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Pregnancy often results in exclusion from clinical trials of antiretroviral (ARV) drugs, resulting in limited data on pharmacokinetics (PK), drug safety, and the efficacy of new ARV drugs in pregnancy and lactation. However, pregnancy, lactation, or
...
the potential for pregnancy should not preclude the use of drug regimens that would be chosen for people who are not pregnant, unless adequate drug levels are not likely to be attained in pregnancy or known adverse effects outweigh potential benefits
more
The Pharmacovigilance team in WHO aims to assure the safety of medicines and vaccines by ensuring reliable and timely exchange of information on safety issues, promoting pharmacovigilance activities throughout the Organization and encouraging participation in the WHO Programme for International
...
Drug Monitoring. This text was developed in consultation with the WHO Collaborating Centre for International Drug Monitoring and the national pharmacovigilance centres participating in the WHO Programme for International Drug Monitoring.
more
PlosOne January 20, 2021
https://doi.org/10.1371/journal.pone.0241899
Antibiotic fixed dose combinations (FDCs) can have clinical advantages such as improving effectiveness and adherence to therapy. However, high use of potentially inappropriate
...
FDCs has been reported, with implications for antimicrobial resistance (AMR) and toxicity.
more
N Engl J Med 2022; 386:911-922, DOI: 10.1056/NEJMoa2104535
Four months of antituberculosis treatment was noninferior to 6 months of treatment in children with drug-susceptible, nonsevere, smear-negative tuberculosis (SHINE Study)
Open Forum Infect Dis . 2022 Apr 5;9(5):ofac148.doi: 10.1093/ofid/ofac148. eCollection 2022 May. Dolutegravir HIV drug resistance (HIVDR) data from Africa remain sparse. We reviewed HIVDR results of Malawians on dolutegravir-based antiretroviral the
...
rapy (November 2020– September 2021). Of 6462 eligible clients, 33 samples were submitted to South Africa, 27 were sequenced successfully, and 8 (30%) had dolutegravir HIVDR. Malawi urgently requires adequate HIVDR testing capacity.
more
WHO guideline on HIV service delivery
recommended
Updated guidance on the integration of diabetes, hypertension and mental health services, and interventions to support adherence to antiretroviral therapy. The guideline offers practical implementation guidance for countries and key stakeholders as
...
well as outlining key research gaps. As life expectancy for people living with HIV continues to increase, managing noncommunicable diseases, mental health, and adherence to antiretroviral therapy is essential to sustaining treatment success, quality of life, and engagement in care. A life course approach addresses these needs from childhood through older age. Service integration supports more person-centred, coordinated care across the life course.
more
July 2023 version .The 2023 ART guideline introduces simplified ART provision and harmonised methods of management of children, adolescents and adults, as well as pregnant women living with HIV/AIDS, TB and other common opportunistic infections.
The guidelines also provide guidance on the use of D
...
olutegravir (DTG) dispersible tablets for children from 3kg and 4 weeks old.
These guidelines have been revised with the Differentiated Models of Care SOPs to ensure simultaneous consideration and alignment of clinical, adherence and service delivery updates.
more
Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection
recommended
The recommendations in these guidelines promote the use of simple, non-invasive diagnostic tests to assess the stage of liver disease and eligibility for treatment; prioritize treatment for those with most advanced liver disease and at greatest risk of mortality; and recommend the preferred use of n
...
ucleos(t)ide analogues with a high barrier to drug resistance (tenofovir and entecavir, and entecavir in children aged 2–11 years) for first- and second-line treatment. Recommendations for the treatment of HBV/HIV-coinfected persons are based on the WHO 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection, which will be updated in 2015.
more
Examining nursing practice guidelines to improve quality of care for patients with sepsis in low income countries is required. • A large amount of information about best practice standards in sepsis management is available for healthcare professionals; however, implementation and
...
adherence to practice guidelines recommended by the Surviving Sepsis Campaign remains low in low income countries.
more
The third edition, released in 2018, has grown to include a total of 18 chapters, contributed by 20 experts and authors from many countries. The goal remains the same: to educate primary care providers on the best practices in TB diagnosis, treatment and follow-up. All articles are richly illustrate
...
d, and most include quizzes and CME questions for self learning. The 3rd edition includes new chapters on MDR-TB, adverse effects of TB drugs, adherence monitoring strategies, and nutritional support. There is also content on how to manage children with TB, care for patients co-infected with TB and HIV, how to read and interpret chest x-rays, and how to avoid common pitfalls in TB management.
