This document summarizes key points from a clinical workshop on HIV and Hepatitis held in Nepal in November 2018. It discusses Nepal's goals of ending the AIDS epidemic by 2030 through strategies like increasing HIV testing and treatment. Testing and treatment access remains low for key populations like female sex workers, transgender individuals, and injecting drug users. The workshop covered improving screening, expanding access to pre-exposure prophylaxis and antiretroviral treatment, and transitioning from preventing mother-to-child transmission to eliminating it.
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
NATIONAL AIDS CONTROL PROGRAM
1992- - NACP 1 launched to show down the spread of HIV infection
- national AIDS control board constituted
- NACO setup
1999- - NACP 2 begins focusing on behaviour change , increased decentralization and NGO involvement.
- state AIDS control societies developed .
2002- - national AIDS control policy adopted.
- national blood policy adopted.
2004- - antiretroviral treatment initiated .
2006- - national council on AIDS constituted under chairmanship of prime minister.
- national policy on paediatric ART formulated.
2007- - NACP 3 launched for years (2007-2012)
2012- - NACP 4 launched for next 5 years
Gabriel Wagner, MD
Assistant Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
NACP (National AIDS Control Programme) launched on February 12 ,2014. The Objectives was:
- Reduce new infections by 50% (2007 Baseline of NACP III)
- Comprehensive care, support and treatment to all persons living with HIV/AIDS
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Annette Verster, WHO
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
NATIONAL AIDS CONTROL PROGRAM
1992- - NACP 1 launched to show down the spread of HIV infection
- national AIDS control board constituted
- NACO setup
1999- - NACP 2 begins focusing on behaviour change , increased decentralization and NGO involvement.
- state AIDS control societies developed .
2002- - national AIDS control policy adopted.
- national blood policy adopted.
2004- - antiretroviral treatment initiated .
2006- - national council on AIDS constituted under chairmanship of prime minister.
- national policy on paediatric ART formulated.
2007- - NACP 3 launched for years (2007-2012)
2012- - NACP 4 launched for next 5 years
Gabriel Wagner, MD
Assistant Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
NACP (National AIDS Control Programme) launched on February 12 ,2014. The Objectives was:
- Reduce new infections by 50% (2007 Baseline of NACP III)
- Comprehensive care, support and treatment to all persons living with HIV/AIDS
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Annette Verster, WHO
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
National guidelines for HIV care and treatment 2021SHOEBULHAQUE1
ART is the cornerstone of HIV treatment. The National AIDS Control Organization (NACO) in India provides free antiretroviral drugs to people living with HIV through various ART centers across the country. The treatment aims to suppress the virus, boost the immune system, and improve overall health.
Jill Blumenthal, MD
Assistant Professor of Medicine
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Michael Tang, MD
Infectious Disease Fellow
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Dr Paba Palihawadana, Chief Epidemiologist, World Hepatitis Day symposium was organized by the Sri Lanka College of Venereologists on world hepatitis day on 28. July 2015 at BMICH
Similar to 8th jan 19 HIV & Hepatitis updates Part I (20)
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
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In the DSM-5, all types of substance abuse and dependence have been
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The four main behavioral effects of AUD are impaired control over
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. Narrative (Part I)
of
Clinical Workshop on HIV & Hepatitis
(attended in KTM on NOV 20-22, 2018, organized by WHO & NCASC)
by:
Dr. Pawan KB Agrawal,
MBBS, MDGP (IOM, Maharajgunj), Distance Fellowship in Diabetes Management (CMC, Vellore)
Consultant, General Practice & Emergency, Nyaya Health Nepal-Possible
8th January, 2019, Tuesday
3. Objectives
• General
• To disseminate HIV & Hepatitis B & C guidelines for building capacity of the
program managers at national & provincial level
• Specific
• To review the national progress on testing and treatment for HIV and
Hepatitis
• To provide updated recommendation on HIV and Hepatitis testing and
treatment
4.
5. “ENDING AIDS EPIDEMIC BY 2030”
Fast Track Targets
Indicator 2016 2020 2030
HIV new
infection
1,800,000 500,000 200,000
HIV deaths 1,000,000 500,000 400,000
ART
coverage
19,500,000 30,000,000 33,000,000
6. Nepal’s perspective
• First HIV diagnosed in 1988
• Estimated number: 31,020
• HIV prevalence in general population <1% and in KPs <5%.
• New HIV infections: 835
• HIV related deaths: 1,306
• Source: NCASC, 2017
7. Nepal’s perspective
• 73 ART sites in 59 districts by Jul 2018
• ART dispensing sites in rest of the districts except Rukumkot.
• 16,428 (out of 31,020) currently under ART.
• Source: NCASC, 2017
8.
