title: Developing an evidence-based, preventive care package for persons with HIV in Africa.
abstract: Currently, 95% of the 40 million persons with HIV live in low and middle income countries; 27 million in sub-Saharan Africa. HIV/AIDS is a leading cause of death in the region, yet access to care and treatment considered standard-of-care in the industrialized world is extremely limited. There is a need for standardized, evidence-based recommendations on preventive measures. We developed a list of potential interventions based, when possible, on documented efficacy in reducing morbidity or mortality among persons with HIV in Africa. We considered the accessibility, affordability, and potential for implementation using existing health care infrastructure. Potential components included cotrimoxazole prophylaxis, safe drinking water, isoniazid prophylaxis, insecticide-treated bed nets, micronutrients, and provision of HIV counseling and testing and condoms to family members of persons with HIV. There are several additional interventions for which further evaluation would be useful before inclusion in a standard package of care, including acyclovir prophylaxis, food supplementation, hand washing, and fluconazole prophylaxis. The provision of a basic care package could be an important step toward reducing health care disparities and gaining more control of the global HIV/AIDS epidemic.
authors.affiliation: CDC-Uganda, Global AIDS Program, National Center for HIV, STD and TB Prevention Centers for Disease Control and Prevention, Entebbe, Uganda. jhm7@cdc.gov
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
authors.forename: John
authors.initials: J
authors.lastname: Lule
authors.forename: Alex
authors.initials: A
authors.lastname: Opio
authors.forename: Amanda
authors.initials: A
authors.lastname: Gibbons
authors.forename: Mark
authors.initials: M
authors.lastname: Dybul
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kaplan
mesh_terms: D017088:AIDS-Related Opportunistic Infections / Q000453:epidemiology / Q000517:prevention & control*; D000349:Africa / Q000453:epidemiology; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000995:Antitubercular Agents / Q000627:therapeutic use; D001512:Bedding and Linens; D017280:Condoms; D003376:Counseling / Q000379:methods; D019317:Evidence-Based Medicine / Q000379:methods*; D005192:Family Health; D015658:HIV Infections / Q000517:prevention & control; D006297:Health Services Accessibility; D006801:Humans; D007306:Insecticides / Q000627:therapeutic use; D007538:Isoniazid / Q000627:therapeutic use; D018977:Micronutrients / Q000008:administration & dosage; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use; D014801:Vitamin A / Q000008:administration & dosage; D014871:Water Microbiology; D014881:Water Supply
chemical_list: D000890:Anti-Infective Agents; D000995:Antitubercular Agents; D007306:Insecticides; D018977:Micronutrients; D014801:Vitamin A; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D007538:Isoniazid