HIV

Malawi has some of the worst health statistics in the world, ranking 166 out of 177 countries. This is the result of HIV & AIDS, food insecurity, weak governance, and many human resources challenges. Health care vacancies range anywhere from 30-80%, and Malawi only has 252 doctors in the entire country. The health system is regularly plagued with stock outs of key medicines and supplies, as a result of poor procurement and distribution practices. Malawi has one of the highest HIV prevalence rates in the world; the average prevalence for sub-Saharan Africa is 7.5%, Malawi has 12% prevalence in the adult population.

More than 50% of Malawi’s population lives further than 5 km from a health center.  Health care workers in the community, who are capable of providing essential health care services to those living in ‘hard to reach areas,’ are essential.  Meet the HSAs – Health Surveillance Assistants.

(This blog post was originally posted on Global Health Council's Global Health Magazine blog.)

How do we set a gold standard for monitoring and evaluating capacity building?

Last week I attended the inaugural HIV Capacity Building Partners Summit in Nairobi from March 16-18, 2011. The Summit provided a timely opportunity to reflect on capacity building achievements in the region thus far, and use the lessons learned to rethink, gather momentum and repackage HIV capacity building in ways that ensure achievement of universal access and the targets set in the Millennium Development Goals 4, 5 and 6.

News from the HIV Capacity Building Partners Summit in Nairobi, Kenya

On the second day of the first ever Regional HIV Capacity Building Partners Summit in Nairobi, Kenya, one of the key issues that continued to dominate the conversations in various sessions was sustainability.

Many speakers noted that despite a mild increase in organizational capacity building efforts by donors, governments, and nongovernmental organizations in the Eastern and Southern Africa region, the documentation and dissemination of these efforts and their effects on HIV & AIDS programs and other health programs and systems remains limited. Apparently, several factors have contributed to this situation.

First, the group noted that evaluative research for questions of program sustainability were primarily based on the objectives, work plans, timeframes and measures of sustainability that had been developed by individual projects. In most cases, these projects were donor funded and had their own agenda and hence did not take an organizational-wide approach in their approach to measuring sustainability. They just focused on the project deliverables.

Every day people are dying in the developing world because they cannot access affordable, quality medicines. Modern pharmaceuticals have revolutionized health care, but weak health systems prevent many people from accessing basic life-saving medicines. The health of men, women, and children can be dramatically improved throughout the world by enhancing access to and improving the use of essential medicines and other health care technologies.

Gaps in the management and availability of essential medicines and health commodities have been a constant weakness for developing countries. These gaps hamper the ability to access and distribute the pharmaceutical and medical supplies needed to treat infectious diseases. We have seen particular success in addressing pharmaceutical management challenges when interventions include: increasing access to products and services, improving the use of those products and services, promoting rational pharmaceutical use, developing public-private partnerships, providing thorough assessments and trainings, and improving procurement processes.

Aberu Hailu and her HIV-Negative son.

 

Aberu Hailu is a 31 year old, mother of four living in Hidmo, Ethiopia a rural community 8 kilometers south east of Adigodum town in Tigray. Two years ago, she visited the Adigodum Health Center to be tested for HIV, a disease she had learned about through community health education. She discovered she was HIV-positive and informed her husband that he should be tested, but he refused.

Two months later, Aberu became pregnant and found herself in despair. She thought she would pass the virus on to her baby and she feared the stigma and discrimination she knew often came with a positive HIV status.

Aberu returned to the Adigodum Health Center and the HIV/AIDS Care and Support Program (HCSP), a USAID-funded MSH-led health project, for help. Aberu learned that her baby could be protected from the virus with prevention of mother to child transmission services.

Issakha Diallo, MD, MPH, DrPH

Part six of the blog series: Spotlight on Global Health Initiative Plus Countries Amid grave health statistics, the Global Health Initiative (GHI) brings hope of a healthier future in Mali.

Mali is one of the ten poorest countries in the world, ranking 173 out of 175 countries on the 2007 Human Development index of the United Nations Development Program (UNDP). Mali has highest percentage of people living on less than a dollar a day.  And, Mali has some of the worst demographic indicators in the sub-Saharan region: a population growth rate of 2.6%, a 6.6 fertility rate (the highest in the sub-Saharan Africa after Niger, at 6.8), and a birth rate of 49.8 per 1,000. The population is very young, with more than 50% of Malians under 15 years old and 17% under 5 years old.

On this World AIDS Day, we reflect yet again on progress made toward global commitments to fight the HIV epidemic. According to UNAIDS, new infections have decreased this past year from 2.7 million to 2.6 million, but, 30 years into the epidemic, only 5.2 million people out of the estimated 15 million who need drugs have access to treatment. Stigma, discrimination and human rights violations against persons living with HIV still exist, even in countries with generalized epidemics.

Integrated HIV programming across the entire health system can minimize many of these barriers to HIV prevention, care and, treatment.

The results from the first Pre-exposure Prophylaxis (PrEP) clinical trial, the iPrEx Study, were just made public and published in today’s issue of the New England Journal of Medicine. In short, the trial showed an overall 44% efficacy in preventing HIV infection in gay, bisexual and transgender subjects who took the daily fixed dose combination antiretroviral pill Truvada (tenofovir [TDF] and emtracitabine [FTC]), compared with participants receiving a placebo. This is the first evidence that oral antiretroviral medications, taken by HIV-negative people before exposure to HIV can reduce the risk of HIV infection. iPrEx is also the first trial showing effectiveness of a new biomedical prevention tool in gay men and other men who have sex with men.

The iPrEx trial enrolled 2,499 participants across 11 sites in six countries---Brazil, Ecuador, Peru, South Africa, Thailand and the United States. It is the first PrEP effectiveness trial to report results. This trial was one of a suite of PrEP trials currently ongoing in a range of populations around the world.

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