Child-headed households in South Africa: What we know and what we don't

Household structures in many countries in Africa have been drastically changed by the HIV/AIDS epidemic. Traditionally, orphans were absorbed by members of the extended family but today this safety net no longer works so well and many children are left to fend for themselves. The South African Government recognises the problem, but views differ on the effectiveness of the programmes for assisting these children. This article looks at what is known and what needs further research. It is known that child-headed households do exist in South Africa and that children living in these households are vulnerable. What is not known is the prevalence of these households and how to deal with the children's psycho-social problems. The article argues that the definition of child-headed households needs to be refined if we are to understand the extent of the problem. This will facilitate assessment of the programmes established for these children.     

Implications of switching away from injectable hormonal contraceptives on the HIV epidemic

A recent study showed that progestogen-only injectable hormonal contraception (POIHC) doubles the risk of HIV transmission. This may affect contraceptive use and HIV-related outcomes, if women switch away from POIHC. A deterministic compartmental model of individuals aged 15–49 distinguishing gender and HIV status was used to simulate various contraceptive use scenarios. We specifically tracked HIV prevalence, new infections, HIV-related deaths, vertical transmission, and births over a 15-year period for five African countries. Stopping POIHC use will result in a large increase in births and vertical transmission. Switching from POIHC to other contraceptives limits these increases while still improving HIV outcomes.     

WHO DEVELOPS INNOVATIONS IN MEDICINE FOR THE POOR? TRENDS IN PATENT APPLICATIONS RELATED TO MEDICINES FOR HIV/AIDS,TUBERCULOSIS, MALARIA,AND NEGLECTED DISEASES

This paper analyzes patent data of medicines and vaccines for diseases spreading in low‐income countries. The data were retrieved from a database of the Japan Patent Office. Who invents medicines for the poor of the world? This is the main question that the paper addresses. Results indicate that not only public institutions but also private firms have played an important role in developing innovations for fighting both global diseases such as HIV/AIDS and tuberculosis, and so‐called neglected diseases including malaria, which seem to spread almost exclusively in low‐income countries. Moreover, the basic mechanism of innovation is similar between the development of medicines for HIV/AIDS and those for neglected diseases. Finally, among firms, infectious disease fighting innovations are quite diverse. R&D stock and economies of scope are used to explain frequent patent applications by a high‐performing pharmaceutical firm.     

变化时代的艾滋病预防

试图从人类人口学的视角和杰米逊关于社会变迁的公共卫生理论对中国目前在艾滋病预防上的困境作出解释 :当市场经济发展和社会变迁导致政治权利迅速分散使传统的社会控制失去作用的时候 ,需要更高思维素质的公民社会尚未形成。笔者就此提出一些建议     

Cost effectiveness of atazanavir-ritonavir versus lopinavir-ritonavir in treatment-naïve human immunodeficiency virus-infected patients in the United States

Abstract

Objective:

To evaluate lifetime cost effectiveness of atazanavir-ritonavir (ATV?+?r) versus lopinavir-ritonavir (LPV/r), both with tenofovir-emtricitabine, in US HIV-infected patients initiating first-line antiretroviral therapy.

Methods:

A Markov microsimulation model was developed to calculate quality-adjusted life-years (QALYs) based on CD4 and HIV RNA levels, coronary heart disease (CHD), AIDS, opportunistic infections (OIs), diarrhea, and hyperbilirubinemia. A million-member cohort of HIV-1-infected, treatment-naïve adults progressed at 3-month intervals through eight health states. Baseline characteristics, virologic suppression, cholesterol changes, and diarrhea and hyperbilirubinemia rates were based on 96-week CASTLE trial results. HIV mortality, OI rates, adherence, costs, utilities, and CHD risk were from literature and experts.

Limitations:

The incremental cost-effectiveness ratio (ICER) may be overestimated because the ATV?+?r treatment effect was based on an intention-to-treat analysis. The QALY weights used for diarrhea, hyperbilirubinemia, and CHD events are uncertain; however, the ICER remained <$50,000/QALY when these values were varied in sensitivity analyses.

Results:

ATV?+?r patients received first-line therapy longer than LPV/r patients (97.3 vs. 70.7 months), had longer quality-adjusted survival (11.02 vs. 10.76 years), similar overall survival (18.52 vs. 18.51 years), and higher costs ($275,986 vs. 269,160). ATR?+?r patients had lower rates of AIDS (19.08 vs. 20.05 cases/1,000 patient-years), OIs (0.44 vs. 0.52), diarrhea (1.27 vs. 6.26), and CHD events (5.44 vs. 5.51), but higher hyperbilirubinemia rates (6.99 vs. 0.25). ATV?+?r added 0.26 QALYs at a cost of $6826, for $26,421/QALY.

Conclusions:

By more effectively reducing viral load with less gastrointestinal toxicity and a better lipid profile, ATV?+?r lowered rates of AIDS and CHD, increased quality-adjusted survival, and was cost effective (<$50,000/QALY) compared with LPV/r.