R4D HIV and AIDS

Variable fate of virus-specific CD4+ T cells during primary HIV-1 infection.

Tue, 10 Nov 2009 17:50:00 GMT

Miscellaneous Oxenius, A.; Fidler, S.; Brady, M.; Dawson, S.J.; Ruth, K.; Easterbrook, P.J.; Weber, J.N.; Phillips, R.E.; Price, D.A. 2001 European Journal of Immunology Volume 31 Issue 12, Pages 3782 - 3788 [doi: 10.1002/1521-4141(200112)31:12<3782::AID-IMMU3782>3.0.CO;2-#] Impairment of CD4+ T lymphocyte responses to human immunodeficiency virus (HIV)-derived antigens is the classic immunological defect observed during the chronic phase of HIV-1 infection. Early intervention with potent antiretroviral therapy (ART) can preserve HIV-specific CD4+ T lymphocyte reactivity, providing indirect evidence that such responses are mounted during primary infection and subsequently lost in the majority of infected individuals. Here, we demonstrate early and dramatic expansions of functional HIV-specific CD4+ T lymphocyte frequencies directly ex vivo. These responses are initially of broad specificity, and can disappear rapidly during the natural course of primary infection. This process of loss is variable, such that the rapidity and extent of functional compromise differs between individuals. Institution of ART during these early phases of HIV-1 infection preserves patterns of functional reactivity within the HIV-specific CD4+ T lymphocyte population. However, there was no evidence for the restoration of deleted responses. These findings indicate that, in some individuals at least, ART must be administered within a narrow window of opportunity during primary HIV-1 infection to effect substantial immune preservation.

Direct ex vivo analysis reveals distinct phenotypic patterns of HIV-specific CD8+ T lymphocyte activation in response to therapeutic manipulation of virus load.

Tue, 10 Nov 2009 17:28:00 GMT

Miscellaneous Oxenius, A.; Günthard, H.F.; Hirschel, B.; Fidler, S.; Weber, J.N.; Easterbrook, P.J.; Bell, J.I.; Phillips, R.E.; Price, D.A. 2001 European Journal of Immunology (2001) Volume 31 Issue 4, Pages 1115 - 1121 [doi:10.1002/1521-4141(200104)31:4<1115::AID-IMMU1115>3.0.CO;2-9] Therapeutic intervention with antiretroviral therapy (ART) enables the modulation of HIV virus load and hence provides a unique opportunity to study the consequences of varying antigen load on the phenotype of virus-specific CD8+ T lymphocytes in a persistent human viral infection. The recent advent of tetrameric peptide / HLA class I complexes has enabled the direct phenotypic characterization of antigen-specific T cell populations ex vivo. Here, we use this technology to examine directly ex vivo the consequences of therapeutic manipulation of HIV virus load on the phenotype of HIV-specific CTL. Our observations using samples from 3 patients show that: (1) distinct sequential activation patterns of CD8+ T cells are associated with increasing virus load; (2) T cell receptor (TCR) down-regulation without apoptosis represents an early event during the generation of a T cell response in a natural infection and precedes the emergence of two distinct antigen-specific CD8+ T cell populations which differ in TCR and CD8 expression levels. Clear differences in surface Annexin V staining were observed between these populations. The observation that CTL activation, demonstrated by TCR and CD8 down-regulation, in response to rising levels of virus load, co-segregates with apoptosis only during later stages of the response indicates that antigen-associated cell death is restricted to distinct subpopulations of CTL.

Simple detection of point mutations associated with HIV-1 drug resistance.

Tue, 10 Nov 2009 16:57:00 GMT

Miscellaneous Frater, A.J.; Chaput, C.C.; Beddows, S.; Weber, J.W.; McClure, M.O. 2001 Journal of Virological Methods (2001) Volume 93, Issues 1-2, Pages 145-156 [doi:10.1016/S0166-0934(01)00266-X] A novel assay is described for the detection of HIV-1 drug resistance that is simple, cheap and sensitive. HIV-1 drug resistance in B and non-B HIV-1 subtypes was investigated using Mutagenically-Separated PCR (MSPCR) a competitive semi-nested PCR which uses mutagenic primers. The assay was assessed for sensitivity, specificity and its ability to detect mutant virus within a mixed mutantwild-type population. Gene sequencing was carried out simultaneously for comparison. MSPCR detected five copies of HIV-1 RNA from laboratory isolates and 50 copies from patient samples. We demonstrate 100% specificity of detection for wild type or mutant virus for clades A, B, C, D and E. For mixed populations of virus, MSPCR can detect at least a 10% mix of wild type:mutant, or vice-versa. When applied to African patient samples MSPCR detected 91.6% of the codons tested. Concordance with sequencing data was 88.8% for protease and 97.2% for RT. MS-PCR is sensitive and specific for the detection of mutations in HIV-1, and can be adapted easily to test for resistance at any codon of interest.

