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Patterns of sexual and HIV-related stigma among men who have sex with men and women living with HIV in Haiti. Sci Rep 2022; 12:7511. [PMID: 35525876 PMCID: PMC9079062 DOI: 10.1038/s41598-022-11647-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 04/27/2022] [Indexed: 02/04/2023] Open
Abstract
Vulnerability to contracting HIV among Men who have Sex with Men and Women (MSMW) was recognized early in the epidemic. However, while global HIV efforts have made tremendous progress for the heterosexually-identified population, the specific needs of MSMW were not directly addressed with tailored and context-adapted interventions. The purpose of this study was to inform this area of research by exploring patterns of stigma through sexual identity developmental history as well as coping mechanisms among MSMW living with HIV in Haiti. A qualitative descriptive study comprised of in-depth interviews with 32 MSMW living with HIV was carried out. Participants were recruited using snowball techniques. An inductive thematic analysis was conducted in NVivo, contextualized by the socio-ecological context of Haiti. MSMW reported struggling with their sexuality since their adolescence, often because of enacted stigma from family members, the community, and cultural conflicts. Most participants described experiencing anxiety, psychological distress, depression, social isolation, suicidal ideation and suicide attempts. Mechanisms for coping with stigma included self-acceptance, social support, hiding their sexual orientation, and tolerance of the voodoo religion. To combat stigma, and improve HIV treatment adherence and retention among MSMW, culturally-tailored multilevel initiatives should be implemented.
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Dunbar W, Alcide Jean-Pierre MC, Pétion JS, Labat A, Maulet N, Coppieters Y. A realist evaluation of the continuum of HIV services for men who have sex with men. AIDS Res Ther 2021; 18:67. [PMID: 34627315 PMCID: PMC8502381 DOI: 10.1186/s12981-021-00396-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background Men who have Sex with Men (MSM) represent the risk group that are disproportionately most affected by the human immunodeficiency virus (HIV) and continue to drop-off from the steps of the continuum of HIV services that have been adopted to overcome poor engagement and retention in care. This realist evaluation aimed at: (1) describing the evaluation carried out in Haiti aiming to ascertain why, how and under which circumstances MSM are linked and retained along the continuum, (2) assessing the outcomes of this approach and (3) exploring the motivators and facilitators for the HIV continuum of services through mechanisms and pathways. Methods Guided by a realist approach, first, an initial program theory (IPT) was developed based on literature and frameworks review, participant observations and discussions with stakeholders. Then, the IPT was tested using a mixed method explanatory study: a quantitative phase to build the continuum from a cross-sectional analysis, and a qualitative phase to explore the motivators and facilitators related to proper linkages along the continuum. Finally, the IPT was refined by eliciting the mechanisms and pathways for outcomes improvement. Results The results showed that the current service delivery model is suboptimal in identifying, engaging, linking and retaining MSM, resulting in loss to follow-up at every step of the continuum and failure to fully realize the health and prevention benefits of antiretroviral. However, the mechanisms through which linkages across the continuum can be improved are: self-acceptance, sense of community support and sense of comprehensive and tailored HIV services. These mechanisms are based on 10 different pathways: self-esteem, awareness and pride, perception of HIV risk, pcceptance and HIV status, addressing community stigma, strengthening of MSM organizations and community networks, societal acceptation and tolerance, stigma reduction training for healthcare providers, engagement of peers as educators and navigators and, adapted services delivery through drug dispensing points and mobile technology and financial assistance. Conclusions The study findings show that engagement, adherence and retention to the continuum of HIV service for MSM are affected by a multi-layer of factors, thus highlighting the importance of taking a comprehensive approach to improve the program.
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Ramaiya MK, Haight E, Simoni JM, Chéry JM, Dervis W, Genna W, Dubé JG, Calixte G, Balan JG, Honoré JG, Puttkammer N. Patient-Provider Communication and Information, Motivation, and Behavioral Skills in HIV-Positive Adults Initiating Antiretroviral Therapy in Haiti. J Int Assoc Provid AIDS Care 2021; 19:2325958220952631. [PMID: 32924764 PMCID: PMC7493277 DOI: 10.1177/2325958220952631] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
While Haiti has scaled up use of antiretroviral therapy (ART), current studies suggest sub-optimal adherence threatens long-term viral suppression in this understudied setting. Patient-provider communication (PPC) and information, motivation, and behavioral skills (IMB) have been implicated in ART adherence globally. However, no studies have examined their relevance in Haiti. The present mixed-methods study utilized cross-sectional survey data from 128 ART-initiating patients at 2 large HIV treatment sites in Haiti, as well as observational data from 12 clinic visits, to document associations between adherence-related PPC and IMB. Multivariate regression analyses suggested that PPC is associated with IMB constructs. At the bivariate level, more effective PPC was associated with higher levels of adherence-related information and motivation, but not behavioral skills. Observational findings indicate infrequent and non-collaborative adherence support. Taken together, findings lay the groundwork for additional research in the area of PPC, IMB, and ART adherence in Haiti.
