Common vaginal infection may double HIV acquisition risk

http://www.aidsmap.com/en/news/1767E991-8D37-4337-8308-4512E2CA3C8E.asp
Bacterial vaginosis (BV), the most common vaginal infection in women of
childbearing age, may double a woman's susceptibility to HIV infection,
according to the results of a South African study published in the October 15th
edition of The Journal of Infectious Diseases, and now available online. If more
effective diagnosis and treatment were available, argues an accompanying
editorial, HIV infection rates in the developing world could be substantially
reduced.

Nevirapine paediatric dosing: adult tablets can be split, Thai study
reports

http://www.aidsmap.com/en/news/27D5459B-000F-4A6D-9102-7AF115D43474.asp
Dosing of children with fractions of adult fixed dose combination
tablets that contain nevirapine can provide the appropriate nevirapine
exposure for children of varying ages, a Thai study reports this month
in the journal AIDS.

Condom promotion in Uganda not reducing HIV risk, study shows

http://www.aidsmap.com/en/news/4E172283-15D5-446A-8CF7-97BCD5B7C8C1.asp
A study of condom distribution and promotion in Uganda has found that
whilst education in condom use increased uptake, it did not lead to
consistent use in the following six months. Men in the intervention
group went on to have a larger number of sexual partners and were
somewhat less likely to use condoms with casual sex partners than the
control group. The findings are published in the September 1st edition
of the Journal of Acquired Immune Deficiency Syndromes.

Efavirenz and rifampicin: UK doctors caution on higher EFV doses in
Africans

http://www.aidsmap.com/en/news/E0929D96-C96B-412D-9C8E-1035DFB87268.asp
Clinicians at St George's Hospital in London report that patients are
much more likely to experience efavirenz-related side-effects when 800mg
efavirenz (Sustiva) is co-administered with the anti-tuberculosis (TB) drug,
rifampicin. In a research letter published in the September 23rd issue of the
journal, AIDS, they argue that using the higher dose of efavirenz with
concomitant anti-TB therapy should not be practised universally, particularly in
patients of black African origin who are more likely to carry a genetic
polymorphism that slows efavirenz clearance.

HIV disproportionately affecting young women in South Africa

http://www.aidsmap.com/en/news/7A4645D5-6C27-4B6F-B647-AAF5FEA4547A.asp
Fifteen percent of young South African women, aged between 15 and 24 are
HIV-positive, compared to only 5% of South African males in the same age group,
according to a study published in the September 23rd edition of AIDS. The
investigators found that older sexual partners, sexually transmitted infections
and inconsistent condom use were amongst the risk factors for HIV infection, but
they also found that young people who had participated in South Africa's
loveLife HIV prevention activities were less likely to be HIV-infected.

Drug-using MSM and transgendered Katoey in Thailand require culturally
appropriate HIV and Hepatitis C targeted prevention

http://www.aidsmap.com/en/news/D338BF8C-F9E2-4B66-8ACA-D2F77E809255.asp
Men who have sex with men (MSM) in Thailand, who often do so with
transgendered men known as Katoey, do not perceive themselves to be
engaging in sex between men, and are consequently requiring culturally
appropriate targeted prevention, according to a study published in the
the September 23rd issue of the journal, AIDS. The study also found that
substance-using MSM are at high risk of both HIV and hepatitis C
infection.

Nevirapine-resistant HIV present in breastmilk of a third of women
exposed to single dose

http://www.aidsmap.com/en/news/702AA7B5-1347-408C-84DE-4A3FB5A4A072.asp
A third of women who take single-dose nevirapine (Viramune) to prevent
mother-to-child transmission of HIV have virus resistant to
non-nucleoside reverse transcriptase inhibitors (NNRTIs) present in
their breastmilk eight weeks after giving birth, according to a study
published in the October 1st edition of Clinical Infectious Diseases
(now online). The investigators also found that almost three quarters of women
had detectable HIV in their breastmilk and that women with
mastitis - breast tissue inflammation - had significantly higher levels of HIV
shedding, leading the researchers to recommend that
"interventions to reduce mastitis.are warranted, to increase the safety of
breast-feeding and prevent breastmilk transmission of HIV."

