The CarePack Concept

Infectious diseases claim the lives of millions each year. HIV-infected people have compromised immune systems and are at a much greater risk for serious repercussions from common illnesses and opportunistic infections. Preventive-care interventions can reduce the risk of diarrhoea and malaria amongst other diseases, which can complicate or threaten the lives of these vulnerable people. The World Health Organization recommends that people living with HIV in resource-limited settings should have access to essential interventions to prevent illness and HIV transmission. They should also benefit from HIV prevention and care, including a core set of effective interventions that are simple, relatively inexpensive, can improve the quality of life, prevent further transmission of HIV, and for some interventions, delay progression of HIV disease. Vestergaard Frandsen has developed a CarePack, which is comprised of evidence-based interventions designed to improve the health of HIV-infected individuals and their families. These preventive-care interventions are designed to be user-friendly and self-managed, thus empowering HIV-infected people to protect themselves from acquiring opportunistic infections. A standard CarePack includes a long-lasting insecticidal net (LN) that can prevent malaria and other vector-borne diseases; an instant microbiological water purifier that can avert diarrhoeal diseases and printed education material providing tips on prevention of malaria, diarrhoea and sexuallytransmitted diseases. Condoms for practicing safe sex and a broad-spectrum antibiotic may also be added in the CarePack depending on country regulations/ programme requirements. Other items as per country requirements may be considered on a case-to-case basis. Repeat intervention is an impediment in the rapid scale-up and success of a public health programme. Therefore, the standard components of CarePack have been designed to be long-lasting in nature and are expected to last for a minimum of three years. When used appropriately, CarePack helps maintain the health of HIV-infected people. Therefore, it has the potential to delay the progression of HIV to AIDS. It can benefit all people living with HIV, whether or not they are on antiretroviral therapy (ART), as well as their family members.

HIV/AIDS and Other Opportunistic Infections

Diarrhoea affects 90% of people living with HIV/AIDS (PLWHA) and results in significant morbidity and mortality.1,2 The risk of dying from diarrhoea is 11 times greater for infants who are HIVinfected.3 In Africa, diarrhoea is four times more common among HIV-infected children and seven times more common among HIV-infected adults than their HIVuninfected household members.4 Diarrhoea increases the HIV viral load by 0.71 log10 per person-year.5 HIV infection has been linked to a doubling in the frequency of malaria and lower CD4-cell counts are associated with a greater risk of malaria.6 Malaria contributes to increased viral load among HIV-infected people.7 Every episode of malaria reduces the CD4 count by 40, thus fast-tracking introduction of ARTs.8

Evidence-based Findings from Published Studies

The provision of a basic care package could be an important step toward reducing health care disparities and gaining more control of the global HIV/AIDS epidemic. -Mermin J et al (2005) Developing an evidence-based, preventive care package for persons with HIV in Africa.

Use of safe water decreased diarrhoeal illness by 36% among HIV-infected persons.5 Combination of co-trimoxazole prophylaxis, antiretroviral therapy and ITNs substantially reduced the severity of malaria in adults with HIV.9 Randomized trials of bednets have shown a 50% reduction in malaria and a 17% reduction in all cause mortality among children.9 Combination of co-trimoxazole, ART and ITNs reduced the incidence of malaria by 95% in a study in Uganda. Compared with a baseline malaria incidence of 50.8 episodes per 100 person-years, co-trimoxazole, ART, and bednets were associated with 2.1 episodes per 100 person-years.9 Male latex condoms provide approximately 80-90% protection, when used consistently.10 Male condoms also protect against other sexually-transmitted infections.11 Based on individual studies of the basic care package components, findings show that components help reduce deaths, hospital visits, and illnesses including malaria and diarrhoea among HIV-positive people.12

For more information on PermaNet 2.0 or PermaNet 3.0 long-lasting insecticidal net, please visit www.permanet.com

CarePack Components
Overview of CarePack components and the potential impact on individuals with HIV and their household: Core interventions PermaNet 2.0 or PermaNet 3.0 (in countries where there is pyrethroid resistance) Product description/ quantity Impact on PLWHA and their household

WHO-recommended long-lasting
insecticidal net (LN) for the prevention of malaria and other vector-borne diseases. A new generation long-lasting insecticidal net with increased* efficacy against pyrethroidresistant** malaria vectors.
*relative to PermaNet 2.0 **as tested with oxidase, esterase and kdr resistant malaria vectors

Consistent use of insecticide-treated nets is

associated with reduction in cases of malaria and all cause mortality among children.13

One or two pieces depending on

existing coverage of bednets in a country.

LifeStraw Family

delivering EPA-quality drinking water and preventing diarrhoeal diseases. One piece.

Instant microbiological purifier

The use of safe drinking water is associated

with 25% reduction in episodes of diarrhoea, 33% reduction in days with diarrhoea and 24% reduction in episodes of diarrhoea with blood or mucous in stool.5 Of all household interventions, filters consistently prevent diarrhoea, with an average 63% reduction.14

For more information on LifeStraw Family instant microbiological purifier, please visit www.lifestraw.com

Core interventions Co-trimoxazole prophylaxis (optional)

Product description/ quantity

Impact on PLWHA and their household

recommended by the WHO. Distribution depends on countryto-country requirement.

