|3/8/2013 8:57 AM|
About the authors:
Jonathan Stadler is a technical head at the Wits Reproductive
Health and HIV Institute. His research focuses on the ethnography
of HIV/AIDS, clinical HIV prevention trials (specifically microbicides),
and community engagement with medical research in rural and
urban South Africa.
Eirik Saethre is an assistant professor of anthropology at the
University of Hawaii at Mānoa. His research examines responses
to disease, medical intervention and pharmaceuticals in urban
South Africa and remote Aboriginal Australia.
The views expressed in this Review are solely those of the authors
and the Centre for the Study of AIDS.
Publisher: Centre for the Study of AIDS, University of Pretoria
Series editor: Mary Crewe
Editor: Robin Hamilton
Design and production: Bluprint Design
Illustrations: Anri Theron, Jacques Lange and Matthew Reid
Copyright © 2012, University of Pretoria and the authors.
All rights reserved.
'Off Label' AIDS Review
|10/29/2012 12:56 PM|
Researchers from the Wits Reproductive Health & HIV Institute (WRHI) in Johannesburg, South Africa, in the first pathological study to address why HIV patients on antiretroviral therapy die, have learned that the vast majority of deaths are due to tuberculosis (TB). During the first three months of antiretroviral therapy, when the risk of death is the highest, the team, led by Dr. Emily Wong, found that tuberculosis contributed to at least 80% of the deaths. Most cases of tuberculosis were undiagnosed and two-thirds were accompanied by at least one other infection or cancer.
Dr. Francois Venter, the senior author, said of the results, “The TB finding was scary and its magnitude surprising. What was even more worrying was how secondary infections co-existed in these patients, and often went undiagnosed, even in a hospital setting. The bottom line is that we need better TB prevention and initiation of antiretroviral therapy before people are at risk of these other cancers and infections.”
Dr. Wong is currently an international associate and research fellow at the KwaZulu Research Institute for Tuberculosis and HIV, which officially opened its new research facility on October 9, 2012. She said, “Despite the roll-out of antiretroviral therapy, HIV and TB continue to be a deadly combination. The patients and the families who participated in this study wanted good to come from their tragic losses. We now have a responsibility to understand how these two diseases work together to cause sickness and death so that we can devise better treatments and save lives.”
Causes of Death on Antiretroviral Therapy.pdf
|10/29/2012 12:53 PM|
South Africa’s current national policy on contraception has been in place for more than 10 years. But much has changed in the field of reproductive health since 2001, when the National Contraception Policy Guidelines within a reproductive health framework were developed. The high prevalence of HIV prompted health officials to call for a review of the policy, in light of the Following:
- New developments in contraceptive research and availability of new technologies, some of which have been introduced in other African countries
- A shrinking number of available contraceptive methods in South Africa
- Weakened delivery of contraceptive services, resulting in high levels of unintended pregnancies
- The need to ensure linkages and alignment with other related national and international policies and frameworks.
Contraception – Bringing Policy up to date.pdf
|10/29/2012 12:47 PM|
In-depth interviews identified considerable weaknesses within operational HIV service delivery. These manifested as missed opportunities for HIV testing in antenatal care due to shortages of test kits; insufficient staff assigned to HIV services; late payment of lay counsellors, with consequent absenteeism; and delayed transcription of CD4 cell count results into patient files (required for ART initiation).
By contrast, individual factors undermining access encompassed psychosocial concerns, such as fear of a positive test result or a partner’s reaction; and stigma. Data and information systems for monitoring in the three peri-urban facilities were markedly inadequate.
Health system weaknesses constrain access to PMTCT and maternal HIV.pdf
|10/29/2012 12:50 PM|
South Africa has taken important steps to turn the tide of mother and infant deaths around. Following the HCT campaign initiated in 2010, there is great emphasis on training nurses and midwives to become NIM-ART practitioners.
The pressure is high to get as many practitioners into the field to increase access to treatment and care, but training without mentoring is no training at all. It is essential that the training of nurses and midwives be followed up with adequate clinical mentoring to assist NIM-ART practitioners to become competent and confident to initiate treatment. Nurses and midwives should not be put under pressure to start initiating without the necessary clinical mentorship recommended and supported by the national Department of Health.