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Search Results: 1 - 10 of 34 matches for " Frieda Behets "
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Desperately seeking targets: the ethics of routine HIV testing in low-income countries
Rennie,Stuart; Behets,Frieda;
Bulletin of the World Health Organization , 2006, DOI: 10.1590/S0042-96862006000100014
Abstract: the human immunodeficiency virus/acquired immune deficiency syndrome (hiv/aids) pandemic, and responses to it, have exposed clear political, social and economic inequities between and within nations. the most striking manifestations of this inequity is access to aids treatment. in affluent nations, antiretroviral treatment is becoming the standard of care for those with aids, while the same treatment is currently only available for a privileged few in most resource-poor countries. patients without sufficient financial and social capital - i.e., most people with aids - die each day by the thousands. recent aids treatment initiatives such as the unaids and who "3 by 5" programme aim to rectify this symptom of global injustice. however, the success of these initiatives depends on the identification of people in need of treatment through a rapid and massive scale-up of hiv testing. in this paper, we briefly explore key ethical challenges raised by the acceleration of hiv testing in resource-poor countries, focusing on the 2004 policy of routine ("opt-out") hiv testing recommended by unaids and who. we suggest that in settings marked by poverty, weak health-care and civil society infrastructures, gender inequalities, and persistent stigmatization of people with hiv/aids, opt-out hiv-testing policies may become disconnected from the human rights ideals that first motivated calls for universal access to aids treatment. we leave open the ethical question of whether opt-out policies should be implemented, but we recommend that whenever routine hiv-testing policies are introduced in resource-poor countries, that their effect on individuals and communities should be the subject of empirical research, human-rights monitoring and ethical scrutiny.
Desperately seeking targets: the ethics of routine HIV testing in low-income countries
Rennie Stuart,Behets Frieda
Bulletin of the World Health Organization , 2006,
Abstract: The human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) pandemic, and responses to it, have exposed clear political, social and economic inequities between and within nations. The most striking manifestations of this inequity is access to AIDS treatment. In affluent nations, antiretroviral treatment is becoming the standard of care for those with AIDS, while the same treatment is currently only available for a privileged few in most resource-poor countries. Patients without sufficient financial and social capital - i.e., most people with AIDS - die each day by the thousands. Recent AIDS treatment initiatives such as the UNAIDS and WHO "3 by 5" programme aim to rectify this symptom of global injustice. However, the success of these initiatives depends on the identification of people in need of treatment through a rapid and massive scale-up of HIV testing. In this paper, we briefly explore key ethical challenges raised by the acceleration of HIV testing in resource-poor countries, focusing on the 2004 policy of routine ("opt-out") HIV testing recommended by UNAIDS and WHO. We suggest that in settings marked by poverty, weak health-care and civil society infrastructures, gender inequalities, and persistent stigmatization of people with HIV/AIDS, opt-out HIV-testing policies may become disconnected from the human rights ideals that first motivated calls for universal access to AIDS treatment. We leave open the ethical question of whether opt-out policies should be implemented, but we recommend that whenever routine HIV-testing policies are introduced in resource-poor countries, that their effect on individuals and communities should be the subject of empirical research, human-rights monitoring and ethical scrutiny.