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Affiliation(s)
- Megan K Ramaiya
- Department of Psychology, 7284University of Washington, Seattle, WA, USA
| | - Elizabeth Haight
- Department of Global Health, 7284University of Washington, Seattle, WA, USA
| | - Jane M Simoni
- Department of Psychology, 7284University of Washington, Seattle, WA, USA
| | - Jean Marcxime Chéry
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Witson Dervis
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Wilner Genna
- Justinien University Hospital, Cape Haitian, Haiti
| | | | | | - Jean Gabriel Balan
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Jean Guy Honoré
- Centre Haïtien pour le Renforcement du Système de Santé (CHARESS), Port-au-Prince, Haiti
| | - Nancy Puttkammer
- Department of Global Health, 7284University of Washington, Seattle, WA, USA.,International Training & Education Center for Health (I-TECH), Seattle, WA, USA
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Llorente-Marrón M, Fontanil-Gómez Y, Díaz-Fernández M, Solís García P. Disasters, Gender, and HIV Infection: The Impact of the 2010 Haiti Earthquake. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7198. [PMID: 34281135 PMCID: PMC8293795 DOI: 10.3390/ijerph18137198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 12/14/2022]
Abstract
Although disasters threaten all people who experience them, they do not affect all members of society in the same way. Its effects are not solely restricted to the economic sphere; they also affect the physical and mental health of those who suffer from them, having a particular impact on women and limiting their life chances. The aim of this study was to examine the impact the 2010 Haiti earthquake had on the seropositivity of female survivors. METHOD Using data from the Demographic and Health Survey, this study examines the impact of the 2010 Haiti earthquake on gender relations associated with the probability of being HIV positive through the differences-in-differences strategy. RESULTS A differential of four percentage points is observed in the probability of HIV seropositivity between men and women, favoring men. Additionally, it is observed that the probability of seropositivity intensifies when the cohabitation household is headed by a woman. CONCLUSION Disasters are not indifferent to the gender of the people affected. In the second decade of the 21st century, the conclusions obtained show, once again, the need for incorporating the gender perspective into the management of natural hazards in the field of health. This is the case of the differential exposure to HIV after the earthquake in Haiti.
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Affiliation(s)
- Mar Llorente-Marrón
- Quantitative Economics Department, University of Oviedo, 33006 Oviedo, Spain;
| | | | | | - Patricia Solís García
- Psychology Department, University of Oviedo, 33003 Oviedo, Spain; (Y.F.-G.); (P.S.G.)
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Dunbar W, Pape JW, Coppieters Y. HIV among men who have sex with men in the Caribbean: reaching the left behind. Rev Panam Salud Publica 2021; 45:e12. [PMID: 33708247 PMCID: PMC7939031 DOI: 10.26633/rpsp.2021.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 11/06/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives. To present the epidemiology, social and cultural factors driving the HIV epidemic among men who have sex with men (MSM) in the Caribbean region and to highlight the regional and national responses, and what remains to be addressed to close the gaps in order to ending AIDS by 2030. Methods. A literature review was performed in the following databases: PubMed and Scopus. Articles published in the past 10 years were selected. The outcomes of interest were sociocultural risk factors, description of regional and national efforts and potential challenges and barriers to effective control of the epidemic among MSM. This report concentrates exclusively on publications related to MSM living in the Caribbean countries. Results. 11 peer-reviewed studies, 9 grey literature reports and programme frameworks were thematically analysed. The prevalence of HIV among MSM is high and the rates also do vary among Caribbean countries. Several factors influence the epidemic among MSM in the Caribbean but stigma and discrimination underlie the social vulnerability and play a central role in driving the HIV epidemic. Conclusions. To end the AIDS epidemic by 2030, MSM can no longer be kept unchecked in the era of the Sustainable Development Goals with the motto ‘Leave no one behind’.