Detectable viral loads in patients on antiretroviral therapy causes slow
development of resistance

http://www.aidsmap.com/en/news/5B43E629-07C7-4769-90B0-623FF2AFD589.asp
HIV-infected patients taking antiretroviral therapy but with detectable levels
of HIV in the blood acquire drug resistance mutations relatively slowly,
according to a prospective observational cohort study presented in the 1st
September edition of The Journal of Acquired Immune Deficiency Syndromes.

Does buprenorphine have a role in preventing HIV transmission and
treating HIV-infected IDUs

http://www.aidsmap.com/en/news/E564BB83-A1AD-4F98-A976-A9A7002CB789.asp A review
article published in the 15th September edition of Clinical Infectious Diseases
has outlined the benefits of buprenorphine (Subutex) in the treatment of
intravenous drug use. The drug, which was added to the World Health
Organization's (WHO's) list of essential drugs in July 2005, may be beneficial
in reducing HIV transmission through injection practices, as well as treating
HIV-infected drug users.

Risk of 5% weight loss increased in HAART era, not linked to
lipodystrophy

http://www.aidsmap.com/en/news/253F1E5A-12E9-467A-A406-A60CF4B1FF02.asp
The proportion of HIV-positive patients who experienced an unintentional loss in
body weight of 5% or more increased significantly between 1995 and 2003,
according to an American study published in the September 1st edition of the
Journal of Acquired Immune Deficiency Syndromes. The investigators found that
this weight loss was not connected with lipodystrophy and express concern that
weight loss of 5% or more has been shown to markedly increase the risk of death
in HIV-positive patients.

HIV treatment dramatically cuts risk of HIV transmission in steady
heterosexual couples

http://www.aidsmap.com/en/news/11D0BCF6-B93A-4FDA-9436-7279344CD363.asp
Effective anti-HIV treatment has significantly reduced the sexual
transmission of HIV amongst steady heterosexual couples, according to
the results of a Spanish study published in the September 1st edition of the
Journal of Acquired Immune Deficiency Syndromes. The investigators found that
HIV prevalence amongst the initially HIV-negative partners fell from 10% before
potent HIV therapy became available to 2% after the introduction of effective
antiretroviral treatment. In addition, the investigators also noted that not a
single case of HIV transmission occurred in a couple where the HIV-positive
partner was taking a powerful combination of anti-HIV drugs.

CD4 percentage could help decide when to start treatment

http://www.aidsmap.com/en/news/F731C054-1B9C-4A8B-BB54-052E27C113DE.asp
CD4 percentages, along with CD4 cell counts, could be of benefit in
helping patients decide when to start antiretroviral therapy, according to a
study published in the 15th September edition of The Journal of Infectious
Diseases. In particular, they suggest that patients with a CD4 cell count above
350 cells/mm3 but a low CD4 percentage could benefit from starting HIV treatment
earlier than recommended in current guidelines.

NNRTIs have a greater risk of resistance than PIs when used in regimens after
treatment break

http://www.aidsmap.com/en/news/24591AF0-90FC-4FD1-96F0-657307860915.asp
Patients who take a non-nucleoside reverse transcriptase inhibitor
(NNRTI) -based regimen after a break from HIV treatment are
significantly less likely to achieve an undetectable viral load than
patients reinitiating HIV therapy with a protease inhibitor-containing
combination, according to the results of a retrospective Spanish study
published in the September 15th edition of Clinical Infectious Diseases.
The investigators believe that the resistance barriers and
pharmacokinetics of NNRTIs could explain these findings and suggest that
resistance tests should be performed before a patient recommences NNRTI
treatment after a break from HIV therapy.

