Establishing targets for advanced HIV disease: A call to action
The World Health Organization (WHO) has published a guideline for the management of individuals with advanced HIV disease (AHD) to reduce HIV-related deaths. The guideline consists of a package of recommendations including interventions to prevent, diagnose and treat common opportunistic infections,...
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Language: | English |
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AOSIS
2021-08-01
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Series: | Southern African Journal of HIV Medicine |
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Online Access: | https://sajhivmed.org.za/index.php/hivmed/article/view/1266 |
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doaj-87a85555ee614a06828db5589cb870be |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
David B. Meya Lillian Tugume Vennie Nabitaka Proscovia Namuwenge Sam Phiri Rita Oladele Bilkisu Jibrin Mojisola Mobolaji-Bello Cecilia Kanyama Werner Maokola Sayoki Mfinanga Cordelia Katureebe Ikechukwu Amamilo Brian Ngwatu Joseph N. Jarvis Thomas S. Harrison Amir Shroufi Radha Rajasingham David Boulware Nelesh P. Govender Angela Loyse |
spellingShingle |
David B. Meya Lillian Tugume Vennie Nabitaka Proscovia Namuwenge Sam Phiri Rita Oladele Bilkisu Jibrin Mojisola Mobolaji-Bello Cecilia Kanyama Werner Maokola Sayoki Mfinanga Cordelia Katureebe Ikechukwu Amamilo Brian Ngwatu Joseph N. Jarvis Thomas S. Harrison Amir Shroufi Radha Rajasingham David Boulware Nelesh P. Govender Angela Loyse Establishing targets for advanced HIV disease: A call to action Southern African Journal of HIV Medicine advanced hiv disease cryptococcal antigen tuberculosis tb-lam targets |
author_facet |
David B. Meya Lillian Tugume Vennie Nabitaka Proscovia Namuwenge Sam Phiri Rita Oladele Bilkisu Jibrin Mojisola Mobolaji-Bello Cecilia Kanyama Werner Maokola Sayoki Mfinanga Cordelia Katureebe Ikechukwu Amamilo Brian Ngwatu Joseph N. Jarvis Thomas S. Harrison Amir Shroufi Radha Rajasingham David Boulware Nelesh P. Govender Angela Loyse |
author_sort |
David B. Meya |
title |
Establishing targets for advanced HIV disease: A call to action |
title_short |
Establishing targets for advanced HIV disease: A call to action |
title_full |
Establishing targets for advanced HIV disease: A call to action |
title_fullStr |
Establishing targets for advanced HIV disease: A call to action |
title_full_unstemmed |
Establishing targets for advanced HIV disease: A call to action |
title_sort |
establishing targets for advanced hiv disease: a call to action |
publisher |
AOSIS |
series |
Southern African Journal of HIV Medicine |
issn |
1608-9693 2078-6751 |
publishDate |
2021-08-01 |
description |
The World Health Organization (WHO) has published a guideline for the management of individuals with advanced HIV disease (AHD) to reduce HIV-related deaths. The guideline consists of a package of recommendations including interventions to prevent, diagnose and treat common opportunistic infections, including tuberculosis (TB), cryptococcosis and severe bacterial infections, along with rapid initiation of antiretroviral treatment and enhanced adherence support. Currently no clear targets exist for these key interventions. Emerging programmatic data from Uganda, Tanzania and Nigeria suggest that an estimated 80% of eligible people continue to miss the recommended cryptococcal or TB testing, highlighting the remaining challenges to the effective implementation of WHO-recommended AHD packages of care in real-world resource-limited settings. The absence of mortality indicators for the leading causes of HIV-related deaths, because of the lack of mechanisms to ascertain cause of death, has had a negative impact on establishing interventions to reduce mortality. We suggest that setting 95-95-95 targets for CD4 testing, cryptococcal antigen and TB testing, and treatment that are aligned to the WHO AHD package of care would be a step in the right direction to achieving the greater goal of the WHO End TB strategy and the proposed new strategy to end cryptococcal meningitis deaths. However, these targets will only be achieved if there is healthcare worker training, expanded access to bedside point-of-care diagnostics for hospitalised patients and those in outpatient care who meet the criteria for AHD, and health systems strengthening to minimise delays in initiating the WHO-recommended therapies for TB and cryptococcal disease. |
