New WHO guideline on HIV may increase Nigerian government spending- Officials
The WHO recently released new guideline for HIV treatment.
Stakeholders in the health sector are already concerned about the cost implication of the new World Health Organisation, WHO, guidelines for HIV treatment, with a Senator calling it ‘a burden on our national budget’.
This is as a result of the United Nation’s, UN, latest prediction that there would be greater drift of assistance from Africa to middle-income countries.
The UN in her Millennium Development Goals Report 2013, launched on Monday by the Secretary-General, Ban Ki-moon in Geneva had stated that “The current shift in aid away from the poorest countries and Africa, and towards middle-income countries, will continue, with a greater share of aid being offered in the form of soft loans rather than grants”.
It disclosed that bilateral net official development assistance to sub-Saharan Africa amounted to $26.2 billion in 2012, an 8 per cent drop from 2011.
These, the stakeholders explained, are part of their reasons for fretting over the WHO’s guidelines as people living with HIV (PLWH) in Nigeria do not pay for drugs; while the country is not getting aids like she used to, hence, would have to create allocations in the healthcare budget for the new recommendation to thrive.
The WHO released its new HIV treatment guidelines on Sunday in her report tagged “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection”.
The recommendation stipulates that all countries should initiate treatment in adults living with HIV when their CD4 cell count is about 500 cells/mm or less. This means when their immune system is still strong.
Previously, the global health body had in 2010 set 350cells/mm or less as the CD4 count at which treatment should commence.
CD4 is a medical terminology for the type of immune cell attacked by the HIV virus.
“Treating people with HIV earlier, with safe affordable, and easier-to-manage medicines can both keep them healthy and lower the amount of virus in the blood, which reduces the risk of passing it to someone else.
“If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources, they will see significant health benefits at the public health and individual level,” the report states.
The recommendation also encourages providing antiretroviral therapy (ART) regardless of CD4 count to all children under five years of age living with the virus, all pregnant and breastfeeding women with HIV and to all persons who are HIV-positive but in a relationship in which their partners are not infected.
Reactions
A senator has now expressed fear over the implications of the new guideline saying “this new guideline if adopted would place an extra burden on the nation’s healthcare budget.”
He said the allocations for health hasn’t been sufficient while donors are not forthcoming like before. This, he said will add more pressure to the budget.
However, the Executive Director, Plan Foundation, Ibadan, Oyo State, Obatunde Oladapo, disagrees with the lawmaker.
“I would say that response is myopic and is based on very little knowledge about the issue of treatment as a strategy for HIV prevention,” Mr. Oladapo told REMIUM TIMES.
“The person is simply considering the various categories and numbers of people to provide ARVs and ARTs for but leaving out the fact that this new regimen will subsequently ensure an HIV/AIDs free Nigeria”.
Also, John Idoko, the Director General, National Agency for the Control of AIDS, NACA, told PREMIUM TIMES in an interview that the guideline is a welcome development long overdue.
Addressing the possible extra pressure on the health budget, he said “it’s a question of balancing between extra budget and the number of lives we would lose. We would have to choose between the two. Are we interested in having more people free of HIV or are we interested in Nigeria full of HIV?
“If we don’t bring and invest the money in preventing and managing the condition, the burden (HIV) will increase and we would lose more people- both the young and old and we won’t be saving lives”.
Also speaking, the Minister of State for Health, Muhammad Ali-Pate, agreed that the new guideline will mount some pressure on the nation’s budget as well as those of developing partners.
“There is always that challenge of resource constraint but we have to look at it from the angle of the patient. But sincerely speaking, of course, it would put pressure on the budget of government and developing partners but I hope that we would put in all resources that can be gotten so that where efficiency is needed, they can actually be gained,” he said.
“There’s always the constraint of resources but we’re working out other ways to cushion the effect this would bring on the budget. For instance, NACA has just developed a new plan for HIV/AIDs and I hope states and local governments will also chip in their own resources and not leave everything to be done by the Federal Government because not much is actually allocated for HIV/AIDS.
“I know some states are more endowed than others so I hope those that are more endowed will put in more,” the minister added.