South Africa: Erratic infant formula supply puts PMTCT at risk

http://www.aidsmap.com/en/news/0624EC9F-F6EE-4624-982C-D14E43B0A984.asp
International food and beverage company Nestlé is to provide a full
report to the South African government on how it is addressing the
erratic supply of infant formula to public health facilities.

Co-trimoxazole in Malawi: risks may outweigh benefits

http://www.aidsmap.com/en/news/FDC11E07-6146-4944-9F1C-FDAEA5F2C614.asp
A study in Malawi has found that whilst most of the opportunistic
infections prevented by the drug co-trimoxazole are rare in people with HIV,
bacterial infections and malarial infection that already have reduced
sensitivity to co-trimoxazole are widespread, calling into question the global
recommendation that all people with HIV with CD4 cell counts below 500 should
receive prophylactic treatment with
co-trimoxazole. Its use in settings where resistance is high in the
general population has been controversial.

Antiretroviral therapy reduces HIV transmission through breast milk

http://www.aidsmap.com/en/news/37FAC18C-BBF2-42F0-AD8F-5F48C16EB2AE.asp
Treatment of HIV-positive breast-feeding mothers with antiretroviral
therapy results in reduced viral loads in breast milk and anti-HIV drug levels
sufficient to prevent HIV transmission, according to findings published in the
1st September edition of The Journal of Infectious Diseases.

Flagship mother-to-child transmission prevention programme in Lusaka
only 30% effective

http://www.aidsmap.com/en/news/E65D7DEE-FF48-47E8-956A-4C0530BE54BA.asp
A free city-wide programme to prevent mother-to-child transmission
(MTCT) in Lusaka, Zambia is only effectively reaching 30% of
mother-child pairs, according to the results of a paper published in the
September 1st issue of the journal Clinical Infectious Diseases. The most
striking findings were that anonymously identified HIV-positive women were
significantly less likely to accept an HIV test than their HIV-negative
counterparts, and that almost one-in-three of the women who knew they were
HIV-positive (32%) did not actually take the single dose of nevirapine
(Viramune) during labour.

Mother-to-child transmission may be more common with subtype D than A

http://www.aidsmap.com/en/news/DF66F343-556F-4B6B-98A1-1DEF35D61CF7.asp
There is a trend for higher rates of mother-to-child transmission of HIV for
women infected with sub-type D versus sub-type A, according to data from the HIV
Network for Prevention Trials (HIVNET) 012 study published in the August 15th
edition of The Journal of Acquired Immune Deficiency Syndromes.

Revised WHO guidelines on prevention of mother to child transmission

By Theo Smart

Earlier this month, the World Health Organization issued proposed
revisions to its recommendations on the use of antiretroviral drugs for the
prevention of mother-to-child transmission (PMTCT) (see
http://www.who.int/entity/3by5/PMTCTreport_June2005.pdf and
http://www.who.int/entity/3by5/PMTCTtable_June2005.pdf).

The recommendations were the product of a panel of experts convened by
WHO at the end of June, 2005 to discuss important new concerning the
development of resistance in women and children using single dose
nevirapine (sdNVP) for PMTCT, as well as new clinical findings on
strategies that might help reduce the development of that resistance.
The panel had the unenviable task of proposing simple, practical
evidence-based recommendations that would work in the variety of
differently resourced environments and clinical situations that confront
healthcare workers trying to help mothers protect their infants from
HIV-infection in the developing world.

HATIP published a couple of issues on the subject of sdNVP resistance
last year. Since that time, several studies have produced important
data.

More Resistance

Initial reports suggested that resistance only occurred in 20-30% of the women
exposed to sdNVP-exposed women in HIVNET and other trials and in a higher
proportion of women exposed to two doses of the drug in the Saint study.

But recent studies using more sensitive techniques to screen for
resistance suggest that it is much more common (see
http://www.aidsmap.com/en/news/379A4719-2FBD-49F8-8353-E3FDFF72F567.asp,
http://www.aidsmap.com/en/news/A3C49CD6-6951-4B70-B872-887600D5C1D3.asp)

The methods used in some of these studies can detect very small
minority populations of drug-resistant virus - which appears to occur in as many
as 60-75% of the women who take it, depending on the study and perhaps the viral
subtype.

