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Implications of the Current Tuberculosis Treatment Landscape for Future Regimen Change

Background: The current tuberculosis (TB) treatment landscape has been studied extensively, but researchers rarely consider how it creates challenges or opportunities for future regimen change.

Peer Counsellors’ Role in Supporting Patients’ Adherence to ART in Ethiopia and Uganda

Our aim was to explore peer counselors' work and their role in supporting patients' adherence to antiretroviral treatment (ART) in resource-limited settings in Ethiopia and Uganda. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda.

Operational Research in Malawi: Making a Difference with Cotrimoxazole Preventive Therapy in Patients with Tuberculosis and HIV

In Malawi, high case fatality rates in patients with tuberculosis, who were also co-infected with HIV, and high early death rates in people living with HIV during the initiation of antiretroviral treatment (ART) adversely impacted on treatment outcomes for the national tuberculosis and ART programmes respectively. This article (1) discusses the operational research that was conducted in the country on cotrimoxazole preventive therapy, (2) outlines the steps that were taken to translate these findings into national policy and practice, (3) shows how the implementation of cotrimoxazole preventive therapy for both TB patients and HIV-infected patients starting ART was associated with reduced death rates, and (4) highlights lessons applicable to other settings and interventions.

Retention and Attrition during the Preparation Phase and after Start of Antiretroviral Treatment in Thyolo, Malawi, and Kibera, Kenya: Implications for Programmes?

Among adults eligible for antiretroviral therapy (ART) in Thyolo (rural Malawi) and Kibera (Nairobi, Kenya), this study (1) reports on retention and attrition during the preparation phase and after starting ART and (2) identifies risk factors associated with attrition.

"Without a Choice": How the Illicit Drug Economy Contributes to HIV Risk in St. Vincent and the Grenadines

St. Vincent and the Grenadines (SVG) is the largest marijuana producer in the Eastern Caribbean. As the European Union has phased out preferred access for its banana crop, marijuana has become one of the main sources of income and a safety net for many young men, in particular.

Why Did the Scale-Up of HIV Treatment Work? A Case Example from Malawi

The national scale-up of antiretroviral therapy (ART) in Malawi is based on a public health approach, with principles and practices borrowed from the successful DOTS tuberculosis control framework. During the first 6 years, the number of patients registered on treatment increased from 3,000 to >350,000 in both the public and private sectors.

HIV-Related Conspiracy Beliefs and Its Relationships with HIV Testing and Unprotected Sex among Men Who Have Sex with Men in Tshwane (Pretoria), South Africa

The objective of this study was to determine extent of HIV conspiracy belief endorsement among men who have sex with men (MSM) in Pretoria, and assess whether endorsement of HIV conspiracy beliefs are associated with inconsistent condom use and never testing for HIV. A cross-sectional survey using respondent-driven sampling was conducted between February and August 2009.

Antiretroviral Drug Supply Challenges in the Era of Scaling up ART in Malawi

The number of people receiving antiretroviral treatment (ART) has increased considerably in recent years and is expected to continue to grow in the coming years. A major challenge is to maintain uninterrupted supplies of antiretroviral (ARV) drugs and prevent stock-outs.

Compliance with Referral of Sick Children: A Survey in Five Districts of Afghanistan

Background: Recognition and referral of sick children to a facility where they can obtain appropriate treatment is critical for helping reduce child mortality. A well-functioning referral system and compliance by caretakers with referrals are essential.

Impact of Health Systems Strengthening on Coverage of Maternal Health Services in Rwanda, 2000–2010: A Systematic Review

From 2000 to 2010, Rwanda implemented comprehensive health sector reforms to strengthen the public health system, with the aim of reducing maternal and newborn deaths in line with Millennium Development Goal 5, among many other improvements in national health.

Taking Stock: Provider Prescribing Practices in the Presence and Absence of ACT Stock

Background Globally, the monitoring of prompt and effective treatment for malaria with artemisinin combination therapy (ACT) is conducted largely through household surveys. This measure; however, provides no information on case management processes at the health facility level.

The Risk Factor Profile of Women with Secondary Infertility: An Unmatched Case-Control Study in Kigali, Rwanda

Background Secondary infertility is a common, preventable but neglected reproductive health problem in resource-poor countries. This study examines the association of past sexually transmitted infections (STIs) including HIV, bacterial vaginosis, and factors in the obstetric history with secondary infertility and their relative contributions to secondary infertility. Methods

Comparative Population Structure of Plasmodium Malariae and Plasmodium Falciparum under Different Transmission Settings in Malawi

Described here is the first population genetic study of Plasmodium malariae, the causative agent of quartan malaria. Although not as deadly as Plasmodium falciparum, P. malariae is more common than previously thought, and is frequently in sympatry and co-infection with P. falciparum, making its study increasingly important. This study compares the population parameters of the two species in two districts of Malawi with different malaria transmission patterns—one seasonal, one perennial—to explore the effects of transmission on population structures. The extent of similarity between P. falciparum and P. malariae population structure described by the high level of multiple infection, the lack of significant population differentiation or haplotype clustering, and lack of linkage disequilibrium is surprising given the differences in the biological features of these species that suggest a reduced potential for out-crossing and transmission in P. malariae. The absence of a rise in P. malariae MOI with increased transmission or a reduction in MOI with age could be explained by differences in the duration of infection or degree of immunity compared to P. falciparum.