Impact of baseline polymorphisms in RT and protease on outcome of highly active antiretroviral therapy in HIV-1-infected African patients

Tue, 10 Nov 2009 16:27:00 GMT

Miscellaneous Frater, A.J.; Beardall, A.; Ariyoshi, K.; Churchill, D.; Galpin, S.; Clarke, J.R.; Weber, J.N.; McClure, M.O. 2001 AIDS (2001) - Volume 15 - Issue 12 - pp 1493-1502. Objective: To assess the therapeutic response and investigate the significance of polymorphic codons in African patients (treated in the UK) receiving highly-active antiretroviral therapy (HAART). Design and methods: African patients were identified from the St Mary's Hospital HIV-1 database. Clinical outcome was assessed by viral load and CD4 cell count. Pre-and post-therapy sequences of RT and protease were analysed. The impact of subtype and individual polymorphic codons on therapeutic outcome was assessed statistically (Fishers exact and χ² tests) and phylogenetically (Jukes and Cantor). Results: Of 79 drug-naive African patients who were prescribed HAART, 60 remained undetectable for 1 year, with no differences detected in the clinical response to nonnucleoside reverse transcriptase inhibitor (NNRTI)- or protease inhibitor (PI)-containing regimes. Country of origin, sex and viral subtype had no impact on outcome of HAART. A total of 133 polymorphisms were identified in pol (37 in protease and 96 in RT), with a mean of 9.0 in protease and 22.3 in RT per patient. There was no significant difference in the overall numbers of polymorphisms per patient, and no single polymorphism had any impact on clinical outcome. Sequences from 'failing' patients experiencing viral rebound produced few mutations known to be associated with drug resistance, suggesting minimal drug pressure. Conclusions: The response of patients infected with African subtypes of HIV-1 to HAART appears to be independent of regime, HIV-1 clade and baseline polymorphisms. Non-B subtypes are fully sensitive to HAART and, accordingly, therapy should not be withheld from African patients for reasons of viral diversity.

A phase I/II study of the safety and activity of a microsphere formulation of KNI-272 in patients with HIV-1 infection.

Tue, 10 Nov 2009 15:44:00 GMT

Miscellaneous Churchill, D.R.; Slade, P.M.; Youle, M.; Gazzard, B.G.; Weber, J.N. 2001 Journal of Antimicrobial Chemotherapy (2001) 47 (3), pp. 353-355. Eighteen patients [in the UK?] with symptomatic HIV disease were enrolled into a phase I/II study of a microsphere formulation of the HIV protease inhibitor KNI-272, with doses escalated up to a maximum dose of 60 mg/kg/day. One patient (only) developed reversible elevation in hepatic transaminase. The plasma half-life of the drug was very short, varying between 0.25 and 1.1 h. No consistent effect on plasma HIV RNA levels or CD4+ lymphocyte counts was seen.

Absence of viral transmission in injecting drug users in Russia

Fri, 06 Nov 2009 17:58:00 GMT

Miscellaneous 2001 The Lancet (2001) Volume 358, Issue 9286 (22 September), Pages 1016-1017 [doi:10.1016/S0140-6736(01)06146-3] The authors draw attention to studies showing that the populations of HIV-1 and HCV subtypes found in injecting drug users (IDUs) in the former Soviet Union differed from those in western Europe (and that human T-cell leukaemia virus type II was common in western European IDUs but not present at all in their Russian counterparts). This indicates that contacts between IDUs in one region and those in the other were limited, and much less pronounced than those within each region.

Serological approaches to subtyping of HIV-1 in injecting drug users in Russia: evidence of subtype homogeneity at the main sites of the epidemic.

Fri, 06 Nov 2009 16:45:00 GMT

Miscellaneous Bobkova, M.R.; Kazennova, E.V.; Selimova, L.M.; Buravtsova, E.V.; Lister, S.; Prilipov, A.G.; Weber, J.N.; Pokrovsky, V.V.; Bobkov, A.F. 2001 International Journal of STD & AIDS (2001) 12 (1), pp. 34-40. The aim of this study was to develop and evaluate a simple V3 peptide-based enzyme immunoassay (PEIA) for large-scale serotyping of HIV-1 specimens derived from injecting drug users (IDUs) in the Russian Federation. Two synthetic peptides were evaluated, named P1 (RKSIHIGPGRAFYATGD) and P2 (RTSVRIGPGQVFYKTGD), in an PEIA, using sera from 63 HIV-1 IDUs (including a few from neighbouring countries) for which genotypes had been determined by heteroduplex mobility assay (HMA) and sequencing. The sensitivities of P1 (subtype B) and P2 (subtype A) were 87% and 75% respectively. Specificity of the assay was 100% for both peptides, with 100% predictive values of a monoreactive positive test for both peptides. Using the PEIA with peptides P1 and P2, we have serotyped 375 of 477 serum samples derived from IDUs in 4 main sites of the HIV-1 epidemic in Russia. The results demonstrated a high level of subtype homogeneity in all regions studied. In 3 of 4 territories, namely Tver (n=345) and Rostov-on-Don (n=61) regions and Krasnodar Kray (n=27), 100% of typable sera were found to belong to env subtype A. On the other hand, all specimens serotyped in the Kaliningrad region (n=38) belonged to env subtype B, and there is strong evidence that the recombinant gagAenvB virus which has caused in this region the largest outbreak of HIV-1 in Russia is common here. At the present time another parental strain with gagBenvB genotype is of minor importance in the IDU HIV-1 epidemic in Russia.

