RESUMEN
Low- and middle-income countries carry a high burden of preventable cervical cancer cases and deaths. Because human papillomavirus DNA-based testing is increasingly becoming the preferred method of screening for cervical cancer prevention, this commentary discusses next steps and key considerations for its expansion.
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Alphapapillomavirus , Infecciones por Papillomavirus , Vacunas contra Papillomavirus , Neoplasias del Cuello Uterino , Detección Precoz del Cáncer , Femenino , Humanos , Tamizaje Masivo , Papillomaviridae/genética , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/diagnóstico , Infecciones por Papillomavirus/prevención & control , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/prevención & controlRESUMEN
Women with HIV bear a significant burden of Human Papillomavirus (HPV) related cervical disease, and a have a higher risk of dying from cervical cancer should it occur. WLH have increased acquisition of HPV and decreased clearance, leading to persistent HPV infection: a risk for cervical cancer. The greatest burden of HIV in women occurs in sub-Saharan Africa where diagnostic and treatment services for cervical disease are limited. This paper will describe the epidemiology of HPV related cervical disease in women living with HIV (WLH) and the efforts to treat precursor lesions in HIV treatment programs supported by the President's Emergency Plan for AIDS Relief (PEPFAR.
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Infecciones por VIH , Infecciones por Papillomavirus , Neoplasias del Cuello Uterino , África del Sur del Sahara/epidemiología , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Papillomaviridae , Neoplasias del Cuello Uterino/prevención & controlRESUMEN
BACKGROUND: Depression is highly prevalent among patients newly starting antiretroviral treatment (ART) in Malawi and many other countries. Untreated depression at ART initiation can disrupt the HIV care continuum. Effective approaches for depression screening and treatment exist for low-resource settings, but they are rarely applied. Identifying effective implementation strategies are critical. METHODS: A pilot program integrated depression screening and treatment into routine HIV care using existing staff at two public health clinics in Malawi in two phases; a screening-only "control" phase and an active "intervention" phase. During the intervention phase, providers prescribed antidepressants or referred patients for Friendship Bench problem-solving therapy. We evaluated the program's impact on retention in HIV care, viral suppression, and depression remission at 6 months using tabular comparisons and log-binomial models to estimate adjusted risk ratios and mean differences among the intervention group relative to the control group. RESULTS: Nearly all consenting participants were screened for depression appropriately and 25% had mild to severe depressive symptoms. During the intervention phase, 86% of participants with mild depressive symptoms started Friendship Bench therapy and 96% of participants with moderate to severe depressive symptoms started antidepressants. Few participants in the intervention group received consistent depression treatment over their first 6 months in care. In the adjusted main analysis, program exposure did not demonstrably affect most HIV or mental health outcomes, though the probability of currently being on ART at 6 months was significantly lower among the intervention group than the control group [RR 0.6(95%CI: 0.4-0.9)]. CONCLUSIONS: While it is feasible to integrate depression screening and treatment initiation into ART initiation, providing ongoing depression treatment over time is challenging. Similar implementation science studies focused on maintaining depression management will be increasingly important as we strive to understand and test the best ways to implement evidence-based depression treatment within HIV care.
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Antirretrovirales/uso terapéutico , Atención a la Salud , Depresión/diagnóstico , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Tamizaje Masivo/organización & administración , Adulto , Antidepresivos/uso terapéutico , Atención a la Salud/métodos , Atención a la Salud/organización & administración , Depresión/complicaciones , Depresión/epidemiología , Depresión/terapia , Estudios de Factibilidad , Femenino , VIH , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Humanos , Ciencia de la Implementación , Malaui/epidemiología , Masculino , Tamizaje Masivo/métodos , Salud Mental , Participación del Paciente/estadística & datos numéricos , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Psicoterapia/métodos , Psicoterapia/organización & administración , Inducción de Remisión , Integración de Sistemas , Resultado del Tratamiento , Carga Viral/efectos de los fármacos , Adulto JovenAsunto(s)
Erradicación de la Enfermedad/organización & administración , Vacunación Masiva/organización & administración , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Neoplasias del Cuello Uterino/prevención & control , Adolescente , Adulto , Factores de Edad , Cuello del Útero/patología , Cuello del Útero/virología , Niño , Erradicación de la Enfermedad/métodos , Femenino , Humanos , Esquemas de Inmunización , Incidencia , Masculino , Vacunación Masiva/métodos , Persona de Mediana Edad , Infecciones por Papillomavirus/epidemiología , Infecciones por Papillomavirus/transmisión , Infecciones por Papillomavirus/virología , Aceptación de la Atención de Salud/estadística & datos numéricos , Participación de los Interesados , Planificación Estratégica , Neoplasias del Cuello Uterino/patología , Neoplasias del Cuello Uterino/virología , Adulto JovenRESUMEN
Human papillomavirus (HPV) vaccination campaigns to prevent cervical cancer are being considered and implemented in countries around the world. While vaccination will protect future generations, it will not help the millions of women currently infected, leading to an estimated 311 000 deaths per year globally. This paper examines a selection of strategies that when applied to both existing and new technologies, could accelerate access to HPV testing. Authors from the US Agency for International Development, the National Institutes of Health, and the Bridge to Health Medical and Dental, a non-governmental organisation, joined forces to propose a scalable and country-directed solution for preventing cervical cancer using an end-to-end approach. Collectively, the authors offer seven evidence-based strategies, that when used alone or in combination have the ability to reduce HPV-caused cervical cancer deaths and disability. These strategies include (1) consistent HPV test intervals to decrease HPV DNA test costs; (2) exploring market shaping opportunities; (3) employing iterative user research methodologies like human-centred design; (4) target product profiles for new HPV tests; (5) encouraging innovation around cervical cancer screen and treat programmes; (6) developing national cancer control plans; and (7) integrating cervical cancer screen and treat services into existing infrastructure. By using the strategies outlined here, in combination with HPV vaccination campaigns, national governments will be able to scale and expand cervical cancer screening programmes and provide evidence-based treatment programmes for HPV-infected women.