Conducting Unlinked Anonymous HIV Surveillance in Developing Countries: Ethical, Epidemiological, and Public Health Concerns
Stuart Rennie ,Abigail Norris Turner,Bavon Mupenda,Frieda Behets
PLOS Medicine , 2009, DOI: 10.1371/journal.pmed.1000004
Abstract:
Bed net ownership, use and perceptions among women seeking antenatal care in Kinshasa, Democratic Republic of the Congo (DRC): Opportunities for improved maternal and child health
Audrey Pettifor, Eboni Taylor, David Nku, Sandra Duvall, Martine Tabala, Steve Meshnick, Frieda Behets
BMC Public Health , 2008, DOI: 10.1186/1471-2458-8-331
Abstract: Women attending their first ANC visit at one maternity in Kinshasa were recruited to take part in a study where they were given free insecticide treated bed nets (ITNs) and then followed up at delivery and 6 months post delivery to assess ITN use. This study describes the baseline levels of bed net ownership and use, attitudes towards net use and factors associated with net useAmong 351 women interviewed at baseline, 115 (33%) already owned a bed net and 86 (25%) reported to have slept under the net the previous night. Cost was reported as the reason for not owning a net by 48% of the 236 women who did not own one. In multivariable analyses, women who had secondary school or higher education were 3.4 times more likely to own a net (95% CI 1.6–7.3) and 2.8 times more likely to have used a net (95% CI 1.3–6.0) compared to women with less educationDistribution of ITNs in antenatal clinics in this setting is needed and feasible. The potential for ITN use by this target population is high.There are between 300 and 500 million malaria infections and 1 million malaria attributed deaths worldwide each year [1]. The global malaria burden is not evenly distributed with Sub-Saharan Africa accounting for 90% of global malaria cases [2], and a majority of these cases occurring among women and children[3]. Malaria adversely impacts maternal health causing malaria-related anemia, and accounts for 20% of all childhood deaths in Africa [1,2]. Because of this, pregnant women and children under 5 have been targeted as key groups for malaria prevention. One major aim of the Roll Back Malaria (RBM) campaign is to have 80% of pregnant women and children under 5 covered by insecticide treated bed nets (ITN) by 2010[4].Insecticide treated bed nets (ITNs) reduce human contact with mosquitoes and are an effective malaria prevention intervention[5]. ITNs have been shown to reduce severe disease and mortality due to malaria in endemic regions and reduce all cause mortality by approximately 20%
Training health care workers to promote HIV services for patients with tuberculosis in the Democratic Republic of Congo
Koen Driessche, Mulangu Sabue, Wendy Dufour, Frieda Behets, Annelies Van Rie
Human Resources for Health , 2009, DOI: 10.1186/1478-4491-7-23
Abstract: The development of training materials to promote HIV services for TB patients involved the definition of target health care workers (HCWs); identification of required tasks, skills and knowledge; review of international guidelines; and adaptation of existing training materials for voluntary counseling and testing, prevention of mother-to-child transmission of HIV, and management of opportunistic infections (OIs). Training effectiveness was assessed by means of questionnaires administered pre- and post-training, by correlating post-training results of HCWs with the centre's HIV testing acceptance rates, and through participatory observations at the time of on-site supervisory visits and monthly meetings.Pre-training assessment identified gaps in basic knowledge of HIV epidemiology, the link between TB and HIV, interpretation of CD4 counts, prevention and management of OIs, and occupational post-exposure prophylaxis (PEP). Opinions on patients' rights and confidentiality varied. Mean test results increased from 72% pre-training to 87% post-training (p < 0.001). Important issues regarding HIV epidemiology and PEP remained poorly understood post-training. Mean post-training scores of clinic's HCWs were significantly correlated with the centre's HIV testing acceptance rates (p = 0.01). On-site supervisory visits and monthly meetings promoted staff motivation, participatory problem solving and continuing education. Training was also used as an opportunity to improve patient-centred care and HCWs' communication skills.Many HCWs did not possess the knowledge or skills necessary to integrate HIV activities into routine care for patients with TB. A participatory approach resulted in training materials that fulfilled local needs.The World Health Organization (WHO) estimated that in 2005 alone there were approximately 8.8 million new tuberculosis (TB) cases and 1.6 million TB deaths, of which 195 000 occurred among people co-infected with the human immunodeficiency virus (HIV)
Syndromic treatment of gonococcal and chlamydial infections in women seeking primary care for the genital discharge syndrome: decision-making
Behets,Frieda M-T.F.; Miller,William C.; Cohen,Myron S.;
Bulletin of the World Health Organization , 2001, DOI: 10.1590/S0042-96862001001100012
Abstract: the syndromic treatment of gonococcal and chlamydial infections in women seeking primary care in clinics where resources are scarce, as recommended by who and implemented in many developing countries, necessitates a balance to be struck between overtreatment and undertreatment. the present paper identifies factors that are relevant to the selection of specific strategies for syndromic treatment in the above circumstances. among them are the general aspects of decision-making and caveats concerning the rational decision-making approach. the positive and negative implications are outlined of providing or withholding treatment following a specific algorithm with a given accuracy to detect infection, i.e. sensitivity, specificity and predictive values. other decision-making considerations that are identified are related to implementation and include the stability of risk factors with regard to time, space and the implementer, acceptability by stakeholders, and environmental constraints. there is a need to consider empirically developed treatment algorithms as a basis for policy discourse, to be evaluated together with the evidence, alternatives and arguments by the stakeholders.
