HIV/AIDS
Paragraphs

Objectives To determine the relation between the HIV/AIDS epidemic and support for dependent elderly people in Africa.
Design Retrospective analysis using data from Demographic and Health Surveys.

Setting 22 African countries between 1991 and 2006.

Participants 123 176 individuals over the age of 60.

Main outcome measures We investigated how three measures of the living arrangements of older people have been affected by the HIV/AIDS epidemic: the number of older individuals living alone (that is, the number of unattended elderly people); the number of older individuals living with only dependent children under the age of 10 (that is, in missing generation households); and the number of adults age 18-59 (that is, prime age adults) per household where an older person lives.

Results An increase in annual AIDS mortality of one death per 1000 people was associated with a 1.5% increase in the proportion of older individuals living alone (95% CI 1.2% to 1.9%) and a 0.4% increase in the number of older individuals living in missing generation households (95% CI 0.3% to 0.6%). Increases in AIDS mortality were also associated with fewer prime age adults in households with at least one older person and at least one prime age adult (P<0.001). These findings suggest that in our study countries, which encompass 70% of the sub-Saharan population, the HIV/AIDS epidemic could be responsible for 582 200-917 000 older individuals living alone without prime age adults and 141 000-323 100 older individuals being the sole caregivers for young children.

Conclusions Africa's HIV/AIDS epidemic might be responsible for a large number of older people losing their support and having to care for young children. This population has previously been under-recognised. Efforts to reduce HIV/AIDS deaths could have large "spillover" benefits for elderly people in Africa.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
BMJ
Authors
Eran Bendavid
Grant Miller
Paragraphs

Objectives: Emergency departments (EDs) are increasingly proposed as high-yield venues for providing preventive health education to a population at risk for unhealthy behaviors and unmet primary care needs. This study sought to determine the preferred health education topics and teaching modality among ED patients and visitors.

Methods: For two 24-hour periods, patients aged 18 years and older presenting to four Boston EDs were consecutively enrolled, and waiting room visitors were surveyed every 3 hours. The survey assessed interest in 28 health conditions and topics, which were further classified into nine composite health education categories. Also assessed was the participants' preferred teaching modality.

Results: Among 1,321 eligible subjects, 1,010 (76%) completed the survey, of whom 56% were patients and 44% were visitors. Among the health conditions, respondents were most interested in learning about stress and depression (32%). Among the health topics, respondents were most interested in exercise and nutrition (43%). With regard to learning modality, 34% of subjects chose brochures/book, 25% video, 24% speaking with an expert, 14% using a computer, and 3% another mode of learning (e.g., a class). Speaking with an expert was the overall preferred modality for those with less than high school education and Hispanics, as well as those interested in HIV screening, youth violence, and stroke. Video was the preferred modality for those interested in learning more about depression, alcohol, drugs, firearm safety, and smoke detectors.

Conclusions: Emergency department patients and visitors were most interested in health education on stress, depression, exercise, and nutrition, compared to topics more commonly targeted to the ED population such as substance abuse, sexual health (including HIV testing), and injury prevention. Despite many recent innovations in health education, most ED patients and visitors in our study preferred the traditional form of books and brochures. Future ED health education efforts may be optimized by taking into account the learning preferences of the target ED population.

All Publications button
1
Publication Type
Policy Briefs
Publication Date
Journal Publisher
Academic Emergency Medicine
Authors
News Type
News
Date
Paragraphs

In mid April, FSI convened a special conference on Technology, Governance, and Global Development, to examine how technical innovation solves, or fails to solve, the problems of chronic global underdevelopment.  Experts from business, medicine, philanthropy, academia, government and non-governmental organizations, along with young Stanford alumni, addressed technology's ability to help secure gains in health, economic development, agricultural innovation, food security, and human development.

With a wealth of expertise and on-the-ground experience, panelists tackled central issues and engaged in spirited debate, animated by moderator Philip Taubman.  "The Promise of Information and Communications Technology" examined whether technology can transform lives of individuals, even in poorly governed countries, finding encouraging evidence in technology-based medical and health services and novel approaches to economic development, including sharing vital information and banking via mobile phones. 

A panel of young Stanford alumni discussed their entrepreneurial efforts that led to the development of a low-cost, lifesaving incubator for low birth weight babies, the FACE AIDS program begun at Stanford that now has 20 chapters and has contributed some $2 million for treatment of people with AIDS in Africa, a new Global Health Corps to train health care workers, and other innovations to save lives in underserved areas.