A Systematic Review of the Epidemiologic Interactions Between Classic Sexually Transmitted Diseases and HIV. How Much Really Is Known?

Thu, 05 Nov 2009 18:27:00 GMT

Miscellaneous Røttingen, J.-A.; Cameron, W.; Garnett, G. 2001 Sexually Transmitted Diseases (2001) Volume 28, Issue 10 pp. 579-597. Background: Many studies have explored the role of classic sexually transmitted diseases (STDs) in determining the pattern of HIV epidemics. However, the many different STDs may contribute in different ways, at different magnitudes. Goal: To review available studies on the bidirectional interactions of HIV and STDs to explore the extent of current knowledge on the different influences of the varied STDs in heterosexual HIV epidemics. Methods: Longitudinal studies on susceptibility and controlled studies on infectiousness and duration of disease identified on electronic databases through reference lists and citation indices up to the end of 1999 were systematically reviewed, including meta-analyses assessing the influence of STDs on susceptibility to HIV. Results: Studies have a clear publication bias with a significant result that hinders robust interpretation. However, genital ulcerative disease appears to have a greater impact than nonulcerative disease, and men are more affected than women by the effects of STDs on susceptibility to HIV. There is evidence that STDs increase the infectiousness of HIV from men to women, whereas the evidence is more equivocal for the infectiousness of women. Few studies identify the impact of different STDs, and there is a marked lack of studies investigating the impact of HIV infection on the transmission of other STDs. Conclusions: A large body of work has measured the association between STDs and HIV. However, publication bias and gaps in the focus of studies mean that a detailed, quantitative understanding of the interaction requires much more attention.

A rural HIV epidemic in Zimbabwe? Findings from a population-based survey.

Thu, 05 Nov 2009 17:55:00 GMT

Miscellaneous Gregson, S.; Mason, P.R.; Garnett, G.P.; Zhuwau, T.; Nyamukapa, C.A.; Anderson, R.M.; Chandiwana, S.K. 2001 International Journal of STD & AIDS (2001) vol. 12 no. 3, pp. 189-196 [doi:10.1258/0956462011917009] The aim of the study was to use population-based data from 689 adults to describe the socio-demographic, behavioural and biomedical correlates of HIV infection and aid identification of effective HIV control strategies for rural Zimbabwe. Dried blood spot and urine samples were collected for HIV and sexually transmitted disease (STD) testing and participants were interviewed on socio-demographic characteristics, sexual behaviour and experience of STD symptoms. HIV seroprevalence was 23.3% and was higher in females, divorcees, widows, working men, estate residents, and respondents reporting histories of STD symptoms. Female HIV seroprevalence rises sharply at ages 16-25. A third of sexually-active adults had experienced STD-associated symptoms but there were delays in seeking treatment. Herpes simplex virus type 2 (HSV-2) and Trichomonas vaginalis are more common causes than syphilis, gonorrhoea, and chlamydia, and are strongly associated with HIV infection. Local programmes promoting safer sexual behaviour and fast and effective STD treatment among young women, divorcees and working men could reduce the extensive HIV transmission in rural communities.

Primary HIV Infection in Antenatal and Postnatal Women, Northern KwaZulu‐Natal, South Africa

Wed, 28 Oct 2009 15:19:00 GMT

Miscellaneous S. Mepham 2009 Presentation at Imperial College London, 18 May 2009. 44 pp.

Straight Talking to combat HIV among young African women

Wed, 28 Oct 2009 01:00:00 GMT

A project in Uganda is helping young women, often disempowered in an environment of gender inequality, to talk about their lives with a view to developing a more gendered HIV prevention approach.

This is Open Access Week

Mon, 19 Oct 2009 01:00:00 GMT

This week, 19-23 October 2009, is the first International Open Access Week, which aims to broaden awareness and understanding of Open Access.

Rewarding Achievements in International Development

Wed, 16 Sep 2009 01:00:00 GMT

DFID, in partnership with Marie Stopes International (MSI) and the Guardian, has unveiled the five finalists of the Guardian Achievements in International Development Award.

HIV therapy could be given safely without routine laboratory tests to save more lives in Africa

Fri, 11 Sep 2009 01:00:00 GMT

The Development of Anti-Retroviral Therapy in Africa (DART) trial, supported by DFID, has found that more people with HIV could be treated by not using routine laboratory tests

Helping vulnerable South African teenagers cope with the impact of AIDS

Tue, 08 Sep 2009 01:00:00 GMT

Research from the he DFID-funded ABBA project (Addressing the Balance of Burden in AIDS) shows how programmes that give young people the skills to improve their education and manage family finances can address some of the costs associated with the AIDS pandemic in South Africa

New funding opportunities for four health-related Research Programme Consortia (RPCs)

Mon, 24 Aug 2009 01:00:00 GMT

DFID is calling for expressions of interest for service providers to lead Research Programme Consortia (RPCs) to work on four health themes. Closing date 9th October 2009.

