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: Introduction: Achieving optimal HIV outcomes, as measured by global 90‐90‐90 targets, that is awareness of HIV‐positive status, receipt of antiretroviral (ARV) therapy among aware and viral load (VL) suppression among those on ARVs, respectively, is critical. However, few data from sub‐Saharan Africa (SSA) are available on older people (50+) living with HIV (OPLWH). We examined 90‐90‐90 progress by age, 15–49 (as a comparison) and 50+ years, with further analyses among 50+ (55–59, 60–64, 65+ vs. 50–54), in 13 countries (Cameroon, Cote d'Ivoire, Eswatini, Ethiopia, Kenya, Lesotho, Malawi, Namibia, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe). Methods: Using data from nationally representative Population‐based HIV Impact Assessments, conducted between 2015and 2019, participants from randomly selected households provided demographic and clinical information and whole blood specimens for HIV serology, VL and ARV testing. Survey weighted outcomes were estimated for 90‐90‐90 targets. Country‐specific Poisson regression models examined 90‐90‐90 variation among OPLWH age strata. Results: Analyses included 24,826 HIV‐positive individuals (15–49 years: 20,170; 50+ years: 4656). The first, second and third 90 outcomes were achieved in 1, 10 and 5 countries, respectively, by those aged 15–49, while OPLWH achieved outcomes in 3, 13 and 12 countries, respectively. Among those aged 15–49, women were more likely to achieve 90‐90‐90 targets than men; however, among OPLWH, men were more likely to achieve first and third 90 targets than women, with second 90 achievement being equivalent. Country‐specific 90‐90‐90 regression models among OPLWH demonstrated minimal variation by age stratum across 13 countries. Among OLPWH, no first 90 target differences were noted by age strata; three countries varied in the second 90 by older age strata but not in a consistent direction; one country showed higher achievement of the third 90 in an older age stratum. Conclusions: While OPLWH in these 13 countries were slightly more likely than younger people to be aware of their HIV‐positive status (first 90), this target was not achieved in most countries. However, OPLWH achieved treatment (second 90) and VL suppression (third 90) targets in more countries than PLWH, INTRODUCTION Persons living with HIV (PLWH), including those in low‐ and middle‐income countries, have experienced extended life expectancies due to the success of antiretroviral (ARV) therapies [1]. In 2014, the [...]

Objective To determine whether integrating antiretroviral therapy (ART) into antenatal care (ANC) and maternal and child health (MCH) clinics could improve programmatic and patient outcomes. Methods The authors systematically searched PubMed, Embase, African Index Medicus and LiLACS for randomized controlled trials, prospective cohort studies, or retrospective cohort studies comparing outcomes in ANC or MCH clinics that had and had not integrated ART. The outcomes of interest were ART coverage, ART enrolment, ART retention, mortality and transmission of human immunodeficiency virus (HIV). Findings Four studies met the inclusion criteria. All were conducted in ANC clinics. Increased enrolment of pregnant women in ART was observed in ANC clinics that had integrated ART (relative risk, RR: 2.09; 95% confidence interval, CI; 1.78-2.46; [I.sup.2]: 15%). Increased ART coverage was also noted in such clinics (RR: 1.37; 95% CI: 1.05-1.79; [I.sup.2]: 83%). Sensitivity analyses revealed a trend for the national prevalence of HIV infection to explain the heterogeneity in the size of the effect of ART integration on ART coverage (P=0.13). Retention in ART was similar in ANC clinics with and without ART integration. Conclusion Although few data were available, ART integration in ANC clinics appears to lead to higher rates of ART enrolment and ART