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The Integrated Infectious Diseases Capacity Building Evaluation designed two interventions for mid-level practitioners from 36 primary care facilities in Uganda: the Integrated Management of Infectious Disease (IMID) training program and On-Site Support (OSS). We evaluated their effects on 23 facility performance indicators, including malaria case management.The combination of IMID and OSS was associated with statistically significant improvements in malaria case management.

Estimating the size of populations most affected by HIV such as men who have sex with men (MSM) though crucial for structuring responses to the epidemic presents significant challenges, especially in a developing society. Using capture-recapture methodology, the size of MSM-SW in Nigeria was estimated in three major cities (Lagos, Kano and Port Harcourt) between July and December 2009. Following interviews with key informants, locations and times when MSM-SW were available to male clients were mapped and designated as "hotspots." Port Harcourt had the largest estimated population of MSM sex workers, 723, followed by Lagos state with 620, and Kano with 353. This study documents a large population of MSM-SW in three Nigerian cities where higher HIV prevalence among MSM compared to the general population has been documented. Research and programming are needed to better understand and address the health vulnerabilities that MSM-SW and their clients face.

A pilot project, implemented in 2 rural districts of Malawi between 2010 and 2011, introduced a mobile phone system to strengthen knowledge exchange within networks of CHWs and district staff. To evaluate the mobile phone intervention, a participatory evaluation method called Net-Map was used. At baseline, community health workers were not mentioned as actors in the information network, while at endline they were seen to have significant connections with colleagues, beneficiaries, supervisors, and district health facilities, as both recipients and providers of information. Focus groups with CHWs complemented the Net-Map findings with reports of increased self-confidence and greater trust by their communities. These qualitative results were bolstered by surveys that showed decreases in stock-outs of essential medicines, lower communication costs, wider service coverage, and more efficient referrals. As an innovative, participatory form of social network analysis, Net-Map yielded important visual, quantitative, and qualitative information at reasonable cost.

Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP’s greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain.

Improving women’s health throughout the life course will contribute to other post-2015 goals. Conversely, women’s social empowerment will improve health. For this virtuous cycle to occur, the next iteration of the Millennium Development Goals (MDGs) has to embrace women’s health and wellbeing as a priority—particularly since indicators of women’s health are those lagging the farthest behind in the current MDGs. Universal health coverage is generally agreed to be an essential means of achieving post-2015 health goals, including addressing inequalities in women’s health care. This article looks at critical factors for designing and implementing universal health coverage to improve women’s health. The authors draw on examples from Afghanistan, Mexico, Thailand, and Rwanda.

In low income countries, Ziehl-Neelsen sputum smear microscopy is the only cost-effective tool for diagnosis and monitoring of patients on treatment for tuberculosis.The objective of this study was to investigate the role of AFB microscopy refresher training on the performance of laboratory professionals in Ethiopia. Training has improved theoretical and practical performance of laboratory professionals. Pre-placement and continuous training irrespective of lab professionals' qualifications and service year and sustainable external quality assessment are highly recommended to ensure quality of AFB microscopy services.

The Health Commodities and Services Management (HCSM) Program, in collaboration with the Kenyan Ministry of Health, works with public, private, and faith-based health facilities, including Esther’s, to minimize commodity stock outs and ensure access to care. HCSM provides training, manuals, and electronic tools that help facility staff manage TB services.

Management Sciences for Health (MSH) envisions a world where all women and men have access to quality family planning and reproductive health services.We promote universal health coverage and strengthen health systems to deliver the promise of full choice and rights for women and girls.

The greatest development challenges of the 21st century are found in fragile states, nations frequently stressed by civil unrest, natural disasters, or war.

Determining the cost of health services is an essential step toward strengthening health systems and working toward universal health coverage.

MSH engages all levels of the health system—from the community to the ministerial level—to develop their capacity to plan, lead, and manage. At the community level, MSH mobilizes local leaders and communities to support and use health services.