DFID releases a new project database

Fri, 21 Aug 2009 01:00:00 GMT

Information about projects funded by DFID, ranging from emergency aid for countries affected by conflict or humanitarian crises, to ongoing support to improve health, education and sanitation in the poorest countries, is now available online.

Activism and aid combine to fight HIV/AIDS in South Africa

Tue, 28 Jul 2009 01:00:00 GMT

A local AIDS advocacy group has teamed up with international aid agency Médecins Sans Frontiéres to both mobilize people living with HIV and AIDS and to provide the medicine and care that patients need. DFID research is helping to document and understand this blending of activism and aid in South Africa.

DFID seeks applications for three posts in the Research Uptake Team

Tue, 21 Jul 2009 01:00:00 GMT

DFID is seeking to fill three posts in the Research Uptake team within the Policy and Research Directorate - Team Leader and two Research Evidence Brokers

Course on Health, Development, and Human Rights to be held in December

Mon, 06 Jul 2009 01:00:00 GMT

Course will examine health inequalities and new challenges in health through a health, development and human rights analysis.

STIs and HIV in Pakistan: from analysis to action

Thu, 21 May 2009 01:00:00 GMT

A recent study from Realising Rights published as a special issue in the journal Sexually Transmitted Infections seeks to understand the drivers of sexually transmitted infections (STIs) in Pakistan.

Update on DFID call for applications for new product development partnerships for drugs and vaccines

Thu, 30 Apr 2009 01:00:00 GMT

The second phase of the DFID call for applications for new product development partnerships for drugs and vaccines is now underway. Seven organisations have been invited to submit bids for funding.

UK boost for AIDS vaccine research

Thu, 30 Apr 2009 01:00:00 GMT

DFID announces a £40 million pound grant to support the work of the International AIDS Vaccine Initiative (IAVI)

Impact Evaluation of Performance-based Contracting for General Health and HIV/AIDS Services in Rwanda

Thu, 15 Jan 2009 11:39:00 GMT

Current The global shortage of human resources for health care delivery is reaching crisis conditions in the poorest countries, adversely affecting the lives of millions and preventing achievement of the Millennium Development Goals (Chen 2004, World Bank 2005). The deficit of well trained and highly motivated health care workers in developing countries is a reflection of the high levels of absenteeism (Chaudhury et al forthcoming) and worker emigration to richer countries (Stilwell et al 2004). This research will provide some of the first rigorous empirical evidence on whether Performance Based Contracting (PBC) for health services is a feasible method for improving quality of care, increasing access to quality health care services, and significantly increasing health outcomes. It will also be the first study of PBC in the African context. This work is especially timely since the human resources crisis, lack of progress towards the MDGs, and health needs of the poor (esp. HIV/AIDS and malaria) are the greatest in Africa. The knowledge generated by this research will not only fundamentally serve the Rwandan government, World Bank and other donor agencies as they prepare for expansion of PBC for health services within Rwanda, but also the international community as it searches for more effective means for addressing the human resource crisis in health care. We propose to evaluate the impact of a new performance-based contracting (PBC) scheme for health care services being implemented by the government of Rwanda for basic preventive and curative health care services and HIV/AIDS treatment. Specifically, the objectives of this research are to identify the impact of performance based contracting on provider behavior, patient utilization and health outcomes. We will observe how incentive-based payment affects behavior, while also studying health care utilization for both preventative and curative care among poor, rural populations. The obstacles facing the Ministry of Health in Rwanda are those which face the majority of poor, developing countries. The objective of this research is to determine the viability of performance-based contracting in health services as a means for overcoming these obstacles in health care. Through extensive data collection and analysis at the facility and household level, our research will provide invaluable evidence on how PBC impacts provider behavior, patient utilization and, ultimately, health outcomes.

Anti-retroviral treatment of HIV/AIDS patients in Africa is better delivered in health centres

Wed, 10 Dec 2008 01:00:00 GMT

A new study by the DFID and Elton John Aids Foundation-funded COMDIS programme has shown the value of local care in treating HIV/AIDS patients

AIDS emergency in Swaziland hits like a tidal wave

Mon, 07 Jul 2008 01:00:00 GMT

Swaziland is experiencing an HIV/AIDS emergency on the scale of traditional emergencies such as tsunamis and earthquakes

Rural Africans gaining access to AIDS treatments

Wed, 14 May 2008 01:00:00 GMT

Anti-retroviral therapy made available for AIDS sufferers in Tanzania

Research and capacity building in reproductive and sexual health and HIV/AIDS in developing countries

