Differentiated service delivery: navigating the path to scale
Purpose of review
Differentiated service delivery (DSD) has emerged as an approach for HIV programs seeking to better serve the needs of people living with HIV, reduce unnecessary burdens on the health system, and improve client outcomes. We reviewed recent evidence that addresses the challenge of DSD scale-up.
Recent findings
Most current evidence focuses on treatment of clinically stable adult clients in high HIV prevalence settings. Nonetheless, a growing body of research is emerging on how the concept of differentiation is being applied to HIV testing, linkage, and initiation; service delivery to specific demograp...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Innovations and challenges in early infant diagnosis of HIV
This article aims at examining the key recent advances in the field of EID, as well as at discussing approaches for resolving the major bottlenecks faced by health systems in the identification and linkage to care of HIV-infected infants.
Recent findings
Programmatic experience in South Africa and research in other high-burden countries showed that birth HIV testing is accurate, feasible and has the potential to decrease infant mortality. Substantial evidence has mounted on the accuracy of point-of-care testing for EID, including for birth testing. Importantly, it has now been demonstrated that point-of-care EID improve...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Diagnosing active tuberculosis in people living with HIV: an ongoing challenge
Purpose of review
Diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) remains a challenge, despite it being the most common comorbidity in this group. In this review, we provide an overview of tests for active TB, and their diagnostic performance in PLHIV.
Recent findings
New and updated diagnostic tests have better performance than traditional bacterial culture or smear microscopy in PLHIV. Recent developments in molecular tests have improved the sensitivity at which TB and drug susceptibility can be detected in PLHIV. Notably, the updated Xpert Ultra test can detect HIV-associated TB with high sensitivi...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Civil society demand for accountability to achieve the 90-90-90 targets: lessons from Eastern and Southern Africa
Purpose of review
Civil society demand for accountability has long been a critical component of the AIDS response. In the age of 90-90-90 HIV treatment goals, civil society advocacy has continued, but often in new forms. In particular, civil society accountability at the intersection of national policy and global health financing has taken on increasing importance, but has not been well documented.
Recent findings
Civil society demand for accountability is a key to addressing both the insufficient progress toward ‘90-90-90’ HIV treatment goals and the gap in democracy in HIV policymaking particularly prevalent in ...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Demand creation for primary biomedical prevention: identifying lessons across interventions to inform daily oral preexposure prophylaxis programs
Purpose of review
At a moment when UNAIDS (Joint United Nations Programme on HIV/AIDS) has acknowledged a ‘prevention crisis,’ and multiple countries and implementers are emphasizing ‘user-centered’ and/or differentiated models of delivering HIV treatment and prevention, it is essential to understand and act on best practices from all relevant interventions to create effective oral preexposure prophylaxis (PrEP) programs.
Recent findings
It is possible to adapt private sector approaches to understanding and segmenting the preferences and mindsets of potential consumers to primary HIV prevention programs, as de...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Demanding an end to tuberculosis: treatment of tuberculosis infection among persons living with and without HIV
This article reviews the current recommendations on the diagnosis and treatment of TB infection (or what is commonly referred to as ‘prophylaxis’ or ‘preventive therapy’ of latent TB) and discusses barriers to implementation that have led to low demand for this life-saving therapeutic intervention.
Recent findings
Treatment of infection for both TB and drug-resistant TB is well tolerated and effective, and several new, shorter regimens – including rfiapenitine-based regimens of 1 month and 12 weeks duration – have been shown to be effective. Not all persons infected with TB go on to develop disease and the r...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Creating demand for long-acting formulations for the treatment and prevention of HIV, tuberculosis, and viral hepatitis
Purpose of review
Long-acting parenteral drug delivery is an established and widely accepted solution to the problem of poor adherence when daily oral medications are used to treat or prevent chronic medical conditions. Poor adherence to oral formulations remains a major barrier to successfully treating or preventing HIV, tuberculosis (TB), and viral hepatitis. The uptake of long-acting formulations developed for these infections is uncertain, despite their promise. This review addresses the current state of development of long-acting and extended-release approaches to HIV, TB, and viral hepatitis in the context of creat...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Community and activists demand for tenofovir/emtricitabine or lamivudine/dolutegravir and routine viral load testing
Purpose of review
Since the beginning of the HIV epidemic, informed communities have demanded and fought for access to life-saving treatment. The last several years have seen interesting developments in this area – particularly with respect to the switch to dolutegravir (DTG)-based regimens and scale-up of routine viral load testing (RVLT), and how these directly and indirectly impact issues of treatment optimization, HIV drug resistance, and sexual and reproductive health. In this review, we present recent advances in antiretroviral treatment and monitoring in the context of how treatment education and community deman...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Strategies for access to affordable hepatitis C testing and treatment in Asia
Purpose of review
With increasing availability of generic direct-acting antivirals (DAAs) and associated price reductions, various governments, multilateral institutions, and donors have started providing testing and treatment for hepatitis C virus (HCV) infection. More data on the quality of these generic medicines and on cost-effectiveness of their use are becoming widely available. This review seeks to describe some of the treatment programs for HCV that are evolving in Cambodia, India, Indonesia, Malaysia, Myanmar, and Thailand.