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Affiliation(s)
- Willy Dunbar
- Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium
| | - Jean William Pape
- Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO) Port-au-Prince Haiti Groupe Haïtien d'Etude du Sarcome de Kaposi et des Infections Opportunistes (GHESKIO), Port-au-Prince, Haiti
| | - Yves Coppieters
- Université libre de Bruxelles Brussels Belgium Université libre de Bruxelles, Brussels, Belgium
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Dunbar W, Alcide C, Raccurt C, Pape JW, Coppieters Y. Attitudes of medical students towards men who have sex with men living with HIV: implications for social accountability. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2020; 11:233-239. [PMID: 33099520 PMCID: PMC7882130 DOI: 10.5116/ijme.5f87.39c2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the attitudes that medical students in Haiti harbour toward Men who have Sex with Men living with HIV in order to better understand how stigma and other factors may impair healthcare, and to explore suggestions of opportunities in line with the values of social accountability. METHODS This study employed a qualitative design by using a grounded theory approach regarding the context of Haiti. We used purposive sampling to select the 22 research participants. In-depth interviews were conducted, audio-recorded, transcribed and analyzed using an inductive content analysis approach. RESULTS Although stigmatizing attitudes emerged through the findings, medical students expressed willingness to provide Men who have Sex with Men with adequate health services in relation to HIV care. Their expressions were based on the Men who have Sex with Men's comprehensive right to receive equitable care, the moral responsibility of healthcare professionals, their perception of health disparities and the HIV global risk reduction. Participants pointed out that the medical education curriculum did not consider sexual health and specificities of sexual minorities and suggested a more inclusive and socially accountable training based on equity and quality. CONCLUSIONS The students expressed favourable attitudes regarding health services to Men who have Sex with Men even though some layered stigmatizing attitudes emerged through the discussions. They all lacked skills on how to handle health specificities of sexual minorities. These findings recommend a revision of the medical education curriculum in regard to social accountability principles.
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Affiliation(s)
- Willy Dunbar
- Health Systems and Policies, International Health, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Colette Alcide
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Christian Raccurt
- Faculty of Health Sciences, Quisqueya University, Port-au-Prince, Haiti
| | - Jean W. Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Yves Coppieters
- Health Systems and Policies, International Health, School of Public Health, Université libre de Bruxelles (ULB), Brussels, Belgium
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Honermann B, Sharp A, Sherwood J, Kshetry P, Jones A, O’Hagan R, Lazar L, Chandra C, Hoffmann T, Millett G. Calculating indirect costs from international PEPFAR implementing partners. PLoS One 2018; 13:e0206425. [PMID: 30372464 PMCID: PMC6205636 DOI: 10.1371/journal.pone.0206425] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/08/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND UNAIDS estimates global HIV investment needs in low- and middle-income countries (LMICs) at $26 billion per year in 2020. Yet international financing for HIV programs has stagnated amidst despite the increasing number of people requiring and accessing treatment. Despite increased efficiencies in HIV service delivery, evaluating programs for greater efficiencies remains necessary. While HIV budgets have been under scrutiny in recent years, indirect costs have not been quantified for any major global HIV program, but may constitute an additional avenue to identify program efficiencies. This analysis presents a method for estimating indirect costs in the President's Emergency Plan for AIDS Relief (PEPFAR). METHODS Utilizing PEPFAR country operational plan (COP) funding data from 2007 to 2016 for international organizations (IOs) and universities and standard regulatory cost bases, we calculated modified total direct costs on which indirect cost rates may be applied by partner and funding agency. We then apply a series of plausible indirect cost rates (10%-36.28%) to develop a range for total indirect costs that have accrued over the period. FINDINGS Of $37.01 billion in total COP funding between 2007 and 2016, $22.24 billion (60.08%) was identifiably allocated to IOs ($17.95B) and universities ($4.29B). After excluding funding for sub-awards ($1.92B) and other expenses ($3.89B) to which indirect rates cannot be applied, $16.44B remained in combined direct and indirect costs. From this, we estimate that between $1.85B (8.30% of total international partner funding) and $4.34B (19.51%) has been spent on indirect costs from 2007-2016, including $157-$369 million in 2016. INTERPRETATION To our knowledge, this is the first analysis to quantify the indirect costs of major implementing partners of a global HIV funder. However, lack of transparency in the indirect cost rates of non-University international partners creates an opaque layer of programmatic costs. Given the current funding environment and evolution of HIV programming in PEPFAR countries, the findings motivate a re-examination of the current policies and the return on investment in indirect cost recovery across the PEPFAR program.