A consultant to the Senate Committee on Health, Wale Okediran, also said that the new regulation “would be an extra burden on our budget especially in view of the latest UN (United Nation) report”.
Mr. Okediran, however, said the guideline will help the nation as a whole to look inward.
“Personally, I think this is one of the things we need to get us on our feet. For too long, we have been depending on foreign donors for everything and I don’t think it is right. In short, somebody said may be this is why corruption is rampant because we have excess money to play with whereas, if donors don’t come close, we would be forced to use that money.
“At the same time, I think it would help us look inward for funding. Our country is too serious to be left alone with politicians and that is why we need to encourage our philanthropists to come into the health sector. I believe that all over Africa, we need to encourage our rich people and corporate organisations to put in some support in health and not only sport and beauty pageant. If they want to organise Miss Nigeria now, you would be surprised how much dollars would be donated, when the health sector which is very important is there. I think we need to allow the donors to move away” he added.
Uncertain about kick-start of guideline in Nigeria
Mr. Idoko also said he was uncertain about when the recommendation would be adopted and started in Nigeria.
“I don’t know when we would commence the implementation in Nigeria but we have to work with WHO and all other partners to see how we can go about it because it would help even the country to not only solve HIV but other health conditions such as Tuberculosis, malaria and even maternal-child care related issues,” he said.
The Health Minister also added that “the guideline is just out so we would have to make deliberations, but I know that the ministry would work closely with NACA on this and make preparations to ensure that we commence it as quickly as possible.
“To expedite this action, we would ensure that in the 2014 budget, more resources would be allocated to the prevention, treatment and management of HIV as well as the procure of ARVs.”
16 Signs You May Have HIV
FEVER : Within a month or two of HIV entering the body, 40% to 90% of people experience flulike symptoms known as acute retroviral syndrome (ARS).
But sometimes HIV symptoms don't appear for years—sometimes even a decade—after infection.
"In the early stages of HIV infection, the most common symptoms are none," says Michael Horberg, MD, director of HIV/AIDS for Kaiser Permanente, in Oakland, Calif. One in five people in the United States with HIV doesn't know they have it, which is why it's so important to get tested, especially if you have unprotected sex with more than one partner or use intravenous drugs.
Here are some signs that you may be HIV-positive.One of the first signs of ARS can be a mild fever, up to about 102 degrees F.
The fever, if it occurs at all, is often accompanied by other usually mild symptoms, such as fatigue, swollen lymph glands, and a sore throat.
"At this point the virus is moving into the blood stream and starting to replicate in large numbers," says Carlos Malvestutto, MD, instructor of infectious diseases and immunology in the department of medicine at NYU School of Medicine in New York City. "As that happens, there is an inflammatory reaction by the immune system."
FATIGUE:The inflammatory response generated by your besieged immune system also can cause you to feel tired and lethargic. Fatigue can be both an early and later sign of HIV.
Ron, 54, a public relations executive in the Midwest, started to worry about his health when he suddenly got winded just walking. "Everything I did, I got out of breath," he says. "Before that I had been walking three miles a day."
Ron had tested HIV positive 25 years before feeling so tired; fatigue during acute, or newly contracted, HIV might not be so obvious.
Achy muscles, joint pain, swollen lymph nodes: ARS is often mistaken for the flu, mononucleosis, or another viral infection, even syphilis or hepatitis.
That's not surprising: Many of the symptoms are the same, including pain in the joints and muscles and swollen lymph glands.
Lymph nodes are part of your body's immune system and tend to get inflamed when there's an infection. Many of them are located in your armpit, groin, and neck.
Sore throat and headache:As with other symptoms, sore throat and headache can often be recognized as ARS only in context, Dr. Horberg says.
If you've engaged recently in high-risk behavior, an HIV test is a good idea. Get tested for your own sake and for others: HIV is most infectious in the earliest stage.
Keep in mind that the body hasn't produced antibodies to HIV yet so an antibody test may not pick it up. (It can take a few weeks to a few monthsfor HIV antibodies to show in a blood test). Investigate other test options such as one that detects viral RNA, typically within nine days of infection.