But most of this resistance seems to diminish over time. In one of the
studies, nevirapine resistance one year after delivery was seen in only 25% of
the women. Encouragingly, HIV DNA in the women's white blood cells did not show
any evidence of nevirapine resistance, despite use of the more sensitive lab
test. This suggests that archiving of the nevirapine-resistance mutations may be
a rare event (HIV DNA represents viral material that has been incorporated into
cells that will lie dormant until that cell is activated, at which point new HIV
particles are produced. This HIV DNA provides a reservoir that allows drug
resistant viruses to persist in the body for long periods).

So it's not clear whether low frequency mutations have much of an
impact. It appears to have little impact on the effectiveness of
subsequent use of sdNVP, at least for PMTCT in a second pregnancy (see
http://www.aidsmap.com/en/news/0507DD7B-0FD6-4A3F-BB67-5E71638EE5EC.asp)

But the potential effect on the mothers' treatment outcomes is more
troublesome. Prior exposure to sdNVP did compromise at least some
mother's subsequent responses to NNRTI-based antiretroviral therapy in a
substudy of the Thai Perinatal HIV Prevention Trial-2 (PHPT-2)
(previously reported here
http://www.aidsmap.com/en/news/94EC3850-D045-4420-A7BB-6EE22D9B70AB.asp)

However most of the mothers exposed to sdNVP in that study went onto
ART only six months after labour (median).

Virologic responses might not be as impaired in women who have more time to wait
until they need antiretroviral therapy for their own health. Yet no subsequent
clinical trial has really addressed this.

One study presented at the 3rd International AIDS Society Conference on HIV
Pathogenesis and Treatment in Rio de Janeiro last just July, did report on CD4
cell responses to ART in women who waited a median of 17 months after being
exposed to sdNVP before starting antiretroviral therapy. (see
http://www.aidsmap.com/en/news/D15A2763-C672-42C2-BE78-34CF7AD207F6.asp)

There were no virologic data from this study but investigators could
find no difference in CD4 cell responses between those who were exposed to sdNVP
and those who were not. However, these women were drawn from the Ditrame-plus
cohort
(http://www.aidsmap.com/en/news/819CD092-3764-4C00-9C68-66E9BA35AA9D.asp) and
also took AZT/3TC for a few days after childbirth.


Covering Nevirapine's Tail - sdNVP plus AZT/3TC or AZT

Those few days of combination therapy when AZT/3TC is given to women who have
taken sdNVP may make a big difference. The selective pressure on the virus to
mutate and become resistant is probably greatest the first few days after dosing
(while nevirapine is at its most potent). And the rate of resistance reported by
the researchers in the Ditrame Plus study seems almost impossibly low (~1.14%).

The question of whether adding AZT/3TC reduces nevirapine resistance was
addressed prospectively in a controlled setting by Dr. James McIntyre, who
presented the most recent data from the Treatments Options Preservation Study
(TOPS) in Rio. In short, TOPS found that adding four to seven days of AZT/3TC
after birth to mothers who have received sdNVP during labour significantly
reduces the risk that they will develop resistance to nevirapine, and may
preserve their future treatment options.

The study had three treatment arms 1) sdNVP, or 2) sdNVP plus four days of
Combivir (AZT/3TC combination tablet), or 3) sdNVP plus seven days of Combivir.
Twice-daily Combivir was started in the mothers during labour and in their
babies as soon as possible after birth.

The sdNVP arm was discontinued after an interim analysis of HIV
resistance data at weeks two and six showed that nine of the 18 women
(50%) randomised to receive single dose nevirapine alone had NNRTI
resistance compared to 4 out of 43 (10%).

