South Africa: Solving treatment bottlenecks. PlusNews. January 4, 2008.

This article features the collaborative work between the Health Workers of South Africa's Mhontlo District and Cathy Green, IHI's Project Manager in South Africa. Learn about the innovative strategies that health workers in the scarcely-resourced, rural district have developed to overcome bottlenecks and provide antiretroviral treatment for HIV-positive residents.

ExpandNet and World Health Organization. Practical Guidance for Scaling Up Health Service Innovations. Geneva, Switzerland: World Health Organization; April 2007.

Based on an analysis of scaling-up literature and the experience of scale-up efforts in several countries, the guide includes a framework for scaling up; attributes of innovations, organizations, environments, and teams that support successful scale up; and strategies for various scale-up and dissemination approaches.

Barker PM, Venter F. Setting district-based annual targets for HAART and PMTCT: A first step in planning effective intervention for the HIV/AIDS epidemic. S Afr Med J. 2007;97(10):916-917.

Calculating the need for HAART in South Africa can be acomplished using the formula outlined in this paper.

Chopra M, Rollins N. Infant feeding in the time of HIV: Assessment of infant feeding policy and programmes in four African countries scaling up prevention of mother to child transmission programmes. Archives of Disease in Childhood. 2007 Aug 8; [Epub ahead of print].

This article assesses the infant feeding components of prevention of mother-to-child HIV transmission (PMTCT) programs in Botswana, Kenya, Malawi, and Uganda. The study found that infant feeding counseling was infrequently discussed in any depth, and often rated poor when it was. National HIV managers are unsure about the infant feeding policy in the context of HIV, and there is an almost universal belief that an HIV positive mother will always infect the child via breastfeeding. The authors conclude that there is a need to scale up PTMTC programs and infant feeding policies.

Friedland G, Harries A, Coetzee D. Implementation issues in tuberculosis/HIV program collaboration and integration: 3 case studies. Journal of Infectious Diseases. 2007 Aug 15;196 Suppl 1:S114-123.

This article describes three strategies for collaboration between national tuberculosis and HIV programs to integrate services at a local level. The three case studies, one at a national level in Malawi and two at local sites in South Africa, feature varying degrees of collaboration and integration, illustrate common themes, and show that the strategies can be successful. Also discussed are the programmatic, medical, staffing, resource, and scale-up challenges.

Tonwe-Gold B, Ekouevi DK, Viho I, et al. Antiretroviral treatment and prevention of peripartum and postnatal HIV transmission in West Africa: evaluation of a two-tiered approach. PLoS Medicine. 2007 Aug 21;4(8):e257.

There are few documented experiences of HIV-infected pregnant women receiving highly active antiretroviral treatment (HAART) in resource-limited settings. The authors evaluated the short-term and long-term effectiveness of a two-tiered strategy of prevention of mother-to-child transmission of HIV (PMTCT) in Africa. Women meeting eligibility criteria received HAART, while women with less advanced HIV disease received short-course antiretroviral PMTCT regimens.

Bishai D, Colchero A, Durack DT. The cost effectiveness of antiretroviral treatment strategies in resource-limited settings. AIDS. 2007 Jun;21(10):1333-1340.

This study simulated five strategies for antiretroviral treatment (ART) to assess the optimal resource allocation for ART in developing countries. The authors concluded that in the absence of second-line ART, the CD4 strategy is a more cost-effective laboratory testing strategy for managing HIV infection than either total lymphocyte count (TLC) or viral (VL). Availability of second-line ART plus CD4 cell count and/or VL measurement would save additional lives, but at high incremental cost.

Walley J, Khan MA, Shah SK, Witter S, Wei X. How to get research into practice: First get practice into research. Bulletin of the World Health Organization. 2007 June;85(6):424-425.

The problem of failing to get research into policy and practice is well known, particularly in resource-poor settings. The authors argue that the aim should not be to perfect techniques of feeding results to decision-makers, but to start from the perspective of the decision-makers even before devising the questions. This means “getting practice into research.”

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Bell DJ, Kapitao Y, Med D, Sikwese R, van Oosterhout JJ, Lalloo DG. Adherence to antiretroviral therapy in patients receiving free treatment from a government hospital in Blantyre, Malawi. Journal of Acquired Immune Deficiency Syndromes. 2007 Jun 7. [Epub ahead of print]

Three measures of adherence to antiretroviral therapy (ART) in HIV-positive adults receiving free treatment from a public hospital in Malawi were compared. The study shows the complexities of such measurement and probable overestimation of adherence by PC and self-report — the main methods used in developing countries, which raises concerns about development of drug resistance.

Pai NP, Tulsky JP, Cohan D, Colford JM Jr, Reingold AL. Rapid point-of-care HIV testing in pregnant women: A systematic review and meta-analysis. Tropical Medicine and International Health. 2007 Feb;12(2):162-173.

The authors aim to summarize the overall diagnostic accuracy of rapid HIV tests in pregnancy and outcomes such as acceptability, patient preference, feasibility, and impact of rapid testing.