Thu, 24 Jan 2008 14:40:00 GMT

Current Reversal of the spread of HIV/AIDS is one of the Millennium Development Goals (MDGs). Failure to achieve this goal will jeopardise other MDGs on poverty eradication, education, and maternal and child health. Success depends critically on improving access to effective interventions for those who are particularly vulnerable to infection (e.g. the poor). Access may be improved and protective behaviour increased through a number of strategies: e.g. mass communication of safe sex messages, together with social marketing of products such as condoms and STI diagnostic tests; provision of integrated SRH and HIV services which decrease stigma and thereby increase uptake; and provision of more effective biomedical interventions which can bring improved diagnostics and preventive technologies to all sections of society. Consortium partners have a long history of working in each of these areas. To support a research programme that will strengthen the evidence base to enable policy makers to identify and prioritise interventions that will improve reproductive and sexual health and reduce HIV incidence among economically poor populations in Africa and Asia. Strategies for behaviour change.

Integration of SRH and HIV services.

New biomedical tools.

Two large community randomised trials measuring the effectiveness of school-based and peer-led adolescent SRH interventions in Tanzania (Mema kwa Vijana study) and Zimbabwe (Regai Dzive Shiri study) have shown that young peoples knowledge about how to prevent HIV increased, and that these effects were sustained for at least 5 years. However, the interventions did not lead to a reduction in HIV, other STIs or unplanned pregnancies. These results will be important in guiding the future direction of HIV prevention activities for young people. The two studies communicated their results simultaneously in several fora including with national and international policy makers and researchers and have proven very influential in shaping the WHO Adolescent and Child Health Departments strategies for curbing HIV incidence in young populations.
A study commissioned by the National AIDS Control Programme in Pakistan, funded by DFID Pakistan and conducted by LSHTM researchers and collaborators from Pakistan shed much-needed light on the health and behaviour of populations often neglected or persecuted, in South Asia and elsewhere. The research has shown that violence, abuse and discrimination are commonly experienced by sex workers and injecting drug users, and can increase the likelihood of HIV and sexually transmitted infections. A future HIV epidemic is likely to be concentrated in those with highest levels of STIs and the highest levels of abuse transgender sex workers. Our research has also shown that policy recommendations targeted at transgender sex workers will have little support among society, and will be difficult for the government and public sector to implement, but they could be implemented successfully by NGOs, with donor funding and support.
As a result of our published evaluations which showed that the new point-of-care (POC) diagnostic dipstick tests for syphilis perform well in screening programmes for pregnant women, these tests were made available at discounted prices through the WHO bulk procurement programme. In 2009, a decision was made to use them for antenatal screening in Ghana, and they will now being rolled out nationally to all antenatal clinics in the country. In Tanzania, our results encouraged the government to agree to introduce one of POC test as a demonstration project, which we will evaluate. The Brazilian government has also decided to use them for screening hard-to-access populations in the Amazonas Region, following several evaluations which we conducted in the region.

Evidence for Action: An International Research Consortium to Maximise Benefits & Equity of HIV Treatment & Care Systems

Thu, 13 Dec 2007 09:45:00 GMT

Current

Effective prevention, treatment and care services are essential to reduce the appalling waste of human life and talent due to HIV, which has killed over 25 million people since the start of the epidemic, with 2.8m (roughly equivalent to the entire population of Wales) dying in 2005 alone. However, the scale and complexity of these services threatens to overwhelm under-resourced health systems, yet the increasing funds that are now available provide a unique opportunity for the whole system to benefit.

Specific research projects will be carried out in the developing countries represented by the research institutes themselves, but also in other countries such as Tanzania and Ukraine, and through international comparative research.

The partners to this consortium are:

International HIV/AIDS Alliance, Brighton, UK
Lighthouse Trust, Lilongwe, Malawi
London School of Hygiene & Tropical Medicine (ILSHTM), London, UK
MRC/UVRI Uganda Research Unit on AIDS , Entebbe, Uganda
National AIDS Research Institute, Pune, India
University College London, with the MRC Clinical Trials Unit, UK
Zambian AIDS-related Tuberculosis Project (ZAMBART), Lusaka, Zambia

The consortium Director is Dr David Ross of LSHTM.

The partners are all leading institutions in research into HIV care for children and adults and systems of delivery. They are also experts in policy and advocacy work, and civil society strengthening. Bringing these institutions together will deliver research solutions that can be translated into policy and actions rapidly and on a large scale in developing countries. Emphasis will be placed on solving problems and bottlenecks in delivery systems that are blocking universal access for people who urgently need HIV treatment and care.

The goal of the research programme will be to increase knowledge on how to design and implement HIV prevention, treatment and care programmes in resource poor settings. Some interesting findings on task shifting.

Critical Mass for Applied, Policy-Relevant Research on HIV Treatment & Care in Low and Middle Income Countries: The Whole is More than the Sum of the Parts
The programme has created a critical mass of southern (India, Malawi, Uganda, Zambia) and northern partner institutions within a collaborative network to identify priority research questions in HIV treatment and care delivery systems in low and middle income countries and thereby provide evidence informed policy and programmatic advice to national governments, funding agencies, international agencies, and civil society organisations.

