School: a place for children to learn their HIV status?

Estimados colegas, les dejo otro editorial interesante, la escuela puede ser el lugar donde los niños sepan y aprendan de su estatus serologico.
Saludos
Dr. Carlos Erazo

http://download.thelancet.com/pdfs/journals/lancet/PIIS0140673611601839.pdf

"The South African Government has announced that it will soon launch a controversial step in its national campaign to test 15 million people for HIV by June this year. Under the plans, children and adolescents will be off ered voluntary HIV testing and counselling in high schools. The details of the initiative are thin at present. The health department has promised that the campaign will be “professional” and “responsible”; that testing will be done in private spaces on school premises during weekends and school holidays; that it will be phased in; and that extensive monitoring and evaluation will be done. An expert task team has been set up to work on implementation, including the provision of ageappropriate counselling, support, and care, and they will make their recommendations public in due course. The team has a lot to address. Under South African law, children aged 12 years and older can give consent to a HIV test. But how should a health worker determine whether consent provided by a 12-year-old or adolescent is suffi ciently informed? Will those who test positive get access to antiretroviral therapy? How will health workers ensure confi dentiality? Will children be pressured by peers or parents to divulge their test results? Will condoms be given to those who come for testing? And how often will testing be off ered? The task team should also be allowed to consider whether schools are the best place for children to learn their HIV status. Problems in the national HIV testing and counselling campaign, launched last April, also heed a cautionary warning. Monitoring and evaluation of the campaign has been poor and there have been reports of HIVpositive people not being referred for treatment, clinics not complying with national testing and counselling protocols, and anecdotal reports of coercive testing. 18% of young people (15–24 years) in South Africa report having fi rst sex by 15 years, and early sexual debut is associated with increased risk of HIV infection.
Improving access to age-appropriate HIV testing, treatment, and counselling for children and adolescents is, therefore, important. But South Africa must take its time and consider how best to do this, to ensure the campaign does not do more harm than good."  The Lancet

Potential utility of empirical tuberculosis treatment for HIV-infected patients with advanced immunodeficiency in high TB-HIV burden settings [Unresolved issues]

Estimados colegas , aquí les dejo otro artículo interesante sobre la co infección VIH-TB
Saludos 
Dr. Carlos Erazo
http://www.ingentaconnect.com/content/iuatld/ijtld/2011/00000015/00000003/art00002

Authors: Lawn, S.D.¹; Ayles, H.²; Egwaga, S.³; Williams, B.⁴; Mukadi, Y.D.⁵; Santos Filho, E.D.⁶; Godfrey-Faussett, P.⁷; Granich, R.M.⁸; Harries, A.D.⁹

Abstract:
"The human immunodeficiency virus (HIV) and HIV-associated tuberculosis (TB-HIV) epidemics remain uncontrolled in many resource-limited regions, especially in sub-Saharan Africa. The scale of these epidemics requires the consideration of innovative bold interventions and `out-of-the-box' thinking. To this end, a symposium entitled `Controversies in HIV' was held at the 40th Union World Conference on Lung Health in Cancun, Mexico, in December 2009. The first topic debated, entitled `Annual HIV testing and immediate start of antiretroviral therapy for all HIV-infected persons', received much attention at international conferences and in the literature in 2009. The second topic forms the subject of this article. The rationale for the use of empirical TB treatment is premised on the hypothesis that in settings worst affected by the TB-HIV epidemic, a subset of HIV-infected patients have such a high risk of undiagnosed TB and of associated mortality that their prognosis may be improved by immediate initiation of empirical TB treatment used in conjunction with antiretroviral therapy. In addition to morbidity and mortality reduction, additional benefits may include prevention of nosocomial TB transmission and TB preventive effect. Potential adverse consequences, however, may include failure to consider other non-TB diagnoses, drug co-toxicity, compromised treatment adherence, and logistical and resource challenges. There may also be general reluctance among national TB programmes to endorse such a strategy. Following fruitful debate, the conclusion that this strategy should be carefully evaluated in randomised controlled trials was strongly supported. This paper provides an in-depth consideration of this proposed intervention"

Keywords: empirical treatment; tuberculosis; HIV; Africa; mortality