The new HATIP blog is a forum where we hope to discuss some of the implications of new research, guidelines and news on the practice of delivering care for HIV, TB and other health services in resource-constrained settings — as well as discuss some of the topics we are currently working on.

Just some background on us. Keith Alcorn, NAM’s senior editor, Carole Leach-Lemens and I all hope to post entries from time to time. We’ve been working in the HIV field for the last twenty years, and have increasingly become focused on the challenges of providing care with limited resources.

In order to address these issues, we’ve been publishing HIV & AIDS Treatment in Practice for the last seven years now. HATIP reports on research, conference reports and the best practices of those working in the field. Issues of HATIP tend to be thoroughly researched and sometimes take months to prepare, and frankly, quite a while to read!

An unintended consequence of this is that we have not always been able to respond quickly to recent but important developments.

We hope to remedy that with this blog. In addition, we hope this can be a more interactive forum that can draw upon the expertise of more of our readership.

We will also be using it to publish comments on HATIP articles that reach us after the article has been published.

Comments can be submitted to the blog, though our policy will be to publish only those that are most relevant in order to keep the column concise and readable.

You can keep up to date with the HATIP blog by visiting the blog page and comment by clicking the `Add a comment` button. You can view comments by clicking the `View comments` button.

Imprisoning TB patients: is this really a smart way to manage non-adherence?

Theo Smart, 06/09/2010

About two weeks ago, the Associated Press ran a story reporting that two men had been sentenced to Kapsabet prison in western Kenya for 8 months. Their crime? Not adhering to their TB regimen.

The article was very brief and further details in the case were frustratingly difficult to come by. It seemed clear however that the rights of these men with TB had been violated. Forced incarceration is seldom, if ever, the best way to encourage good adherence and prisons are not the best place to receive TB care.

Read more about this case and the debate about the use of imprisonment to manage `difficult` TB cases in the blog post here.

HATIP would like to hear from our advisory panel and readership with experience in promoting adherence in some of these more difficult cases.

• How do you manage hardcore cases who simply will not take their medications, or those who will go on treatment for short periods of time and then default?
• Finally, to what extent have you developed effective partnerships with the local community and activists and worked together to develop a ‘mutually beneficial’ approach

TB patient incarcerated in the US and some more posts from our panel regarding the CAMELIA Study

Theo Smart, 11/09/2010

This post is just a brief update to report on another case where a TB patient was incarcerated and to relate an important comment in response to a query from a previous HATIP article.

Once again, it is hard to know exactly what has happened from the press report, but it appears that another individual with drug-susceptible TB has been detained in order to make him take his TB medications. But this time, the case wasn’t in Kenya, South Africa, Ukraine or Russia — it was in Seattle.

Read more of this blog post here.

Dr Illia Podolyan — in detention in Ukraine for legally providing opioid substitution therapy for people who inject drugs

Theo Smart, 15/09/2010

“I have been working with opioid substitution therapy (OST) programmes for the last 4 years and I can tell you, honestly, that sometimes I am tired of it. Sometimes I feel so fed up with all of these clients and I feel like quitting because it really is difficult,” Dr Illia Podolyan, chief narcologist of the Odessa Regional Narcological Dispensary, told me last October when I was on a trip in Ukraine to see how that country was, haltingly, rolling out integrated TB/HIV and OST care for people who inject drugs (PWID).

About six months later, Dr Podolyan was arrested for providing OST within the framework of a state sanctioned programme. Dr Podolyan was one of a number of dedicated service providers in Ukraine trying to provide OST with HIV prevention services, and, when funding allowed, integrated treatment services as well.

Read more of this blog post here.

Family-centred care and children with HIV – what’s the reality on the ground?

Carole Leach-Lemens, 16/09/2010

I am in the process of pulling together an article about family-centred care as a means to improve the treatment outcomes of HIV-infected children.

My main objective is to be able to provide practical examples of models (and tools) that are working in resource-poor settings. The evidence, it appears is pretty sparse.

So I would like to invite our readers as well as our advisory committee to let me know of models or projects that are working on the ground in resource-poor settings, family-centred or otherwise, that are keeping children on treatment and in care.

We know that early infant diagnosis is important so that children get treated in a timely fashion. Without treatment 50% of HIV-infected children will die before they reach the age of two.

But the sad reality is that there is an enormous gap between getting tested and getting treatment and care and staying in care. As we heard at the Vienna conference, around Johannesburg for example, the numbers getting tested are increasing but the numbers getting treatment and staying in care are not budging at all.

The barriers to care are many and include health care systems not set up to deal with chronic long-term illnesses; lack of human and financial resources; inadequate infrastructure; the difficulties of engaging male partners and so on.

There is much talk about the implications of family-centred care as a means, in theory, of improving an HIV-infected child’s prospects of living into adulthood. Where is the hard evidence? 

Your observations and input on this critical issue would be greatly appreciated. Please contact carole@nam.org.uk.

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Delivery of care

Loss to follow-up high in South African public sector ARV programmes

Almost thirty per cent of patients who started antiretroviral treatment in eight South African public sector programmes were lost to follow-up within three years, according to a cohort study published in the journal AIDS.

Kenyan study shows people with HIV can provide safe, effective community management of ART

Community-based care delivered to adults living with HIV by people living with HIV using mobile technologies provided care as safe and effective as clinic-based care, researchers report.

