The end of HIV: Still a very long way to go, but progress continues.

In an Editorial accompanying PLOS Medicine's Special Issue on Advances in Prevention, Treatment and Cure of HIV/AIDS, Guest Editors Steven Deeks, Sharon Lewin, and Linda-Gail Bekker discuss priorities in the field and the content of the issue

Isoniazid preventive therapy for tuberculosis in South Africa: An assessment of the local evidence base

Worldwide, South Africa (SA) has the worst tuberculosis (TB) epidemic. In SA, there are > 6.1 million people living with HIV (PLWH) and the country now has the largest antiretroviral treatment programme with > 2 million people receiving combination therapy. While there has been a marked recent decline in HIV-associated deaths, > 50% of TB cases still continue to be diagnosed in PWLH. The current TB control strategy based on passive case finding, chemotherapy of childhood TB contacts and directly observed therapy has clearly failed to control endemic TB in SA. Two recent meta-analyses have shown a > 60% reduction in TB in HIV-infected adults after isoniazid preventive therapy (IPT). SA has implemented the World Health Organization policy and IPT is now recommended for HIV-positive people for up to 36 months. Originally, there was only one SA study included in the evidence base supporting this policy, but subsequently four randomised controlled trials have been conducted in SA populations. These studies, together with local observational studies, are the subject of this local, evidence-based review

HIV counselling

No abstract available

A crack in the dam wall

No abstract available

Something to offer

No abstract available

South Africa is my fantasy world

No abstract available

Cost of a dedicated ART clinic

Background. The provision of antiretroviral therapy (ART) is being rolled out across South Africa. Little evidence exists on the cost of running clinics for ART provision.Objectives. To determine the cost per patient-month enrolled in an ART programme and per patient-visit for a dedicated, public-sector ART clinic in a South African peri-urban setting in 2004/05 and 2005/06, as the clinic moved from a temporary to a permanent site.Methods. A retrospective costing study was performed from a programme perspective. Two years of expenditure data for the clinic were collected from primary sources. Costs per patientvisit and per patient-month were calculated in Rand and converted to 2004 US$(R6.4347 = US$1).Results. The total cost of running the site, excluding patient-specific items (medicines and medical tests), was $174 072 in 2004/05 and$421 872 in 2005/06. Cost per patient-month fell from $40.29 to$36.47, a 9% decrease; cost per patient-visit fell from $54.79 to$41.62, a 24% decrease. In 2005/06, 68% of all expenditure was on medical and pharmacy staff (versus 62% in 2004/05), 23% was on the employment of peer adherence counsellors (versus 35%), and the remaining 9% was on capital costs and supplies (versus 3%).Conclusions. The increase in scale of operation for the provision of ART at this clinic allowed economies of scale to be reaped. Staff costs, both medical and support, comprised the large majority of total clinic costs, such that the erection of a dedicated building for the clinic had little impact on the economic cost of care

Isoniazid preventive therapy for tuberculosis in South Africa: An assessment of the local evidence base

Worldwide, South Africa (SA) has the worst tuberculosis (TB) epidemic. In SA, there are >6.1 million people living with HIV (PLWH) and the country now has the largest antiretroviral treatment programme with >2 million people receiving combination therapy. While there has been a marked recent decline in HIV-associated deaths, >50% of TB cases still continue to be diagnosed in PWLH. The current TB control strategy based on passive case finding, chemotherapy of childhood TB contacts and directly observed therapy has clearly failed to control endemic TB in SA. Two recent meta-analyses have shown a >60% reduction in TB in HIV-infected adults after isoniazid preventive therapy (IPT). SA has implemented the World Health Organization policy and IPT is now recommended for HIV-positive people for up to 36 months. Originally, there was only one SA study included in the evidence base supporting this policy, but subsequently four randomised controlled trials have been conducted in SA populations. These studies, together with local observational studies, are the subject of this local, evidence-based review

Do we need a national antiretroviral treatment register?

Combination antiretroviral therapy (ART) has greatly improved the prognosis of HIV-infected individuals in affluent countries, resulting in a marked drop in AIDS-related mortality. 1-3 ART programmes have also been successfully initiated in less well-resourced health systems. Brazil, a middle-income developing country, has incorporated ART into its public health service4 and a successful ART programme has been implemented in rural Haiti, the poorest country in the Western hemisphere.