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Study Shows Decreased Risk Of Death From Opportunistic Infections With Earlier Antiretroviral Treatment
HIV-positive people with opportunistic infections who receive earlier antiretroviral treatment lower their risk of death compared with people who delay treatment, according to a new study conducted by the Stanford University School of Medicine and published in PLoS One, the San Jose Mercury News reports. The findings could lead to changes in recommendations for antiretroviral treatment protocol, specifically for patients diagnosed with HIV at an advanced stage, the Mercury News reports. The study included 262 HIV-positive participants at 39 health care sites across the U.S., and 20 participants in South Africa. During the yearlong study, the researchers found that among the participants who were treated promptly after developing an opportunistic infection, 14% died or developed another infection. The researchers also found that 24% of participants who deferred treatment for an average of 45 days died or had a decrease in health outcomes. According to the Mercury News, the question of when to start HIV-positive people on antiretroviral treatment remains unclear because of issues such as the high cost of medicines, side effects, and drug interactions or resistance. Andrew Zolopa, head of Stanford University School of Medicine"s division of infectious diseases and lead investigator of the study, said that physicians often treat HIV-positive people for an "acute crisis, then follow up later with treatment for HIV." He continues, "But that answer is wrong. The study shows very clearly that there is no safety downside to doing this -- and the benefit is quite substantial, reducing death by 50%." "Even in San Francisco, one of the first epicenters of HIV in the United States, we still find that many people present late in the course of their illness with an opportunistic infection," Mitch Katz, director of San Francisco"s Department of Health who was not involved in the study, said. He added, "This study shows that it is lifesaving to treat those persons with antiretroviral drugs while they are still in the hospital." Katz said that the results could lead to changes in HIV/AIDS practices worldwide. The International AIDS Society, CDC and the British AIDS Society have developed guidelines recommending that early antiretroviral treatment be considered in patients with opportunistic infections, Zolopa said. In addition, NIH is considering an international study to examine earlier initiation of antiretroviral treatment involving more than 9,000 people from both developed and developing countries (Krieger, San Jose Mercury News, 5/15).
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Encouraging People To Sit Less And Eat Better Through Workplace E-Mail Intervention Program
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Diagnostics

Leading Health Organizations Launch New Accreditation Process For Laboratories Across Africa