Condoleezza Rice, former Secretary of State and National Security Advisor, gave the lunchtime keynote with a focus on why democracies are more effective and ultimately more efficient in delivering economic development. Democracies are better at protection of rule of law and property rights, she noted. Democracies are less corrupt, more in touch with their people, more stable, and better able to deliver the benefits of human capital development, health, and education to their population as a whole.

A third panel on "Governance, Innovation, and Service Delivery" addressed how innovative institutions and technologies could overcome poor governance and deliver needed services in underdeveloped regions. "Despite extraordinary growth in our technical capacity to prevent and treat child illness and death, we are seeing stagnation or a rise in mortality rates of children under five in some areas," said pediatrician Paul Wise. "This reflects gross failures in delivering highly efficacious health interventions." Some 9 million children still die each year, and 65 percent of child deaths in unstable areas are preventable, he noted. Wise has launched a new program to improve child health in areas of unstable governance through new integrated technical and political strategies.

A fourth session on "Creative Markets for Technical Innovation" honed in on the institutions, innovations, and incentives needed to stimulate development of products and services that address the needs of the poor. Panelists focused on pharmaceuticals, agricultural innovation, use of mobile technologies to share information on best practices, improved food security through innovative technology - such as solar-powered irrigation to expand growing seasons, crops, and incomes, and the development of human capital in China through rigorous evaluation, field trials, and nutritional intervention.

Among the experts addressing these vital issues were Google.org's Megan Smith, BP Solar's Reyad Fezzani, Center for Global Development President Nancy Birdsall, Gates Foundation Director of Agricultural Development Sam Dryden, Gilead Science's Clifford Samuel, dynamic Stanford alumni Nava Ashraf ‘97, Jared Cohen ‘04, Jane Chen ‘08, and Jonny Dorsey ‘07, and FSI's Coit D. Blacker, Joshua Cohen, Stephen D. Krasner, Paul H. Wise, Rosamond L. Naylor, and Scott Rozelle.

FSI Payne Lecturer Bill Gates, Co-chair of the Bill & Melinda Gates Foundation and Chairman, Microsoft, gave an address on "Giving Back: Finding the Best Way to Make a Difference."  He urged students to become involved in the central issues of global healthincluding the need to reduce child mortality through more vaccines and better delivery systemsand education, saying we need to find out "what works" and use the Internet to share lessons learned globally.

"We need to shift talent toward bigger needs," Gates said, urging students to provide the passion and ideas to drive us forward in health, education, and energy.  To make a difference, Gates advised, "Get your hands dirty, do the hard work in the actual environment, early in your career."  Telling students that he is looking for "great ideas," he challenged them to post answers on the Gates Foundation Facebook wall to three questions: What problems are you working on? What draws you in? How will you draw other people in to work on solutions to the world's great challenges.

Hero Image
gallerycover scene
All News button
1
Paragraphs

BACKGROUND: The CDC recommends routine voluntary HIV testing of all patients 13-64 years of age. Despite this recommendation, HIV testing rates are low even among those at identifiable risk, and many patients do not return to receive their results. OBJECTIVE: To examine the costs and benefits of strategies to improve HIV testing and receipt of results. DESIGN: Cost-effectiveness analysis based on a Markov model. Acceptance of testing, return rates, and related costs were derived from a randomized trial of 251 patients; long-term costs and health outcomes were derived from the literature. SETTING/TARGET POPULATION: Primary-care patients with unknown HIV status. INTERVENTIONS: Comparison of three intervention models for HIV counseling and testing: Model A = traditional HIV counseling and testing; Model B = nurse-initiated routine screening with traditional HIV testing and counseling; Model C = nurse-initiated routine screening with rapid HIV testing and streamlined counseling. MAIN MEASURES: Life-years, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness. KEY RESULTS: Without consideration of the benefit from reduced HIV transmission, Model A resulted in per-patient lifetime discounted costs of $48,650 and benefits of 16.271 QALYs. Model B increased lifetime costs by $53 and benefits by 0.0013 QALYs (corresponding to 0.48 quality-adjusted life days). Model C cost $66 more than Model A with an increase of 0.0018 QALYs (0.66 quality-adjusted life days) and an incremental cost-effectiveness of $36,390/QALY. When we included the benefit from reduced HIV transmission, Model C cost $10,660/QALY relative to Model A. The cost-effectiveness of Model C was robust in sensitivity analyses. CONCLUSIONS: In a primary-care population, nurse-initiated routine screening with rapid HIV testing and streamlined counseling increased rates of testing and receipt of test results and was cost-effective compared with traditional HIV testing strategies.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
Journal of General Internal Medicine
Authors
Douglas K. Owens
-

