Establishing targets for advanced HIV disease: A call to action.

Autor:	Meya DB; Department of Research, Infectious Diseases Institute, Makerere University, Kampala, Uganda.; Department of Medicine and International Health, University of Minnesota, Minneapolis, United States of America., Tugume L; Department of Research, Infectious Diseases Institute, Makerere University, Kampala, Uganda., Nabitaka V; HIV Department, Clinton Health Access Initiative, Kampala, Uganda., Namuwenge P; Department of HIV Care and Treatment, Ministry of Health, Uganda, Kampala, Uganda., Phiri S; HIV Department, Lighthouse Trust Malawi, Lilongwe, Malawi., Oladele R; College of Medicine University of Lagos, Lagos, Nigeria., Jibrin B; Department of HIV Care, Treatment and Support, Ministry of Health, Lagos, Nigeria., Mobolaji-Bello M; Department of HIV Care, Treatment and Support, Ministry of Health, Lagos, Nigeria., Kanyama C; Department of Medicine, University of North Carolina Project-Malawi, Kamuzu Central Hospital, Lilongwe, Malawi., Maokola W; National AIDS Control Program, Ministry of Health, Tanzania, Dar-es-Saalam, Tanzania., Mfinanga S; Department of Research, Muhimbili Medical Research Centre, Dar-es-Salaam, Tanzania., Katureebe C; Department of National HIV Care and Treatment, Ministry of Health, Kampala, Uganda., Amamilo I; Global Health Access Program, Clinton Health Access Initiative, Abuja, Nigeria., Ngwatu B; HIV Program, Clinton Health Access Initiative, Kampala, Uganda., Jarvis JN; Department of HIV, London School of Hygiene and Tropical Medicine, London, United Kingdom., Harrison TS; Centre for Global Health, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom., Shroufi A; Department of HIV, Centres for Disease Control Foundation, Atlanta, United States of America., Rajasingham R; Department of Medicine and International Health, University of Minnesota, Minneapolis, United States of America., Boulware D; Department of Medicine and International Health, University of Minnesota, Minneapolis, United States of America., Govender NP; Department of Research, National Institute for Communicable Diseases, Johannesburg, South Africa., Loyse A; Department of Research, Centre for Global Health, Institute for Infection and Immunity, St. George's University of London, London, United Kingdom.
Jazyk:	angličtina
Zdroj:	Southern African journal of HIV medicine [South Afr J HIV Med] 2021 Aug 10; Vol. 22 (1), pp. 1266. Date of Electronic Publication: 2021 Aug 10 (Print Publication: 2021).
DOI:	10.4102/sajhivmed.v22i1.1266
Abstrakt:	The World Health Organization (WHO) has published a guideline for the management of individuals with advanced HIV disease (AHD) to reduce HIV-related deaths. The guideline consists of a package of recommendations including interventions to prevent, diagnose and treat common opportunistic infections, including tuberculosis (TB), cryptococcosis and severe bacterial infections, along with rapid initiation of antiretroviral treatment and enhanced adherence support. Currently no clear targets exist for these key interventions. Emerging programmatic data from Uganda, Tanzania and Nigeria suggest that an estimated 80% of eligible people continue to miss the recommended cryptococcal or TB testing, highlighting the remaining challenges to the effective implementation of WHO-recommended AHD packages of care in real-world resource-limited settings. The absence of mortality indicators for the leading causes of HIV-related deaths, because of the lack of mechanisms to ascertain cause of death, has had a negative impact on establishing interventions to reduce mortality. We suggest that setting 95-95-95 targets for CD4 testing, cryptococcal antigen and TB testing, and treatment that are aligned to the WHO AHD package of care would be a step in the right direction to achieving the greater goal of the WHO End TB strategy and the proposed new strategy to end cryptococcal meningitis deaths. However, these targets will only be achieved if there is healthcare worker training, expanded access to bedside point-of-care diagnostics for hospitalised patients and those in outpatient care who meet the criteria for AHD, and health systems strengthening to minimise delays in initiating the WHO-recommended therapies for TB and cryptococcal disease. Competing Interests: The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. (© 2021. The Authors.)
Databáze:	MEDLINE
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