Government health officials from 13 African countries today launched the first-ever push for accreditation of the continent"s medical laboratories, starting a process that the World Health Organization (WHO) and the U.S. Government believe will be an historic step to strengthen health systems and lead to better care for patients. Just a handful of Africa"s laboratories are now accredited, in part because the existing international accreditation process is so time-consuming. Many laboratories lack equipment, proper funding, adequate training for lab workers, and systematic management of work. This new effort will operate under the guidance of the WHO Regional Office for Africa (WHO/AFRO) and the U.S. President"s Emergency Plan for AIDS Relief (PEPFAR), implemented through the U.S. Department of Health and Human Services/Centers for Disease Control and Prevention (HHS/CDC). The American Society for Clinical Pathology (ASCP) will assign dozens of volunteer American lab professionals and the Clinton HIV/AIDS Initiative will help implement action-oriented training programs to boost and standardize the quality of African laboratories. WHO-AFRO has established a five-step accreditation process structured around its core standards for laboratories, which will allow labs to gradually receive credit for improvement - and eventually attain accreditation. For many laboratories that employ top-notch workers, this extra help is seen as critical to reach a consistent high standard of work. "It"s time for Africa to go in this direction - accreditation is the only way to be sure a laboratory is a good laboratory," said Agnes Binagwaho, Rwanda"s Permanent Secretary in the Ministry of Health. "We cannot provide high quality care - no matter what type of disease we"re fighting - without strong laboratories. This will greatly strengthen our health systems in the short term and long term. This is all about building sustainable health systems." Laboratories form the backbone of health systems around the world, providing doctors and other health care workers with results of a battery of tests for deadly diseases. Sub-Saharan Africa carries a huge burden of disease - it is estimated that the continent has more than 2 million deaths annually from AIDS, nearly 2 million deaths from tuberculosis, and roughly 1 million deaths from malaria - and yet its laboratories are among the most ill-equipped and poorly red facilities anywhere. If laboratories function properly, doctors and nurses will not only get correct diagnoses of diseases and an indication of when and how to begin treatment, but they will also know when drugs fail and when people develop resistance to medications. This is a critical component of monitoring patients infected with HIV, tuberculosis, and malaria, as well as a host of other diseases. In addition, an efficient laboratory can dramatically reduce waiting time to get results - allowing patients in parts of Africa who often travel a day or more for testing to receive the laboratory results sooner. Studies have shown that when patients need to return for a second visit to a hospital or clinic for test results, significant percentages fail to do so. The work to improve laboratories began to gain momentum nearly a decade ago; the intensified fight against HIV/AIDS represented by PEPFAR and others provided funding and demand to improve laboratory services. Two of the integral partners in this process have been the WHO-AFRO and PEPFAR through HHS/CDC. "Supporting governments" efforts to strengthen national health care systems, including laboratory quality management, is essential to ensuring sustainability of country-driven HIV/AIDS interventions," said Ambassador Eric Goosby, U.S. Global AIDS Coordinator. "Efforts like this new lab accreditation process are essential to equipping countries and communities with the tools necessary for progress on health." El-hadj Belabbes, HIV Lab Officer for the WHO Inter-country Support Team, Central Africa, said the outcome is the result of efforts initiated by WHO-AFRO and HHS/CDC eight years ago, leading to meetings with partners in Zimbabwe, Ghana, South Africa, Ethiopia, and Senegal. "Following these meetings, WHO-AFRO, in collaboration with its partners, has initiated the first phase of laboratory accreditation but also has started the implementation of comprehensive Quality Management Systems and laboratory management training," Belabbes said. At the Kigali meeting, which runs from July 27 to 29, participants include 120 experts and policymakers from Rwanda, Botswana, Cameroon, Cote d"Ivoire, Ethiopia, Kenya, Malawi, Nigeria, Senegal, Tanzania, Ghana, Uganda, and Zambia. The meeting will have three goals: unveil a blueprint toward the path of accreditation; obtain key stakeholders" support for accreditation; and showcase a task-based training program in support of laboratory improvement required for accreditation. "This is a tremendous leap forward for diagnostic laboratory services in Africa," said Dr. Lee H. Hilborne, past president of the American Society for Clinical Pathology, which helped design the training program and will send volunteers from U.S. laboratories to assist the training. "The commitment of laboratories, Ministries of Health, and international partners, including ASCP, speaks to the realization that investments in infrastructure to date have matured to the point where it is now possible to explicitly commit to having Africa"s laboratories aspire to and achieve compliance with international standards. The people of Africa and the world will benefit from this essential step forward." "Every patient deserves "access to accurate and reliable diagnostics that meaningfully inform the care and treatment they receive. The laboratory accreditation process is an important means to encourage, evaluate and recognize competence, quality and reliability in medical laboratory testing. We consider laboratories to be a gateway to the management and treatment of priority diseases," said Philip Rotz, Training Coordinator of the Laboratory Services Team for the Clinton HIV/AIDS Initiative. Connie Wilkins, a hospital laboratory director in Joplin, Missouri, in the United States and one of ASCP"s volunteers, said that the process will be critically important in helping laboratories run more efficiently. Much of the effort will be focused on training laboratory managers and other administrative staff to improve the management of the facilities. After the laboratories go through the five-stage process for WHO-AFRO, they will be closer to applying for international accreditation as well. "Anything we can do in education, including in improving laboratories is not just about saving a life but about improving quality of life," Wilkins said. "We"re improving healthcare starting with being able to deliver to doctors a more accurate diagnosis of the problem and by allowing doctors to see how well treatments are working through periodic testing. It"s just a huge deal." Preeti Singh Burness Communications


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