Carolina for Kibera (CFK) inspires and nurtures youth leaders in the slum of Kibera, Kenya through a unique model of participatory development.  CFK recognizes the youth of Kibera as resilient, wise, innovative, and eager to lift their community above the poverty and violence that plagues it.  CFK's long-term initiatives provide youth opportunities to learn and serve while addressing a wide range of community needs including healthcare, education, waste recycling and reduction, HIV/AIDS testing and counseling, and girls' empowerment.  CFK's model of participatory to fight abject poverty, and prevent ethnic, gender and religious violence has been internationally recognized, earning awards as a Time Magazine and Gates Foundation "Hero of Global Health" and the 2008 Oklahoma City National Memorial Foundation's Reflections of Hope Award.  CFK is a major affiliated entity of UNC based at the Center for Global Initiatives.


Salim Mohamed Salim Mohamed co-founded and served as the Executive Director of Carolina for Kibera for eight years. At the age of 16, he was involved in the development of MYSA - the largest youth sports program in Africa based in the Mathare slum of Nairobi.  Salim has helped launch community based sports and development programs in Ghana, Gambia, and Nigeria and presented at the International AIDS Conference. He serves as a director for Shoe 4 Africa, an advisor to Global Education Fund and a YES! facilitator.  A TED Africa Fellow, he is currently pursuing a master's degree at the University of Manchester.

Rye Barcott  While an undergraduate on an NROTC scholarship at UNC-Chapel Hill in 2001, Barcott founded CFK with the late nurse Tabitha Atieno Festo and community organizer Salim Mohamed. Barcott served five years in the Marine Corps before earning a combined MBA and MPA at Harvard as a Reynolds Social Entrepreneurship Fellow and a member of the Harvard Endowment's Advisory Committee on Shareholder Responsibility.  In 2006, he was named an ABC World News Person of the Year.  A TED Fellow and member of the UNC Chancellor's Innovation Circle, Barcott is writing a book that juxtaposes community organizing and counter-insurgency (under contract, Bloomsbury Publishing).

Oksenberg Conference Room

Rye Barcott Founder (l) Speaker Carolina for Kibera (CFK)
Salim Mohamed Co-Founder (r) Speaker Carolina for Kibera (CFK)
Conferences
-

Steven Robins is an anthropologist from Stellenbosch University in South Africa whose research covers issues of governance, citizenship, and social mobilization in post-conflict societies. Robins will give lectures and seminars based on his forthcoming book, From Revolution to Rights in South Africa: Social Movement, NGOs and Popular Politics.

Co-sponsored with African Studies

Encina Ground Floor Conference Room

Steve Robins Associate Professor, Department of Sociology and Social Anthropology Speaker University of Stellenbosch, South Africa; FSI-Humanities Center International Visitor, 2009-2010
Seminars
Paragraphs

Abstract

BACKGROUND:

Raltegravir is a potential treatment option for virologically suppressed HIV-1 infected patients on enfuvirtide with injection site reactions.

OBJECTIVES:

To characterize safety and efficacy of an enfuvirtide to raltegravir switch including changes in T-cells, quality of life, and residual viremia.

STUDY DESIGN:

In patients with viral load <50 copies/mL and injection site reactions, enfuvirtide was switched to raltegravir without additional changes to the antiretroviral regimen. Virologic failure was defined as a viral load >1000 copies/mL or two consecutive viral load measurements between 50 and 1000 copies/mL (low-level viremia). Over the 24 week study, we compared changes in T-cells, injection site reactions, quality of life, and residual viremia, as measured through the single-copy assay which can detect plasma virus down to a single copy, using paired t-tests.

RESULTS:

Fourteen patients with a median CD4+ T-cell count of 420 cells/microL were enrolled. After the switch, two patients experienced virologic failure due to confirmed low-level viremia. However, both patients subsequently were re-suppressed, one without any changes to his regimen. There was no change in CD4+ T-cell count. Injection site reactions resolved. However, there was little reported change in quality of life. The baseline median level of residual viremia was 6 copies/mL and did not change after the switch to raltegravir.

CONCLUSIONS:

A switch to raltegravir in virologically suppressed patients on enfuvirtide is effective in maintaining immunologic and virologic control at 24 weeks but did not result in a change in residual viremia.

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
Journal of Clinical Virology
Authors
Eran Bendavid
Paragraphs

This paper develops a mathematical/economic framework to address the following question: Given a particular population, a specific HIV prevention program and a fixed amount of funds that could be invested in the program, how much money should be invested?

All Publications button
1
Publication Type
Journal Articles
Publication Date
Journal Publisher
Health Care Management Science
Authors
Subscribe to HIV/AIDS