For Ron, this was another sign that he might not have run-of-the-mill allergies or a cold.
"They were like boils, with some itchy pink areas on my arms," Ron says. The rashes can also appear on the trunk of the body. "If [the rashes] aren't easily explained or easily treated, you should think about having an HIV test," Dr. Horberg says.
These symptoms can also appear as a result of antiretroviral therapy and later in the infection, usually as the result of an opportunistic infection.
"Diarrhea that is unremitting and not responding at all to usual therapy might be an indication," Dr. Horberg says. Or symptoms may be caused by an organism not usually seen in people with healthy immune systems, he adds.
"If you're already losing weight, that means the immune system is usually fairly depleted," Dr. Malvestutto says. "This is the patient who has lost a lot of weight even if they continue to eat as much as possible. This is late presentation. We still see a lot of these." It has become less common, however, thanks to antiretroviral therapy.
A person is considered to have wasting syndrome if they lose 10% or more of their body weight and have had diarrhea or weakness and fever for more than 30 days, according to the U.S. Department of Health and Human Services.
But it went on for a year and a half—and kept getting worse. Benadryl, antibiotics, and inhalers didn't fix the problem. Neither did allergists.
This symptom—an "insidious cough that could be going on for weeks that doesn't seem to resolve," Dr. Malvestutto says—is typical in very ill HIV patients.
"There are many different opportunistic infections and each one can present differently," Dr. Malvestutto says. In Ron's case, it was Pneumocystis pneumonia (PCP), aka "AIDS pneumonia," which eventually landed him in the hospital.
Other opportunistic infections include toxoplasmosis, a parasitic infection that affects the brain; a type of herpes virus called cytomegalovirus; and yeast infections such as thrush.
These can be even more common later in infection and aren't related to exercise or the temperature of the room.
Similar to the hot flashes that menopausal women suffer, they're also hard to dismiss, given that they soak your bedclothes and sheets.
Often this is due to a fungal infection, such as candida. "Patients with depleted immune systems will be more susceptible to fungal infections," Dr. Malvestutto says.
"It's a very common fungus and the one that causes yeast infections in women," Dr. Malvestutto says. "They tend to appear in the mouth or esophagus, making it difficult to swallow."
Ron woke up one day to find white patches on his tongue. He had thrush. For him, "It was not bothersome other than I didn't like having it." The infection was hard to get rid of, but finally cleared up after Ron started taking drugs to combat HIV.
In addition to confusion and difficulty concentrating, AIDS-related dementia might also involve memory problems and behavioral issues such as anger or irritability.
It may even include motor changes: becoming clumsy, lack of coordination, and problems with tasks requiring fine motor skills such as writing by hand.
And having herpes can also be a risk factor for contracting HIV. This is because genital herpes can cause ulcers that make it easier for HIV to enter the body during sex. And people who have HIV tend to have more severe herpes outbreaks more often because HIV weakens the immune system.
"This is when the nerves are actually damaged," Dr. Malvestutto says. These symptoms can be treated with over-the-counter pain relievers and antiseizure medicines such as Neurontin (gabapentin).
These changes, however, probably have more to do with the weight loss and poor health of women with late-stage infection rather than the infection itself.
Infection with HIV also has been associated with earlier age of menopause (47 to 48 years for infected women compared to 49 to 51 years for uninfected women).
.
The WHO recently released new guideline for HIV treatment.
Stakeholders in the health sector are already concerned about the cost implication of the new World Health Organisation, WHO, guidelines for HIV treatment, with a Senator calling it ‘a burden on our national budget’.
This is as a result of the United Nation’s, UN, latest prediction that there would be greater drift of assistance from Africa to middle-income countries.
The UN in her Millennium Development Goals Report 2013, launched on Monday by the Secretary-General, Ban Ki-moon in Geneva had stated that “The current shift in aid away from the poorest countries and Africa, and towards middle-income countries, will continue, with a greater share of aid being offered in the form of soft loans rather than grants”.
It disclosed that bilateral net official development assistance to sub-Saharan Africa amounted to $26.2 billion in 2012, an 8 per cent drop from 2011.
