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A poster presented at a MSH Kenya symposium, Achieving Universal Health Coverage through Stronger Health Systems, April 28, 2014, Crown Plaza Hotel, Nairobi Upper Hill.

A poster presented at a MSH Kenya symposium, Achieving Universal Health Coverage through Stronger Health Systems, April 28, 2014, Crown Plaza Hotel, Nairobi Upper Hill.

To document the prevalence of multidrug resistance among people newly diagnosed with--and those retreated for--tuberculosis in Malawi, we conducted a nationally representative survey of people with sputum-smear-positive tuberculosis between 2010 and 2011. For all consenting participants, we collected demographic and clinical data, two sputum samples and tested for human immunodeficiency virus (HIV).The samples underwent resistance testing at the Central Reference Laboratory in Lilongwe, Malawi. All Mycobacterium tuberculosis isolates found to be multidrug-resistant were retested for resistance to first-line drugs – and tested for resistance to second-line drugs--at a Supranational Tuberculosis Reference Laboratory in South Africa. Overall, M. tuberculosis was isolated from 1777 (83.8%) of the 2120 smear-positive tuberculosis patients. Multidrug resistance was identified in five (0.4%) of 1196 isolates from new cases and 28 (4.8%) of 581 isolates from people undergoing retreatment. Of the 31 isolates from retreatment cases who had previously failed treatment, nine (29.0%) showed multidrug resistance. Although resistance to second-line drugs was found, no cases of extensive drug-resistant tuberculosis were detected. HIV testing of people from whom M. tuberculosis isolates were obtained showed that 577 (48.2%) of people newly diagnosed and 386 (66.4%) of people undergoing retreatment were positive. The prevalence of multidrug resistance among people with smear-positive tuberculosis was low for sub-Saharan Africa--probably reflecting the strength of Malawi’s tuberculosis control programme. The relatively high prevalence of such resistance observed among those with previous treatment failure may highlight a need for a change in the national policy for retreating this subgroup of people with tuberculosis.

In July 2011, Malawi introduced an ambitious public health program known as “Option B+,” which provides all HIV- infected pregnant and breastfeeding women with lifelong combination antiretroviral therapy, regardless of clinical stage or CD4 count. Option B+ is expected to have benefits for HIV-infected women, their HIV-exposed infants, and their HIV-uninfected male sex partners. However, these benefits hinge on early uptake of prevention of mother-to-child transmission, good adherence, and long-term retention in care. The Prevention of mother-to-child transmission Uptake and REtention (PURE) study is a 3-arm cluster randomized controlled trial to evaluate whether clinic- or community-based peer support will improve care-seeking and retention in care by HIV- infected pregnant and breastfeeding women, their HIV-exposed infants, and their male sex partners, and ultimately improve health outcomes in all 3 populations. We describe the PURE Malawi Consortium, the initial work conducted to inform the trial and interventions, the trial design, and the analysis plan. We then discuss concerns and expected contributions to Malawi and the region.

On April 23, 2013, Kenya's Pharmacy and Poisons Board launched and demonstrated its digital reporting tool for reporting suspected poor quality medicinal products and adverse drug reactions. The media event featured:  Ms. Mary Ngari, Permanent Secretary Ministry of Public Health and Sanitation Dr. Bitange Ndemo, Permanent Secretary Ministry of Information and Communications

On November 6, 2013, the Kenya ministry of health launched cancer management guidelines. Prior to the guidelines, cancer prevention and treatment had been addressed in divergent ways by the few physicians and practitioners, most of whom are not prepared to handle these challenges.

On September 6, 2013, Kenyatta National Hospital in Nairobi, Kenya held a media event to launch the first comprehensive, locally developed formulary for a public sector health institution in Kenya. A hospital formulary is a document or manual listing all medicines approved for use in a specific healthcare institution.

This third issue of the Newsletter - HCSM Recap, builds upon previous editions in bringing out the latest global best practices in commodity management, supply chain and health systems strengthening. It puts Kenya experiences into global perspective as well as bringing out issues pertaining to the unique county set up.

