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1. Integrated care for human immunodeficiency virus, diabetes and hypertension in Africa.

Author

Garrib A, Birungi J, Lesikari S, Namakoola I, Njim T, Cuevas L, Niessen L, Mugisha K, Mutungi G, Mghamba J, Ramaiya K, Jaffar S, Mfinanga S, and Nyirenda M

Subjects
Africa epidemiology, Diabetes Mellitus epidemiology, Disease Management, HIV Infections epidemiology, Humans, Hypertension epidemiology, Delivery of Health Care, Integrated organization & administration, Diabetes Mellitus therapy, HIV Infections therapy, Hypertension therapy
Abstract

The rising burden from non-communicable diseases (NCDs) poses a huge challenge for health care delivery in Africa, where health systems are already struggling with the long-term care requirements for the millions of people now on antiretroviral therapy requiring regular visits to health facilities for monitoring, adherence support and drugs. The HIV chronic disease management programme is comparatively well-funded, well-organised and well-informed and offers many insights and opportunities for the expansion of NCD prevention and treatment services. Some degree of human immunodeficiency virus (HIV) and NCD service integration is essential, but how to do this without risking the HIV treatment gains is unclear. Both HIV and NCD services must expand within a resource-constrained environment and policymakers are in urgent need of evidence to guide cost-effective and acceptable changes in these health services., (© The Author(s) 2018. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Published
2019
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2. Leave no one behind: response to new evidence and guidelines for the management of cryptococcal meningitis in low-income and middle-income countries.

Author

Loyse A, Burry J, Cohn J, Ford N, Chiller T, Ribeiro I, Koulla-Shiro S, Mghamba J, Ramadhani A, Nyirenda R, Aliyu SH, Wilson D, Le T, Oladele R, Lesikari S, Muzoora C, Kalata N, Temfack E, Mapoure Y, Sini V, Chanda D, Shimwela M, Lakhi S, Ngoma J, Gondwe-Chunda L, Perfect C, Shroufi A, Andrieux-Meyer I, Chan A, Schutz C, Hosseinipour M, Van der Horst C, Klausner JD, Boulware DR, Heyderman R, Lalloo D, Day J, Jarvis JN, Rodrigues M, Jaffar S, Denning D, Migone C, Doherty M, Lortholary O, Dromer F, Stack M, Molloy SF, Bicanic T, van Oosterhout J, Mwaba P, Kanyama C, Kouanfack C, Mfinanga S, Govender N, and Harrison TS

Subjects
Africa epidemiology, Amphotericin B agonists, Amphotericin B supply & distribution, Antifungal Agents economics, Antifungal Agents supply & distribution, Coinfection, Cryptococcus neoformans drug effects, Cryptococcus neoformans pathogenicity, Developing Countries, Disease Management, Drug Administration Schedule, Drug Therapy, Combination economics, Fluconazole economics, Fluconazole supply & distribution, Flucytosine economics, Flucytosine supply & distribution, Guidelines as Topic, HIV Infections pathology, HIV Infections virology, Humans, Income, Meningitis, Cryptococcal microbiology, Meningitis, Cryptococcal mortality, Meningitis, Cryptococcal pathology, Survival Analysis, Amphotericin B therapeutic use, Antifungal Agents therapeutic use, Drug Therapy, Combination methods, Fluconazole therapeutic use, Flucytosine therapeutic use, HIV Infections mortality, Meningitis, Cryptococcal drug therapy
Abstract

In 2018, WHO issued guidelines for the diagnosis, prevention, and management of HIV-related cryptococcal disease. Two strategies are recommended to reduce the high mortality associated with HIV-related cryptococcal meningitis in low-income and middle-income countries (LMICs): optimised combination therapies for confirmed meningitis cases and cryptococcal antigen screening programmes for ambulatory people living with HIV who access care. WHO's preferred therapy for the treatment of HIV-related cryptococcal meningitis in LMICs is 1 week of amphotericin B plus flucytosine, and the alternative therapy is 2 weeks of fluconazole plus flucytosine. In the ACTA trial, 1-week (short course) amphotericin B plus flucytosine resulted in a 10-week mortality of 24% (95% CI -16 to 32) and 2 weeks of fluconazole and flucytosine resulted in a 10-week mortality of 35% (95% CI -29 to 41). However, with widely used fluconazole monotherapy, mortality because of HIV-related cryptococcal meningitis is approximately 70% in many African LMIC settings. Therefore, the potential to transform the management of HIV-related cryptococcal meningitis in resource-limited settings is substantial. Sustainable access to essential medicines, including flucytosine and amphotericin B, in LMICs is paramount and the focus of this Personal View., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Published
2019
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