These, the stakeholders explained, are part of their reasons for fretting over the WHO’s guidelines as people living with HIV (PLWH) in Nigeria do not pay for drugs; while the country is not getting aids like she used to, hence, would have to create allocations in the healthcare budget for the new recommendation to thrive.
The WHO released its new HIV treatment guidelines on Sunday in her report tagged “Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection”.
The recommendation stipulates that all countries should initiate treatment in adults living with HIV when their CD4 cell count is about 500 cells/mm or less. This means when their immune system is still strong.
Previously, the global health body had in 2010 set 350cells/mm or less as the CD4 count at which treatment should commence.
CD4 is a medical terminology for the type of immune cell attacked by the HIV virus.
“Treating people with HIV earlier, with safe affordable, and easier-to-manage medicines can both keep them healthy and lower the amount of virus in the blood, which reduces the risk of passing it to someone else.
“If countries can integrate these changes within their national HIV policies, and back them up with the necessary resources, they will see significant health benefits at the public health and individual level,” the report states.
The recommendation also encourages providing antiretroviral therapy (ART) regardless of CD4 count to all children under five years of age living with the virus, all pregnant and breastfeeding women with HIV and to all persons who are HIV-positive but in a relationship in which their partners are not infected.
Reactions
A senator has now expressed fear over the implications of the new guideline saying “this new guideline if adopted would place an extra burden on the nation’s healthcare budget.”
He said the allocations for health hasn’t been sufficient while donors are not forthcoming like before. This, he said will add more pressure to the budget.
However, the Executive Director, Plan Foundation, Ibadan, Oyo State, Obatunde Oladapo, disagrees with the lawmaker.
“I would say that response is myopic and is based on very little knowledge about the issue of treatment as a strategy for HIV prevention,” Mr. Oladapo told REMIUM TIMES.
“The person is simply considering the various categories and numbers of people to provide ARVs and ARTs for but leaving out the fact that this new regimen will subsequently ensure an HIV/AIDs free Nigeria”.
Also, John Idoko, the Director General, National Agency for the Control of AIDS, NACA, told PREMIUM TIMES in an interview that the guideline is a welcome development long overdue.
Addressing the possible extra pressure on the health budget, he said “it’s a question of balancing between extra budget and the number of lives we would lose. We would have to choose between the two. Are we interested in having more people free of HIV or are we interested in Nigeria full of HIV?
“If we don’t bring and invest the money in preventing and managing the condition, the burden (HIV) will increase and we would lose more people- both the young and old and we won’t be saving lives”.
Also speaking, the Minister of State for Health, Muhammad Ali-Pate, agreed that the new guideline will mount some pressure on the nation’s budget as well as those of developing partners.
“There is always that challenge of resource constraint but we have to look at it from the angle of the patient. But sincerely speaking, of course, it would put pressure on the budget of government and developing partners but I hope that we would put in all resources that can be gotten so that where efficiency is needed, they can actually be gained,” he said.
“There’s always the constraint of resources but we’re working out other ways to cushion the effect this would bring on the budget. For instance, NACA has just developed a new plan for HIV/AIDs and I hope states and local governments will also chip in their own resources and not leave everything to be done by the Federal Government because not much is actually allocated for HIV/AIDS.
“I know some states are more endowed than others so I hope those that are more endowed will put in more,” the minister added.
A consultant to the Senate Committee on Health, Wale Okediran, also said that the new regulation “would be an extra burden on our budget especially in view of the latest UN (United Nation) report”.
Mr. Okediran, however, said the guideline will help the nation as a whole to look inward.
“Personally, I think this is one of the things we need to get us on our feet. For too long, we have been depending on foreign donors for everything and I don’t think it is right. In short, somebody said may be this is why corruption is rampant because we have excess money to play with whereas, if donors don’t come close, we would be forced to use that money.
“At the same time, I think it would help us look inward for funding. Our country is too serious to be left alone with politicians and that is why we need to encourage our philanthropists to come into the health sector. I believe that all over Africa, we need to encourage our rich people and corporate organisations to put in some support in health and not only sport and beauty pageant. If they want to organise Miss Nigeria now, you would be surprised how much dollars would be donated, when the health sector which is very important is there. I think we need to allow the donors to move away” he added.
