1. Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings
- Author
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Diana Dickinson, Nicola Low, H J Schilthuis, Hans Prozesky, Lucas M. Bachmann, Pedro Cahn, James McIntyre, François Dabis, Matthias Egger, Eduardo Sprinz, M Pujdades-Rodriquez, Anne Spaar, Marcos C. Schechter, Anna Coutsoudis, Suely H. Tuboi, Nagalingeswaran Kumarasamy, and Claire Graber
- Subjects
Adult ,Counseling ,Male ,Sexually transmitted disease ,medicine.medical_specialty ,Asia ,Health (social science) ,Adolescent ,Social Psychology ,Social stigma ,Voluntary counseling and testing ,Population ,HIV prevention ,HIV Infections ,Article ,Condoms ,Patient Education as Topic ,Acquired immunodeficiency syndrome (AIDS) ,Surveys and Questionnaires ,Preventive Health Services ,medicine ,Humans ,Child ,education ,Health Education ,education.field_of_study ,Traditional medicine ,business.industry ,Public health ,Infant, Newborn ,Public Health, Environmental and Occupational Health ,Infant ,Social Support ,South America ,Partner notification ,medicine.disease ,Infectious Disease Transmission, Vertical ,Antiretroviral therapy ,Anti-Retroviral Agents ,Family medicine ,Africa ,Serodiscordant ,resource limited setting ,Female ,business ,Delivery of Health Care ,Program Evaluation - Abstract
Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely.
- Published
- 2010