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Article ; Online: The challenge: streamlining HIV treatment and care while improving outcomes.

Clumeck, Nathan

Journal of the International AIDS Society

2014 Volume 17, Issue 4 Suppl 3, Page(s) 19493

Abstract: ART coverage among HIV-positive population varies, depending on the countries, between 10% (e.g. Indonesia) and 65% (Botswana). Death rates and new HIV infections have been linked to ART coverage. Therefore, streamlining tasks and roles to expand ... ...

Abstract	ART coverage among HIV-positive population varies, depending on the countries, between 10% (e.g. Indonesia) and 65% (Botswana). Death rates and new HIV infections have been linked to ART coverage. Therefore, streamlining tasks and roles to expand treatment and care and to provide quality and equitable health is an ongoing concern globally. One concept that has been applied to improve the delivery of HIV services is that of task shifting. Defined as the systematic delegation of tasks from doctors to cadre with less training such as nurses or lay workers, task shifting has been used as an effective strategy to address the current healthcare worker shortage in many African countries. A body of literature supports the use of task shifting as a successful approach in delivering healthcare services including HIV testing, counselling and ART treatment. In addition, in a time of economic burden and scare resources, task shifting may also help to relieve the situation. This concern is highlighted in recommendation of WHO to strengthen and expand human capacity among healthcare workers. The major issues that are raised are: How can task shifting be implemented in a way that is sustainable? How can clinical care services be organized to maximize the potential of the task-shifting approach while ensuring safety, efficiency and effectiveness? What preconditions must be met, what are the country-specific factors that will guide decision-making in the implementation of task shifting? In addition, task shifting should be implemented alongside other efforts to increase the numbers of skilled health workers. Quality assurances mechanisms should provide the necessary checks balances to protect both service users and health workers.
Language	English
Publishing date	2014
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2467110-1
ISSN	1758-2652 ; 1758-2652
ISSN (online)	1758-2652
ISSN	1758-2652
DOI	10.7448/IAS.17.4.19493
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Article: La lutte contre le Sida; entre nouveaux paradigmes et inerties.

Clumeck, N

Bulletin et memoires de l'Academie royale de medecine de Belgique

2010 Volume 165, Issue 3-4, Page(s) 173–7; discussion 177–9

Abstract: Recent statistics on the global HIV epidemic illustrate that HIV incidence continues to increase and provide stark reminders of the urgent need for new and more effective HIV prevention tools. The new paradigm of HIV prevention strategies consists on a ... ...

Title translation	The struggle against AIDS: between new paradigms and inertia.
Abstract	Recent statistics on the global HIV epidemic illustrate that HIV incidence continues to increase and provide stark reminders of the urgent need for new and more effective HIV prevention tools. The new paradigm of HIV prevention strategies consists on a biomedical approach including circumcision, vaginal microbicides, pre and post exposure prophylaxis and the treatment of the infected individual. The goal of the ARV therapy is to reach level of plasma HIV indetectability. At less than 20c/ml the risk of sexual transmission is equal to zero. A mathematical model shows that by universal testing associated with immediate therapy the epidemic could be driven towards elimination by the year 2020. It is anticipated that there will be substantial barriers to making biomedical HIV prevention tools available to individuals who are the highest risk of infection. Operationalizing biomedical approaches will require tight links between HIV testing and treatment programs, as HIV testing will be the common entry point for people to receive either biomedical prevention tools or treatment.
MeSH term(s)	Acquired Immunodeficiency Syndrome/prevention & control ; Attitude to Health ; Circumcision, Male ; Epidemics ; Global Health ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; HIV Infections/therapy ; HIV Infections/transmission ; Humans ; Male
Language	French
Publishing date	2010
Publishing country	Belgium
Document type	English Abstract ; Journal Article
ZDB-ID	1445946-2
ISSN	0377-8231
ISSN	0377-8231
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Article: La gestion et le traitement des patients infectés par le "pandemic A/H1N1 2009 influenza virus" en milieu hospitalier.