Uncertain about kick-start of guideline in Nigeria
Mr. Idoko also said he was uncertain about when the recommendation would be adopted and started in Nigeria.
“I don’t know when we would commence the implementation in Nigeria but we have to work with WHO and all other partners to see how we can go about it because it would help even the country to not only solve HIV but other health conditions such as Tuberculosis, malaria and even maternal-child care related issues,” he said.
The Health Minister also added that “the guideline is just out so we would have to make deliberations, but I know that the ministry would work closely with NACA on this and make preparations to ensure that we commence it as quickly as possible.
“To expedite this action, we would ensure that in the 2014 budget, more resources would be allocated to the prevention, treatment and management of HIV as well as the procure of ARVs.”
16 Signs You May Have HIV
FEVER : Within a month or two of HIV entering the body, 40% to 90% of people experience flulike symptoms known as acute retroviral syndrome (ARS).
But sometimes HIV symptoms don't appear for years—sometimes even a decade—after infection.
"In the early stages of HIV infection, the most common symptoms are none," says Michael Horberg, MD, director of HIV/AIDS for Kaiser Permanente, in Oakland, Calif. One in five people in the United States with HIV doesn't know they have it, which is why it's so important to get tested, especially if you have unprotected sex with more than one partner or use intravenous drugs.
Here are some signs that you may be HIV-positive.One of the first signs of ARS can be a mild fever, up to about 102 degrees F.
The fever, if it occurs at all, is often accompanied by other usually mild symptoms, such as fatigue, swollen lymph glands, and a sore throat.
"At this point the virus is moving into the blood stream and starting to replicate in large numbers," says Carlos Malvestutto, MD, instructor of infectious diseases and immunology in the department of medicine at NYU School of Medicine in New York City. "As that happens, there is an inflammatory reaction by the immune system."
FATIGUE:The inflammatory response generated by your besieged immune system also can cause you to feel tired and lethargic. Fatigue can be both an early and later sign of HIV.
Ron, 54, a public relations executive in the Midwest, started to worry about his health when he suddenly got winded just walking. "Everything I did, I got out of breath," he says. "Before that I had been walking three miles a day."
Ron had tested HIV positive 25 years before feeling so tired; fatigue during acute, or newly contracted, HIV might not be so obvious.
Achy muscles, joint pain, swollen lymph nodes: ARS is often mistaken for the flu, mononucleosis, or another viral infection, even syphilis or hepatitis.
That's not surprising: Many of the symptoms are the same, including pain in the joints and muscles and swollen lymph glands.
Lymph nodes are part of your body's immune system and tend to get inflamed when there's an infection. Many of them are located in your armpit, groin, and neck.
Sore throat and headache:As with other symptoms, sore throat and headache can often be recognized as ARS only in context, Dr. Horberg says.
If you've engaged recently in high-risk behavior, an HIV test is a good idea. Get tested for your own sake and for others: HIV is most infectious in the earliest stage.
Keep in mind that the body hasn't produced antibodies to HIV yet so an antibody test may not pick it up. (It can take a few weeks to a few monthsfor HIV antibodies to show in a blood test). Investigate other test options such as one that detects viral RNA, typically within nine days of infection.
Skin rash
Skin rashes can occur early or late in the course of HIV/AIDS.For Ron, this was another sign that he might not have run-of-the-mill allergies or a cold.
"They were like boils, with some itchy pink areas on my arms," Ron says. The rashes can also appear on the trunk of the body. "If [the rashes] aren't easily explained or easily treated, you should think about having an HIV test," Dr. Horberg says.
Nausea, vomiting, diarrhea
Anywhere from 30% to 60% of people have short-term nausea, vomiting, or diarrhea in the early stages of HIV, Dr. Malvestutto says.These symptoms can also appear as a result of antiretroviral therapy and later in the infection, usually as the result of an opportunistic infection.
