn, P; Low, N; Egger, M
Journal:
AIDS Care
Abstract:
Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely.
Affiliation:
Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Horten Centre for Patient-oriented Research and Knowledge Transfer, University Hospital of Zurich, Zurich, Switzerland; Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED), Université Victor Segalen, Bordeaux, France; Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa; Perinatal HIV Research Unit (PHRU), Soweto, South Africa; Rio HIV Cohort, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Tygerberg Academic Hospital, Cape Town, South Africa; Independent Surgery, Gaborone, Botswana; Y R Gaitonde Centre for AIDS Research and Education (YRG Care), Chennai, India; Epicentre, Paris, France; South Brazil HIV Cohort (SOBRHIV), Hospital de Clinicas, Porto Alegre, Brazil; Heineken Medical Services, Amsterdam, The Netherlands; Fundación Huesped, Buenos Aires, Argentina
Issue Date:
13-May-2010
URI:
http://hdl.handle.net/10144/120330
DOI:
10.1080/09540120903349102
PubMed ID:
20473792
Additional Links:
http://www.informaworld.com/smpp/content~db=all?content=10.1080/09540120903349102
Type:
Article
Language:
en
ISSN:
1360-0451
Appears in Collections:
HIV/AIDS

Full metadata record

DC FieldValue Language
dc.contributor.authorSpaar, Aen
dc.contributor.authorGraber, Cen
dc.contributor.authorDabis, Fen
dc.contributor.authorCoutsoudis, Aen
dc.contributor.authorBachmann, Len
dc.contributor.authorMcIntyre, Jen
dc.contributor.authorSchechter, Men
dc.contributor.authorProzesky, H Wen
dc.contributor.authorTuboi, Sen
dc.contributor.authorDickinson, Den
dc.contributor.authorKumarasamy, Nen
dc.contributor.authorPujdades-Rodriquez, Men
dc.contributor.authorSprinz, Een
dc.contributor.authorSchilthuis, H Jen
dc.contributor.authorCahn, Pen
dc.contributor.authorLow, Nen
dc.contributor.authorEgger, Men
dc.date.accessioned2011-01-25T16:43:13Z-
dc.date.available2011-01-25T16:43:13Z-
dc.date.issued2010-05-13-
dc.identifier.citationAIDS Care 2010;22(6):775-83en
dc.identifier.issn1360-0451-
dc.identifier.pmid20473792-
dc.identifier.doi10.1080/09540120903349102-
dc.identifier.urihttp://hdl.handle.net/10144/120330-
dc.description.abstractExpanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely.en
dc.language.isoenen
dc.relation.urlhttp://www.informaworld.com/smpp/content~db=all?content=10.1080/09540120903349102en
dc.rightsFree access to this article was provided by kind permission of Taylor & Francisen
dc.subject.meshAntiretroviral therapyen
dc.subject.meshHIV preventionen
dc.subject.meshresource limited settingen
dc.titlePrioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settingsen
dc.typeArticleen
dc.contributor.departmentInstitute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Horten Centre for Patient-oriented Research and Knowledge Transfer, University Hospital of Zurich, Zurich, Switzerland; Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED), Université Victor Segalen, Bordeaux, France; Department of Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa; Perinatal HIV Research Unit (PHRU), Soweto, South Africa; Rio HIV Cohort, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil; Tygerberg Academic Hospital, Cape Town, South Africa; Independent Surgery, Gaborone, Botswana; Y R Gaitonde Centre for AIDS Research and Education (YRG Care), Chennai, India; Epicentre, Paris, France; South Brazil HIV Cohort (SOBRHIV), Hospital de Clinicas, Porto Alegre, Brazil; Heineken Medical Services, Amsterdam, The Netherlands; Fundación Huesped, Buenos Aires, Argentinaen
dc.identifier.journalAIDS Careen

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