Ten years ago, in 2004, testing positive for HIV in Ethiopia was a death sentence. It was the start of a painful decline, including illness and ostracism from society, ultimately leading to premature death.

The Ethiopia Network for HIV/AIDS Treatment, Care, & Support (ENHAT-CS) program, a USAID initiative funded by PEPFAR. was an MSH-led consortium of national and international partners.

Background In Ethiopia, over 60% of all people who are eligible for antiretroviral therapy (ART) receive it. However, coverage is only 12% among children under 15 years of age. Due to scarcity of data and limited awareness of possible HIV infection, especially in older children, the AIDS epidemic among Ethiopian children appears neglected in national programs. Methods

In Ethiopia, male-dominated gender dynamics and health care provider attitudes lead many women to avoid or not fully utilize antenatal care (ANC) and prevention of mother-to-child transmission (PMTCT) services, creating barriers to women’s access to care and to interrupting vertical transmission of HIV.

Following the World Health Organization’s 2013 guidelines endorsing antiretroviral therapy for all HIV-infected pregnant women, Ethiopia adopted Option B+ (initiation of triple regimen antiretroviral therapy (ART) for the duration of breastfeeding or for life regardless of a pregnant woman’s CD4 count) as the national standard for prevention of mother-to-child transmission (PMTCT

Ethiopia’s HIV prevalence rate is approximately 1.2 percent,2 equating to about 700,000 HIV-infected people. Since 2005, Ethiopia has been decentralizing free antiretroviral (ART) services from hospitals to health centers as a strategy to improve access to HIV care and treatment.

Mother-to-Child Transmission of HIV and Early Infant Diagnosis:The Global Situation

Launched in 2009, the Integrated Health Systems Strengthening Project (IHSSP) expanded on work initiated by the Rwanda HIV/Performance-Based Financing Project (2005 – 2009), also funded by the US Agency for International Development (USAID) and implemented by Management Sciences for Health (MSH).

The Rwandan Ministry of Health partnered with the Integrated Health Systems Strengthening Project (IHSSP) to strengthen and coordinate its health information system. In 2009, when IHSSP was launched, the ministry had multiple systems to gather data from the country’s health services, but the systems used to aggregate and analyze the information were weak and were not interoperable.

The Government of Rwanda’s vision for its health system is that every citizen will consistently use health services that are easily accessible, meet international standards of care, and directly respond to individuals’ perceived and actual needs.

Integrated community case management (iCCM) can be an effective strategy for expanding the provision of diarrhea, pneumonia, and malaria services to children under 5 years old but there are concerns in some countries about the corresponding cost and impact. This paper presents and compares findings from a multi–country analysis of iCCM program costs. Data were collected on iCCM programs in seven sub–Saharan African countries: Cameroon, the Democratic Republic of the Congo, Malawi, Senegal, Sierra Leone, South Sudan and Zambia. The data were used to compare some elements of program performance as well as costs per capita and costs per service (which are key indicators of resource allocation and efficiency). A comprehensive understanding of iCCM program costs and results can help countries obtain resources and use them efficiently. To be cost–effective and affordable, iCCM programs must be well utilized, while program management and supervision should be organized to minimize costs and ensure quality of care. iCCM programs will not always be low–cost, however, particularly in small, remote villages where supervision and supply challenges are greater.

Tuberculosis (TB) patients face many psychological, social and economic problems that complicate treatment and care. This may lead to decreasing adherence to prescribed treatment regimens and poorer clinical outcomes, including higher loss-to-follow-up, relapse and mortality rates. 

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Return of Organization Exempt from Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code

In this third special issue published by the International Journal of Drug Policy, the authors of ten research papers and commentaries seek to provide additional knowledge on a range of issues related to illicit drugs in the region, including the epidemiology of drug use and drug-related infectious diseases and other consequences, drug treatment and harm reduction pro

The five-year anniversary of the Haitian earthquake brings Haiti to the forefront of international development conversations once again. Much of the dialogue has focused on the setbacks of large-scale infrastructure and rebuilding projects, but there has been important progress in some sectors, especially the health sector.

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