CarePack® for HIV Programmes
In many parts of the world access to care and treatment is limited. There, interventions to prevent opportunistic infections can have a great impact.
The World Health Organization and the Centers For Disease Control recommend that people with HIV in resource-limited settings have access to essential interventions to prevent illness and HIV transmission.
Vestergaard has developed a CarePack® preventive care package, which is comprised of evidence-based interventions designed to improve the health of HIV positive individuals and their families. These interventions targeting infectious diseases are user-friendly and self-managed, which empowers HIV positive individuals to protect themselves.
A standard CarePack® for an HIV programme includes:
- A PermaNet® long-lasting insecticidal net that can prevent malaria and other vector-borne diseases
- A LifeStraw® Family household water purifier that can prevent diarrhea and other waterborne diseases
- Printed health education material providing tips on prevention of malaria, diarrhea, and sexually-transmitted diseases
- Condoms, broad-spectrum antibiotics and other items may also be added to the CarePack® depending on country requirements.
Supply chain interventions that require monthly provision create complex supply chains. This is an impediment to the rapid scale up and success of a public health programme. Therefore, the standard components of CarePack® have been designed to be long-lasting and last for a minimum of three years.
Delaying HIV Disease Progression with CarePack®
HIV positive individuals are often infected for many years before the virus eventually weakens their immune system to a point where they start becoming sick and require drugs to treat the HIV infection (ART). During this time, recurrent infections with malaria and diarrheal diseases may accelerate the progression of the HIV disease. In addition, these infections may lead to an increased amount of the HIV virus in their blood, leading to possible increases in the risk of HIV transmission to their partners.
Providing effective interventions to prevent malaria and diarrheal disease may represent a practical and relatively inexpensive strategy to delay the progression of HIV and, possibly, to reduce HIV transmission.
A 2-year study in Kenya1 measured the impact of PermaNet® long-lasting insecticidal net (LLIN) and LifeStraw® Family water purifier on HIV disease progression by monitoring CD4 counts. The primary measure of efficacy was time to reach a CD4 count of 350 cells or below which was the retro viral therapy.
The results were as follows:
- Individuals receiving the LLIN and water purifier were 27 percent less likely to reach the endpoint of CD4 count.
- CD4 decline was also significantly less in the group receiving the LLIN and water purifiers than in the control group ( 54 vs. -71 cells/mm /year, p=0.03).
Cost-Effectiveness of Delaying HIV Disease Progression with CarePack®
Delaying the time to start treatment has obvious economic benefits for programmes due to the reduction in ART and healthcare costs.
A cost and cost effectiveness study2 of the Kenya multisite study gave the following results:
- Net cost savings of about USD26,000 for the intervention, over 1.7 years for healthcare providers due to reduced ART use and malaria and diarrhea cases.
- The intervention was found to be very cost-effective at a cost of US$ 3100 per death averted or US$ 99 per disability-adjusted life year (DALY) averted.
- The provision of LLINs and water filters to ART-naive HIV-infected adults in the Kenyan study resulted in substantial net cost savings, due to the delay in the initiation of ART. The addition of an LLIN and a point-of-use water filter to the existing package of care provided to ART-naıve HIV-infected adults could bring substantial cost savings to resource-constrained health systems in low- and middle-income countries.
Reduction of Diarrheal Diseases with LifeStraw® Family
Unsafe drinking water presents a particular threat to people living with HIV/AIDS (PLHIV) due to the increased risk of opportunistic infections, diarrhea-associated mal absorption of essential nutrients, and increased exposure to untreated water for children of HIV-positive mothers who use replacement feeding to reduce the risk of HIV transmission. This population may particularly benefit from an intervention to improve water quality in the home.
A 12-month randomized, controlled field trial was conducted in Zambia among 120 households with children.3
Findings from the study:
- Filter use was high, with 96% (596/620) of household visits meeting the criteria for users.
- The quality of water stored in intervention households was significantly better than in control households (3 vs. 181 TTC/100 mL, respectively, p<0.001).
- The intervention was associated with reductions in the longitudinal prevalence of reported diarrhea of 53% among children.
In this population living with HIV/AIDS, a water filter combined with safe storage was used correctly and consistently, was highly effective in improving drinking water quality, and was protective against diarrhea.
1Walson J. (2013). Evaluation of impact of long-lasting insecticide-terated bed nets and point-of-use water filters on HIV-1 disease progression in Kenya. AIDS. 2013 Jun 1;27(9):1493-501.
2Kern E. (2013). Provision of bednets and water ilters to delay HIV1 progrssion: cost-effectiveness analysis of a Kenyan multisite study. Trop Med Int Health. 2013 Aug 18(8):916-24.
3Peletz R (2012). Assessing water filtration and safe storage in households with young children of HIV-positive mothers: a randomized, controlled trial in Zambia. PLoS One. 2012;7(10):e46548.