Blog post by Joyce Wamoyi1, Dominic Bukenya2, Robert Ssekubugu3, Alison Wringe4 and Jenny Renju4 National Institute for Medical Research, Tanzania Medical Research Council, Uganda Rakai health Sciences Programme, Uganda London School of Hygiene and Tropical Medicine, UK A newly published supplement to Sexually Transmitted Infections on the HIV Bottlenecks study presents the multiple tensions that exist […]
Category: HIV care
HPTN 071 attempts universal home-based HIV testing in sub-Saharan Africa: scaling the mountainous challenge of UNAIDS 90-90-90 target
Estimates of 96% for the preventative efficacy of ART against HIV transmission, reported in 2011 by Myron & Cohen (M&C), appeared at last to place long-term containment of the epidemic in our hands. In the wake of this, UNAIDS: 90-90-90 proposed ambitious targets: 90% of those living with HIV to know their status; 90% of […]
Health vulnerability of peri-natally HIV-infected youth: a growing problem throughout the world
Mother-to-child, or ‘vertical’, transmission of HIV is not just a problem for developing countries; even in countries like the US and the UK, peri-natal transmission has probably not been eliminated. But, with routine ‘opt-out’ ante-natal testing (BHIVA guidelines on HIV testing), cases are increasingly likely to involve births that have taken place overseas or before […]
‘Scoping’ location: the role of ‘place’/’space’ as an influence on HIV outcomes amongst young MSM
Bauermeister & Stephenson (B&S) is a scoping review addressing the impact of location – ‘space’ and ‘place’ – on HIV prevention and care outcomes for young MSM (YMSM). It owes much to Diaz & Ayala and their concern to view human behaviour in terms of ‘social location’ ‘within a context of social oppressive factors’ rather […]
The PrEP ‘care continuum/cascade’: how would it look?
We take for granted the value of the care continuum (or ‘cascade’), now increasingly seen as the key measure of health system response to HIV (Cassell (STIs editorial)). The application of this model to HIV has provided a benchmark for evaluation in contexts as diverse as Moscow (Wirtz & Beyrer (STIs)), South Africa (Schwartz & […]
Changes in the WHO Guidelines for treatment of HIV
The WHO has released early its revised guidelines on the treatment of those infected with HIV (WHO early release guideline; WHO press release). There are two important changes. First, ART is recommended to all HIV infected individuals regardless of their CD4+ count. Second, PrEP is recommended for people at ‘substantial’ risk of HIV infection as […]
A case for immediate ART initiation in all HIV diagnosed, regardless of CD4+ count?
The year 2013 saw the WHO recommended threshold for treatment of HIV+ patients with ART rise from a count of 350 CD4+ per mm3 to one of 500 CD4+ per mm3.. The threshold had been fixed as early as three years before (2010) at 350 CD4+ per mm3 (WHO ART recommendations). These recommendations have doubtless […]
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 […]
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 […]
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 […]