Roughly 70% of infected children are not receiving live-saving HIV care and treatment. Strengthening case finding through improved diagnosis strategies and actively linking identified HIV-infected children to care and treatment are essential to ensuring that these children benefit from the care and treatment available to them. This article summarizes the challenges of identifying HIV-infected infants and children, reviews currently available evidence and guidance, describes promising new strategies for case finding, and makes recommendations for future research and interventions to improve identification of HIV-infected infants and children.

As of 2012, only 34% of treatment eligible children in low- and middle-income countries were receiving antiretroviral treatment (ART) despite proven benefits of early initiation of antiretroviral treatment (ART) on child survival. We reviewed routine EID (early infant diagnosis) laboratory and paediatric ART patient records to determine missed opportunities for optimizing EID and current status of linkage between EID entry points to paediatric ART initiation in Tanzania, Uganda, and Zimbabwe. These are three countries with EID coverage of 22, 11 and 14%, respectively and ART coverage rates of 18, 16 and 32%, respectively. This article examines the most likely delivery points for collection of blood samples for EID testing for infant and young children and the most likely referral points for ART initiation of HIV-infected children in these three countries. This data provides evidence of consistent missed opportunities for linking HIV-infected children identified during EID to early ART treatment. We also argue for expanding the provision of EID to other service delivery points beyond PMTCT platform and provide suggestions for better linkages from EID to care and treatment.

Treatment 2.0 is an initiative launched by UNAIDS and WHO in 2011 to catalyze the next phase of treatment scale-up for HIV. The initiative defines strategic activities in 5 key areas--drugs, diagnostics, commodity costs, service delivery and community engagement--in an effort to simplify treatment, expand access and maximize program efficiency. For adults, many of these activities have already been turned into treatment policies. The recent WHO recommendation to use a universal first line regimen regardless of gender, pregnancy and TB status is a treatment simplification very much in line with Treatment 2.0. But despite that fact that Treatment 2.0 encompasses all people living with HIV, we have not seen the same evolution in policy development for children. In this paper we discuss how Treatment 2.0 principles can be adapted for the pediatric population.

A new and more expansive agenda must be articulated to ensure that those infants and children who will never feel the impact of the current elimination agenda are reached and linked to appropriate care and treatment. This agenda must addresses challenges around both reducing vertical transmission through PMTCT and ensuring access to appropriate HIV testing, care, and treatment for all affected children who were never able to access PMTCT programming. Option B+, or universal test and treat for HIV-infected pregnant women, is an excellent start, but it may be time to rethink our current approaches to delivering PMTCT services. New strategies will reduce vertical transmission to less than 1% for those mother-infant pairs who can access them allowing for the contemplation of not just PMTCT, but actual elimination of MTCT. But expanded thinking is needed to ensure elimination of pediatric HIV.

The current elimination strategy has focused primarily on the expansion of HIV testing and counseling of pregnant women and the provision of antiretroviral therapy (ART) to those living with HIV to protect their health and prevent HIV transmission to their infants. Something is missing: despite WHO guidelines calling for 100% treatment coverage for all infected children younger than 5 years, early infant diagnosis and pediatric treatment have thus far been neglected. The primary focus on prevention of maternal-to-child transmission (PMTCT) has inadvertently perpetuated poor access to treatment for those children who still are inevitably acquire HIV. New ideas are needed that can propel programming to diagnose, link, and retain infected children in care, particularly those missed by current PMTCT programming, and provide optimal care for those children who do get diagnosed and linked to care and treatment services.

Although antiretroviral treatment (ART) has reduced the incidence of HIV-related opportunistic infections among children living with HIV, access to ART remains limited for children, especially in resource-limited settings. This paper reviews current knowledge on the contribution of opportunistic infections and common childhood illnesses to morbidity and mortality in children living with HIV, highlights interventions known to improve the health of children, and identifies research gaps for further exploration.

In 2012, there were an estimated 2 million children in need of antiretroviral therapy (ART) in the world, but ART is still reaching fewer than 3 in 10 children in need of treatment. As more HIV-infected children are identified early and universal treatment is initiated in children under 5 regardless of CD4, the success of pediatric HIV programs will depend on our ability to link children into care and treatment programs, and retain them in those services over time. In this review, we summarize key individual, institutional, and systems barriers to diagnosing children with HIV, linking them to care and treatment, and reducing loss to follow-up. We also explore how linkage and retention can be optimally measured so as to maximize the impact of available pediatric HIV care and treatment services.

