Prioritising prevention strategies for patients in antiretroviral treatment programmes in resource-limited settings

Abstract

Expanded access to antiretroviral therapy (ART) offers opportunities to strengthen HIV prevention in resource-limited settings. We invited 27 ART programmes from urban settings in Africa, Asia and South America to participate in a survey, with the aim to examine what preventive services had been integrated in ART programmes. Twenty-two programmes participated; eight (36%) from South Africa, two from Brazil, two from Zambia and one each from Argentina, India, Thailand, Botswana, Ivory Coast, Malawi, Morocco, Uganda and Zimbabwe and one occupational programme of a brewery company included five countries (Nigeria, Republic of Congo, Democratic Republic of Congo, Rwanda and Burundi). Twenty-one sites (96%) provided health education and social support, and 18 (82%) provided HIV testing and counselling. All sites encouraged disclosure of HIV infection to spouses and partners, but only 11 (50%) had a protocol for partner notification. Twenty-one sites (96%) supplied male condoms, seven (32%) female condoms and 20 (91%) provided prophylactic ART for the prevention of mother-to-child transmission. Seven sites (33%) regularly screened for sexually transmitted infections (STI). Twelve sites (55%) were involved in activities aimed at women or adolescents, and 10 sites (46%) in activities aimed at serodiscordant couples. Stigma and discrimination, gender roles and funding constraints were perceived as the main obstacles to effective prevention in ART programmes. We conclude that preventive services in ART programmes in lower income countries focus on health education and the provision of social support and male condoms. Strategies that might be equally or more important in this setting, including partner notification, prompt diagnosis and treatment of STI and reduction of stigma in the community, have not been implemented widely.

Keywords:

• HIV/AIDS
• antiretroviral therapy
• prevention
• partner notification
• serodiscordant couples

Acknowledgements

We are grateful to all the sites that participated in this survey: Fundación Huesped, Buenos Aires, Argentina: Independent Surgery, Gaborone, Botswana; Service des Maladies Infectieuses, Casablanca, Maroc; McCord Hospital, University of Kwazulu Natal, South Africa; MTCT+ Network, Cato Manor, South Africa; Y R Gaitonde Centre for AIDS Research and Education (YRG Care), Chennai, India; Helen Joseph Hospital Themba Lethu Clinic, Johannesburg, South Africa; Perinatal HIV Research Unit, Soweto, South Africa; CorpMed Medical Centre, Lusaka, Zambia; Centre de Prise en Charge, de Recherche et de Formation sur le VIH/SIDA (CEPREF), Abidjan, Côte d'Ivoire; Immune Suppression Syndrome (ISS) Clinic, Mbarara, Uganda; Gugulethu ART Programme, Cape Town, South Africa; Masiphumalele ART Programme, Cape Town, South Africa; Connaught Clinic, Harare, Zimbabwe; Tygerberg Hospital, Cape Town, South Africa; Heineken Medical Services ART Programme, Amsterdam, The Netherlands; South Brazil HIV Cohort (SOBRHIV), Hospital de Clinicas, Porto Alegre, Brazil; MTCT+ Network, Lusaka, Zambia; Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Rio HIV Cohort, Rio de Janeiro, Brazil; Khayelitsha ART Programme, Cape Town, South Africa; Lighthouse Trust Clinic, Lilongwe, Malawi. We thank Kamal El Filali, Janet Giddy, Gupreet Kindra, Pappie Louis Majuba, Tim Meade, Eugène Messou, Nicholas Musinguzi, Catherine Orrell, Margaret Pascoe, Elizabeth Stringer, Somsri Tantipaibulvut, Gilles Van Cutsem and Ralf Weigel for completing the questionnaire.

The ART-LINC collaboration of the International epidemiological Databases to Evaluate AIDS (IeDEA) is funded by the US National Institutes of Health (Office of AIDS Research and National Institute of Allergy and Infectious Diseases) and the French Agence Nationale de Recherches sur le Sida (ANRS).