topic |
advanced hiv disease cryptococcal antigen tuberculosis tb-lam targets |
url |
https://sajhivmed.org.za/index.php/hivmed/article/view/1266 |
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doaj-87a85555ee614a06828db5589cb870be2021-09-03T09:18:27ZengAOSISSouthern African Journal of HIV Medicine1608-96932078-67512021-08-01221e1e510.4102/sajhivmed.v22i1.1266758Establishing targets for advanced HIV disease: A call to actionDavid B. Meya0Lillian Tugume1Vennie Nabitaka2Proscovia Namuwenge3Sam Phiri4Rita Oladele5Bilkisu Jibrin6Mojisola Mobolaji-Bello7Cecilia Kanyama8Werner Maokola9Sayoki Mfinanga10Cordelia Katureebe11Ikechukwu Amamilo12Brian Ngwatu13Joseph N. Jarvis14Thomas S. Harrison15Amir Shroufi16Radha Rajasingham17David Boulware18Nelesh P. Govender19Angela Loyse20Department of Research, Infectious Diseases Institute, Makerere University, Kampala, Uganda; and, Department of Medicine and International Health, University of Minnesota, Minneapolis, United States of AmericaDepartment of Research, Infectious Diseases Institute, Makerere University, KampalaHIV Department, Clinton Health Access Initiative, KampalaDepartment of HIV Care and Treatment, Ministry of Health, Uganda, KampalaHIV Department, Lighthouse Trust Malawi, LilongweCollege of Medicine University of Lagos, LagosDepartment of HIV Care, Treatment and Support, Ministry of Health, LagosDepartment of HIV Care, Treatment and Support, Ministry of Health, LagosDepartment of Medicine, University of North Carolina Project-Malawi, Kamuzu Central Hospital, LilongweNational AIDS Control Program, Ministry of Health, Tanzania, Dar-es-Saalam, TanzaniaDepartment of Research, Muhimbili Medical Research Centre, Dar-es-Salaam, TanzaniaDepartment of National HIV Care and Treatment, Ministry of Health, KampalaGlobal Health Access Program, Clinton Health Access Initiative, AbujaHIV Program, Clinton Health Access Initiative, KampalaDepartment of HIV, London School of Hygiene and Tropical Medicine, LondonCentre for Global Health, Institute for Infection and Immunity, St. George’s University of London, LondonDepartment of HIV, Centres for Disease Control Foundation, Atlanta, United States of AmericaDepartment of Medicine and International Health, University of Minnesota, Minneapolis, United States of AmericaDepartment of Medicine and International Health, University of Minnesota, Minneapolis, United States of AmericaDepartment of Research, National Institute for Communicable Diseases, JohannesburgDepartment of Research, Centre for Global Health, Institute for Infection and Immunity, St. George’s University of London, LondonThe World Health Organization (WHO) has published a guideline for the management of individuals with advanced HIV disease (AHD) to reduce HIV-related deaths. The guideline consists of a package of recommendations including interventions to prevent, diagnose and treat common opportunistic infections, including tuberculosis (TB), cryptococcosis and severe bacterial infections, along with rapid initiation of antiretroviral treatment and enhanced adherence support. Currently no clear targets exist for these key interventions. Emerging programmatic data from Uganda, Tanzania and Nigeria suggest that an estimated 80% of eligible people continue to miss the recommended cryptococcal or TB testing, highlighting the remaining challenges to the effective implementation of WHO-recommended AHD packages of care in real-world resource-limited settings. The absence of mortality indicators for the leading causes of HIV-related deaths, because of the lack of mechanisms to ascertain cause of death, has had a negative impact on establishing interventions to reduce mortality. We suggest that setting 95-95-95 targets for CD4 testing, cryptococcal antigen and TB testing, and treatment that are aligned to the WHO AHD package of care would be a step in the right direction to achieving the greater goal of the WHO End TB strategy and the proposed new strategy to end cryptococcal meningitis deaths. However, these targets will only be achieved if there is healthcare worker training, expanded access to bedside point-of-care diagnostics for hospitalised patients and those in outpatient care who meet the criteria for AHD, and health systems strengthening to minimise delays in initiating the WHO-recommended therapies for TB and cryptococcal disease.https://sajhivmed.org.za/index.php/hivmed/article/view/1266advanced hiv diseasecryptococcal antigentuberculosistb-lamtargets |