Dealing with a positive result: routine HIV testing of pregnant women in Vietnam.

HIV testing is an essential component of PMTCT. It can be offered to pregnant women through different testing models, ranging from voluntary counseling and testing (VCT) to routine and mandatory testing. This study was conducted in Hanoi, Vietnam, where HIV-prevalence is low among the general population, but high among young, urban, sexually active, male intravenous drug users. Women who want to deliver in a state hospital are routinely tested for HIV in the absence of well-defined opt-out procedures. In-depth interviews with a convenience sample of 38 seropositive pregnant women and mothers and 53 health workers explored the acceptability of routine testing. Patients and healthcare workers appeared to accept routine 'blood' tests (including HIV tests) because they feel uncomfortable discussing issues specific to HIV/AIDS. To avoid having to inform women directly about their HIV status, health workers at routine testing sites rely on the official notification system, shifting the responsibility from the hospitals to district and commune health staff. The notification system in Hanoi informs these local officials about the HIV status of people living in their catchment area without patients' consent. Our study shows that this non-confidential process can have serious social, economic and health consequences for the HIV-positive women and their children.

Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa.

Adherence levels in Africa have been found to be better than those in the US. However around one out of four ART users fail to achieve optimal adherence, risking drug resistance and negative treatment outcomes. A high demand for 2nd line treatments (currently ten times more expensive than 1st line ART) undermines the sustainability of African ART programs. There is an urgent need to identify context-specific constraints to adherence and implement interventions to address them. We used rapid appraisals (involving mainly qualitative methods) to find out why and when people do not adhere to ART in Uganda, Tanzania and Botswana. Multidisciplinary teams of researchers and local health professionals conducted the studies, involving a total of 54 semi-structured interviews with health workers, 73 semi-structured interviews with ARTusers and other key informants, 34 focus group discussions, and 218 exit interviews with ART users. All the facilities studied in Botswana, Tanzania and Uganda provide ARVs free of charge, but ART users report other related costs (e.g. transport expenditures, registration and user fees at the private health facilities, and lost wages due to long waiting times) as main obstacles to optimal adherence. Side effects and hunger in the initial treatment phase are an added concern. We further found that ART users find it hard to take their drugs when they are among people to whom they have not disclosed their HIV status, such as co-workers and friends. The research teams recommend that (i) health care workers inform patients better about adverse effects; (ii) ART programmes provide transport and food support to patients who are too poor to pay; (iii) recurrent costs to users be reduced by providing three-months, rather than the one-month refills once optimal adherence levels have been achieved; and (iv) pharmacists play an important role in this follow-up care.

Towards rational medicine use: is there a role for children?

Irrational, wasteful, and even dangerous medicine use is a serious problem in developing countries. It is important to work to solve it through the provision of safe, efficacious and affordable drugs, through strengthening the drug regulatory systems and through the education of health care providers. However, it is important as well that the population learns to use medicines wisely. Educating children in developing countries about appropriate use of medicines is a strategy that has the potential to improve medicine use throughout the communities where the children live and for future generations. Currently, very few children's health education curricula include anything on appropriate medicine use, and what exists has not been based on what children know, or on their behavior or expectations relative to medicines in the context of their cultures. Support is sought for the inclusion of rational medicine use in comprehensive school health curricula and researchers are encouraged to develop and evaluate culturally sensitive, age appropriate, and acceptable medicine use education programs.

Indigenised pharmaceuticals in developing countries: widely used, widely neglected.

PIP: In many developing countries, Western prescription drugs have become indigenized. They are prepared in traditional ways, administered by traditional healers, sold in local shops, given local names, and widely used in self-medication. Examples are Diatabs and Polymagma in the Philippines and Terramicina and Ambra-Sinto in Brazil. These antibiotics are sprinkled on wounds or taken orally and are given to children whenever they have a fever. In the Cameroon, tetracycline is called Folkolo, which means "wound healer," and in India, Ayurvedic healers assert that penicillin was known to the Brahmanic sages in the past. Health care workers in developing countries should study local drug use patterns before prescribing medications.^ieng

The use of modern pharmaceuticals in a Filipino village: doctors' prescription and self medication.

The use of pharmaceuticals in common childhood illnesses is evaluated. The extent to which drug use is related to doctors' prescription is assessed. Attention is paid to the social context in which pharmaceuticals are applied. The study shows that the majority of the childhood illnesses are treated without consulting a doctor. In half of the cases, in which no doctor is consulted, pharmaceuticals--both prescription and nonprescription--are used. Symptomatic therapies as anti-diarrhoeals and cough syrups are found to be most popular. All of the anti-diarrhoeals and nearly half of the cough syrups used, are considered unsuitable for use in common childhood illnesses. Prescription practices by doctors have many harmful characteristics in common with self medication. Moreover, the example of doctors' prescriptions seems to encourage the choice for expensive, often dangerous, symptomatic therapy in self medication. To diminish this wasteful and dangerous use of drugs in self medication, reforms in distribution and production of drugs at national level and education in drug use at the community level are recommended. More knowledge of self medication practices is considered crucial in the implementation of such policies.

The enumeration of thermotrophic types amongst the Enterobacteriaceae colonizing perishable foods.

A total of 41 pure cultures of Enterobacteriaceae, comprising 32 thermotrophic and nine psychrotrophic strains, pathogens or marker organisms, were examined for numbers of colony forming units obtained at 37 degrees and 42.5 degrees C (thermotrophs) and 30 degrees C (psychrotrophs), when surface-plated on a rich infusion agar and violet red bile agar. In addition 42 food and water samples, collected in a rural area of the Philippines, were examined by surface inoculating violet red bile AIPC (agar immersion plating and contact; 'dip') slides and incubating at 37 degrees and 42.5 degrees C. At 42.5 degrees C there was almost total recovery of the thermotrophic Enterobacteriaceae, whereas the psychrotrophic strains were completely suppressed. At 37 degrees C the psychrotrophs were only slightly inhibited. The Philippine foods, predominantly cooked meals, milk and drinking water, appeared to be significantly colonized by thermotrophic Enterobacteriaceae. It is concluded that incubation at 42.5 degrees C satisfactorily selects enteropathogenic and other enteric Enterobacteriaceae while suppressing the psychrotrophic types which are mainly of vegetable origin. It is emphasized that, regardless of the temperature used, a resuscitation procedure for Enterobacteriaceae populations that have incurred sublethal injury in food has to precede counts on or in the usual selective media.