Responding to HIV in Afghanistan.

National AIDS Control Programme, Ministry of Public Health, Kabul, Afghanistan.
The Lancet (Impact Factor: 39.21). 01/2008; 370(9605):2167-9. DOI: 10.1016/S0140-6736(07)61911-4
Source: PubMed
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective. Occupational exposures to blood and other bodily fluids occur in approximately 5 per 100 persons every year in US hospitals. Since the provision of health care in the deployed environment poses unique challenges to hospital personnel, it is important to characterize the rates of occupational exposures and understand the prevalence of blood-borne pathogens (BBPs) in host nations. Methods. A retrospective review of public health and laboratory records at a US military trauma center in Afghanistan from October 1, 2010, to March 31, 2012. Results. A total of 65 occupational exposures were reported, including 47 (72%) percutaneous and 18 (28%) mucocutaneous, with a yearly rate of 8.6 exposures per 100 persons. During 6-month deployment cycles, the majority of exposures (46.2%) occurred in the first 2 months after arrival in Afghanistan. Physicians reported the most exposures (26%), and the operating room (48%) was the most common hospital location. The prevalence of hepatitis B and hepatitis C among local national source patients ([Formula: see text]) was 8.9% and 2.3%, respectively, with no cases of HIV or syphilis detected. In contrast, there were no BBPs detected in coalition source ([Formula: see text]) or exposed ([Formula: see text]) patients. Conclusions. The characteristics of occupational exposures in this deployed environment were comparable to those of US-based hospitals. Standard practices used to reduce occupational exposures, such as use of personal protective equipment and safety devices, should continue to be prioritized in the deployed setting. Although BBP rates are not well defined in Afghanistan, our results were consistent with those of prior epidemiologic studies.
    Infection Control and Hospital Epidemiology 01/2013; 34(1):74-79. DOI:10.1086/668784 · 3.94 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: It is increasingly important to prioritize the most cost-effective HIV interventions. We sought to summarize the evidence on which types of interventions provide the best value for money in regions with concentrated HIV epidemics.Methods: We conducted a systematic review of peer-reviewed and grey literature reporting measurements of cost-effectiveness or cost-benefit for HIV/AIDS interventions in Asia and Eastern Europe. We also collated HIV/AIDS spending assessment data from case-study countries in the region.Results: We identified 91 studies for inclusion, 47 of which were from peer-reviewed journals. Generally, in concentrated settings, prevention of mother-to-child transmission programmes and prevention programmes targeting people who inject drugs and sex workers had lower incremental cost-effectiveness ratios than programmes aimed at the general population. The few studies evaluating programmes targeting men who have sex with men indicate moderate cost-effectiveness. Collation of prevention programme spending data from 12 countries in the region (none of which had generalized epidemics) indicated that resources for the general population/non-targeted was greater than 30% for eight countries and greater than 50% for five countries.Conclusions: There is a misalignment between national spending on HIV/AIDS responses and the most affected populations across the region. In concentrated epidemics, scarce funding should be directed more towards most-at-risk populations. Reaching consensus on general principles of cost-effectiveness of programmes by epidemic settings is difficult due to inconsistent evaluation approaches. Adopting a standard costing, impact evaluation, benefits calculation, analysis and reporting framework would enable cross comparisons and improve HIV resource prioritization and allocation.
    Journal of the International AIDS Society 02/2014; 17(1):18822. DOI:10.7448/IAS.17.1.18822 · 4.21 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Worldwide, the male to female ratio of new smear-positive tuberculosis (TB) cases is approximately two to one. However, in Pakistan, this is not the case. Rates of notified TB cases are 20-30% higher in young females compared with males, and female rates remain high regardless of increasing age. This is in stark contrast to neighboring India, which is characterized by an excess of male TB cases. It is currently unknown why rates of notified TB are so high in females in Pakistan, but it is clear that this epidemiology is a public health issue of importance that impacts transmission dynamics and disease control initiatives.
    The American journal of tropical medicine and hygiene 09/2011; 85(3):514-7. DOI:10.4269/ajtmh.2011.10-0701 · 2.74 Impact Factor

Full-text (2 Sources)

Available from
Jun 2, 2014