Theo Smart

You are more invested in the DOTS model, which has failed multidrug-resistant TB (MDR-TB) and now which is breeding XDR-TB, than you are in saving lives, Mark Harrington, Executive Director for the Treatment Action Campaign told TB (tuberculosis) experts attending a symposium held on Tuesday by the Stop TB Partnership of the World Health Organization. The symposium was held the day before the 37th Union World Conference on Lung Health, which is being held this week from November 1-4th in Paris.

Certain cultural factors in resource limited settings pose significant challenges to prevention efforts and must be addressed to make it possible for people (especially youth) to adopt behaviours such as abstinence, being faithful, and correct and consistent condom use (ABC) according to several presentations at the 2006 PEPFAR Implementers Meeting held mid-June in Durban, South Africa. Some PEPFAR-funded prevention programmes are attempting to change cultural norms around polygamy, cross-generational sex, male attitudes towards women, sexual coercion and violence, taboos surrounding discussing sex, economic pressures and social expectations to have sex. Failure to confront these challenges could lead to the failure of prevention programmes, and could also have extremely negative unintended consequences including, potentially, the rape of girls known to be abstinent.

The high prevalence HIV epidemic in sub-Saharan Africa is characterised by close-knit sexual networks that allow the propagation of the virus to large numbers of individuals said epidemiologist David Stanton, who believes that Abstinence, Being Faithful and Condoms-based (ABC) interventions, but especially the A & B parts, are the means to disrupt these networks. Stanton, who serves as the Chief of the Division of Technical Research in the Office of HIV/AIDS at USAID, made a scientific case in support of PEPFARs emphasis on A & B, at the 2006 Implementers meeting in Durban last month.

In 2005, a substantial reduction in national HIV prevalence during the previous year was observed in Zimbabwe. Zimbabwe is being held up as an example of the early success of PEPFAR's ABC approach, but do findings from the field really support that claim? A report on what happened in Zimbabwe was presented at the PEPFAR Implementers meeting last month in Durban, South Africa, by Dr. Owen Murungi from Zimbabwes Ministry of Health and Child Welfare (MoHCW) during a session on ABC.

Prior exposure to single-dose nevirapine (sdNVP, Viramune) for the prevention of mother-to-child transmission (PMTCT) does not necessarily impair a womans subsequent response to nevirapine-containing antiretroviral treatment (ART), particularly if enough time passes between that exposure and the need for ART, according to studies presented at the Thirteenth Conference on Retroviruses and Opportunistic Infections in Denver. The studies suggest that nevirapine-containing regimens are still a good first-line option for ART for many sdNVP-exposed women in resource-limited settings.

HIV and malaria are diseases of massive importance with overlapping distributions, which raises the question about how these two diseases interact. Even small effects and small interactions can have a huge impact, Dr Laurence Slutsker, told an audience at the Thirteenth Conference on Retroviruses and Opportunistic Infections in Denver last month.

Contrary to expectations about the expense of antiretroviral therapy (ART), using ART in people with AIDS should be cost-effective for South Africa's public health sector according to a study published in January's PLoS Medicine (an 'open-access' medical journal). The cost of not using ART to treat people with AIDS is significantly greater - as patients with AIDS required more expensive time in the hospital and other medical care.

Three studies presented last Wednesday at the 2nd South African AIDS Conference Durban show that there is room for improvement in the countrys HIV intelligence gathering (HIV surveillance).

A six-dose course of the combination of two drugs - artemether and lumefantrine (coartum or Riamet)- is a highly effective treatment for malaria in the areas of Africa where resistance to frequently used malaria drugs is common, according to two randomised controlled studies published in the April 22nd issue of The Lancet.

A 3-month course of isoniazid (INH) plus rifampicin (RIF) is as effective a treatment of latent tuberculosis (TB) as the standard six to twelve month course of INH alone, according to review published in the March 1 issue of the journal Clinical Infectious Diseases. The review (actually an analysis of the combined data from five randomised controlled clinical trials) also concluded that severe side effects and mortality were similar on both regimens.