Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings

Spaar, A; Graber, C; Dabis, F; Coutsoudis, A; Bachmann, L; McIntyre, J; Schechter, M; Prozesky, H W; Tuboi, S; Dickinson, D; Kumarasamy, N; Pujdades-Rodriquez, M; Sprinz, E; Schilthuis, H J; Cahn, P; Low, N; Egger, M (2010). Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings. AIDS Care-Psychological and Socio-Medical Aspects of AIDS/HIV, 22(6), pp. 775-783. Taylor & Francis 10.1080/09540120903349102

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine

UniBE Contributor:

Graber, Claire; Low, Nicola and Egger, Matthias

ISSN:

0954-0121

Publisher:

Taylor & Francis

Language:

English

Submitter:

Factscience Import

Date Deposited:

04 Oct 2013 14:09

Last Modified:

13 Sep 2017 10:36

Publisher DOI:

10.1080/09540120903349102

PubMed ID:

20473792

Web of Science ID:

000278681800015

BORIS DOI:

10.7892/boris.1148

URI:

https://boris.unibe.ch/id/eprint/1148 (FactScience: 201954)

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