Journal Article > CommentaryFull Text
PLoS Negl Trop Dis. 2013 October 31; Volume 7 (Issue 10); e2300.; DOI:10.1371/journal.pntd.0002300
Hotez PJ, Dumonteil E, Cravioto MB, Bottazzi ME, Tapia-Conyer R, et al.
PLoS Negl Trop Dis. 2013 October 31; Volume 7 (Issue 10); e2300.; DOI:10.1371/journal.pntd.0002300
Journal Article > Short ReportFull Text
J Int AIDS Soc. 2009 October 8; Volume 12 (Issue 1); DOI:10.1186/1758-2652-12-23
Cohen RM, Lynch S, Bygrave H, Eggers E, Vlahakis N, et al.
J Int AIDS Soc. 2009 October 8; Volume 12 (Issue 1); DOI:10.1186/1758-2652-12-23
ABSTRACT: INTRODUCTION: Lesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level. PROGRAMME APPROACH: We describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Médecins Sans Frontières, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008. DISCUSSION AND EVALUATION: Overall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care. CONCLUSION: Despite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor-supported testing and counselling, adherence and case management.
Journal Article > CommentaryFull Text
PLOS Med. 2007 April 1; Volume 4 (Issue 4); d162.; DOI:10.1371/journal.pmed.0040162
Goemaere E, Ford NP, Berman D, McDermid C, Cohen RM
PLOS Med. 2007 April 1; Volume 4 (Issue 4); d162.; DOI:10.1371/journal.pmed.0040162
Journal Article > ReviewFull Text
PLoS Negl Trop Dis. 2019 September 26; Volume 13 (Issue 9); e0007447..; DOI:10.1371/journal.pntd.0007447
Forsyth C, Meymandi S, Moss I, Cone J, Cohen RM, et al.
PLoS Negl Trop Dis. 2019 September 26; Volume 13 (Issue 9); e0007447..; DOI:10.1371/journal.pntd.0007447
BACKGROUND
Chagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world's most advanced healthcare systems?
METHODOLOGY/PRINCIPAL FINDINGS
This analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma.
CONCLUSIONS
We propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.
Chagas disease (CD) affects over 300,000 people in the United States, but fewer than 1% have been diagnosed and less than 0.3% have received etiological treatment. This is a significant public health concern because untreated CD can produce fatal complications. What factors prevent people with CD from accessing diagnosis and treatment in a nation with one of the world's most advanced healthcare systems?
METHODOLOGY/PRINCIPAL FINDINGS
This analysis of barriers to diagnosis and treatment of CD in the US reflects the opinions of the authors more than a comprehensive discussion of all the available evidence. To enrich our description of barriers, we have conducted an exploratory literature review and cited the experience of the main US clinic providing treatment for CD. We list 34 barriers, which we group into four overlapping dimensions: systemic, comprising gaps in the public health system; structural, originating from political and economic inequalities; clinical, including toxicity of medications and diagnostic challenges; and psychosocial, encompassing fears and stigma.
CONCLUSIONS
We propose this multidimensional framework both to explain the persistently low numbers of people with CD who are tested and treated and as a potential basis for organizing a public health response, but we encourage others to improve on our approach or develop alternative frameworks. We further argue that expanding access to diagnosis and treatment of CD in the US means asserting the rights of vulnerable populations to obtain timely, quality healthcare.
Journal Article > ReviewFull Text
Lancet Global Health. 2024 September 1; Volume 12 (Issue 9); e1552-e1559.; DOI:10.1016/S2214-109X(24)00225-0
Lee JSF, Cohen RM, Khan RA, Burry J, Casas EC, et al.
Lancet Global Health. 2024 September 1; Volume 12 (Issue 9); e1552-e1559.; DOI:10.1016/S2214-109X(24)00225-0