A practical guide for healthcare professionals adapted to the conditions of the COVID-19 pandemic has been developed

WHO has developed a practical guide adapted to the conditions of the COVID-19 pandemic for healthcare professionals treating patients with severe acute respiratory viral infections.

The manual provides tools and practical recommendations that can be used to care for patients with severe disease: from admission to discharge from hospital.

The Ukrainian, English and Russian versions of the manual can be downloaded here: Clinical care for severe acute respiratory infection: toolkit: COVID-19 adaptation 

COVID-19 Lessons on Improving Service Sustainability for Eastern Europe and Central Asia

Following the online discussion “COVID-19 Lessons on Improving Service Sustainability Indicators for Eastern Europe and Central Asia” held in May 2020, practical recommendations for transforming a sustainable response to HIV, TB and HCV in the context of COVID-19 were developed and published. 

Stakeholder experts report the need to:

  • Reformatting health care systems in response to COVID-19;
  • Increasing the availability of diagnosis and treatment;
  • Transformations of HIV, TB and HCV service delivery models for key groups.

The COVID-19 pandemic has shown that health systems around the world need to become more resilient, flexible and result-oriented. The approach to the provision of a range of services has changed, including the treatment of HIV and opioid dependence, as well as TB and hepatitis C virus (HCV) among key populations.

So, we present the main theses of the online conference:

  • Effective communication by the government is very important during a crisis. It is the government that must prepare citizens for the probable development of events and involve the population in measures to counteract the epidemic.
  • In an epidemic, it is crucial to unlock emergency funding in a timely manner. Timely allocation of funds facilitates the use of funds and helps to strike a balance between flexibility and accountability.
  • Global communication and recommendations are an important source of information for national decision-making.
  • The use of information technology (IT) as a means of monitoring and protecting society from COVID-19 has become an important innovation.
  • New global mechanisms need to be sought to prevent supply disruptions at the local level.
  • Possibilities for reviewing patent rights in emergencies should be considered.
  • A reorientation of international assistance programs is needed to support measures to combat COVID-19.
  • Models of service delivery for key groups in relation to HIV, TB and HCV need to transform and simplify methods for the benefit of patients.

The full findings of the online discussion "COVID-19 Lessons on Improving Service Sustainability for Eastern Europe and Central Asia" can be found here.

 

As part of the fight against HIV in the USА, a new ARVT drug Trogarzo (ibalizumab) was approved

As part of therapy, Trogarzo (ibalizumab) will be used by people who have experienced ineffective treatment with other ARVs. The new drug could be a solution for those who have been living with HIV for a long time and whose virus has acquired resistance to most of the available drugs.

A new study found that people with Trogarzo (Ibalizumab) were able to achieve a reduction in viral load 48 weeks before a condition when the virus was not detected by a test.

The new drug has proven to be safe and effective both in the third phase and in human studies. The most common side effects were diarrhea, headache, fatigue and nausea. However, all side effects were mild or moderate. In addition, Trogarzo is the first HIV drug to be taken not every day, but only once every two weeks.

The cause of resistance is incomplete suppression of virus mutations that occur in cases where the patient violates the treatment regimen. Multiple resistance is dangerous because at some stage it becomes difficult or impossible for the patient to find an effective alternative treatment regimen.

The medicine that reduces the risk of mother-to-child transmission of HIV

A new study from the University of Liverpool found a solution to most issues to reduce the likelihood of HIV transmission during pregnancy, childbirth and breastfeeding from a positive mother to a child in late pregnancy. The study was published in the journal «The Lancet HIV».

It is known that without ARV therapy, the risk of mother-to-child transmission of HIV is 15 to 45%. With ARV therapy, this risk can be reduced to less than 5% if treatment is started in the early stages of pregnancy.

A study from the University of Liverpool compared the reduction in viral load before childbirth in women taking Dolutegravir and Efavirenz. Women started taking ARV therapy in the third trimester. The study included pregnant women 18 years of age and older from South Africa and Uganda with confirmed HIV-positive status who had not previously received ARV therapy and were pregnant for 25 weeks. Participants were randomly divided into Dolutegravir and Efavirenz groups, and viral load was determined 7 and 28 days after the start of ART, at 36 weeks of gestation, and postpartum (0-14 days postpartum).

The primary efficacy endpoint was less than 50 copies per ml during the first postpartum visit, and the primary safety margin was determined by the incidence of side effects associated with maternal and infant use. Long-term monitoring of infants and their mothers continues.

In the period from January 23 to August 15, 2018, 268 mothers received ARV therapy, of which 135 - Dolutegravir and 133 - Efavirenz. The duration of ART use before delivery was 55 days. Viral load of less than 50 copies per ml was observed in 74% of women in the Dolutegravir group and 43% in the Efavirenz group.

Serious side effects were reported by 22% of women in the Dolutegravir group and 11% in the Efavirenz group. There were three stillbirths in the Dolutegravir group and 1 case in the Efavirenz group, but all cases were considered unrelated to ARV treatment. Three children were born with HIV - all in the Dolutegravir group; these cases are attributed to intrauterine infection.

Conclusion: The results support the revised WHO guidelines for switching to Dolutegravir in the first-line regimens for all adult men and women living with HIV, regardless of whether they are pregnant or not.

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