survey in Northern Uganda found that decentralised HIV testing and antenatal
care had a positive impact on increasing rates of HIV testing, usage of
antenatal services, and ART uptake. The data was presented by Sylvia Muyingo
for the Lablite Project, an initiative of the UK's Medical Research Council,
which is focused on cost-effective HIV treatment and care strategies.
participants who answered a survey considering HIV knowledge and uptake of
services conducted from March to April 2013, 82% reported ever having tested for
HIV (77% of men and 85% of women). In total, 62% of female study participants had given
birth in the last five years, with 96% accessing antenatal services, 98% of
whom tested for HIV at an antenatal care visit. Two-third of HIV-infected mothers and
their babies had received drugs for PMTCT in last five years. Of those who were
HIV positive, 97% of men and 95% of women were in care; 90% of men and 92% of
women were receiving cotrimoxazole; and 68% of men and 62% of women were on
ART. Of those in HIV care, 71% reported that their blood was taken in the last
12 months, 96% of whom understood that this was for CD4 testing. Those on ART
were more likely to get CD4 tests. Communitymembers who were older, less
educated, never married, or not earning income, were less likely to test for
testing and antenatal care were decentralised, ART provision was not, but
Muyingo notes that ART rates were high despite the fact that most patients had
to travel between 28 and 38 km to access ART. She says that ART rates may increase
now that treatment is also being decentralised to the community level.
of Uganda's Infectious Diseases Institute and a visiting fellow at University
of California at San Francisco presented an observational study considering
patients' vulnerability to Kaposi's sarcoma (KS) in Uganda and Kenya. By
following a cohort of 160,000 HIV-infected adults, initially without KS, in
Mbarara and Kampala, Uganda, and Eldoret, Kenya, from 2004 until 2012, the
study found 1375 new cases of Kaposi's sarcoma, with an overall incidence of
260 per 100,000 person-years (the study considered any new case of KS to be one
found after 30 days of clinical enrolment. KS was diagnosed either clinically
or through biopsy). Rates were higher among men.
that those on ART experienced rates of KS much lower than those not
initiated: 260 per 100,000 person-years, compared with 347 per 100,000 person-years.
"ART provided to patients at these three clinics in east Africa was able
to reduce the risk of KS by 80%.” Patients with the lowest CD4 count had the
greatest effect from ART.
that Kaposi's sarcoma is the most commonly reported HIV-associated cancer in many
resource-limited areas, including sub-Saharan Africa. He says that the rates of
the cancer in the cohort may actually be higher than recorded, as the study was
observational and did not confirm all KS results with a biopsy. As
comparison, Semeere notes that the rate of prostate cancer in the U.S. is
40 per 100,000 person-years.
impact on rates of KS, Sameere says that countries should consider scale-up of
ART. Despite its expense, it could have a cost-saving impact, as "Kaposi
sarcoma is expensive in terms of chemotherapy", he said.