To download book chapters or the whole book go to the website: http://www.letstalktb.org/download/
more
The WHO South-East Asia (SEA) Region bears a high burden of tuberculosis (TB) and MDR-TB. In 2015, the Region accounted for nearly 200 000 or 35% of the global estimated new RR/MDR-TB cases eligible for treatment. Extensively drug-resis
...
tant TB (XDRTB) has also been reported from six countries of the SEA Region. MDR-TB could potentially replace drug-susceptible TB, and constitutes a threat to global public health security. The South- East Asia Regional Response Framework for DR-TB 2017–2021 complements the Ending TB in the South-East Asia Region: Regional Strategic Plan 2016–2020” and outlines key strategies for reducing morbidity, mortality and transmission of DR-TB.
more
Journal of the International AIDS Society Vol. 21 (2018) e25133
Many prevention of mother-to-child HIV transmission programmes across Africa initiate HIV-infected (HIV positive) pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care (“same-day” initiation ... ). However, there are concerns that same-day initiation may limit patient preparation before starting ART and contribute to subsequent non-adherence, disengagement from care and raised viral load. We examined if same-day initiation was associated with viral suppression and engagement in care during pregnancy.
The data suggest that same-day ART initiation during pregnancy is not associated with lower levels of engagement in care or viral suppression through 12 months post-delivery in this setting, providing reassurance to ART programmes implementing Option B+.
https://doi.org/10.1002/jia2.25133 more
Many prevention of mother-to-child HIV transmission programmes across Africa initiate HIV-infected (HIV positive) pregnant women on lifelong antiretroviral therapy (ART) on the first day of antenatal care (“same-day” initiation ... ). However, there are concerns that same-day initiation may limit patient preparation before starting ART and contribute to subsequent non-adherence, disengagement from care and raised viral load. We examined if same-day initiation was associated with viral suppression and engagement in care during pregnancy.
The data suggest that same-day ART initiation during pregnancy is not associated with lower levels of engagement in care or viral suppression through 12 months post-delivery in this setting, providing reassurance to ART programmes implementing Option B+.
https://doi.org/10.1002/jia2.25133 more
TB remains one of the world’s deadliest infectious diseases, second only to COVID-19, and drug-resistant TB strains are still a major concern. In the fight against TB, urgent investment is critical, especially in the context of the ongoing pandemi
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c.
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Antimicrobials have been a critical public health tool since the discovery of penicillin in 1928, saving the lives of millions of people around the world. Today, however, the emergence of drug resistance is reversing the miracles of the past eighty
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years, with drug choices for the treatment of many infections becoming increasingly limited, expensive, and, in some cases, non-existent.
Conscious of the public health threats of AMR to both humans, animals and the environment, the ministries of health and sanitation, agriculture forestry and food security and the environmental protection agency put together a national multi-sectoral coordinating group tasked with the responsibility of establishing mechanisms to integrate all initiatives into a single concerted action and development of the national AMR strategic plan (2018-2022). The National Strategic Plan on Antimicrobial Resistance is the first approach which addresses AMR specifically.
