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Saturday, July 3, 2010

Tackling the HIV/AIDS pandemic: The opportunity is big but the labourers are few

The current issue of The Lancet has several articles on HIV/AIDS, ahead of AIDS 2010—the International AIDS Conference in to be held in Vienna, Austria between July 18 and 23.

2010 is significant because it is the year set by world leaders as the deadline for achieving universal access to HIV prevention, treatment, and care. Regrettably, we as a global collective will not meet this ambitious and imperative goal.

But there is something we can all celebrate. Advances in understanding of HIV biology and pathogenesis, and in application of that knowledge to reduce morbidity and mortality, rank among the most impressive accomplishments in medical history. Nothing, since penicillin, rivals the development of antiretroviral drugs in controlling a previously fatal infection. Today Antiretroviral therapy (ART) is potent, convenient, and typically well tolerated.

In the current issue of the Lancet, Ian Sanne and others report the findings of a randomized controlled study to compare nurses-managed and physician-managed therapy of ART in South Africa. A composite endpoint indicative of multiple aspects of ART delivery showed that nurse monitored therapy was not inferior to doctor monitored therapy. Most importantly, I think, the study reports no difference in mortality, viral failure, or immune recovery between study groups.

These findings lend support to observational data from other treatment programs reporting successful use of task shifting in HIV care, especially in resource-poor countries. Furthermore, these findings are especially critical for the expansion of ART services is urgently needed in resource-poor countries to achieve universal access expansion of universal testing and treating strategies.

The role of nurses and task shifting is even more critical from a public policy perspective when you consider that there are less than 10 physicians per 100,000 people in sub-Saharan Africa.

It is important to look at the findings of Ian Sanne et al study in context of the fact that HIV/AIDS presents a monumental challenge to health care systems in sub-Saharan Africa where people with HIV-related diseases occupy more than half of all hospital beds. Government-funded research in South Africa has suggested that, on average, HIV-positive patients stay in hospital four times longer than other patients.

Increased public investment in training and deployment of nurses in the community to deliver ART would help to ease the burden of HIV/AIDS related morbidity on Africa’s fragile and under resourced health care system.

The International AIDS Conference in Vienna 2010 should be less about bemoaning the lack of resources, dwelling on dreadful evidence of AIDS fatalities in Africa, elaborating the failures of universal access goals of United Nations General Assembly Special Session (UNGASS) and more about the harnessing the enormous opportunities for doing more with less to provide relief and hope to millions of people infected or affected by HIV/AIDS.

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