coverage. Rates of retention in ART remain similar to those observed in referral-based models. Objectif Determiner si l'integration de la therapie antiretrovirale (TAR) dans les etablissements de soins prenataux (ESP) et de sante maternelle et infantile (SMI) pourrait ameliorer les resultats du programme et la sante du patient. Methodes Les auteurs ont systematiquement recherche via PubMed, Embase, African Index Medicus et LILACS des essais controles randomises, des etudes de cohorte prospectives et des etudes de cohorte retrospectives comparant les resultats des cliniques ESP ou SMI ayant ou n'ayant pas integre la TAR. Les resultats pris en compte comprenaient la couverture, la participation et la retention de la TAR, ainsi que la mortalite et la transmission du virus d'immunodeficience humaine (VIH). Resultats Quatre etudes repondaient aux criteres d'inclusion. Toutes ont ete menees dans des cliniques ESP. Une participation accrue des femmes enceintes a la TAR a ete observee dans les cliniques ESP qui l'avaient integree (risque relatif, RR: 2,09; intervalle de confiance IC a 95%: 1,78 a 2,46; [I.sup.2]: 15%). Une couverture plus importante de la TAR a egalement ete notee dans ces cliniques (RR: 1,37; IC a 95%: 1,05 a 1,79; [I.sup.2]: 83%). Les analyses de sensibilite ont revele une tendance a la prevalence nationale de l'infection par le VIH pour expliquer l'heterogeneite de la taille de l'effet de l'integration de la TAR sur sa couverture (P = 0,13). La retention de la TAR etait similaire dans les cliniques ESP avec ou sans integration de la TAR. Conclusion Bien que peu de donnees aient ete disponibles, l'integration de la TAR dans les cliniques ESP semblait entrainer une augmentation des taux de participation et de couverture de la TAR. Les taux de retention de la TAR restent semblables a ceux qui sont observes dans les modeles de reference. Objetivo Determinar si la integraciin del tratamiento antirretroviral (TAR) en la atenciin prenatal (APN) y la salud materno-infantil (SMI) podria mejorar los resultados programaticos y del paciente. Metodos Partiendo de las bases de datos PubMed, Embase, Index Medicus de la Regiin de Africa y LiLACS, los autores realizaron busquedas sistematicas de ensayos controlados aleatorizados, estudios de cohortes prospectivos o estudios de cohortes retrospectivos en los que se compararon los resultados en clinicas de APN o SMI que habian y que no habian integrado elTAR. Los resultados de interes fueron la cobertura del TAR, la inclusiin en el TAR, la retenciin en el TAR, la mortalidad y la transmisiin del virus de la inmunodeficiencia humana (VIH). Resultados Cuatro estudios cumplieron los criterios de inclusiin. Todos ellos se realizaron en clinicas de APN. Se observi un aumento de la inclusiin de mujeres embarazadas en el TAR en aquellas clinicas de APN que se habian integrado el TAR (riesgo relativo, RR: 2,09, intervalo de confianza del 95%, IC; 1,78-2,46; [I.sup.2]: 15%). En estas clinicas tambien se observi un aumento de la cobertura del TAR (RR: 1,37; IC del 95%: 1,05-1,79; [I.sup.2]: 83%). Los analisis de sensibilidad revelaron una tendencia en la prevalencia nacional de la infecciin por el VIH para explicar la heterogeneidad en la magnitud del efecto de la integraciin del TAR sobre la cobertura del TAR (P=0,13). La retenciin en el TAR fue similar en las clinicas de APN con y sin integraciin del TAR. Conclusiin A pesar de la escasez de los datos disponibles, la integraciin del TAR en las clinicas de APN parece traducirse en mayores tasas de inclusiin en el TAR y de cobertura del TAR. Las tasas de retenciin en el TAR siguen siendo similares a las observadas en los modelos basados en derivaciones medicas., Introduction In 2009, 49% of pregnant women in low- and middle-income countries did not attend the minimum number of antenatal care (ANC) visits recommended by the World Health Organization (WHO) [...]