Key WHO Guidelines
Members of the programme played leading roles in the writing of a key set of WHO guidelines Priority Interventions: HIV/AIDS prevention, treatment and care in the health sector which was published in 2008 and is already being very influential in national programmes and among international agencies and NGOs.

Decentralisation of HIV Treatment & Care Services
The programme has made important contributions to the debate on how best to decentralize the provision of antiretroviral therapy within a broader package of HIV treatment, prevention and care and support. This has included a major community-based randomised controlled trial in Uganda (the Jinja Trial, funded by UK MRC and DFID, conducted by MRC-UVRI's AIDS Research Unit in Entebbe and facilitated by the programme), which established the potential for improving adherence to HIV treatment regimens through the use of trained lay health workers to deliver antiretroviral drugs for HIV treatment and to provide adherence counselling and support within the home. Meanwhile, a parallel study, directly generated through the programme and supported by DFID (the WAKISO Project), has identified the key steps that need to be in place for successful decentralisation of HIV treatment and care services to the health centre level in Uganda, and studies in Zambia have highlighted the changing roles of NGOs and CBOs in the provision of community-based HIV services since the scale-up of HIV treatment services.

Barriers and Solutions to Integration of HIV and TB Services
The programme and collaborators have identified key barriers to integration of HIV and TB treatment services and tested potential solutions to overcome these, both through reviews of lessons learned in programmes and within rigorous studies in Malawi, South Africa, and Zambia (eg. ZAMSTAR trial).

Strategies for Getting Research Findings into Policy and Programmes
A policy analysis of key factors that slowed or facilitated the introduction of cotrimoxazole prophylaxis of HIV-positive individuals into national policy and programmes in Zambia, Uganda and Malawi has revealed that the premise that efforts to communicate research findings to policy makers, while important, may not be sufficient. Efforts also need to be made to find and influence the key actors and networks that have it within their power to change policy, and to identify or create key windows of opportunity for change in policy processes at strategic points, such as the creation or revision of both international (eg. WHO) and national policy or programme implementation guidelines.

Unintended Impacts of Global Health Initiatives
A qualitative policy analysis study in Zambia showed that while funding and technical support from Global Health Initiatives (GHIs such as PEPFAR, GFATM, World Bank MAP) successfully supported the training of large numbers of health workers to provide HIV treatment and care services, they actively depleted the pool of skilled human resources for health within the government sector by recruiting public sector staff to work for GHI-funded NGO implementing agencies. The study researchers recommended that GHIs should review their policies of not providing significant funding for additional human resources within government programmes. The results of this study have provoked considerable interest and debate among government, NGO and GHI staff in Zambia and beyond.

Mental Health Disorders among HIV-positive Individuals: A Neglected Priority
The programme has identified that recognition and treatment of mental health disorders among HIV-positive clients may be a very important and neglected aspect of clinical care, and is in the process of quantifying the scale of the burden of mental health disorders in a series of linked studies in Uganda, Zambia and India.

Health & HIV/AIDS education in primary & secondary schools in Africa & Asia

Tue, 20 Nov 2007 00:00:00 GMT

Completed

Cost-effectiveness of preventive therapy for HIV infected South African mine workers

Tue, 20 Nov 2007 00:00:00 GMT

Ongoing Isoniazid preventive therapy (IPT) is effective in preventing TB, and is recommended by WHO for people with HIV infection, and by the American Thoracic Society for people with silicosis. However, important practical questions about TB preventive therapy remain unanswered: in particular, the optimum duration of preventive therapy has not been determined, and the cost-effectiveness of the intervention is unknown. Cotrimoxazole has been shown to prevent morbidity and mortality among HIV-infected individuals in West Africa but there is uncertainty about its effectiveness in other regions of Africa. A special clinical service (the "Prevention Clinic") has been established at Ernest Oppenheimer Hospital (EOH), Welkom, aiming to deliver IPT to employees at high risk of tuberculosis, namely those with silicosis or HIV infection, and cotrimoxazole to those with HIV disease and a CD4 count less than 200. The study evaluates the cost-effectiveness of isoniazid and cotrimoxazole in preventing tuberculosis and other opportunistic infections among South African mineworkers, as well as the cost-benefits of such an intervention to the firm in terms of reduced abseenteism, turnover and sickness benefits.