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Affiliation(s)
- Brian Honermann
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Alana Sharp
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Jennifer Sherwood
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Pratima Kshetry
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Austin Jones
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Richael O’Hagan
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Laura Lazar
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Christina Chandra
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Topher Hoffmann
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
| | - Greg Millett
- amfAR, the Foundation for AIDS Research, Washington, DC, United States
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8
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Koenig SP, Furin J. Providing quality care on the border with Haiti. Lancet 2018; 392:382. [PMID: 30102166 DOI: 10.1016/s0140-6736(18)31489-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/27/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Serena P Koenig
- Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA 02115, USA.
| | - Jennifer Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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9
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Hennessey KA, Leger TD, Rivera VR, Marcelin A, McNairy ML, Guiteau C, Devieux JG, Marcelin Y, Charles B, Cremieux PY, Koenig SP, Pape JW. Retention in Care among Patients with Early HIV Disease in Haiti. J Int Assoc Provid AIDS Care 2017; 16:523-526. [PMID: 29187075 DOI: 10.1177/2325957417742670] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In September 2015, the World Health Organization updated their guidelines to recommend antiretroviral therapy (ART) for all people living with HIV. Countries are now in the process of implementing strategies to provide universal HIV treatment. We analyzed the rate of retention and time to ART eligibility (according to 2013 WHO guidelines) among 3,345 adult patients receiving positive HIV test results between February 1, 2003 and March 31, 2013 at the GHESKIO Clinic in Haiti, with WHO stage 1 or 2 disease and initial CD4 cell count >500 cells/mm3. Among the 3,345 patients, 2,423 (72%) were female, the median age was 33 years, 3,089 (92%) lived in Port-au-Prince, and 1,944 (58%) had attended no school or primary school only. The median initial CD4 cell count was 668 cells/mm3 (IQR: 572-834); over the subsequent 2 years, 1,485 patients (44%) were lost to follow-up and 7 (<1%) died pre-ART, 1,041 (31%) were retained in pre-ART care, and 819 (24%) initiated ART. In multivariate analysis, secondary education (aOR 1.27; 95% CI: 1.10-1.47), female gender (aOR: 1.28; 95% CI: 1.09-1.50), co-habitation (aOR: 1.31; 95% CI: 1.09-1.57), and residence in Port-au-Prince (aOR: 1.43; 95% CI: 1.09-1.88) were associated with retention in care. The median time from baseline CD4 count to ART eligibility was 1.7 years. Prior to the implementation of universal treatment, pre-ART attrition was high among patients who did not qualify for ART at presentation. Though implementing WHO recommendations for universal ART will require service expansion, it will likely result in improved retention for those at risk of being lost to follow-up.
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Affiliation(s)
- Kelly A Hennessey
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.,2 Analysis Group, Boston, MA, USA
| | - Taina Dadaille Leger
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa R Rivera
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.,3 Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Adias Marcelin
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Margaret L McNairy
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.,3 Center for Global Health, Weill Cornell Medical College, New York, NY, USA
| | - Colette Guiteau
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jessy G Devieux
- 4 AIDS Prevention Program, Florida International University, Miami, FL, USA
| | - Yvel Marcelin
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Benedict Charles
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | - Serena P Koenig
- 5 Division of Global Health Equity, Brigham and Women's Hospital, Boston, MA, USA
| | - Jean W Pape
- 1 Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti.,3 Center for Global Health, Weill Cornell Medical College, New York, NY, USA