Each year over a million infants are born to HIV-infected mothers. With scale up of prevention of mother-to-child transmission (PMTCT) interventions, only 210 000 of the 1.3 million infants born to mothers with HIV/AIDS in 2012 became infected. Current programmatic efforts directed at infants born to HIV-infected mothers are primarily focused on decreasing their risk of infection, but an emphasis on maternal interventions has meant follow-up of exposed infants has been poor. Programs are struggling to retain this population in care until the end of exposure, typically at the cessation of breastfeeding, between 12 and 24 months of age. But HIV exposure is a life-long condition that continues to impact the health and well being of a child long after exposure has ended. A better understanding of the impact of HIV on exposed infants is needed and new programs and interventions must take into consideration the long-term health needs of this growing population. The introduction of lifelong treatment for all HIV-infected pregnant women is an opportunity to rethink how we provide services adapted for the long-term retention of mother–infant pairs.

If children are to be protected from HIV, the expansion of PMTCT programs must be complemented by increased provision of paediatric treatment. This is expensive, yet there are humanitarian, equity and children's rights arguments to justify the prioritization of treating HIV-infected children. In the context of limited budgets, inefficiencies cost lives, either through lower coverage or less effective services. With the goal of informing the design and expansion of efficient paediatric treatment programs able to utilize to greatest effect the available resources allocated to the treatment of HIV-infected children, this article reviews what is known about cost drivers in paediatric HIV interventions, and makes suggestions for improving efficiency in paediatric HIV programming. High-impact interventions known to deliver disproportional returns on investment are highlighted and targeted for immediate scale-up. Progress will carry a cost - increased funding, as well as additional data on intervention costs and outcomes, will be required if universal access of HIV-infected children to treatment is to be achieved and sustained.

Achievement of Millennium Development Goal (MDG) 4 for child survival requires acceleration of gains in newborn survival, and current trends in improving maternal health will also fall short of reaching MDG 5 without more strategic actions. We present a Maternal Newborn and Child Health (MNCH) strategy for accelerating progress on MDGs 4 and 5, sustaining the gains beyond 2015, and further bringing down maternal and child mortality by two thirds by 2030. The strategy takes into account current trends in coverage and cause-specific mortality, builds on lessons learned about what works in large-scale implementation programs, and charts a course to reach those who do not yet access services. A central hypothesis of this strategy is that enhancing interactions between frontline workers and mothers and families is critical for increasing the effective coverage of life-saving interventions. We describe a framework for measuring and evaluating progress which enables continuous course correction and improvement in program performance and impact. Evidence for the hypothesis and impact of this strategy is being gathered and will be synthesized and disseminated in order to advance global learning and to maximise the potential to improve maternal and neonatal survival.

This United States Agency for International Development discussion paper seeks to provide background on some of the recent contributions to the policy literature on extreme poverty. It does not represent the official policy or position of USAID but is meant to spark and inform dialogue on important development issues, both within the Agency and with our external partners.

This supplement to the Journal of Global Public Health is devoted to the re-development of the health system in Afghanistan beginning in 2002. It discusses the processes that were adopted by the Ministry of Public Health and its partners, and the activities of the non-governmental organisations that, for the most part, were responsible for overseeing the delivery of health services to the population. It also presents an overview of the results that were obtained during the ensuing 10 years.

Ensuring that medicines which achieve important health outcomes are available, accessible to all, used appropriately, and sustainably affordable is essential for realizing universal health coverage. Stakeholder cooperation and use of information and financing system levers provide opportunities to work toward this goal.

Indonesia has made great strides in expanding tuberculosis (TB) control over the last few years, with significant assistance from donors, such as the Global Fund. While there are presently substantial external funds for the Human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), TB and Malaria health programs, these are likely to diminish greatly over the next few years.


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