The Purchase price report released in August 2004 by the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund', was the first publication of a significant amount of real transaction purchase data for antiretrovirals (ARVs). We did an observational study of the ARV transaction data in the Purchase price report to examine the procurement behaviour of principal recipients of Global Fund grants in developing countries. We found that, with a few exceptions for specific products (e.g. lamivudine) and regions (e.g. eastern Europe), prices in low-income countries were broadly consistent or lower than the lowest differential prices quoted by the research and development sector of the pharmaceutical industry. In lower middle-income countries, prices were more varied and in several instances (lopinavir/ritonavir, didanosine, and zidovudinetlamivudine) were very high compared with the per capita income of the country. In all low- and lower middle-income countries, ARV prices were still significantly high given limited local purchasing power and economic strength, thus reaffirming the need for donor support to achieve rapid scale-up of antiretroviral therapy. However, the price of ARVs will have to decrease to render scale-up financially sustainable for donors and eventually for governments themselves. An important first step in reducing prices will be to make available in the public domain as much ARV transaction data as possible to provide a factual basis for discussions on pricing. The price of ARVs has considerable implications for the sustainability of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) treatment in the developing world. Resume Le Purchase price report, publie en aout 2004 par le Fonds mondial de lutte contre le SIDA, la tuberculose et le paludisme (Fonds mondial), a ete la premiere publication a contenir une quantite importante de donnees de transaction reelles concernant les antiretroviraux (ARV). Une etude d'observation a ete realisee sur les donnees de ce rapport en vue d'analyser les comportements d'achat des principaux beneficiaires des subventions du Fonds mondial parmi les pays en developpement. D'apres les resultats de cette etude, mises a part quelques exceptions concernant des produits (lamivudine, par exemple) ou des regions specifiques (Europe de l'Est, par exemple), les prix payes par les pays a faible revenu etaient a peu pres du meme ordre, voire plus faibles, que les prix differentiels les plus bas cites par le secteur recherche et developpement de l'industrie pharmaceutique. Dans les pays a revenu faible a modere, les prix presentaient de plus fortes variations et, dans certains cas (Iopinavir/ritonavir, didanosine et zidovudine/lamivudine) etaient meme tres hauts en comparaison du revenu par habitant national. Pour l'ensemble de ces pays, les prix des ARV restaient considerablement eleves en regard du pouvoir d'achat et de la puissance economique limites de ces pays, ce qui conduit a reaffirmer la necessite d'un soutien sous forme de dons pour obtenir un elargissement rapide de l'acces au traitement antiretroviral. Il faudra toutefois que les prix de revient des ARV baissent pour rendre cet elargissement supportable sur le plan financier pour les donateurs et ulterieurement pour les gouvernements eux-memes. Une etape importante dans la reduction des prix consistera a rendre publiques, dans la mesure du possible, les donnees de transaction relatives aux ARV, en vue de fournir une base factuelle aux negociations concernant les prix de ces medicaments. Ces prix ont des consequences majeures sur les possibilites de maintenir l'acces au traitement du VlH/SIDA dans le monde en developpement. Resumen El Informe sobre precios de adquisicion publicado en agosto de 2004 por el Fondo Mundial de Lucha contra el SIDA, la Tuberculosis y la Malaria (Fondo Mundial) fue la primera publicacion en la que se presento un conjunto relevante de datos de compras de antirretrovirales (ARV) correspondientes a transacciones reales. Llevamos a cabo un estudio observacional de los datos de transaccion de ARV que figuran en el Informe sobre precios de adquisicion a fin de examinar el comportamiento de adquisicion de los principales beneficiarios de las subvenciones del Fondo Mundial en los paises en desarrollo. Descubrimos que, exceptuando solo algunos productos (como la lamivudina) y regiones (por ejemplo Europa oriental), los precios en los paises de bajos ingresos eran en general similares o inferiores a los precios diferenciales mas bajos citados por el sector de investigacion y desarrollo de la industria farmaceutica. En los paises de ingresos medianos bajos, los precios eran mas variados y en algunos casos (lopinavir/ ritonavir, didanosina y zidovudina/lamivudina) eran muy altos en comparacion con los ingresos por habitante del pais. En todos los paises de ingresos bajos o medianos bajos, los precios de los ARV eran todavia significativamente altos, considerando el nivel economico y el limitado poder adquisitivo local, lo que confirma la necesidad de conseguir apoyo de donantes para expandir rapidamente el tratamiento antirretroviral. Sin embargo, el precio de los ARV tendra que disminuir si se quiere que la expansion sea economicamente sostenible para los donantes y, en definitiva, para los propios gobiernos. Un primer e importante paso para reducir los precios consistira en hacer de dominio publico todos los datos posibles sobre transacciones de ARV, proporcionando asi una base objetiva para las discusiones sobre la fijacion de precios. Del precio de los ARV depende en gran medida la sostenibilidad de la terapia contra el virus de la inmunodeficiencia humana/ sindrome de inmunodeficiencia adquirida (VIH/SIDA) en el mundo en desarrollo., Introduction Since the launch of the "3 by 5" initiative by the WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS), the number of people receiving antiretroviral (ARV) therapy [...]