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Auld AF, Valerie Pelletier, Robin EG, Shiraishi RW, Dee J, Antoine M, Desir Y, Desforges G, Delcher C, Duval N, Joseph N, Francois K, Griswold M, Domercant JW, Patrice Joseph YA, Van Onacker JD, Deyde V, Lowrance DW, And The Groupe d'Analyses Salvh. Retention Throughout the HIV Care and Treatment Cascade: From Diagnosis to Antiretroviral Treatment of Adults and Children Living with HIV-Haiti, 1985-2015. Am J Trop Med Hyg 2017; 97:57-70. [PMID: 29064357 PMCID: PMC5676635 DOI: 10.4269/ajtmh.17-0116] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Monitoring retention of people living with HIV (PLHIV) in the HIV care and treatment cascade is essential to guide program strategy and evaluate progress toward globally-endorsed 90–90–90 targets (i.e., 90% of PLHIV diagnosed, 81% on sustained antiretroviral therapy (ART), and 73% virally suppressed). We describe national retention from diagnosis throughout the cascade for patients receiving HIV services in Haiti during 1985–2015, with a focus on those receiving HIV services during 2008–2015. Among the 266,256 newly diagnosed PLHIV during 1985–2015, 49% were linked-to-care, 30% started ART, and 18% were retained on ART by the time of database closure. Similarly, among the 192,187 newly diagnosed HIV-positive patients during 2008–2015, 50% were linked to care, 31% started ART, and 19% were retained on ART by the time of database closure. Most patients (90–92%) at all cascade steps were adults (≥ 15 years old), among whom the majority (60–61%) were female. During 2008–2015, outcomes varied significantly across 42 administrative districts (arrondissements) of residence; cumulative linkage-to-care ranged from 23% to 69%, cumulative ART initiation among care enrollees ranged from 2% to 80%, and cumulative ART retention among ART enrollees ranged from 30% to 88%. Compared with adults, children had lower cumulative incidence of ART initiation among care enrollees (64% versus 47%) and lower cumulative retention among ART enrollees (64% versus 50%). Cumulative linkage-to-care was low and should be prioritized for improvement. Variations in outcomes by arrondissement and between adults and children require further investigation and programmatic response.
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Affiliation(s)
- Andrew F Auld
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie Pelletier
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Ermane G Robin
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Ray W Shiraishi
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacob Dee
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mayer Antoine
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Yrvel Desir
- National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Gracia Desforges
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Chris Delcher
- Department of Health Outcomes and Policy, University of Florida, Gainesville, Florida.,National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Nirva Duval
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Nadjy Joseph
- National Alliance of State and Territorial AIDS Directors (NASTAD), Port-au-Prince, Haiti
| | - Kesner Francois
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Mark Griswold
- National Alliance of State and Territorial AIDS Directors (NASTAD), Washington, District of Columbia
| | - Jean Wysler Domercant
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Yves Anthony Patrice Joseph
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - Joelle Deas Van Onacker
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
| | - Varough Deyde
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - David W Lowrance
- Division of Global HIV & Tuberculosis, Center for Global Health, Centers for Disease Control and Prevention, Port au Prince, Haiti
| | - And The Groupe d'Analyses Salvh
- Programme National de Lutte contre le VIH/SIDA (National AIDS Program), Ministère de la Sante Publique et de la Population (Ministry of Health), Port au Prince, Haiti
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11
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Conserve DF, Iwelunmor J, Whembolua GL, Sofolahan-Oladeinde Y, Teti M, Surkan PJ. Factors Associated With HIV Testing Among Men in Haiti: Results From the 2012 Demographic and Health Survey. Am J Mens Health 2017; 11:1322-1330. [PMID: 26961936 PMCID: PMC5102815 DOI: 10.1177/1557988316635247] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
HIV testing serves as the gateway to HIV prevention and treatment. However, research examining men's HIV testing behaviors in the Caribbean remains limited. The Andersen Behavioral Model of Health Services Utilization was used to examine factors associated with HIV testing among 7,354 men who participated in the 2012 Demographic and Health Survey conducted in Haiti. Few men (35%) reported having ever been tested for HIV. Logistic regression analyses revealed that HIV testing increased with education and wealth. Marital status was associated with HIV testing, with married men more likely to have been tested (adjusted odds ratio: 2.57, 95% CI [2.07, 3.19]) than unmarried men. Positive attitudes toward people living with HIV, indicated by willing to care for a relative who has HIV/AIDS, was also correlated with higher odds of having been tested (adjusted odds ratio: 1.28, 95% CI [1.08, 1.51]). Men who reported condom use during last sex were more likely to have been tested (odds ratio: 1.58, 95% CI [1.33, 1.88). The findings indicate that HIV testing rates remain low among men in Haiti and more efforts are needed to increase HIV testing among men who are not married, have low level of education, and engage in unprotected sex.