Recent findings
The quality of multiple generic DAAs has been shown to be bioequivalen...
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: CREATING DEMAND FOR HIV PRODUCTS, DRUGS AND DIAGNOSTICS: Edited by David Ripin and Sharonann Lynch Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in HIV and AIDS)
Source: Current Opinion in HIV and AIDS - December 3, 2018 Category: Infectious Diseases Tags: EDITORIAL INTRODUCTIONS Source Type: research
Identifying priorities for HIV-associated tuberculosis research through the WHO guidelines process
Purpose of review
Guidelines developed by the WHO aim to provide recommendations to support best practice in health delivery, with a focus on low-income and middle-income countries. As part of the guideline development process, critical knowledge gaps are identified and one of the core functions of WHO guidelines is to set forth priorities for future research. A review of research priorities identified through the WHO guideline development has recently been promoted as one approach to building an overarching priority research agenda in a given area. This paper outlines priorities for HIV-associated TB research identified...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
90-90-90 HIV targets: implications for HIV-associated tuberculosis
Purpose of review
The HIV and Mycobacterium tuberculosis syndemic remains a major global public health threat. HIV and tuberculosis (TB) global targets have been set. Success will depend on achieving combined disease control. We explore current policy, economic investment, and disease control strategies for HIV, TB, and HIV-associated TB. We review published HIV, TB, and HIV-associated TB data for 30 WHO priority countries and propose a comprehensive HIV and TB care continua.
Recent findings
In 2016, people living with HIV (PLHIV) on antiretroviral treatment (ART) ranged from 13 to 84%; viral suppression ranged from 2...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Prospects for a vaccine to prevent HIV-related tuberculosis
Purpose of review
To outline the need for a new tuberculosis (TB) vaccine; challenges for induction of vaccine-mediated protection in HIV-infected persons; and recent advances in clinical development.
Recent findings
HIV has a detrimental effect on T-cell function, polarization and differentiation of Mycobacterium tuberculosis (Mtb)-specific T cells, Mtb antigen presentation by dendritic cells, and leads to B-cell and antibody-response deficiencies. Previous observations of protection against TB disease in HIV-infected persons by Mycobacterium obuense suggest that an effective vaccine against HIV-related TB is feasibl...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
The tuberculosis-associated immune reconstitution inflammatory syndrome: recent advances in clinical and pathogenesis research
Purpose of review
Antiretroviral therapy (ART) is an essential, life-saving intervention for HIV infection. However, ART initiation is frequently complicated by the tuberculosis-associated immune reconstitution inflammatory syndrome (TB-IRIS) in TB endemic settings. Here, we summarize the current understanding highlighting the recent evidence.
Recent findings
The incidence of paradoxical TB-IRIS is estimated at 18% (95% CI 16–21%), higher than previously reported and may be over 50% in high-risk groups. Early ART initiation in TB patients increases TB-IRIS risk by greater than two-fold, but is critical in TB patient...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
Preventive therapy for HIV-associated tuberculosis
Purpose of review
Tuberculosis (TB) remains the leading cause of death in people living with HIV (PLHIV) despite the achievements in antiretroviral therapy coverage. TB preventive therapy (TPT) has proved efficacy but has been neglected and poorly implemented. We reviewed recent publications and guidelines about TPT in PLHIV.
Recent findings
High-quality studies showed that TPT has a durable effect, over 5 years, preventing TB and all-cause mortality. There is new evidence showing the noninferiority of shorter, rifamycin-based regimens of TPT increasing the options for treatment. Recent studies describing robust imple...
Source: Current Opinion in HIV and AIDS - October 9, 2018 Category: Infectious Diseases Tags: TUBERCULOSIS AND HIV: Edited by Richard E. Chaisson and Haileyesus Getahun Source Type: research
