The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings

Gilks, Charles F.; Crowley, Siobhan; Ekpini, René; Gove, Sandy; Perriëns, Jos; Souteyrand, Yves; Sutherland, Donald; Vitória, Marco; Guerma, Teguest; Cock, Kevin De

doi:10.1016/s0140-6736(06)69158-7

Cited by 607 publications

(479 citation statements)

References 8 publications

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“…Reasons include adolescents' risk taking behavior, the stage of development when thought and reasoning is not fully developed, and regimen fatigue [18,38]. As perinatally infected HIV children who have been on ARVs grow into adolescence, adherence was found to decrease because of long period on medication [18,19,[36][37][38]. Some studies have reported adherence rates for long term prescription medications to be between 50-75% [18,19].…”

Section: Discussionmentioning

confidence: 99%

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Aa¹

2015

J HIV Clin Sci Res

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Background: In high-income countries, viral load is routinely used for monitoring HIV patients on antiretroviral therapy for early detection of drug failure. This is not the case in most resource limited settings like ours where only WHO immunological and clinical criteria are used for monitoring. This study is aimed at determining the rate/time of failure to 1 st and 2 nd antiretroviral drugs in children in our centers.Method: Is a retrospective study of children ≤18 years switched to 2 nd line antiretroviral regimen and those requiring third line drugs from Jan 2006 to June 2015 in our health institution. Data analysis was conducted using SPSS version 16.0 software and statistical significance set at p < 0.05. Result:Sixteen percent (82/514) of children on 1 st line medication were switched to 2 nd line drugs with switch over rate of 9 persons/year, and 6/82 (7.3%) required 3 rd line medication. The median switch over time was 31.3 months (IQR 26.4-36.2) for 2 nd line medication, and 42.6 months (IQR 40.1-44.3) from time of switch to 2 nd line drugs for those requiring 3 rd line regimen. Over 90% of patients switched to 2 nd line drugs were between 9-18 years, none was an infant. The mean CD4 cell count and viral load before switch to 2 nd line drugs were 109.09±29.23 cell/mm 3 and 180,480.29±35,303 copies/ ml, and 89.42±28.67 cell/mm 3 / 237,337.5±64,619 copies/ml for those requiring 3 rd line medications. There was over 450 fold increase in viral load from the expected undetectable level of 400 copies/ml after 6 months on medication before patients were switch to 2 nd line drugs, and over 590 folds increase for those that require 3 rd line medications. Significant difference was seen in the mean CD4 cell count and weight of those with adherence of ≥ 95% and ≤ 95% (p values were <0.05). Conclusion:WHO immunological and clinical criteria were found not to be ideal for monitoring of children on antiretroviral therapy. Six monthly viral load monitoring and resistance testing should be introduced in Nigerian guideline for managing HIV children for better therapeutic and pharmacoeconomic outcomes. Third line medication should also be made available in the country and intensification of adherence is required in adolescent age group.

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Section: Discussionmentioning

confidence: 99%

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Aa¹

2015

J HIV Clin Sci Res

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“…The same issues apply to HIV/AIDS, and there is a strong rationale to extend existing eff orts to ensure quality of care for HIV to patients with NCDs. 60 Simplifi ed monitoring and treatment regimens, 61 point-of-care tests, 62 decentralisation of care to the periphery, shifting of tasks from doctors to nurses, 63 and use of adherence counsellors instead of provider-controlled directly observed treatment 64 have all supported improved adherence. 65 The best-buy options for countries to reduce preventable deaths from NCDs include management of cardiometabolic risk in high-risk individuals at the primary health-care level.…”

Section: Integrate Pharmaceutical Management Of Ncds With Existing Inmentioning

confidence: 99%

Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration

et al. 2013

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“…The WHO estimated that by the end of 2005, out of 6.5 million people, only 1.3 million were received it. 6,7 Antiretroviral therapy more than doubled in sub-Saharan Africa in 2005, with one in six received the treatment, with a coverage level of 50% or more have been achieved in some countries such as Botswana and Uganda, while in others levels remained at less than 10%. As at the same time, 250,000 to 350,000 deaths were averted even in the areas are in the treatment access.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of ADRs and Associated Factors of Antiretroviral Treatment on HIV Positive Adults at Jush

Tatiparthi¹,

Mamo²

2015

IJOPP

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A cross sectional study is designed to assess the prevalence of adverse drug reactions and its associated factors on who are already under Highly Active Antiretroviral Therapy. Considerable progress has been made to access the therapy since the decades, even though; currently five million people do not have an access to HIV therapy, it just represents 35% only. The objective of present research is to assess the prevalence of ADRs and its associated factors on HAART at Jimma University Specialized Hospital. The data was pooled by reviewing the previous clinical records of HIV positive adults, who admitted from January 2010 to December 2013. The total sample size is found to be 233. The results showed from the total of 233 patients, 70.8% were developed ADRs and the most of them are nausea, vomiting and diarrhea at 18.9%, 15% and 7.7% respectively, and the least one is hepatotoxicity at 0.43% only. The prevalence of ADRs of HAART was high at JUSH. Low CD 4 cell count was identified at initial stages and concomitant use of cotrimoxazole with ARVs is the major risk factor for ADRs. Thus, health care providers working in the JUSH ART clinic need to monitor the CD 4 count of patients, particularly those treated with combination of antibiotics and ARVs.

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The WHO public-health approach to antiretroviral treatment against HIV in resource-limited settings

Cited by 607 publications

References 8 publications

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

First and Second Line Highly Active Anti-Retroviral Therapy Failure in HIV Infected Nigerian Children at University of Abuja Teaching Hospital Gwagwalada, Nigeria

Promotion of access to essential medicines for non-communicable diseases: practical implications of the UN political declaration

Prevalence of ADRs and Associated Factors of Antiretroviral Treatment on HIV Positive Adults at Jush

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