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12
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Masur J, Koenig SP, Julma P, Ocheretina O, Durán-Mendicuti MA, Fitzgerald DW, Pape JW. Active Tuberculosis Case Finding in Haiti. Am J Trop Med Hyg 2017; 97:433-435. [PMID: 28722608 DOI: 10.4269/ajtmh.16-0674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In 2010, Haiti suffered from a devastating earthquake; data on the impact on the tuberculosis (TB) epidemic are limited. From January to June 2013, we conducted active case finding at the household level in a slum in Port-au-Prince. Community health workers identified individuals with cough ≥ 2 weeks, and referred them for evaluation. Contact tracing was conducted for patients with active TB. Of an estimated 7,500 residents screened, 394 (5%) had cough and were tested for TB. One hundred (25%) were diagnosed with active TB; 53 (53%) were smear positive. Ninety of these TB index cases provided 317 contacts, and 44 (14%) were diagnosed with active TB; 17 (39%) were smear positive. Overall, 144 TB cases were detected in 6 months (1,920/100,000; national estimate 200/100,000). We found a high burden of undiagnosed TB in Port-au-Prince 3 years after the earthquake. Further assessment of the burden of TB is indicated.
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Affiliation(s)
- Jack Masur
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Serena P Koenig
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pierrot Julma
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | | | | | | | - Jean W Pape
- Weill Cornell Medical College, New York, New York.,Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
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McNairy ML, Joseph P, Unterbrink M, Galbaud S, Mathon JE, Rivera V, Jannat-Khah D, Reif L, Koenig SP, Domercant JW, Johnson W, Fitzgerald DW, Pape JW. Outcomes after antiretroviral therapy during the expansion of HIV services in Haiti. PLoS One 2017; 12:e0175521. [PMID: 28437477 PMCID: PMC5402937 DOI: 10.1371/journal.pone.0175521] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 03/27/2017] [Indexed: 11/18/2022] Open
Abstract
Background We report patient outcomes after antiretroviral therapy (ART) initiation in a network of HIV facilities in Haiti, including temporal trends and differences across clinics, during the expansion of HIV services in the country. Methods We assessed outcomes at 12 months after ART initiation (baseline) using routinely collected data on adults (≥15 years) in 11 HIV facilities from July 2007-December 2013. Outcomes include death (ascertained from medical records), lost to follow-up (LTF) defined as no visit > 365 days from ART initiation, and retention defined as being alive and attending care ≥ 365 days from ART initiation. Outcomes were compared across calendar year of ART initiation and across facilities. Risk factors for death and LTF were assessed using Cox proportional hazards and competing risk regression models. Results Cumulatively, 9,718 adults initiated ART with median age 37 years (IQR 30–46). Median CD4 count was 254 cells/uL (IQR 139–350). Twelve months after ART initiation, 4.4% (95% CI 4.0–4.8) of patients died, 21.7% (95% CI 20.9–22.6) were LTF, and 73.9% (95% CI 73.0–74.8) were retained in care. Twelve-month mortality decreased from 13.8% among adults who started ART in 2007 to 4.4% in 2013 (p<0.001). Twelve-month LTF after ART start was 29.2% in 2007, 18.7% in 2008, and increased to 30.1% in 2013 (p<0.001). Overall, twelve-month retention after ART start did not change over time but varied widely across facilities from 61.1% to 86.5%. Conclusion Expansion of HIV services across Haiti has been successful with increasing numbers of patients initiating ART and decreasing twelve-month mortality rates. However, overall retention has not improved, despite differences across facilities, suggesting additional strategies to improve engagement in care are needed.
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Affiliation(s)
- Margaret L. McNairy
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Division of General Medicine, Weill Cornell Medical College, New York, New York, United States of America
- * E-mail:
| | - Patrice Joseph
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Michelle Unterbrink
- Division of General Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Stanislas Galbaud
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Jean-Edouard Mathon
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Vanessa Rivera
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
| | - Deanna Jannat-Khah
- Division of General Medicine, Weill Cornell Medical College, New York, New York, United States of America
| | - Lindsey Reif
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Serena P. Koenig
- Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | | | - Warren Johnson
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Daniel W. Fitzgerald
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
| | - Jean W. Pape
- Center for Global Health, Weill Cornell Medical College, New York, New York, United States of America
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), Port-au-Prince, Haiti
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14
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Retention in Care among HIV-Infected Pregnant Women in Haiti with PMTCT Option B. AIDS Res Treat 2016; 2016:6284290. [PMID: 27651953 PMCID: PMC5019862 DOI: 10.1155/2016/6284290] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/28/2016] [Accepted: 08/03/2016] [Indexed: 01/08/2023] Open
Abstract
Background. Preventing mother-to-child transmission of HIV relies on engagement in care during the prenatal, peripartum, and postpartum periods. Under PMTCT Option B, pregnant women with elevated CD4 counts are provided with antiretroviral prophylaxis until cessation of breastfeeding. Methods. Retrospective analysis of retention in care among HIV-infected pregnant women in Haiti was performed. Logistic regression was used to identify risk factors associated with loss to follow-up (LFU) defined as no medical visit for at least 6 months and Kaplan-Meier curves were created to show LFU timing. Results. Women in the cohort had 463 pregnancies between 2009 and 2012 with retention rates of 80% at delivery, 67% at one year, and 59% at 2 years. Among those who were LFU, the highest risk period was during pregnancy (60%) or shortly afterwards (24.4% by 12 months). Never starting on antiretroviral therapy (aRR 2.29, 95% CI 1.4–3.8) was associated with loss to follow-up. Conclusions. Loss to follow-up during and after pregnancy was common in HIV-infected women in Haiti under PMTCT Option B. Since sociodemographic factors and distance from home to facility did not predict LFU, future work should elicit and address barriers to retention at the initial prenatal care visit in all women. Better tracking systems to capture engagement in care in the wider network are needed.