IIEP Research partnership - Plannning and management research (impact of poverty on schooling, ed. for disadvantaged groups, HIV/AIDS education prevention, education in crisis situations, virtual univ. progs)

Tue, 20 Nov 2007 00:00:00 GMT

Completed

Development of methodologies and their implications for scaling up resource allocation for HIV prevention

Tue, 20 Nov 2007 00:00:00 GMT

Completed

Knowledge for Action in HIV/AIDS and Sexually Transmitted Infections (STIs)

Tue, 20 Nov 2007 00:00:00 GMT

Current This programme is already able to cite examples where work has informed policy and practice related to the themes identified in the purpose statement. A policy document on mainstreaming has influenced the HIV strategy within Ghana and Uganda, and other projects have also influenced national policy (e.g. quality assurance work on VCT implemented in Kenya). The programme appears to work closely with the Kenyan National AIDS Control Programme and the Malawi ARV Taskforce. Strong links also exist with WHO and UNAIDS. Relationships with DFID both at HQ and country level appear strong. To inform and integrate policy and planning across all sectors and civil society with regard to normalising responses to HIV/AIDS, reducing HIV and STI transmission, mitigating the impact of HIV/AIDS, in particular for poor and vulnerable people. Output 1. Responsiveness: Identification of knowledge needs and research opportunities emerging from the evolving HIV/AIDS epidemic.

Output 2. New knowledge available
1. pathways to develop inter-sectoral policies and networks
2. ways to normalise and mainstream HIV/AIDS & STI activities at all levels
3. the social, economic and cultural influences on sexual behaviour that affect HIV & STI transmission
4. mechanisms for modifying these influences to reduce HIV transmission
5. approaches to mitigate the impact of HIV/AIDS in the poor

Output 3. New products developed
1. virucides/microbicides
2. Whole system assessment and response tool
3. advocacy tools
4. activity maps for inter-sectoralising

Output 4. Dissemination
1. New knowledge communicated to policy makers and agencies
2. New technology transferred to users

Output 5. Strengthened capacity
1. Communities' capacity to change behaviour and normalise responses to HIV/AIDS strengthened
2.Health service providers' QA skills enhanced in HIV/AIDS & STI services
3. Policy makers are more able to promote inter-sectoral responses and translate evidence based policy into practice.

Knowledge for Action in HIV/AIDS in the Russian Federation

Tue, 20 Nov 2007 00:00:00 GMT

Current

The Knowledge for Action project was approved as an accountable grant in July 2002 with total allocation of £1,500,000 over 3 years. The Knowledge for Action in HIV/AIDS in the Russian Federation was a collaborative research programme, which had been implemented in the Russian Federation. The programme had been funded by the UK Department for International Development as part of its wider programme to support Russian Authorities and civil society in responding to the epidemic of HIV/AIDS, which is believed to be among the fastest growing in the world.

The programme included 15 research projects, which focused on behavioural, epidemiological, economic and political aspects of HIV/AIDS in Russia. At the end October the final report outlining the key findings, implications and policy recommendations was published in the Russian language; and will be circulated among federal and local decision-makers, health care professionals, civil society organisations and international agencies.

The programme has been directed and managed by the team currently based in the Institute of Health & Human Development at the University of East London. Other UK research groups are based in the Imperial College, University College London and London School of Hygiene & Tropical Medicine. On the Russian side the programme has been led by three major Research centres: the Federal AIDS Centre; the Scientific Centre for Addiction and the Public health Institute with the full support and endorsement from the Russian Ministry of Health. Most data have been collected in three geographical areas in Russia, Altai Krai, Volgograd Oblast and the city of Moscow; with the support of local Administrations and active involvement of local academic institutions; health care services; and NGOs.

The programme has been unique and innovative in many ways. Firstly, the programme for the first time systematically linked data on risk behavior, HIV epidemiology, economics and policy environment. This approach allowed a more coherent and comprehensive understanding of both the Russia HIV epidemic and response. Secondly, the programme has been delivered at unprecedented speed for such a complex undertaking. Fifteen primary fieldwork-based studies carried out in three research sites across Russia involved the conduct of several thousand interviews; documentary analyses and laboratory based tests. Thirdly, the programme has been implemented through genuine partnerships between the UK and Russia based teams and between multiple governmental and non-governmental stakeholders in Russia. The key focus of the programme has been on building local capacities for epidemiological, sociological and public health research and on developing sustainable links between policy-makers, clinicians, sociologists epidemiologists and community workers.

Key achievements of the programme:

The programme has undertaken a study estimating prevalence of HIV, Hepatitis C and syphilis among community-recruited samples of injecting drug-users (IDUs), using an innovative technique of saliva testing, which is not being used in Russia at present;
validation of the test performed by Russian scientists showed high sensitivity and specificity of the test; and the test has been recommended for application as part of the second generation surveillance for HIV infection;
the programme conducted a study estimating the prevalence of drug use in the participating regions using a capture-recapture method, which had not been used in Russia earlier;
the programme explored injecting risk environments and factors that increase risks of contracting HIV and hepatitis C by injecting drug- users;
the programme examined barriers for implementing effective HIV control programmes including drug treatment and rehabilitation programmes; harm reduction programmes for IDUs; sex education in schools; and HIV antiretrov
The project goal is to support the Russian government and society to make a timely and effective response to HIV/AIDS.

The project purpose is to create the knowledge base on HIV in the Russian Federation necessary to guide effective policy and intervention.

Four objectives resulted in 4 main outputs:
The Russian version of the Report will be available for downloading from the website of the Federal Service for Protection of Consumer Rights and Wellbeing, Russian Ministry of Health.