Clumeck, N

Bulletin et memoires de l'Academie royale de medecine de Belgique

2009 Volume 164, Issue 10, Page(s) 288–290

Title translation	Management and treatment of patients infected with the. "pandemic A/H1N1 2009 influenza virus" in a hospital milieu.
MeSH term(s)	Disease Outbreaks ; History, 21st Century ; Humans ; Influenza A Virus, H1N1 Subtype/pathogenicity ; Influenza, Human/therapy ; Inpatients
Language	French
Publishing date	2009
Publishing country	Belgium
Document type	Historical Article ; Journal Article
ZDB-ID	1445946-2
ISSN	0377-8231
ISSN	0377-8231
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Article: The rapid evolution of HIV therapy.

Clumeck, N

HIV medicine

2001 Volume 1, Issue 2, Page(s) 75

MeSH term(s)	Anti-HIV Agents/adverse effects ; Anti-HIV Agents/therapeutic use ; HIV Infections/drug therapy ; Humans ; Practice Guidelines as Topic ; United Kingdom
Chemical Substances	Anti-HIV Agents
Language	English
Publishing date	2001-11-16
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	2001932-4
ISSN	1464-2662
ISSN	1464-2662
DOI	10.1046/j.1468-1293.2000.00014.x
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Article: The debate on HIV in Africa.

Clumeck, N

Lancet (London, England)

2000 Volume 355, Issue 9221, Page(s) 2162

MeSH term(s)	Attitude to Health ; HIV Infections/prevention & control ; Humans ; Politics ; South Africa
Language	English
Publishing date	2000-06-17
Publishing country	England
Document type	Comment ; Letter
ZDB-ID	3306-6
ISSN	1474-547X ; 0140-6736 ; 0023-7507
ISSN (online)	1474-547X
ISSN	0140-6736 ; 0023-7507
DOI	10.1016/s0140-6736(00)02391-6
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Article: Choosing the best initial therapy for HIV-1 infection.

Clumeck, N

The New England journal of medicine

1999 Volume 341, Issue 25, Page(s) 1925–1926

MeSH term(s)	Benzoxazines ; Drug Therapy, Combination ; HIV Infections/drug therapy ; HIV Protease Inhibitors/therapeutic use ; HIV-1 ; Humans ; Indinavir/therapeutic use ; Nelfinavir/therapeutic use ; Oxazines/therapeutic use ; RNA, Viral/blood ; Reverse Transcriptase Inhibitors/therapeutic use
Chemical Substances	Benzoxazines ; HIV Protease Inhibitors ; Oxazines ; RNA, Viral ; Reverse Transcriptase Inhibitors ; Indinavir (5W6YA9PKKH) ; Nelfinavir (HO3OGH5D7I) ; efavirenz (JE6H2O27P8)
Language	English
Publishing date	1999-12-16
Publishing country	United States
Document type	Comment ; Editorial
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJM199912163412510
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Article: SIDA: impact des nouvelles molécules.

Clumeck, N

Revue medicale de Bruxelles

1999 Volume 20, Issue 4, Page(s) A373–6

Abstract: In recent times important progress has been made in the treatment of HIV. Plasma viral load count is now used in routine practice permitting a accurate evaluation of each patient and in particular the risk of progression to symptomatic AIDS. A better ... ...

Title translation	AIDS: the impact of new molecules.
Abstract	In recent times important progress has been made in the treatment of HIV. Plasma viral load count is now used in routine practice permitting a accurate evaluation of each patient and in particular the risk of progression to symptomatic AIDS. A better understanding of the natural history of HIV has enabled physicians to recognise the need for commencing treatment early. The availability of more effective therapies like protease inhibitors and their use in tritherapy regimens permit more ambitious therapeutic strategies aimed at prolonging life and perhaps even viral eradication. Already the first positive effects of these treatments have been observed with the reduction of mortality and in hospitalisation rates, etc. The impact of these developments on the prevention and testing for HIV is of course very important with the risk of a demobilizing effect in primary as much as in secondary HIV prevention. Conversely the possibility of very early treatment is a major argument for effective education on early HIV testing. The future politics of prevention and testing must be elaborated taking into account these changes in the public perception of HIV.
MeSH term(s)	AIDS Serodiagnosis ; Acquired Immunodeficiency Syndrome/drug therapy ; Acquired Immunodeficiency Syndrome/prevention & control ; Anti-HIV Agents/therapeutic use ; Disease Progression ; Drug Combinations ; HIV ; HIV Infections/drug therapy ; HIV Infections/prevention & control ; HIV Protease Inhibitors/therapeutic use ; Health Policy ; Humans ; Risk Factors ; Survival Rate ; Viral Load
Chemical Substances	Anti-HIV Agents ; Drug Combinations ; HIV Protease Inhibitors
Language	French
Publishing date	1999-09
Publishing country	Belgium
Document type	English Abstract ; Journal Article
ZDB-ID	760217-0
ISSN	0035-3639
ISSN	0035-3639
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Article: Stavudine plus a non-thymidine nucleoside reverse transcriptase inhibitor as a backbone for highly active antiretroviral therapy.