9. National HIV Strategic Plan
• Targets 90-90-90 by 2020 and 95-95-95 by 2030
•90%of people with HIV known their status
•90% of people who know their status are on ART
•90% of people on ART achieve viral suppression
10.
11.
12. National HIV Strategic Plan
• Eliminate vertical transmission of HIV
• Eliminate congenital syphilis
• Reduce 75% of new HIV infections
13. Key achievements
• Reduction of HIV prevalence in general population
(0.55% in 2005 to 0.15% in 2017)
• Reduction of HIV prevalence in PWID (68% in 2002 to
8.5% in 2017)
14. Pertaining facts from NDHS 2016
• 81% women & 98% men have heard of HIV
• 72% women and 92% men are aware of STI
prevention using condom.
• 34% women and 58% men know where to seek for
their HIV status.
15. Key Population
• Six as per National HIV Strategic Plan
• Relative risk:
FSW, TG 13X < PWID 22X < MSM 28X
• Only one third of overall prevalent infection in KPs
• However, two thirds of new infection are seen in KPs
• Remarkably low levels of access to HIV treatment & prevention
among KPs
17. Contributors to AIDS Epidemic
• Dwindling international funding and NGOs
• Inequities in budget allocation for KP targeted programs
• Lack of local data
• Enormous time loss between data collection and action
• Restrictive laws and policies towards KPs Stigma
Loss of access to prevention, screening and treatment
18.
19. How to curb the epidemic??
• Identification of key population
• Combination prevention
• Strengthening of HIV screening, treatment and viral load suppression
• Enabling environment
• Strategic information generation and dissemination
• Financial sustainability
20. Increase access to screening
• Community based approaches
• Partner testing
• HIV self testing
• Testing narrative needs to change from
“everybody has the right to refuse a test” to
“everybody has the right to test”
21. Task sharing in screening
• A fundamental approach to ensure universal health coverage.
• National HIV Strategic Plan (2016-21) mentions that “Nepal will roll
out HIV screening by trained lay providers (TLPs) to increase HIV
testing among key population”
• The TLPs should belong to community of interest.
• Major role of TLPs:
• screening,
• ensuring referral for confirmation,
• supporting clients in access to ART and thereafter continuation
• perform under supervision of a lab assistant
22.
23.
24.
25.
26.
27.
28.
29. • HIV DNA PCR is used for early infant diagnosis.
• For those infected before and during birth, the sensitivity of the test
is 40-50% in the first 48 hours of life, 90% at 14 days of age and >95%
at six weeks of age.
• Samples for DNA PCR can be collected in DBS paper specialized for
nucleic acid
30. Access & Quality of ART
• Treat all
• ART distribution by TLPs as well
• Better adherence
• Cost NPR 30,000/month in 1998 to NPR 1000/month at present
• 32 pills to 1 pill per day (TDF 300 + 3TC 300 + EFV 600 containing FDC at
bedtime)
• Better drugs with reduced side effects are available over the time.
• Monitoring of treatment
31.
32.
33. Dolutegravir
• Approved in 2013
• Showed earlier viral suppression ( 4 Vs 12 wks)
• Improved side effect profile
• Low incidence of resistance.
• Effective in pregnancy as well (signals of NTD
have been generated however)
34.
35. Pre exposure prophylaxis
• Recommended for
• People at substantial risks
• Serodiscordant couples
• Client whose partner are hesitant to start ART
• MSMs
• FDA approved in 2012
• WHO recommendation in 2016
36.
37. Pre exposure prophylaxis
• Relative risk reduction ranges from 44% to 86% in different studies.
• TDF alone or in combination with 3TC or FTC are recommended
• Regimen: TDF 300 + FTC 200 daily X 90 days
38.
39.
40. Pre exposure prophylaxis
• Indication
• HIV negative
• Seropositive spouse without viral suppression
• Multiple sexual partner
• Hesitancy to use condoms
• History of postexposure prophylaxis
• On request
41. Pre exposure prophylaxis
• Contraindications
• HIV positive
• CrCl <60ml/min
• Acute HIV infection with recent exposure to HIV
• Allergy to PrEP regimen
• Side effect
• 1 in 10 have nausea, abdominal cramps and headache which resolve over the
duration of first month.
• 1 in 200 may have Cr elevation (reversible on discontinuation)
42.
43. Path ‘PMTCT’ to ‘EMTCT’
• MTCT rate of HIV <2% in non breast feeding and <5% in breast feeding
populations. AND
• A case rate of new pediatric HIV infection due to MTCT of ≤50 cases
per 100,000 live births.
• A case rate of congenital syphilis of ≤50 cases per 100,000 live births.
Editor's Notes
Sex workers; MSM; PWID; Client of sex workers; Male labor migrants and prison population and TB
However, first line for HIV-2 infection: Tenofovir (300mg) plus Lamivudine (300mg) plus Lopinavir/Ritonavir (800/200 mg)