Data on the remaining 226 mothers and 228 infants who were enrolled at
the time of the closure of the sdNVP arm are in the table below.

sdNVP

sdNVP plus 4 days AZT/3TC

sdNVP plus 7 days AZT/3TC

Number who developed resistance /number in treatment arm (%)

41/68(60)

8/67(12)

7/68(10)

Baseline viral load (median)

23,200

24,700

35,000

Viral load at nadir (median)

8,300

< 400

436

No resistance to AZT/3TC was detected in the study. However, adding
AZT/3TC significantly reduced the rate of NNRTI resistance among mothers from
60% to 12% (4 days) and 10% (7 days). It also greatly reduced the viral load
which could be of critical importance. Among the mothers who took only sdNVP,
the median viral load (at baseline and nadir) was higher in the mothers who
developed resistance, (43,650 and 16,600 copies/ml) than in those who did not,
(10,600 and 4,160 copies/ml).

The total infection rate at 6 weeks was 10.5% (24/228) however all but
three of these cases were determined to be from in utero transmission.

Two infants had NNRTI mutations at birth, one in the sdNVP and another
in the 4-day arm but no new NNRTI mutations emerged in any of the 13
infants who received AZT/3TC. However, 6 out of 9 (66.7%) of the
infected infants in the sdNVP only arm developed new NNRTI mutations.


sdNVP in the infant - but not the mother

Another way to keep a mother's treatment options open would be to simply skip
the maternal nevirapine dose, and just give sdNVP to the infant. This idea has
been explored in Botswana, where treatment realities are somewhat different than
in the rest of Africa.

The Botswana 'Mashi' study has been adjusted several times to reflect
changes in the standard of care. Originally, the trial gave all mothers AZT from
34 weeks to delivery, and to the babies from birth to one month. It then
randomised participants to sdNVP as per the HIVNET 012 protocol, or a placebo to
both mother and infant. Then the placebo was judged unethical due to revisions
in Botswana's national protocol. The revised protocol gave nevirapine to all
babies as soon as possible (an average of 24 minutes) after birth. Nevertheless,
half of the mothers were still placed on placebo. (see
http://www.aidsmap.com/en/news/819CD092-3764-4C00-9C68-66E9BA35AA9D.asp)


The transmission rates at birth were 2.3% for mother/baby pairs who both
received sdNVP and 3.8% where the mother received a placebo.
Transmission increased from 3.7% and 4.3% respectively a month after
birth.

A resistance sub-study found that 44% of women given sdNVP developed
resistance mutations.

The consequences of nevirapine resistance to women in Botswana may be
more immediate than in much of the rest of the developing world. In
Botswana, a woman with HIV who needs antiretroviral therapy for her own health
can access it. For various reasons, though, pregnant women do not always present
to an antenatal clinic or have an HIV test result in time before their child is
due to start combination antiretroviral therapy. Consequently, women in
countries with good treatment access like Botswana who receive single dose
nevirapine and who then start treatment shortly afterwards may be at higher risk
of a compromised treatment outcome than women in other, less well-resourced
settings.

Fortunately, there are also increasing data showing that ART can be
successfully given to pregnant women in resource limited settings (see
section on Dream study in
http://www.aidsmap.com/en/news/819CD092-3764-4C00-9C68-66E9BA35AA9D.asp)
, and from an antenatal clinic in one Pepfar-funded study in South
Africa
(http://www.aidsmap.com/en/news/0B7338AE-5DBB-43CC-9ABA-9D37F516F012.asp


Some thoughts on the WHO Revised Recommendations


The Revised WHO PMTCT recommendations clearly try to take into account
improvements in treatment access, tailoring their recommendations to
situations where there is access to the full complement of
antiretrovirals and where there is not. When the original PMTCT
guidelines were written, such access seemed a remote possibility.
Increasing availability to antiretroviral therapy has changed the
equation completely - and made continued sdNVP in mothers who can access
ART more risky.