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This manual summarizes key issues related to the safety of NTD medicines and their administration, with a focus on essential medicines used in mass drug administration (MDA), also called preventive chemotherapy. It can be used as a standalone refere
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nce manual, but is intended to be used in conjunction with the accompanying training modules, which provide practical instruction, and the aide-mémoires. Versions of the aide-mémoires and training modules are available respectively for both (i) programme managers and district-level health officials and (ii) community drug distributors and community health workers
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The Updated guidelines on Management of tuberculosis in children and adolescents include new recommendations that cover diagnostic approaches for TB, shorter treatment for children with non-severe drug-susceptible TB, a new option for the treatment
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of TB meningitis, the use of bedaquiline and delamanid in young children with multidrug- and rifampicin-resistant TB and decentralized and family-centred, integrated models of care for TB case detection and prevention in children and adolescents.
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This was a Phase 3, multi-center, randomized, open-label, parallel-group, active control study where 273 male and female patients with first stage Trypanosoma brucei gambiense HAT were treated at six sites: one trypanosomiasis reference center in Angola, one hospital in South Sudan, and four hospita
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ls in the Democratic Republic of the Congo between August 2005 and September 2009 to support the registration of pafuramidine for treatment of first stage HAT in collaboration with the United States Food and Drug Administration. Patients were treated with either 100 mg of pafuramidine orally twice a day for 10 days or 4 mg/kg pentamidine intramuscularly once daily for 7 days to assess the efficacy and safety of pafuramidine versus pentamidine. Pregnant and lactating women as well as adolescents were included.
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The WHO standard: Universal access to rapid tuberculosis diagnostics sets benchmarks to achieve universal access to WHO-recommended rapid diagnostics (WRDs), increase bacteriologically confirmed tuberculosis and drug resistance detection, and reduce
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the time to diagnosis. WHO-recommended rapid diagnostics are highly accurate, cost-effective, reduce the time to treatment initiation, and impact patient-important outcomes.
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The Democratic Republic of Timor-Leste has the highest TB incidence rate in the South East Asian Region - 498 per 100,000, which is the seventh highest in the world. In Timor-Leste TB is the eighth most common cause of death.
The salient observations are as follows:
In 2018, 487 (12.5%) of the
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3906 notified TB patients were tested for RR-TB and only 12 lab confirmed RR-TB patients were initiated on standard MDR-TB treatment of 20-months duration, (a 3-fold increase in RR-TB detection compared with 2017). This amounts to treatment coverage of only 17% of 72 estimated MDR/RR-TB among notified TB patients (3906) and 5% of 240 estimated incident MDR-TB patients as compared to 62% treatment coverage of 6300 incident drug sensitive TB patients estimated in TLS. The treatment success in the 2016 annual cohort of 6 MDR-TB patients has been reported at 83%. 80% of TB patients know their HIV Status with around 1% TB-HIV co-infection, 37/ 77 (48%) TB-HIV Co-infection Detected. Of the 387 PLHIV currently alive on ART, exact status on TB screening and testing is unknown. % of PLHIV newly enrolled in HIV care who received IPT is not known.
In 2018, the mortality rate for TB was 94 deaths per 100,000 people (1200 per annum) in TL with an increasing mortality trend (Figure 1), despite TB services being available for nearly two decades.
A survey of catastrophic costs due to TB (2016) highlights that 83% of TB patients are reported to be facing catastrophic costs due to the disease. This is the highest rate in the world.
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This is an update (third edition) of the BACPR Standards & Core Components and represents current evidence-based best practice and a pragmatic overview of the structure and function of Cardiovascular Prevention and Rehabilitation Programmes (CPRPs) in the UK. The previously described seven standards
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have now been reduced to six but without sacrificing any of the key elements and with a greater emphasis placed on measurable clinical outcomes, audit and certification. Similarly, the second edition provided an overview of seven core components felt to be essential for the delivery of quality prevention and rehabilitation, and this too has been reduced to six. The interplay between cardio-protective therapies and medical risk factors is almost impossible to disentangle for the vast majority of patients and even if specific drug therapies are deployed exclusively for risk factor modulation, the indirect effect will also be cardio-protective. Thus, these have been combined into a single core component – medical risk management.
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