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Treating HIV in war zones -- Public health emergencies need rapid advice from WHO

HIV treatment can be delivered even in settings of armed conflict, and humanitarian health agencies should not wait until a conflict is over before launching HIV care programs, say a team from Médecins Sans Frontières (MSF) in this week’s PLoS Medicine.

Heather Culbert and colleagues report their results of three years’ experience of providing HIV care, including antiretroviral therapy (ART), to a conflict-affected population in the Democratic Republic of the Congo (DRC). The reported treatment outcomes were similar to those in HIV projects in non-conflict settings.

"Our experience has shown us that one of the keys to successful provision of ART in conflict settings is preparation for disruption," say the authors. Some of the crucial contingency measures include:

  • Providing patients with extra emergency drug supplies that can be taken in case of program interruption.
  • Stockpiling emergency supplies of ART and securing them against vandals and looters
  • Distributing clinics widely throughout the treatment area, thus reducing travel requirements and making it easier and safer for staff and patients to access the clinics in times of insecurity
  • Establishing links with HIV care programs in neighboring regions, allowing displaced patients to continue to receive care
  • Educating patients on the importance of not conserving their pills and trying to take them on time even during periods of instability.

Culbert and colleagues' paper includes powerful testimonies from patients who have been under the care of MSF. One patient, followed in the clinic since May 2003, and on ART since December 2003, says:

"I heard gun fire all through the night. When I had only five pills left I lost my appetite and felt desperate…but despite the uncertainty I continued to take my treatment at the correct hour… When I had only one pill left I had the courage to go out and seek some more treatment. I went to see nu rse who informed me that she would be able to distribute antiretrovirals; with that I had a month’s worth of treatment. If we have to give up this treatment we will return to how we were at the start, sick."

The authors acknowledge that their results have been achieved with the resources of an international nongovernmental organization (MSF), in an urban setting, with the episode of conflict-related disruption occurring early in the programme, and thus similar results in conflict settings may not always be possible. "Nevertheless," they say, "the key elements of contingency planning for care delivery in conflict settings are not resource-intense and we believe they can generally be applied to most care programmes."

Citation: Culbert H, Tu D, O’Brien DP, Ellman T, Mills C, et al. (2007) HIV treatment in a conflict setting: Outcomes and experiences from Bukavu, Democratic Republic of the Congo. PLoS Med 4(5): e129.

IN YOUR ARTICLE, PLEASE LINK TO THIS URL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER::"request=get-document&doi=10.1371/journal.pmed.0040129


Related images for press use:’brien-graph.pdf

Daniel O’Brien
Médecins Sans Fron tières (MSF) Holland
Public Health Department
Plantage Middenlaan
Amsterdam, Holland 1001 EA
+31 20 520 8031
+31 20 620 5170 (fax)

Public health emergencies require urgent advice from the WHO

The World Health Organization (WHO) has developed a new mechanism, described in this week's PLoS Medicine, for issuing urgent guidelines to health professionals in a public health emergency such as an infectious disease outbreak.

The first rapidly issued guideline was developed by the WHO in order to advise countries that were dealing with avian influenza A (H5N1) infection.

Typically, the most rigorous clinical practice guidelines take two years or more to develop. The laborious process involves convening experts who search for and appraise all the relevant research literature, and who meet several times before making treatment recommendations. Such a time frame is clearly not practical in an emergency situation.

Holger J. Schünemann and colleagues, authors of the rapidly issued guideline on H5N1 infection, say that it took just one month to convene an expert team, and only five weeks for the team to summarize the evidence and prepare draft guidelines. The guidelines were then discussed at a two-day meeting, after which a draft manuscript for publication was prepared within 10 days.

In a related editorial discussing how WHO is responding to global public health threats, the PLoS Medicine editors comment that while the time scale for developing the H5N1 guideline was "miraculously quick in WHO terms", an even quicker time frame is sometimes going to be needed.

Citation: Schünemann HJ, Hill SR, Kakad M, Vist GE, Bellamy R, et al. (2007) Transparent development of the WHO Rapid Advice Guidelines. PLoS Med 4(5): e119.

IN YOUR ARTICLE, PLEASE LINK TO THIS U RL, WHICH WILL PROVIDE ACCESS TO THE PUBLISHED PAPER::"request=get-document&doi=10.1371/journal.pmed.0040119


Holger J. Schünemann
Italian National Cancer Institute Regina Elena
Department of Epidemiology
Via Elio Chianesi 53
Rome, RM 00144
+39 3460846102

Related PLoS Medicine Editorial:

Citation: The PLoS Medicine Editors (2007) How is WHO responding to global public health threats" PLoS Med 4(5): e197.



Source:Public Library of Science

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