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Crabtree-Ramírez B, Vega YNC, Shepherd BE, Turner M, Carriquiry G, Fink V, Luz PM, Cortes CP, Rouzier V, Padgett D, Jayathilake K, McGowan CC, Person AK. Temporal Trends in Age at HIV Diagnosis in Cohorts in the United States, the Caribbean, and Central and South America. AIDS Behav 2015; 19:1599-608. [PMID: 25613592 DOI: 10.1007/s10461-014-0974-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In the United States (USA), the age of those newly diagnosed with HIV is changing, particularly among men who have sex with men (MSM). A retrospective analysis included HIV-infected adults from seven sites in the Caribbean, Central and South America network (CCASAnet) and the Vanderbilt Comprehensive Care Clinic (VCCC-Nashville, Tennessee, USA). We estimated the proportion of patients <25 years at HIV diagnosis by calendar year among the general population and MSM. 19,466 (CCASAnet) and 3,746 (VCCC) patients were included. The proportion <25 years at diagnosis in VCCC increased over time for both the general population and MSM (p < 0.001). Only in the Chilean site for the general population and the Brazilian site for MSM were similar trends seen. Subjects <25 years of age at diagnosis were less likely to be immunocompromised at enrollment at both the VCCC and CCASAnet. Recent trends in the USA of greater numbers of newly diagnosed young patients were not consistently observed in Latin America and the Caribbean. Prevention efforts tailored to young adults should be increased.
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16
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Kojima N, Bristow CC, Pollock N, Crouse P, Theodore H, Bonhomme J, Gaston CFS, Dévieux JG, Pape JW, Klausner JD. Rapid Training and Implementation of the Pollock Technique, a Safe, Effective Newborn Circumcision Procedure, in a Low-Resource Setting. Glob Pediatr Health 2015; 2:2333794X15589114. [PMID: 27335959 PMCID: PMC4784613 DOI: 10.1177/2333794x15589114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Male circumcision is highly protective against urinary tract infections, inflammatory conditions of the penis, sexually transmitted infections, and urogenital cancers. We aimed to reintroduce newborn male circumcision through the creation of a training program in Port-au-Prince, Haiti-an area with a considerable burden of preventable urogenital infections, sexually transmitted infections, and low circumcision rate-after an earlier study reported that a majority of Haitian medical providers were in need of and wanted newborn circumcision training. The program was conducted at the GHESKIO Health Centers, a large, non-governmental clinic offering comprehensive pediatric and adult health services. Two Haitian obstetricians and seven nurses learned circumcision procedures. On training completion, one of two obstetricians achieved surgical competence. Introduction of a newborn male circumcision training program was feasible, achieving an acceptable rate of procedural competency and high-quality services. Permanent resources now exist in Haiti to train additional providers to perform newborn male circumcisions.