Syndromic treatment of gonococcal and chlamydial infections in women seeking primary care for the genital discharge syndrome: decision-making
Behets Frieda M-T.F.,Miller William C.,Cohen Myron S.
Bulletin of the World Health Organization , 2001,
Abstract: The syndromic treatment of gonococcal and chlamydial infections in women seeking primary care in clinics where resources are scarce, as recommended by WHO and implemented in many developing countries, necessitates a balance to be struck between overtreatment and undertreatment. The present paper identifies factors that are relevant to the selection of specific strategies for syndromic treatment in the above circumstances. Among them are the general aspects of decision-making and caveats concerning the rational decision-making approach. The positive and negative implications are outlined of providing or withholding treatment following a specific algorithm with a given accuracy to detect infection, i.e. sensitivity, specificity and predictive values. Other decision-making considerations that are identified are related to implementation and include the stability of risk factors with regard to time, space and the implementer, acceptability by stakeholders, and environmental constraints. There is a need to consider empirically developed treatment algorithms as a basis for policy discourse, to be evaluated together with the evidence, alternatives and arguments by the stakeholders.
The Effect of Highly Active Antiretroviral Therapy on the Survival of HIV-Infected Children in a Resource-Deprived Setting: A Cohort Study
Andrew Edmonds ,Marcel Yotebieng,Jean Lusiama,Yori Matumona,Faustin Kitetele,Sonia Napravnik,Stephen R. Cole,Annelies Van Rie,Frieda Behets
PLOS Medicine , 2011, DOI: 10.1371/journal.pmed.1001044
Abstract: Background The effect of highly active antiretroviral therapy (HAART) on the survival of HIV-infected children has not been well quantified. Because most pediatric HIV occurs in low- and middle-income countries, our objective was to provide a first estimate of this effect among children living in a resource-deprived setting. Methods and Findings Observational data from HAART-na?ve children enrolled into an HIV care and treatment program in Kinshasa, Democratic Republic of the Congo, between December 2004 and May 2010 were analyzed. We used marginal structural models to estimate the effect of HAART on survival while accounting for time-dependent confounders affected by exposure. At the start of follow-up, the median age of the 790 children was 5.9 y, 528 (66.8%) had advanced or severe immunodeficiency, and 405 (51.3%) were in HIV clinical stage 3 or 4. The children were observed for a median of 31.2 mo and contributed a total of 2,089.8 person-years. Eighty children (10.1%) died, 619 (78.4%) initiated HAART, six (0.8%) transferred to a different care provider, and 76 (9.6%) were lost to follow-up. The mortality rate was 3.2 deaths per 100 person-years (95% confidence interval [CI] 2.4–4.2) during receipt of HAART and 6.0 deaths per 100 person-years (95% CI 4.1–8.6) during receipt of primary HIV care only. The mortality hazard ratio comparing HAART with no HAART from a marginal structural model was 0.25 (95% CI 0.06–0.95). Conclusions HAART reduced the hazard of mortality in HIV-infected children in Kinshasa by 75%, an estimate that is similar in magnitude but with lower precision than the reported effect of HAART on survival among children in the United States. Please see later in the article for the Editors' Summary
Computed CD4 percentage as a low-cost method for determining pediatric antiretroviral treatment eligibility
Steven FJ Callens, Faustin Kitetele, Jean Lusiama, Nicole Shabani, Samuel Edidi, Robert Colebunders, Frieda Behets, Annelies Van Rie
BMC Infectious Diseases , 2008, DOI: 10.1186/1471-2334-8-31