Haiti study shows lab tests sometimes cost-effective for HIV, even in poorest countries

Only routine laboratory monitoring for asymptomatic anaemia was clinically beneficial and cost-effective when compared to symptom-driven testing in a study of HIV-positive patients in Haiti. 

HIV testing rate increased if screening offered at home

Household members of HIV-positive individuals are more likely to test for the virus if their housemate is receiving home rather than clinic-based antiretroviral therapy, a Ugandan study shows.

Nurses 'critical link' in implementing new WHO HIV guidelines

Active support of nurses is critical for effective implementation of the revised World Health Organization (WHO) HIV treatment guidelines, MaryAnn Vitiello and Suzanne Willard state in a letter

Prevention of mother-to-child transmission

Kesho Bora study reports on effects on maternal health of stopping triple ART after breastfeeding

Stopping triple antiretroviral drug treatment, begun in pregnancy and continued throughout the breast feeding period, was not associated with faster disease progression eighteen months after stopping treatment, researchers

Vitamin A supplements linked to high HIV levels in breast milk

Research in Tanzania shows that women with HIV who took vitamin A and beta-carotene (VA/BC) supplements had more HIV in their breast milk than those who did

Children and HIV

Daily cotrimoxazole better than three times weekly for infants with HIV

Use of co-trimoxazole preventive therapy (CPT) three times a week compared to daily use in infants was linked to more severe bacterial infections and longer hospital stays.

Breastfeeding reduces risk of malaria in infants with HIV

In HIV-exposed and HIV-infected infants aged six to 15 months breastfeeding significantly lowered the risks of getting malaria according to Neil Vora and colleagues in a prospective study in Uganda.

Treatment as prevention

High genital HIV levels may persist in women who appear to achieve viral suppression with use of ART

HIV-positive women whose plasma HIV RNA viral loads drop to undetectable levels following initiation of ART still may have intermittent surges in the amount of virus in

HIV diagnoses fall as treatment expands in British Columbia

Canadian researchers have published a large cohort study indicating that higher uptake of antiretroviral therapy might reduce HIV transmission considerably in some populations.

Sexual risk behaviour doesn’t increase in injecting drug users who start HIV treatment

There is no evidence that starting antiretroviral therapy leads HIV-positive injecting drug users to have more risky sex, Canadian researchers report in the online edition of AIDS.

Thai activists call for treatment for hepatitis C for people with HIV

Treating co-infection of HIV and hepatitis C (HCV) in Thailand makes sound economic sense, Noah Methany argues in a policy paper published by the Thai AIDS Treatment Action group.

Tuberculosis

More intensive screening for TB needed for HIV-positive patients in South Africa

Many cases of tuberculosis (TB) in patients starting HIV therapy will be missed if screening for the disease relies on 2006 World Health Organization (WHO) guidelines,

Patients taking TB treatment may be potentially infectious for longer than previously thought

Patients taking directly observed therapy (DOTS) for tuberculosis (TB) may be potentially infectious for longer than previously thought, investigators report in the August 15th edition of Clinical Infectious Diseases.

NEWS FROM OTHER SOURCES: Major stories

SOUTH AFRICA: National HIV testing campaign disappoints

South Africa, home to the world's largest HIV treatment programme, is trying to pull off the most extensive global HIV testing campaign but the ambitious initiative is facing some daunting realities.

From: Plus NEWS

KENYA: Help HIV-positive children in pain, urges HRW

A new report by Human Rights Watch (HRW) says the Kenyan government needs to do more to provide palliative care for children with chronic illnesses, including cancer and HIV/AIDS.

From: Plus News

AFRICA: Drug-resistant HIV threat looming

A recent study in Zambia found 6% of untreated people have drug-resistant virus. What are the implications for treatment programmes in the next 20 years?

From: Plus News

Money missing to confirm trial of microbicide against HIV

Donors have not committed enough money for even one of the two studies needed to confirm a promising South African trial of the microbicide. Only about $58 million of the $100 million needed for follow-up research has been pledged, according to UNAIDS.

From: New York Times

Uganda: 72,000 More to Get Free Aids Drugs

An additional 72,000 Ugandans living with HIV/AIDS will be enrolled for free antiretroviral (ARV) treatment over the next two years, following increased American funding.

From: All-Africa.com

Road-map agreed for confirmatory trials of promising microbicide

Two further clinical trials are planned to confirm a vaginal gel which has shown potential in reducing the risk of HIV.

From: UNAIDS

Zambia moving fast to scale up male circumcision

Male circumcision (MC) was a recurring theme throughout our congressional study tour, since the intervention has been shown to provide up to 60 percent protection for men from HIV infection from a female partner. 

From: Science Speaks blog

South Africa: Nation Becomes a Victim of its ARV Treatment Success

Almost a million South Africans are already on lifelong antiretroviral (ARV) treatment and this number is supposed to triple in the next decade if the South African government keeps to its implementation plan.

From: IPS

KENYA: TB patients with HIV miss out on ARVs

Only a third of Kenyans infected with tuberculosis and HIV are receiving treatment for both conditions, despite the latest World Health Organization (WHO) guidelines recommending that anti-retrovirals be taken soon after TB treatment begins.

From: Plus News