Clumeck, N

Antiviral therapy

1998 Volume 3 Suppl 4, Page(s) 39–43

Abstract: Current guidelines for treatment of human immunodeficiency virus (HIV) disease favour the use of triple-drug combinations consisting of two nucleoside analogue reverse transcriptase inhibitors (NRTIs) plus a protease inhibitor to achieve maximum ... ...

Abstract	Current guidelines for treatment of human immunodeficiency virus (HIV) disease favour the use of triple-drug combinations consisting of two nucleoside analogue reverse transcriptase inhibitors (NRTIs) plus a protease inhibitor to achieve maximum suppression of HIV replication. There is considerable evidence for including one thymidine NRTI to target activated HIV host cells and one non-thymidine NRTI to target quiescent host cells as the backbone of such regimens. A number of recent studies have shown that stavudine in combination with didanosine or lamivudine is at least as effective as zidovudine-based combinations with regard to virological outcomes, with available data suggesting an enhanced effect on immunological outcome with stavudine-based combinations. When considered along with such advantageous characteristics of stavudine as infrequent and low-level resistance and good cerebrospinal fluid penetration, these findings indicate that stavudine in combination with didanosine or lamivudine should be considered for use as the backbone of multiple-agent highly active antiretroviral therapy (HAART).
MeSH term(s)	Clinical Trials as Topic ; Didanosine/therapeutic use ; Drug Therapy, Combination ; HIV Infections/drug therapy ; Humans ; Lamivudine/therapeutic use ; Retroviridae/drug effects ; Reverse Transcriptase Inhibitors/therapeutic use ; Stavudine/therapeutic use ; Zidovudine/therapeutic use
Chemical Substances	Reverse Transcriptase Inhibitors ; Lamivudine (2T8Q726O95) ; Zidovudine (4B9XT59T7S) ; Stavudine (BO9LE4QFZF) ; Didanosine (K3GDH6OH08)
Language	English
Publishing date	1998
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1339842-8
ISSN	1359-6535
ISSN	1359-6535
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Article ; Online: Isolation unit for multidrug-resistant tuberculosis patients in a low endemic country, a step towards the World Health Organization End TB Strategy.

Payen, M C / VAN Vooren, J P / Vandenberg, O / Clumeck, N / DE Wit, S

Epidemiology and infection

2017 Volume 145, Issue 7, Page(s) 1368–1373

Abstract: Tuberculosis (TB) remains a threat to public health and is the second cause of death due to a single infectious agent after HIV/AIDS. The worldwide distribution of TB is heterogeneous. The incidence is decreasing in most high-income regions, but the ... ...

Abstract	Tuberculosis (TB) remains a threat to public health and is the second cause of death due to a single infectious agent after HIV/AIDS. The worldwide distribution of TB is heterogeneous. The incidence is decreasing in most high-income regions, but the situation remains worrying in many parts of the world. The emergence of Mycobacterium tuberculosis strains resistant to key agents used in treatment (rifampin and isoniazid) contributes to TB transmission around the world. To achieve TB elimination, both high and low endemic countries must upscale their efforts to decrease disease transmission and improve cure rates. Management of drug-resistant TB is of particular importance. In this paper, we discuss the different models of care of multidrug-resistant TB (MDR-TB), the ethical considerations and the specific constraints present in high income countries. The management model chosen by the Belgian TB specialists in accordance with public health authorities as well as building of a specific MDR/XDR-TB isolation unit are also discussed.
MeSH term(s)	Antitubercular Agents/therapeutic use ; Belgium ; Communicable Disease Control/methods ; Extensively Drug-Resistant Tuberculosis/drug therapy ; Extensively Drug-Resistant Tuberculosis/therapy ; Mycobacterium tuberculosis/drug effects ; Mycobacterium tuberculosis/physiology ; Patient Isolation/instrumentation ; Patient Isolation/methods ; Tuberculosis, Multidrug-Resistant/drug therapy ; Tuberculosis, Multidrug-Resistant/therapy
Chemical Substances	Antitubercular Agents
Language	English
Publishing date	2017-02-16
Publishing country	England
Document type	Journal Article
ZDB-ID	632982-2
ISSN	1469-4409 ; 0950-2688
ISSN (online)	1469-4409
ISSN	0950-2688
DOI	10.1017/S0950268817000267
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Article ; Online: Effects of switching to protease inhibitor monotherapy on nucleoside analogue-related adverse events.