Availability and Utilization of Malaria Prevention Strategies in Pregnancy in Eastern India

A cross-sectional study conducted in two states of India during 2006-08 found a disconnect between routine antenatal practices in India and known strategies to prevent and treat malaria in pregnancy. Prevention strategies, in particular the use of insecticide-treated bednets, are underutilized.

Positive Spill-Over Effects of ART Scale Up on Wider Health Systems Development: Evidence from Ethiopia and Malawi

Drawing on evidence from Malawi and Ethiopia, this article analyses the eff ects of ARTscale-up interventions on human resources policies, service delivery and general health outcomes, and explores how synergies can be maximized.

Improvements in Access to Malaria Treatment in Tanzania after Switch to Artemisinin Combination Therapy and the Introduction of Accredited Drug Dispensing Outlets: A Provider Perspective

Background To improve access to treatment in the private retail sector a new class of outlets known as accredited drug dispensing outlets (ADDO) was created in Tanzania. Tanzania changed its first-line treatment for malaria from sulphadoxine-pyrimethamine (SP) to artemether-lumefantrine (ALu) in 2007. Subsidized ALu was made available in both health facilities and ADDOs.

The Experiences of People Living with HIV/AIDS and of Their Direct Informal Caregivers in a Resource-Poor Setting

HIV/AIDS is a critical concern in South Africa, where extreme poverty and gender issues are major determinants of health. A comprehensive home-based care programme is needed to lessen the burden placed on the caregivers of those suffering from HIV/AIDS. The purpose of this study was to explore and describe the challenges faced by people who are living with HIV/AIDS and by their caregivers in resource-poor, remote South African villages.

A Situational Analysis of Pharmacovigilance Plans in the Global Fund Malaria and U.S. President's Malaria Initiative Proposals

In 2008, The Roll Back Malaria partnership issued guidelines for inclusion of pharmacovigilance in Global Fund and other related proposals. In light of this recommendation and the rapid scale-up of ACT worldwide, an analysis of Global Fund Round 8 proposals and the President's Malaria Initiative (PMI) 2009 Malaria Operational Plans was conducted to assess if and how pharmacovigilance has been incorporated into countries' national malaria plans and donor budget requests.

Measuring Adherence to Antiretroviral Treatment in Resource-Poor Settings: The Feasibility of Collecting Routine Data for Key Indicators

An East African survey showed that among the few health facilities that measured adherence to antiretroviral therapy, practices and definitions varied widely. We evaluated the feasibility of collecting routine data to standardize adherence measurement using a draft set of indicators.

Delay in Tuberculosis Case Detection in Pwani Region, Tanzania: A Cross Sectional Study

Background: Delay in Tuberculosis (TB) case detection may worsen the disease and increase TB transmission. It is also a challenge to the National TB and Leprosy control Program (NTLP).Methods: We conducted a cross sectional study in four out of six districts in Pwani region to estimate the extent and factors responsible for delay in TB case detection in Pwani region.

Reviewing the Literature on Access to Prompt and Effective Malaria Treatment in Kenya: Implications for Meeting the Abuja Targets

This review aimed to document evidence on access to effective malaria treatment in Kenya, identify factors that influence access, and make recommendations on how to improve prompt access to effective malaria treatment. Since treatment-seeking patterns for malaria are similar in many settings in sub Saharan Africa, the findings presented in this review have important lessons for other malaria endemic countries.

Burden of Malaria in Pregnancy in Jharkhand State, India

Given the large population at risk, a cross sectional study was conducted in order to better define the burden of malaria in pregnancy in Jharkhand, a malaria-endemic state in central-east India.

Pulmonary Tuberculosis among Women with Cough Attending Clinics for Family Planning and Maternal and Child Health in Dar Es Salaam, Tanzania

Background: Tuberculosis (TB) case detection in women has remained low in developing world. This study was conducted to determine the proportion of smear positive TB among women with cough regardless of the duration attending family Planning (FP) and Maternal and child health (MCH) clinics in Dar es Salaam.Methods: We conducted a cross sectional study in all three municipal hospital

Records Linkage of Electronic Databases for the Assessment of Adverse Effects of Antiretroviral Therapy in Sub-Saharan Africa

The Ministry of Health and Social Services in Namibia conducted a confirmatory assessment of the risk of anemia associated with zidovudine (AZT)-based highly active antiretroviral therapy (HAART) using records contained in three electronic databases. A total of 12,358 records were examined. We measured the sensitivity of the starting HAART regimen (the proportion of AZT users in the clinical record correctly identified in the electronic record), and specificity of severe anemia (the proportion of non-cases of severe anemia in the clinical records correctly identified in the electronic record). Probabilistic record linkage methods were effective for records linkage in this sub-Saharan African setting.

Building a National Model for Knowledge Exchange in Malawi: Findings from a Health Information Needs Assessment

This assessment of health information needs, conducted in the capital city and 3 districts of Malawi in 2009, showed the need to build the capacity of government technical working groups to collect and store information and promote information exchange; improve information synthesis and packaging; strengthen the district level to serve as an information hub; and explore the use of mobile technologies.

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