Pakistan is a nation in the Asia-Pacific region where new HIV infections have been growing at an alarming rate since 2010. The Asia-Pacific region had an estimated 5.8 million people living with HIV (PLHIV) in 2019.
Along with some Central Asian countries, Bangladesh, the Philippines, Pakistan, and Afghanistan are facing a rapidly spreading HIV epidemic.
This was stated by Dr. Sharaf Ali Shah, an internationally recognized Pakistani expert on HIV / AIDS, in his research paper on the challenges of antiretroviral treatment for human immunodeficiency virus infection in Pakistan.
He said that in these eight years, the number of new infections in Pakistan increased by 75% between 2010 and 2018. According to the National AIDS Control Program (NACP), there are an estimated 180,000 PLHIVs in the country, of which only 23,592 (13.1%) are receiving antiretroviral treatment (ART).
Of those with ART, 6,933 (29.3%) are vaccinated with PWIDs. UNAIDS also reported in 2018 that only 14% of PLHIVs in Pakistan were aware of their HIV status and there were 22,000 new infections a year. This is far below UNAIDS and WHO’s 90-90-90 targets for 2020 in which 90% of PLHIVs should know their status, 90 of them are linked to AR ART-based clinical care, and 90 * Verbal pressure on caregivers, Dr. Shah added.
Dr. Shah said in his article that while the national level of HIV is less than one percent (0.1%), the HIV epidemic in Pakistan has been at a concentrated stage for at least two decades. I have an epidemic of more than 5% in one or more. A significant population (KP). The national HIV prevalence among PWIDs was 37.8 percent in 2011 and estimated at 38.4 percent in 2016-17, according to a survey cited in the article.
The prevalence of HIV among transgender people (TGs) in the country was reported to be 7.2 percent in 2011 and 7.5 percent in 2016-17. Program life statistics from a non-governmental organization (NGO) that provides damage reduction services to PWID in 38 districts of the country show that from 2011 to 2019, PWID The prevalence of HIV had reached 46.1%. Even recognizing methodological limitations to the use of programmatic data for monitoring, such as the opportunity for duplicates, ie repeating the actions of the same person, this number is alarming.
Dr. Sharaf Shah says that in April 2019, a small town in the rural province of Sindh, Pakistan, reported an unusual outbreak of HIV in the community. It affected a large number of the general population, mostly children. Following the confirmation of the pandemic in children in Ratodero, HIV testing in the area tested 31,239 people and confirmed 930 (3%) HIV positive, 763 (82%) of which There were 604 children under the age of 16 and (79%) five years or younger. Six months after the outbreak of Ratodero, 15 new cases of HIV have been reported from nine different villages in rural areas around Hyderabad, Sindh Province.
Given the high rates of infection in children, the unsafe use of needles and syringes for medical care or vaccination was suggested as a non-source source of infection.
With the growing number of new HIV cases, he says, there are serious challenges to accessing and adhering to ART therapy. Although the NACP has established 45 HIV treatments in all four provinces of the country in collaboration with the Global Fund, PLHIV often travels long distances for care and pays out-of-pocket expenses for travel expenses. Is. Given the shortage of infectious disease specialists, ART centers are rarely monitored by specialists.
Disrupting the supply of ART also remains a challenge. ARTs are not manufactured in Pakistan and are imported through a global fund to fight the country’s support for AIDS, tuberculosis and malaria. Pediatric formulations in particular have stockpile issues, as noted in Pepper programs in Africa. HIV drug resistance is an additional serious global health risk that could affect HIV treatment outcomes in low- and middle-income countries, including poor health care systems, care limitations, and so on. Lack of line art regime, and most viral monitoring. HIV drug resistance could undermine UNAIDS Fast Track’s goal of eradicating AIDS by 2030.
He said that the overall provision of health care and prevention services globally has been severely affected by the outbreak of Code 19 epidemic and Pakistan is no exception. As of September 28, 2020, there were 310,841 confirmed confirmed 19 cases and 6,466 deaths in Pakistan. People living with HIV with advanced disease (such as not on treatment or not on oral contraceptives) may have a higher risk of Covid-19. Statistics on PLHIV with cohyde 19 or deaths due to coronavirus infection are not available in Pakistan.
Dr. Shah advises that adherence to ART is essential to reduce the risk of persistent viral stress and opportunistic infections. Studies According to a meta-analysis of studies, only ٪٪ HIV patients received maximum follow-up (> 90% prescribed medication). Restrictions on ART remain a challenge in Pakistan. Most PLHIVs in Pakistan who are known for their HIV status belong to a significant population, including PWIDs who are often homeless and lack family support. Therefore, PWIDs face serious challenges in complying with ART.
In 2019, the International Fund launched a study in all four provinces, as well as in the Islamabad Capital Territory, to determine how well PLHIV is responding to HIV treatment. The treatment data includes an arm of 24 centers receiving 846 PLHIV treatments from 246 centers and an additional 12-month collaboration with 1086 PLHIVs in 28 treatment centers. Over a 12-month period, only 26% of PLHIVs were retained in care, while in the 24-month cohort, only 11% were fully maintained. As a proxy for maintenance, this study looked at the regularity of the monthly ART visits of patients on both coaches, ie, what they indicated for each visit to the ART center.
The article says that in order to make ART accessible at the district level in Pakistan, the number of HIV treatments should be increased. All HIV treatments should work under the supervision of a specialist in infectious disease training, and this will improve staff training along the national guidelines of ART, advancing telemedicine in the era of CoV 19. May be followed by
Genetic typing for HIV drug resistance should be enhanced (molecular monitoring) to help healthcare providers choose appropriate ART arrangements. Better client counseling on ART, including community home-based care for people living with HIV. Dr. Shahraf Ali Shah concluded, and has improved professionalism in HIV treatment at all levels to protect the privacy and human rights of PLHIV and their families.
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