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The functioning of the supply chain may be a driving factor behind the development of human immunodeficiency virus (HIV) drug resistance (HIVDR) in many low- and middle-income countries (LMICs). Additionally, the effectiveness of supply chains will likely impact the scale-up of both viral-load monitoring and HIVDR testing. This article describes the complexities of global supply chains relevant for LMICs and presents early data on stock-outs and drug substitutions in several countries supported by the US President's Emergency Plan for AIDS Relief. Supply chain systems will need to be strengthened to minimize interruptions as new antiretroviral therapy regimens are introduced and to facilitate adoption of new laboratory technologies.
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Fármacos Anti-VIH/uso terapéutico , Países en Desarrollo , Infecciones por VIH/tratamiento farmacológico , VIH/efectos de los fármacos , Fármacos Anti-VIH/provisión & distribución , Países en Desarrollo/estadística & datos numéricos , Farmacorresistencia Viral , Infecciones por VIH/prevención & control , Infecciones por VIH/virología , Humanos , Cooperación Internacional , Carga Viral/efectos de los fármacos , Carga Viral/estadística & datos numéricosAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Infecciones por VIH/prevención & control , Política de Salud , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/terapia , Atención a la Salud , Países en Desarrollo , Infecciones por VIH/complicaciones , Infecciones por VIH/epidemiología , Infecciones por VIH/terapia , Accesibilidad a los Servicios de Salud , Humanos , Servicio SocialAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Infecciones por VIH/prevención & control , Evaluación del Impacto en la Salud , Literatura de Revisión como Asunto , Infecciones Oportunistas Relacionadas con el SIDA/economía , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Infecciones Oportunistas Relacionadas con el SIDA/terapia , Antirretrovirales/uso terapéutico , Análisis Costo-Beneficio , Países en Desarrollo , Infecciones por VIH/economía , Infecciones por VIH/epidemiología , Infecciones por VIH/terapia , Recursos en Salud , Humanos , Renta , Evaluación de Resultado en la Atención de Salud , Calidad de Vida , Factores SocioeconómicosRESUMEN
INTRODUCTION: HIV makes a significant contribution to maternal mortality, and women living in sub-Saharan Africa are most affected. International commitments to eliminate preventable maternal mortality and reduce HIV-related deaths among pregnant and postpartum women by 50% will not be achieved without a better understanding of the links between HIV and poor maternal health outcomes and improved health services for the care of women living with HIV (WLWH) during pregnancy, childbirth, and postpartum. METHODS: This article summarizes priorities for research and evaluation identified through consultation with 30 international researchers and policymakers with experience in maternal health and HIV in sub-Saharan Africa and a review of the published literature. RESULTS: Priorities for improving the evidence about effective interventions to reduce maternal mortality and improve maternal health among WLWH include better quality data about causes of maternal death among WLWH, enhanced and harmonized program monitoring, and research and evaluation that contributes to improving: (1) clinical management of pregnant and postpartum WLWH, including assessment of the impact of expanded antiretroviral therapy on maternal mortality and morbidity, (2) integrated service delivery models, and (3) interventions to create an enabling social environment for women to begin and remain in care. CONCLUSIONS: As the global community evaluates progress and prepares for new maternal mortality and HIV targets, addressing the needs of WLWH must be a priority now and after 2015. Research and evaluation on maternal health and HIV can increase collaboration on these 2 global priorities, strengthen political constituencies and communities of practice, and accelerate progress toward achievement of goals in both areas.
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Fármacos Anti-VIH/uso terapéutico , Prestación Integrada de Atención de Salud/organización & administración , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/mortalidad , Política de Salud/tendencias , Servicios de Salud Materna/organización & administración , Mortalidad Materna , Adolescente , Adulto , África del Sur del Sahara , Causas de Muerte , Niño , Preescolar , Países en Desarrollo , Femenino , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Periodo Posparto , Embarazo , Estados Unidos , Adulto JovenRESUMEN
In the fourth article of a five-part series providing a global perspective on integrating mental health, Sylvia Kaaya and colleagues discuss the importance of integrating mental health interventions into HIV prevention and treatment platforms.