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HIV Epidemiology + Prevention (ii) (ART (prevents as well as treats,…
HIV Epidemiology + Prevention (ii)
ART
prevents as well as treats
decreases incidence of HIV in a community setting
people in areas of high uptakes nearly 40% less likely to get HIV than people in low uptake areas
if a HIV +ve person adheres to effective ART their risk of transmission can be reduced by 96%
coverage increasing
decreasing AIDS-related deaths
needed for rest of life
problems with adherence (resistance), costs (coming down, donor countries)
Global goals
universal access to prevention, tx, care + support by 2010
by 2020: getting to 0 (UNAIDS vision)
0 new infections
0 discrimination
0 AIDS-related deaths
by 2020
90% of all HIV+ve people know their status
90% of all dxed receive sustained ART
90% of all people on ART have durable viral load suppression
reaching these goals
UNAIDS recommends a fast-track approach
substantially increasing + front loading investment over the nest 5 yrs to accelerate scale-up + establish momentum
National HIV control programmes
prevention, tx, care, support
national strategies for HIV/AIDS control - national AIDS coordinating authorities
mainstreaming of HIV response, managing HIV funds
sector responses
ministry of health AIDS control programmes
ministry of eduction
social welfare
agriculture / rural development
national development plans - poverty reduction strategies
VCT
fundamental part of preventative strategy across all pop groups
move towards universal access to testing
anonymous, targeted, voluntary
offer to all those pregnant, TB or STIs
counselling pre+post test, specialist care
health system constraints
weak drug procurement (obtaining) + supply management systems
poor lab infrastructure
severe human resource shortages (not enough HCWs)
not enough money
fencing for HIV programmes needs to be increased
global fund to fight AIDS+TB+Malaria
$33 billion to support prevention, tx + care programmes
57% in SSA
61% for HIV/AIDS
45% for commodities, products, drugs
Strengthening the health workforce
actions by developing countries
greater use of mid-level workers (task shifting)
additional investment in training (Pre + In service)
improved working conditions + benefits
actions by developed countries (to reduce migration)
WHO code of conduct on recruitment
support training + capacity building in home country (train + retain)
factors that prevent reduction in prevalence
lack of political leadership
denial, stigma, myths
gender inequality, vulnerable women
Thailand "100% condom programme"
strong political + financial commitment
government distribution of free condoms to achieve 100% saturation of market - clients of sex workers, high risk groups (army, truck drivers, police)
social marketing
education + regulation in commercial sex work places
STI testing + tx
surveillance + contact tracing
Current challenges
maintaining funding + political commitment
developing preventative strategies
vaccines
microbicides (virucical creams women apply before sex)
increasing HIV testing coverage
increasing tx adherence
control in most @ risk pops (MARPs)
pre-exposure prophylaxis
self-testing
HIV in Ire
change in case definition in 2015 resulted in increased no. of notifications
more men
most common route = MSM (has overtaken heterosexual sex)
mostly 25-49 y/o
other common routes: heterosexual, unknown, IVDUs (mostly men)
most migrants, most born in SSA
2014: outbreak among IVDUs in Dublin