Retention in care rather than diagnosis may prove the ultimate challenge for US HIV response

The real challenge which the US HIV/AIDS epidemic poses for the US public health services is not simply to achieve higher levels of diagnosis – but, far more than that, to improve linkage to, and retention in, care.  This claim is hardly controversial. But it is thrown into stark relief in a recent study by […]

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HIV impact of ObamaCare reduced by US Supreme Court decision

What impact will the roll-out of the US Affordable Care Act (ACA) – ObamaCare – have on health insurance coverage of people with HIV?  A recently published “issue brief” on behalf of the US Centers for Disease Control and Prevention (CDC) offers a first estimate (Kates & Garfield (K&G)). The ACA includes a provision to […]

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Partners PrEP sub-study finds no evidence that PrEP use is associated with risk compensation behaviour

How useful is pre-exposure prophylaxis (PrEP)?  The Partners PrEP randomized control study of daily pre-exposure prophylaxis among HIV-uninfected partners of heterosexual HIV-discordant couples in Uganda and Kenya has indicated that, given adequate adherence, PrEP has high biologic efficacy.  The study itself (Baeten & Celum) demonstrates levels of risk reduction of 75%; while a spin-off sub-study […]

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UNAIDS assesses progress towards #HIV Millennium Development Goal

In the run-up to the 2013 General Assembly of the UN in New York, a new report from the Joint United National Program on HIV/AIDS seeks to give an overview of progress to date towards Millenium Goal 6 – the goal of halting and beginning to reverse the HIV/AIDS epidemic by 2015 (UNAIDS Report 2013). […]

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Should ART provision be decentralized to health centres in low and middle income countries?

With the realization of the value of ART as a means of preventing HIV transmission, the question of how best to retain HIV-diagnosed in care becomes all the more pressing.  Recent STI blogs have covered such topics as the potential role of computer-generated reminders in retaining patients (sti blogs03/05/13), as well as the re-engagement of […]

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HIV+ mothers without ART: when and how should they wean?

Without antiretrovirals, breastfeeding contributes 28% to the risk of mother-to-child HIV transmission (MTCT) (http://sti.bmj.com/content/88/Suppl_2/i44.abstract?sid=fcfaeecc-767f-4db8-b644-77db5aa8db63).  Antiretroviral drugs make achieving he WHO goal of near elimination of MTCT imaginable (http://sti.bmj.com/content/87/3/261.full; http://sti.bmj.com/content/86/Suppl_2/ii48.abstract?sid=fcfaeecc-767f-4db8-b644-77db5aa8db63).  But, in the meantime, what advice should be given to HIV+ mothers in those low-resource settings where antiretrovirals are still not available? In this context, the […]

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Taking seriously the public health impact of disengagement from HIV care in the US

ART as a strategy for “treatment-as-prevention” is frequently acknowledged.  Public health efforts, in the US as elsewhere, have focussed on prompt initiation of ART for the newly-diagnosed so as to shorten the duration of viremia – and thereby also reduce transmission risk.  But what about the public health implications of people living with HIV (PLWH) […]

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Computerized “clinical decision support systems” (CDSS): their potential for improving HIV follow-up in low-resource settings

Kit Fairley (http://sti.bmj.com/content/87/Suppl_2/ii25.full)  in this journal offers an overview of the many ways in which information technology can be used in the area of STIs.  This is most obviously through the role of electronic medical records (EMR); but also through the possibility these offer for clinical decision support systems that can be used to generate […]

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First ever WHO guidelines on HIV prevention and treatment for MSM and TG

The World Health Organization (WHO) has issued its first ever guidelines on the prevention and treatment of HIV for populations of men who have sex with men (MSM) and transgender individuals (TG). The guidelines have been in preparation since the September 2008 WHO global consultation in Geneva. Both populations – MSM and TG – are […]

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The right way forward for global HIV/AIDS response?

Almost thirty years exactly after the first official AIDS diagnosis on 1st June 1981, and 10 years since the landmark UN General Assembly Special Session on HIV/AIDS, member countries meet once again to review the global response to HIV AIDS at the UN General Assembly High-Level Meeting on HIV/ AIDS from 8–10 June in New […]

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