Unfortunately, it's not clear what revising the guidelines can do for
the vast majority of women who live somewhere in the middle, those who
may be able to access nevirapine through the antenatal clinic but not
ART.

However, is it wise, especially in a breastfeeding population, to
continue recommending the same postnatal treatment regimen (eg, AZT plus
sdNVP or AZT/3TC) for the mother and the child? This would seem to be a
recipe for the transmission of resistance when it occurs in the mother.

Although there is no reliable well-controlled study demonstrating that
the treatments should be switched to decrease the chance of resistant
virus being transmitted, do we really need to wait three years for
another large trial to tell us that one week of AZT/3TC in the mother,
and sdNVP in the child makes more sense?

Finally, WHO should be lauded for their increased emphasis on CD4 cell
monitoring in people with HIV - and for recommending the consideration
of treatment for pregnant women with 200-350 CD4 cells.

According to Dr. Siobhan Crowley, of WHO's HIV/AIDS Department: "Clearly
it is not OK to wait for AIDS before starting ART - this is way too
late. Criteria for initiation of ART need to be clinical and
immunological and may well change with time and advancing knowledge and
experience. Unfortunately in many countries waiting for ART,
AIDS-defining conditions (CDC or WHO defined ) is how people are
recognised as eligible for ART."



New publications from the International HIV/AIDS Alliance


Setting up and managing sexual health clinical services in resource-poor
settings: A comprehensive programmatic guide for NGOs (Volume I)


http://www.aidsalliance.org/sw28653.asp

This manual was developed to support the provision of clinical services
to key populations (men who have sex with men, people living with
HIV/AIDS, sex workers and injecting drug users) in Andhra Pradesh as
part of the India AIDS Initiative-Avahan programme and the Frontiers
Prevention Project.


Clinical management of sexually transmitted infections in resource-poor
settings: A comprehensive guide for clinicians (Volume II)


http://www.aidsalliance.org/sw28656.asp
<http://www.aidsalliance.org/sw28656.asp>

This volume is primarily intended as a manual for clinical staff who
will oversee and manage a variety of interventions, including the
diagnosis and treatment of STIs, within the specialised NGO clinics.

It features a comprehensive approach for the effective management of
STIs, including taking a patient's sexual history, the management and
treatment of STIs, tools which may be useful in implementing clinical
services, and participatory exercises for those who wish to use this
manual to assist in training.


Other Alliance publications on HIV treatment and care


The Alliance is committed to making access to care, treatment, and
prevention a reality for all, including HIV testing and counselling,
treatment, palliative care, support and prevention. These should be
available and accessible to everyone living with and affected by
HIV/AIDS, including children and others who have to face the effects of
the epidemic - caring for or losing parents or siblings, for example. To
this end, the Alliance has developed a range of publications and
resources, including toolkits, fact sheets and reports on lessons
learnt.

The titles below are listed by date of publication.


Community education and referral: Supporting adherence to ARV treatment
and prevention for people with HIV in Zambia


http://www.aidsalliance.org/sw23263.asp
<http://www.aidsalliance.org/sw23263.asp>


Human resources for health exist in communities


http://www.aidsalliance.org/sw23323.asp
<http://www.aidsalliance.org/sw23323.asp>


ARV treatment fact sheets


http://www.aidsalliance.org/sw19588.asp

* ARV treatment fact sheet 01: HIV/AIDS and treatment
<http://www.aidsalliance.org/sw7428.asp>
* ARV treatment fact sheet 02: ARV treatment
<http://www.aidsalliance.org/sw7429.asp>
* ARV treatment fact sheet 03: testing and counselling
<http://www.aidsalliance.org/sw25601.asp>
* ARV treatment fact sheet 04: adherence
<http://www.aidsalliance.org/sw7430.asp>
* ARV treatment fact sheet 05: side effects
<http://www.aidsalliance.org/sw7431.asp>
* ARV treatment fact sheet 06: side effects detailed information
<http://www.aidsalliance.org/sw19578.asp>
* ARV treatment fact sheet 08: food for people on treatment
<http://www.aidsalliance.org/sw19583.asp>
* ARV treatment fact sheet 12: stigma
<http://www.aidsalliance.org/sw7432.asp>
* ARV treatment fact sheet 13: Living with a chronic condition
<http://www.aidsalliance.org/sw28227.asp>
* ARV treatment fact sheet 18: Symptom control and palliative care
<http://www.aidsalliance.org/sw28235.asp>


