By X. Milok. State University of New York College at Potsdam.
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For instance 75mg doxepin visa, it is possible that people who owned ITNs shared The need for research other characteristics that contributed to the reduc- By the end of 2011 generic 25 mg doxepin free shipping, more than eight million tion in parasitaemia prevalence and childhood people in low- and middle-income countries were deaths. Possible confounding factors include the estimated to be receiving antiretroviral therapy use of anti-malarial drugs, better use and recourse (ART). On the basis of current ART eligibility to health care, and household wealth. Despite the caveats, these fndings suggest that Despite this achievement, HIV/AIDS con- the benefcial efects of ITNs demonstrated in tinues to impose a major burden on health: an clinical trials are also obtained in routine use. It is clear that the HIV/AIDS national programmes that the investments made epidemic will not be brought under control with- so far have been efective in controlling malaria. Te evidence from this study justifes con- and North America, 1763 couples were enrolled tinued eforts to scale up ITN coverage in sub- in a randomized placebo-controlled trial (HPTN Saharan Africa and highlights the importance 052) in which one partner was HIV-positive and of maintaining ITN coverage in countries where the other was HIV-negative (i. HIV-infected persons whose CD4- lymphocyte counts were between 350 and 550 Main conclusions cells/uL were assigned to receive ART immedi- ■ Under routine use in African households, ately (early ART group) or afer the CD4 count the efectiveness of ITNs in reducing had declined to ≤ 250 cells/uL or afer the devel- malaria parasitaemia and child mortality opment of an AIDS-related illness (delayed ART 63 Research for universal health coverage group). HIV transmission linked to aged to return for all visits to receive counsel- partners within serodiscordant ling on risk reduction and the use of condoms, couples, with respect to the for treatment of sexually transmitted infections, year since entering the trial, and and for management of other medical condi- according to whether ART was tions. Of the 28 linked HIV transmissions, only one occurred in the 0. Early ART was also associated with a reduction in individual 0. Previous observational cohort studies had ART, antiretroviral therapy; HIV, human immunodefciency suggested that early start of ART had an HIV- virus. Te most likely mechanism is sustained ART to reduce HIV transmission to uninfected suppression of HIV in genital secretions. WHO also published a program- study provides strong support for the early use matic update on the use of ART for treating of ART in serodiscordant couples as one com- pregnant women and preventing HIV infection ponent of a comprehensive public health strat- in infants, including the use of so-called Option egy to reduce the spread of HIV that includes B+. Tis option provides ART to HIV-infected behaviour change, use of condoms, male cir- women, regardless of CD4 count, as a simple cumcision, female ART-based microbicides and strategy to eliminate HIV infection in infants pre-exposure ART prophylaxis. Towards universal health coverage Malawi was the frst country to propose such Te HPTN 052 study was voted “breakthrough an approach, and provided Option B+ to over of the year” in 2011 by the journal Science, gal- 35 000 HIV-infected pregnant women in the frst vanizing eforts to end the global HIV/AIDS 12 months of implementation (25). In April 2012, WHO issued guid- now provides additional, strong scientifc justi- ance on HIV testing and counselling for couples, fcation for this intervention. In mid-2012 WHO recommending that HIV serodiscordant couples released a discussion paper on the strategic use with CD4 counts ≥ 350 cells/uL should be ofered of antiretroviral drugs to help end the HIV 64 Chapter 3 How research contributes to universal health coverage epidemic, providing the rationale for develop- malaria.