HIV & AIDS

Uganda. {Photo credit: Paydos/MSH.}Photo credit: Paydos/MSH.

The Ugandan government launched a new prevention of mother-to-child HIV transmission (PMTCT) strategy on September 12.

Uganda will transition from an approach based on the World Health Organization's (WHO) Option A --- which is contingent on an HIV-positive pregnant woman’s CD4 count --- to WHO's newest PMTCT strategy, Option B+.

Option B+ — whereby HIV-positive pregnant women receive lifelong treatment, regardless of their CD4 levels — originated in 2010 when the Malawian government decided to combine antiretroviral therapy (ART) with PMTCT in response to the challenges of providing reliable CD4 testing in remote settings.

The WHO updated its PMTCT guidelines with Option B+ in April of this year.

Health workers listen during the Mahalapye Hospital staff meeting, Botswana. {Photo credit: MSH/}Photo credit: MSH/

“J’mappelle Mompati. Comment t’appelles tu?”

Overcoming my confusion at being greeted by a French-speaking man in Botswana, I smile, take his proffered hand and reply in my rusty, stilted French, “J’mappelle Naume...”

Mompati is Mahalapye Hospital’s dynamic public relations officer. Now that he has my full attention, Mompati wastes no time in telling me about his work linking the hospital and the surrounding community through events and the media. We exchange contacts and he hands me a few copies of his newsletter before dashing off to his duties.

Mahalapye is a small town in the Central District of Botswana on the edge of the Kalahari Desert. Situated along the main road between the capital, Gaborone, and the second largest city, Francistown, Mahalapye is a convenient stopover place.

The hospital has been recently renovated and serves 300 outpatients a day and up to 200 inpatients.

Sheba (right), her siblings and their aged blind grandmother. {Photo credit: MSH.}Photo credit: MSH.

Sheba Joshua became the head of her household at just 18 years of age, when she lost her parents to AIDS. She is responsible for seven siblings and her blind grandmother and earns money by running a catering business out of her home in Gombe State, Nigeria. Becoming the main caregiver for an entire family at that age would have been a daunting experience for most teenagers, but Sheba was not fazed. Now 23, the young woman is fast becoming a respected business owner.

Sheba’s family recently began to receive support from the PEPFAR-funded Community Based Support for Orphans and Vulnerable Children (CUBS) project, led by Management Sciences for Health (MSH). CUBS’ support is routed through the Knightingale Women’s Health Organization (KWHO), which registered two of Sheba’s siblings in school and provided the children with school uniforms, books, pens, and care kits that include mosquito nets, buckets, spigots, and a Water Guard. KWHO also periodically provides the family with food, soap, and money.

Frieda Komba, a licensed drug dispenser in Tanzania. {Photo credit: MSH.}Photo credit: MSH.

Each year over 10 million men, women, and children in developing countries die as a result of our collective failure to deliver available safe, affordable, and proven prevention and treatment. A recent analysis of innovations in products and practices for global health, from the Hepatitis B vaccine to use of skilled birth attendants, revealed virtually none of these life-saving interventions reaches much more than half their target population—even after as many as 28 years of availability. This reflects a vast gap between knowledge and action in global health.

Successful Health Systems Innovations

Low- and middle-income countries (LMIC) benefit from continued innovations in health products and health practices, such as use of misoprostol to prevent post-partum hemorrhage, and technologies such as internet-based mHealth applications to protect the poor from catastrophic health expenditures.  To ensure such innovations achieve large-scale, widespread coverage, they must be accompanied by much more effective health systems innovations.

President William Clinton at Closing Session of AIDS 2012. {Photo credit: © IAS/Steve Shapiro - Commercialimage.net.}Photo credit: © IAS/Steve Shapiro - Commercialimage.net.

It's been nearly two weeks since former President William J. Clinton closed the last session of the XIX International AIDS Conference (AIDS 2012) and delegates returned home.

This year's conference featured commitment and calls for an AIDS-free generation, a growing interest in Option B+, and new research towards a cure.  Here are some reflections from what we learned at AIDS 2012, where we truly started "turning the tide together".

Clinton calls for a blueprint toward an AIDS-free generation

Secretary Hilary Rodham Clinton announced significant funding towards preventing mother-to-child transmission (PMTCT) of HIV, South Africa’s plan for voluntary medical male circumcision, and money for “implementation research,” civil society, and country-led plans. Sec. Clinton also called on Ambassador Eric Goosby to provide a blueprint for achieving an AIDS-free generation during her plenary address. Numerous other stakeholders echoed her commitment. But, if we really want to achieve an AIDS-free generation, the $7 billion funding gap that stands between where we are now, and where we should be, will need to be erased

The XIX International AIDS Conference featured five full days of plenaries with high-level speakers and community activists. The plenaries exemplified the diversity of topics covered throughout, and the global experience of people attending the July 22-27  conference. The plenary round-ups below are a great way to re-enter the experience of AIDS 2012, whether you attended the conference or just want to learn more.

Read more at storify.com.

(Cross-posted on MSH at AIDS 2012 conference blog)

On Sunday, July 22, 2012, Management Sciences for Health (MSH) hosted a satellite session, Beyond MDG 6: HIV and Chronic NCDs: Integrating Health Systems Towards Universal Health Coverage at the XIX International AIDS Conference (AIDS 2012). The session panelists were (left to right): Dr Ayoub Magimba, Till Baernighausen, Dr Jemima Kamano, John Donnelly (moderator), Sir George Alleyne, Dr Doyin Oluwole, and Dr Jonathan D. Quick

Luanda, Angola. {Photo credit: MSH.}Photo credit: MSH.

I am in Luanda, Angola right now, and what an interesting place. It is the most expensive city in the world: a can of coke costs $5, a car and driver for the day costs between $250-$300, and a basic hotel room with a view of people living in shacks below and cranes building more skyscrapers above is $380 (and it is difficult to find it for less).

Luanda feels like Africa mixed with Latin American and European energy and music. The traffic is bumper to bumper. It is not possible to have more than two meetings in a day because it takes that long to get from one area to another in the city. But it feels calm. Drivers in Luanda have figured out how to navigate the maze...slowly weaving in and out, letting a car in as they make a two lane road into three, and double parking with half the car on the sidewalk. Hardly anyone honks, it is hot and slow, and it feels like there is a sense of order to the chaos.

Angola is a country that has tremendous wealth, primarily derived from oil and other minerals. That wealth is controlled by an elite few, and there are wide disparities between the rich and the poor; 54% of the population lives on less than $1.25 a day. The public health challenges in Angola are significant. The under-five mortality rate in 2010 was 161/1,000 births, and the maternal mortality rate is 610 per 100,000 live births.

{Photo credit: MSH, South Africa.}Photo credit: MSH, South Africa.

The prospect that we may see the end of AIDS in our lifetime has never been greater. Over the last decade, the global HIV & AIDS community has achieved stunning successes, including a steady decrease in new HIV cases, a massive scale-up of antiretroviral therapy (ART), and proof that treatment is prevention. As we begin the XIX International AIDS Conference, we are also excited by new scientific advances in prevention and treatment, such as Option B+  for prevention of maternal-to-child transmission (PMTCT). As new possibilities develop, we must also build on the successes of the last decade. Only by "turning the tide together" through the simultaneous pursuit of new possibilities, leveraging of proven interventions for scale and sustainability, and strengthening of health systems overall, can we hope to reach our goal of ending the HIV & AIDS epidemic.

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