Clumeck, Nathan / Hill, Andrew / Moecklinghoff, Christiane

AIDS reviews

2014 Volume 16, Issue 4, Page(s) 236–245

Abstract: Switching from triple combination treatment to protease inhibitor monotherapy may increase the risk of elevations in HIV RNA, and is not recommended in most international treatment guidelines. However, the use of protease inhibitor monotherapy could ... ...

Abstract	Switching from triple combination treatment to protease inhibitor monotherapy may increase the risk of elevations in HIV RNA, and is not recommended in most international treatment guidelines. However, the use of protease inhibitor monotherapy could prevent or reverse adverse events related to long-term use of nucleoside analogues, such as lipoatrophy, renal adverse events, osteopenia, and anemia. A detailed MEDLINE search was conducted to identify randomized clinical trials of triple-combination treatment versus protease inhibitor monotherapy with detailed analyses of safety. Summary results from analysis of changes in body composition, changes in lipids, renal adverse events, and anemia were evaluated for patients taking either protease inhibitor monotherapy or triple therapy. In six trials with dual-energy X-ray absorptiometry data available, the percentage of patients with lipoatrophy was significantly lower in the protease inhibitor monotherapy arms than the triple therapy arms (p = 0.03). In these trials there was also no significant difference in the risk of lipohypertrophy between protease inhibitor monotherapy and triple therapy arms. In one trial there was a higher risk of renal adverse events for patients taking tenofovir in the triple therapy arm. In two trials there were rises in total cholesterol when patients stopped taking tenofovir in the protease inhibitor monotherapy arms. In conclusion, there is a mixed pattern of changes in nucleoside analogue-related adverse events after switching from triple therapy to protease inhibitor therapy. The potential for safety benefits of stopping nucleoside analogues needs to be set against a higher risk of HIV RNA elevations during protease inhibitor monotherapy.
MeSH term(s)	Absorptiometry, Photon ; Anemia/chemically induced ; Anemia/physiopathology ; Anemia/prevention & control ; Anti-HIV Agents/administration & dosage ; Anti-HIV Agents/adverse effects ; Body Fat Distribution ; Bone Density/drug effects ; Bone Diseases, Metabolic/chemically induced ; Bone Diseases, Metabolic/physiopathology ; Bone Diseases, Metabolic/prevention & control ; Drug Substitution ; Drug Therapy, Combination ; Follow-Up Studies ; HIV Infections/drug therapy ; HIV Infections/physiopathology ; HIV Protease Inhibitors/administration & dosage ; HIV Protease Inhibitors/adverse effects ; HIV-Associated Lipodystrophy Syndrome/chemically induced ; HIV-Associated Lipodystrophy Syndrome/physiopathology ; Humans ; Lipids/blood ; Nucleosides/administration & dosage ; Nucleosides/adverse effects ; Practice Guidelines as Topic ; RNA, Viral/drug effects ; Randomized Controlled Trials as Topic ; Treatment Outcome ; Viral Load
Chemical Substances	Anti-HIV Agents ; HIV Protease Inhibitors ; Lipids ; Nucleosides ; RNA, Viral
Language	English
Publishing date	2014-10
Publishing country	Spain
Document type	Journal Article ; Meta-Analysis ; Review
ZDB-ID	2086783-9
ISSN	1698-6997 ; 1139-6121
ISSN (online)	1698-6997
ISSN	1139-6121
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