A broad-spectrum antibiotic

associated with 46% reduction in mortality, 72% reduction in malaria, 35% reduction in diarrhoea and 31% reduction in hospitalizations.15 This antibiotic has possible beneficial 15 effect on viral load and CD4 cell count.

The use of co-trimoxazole prophylaxis is

Condoms (optional)

of infection from the viruses that cause AIDS, other HIV-related illnesses, and other sexuallytransmitted diseases (STDs). 120 pcs or as appropriate.

Effective tool for reducing the risk

Latex condoms, when used consistently and

correctly, are highly effective in preventing the sexual transmission of HIV, the virus that causes AIDS. In addition, consistent and correct use of latex condoms reduces the risk of other sexually-transmitted diseases (STDs), including diseases transmitted by genital secretions, and to a lesser degree, genital ulcer diseases.12

IEC material

HIV prevention, malaria prevention, hygiene, water and sanitation. As appropriate.

Product usage instructions, tips for

Provision of education material is associated with reduction in high-risk behavior, leading to: Reduction in transmission of HIV to others.

Reduction in risk of acquiring additional

STIs.

Reduction in the number of new/

opportunistic infections.

CarePack Logistics
Packaging The standard components of CarePack are assembled together at Vestergaard Frandsen's facility in Vietnam. The packaging, which is in the form of a cardboard box, has been designed to be reopenable in order to facilitate the option of adding specific components according to different country requirements. Carton packaging offers an advantage of efficient storage of multiple stacking and onward handling over multi-modal transportation. Delivery Vestergaard Frandsen works with a multitude of local partners to provide the exceptional service of delivering products to in-country destinations rather than simply shipping them to the container port, as is the case with most suppliers. We have developed a distribution network across the African continent, establishing delivery channels for deeper penetration inland and ensuring a seamless delivery to the end destination. With 11 regional offices across Africa, Asia, Europe and the Americas, Vestergaard Frandsen provides an exceptional local and international customer service. Being close to the market is an unequivocal benefit for our customers and partners, allowing rapid and proactive service and market intelligence. Warehousing Vestergaard Frandsen also has warehouse facilities in the remotest parts of the world, allowing the company to help programme implementers distribute products affordably and efficiently.

Standard Packing

Optional Packing

References
1

Katabira, E.T. (1999). Epidemiology and management of diarrheal disease in HIV-infected

patients. International Journal of Infectious Disease 3(3):164-7.

2

Monkemuller, K.E. and Wilcox, C.M. (2000). Investigation of Diarrhea in AIDS. Canadian

Journal of Gastroenterology 14(11):933-40.

3

Thea, D.M. et al (1993). A prospective study of diarrhea and HIV-1 infection among 429

Zairian infants. New England Journal of Medicine 329(23):1696-702.

4

Mermin, J. et al. Developing an evidence-based, preventive care package for persons with

HIV in Africa. Trop Med Int Health. Volume 10 no 10 pp 961970 October 2005.
5

Lule, J.R. et al. Effect of home-based water chlorination and safe storage on diarrhea among

persons with human immunodeficiency virus in Uganda. Am J Trop Med Hyg. 2005 Nov;73(5):926-33.
6

Whitworth, J. et al. Effect of HIV-1 and increasing immunosuppression on malaria

parasitaemia and clinical episodes in adults in rural Uganda: a cohort study. Lancet 2000; 356: 105156.
7

WHO 2005 report Malaria and HIV interactions and their implications for public health

policy.
8

Mermin, J. et al. Association between malaria and CD4 cell count decline among persons

with HIV. J Acquir Immune Defic Syndr 2006;41:129-30.

9

Mermin, J. et al. Effect of co-trimoxazole prophylaxis, antiretroviral therapy, and insecticide-

treated bednets on the frequency of malaria in HIV-1-infected adults in Uganda: a prospective cohort study. Lancet, 2006, 367:12561261.
10

Hearst, N. and Chen, S. Condom promotion for AIDS prevention in the developing world: is it

working? Stud Fam Plann 2004;35:39-47.

11

Delvaux, T. and Nstlinger, C. Reproductive Choice for Women and Men Living with HIV:

Contraception, Abortion and Fertility. Reproductive Health Matters , Volume 15 , Issue 29 , Pages 46 - 66.
12

Centers for Disease Control and Prevention.

13

Lengeler, C. (2004). Insecticide-treated bed nets and curtains for preventing malaria. The

Cochrane Database of Systematic Reviews, Issue 2, Art. no. CD000363.

14

Interventions to improve water quality for preventing diarrhoea (Review) 2006 The

Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

15

Mermin, J. et al. Effect of cotrimoxazole prophylaxis on morbidity, mortality, CD4 cell count,

and HIV viral load among persons with HIV in rural Uganda. Lancet. 2004 Oct 16;364(9443):1428-34.

Customer Support Offices

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Product code - CPBE03

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