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- Volume 2007, Issue 27, 2007
Southern African Journal of HIV Medicine - Volume 2007, Issue 27, 2007
Volumes & issues
Volume 2007, Issue 27, 2007
The South African National Strategic Plan : what does it mean for our health system? : news - nationalAuthor W.D. Francois VenterSource: Southern African Journal of HIV Medicine 2007, pp 8 –11 (2007)More Less
South Africa has a new and highly ambitious guiding document to comprehensively deal with HIV over the next 5 years, the National Strategic Plan (NSP) (Table I). The country has an HIV problem resulting in huge mortality and morbidity, with an associated tuberculosis crisis, a growing orphan population, and a range of well-documented adverse social and economic impacts.
In 2000 the South African government, under siege internationally for its denialist President and combative Health Minister, hurriedly unveiled its 5-year programme for HIV. The plan was vague and committed the government to very little of substance, and its soft wording contrasted with the strong and clearly defined advocacy campaigns around prevention of mother-to-child transmission (PMTCT) and antiretroviral therapy (ART) provision, nutrition and unscientific supplements. In 2003, the release of the ART component of the Operational Plan for Comprehensive HIV and AIDS Care, Management, and Treatment resulted in the provision of antiretroviral treatment throughout the country over the next 4 years.
The original Plan expired in 2005, but it was only when the absence of an updated version was highlighted in the media, that the Department of Health began responding by drawing up a new Plan. An initial very rough draft, released after some consultation with special interest groups in the middle of 2006, rapidly attracted civil society interest and mobilisation, as well as strong media interest.
Source: Southern African Journal of HIV Medicine 2007, pp 12 –13 (2007)More Less
South Africa is likely to enrol adolescents into a phase IIb proof of concept HIV vaccine trial in late 2007 or early 2008, which would make it the first country in the world to enrol adolescents into HIV vaccine trials. These healthy adolescents will be at high risk of HIV infection. They will have to undergo a general physical examination, answer questions about their personal HIV risk, be administered an experimental HIV vaccine or placebo via injection, have blood drawn for laboratory safety and immunogenicity testing, and have regular testing for HIV infection. Many ethical / legal complexities exist, in part due to our fluctuating ethical-legal framework, the lack of legal guidance on issues such as adolescent privacy rights in research, and differing approaches towards child antonomy in child care and health legislation that enable children of a certain age to consent independently to medical treatment but not to research.
Against this backdrop, in 2005 a member of the UCT Research Ethics Committee (REC) initiated a process of research into the minimum legal requirements that need to be met to ensure that adolescent HIV vaccine trials are lawful. As a result, a unique collaboration was established between an ethics and law research unit, (the HIV / AIDS Vaccines Ethics Group - HAVEG); members of the UCT REC, and researchers at the Desmond Tutu HIV Centre, Cape Town, and the Perinatal HIV Research Unit, Soweto. This collaboration resulted in the development of a roadmap of issues that ought to be addressed in order to promote the rights and welfare of adolescent participants in HIV vaccine trials, which was published in Biomedical Central: Medical Ethics in 2007. From November 2006 onwards, work began to apply these legal principles to a protocol for an adolescent HIV vaccine trial and its accompanying informed consent / assent forms. This article summarises the issues identified by this unique and on-going collaboration, published in an earlier article.
Author Gesine Meyer-RathSource: Southern African Journal of HIV Medicine 2007, pp 15 –16 (2007)More Less
A growing body of international and local evidence shows that infectious disease control and HIV prevention and treatment are the most efficient ways for governments to spend their money to improve the lot of their citizens, in both developed and developing countries.
Secure the future : seven steps to involve the community in HIV / AIDS treatment support programmes : communityAuthor Richard Sebastian WanlessSource: Southern African Journal of HIV Medicine 2007, pp 18 –21 (2007)More Less
In this issue of the Southern African Journal of HIV Medicine, Secure the Future is pleased to present in CD form the manual, Seven Steps to Involve the Community in HIV / AIDS Treatment Support Programmes. The manual is the product of 4 years of intensive work on the implementation of a programme of community-based treatment support for patients with HIV / AIDS. Its overall purpose is to guide any group in how to integrate medical care with the power of community mobilisation and community services provided to patients in their homes and communities.
Nutrition and HIV / AIDS : nutritional guidelines for HIV-infected adults and children in Southern Africa : meeting the needs : guidelinesSource: Southern African Journal of HIV Medicine 2007, pp 22 –32 (2007)More Less
Source: Southern African Journal of HIV Medicine 2007, pp 34 –43 (2007)More Less
The Conference on Retroviruses and Opportunistic Infections is held annually in the USA. This meeting, organised by the Foundation on Retroviruses and the Centers for Disease Control, has a mission to provide a forum for basic scientists and clinicians to present, discuss, and critique their investigations into the biology and epidemiology of human retroviruses and the diseases they produce with the ultimate goal of translating laboratory and clinical research into progress against the AIDS epidemic. The 14th conference was held in Los Angeles from 25 to 28 February 2007. This conference is relatively small with steep competition to get abstracts accepted for posters and presentations, yet South Africa has a growing representation at this prestigious and excellent meeting. The Journal invited a selection of South African authors whose abstracts were accepted and published to describe the background and relevance of their work and contextualise their findings for us in South Africa.
Challenges of TB diagnosis and treatment in South Africa : Roche Symposium, 3rd South African AIDS Conference, Durban, 5 - 8 June 2007 : TB diagnosticsAuthor Robin WoodSource: Southern African Journal of HIV Medicine 2007, pp 44 –48 (2007)More Less
It is estimated that 2 billion of the world's population are latently infected with Mycobacterium tuberculosis (Mtb) with a resultant 8 - 9 million cases of active tuberculosis (TB) and 1.6 million deaths annually. The tools used for diagnosis of TB have remained largely unchanged since the 1880s when sputum microscopy, Mtb culture on solid media, tuberculin skin testing and chest radiology were initially developed. In 1991 the World Health Assembly set targets to be reached in 2005 for 70% case finding of smear-positive TB, which represents 6 million cases to be identified per annum. A second target was that 80% (5 million) of those identified cases should complete anti-TB treatment. Subsequently the millennium development goals of 2000 set a target of halving the prevalence of TB disease from 300/100 000 to 150/100 000 and deaths from 30/100 000 to 15/100 000 by 2015. While progress toward these targets was being made in countries with established market economies there was a quadrupling of TB incidence between 1990 and 2005 in most African countries. In 2005 the World Health Organization Regional Committee for Africa declared TB an emergency for the African region.
In South Africa in 2005 the WHO estimated that of 284 592 TB cases 270 360 were notified to the national TB control programme, representing a somewhat ambitious reported case finding proportion of 95%. The proportion treated under the directly observed treatment (DOTS) programme is 94%, and HIV prevalence among notified cases was 58% (97.5% confidence interval (CI) 49 - 65%). South Africa is a middle-income country and is relatively well provided with 143 laboratories performing sputum smears, and 18 culture laboratories also capable of performing drug sensitivity testing. Multidrug resistance (MDR) in new TB cases varies between provinces from 0.9% to 3.6%, while MDR is higher among retreatment cases, with prevalence rates varying between 1.8% to 13.7% in different provincial surveys.
Telling stories to change the country - a combined effort by the HIV Clinicians Society and Soul City : new partnershipsSource: Southern African Journal of HIV Medicine 2007, pp 50 –51 (2007)More Less