Access to rights and services of people living with HIV in Ukraine:
social research results


http://www.aidsalliance.org/sw21036.asp


What is community engagement for ARV treatment?


http://www.aidsalliance.org/sw7427.asp


Voices from Zambian communities - Experiences of HIV/AIDS-related
treatment in urban and rural settings


http://www.aidsalliance.org/sw7434.asp


Scaling up testing and counselling services - Toolkit


http://www.aidsalliance.org/sw7420.asp


A public health approach for scaling up ARV treatment - A toolkit for
programme managers


http://www.aidsalliance.org/sw7419.asp


Movilizar ONGs, OBCs y Grupos de PVVs Para Mejorar el Acceso a
Tratamientos Relacionados al VIH/SIDA


http://www.aidsalliance.org/sw8143.asp


Voluntary counselling and testing - Emerging approaches from Asia and
Eastern Europe


http://www.aidsalliance.org/sw7433.asp


Antiretroviral treatment in Zambia - A study of the experiences of
treatment users and health care workers


http://www.aidsalliance.org/sw7422.asp


Improving Access to Antiretroviral Treatment in Cambodia


http://www.aidsalliance.org/sw7405.asp


Linking HIV and TB - underlying issues to consider when scaling up
integration of HIV and TB services in Cambodia


http://www.aidsalliance.org/sw7424.asp


Guide sur l'accès aux traitements liés au VIH/SIDA - Recueil
d'informations, d'outils et de references à l'intention des ONG, des
organisations communautaires (OC) et des groupes de PVS


http://www.aidsalliance.org/sw7438.asp


The care and support cellule - an integrated and decentralised approach
to care and support for people living with HIV/AIDS in developing
countries


http://www.aidsalliance.org/sw8152.asp


Handbook on access to HIV/AIDS treatment - A collection of information,
tools and resources for NGOs, CBOs and PLWHA groups


http://www.aidsalliance.org/sw7421.asp


Integrating HIV/AIDS and TB services - A practical resource


http://www.aidsalliance.org/sw7435.asp


Improving access to HIV/AIDS-related treatment - A report sharing
experiences and lessons learned on improving access to HIV/AIDS-related
treatment


http://www.aidsalliance.org/sw7423.asp


Care, involvement and action: Mobilising and supporting community
responses to HIV/AIDS care and support in developing countries


http://www.aidsalliance.org/sw7425.asp


An evaluation of the MoH/NGO home care programme for people with
HIV/AIDS in Cambodia


http://www.aidsalliance.org/sw7426.asp




About NAM & aidsmap.com


NAM


NAM is an award-winning, community-based organisation, which works from
the UK. We deliver reliable and accurate HIV information across the
world to HIV-positive people and to the professionals who treat, support
and care for them. NAM is a UK registered charity number 1011220.

NAM's publications are evidence-based and reviewed by two international
medical panels and one of HIV-positive people, which ensure accuracy,
balance, relevance, and accessibility.

NAM supports people to

* take control of their lives and healthcare
* understand and adhere to their HIV treatment
* live longer, healthier lives


aidsmap.com <http://www.aidsmap.com>


aidsmap.com is NAM's award-winning website

On the site you can find more original, daily news on developments in
the world of HIV than any other HIV website. The site also includes
completely searchable databases of HIV treatment and care, worldwide HIV
organisation listings, and one of the most comprehensive ranges of
patient information available on the web.


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Tel: +44 (0)20 7840 0050 | Fax: +44 (0)20 7735 5351
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