"Diarrhea that is unremitting and not responding at all to usual therapy might be an indication," Dr. Horberg says. Or symptoms may be caused by an organism not usually seen in people with healthy immune systems, he adds.
Weight loss
Once called "AIDS wasting," weight loss is a sign of more advanced illness and could be due in part to severe diarrhea."If you're already losing weight, that means the immune system is usually fairly depleted," Dr. Malvestutto says. "This is the patient who has lost a lot of weight even if they continue to eat as much as possible. This is late presentation. We still see a lot of these." It has become less common, however, thanks to antiretroviral therapy.
A person is considered to have wasting syndrome if they lose 10% or more of their body weight and have had diarrhea or weakness and fever for more than 30 days, according to the U.S. Department of Health and Human Services.
Dry cough
A dry cough was the first sign Ron had that something was wrong. He at first dismissed it as bad allergies.But it went on for a year and a half—and kept getting worse. Benadryl, antibiotics, and inhalers didn't fix the problem. Neither did allergists.
This symptom—an "insidious cough that could be going on for weeks that doesn't seem to resolve," Dr. Malvestutto says—is typical in very ill HIV patients.
Pneumonia
The cough and the weight loss may also presage a serious infection caused by a germ that wouldn't bother you if your immune system was working properly."There are many different opportunistic infections and each one can present differently," Dr. Malvestutto says. In Ron's case, it was Pneumocystis pneumonia (PCP), aka "AIDS pneumonia," which eventually landed him in the hospital.
Other opportunistic infections include toxoplasmosis, a parasitic infection that affects the brain; a type of herpes virus called cytomegalovirus; and yeast infections such as thrush.
Night sweats
About half of people get night sweats during the early stages of HIV infection, Dr. Malvestutto says.These can be even more common later in infection and aren't related to exercise or the temperature of the room.
Similar to the hot flashes that menopausal women suffer, they're also hard to dismiss, given that they soak your bedclothes and sheets.
Nail changes
Another sign of late HIV infection are nail changes, such as clubbing (thickening and curving of the nails), splitting of the nails, or discoloration (black or brown lines going either vertically or horizontally).Often this is due to a fungal infection, such as candida. "Patients with depleted immune systems will be more susceptible to fungal infections," Dr. Malvestutto says.
Yeast infections
Another fungal infection that's common in later stages is thrush, a mouth infection caused by Candida, a type of yeast."It's a very common fungus and the one that causes yeast infections in women," Dr. Malvestutto says. "They tend to appear in the mouth or esophagus, making it difficult to swallow."
Ron woke up one day to find white patches on his tongue. He had thrush. For him, "It was not bothersome other than I didn't like having it." The infection was hard to get rid of, but finally cleared up after Ron started taking drugs to combat HIV.
Confusion or difficulty concentrating
Cognitive problems could be a sign of HIV-related dementia, which usually occurs late in the course of the disease.In addition to confusion and difficulty concentrating, AIDS-related dementia might also involve memory problems and behavioral issues such as anger or irritability.
It may even include motor changes: becoming clumsy, lack of coordination, and problems with tasks requiring fine motor skills such as writing by hand.
Cold sores or genital herpes
Cold sores (oral herpes) and genital herpes can be a sign of both ARS and late-stage HIV infection.And having herpes can also be a risk factor for contracting HIV. This is because genital herpes can cause ulcers that make it easier for HIV to enter the body during sex. And people who have HIV tend to have more severe herpes outbreaks more often because HIV weakens the immune system.
Tingling and weakness
Late HIV can also cause numbness and tingling in the hands and feet. This is called peripheral neuropathy, which also occurs in people with uncontrolled diabetes."This is when the nerves are actually damaged," Dr. Malvestutto says. These symptoms can be treated with over-the-counter pain relievers and antiseizure medicines such as Neurontin (gabapentin).
Menstrual irregularities
Advanced HIV disease appears to increase the risk of having menstrual irregularities, such as fewer and lighter periods.These changes, however, probably have more to do with the weight loss and poor health of women with late-stage infection rather than the infection itself.
Infection with HIV also has been associated with earlier age of menopause (47 to 48 years for infected women compared to 49 to 51 years for uninfected women).
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