Reviewing the evidence on effectiveness and cost-effectiveness of HIV prevention strategies in Thailand

<p>Abstract</p> <p>Background</p> <p>Following universal access to antiretroviral therapy in Thailand, evidence from National AIDS Spending Assessment indicates a decreasing proportion of expenditure on prevention interventions. To prompt policymakers to revitalize HIV prevention, this study identifies a comprehensive list of HIV/AIDs preventive interventions that are likely to be effective and cost-effective in Thailand.</p> <p>Methods</p> <p>A systematic review of the national and international literature on HIV prevention strategies from 1997 to 2008 was undertaken. The outcomes used to consider the effectiveness of HIV prevention interventions were changes in HIV risk behaviour and HIV incidence. Economic evaluations that presented their results in terms of cost per HIV infection averted or cost per quality-adjusted life year (QALY) gained were also included. All studies were assessed against quality criteria.</p> <p>Results</p> <p>The findings demonstrated that school based-sex education plus life-skill programs, voluntary and routine HIV counselling and testing, male condoms, street outreach programs, needle and syringe programs, programs for the prevention of mother-to-child HIV transmission, male circumcision, screening blood products and donated organs for HIV, and increased alcohol tax were all effective in reducing HIV infection among target populations in a cost-effective manner.</p> <p>Conclusion</p> <p>We found very limited local evidence regarding the effectiveness of HIV interventions amongst specific high risk populations. This underlines the urgent need to prioritise health research resources to assess the effectiveness and cost-effectiveness of HIV interventions aimed at reducing HIV infection among high risk groups in Thailand.</p

The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed

Lipid profile and histological measurements of iliac artery in various experimental groups.

<p>Results expressed as mean ± SEM. TC: Total Cholesterol, TG: Triglyceride, LDL: Low density lipoprotein, HDL: High density lipoprotein, I/M thickness ratio: Intimal/medial thickness ratio, %CSN: Percentage cross sectional narrowing. ***p<0.001 vs. normal; #p<0.05, ##p<0.01 and ###p<0.001 <i>vs</i> Baseline. number of sections = 25–30 sections/group.</p

Cholesterol Diet Withdrawal Leads to an Initial Plaque Instability and Subsequent Regression of Accelerated Iliac Artery Atherosclerosis in Rabbits

<div><p>Effect of long term cholesterol diet withdrawal on accelerated atherosclerosis in iliac artery of New Zealand White (NZW) rabbits has not been explored so far. Atherosclerosis was thus induced in rabbits by a combination of balloon injury and atherogenic diet (AD) (1% cholesterol and 6% peanut oil) feeding for 8 weeks (baseline) followed by chow diet (CD) feeding for 4, 8, 16, 32, 50 and 64 weeks. The plaque characterization was done using histology, real time RT-PCR and vasoreactivity studies. Significant elevation in plasma lipids with AD feeding was normalized following 16 weeks of CD feeding. However, baseline comparison showed advanced plaque features even after 8 weeks of CD period with significant elevation in intima/media thickness ratio and plaque area later showing reduction at 50 and 64 weeks CD periods. Lesion lipid accumulation and CD68 positivity was maintained till 16 weeks of CD feeding which significantly reduced from 32 to 64 weeks CD periods. Baseline comparison showed significant increase in ground substance, MMP-9 and significant decrease in α-actin and collagen content at 8 weeks CD period indicating features of unstable plaque. These features regressed up to 64 weeks of CD. Partial restoration of functional vasoconstriction and vasorelaxation was seen after 64 weeks of CD feeding. mRNA expression of MCP-1, VCAM-1, collagen type I and III, MMP-9, TIMP-1, IFN-γ, TNF-α, IL-10 and eNOS supported the above findings. The study thus reveals insights into initial plaque instability and subsequent regression on AD withdrawal in this model. These results are suggestive of an appropriate window for drug intervention for plaque stability/regression and restenosis as well as improves understanding of plaque regression phenomenon in this model.</p></div

Biphasic elevation and subsequent regression of ground substance and matrix metalloproteinase-9.

<p>Panel (A) Representative images of movat pentachrome stained sections of all groups (Scale bar  = 50 µm). Panel (B) Immunohistochemical staining showing MMP-9 positive area of all groups (Scale bar  = 50 µm). (C) Quantitative analysis of alcian blue stained area in respective groups (D) Quantitative analysis of MMP-9 positive areas in respective groups (E) Arterial MMP-9 mRNA expression (fold change over normal) in all groups as determined by real time PCR (F) Arterial TIMP-1 mRNA expression (fold change over normal) in all groups as determined by real time PCR. **p<0.01 and ***p<0.001 <i>vs</i> normal; ^#p<0.05, ^##p<0.01 and ^###p<0.001 <i>vs</i> Baseline. (* indicates lumen, arrow heads indicate positive staining)</p

Vasomodulatory effects and mass spectral analysis of <em>Bridelia ferruginea</em> Benth.

621-628Bridelia ferruginea Benth. (Fam. 'Euphorbiaceae) is known to possess potent anti-inflammatory activity. Here, we investigated its vasomodulatory effect, as anti-inflammatory therapy that beneficially impact the cardiovascular system. Extracts (Bf1, Bf-HA) and fraction (Bf2) of B. ferruginea (Bf), were prepared from the bark of Bf to study their vasomodulatory effect using rat aortic rings. The vasorelaxant effect of Bf1 and Bf2 was mediated by the activation of nitric oxide synthase/endothelial isoform (NOS3) as confirmed by EA.hy926 endothelial cells, real-time PCR and Western blotting. Mass spectral analysis of these extracts and fraction was performed to understand the profile of compounds present in them. Mass spectral analysis showed the presence of similar ions in both Bf1 and Bf2 while Bf-HA showed different patterns. Vasorelaxant effect of Bf1 and Bf2 in phenylephrine (PE) pre-contracted endothelium intact aortic rings was blocked significantly in the presence of both N-nitro-L-arginine methyl ester (L-NAME) or soluble guanylate cyclase inhibitor (1H-[1,2,4]oxadiazolo-[4,3-a]quinoxalin-1-one [ODQ]). However, cyclo-oxygenase (COX) inhibitor (indomethacin) did not exert any change. In contrast, Bf-HA significantly inhibited ACh-induced vasorelaxation, but had no effect on sodium nitroprusside (SNP)-mediated relaxation, thereby suggesting NOS inhibitory activity in the extract. Studies with Bf1 and Bf2 on EA.hy926 cells demonstrated NOS3 mediated nitric oxide (NO) generation. Purified fractions of Bf, thus possess vasorelaxant compounds, which remain to be identified