Preparation of concept note on HIV/AIDS and rural livelihoods

Tue, 20 Nov 2007 00:00:00 GMT

Completed Since the late 1980s there has been increasing interest in the socio-economic impact of HIV/AIDS as the presence of the disease and its effects on adults in their prime working and parenting years has become increasingly visible. The loss of these adults and the diversion of labour and other assets to care for the sick and their dependants, has an impact not only on the individual household but also at the community level. The rural sector is particularly vulnerable. Communities in rural areas are not only responding to the needs of the sick who are living amongst them, but in many cases relatives living in urban areas and who are afflicted with the disease return to their native villages to be cared for. A further issue for concern is the irreversible damage which the coping strategies which emerge in the face of HIV/AIDS can inflict on individual livelihoods, the wider community, and the rural sector as a whole. Over recent years organisations such as the UN Food and Agricultural Organisation (FAO) have been highlighting the impact of HIV/AIDS on agricultural production and institutions. An important question which is often raised is how existing policies, strategic approaches and patterns of investment in the agricultural and rural livelihoods sector should be adapted to address the current and future impact of AIDS. This project aims to contribute to this growing debate and assist DFID in developing an appropriate response. To produce a concept note outlining the links between HIV/AIDS, livelihoods and the natural resources sector. The implications arising for the DFID Natural Resources Advisers and policy-makers and practitioners more generally will be discussed. The importance of inter-disciplinary approaches are likely to be emphasised.
This note will be circulated at the DFID Africa NR Adviser's meeting in Pretoria at the end of January 2001. Project concept note on HIV/AIDS and rural livelihoods Progress against Milestones:

To inform the writing of this concept note, the project leader and NRI colleague Elizabeth Robinson attended the DFID-IFPRI Consultation on HIV/AIDS and Rural Livelihoods, held 8-9 January 2001 at IFPRI. The Consultation enabled some useful discussions to take place, and benefited from the participation of a number of 'key players' working in the field of HIV/AIDS impact and impact mitigation. These included Tony Barnett (University of East Anglia), Daphne Topouzis (freelance consultant who has worked for FAO, and more recently UNAIDS), Gabriel Rugalema (KIT, soon to be UNAIDS South Africa) and Hans Binswanger (World Bank).

A Back to Office Report on the DFID-IFPRI consultation was produced for the client in mid-January 2001. This report outlined the main points arising from the consultation meeting, and highlighted specific implications for DFID's work.

A discussion note was submitted to RLD on 26 January 2001 and was circulated in advance of the Pretoria meeting.

The note outlined current thinking on the impact of the epidemic (drawing closely on the discussions held at the DFID/IFPRI consultation) and suggested methods by which Rural Livelihoods Advisers could use existing knowledge of the impact of HIV/AIDS to inform their policy and programme making. Particular emphasis was placed on the need to develop approaches which address both risk and vulnerability to the epidemic.

One particular approach proposed in the note is that of livelihood vulnerability mapping. Such a mapping system could be used at both macro- and micro- levels within a country or a region and could draw on existing quantitative and qualitative data on HIV prevalence data and prevalence and mortality projections, agro-ecological zones, ethnicity, population distribution, migration patterns. New indicators for monitoring changes in livelihood activity which have a strong correlation with the local impact of the epidemic (e.g. shift in crops cultivated, reduction in areas of land farmed) could also be integrated within this mapping system. This mapping system could enhance understanding of the links between HIV/AIDS and livelihoods. In a more practical sense, it could assist in the targeting of vulnerable groups, identify when and where prevention activities should be a particularly central element of livelihood interventions, and could indicate how existing programmes may be compromised by the impact of HIV/AIDS.

The discussion note also highlights the challenges which HIV/AIDS poses to the premises which inform conventional development planning. For example, the inter-generational transmission of knowledge and cultural values may no longer be taking place as before due to the increasing orphaning of children at an early stage and the strain this is placing on grandparents, extended families and communities as a whole. The prospect of a new generation of dislocated and disaffected youth is startling, and it may be that more formalised methods of sharing knowledge among generations will need to be found.

Finally, the note identifies key entry points for RLD in tackling the impact of HIV/AIDS, including possible methods for mainstreaming HIV/AIDS within the Department. Partnerships with HIV prevention and care agencies, network organisations are emphasised.

Understanding TB-HIV Related Stigma in Zambia

Fri, 05 Jan 2007 01:00:00 GMT

Research co-funded by DFID and USAID reveals that Tuberculosis-HIV stigma has severe implications for the treatment of TB Patients

Africa: the role of research

Thu, 28 Sep 2006 01:00:00 GMT

Research is tackling the problems faced by people in Africa in many areas including health, agriculture and climate change

TB and HIV: Fighting a Dual Epidemic in Africa

Tue, 28 Mar 2006 01:00:00 GMT

The ProTest project, reducing the impact of TB and other HIV-related illnesses on the community...