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The HIV epidemic in Indonesia is among the fastest growing in Asia although the aggregate HIV prevalence among adults (15-49 years of age) is still low (0.16%). An estimated 193,000 people were living with HIV as of 2006. The epidemic remains concentrated, in most parts of the country, among groups at high risk: populations sharing injecting equipment and engaging in unprotected sex.
The national commitment to respond effectively to the epidemic is strong. An impressive expansion of the response to the epidemic has been seen in the last two to three years but major disparities exist: geographical, the nature and size of the epidemic, health systems capacity, and available resources.
As part of the process of development of the National Strategic Plan on HIV/AIDS for 2007-2011, the Ministry of Health and the World Health Organization (WHO), in collaboration with a range of partners, organized, from 5 to 17 February 2007, a review of the health sector response to the HIV epidemic in Indonesia. The overall objective was to review progress in the national AIDS programme, especially in areas related to the health sector response, and recommend appropriate measures towards revision of interventions and strategies.
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The two overriding goals of national AIDS programmes are to reduce the transmission of HIV and to care for and mitigate the impact of HIV on those already infected. Achieving these goals requires an understanding of the extent of prevalence of HIV infection and also where it is spreading.
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The focus of this module is the implementation of HIV prevention, care, and treatment strategies. It is composed of 6 submodules:
- Submodule 6.1: Minimizing sexual transmission of HIV and other STIs
- Submodule 6.2: HIV prevention and care among drug users
- Submodule 6.3: HIV counselling and testing
- Submodule 6.4: The continuum of care for people living with HIV/AIDS and access to antiretroviral therapy
- Submodule 6.5: Prevention of mother-to-child transmission
- Submodule 6.6: Prevention of HIV transmission through blood
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To introduce HIV-related services in health and community facilities, it is essential that a rapid and comprehensive process of appraisal and implementation planning occur for each site. This process includes several steps to ensure that the proper contacts are made, accurate data are gathered and used for program planning, and comprehensive program planning occurs. Participants from technical and program support areas should be involved in all aspects of the process. This manual outlines the rapid appraisal and implementation planning framework used to plan service delivery in FHI-supported sites and provides tools to be used along the way.
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The World Health Organization (WHO) recommends that national programmes establish capacity to provide early infant virological testing for HIV given the high risk of death by 2 years of age for infected infants and the increasing availability of paediatric antiretroviral treatment in many resource limited settings. Currently available assays and diagnostic platforms that should be considered by MOH programs for early infant HIV diagnosis include appropriately ongoing externally validated commercially and non-commercially available tests for HIV DNA (PCR) or HIV RNA.
This document is a guidance note on consideration of options for selection of technology for early diagnosis of HIV in infants in resource-limited settings.
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The purpose of this course is to improve the management of national AIDS programmes by presenting a systematic process for developing and managing a comprehensive national AIDS prevention, care and treatment programme; and providing an opportunity to increase the knowledge and practice skills needed to implement such a process.
The primary audience for this training is AIDS programme managers – individuals who have the authority and primary responsibility for managing national AIDS programmes. The secondary audience includes people who can influence decision-making about the programme. This training course will be repeated periodically to take account of the turnover of people in these key positions. The training course will initially be provided at the regional level, and may then be tailored to national needs and provided within countries, for state or provincial AIDS programme managers.
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In Modules 3 and 4, we worked on setting priorities for interventions with populations most affected by HIV. In this module, we will build on that work and set some initial targets for programmes.
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The aim of this review was to gather information relating to HIV prevention, care and treatment in prisons in the WHO South-East Asia Region. Countries selected for inclusion in the review were India, Indonesia, Nepal and Thailand.
South-East Asia is second only to sub-Saharan Africa in terms of estimated numbers of people living with HIV. South-East Asia has also been home to some stunning successes in scaling up HIV prevention, care and treatment interventions. However, the role of HIV transmission in prisons as a key factor for the spread of HIV in the community has largely been ignored. Prisoners are often seen as less deserving of health care or other assistance, particularly when resources are scarce. Yet it must be remembered that prisoners are only temporarily removed from the general community. At some stage, most prisoners will be released and resume living in the community. When prisoners are released, so too are their infections and illnesses.
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This is the report of the third joint antiretroviral treatment (ART) programme review for Thailand since the programme started in 1992. Based on the recommendations of the first review held in 1995, the Ministry of Public Health (MOPH), Thailand started a pilot programme for the prevention of mother-to child transmission (PMTCT) of HIV in north-east and northern Thailand, along with the establishment of a HIV/AIDS clinical research network. This was followed, in 2000, by large-scale implementation of the national PMTCT programme in public hospitals. The second joint programme review, conducted in July 2000, recommended expansion of quality ART services to cover all government hospitals following the example of the national PMTCT programme.
This ART programme review was conducted from 12–19 October 2004 by a team of three national and 10 international experts, identified in consultation with the national authorities.
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At the G8 meeting in Gleneagles in 2005 and again at the United Nations UNGASS session in 2006, world leaders promised to come as close as possible to providing universal access to AIDS treatment and prevention by 2010. Estimates of HIV incidence and prevalence will change, but by any account, today several million people in desperate need of AIDS treatment do not have access to it. And at the current pace of growth in treatment delivery, several million will not have access by the end of 2010. Broken promises will mean millions of deaths.
Scale up of AIDS treatment is driving unprecedented expansion of health delivery and, in the process, identifying critical challenges to health systems as well as practical solutions to address them. This report identifies many ways in which governments and global agencies must act to correct systems essential to delivery of health. In the area of antiretroviral drug access—a special focus of this report—our research found that in many countries drug registration, procurement, and supply management systems are inadequate, drug stock-outs are common, and most people are not being treated with ARV regimens that are consistent with recent WHO recommendations for improved first-line and standardized second-line treatment combinations.