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- Volume 2004, Issue 17, 2004
Southern African Journal of HIV Medicine - Volume 2004, Issue 17, 2004
Volumes & issues
Volume 2004, Issue 17, 2004
Source: Southern African Journal of HIV Medicine 2004, pp 7 –11 (2004)More Less
As South Africa and the rest of the developing world respond to the AIDS crisis, a critical task will be to develop scalable systems for sustainable and effective delivery of antiretroviral (ARV) drugs in a variety of resource-restricted settings. With the emergence, from national governments, the World Health Organization (WHO) and major international donors, of the political will and funding to support treatment programmes, it has become urgent that we consider how ARVs will be delivered. In this review, we consider how ARVs allow us to manage HIV / AIDS as a chronic disease, and the data systems that are required to support this approach to therapy.
Source: Southern African Journal of HIV Medicine 2004, pp 12 –17 (2004)More Less
Human immunodeficiency virus (HIV) infection can lead to a variety of clinical cutaneous manifestations. These cutaneous disorders occur universally during the course of HIV infection. Cutaneous manifestations of HIV are very diverse. The course and clinical presentation of HIV in individuals who have access to highly active antiretroviral therapy (HAART) is completely different from that in those who do not. Many of the HIV cutaneous presentations seen in South Africa become chronic and progressive. There is a marked reduction in the incidence of opportunistic infections and neoplasms in North America, Western Europe and Australia, where there is access to HAART. <br>Approximately 90% of patients will develop one or more skin diseases during the course of their illness. It is therefore crucial that health professionals become familiar with and are able to recognise the various skin manifestations of HIV.
Source: Southern African Journal of HIV Medicine 2004, pp 18 –31 (2004)More Less
As southern Africa has finite medical resources and the public sector roll-out of antiretrovirals (ARVs) is in its infancy, it is incumbent on medical practitioners to attempt to preserve the immune status of the patient for as long as possible so as to delay the initiation of antiretroviral therapy (ART). These guidelines attempt to address the factors which are important in the holistic approach to patient management and which could also influence the progression and outcome of disease, including: <ul> <li> natural history of HIV infection</li> <li> primary prophylaxis and immunisations</li> <li> nutrition</li> <li> support and counselling.</li> </ul>
Source: Southern African Journal of HIV Medicine 2004, pp 32 –40 (2004)More Less
There is anecdotal evidence that certain categories of patients at Red Cross War Memorial Children's Hospital (RCH) are thought to be utilising more resources than others. Faced with an ever-increasing demand for care, shrinking budgets and tough measures by government to force health managers to operate within budget, bold decisions need to be taken regarding future admission policy. The <I>aim</I> of this retrospective record-based study was to assess the cost of inpatient care for paediatric HIV-positive patients at RCH over a 1-year period (January - December 2001). The <I>objectives</I> were (i) to determine the cost of inpatient care for paediatric HIV-positive patients; and (ii) to provide baseline data for health managers to develop future admission policy and to plan for future needs in terms of management and budgetary protocols. <br><I>Methods.</I> The study population consisted of HIV-positive inpatients admitted to RCH. Information on patients' demographic details, date and duration of admission, reason for admission, additional diagnosis, nutritional status, laboratory investigations done, surgical procedures performed and medication prescribed were obtained from the patient records. Direct costs were recorded for admissions (bed costs), X-rays, laboratory and surgical procedures. The tariff fees charged for these services were obtained in consultation with management at RCH. <br><I>Results.</I> There were 16 032 admissions to RCH in 2001. Of these patients 616 (4%) were HIV+. A 25% random sample (N = 154) with a mean age of 1.75 years was analysed. Almost 80% were admitted with diarrhoea and vomiting and/or chest problems. The mean number of previous admissions was 2.0. The most common conditions diagnosed clinically were failure to thrive (64%), pneumonia (54%), gastroenteritis (43%), oral thrush (42%) and tuberculosis (22%). Over half were found to be underweight for their age, 20% were marasmic and 87% suffered some form of malnutrition at admission. HIV+ patients were 4.7 times more likely to die in hospital than HIV-ve patients. Their average length of stay in hospital was 9 days, compared with 4 days for HIV-ve patients. HIV+ patients consumed 12%, 61% and 9% of the total budgets allocated for antibiotics, antifungals and analgesics, respectively (7% of the total budget for medicines). The average cost (direct cost) for each HIV+ inpatient amounted to R18 765.76. Admission (bed) costs formed the bulk of this amount (84%) followed by laboratory costs (9%), medication (3%), surgical (2%) and X-rays (2%). Alarmingly, HIV+ patients, who formed 4% of the total admissions, consumed 26% (R11.56 million) of the total budget for direct treatment costs (R44.65 million). <br><I>Conclusion.</I> The current admission policies regarding HIV+ patients to RCH appear unsustainable, given the continued high demand for care, an ever-increasing HIV pandemic, the non-availability of antiretroviral therapy, lower health budgets and the continued inability of these patients to pay for health services.
Author Anna CoutsoudisSource: Southern African Journal of HIV Medicine 2004, pp 45 –48 (2004)More Less
Breast-feeding is a route of transmission of HIV from an infected mother to her infant. However, breast-feeding is an important pillar of child survival and the ideal way of feeding an infant, as well as providing a unique biological and emotional basis for child development. This article highlights the dilemma created by the risks and benefits of breast-feeding and will discuss factors that increase the risk of HIV transmission during breast-feeding as well as strategies that could be employed to reduce these risks. Many questions remain unanswered.