Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings
Open Access
- 11 May 2010
- journal article
- research article
- Published by Taylor & Francis Ltd in AIDS Care
- Vol. 22 (6), 775-783
- https://doi.org/10.1080/09540120903349102
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.Keywords
This publication has 31 references indexed in Scilit:
- Electronic medical record systems, data quality and loss to follow-up: survey of antiretroviral therapy programmes in resource-limited settingsBulletin of the World Health Organization, 2008
- Coming to terms with complexity: a call to action for HIV preventionThe Lancet, 2008
- Public-Health and Individual Approaches to Antiretroviral Therapy: Township South Africa and Switzerland ComparedPLoS Medicine, 2008
- Population-level effect of HIV on adult mortality and early evidence of reversal after introduction of antiretroviral therapy in MalawiThe Lancet, 2008
- HIV, infant feeding and more perils for poor people: new WHO guidelines encourage review of formula milk policiesBulletin of the World Health Organization, 2008
- Improved effectiveness of partner notification for patients with sexually transmitted infections: systematic reviewBMJ, 2007
- Cohort Profile: Antiretroviral Therapy in Lower Income Countries (ART-LINC): international collaboration of treatment cohortsInternational Journal of Epidemiology, 2005
- Free formula milk for infants of HIV-infected women: blessing or curse?Health Policy and Planning, 2002
- Strategies for partner notification for sexually transmitted diseasesPublished by Wiley ,2001
- Efficacy of voluntary HIV-1 counselling and testing in individuals and couples in Kenya, Tanzania, and Trinidad: a randomised trialThe Lancet, 2000