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Affiliation(s)
- Noah Kojima
- University of California Los Angeles, CA, USA
| | | | - Neil Pollock
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | | - Jean William Pape
- Les Centres GHESKIO, Port-au-Prince, Haiti
- Weill Medical College of Cornell University, New York, NY, USA
| | - Jeffrey D. Klausner
- University of California Los Angeles, CA, USA
- David Geffen School of Medicine at UCLA, Division of Infectious Diseases and Department of Epidemiology, CA, USA
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Koenig SP, Rouzier V, Vilbrun SC, Morose W, Collins SE, Joseph P, Decome D, Ocheretina O, Galbaud S, Hashiguchi L, Pierrot J, Pape JW. Tuberculosis in the aftermath of the 2010 earthquake in Haiti. Bull World Health Organ 2015; 93:498-502. [PMID: 26170508 PMCID: PMC4490810 DOI: 10.2471/blt.14.145649] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 02/18/2015] [Accepted: 02/19/2015] [Indexed: 11/27/2022] Open
Abstract
Problem In 2010, Haiti sustained a devastating earthquake that crippled the health-care infrastructure in the capital city, Port-au-Prince, and left 1.5 million people homeless. Subsequently, there was an increase in reported tuberculosis in the affected population. Approach We conducted active tuberculosis case finding in a camp for internally displaced persons and a nearby slum. Community health workers screened for tuberculosis at the household level. People with persistent cough were referred to a physician. The National Tuberculosis Program continued its national tuberculosis reporting system. Local setting Even before the earthquake, Haiti had the highest tuberculosis incidence in the Americas. About half of the tuberculosis cases occur in the Port-au-Prince region. Relevant changes The number of reported tuberculosis cases in Haiti has increased after the earthquake, but data are too limited to determine if this is due to an increase in tuberculosis burden or to improved case detection. Compared to previous national estimates (230 per 100 000 population), undiagnosed tuberculosis was threefold higher in a camp for internally displaced persons (693 per 100 000) and fivefold higher in an urban slum (1165 per 100 000). With funding from the World Health Organization (WHO), active case finding is now being done systematically in slums and camps. Lessons learnt Household-level screening for prolonged cough was effective in identifying patients with active tuberculosis in this study. Without accurate data, early detection of rising tuberculosis rates is challenging; data collection should be incorporated into pragmatic disease response programmes.
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Affiliation(s)
- Serena P Koenig
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Vanessa Rouzier
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Stalz Charles Vilbrun
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Willy Morose
- Haitian National Tuberculosis Program (Programme National de Lutte contre la Tuberculose, PNLT), Port-au-Prince, Haiti
| | - Sean E Collins
- Department of Medicine, Stanford University, Palo Alto, United States of America (USA)
| | - Patrice Joseph
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Diessy Decome
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Oksana Ocheretina
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Stanislas Galbaud
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Lauren Hashiguchi
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Julma Pierrot
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
| | - Jean William Pape
- Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections (GHESKIO), 33 Boulevard Harry Truman, BP 15727, Port-au-Prince, Haiti
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Beck EJ, Passarelli C, Lui I, Guichard AC, Simao M, De Lay P, Loures L. Scaling-up the use of generic antiretrovirals in resource-limited countries: generic drugs for health. Antivir Ther 2014; 19 Suppl 3:117-23. [PMID: 25310477 DOI: 10.3851/imp2906] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
Abstract
The number of people living with HIV (PLHIV) continues to increase around the world because of the increasing number on antiretroviral therapy (ART) and their associated increase of life expectancy, in addition to the number of people newly infected with HIV each year. Unless a 'cure' can be found for HIV infection, PLHIV can anticipate the need to take antiretroviral drugs (ARVs) for the rest of their lives. Because ARVs are now being used for HIV prevention, as well as for therapeutic purposes, the need for effective, affordable ARVs with few adverse effects will continue to rise. It is important to note that the dramatic growth in treatment coverage of PLHIV seen during the past decade has been primarily due to the increased use of generic ARVs. Thus, there will be a need to scale-up the research and development, production, distribution and access to generic ARVs and ART regimens. However, these processes must occur within national and international regulated free-market economic systems and must deal with increasingly multifaceted patent issues affecting the price while ensuring the quality of the ARVs. National and international regulatory mechanisms will have to evolve, which will affect broader national and international economic and trade issues. Because of the complexity of these issues, the Editors of this Supplement conceived of asking experts in their fields to describe the various steps from relevant research and development, to production of generic ARVs, their delivery to countries and subsequently to PLHIV in low- and middle-income countries. A main objective was to highlight how these steps are interrelated, how the production and delivery of these drugs to PLHIV in resource-limited countries can be made more effective and efficient, and what the lessons are for the production and delivery of a broader set of drugs to people in low- and middle-income countries.
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Affiliation(s)
- Eduard J Beck
- Office of the Deputy Executive Director, UNAIDS, Geneva, Switzerland.
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