Abstract: We compared clinical and immunological criteria in 366 children aged 0 to 12 years in Kinshasa and evaluated a simple computation to estimate CD4 percent, based on CD4 count, total white blood cell count and percentage lymphocytes. Kappa (κ) statistic was used to evaluate eligibility criteria and linear regression to determine trends of CD4 percent, count and total lymphocyte count (TLC).Agreement between clinical and immunological eligibility criteria was poor (κ = 0.26). One third of children clinically eligible for ART were ineligible using immunological criteria; one third of children immunologically eligible were ineligible using clinical criteria. Among children presenting in WHO stage I or II, 54 (32%) were eligible according to immunological criteria. Agreement with CD4 percent was poor for TLC (κ = 0.04), fair for total CD4 count (κ = 0.39) and substantial for CD4 percent computational estimate (κ = 0.71). Among 5 to 12 years old children, total CD4 count was higher in younger age groups (-32 cells/mm3 per year older), CD4 percent was similar across age groups.Age-specific thresholds for CD4 percent optimally determine pediatric ART eligibility. The use of CD4 percent computational estimate may increase ART access in settings with limited access to CD4 percent assays.To facilitate the rapid scale-up of pediatric antiretroviral treatment (ART), the World Health Organization (WHO) published revised pediatric ART guidelines for resource poor settings in 2006 [1]. The ART eligibility criteria for infants and children rely on clinical and/or immunological thresholds and aim to identify those children with poor prognosis if ART initiation is delayed.The WHO clinical staging system has been widely used in resource-limited countries, particularly in the African Region, and has proved pragmatic and useful in facilities at the primary care and referral level [1]. An evaluation of the guidelines in Zambia showed 20-fold higher mortality rates in children with WHO clin
Pulmonary cystic disease in HIV positive individuals in the Democratic Republic of Congo: three case reports
Steven FJ Callens, Faustin Kitetele, Patricia Lelo, Nicole Shabani, Jean Lusiama, Okitolanda Wemakoy, Robert Colebunders, Frieda Behets, Annelies Van Rie
Journal of Medical Case Reports , 2007, DOI: 10.1186/1752-1947-1-101
Abstract: In this report, we describe three HIV-infected individuals (one woman and two children) presenting with extensive pulmonary cystic disease.A number of reports from the US and Europe have described cystic lesions in the lungs of children and adults infected with the human immunodeficiency virus (HIV) with or without overt acquired immunodeficiency syndrome (AIDS) [1,2]. Pulmonary emphysema, an anatomic alteration of the lung, is characterized by abnormal enlargement of the air spaces distal to the terminal bronchiole, with destruction of their walls and without obvious fibrosis. In industrialized countries, a 15 to 42% prevalence of HIV related pulmonary emphysema has been observed in small case series, much higher than the estimated 1.8% prevalence in the general population [1]. Bronchiectasis is defined as irreversible dilatation of the bronchi, usually associated with inflammation. In a cohort of 164 HIV infected children from New York, the prevalence of bronchiectasis was estimated at 15% [2].Little is known about the pulmonary emphysema and bronchiectasis in people living with HIV from resource poor settings. We report on three HIV seropositive patients (one adult and two children) with pulmonary emphysema seen at the pediatric Hospital Kalembe Lembe in Kinshasa, Democratic Republic of Congo and review the literature on HIV-associated pulmonary emphysema.A 39-year old HIV seropositive woman, with a medical history of recurrent oral ulcerations, thoracic Herpes zoster, weight loss, caries, repeated pneumonia and three episodes of smear positive tuberculosis (1990, 2001 and 2003), presented in our clinic in May 2005 with chronic productive cough and intermittent hemoptysis. Her family history did not reveal any hereditary lung diseases. She had never smoked or used intravenous drugs. She received cotrimoxazole prophylaxis but had never had access to ART.Clinical exam revealed a normal respiratory and cardiac rate, weight 47.3 kg and height 159 cm (body mass index;
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