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Moving the global response towards the universal test and treat model will pose huge challenges to public health systems in resource-limited settings, including global and local supply chain systems. These challenges are especially acute in Africa, which accounts for over 70% of the persons affected by HIV.To ensure that there are enough anti-retrovirals available to treat the nearly 25 million people that will require them by 2020 represents a near doubling of the ARV supplied to treat the 13 million currently on treatment. Similarly, to monitor those on treatment means an unprecedented scale-up of viral load testing throughout Africa. Larger issues include whether the capacity exists at the local level to handle these commodities when they arrive in the most severely affected countries, including considerations of the human resources and costs needed to make this strategy effective. We believe that such ‘‘real world’’ analysis of proposed strategies and policies is essential to ensure their most effective implementation.

In this opinion paper, we discuss lessons learned from the global scale-up of these laboratory devices and the pathway to tapping the potential of laboratory-generated information in the field of TB by using connectivity. Responding to the demand for connectivity, innovative third-party players have proposed solutions that have been widely adopted by field users of the Xpert® MTB/RIF assay. The experience associated with the utilisation of these systems, which facilitate the monitoring of wide laboratory networks, stressed the need for a more global and comprehensive approach to diagnostic connectivity. In addition to facilitating the reporting of test results, the mobility of digital information allows the sharing of information generated in programme settings. When they become easily accessible, these data can be used to improve patient care, disease surveillance and drug discovery. We list several examples of initiatives that should allow data sources to be combined to improve the understanding of the epidemic, support the operational response and, finally, accelerate TB elimination.

This publication shares stories from the Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E) project. STAR-E is a key partner with the government of Uganda in scaling up HIV and TB services. When the project began in 2009, STAR-E supported just 16 health facilities, with only one that provided antiretroviral therapy (ART).

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We reviewed literature on HIV and tuberculosis in sub-Saharan African prisons published between 2011 and 2015, and identified data from only 24 of the 49 countries in the region. Where data were available, they were frequently of poor quality and rarely nationally representative. Prevalence of HIV infection ranged from 2·3% to 34·9%, and of tuberculosis from 0·4 to 16·3%; detainees nearly always had a higher prevalence of both diseases than did the non-incarcerated population in the same country.We identified barriers to prevention, treatment, and care services in published work and through five case studies of prison health policies and services in Zambia, South Africa, Malawi, Nigeria, and Benin. These barriers included severe financial and human-resource limitations and fragmented referral systems that prevent continuity of care when detainees cycle into and out of prison, or move between prisons. These challenges are set against the backdrop of weak health and criminal-justice systems, high rates of pre-trial detention, and overcrowding. A few examples of promising practices exist, including routine voluntary testing for HIV and screening for tuberculosis upon entry to South African and the largest Zambian prisons, reforms to pre-trial detention in South Africa, integration of mental health services into a health package in selected Malawian prisons, and task sharing to include detainees in care provision through peer-educator programmes in Rwanda, Zimbabwe, Zambia, and South Africa. However, substantial additional investments are required throughout sub-Saharan Africa to develop country-level policy guidance, build human-resource capacity, and strengthen prison health systems to ensure universal access to HIV and tuberculosis prevention, treatment, and care of a standard that meets international goals and human rights obligations.

It is well known that safe delivery in a health facility reduces the risks of maternal and infant mortality resulting from perinatal complications. What is less understood are the factors associated with safe delivery practices. We investigated factors influencing health facility delivery practices while adjusting for multiple other factors simultaneously, spatial heterogeneity, and trends over time. We fitted a logistic regression model to Lot Quality Assurance Sampling (LQAS) data from Uganda in a framework that considered individual-level covariates, geographical features, and variations over five time points. We showed that ease of access, maternal age and education are strongly associated with delivery in a health facility; after accounting for this, there remains a significant trend towards greater uptake over time. We used this model together with known demographics to formulate a nascent early warning system that identifies candidate districts expected to have low prevalence of facility-based delivery in the immediate future. We provided a statistical method for using inexpensive and routinely collected monitoring and evaluation data to answer complex epidemiology and public health questions in a resource-poor setting.

Uganda introduced a multipronged intervention, the supervision, performance assessment, and recognition strategy (SPARS), to improve medicines management (MM) in public and not-for-profit health facilities. This paper, the first in a series, describes the SPARS intervention and reports on the MM situation in Uganda before SPARS (baseline).

Beginning in 2003, Uganda used Lot Quality Assurance Sampling (LQAS) to assist district managers collect and use data to improve their human immunodeficiency virus (HIV)/AIDS program. Uganda's LQAS-database (2003–2012) covers up to 73 of 112 districts. Our multidistrict analysis of the LQAS data-set at 2003–2004 and 2012 examined gender variation among adults who ever tested for HIV over time, and attributes associated with testing. Conditional logistic regression matched men and women by community with seven model effect variables. HIV testing prevalence rose from 14% (men) and 12% (women) in 2003–2004 to 62% (men) and 80% (women) in 2012. In 2003–2004, knowing the benefits of testing, knowing where to get tested, and secondary education were significantly associated with HIV testing. By 2012, knowing the benefits of testing, where to get tested, primary education, being female, and being married were significantly associated with HIV testing. HIV testing prevalence in Uganda has increased dramatically, more for women than men. Our results concurred with other authors that education, knowledge of HIV, and marriage (women only) are associated with testing for HIV and suggest that couples testing is more prevalent than other authors found.

SETTING: Amhara and Oromia Regions, Ethiopia.OBJECTIVE: To determine trends in case notification rates (CNRs) among new tuberculosis (TB) cases and treatment outcomes of sputum smear-positive (SS+) patients based on geographic setting, sex and age categories.METHODS: We undertook a trend analysis over a 4-year period among new TB cases reported in 10 zones using a trend test, a mean comparison t-test and one-way analysis of variance.RESULTS: The average CNR per 100 000 population was 128.9: 126.4 in Amhara and 131.4 in Oromia. The CNR in the project-supported zones declined annually by 6.5%, compared with a 14.5% decline in Tigray, the comparator region. TB notification in the intervention zones contributed 26.1% of the national TB case notification, compared to 13.3% before project intervention. The overall male-to-female ratio was 1.2, compared to 0.8 among SS+ children, with a female preponderance. Over 4 years, the cure rate increased from 75% to 88.4%, and treatment success from 89% to 93%. Default, transfer out and mortality rates declined significantly.CONCLUSION: Project-supported zones had lower rates of decline in TB case notification than the comparator region; their contribution to national case finding increased, and treatment outcomes improved significantly. High SS+ rates among girls deserve attention.

Universal health coverage (UHC) has gained prominence as a global health priority. The UHC movement aims to increase access to quality, needed health services while reducing financial hardship from health spending, particularly in low- and middle-income countries. As a policy agenda, UHC has been identified primarily with prepayment and risk-pooling programs. While financing policies provide important benefits, increasing access to health services will require broader reforms. For lessons, the UHC movement should look to the global HIV response, which has confronted many of the same barriers to access in weak health systems. Considerable success on HIV has resulted from innovative approaches that UHC efforts can build upon, in areas including governance, financing, service delivery, political mobilization, accountability, and human rights. UHC and HIV efforts must capitalize on potential synergies, especially in settings with a high HIV burden and major resource limitations.

The objective of this study was to compare the diagnostic yield of GeneXpert MTB/RIF with Ziehl-Neelson (ZN) sputum smear microscopy among index TB cases and their household contacts. A cross sectional study was conducted among sputum smear positive index TB cases and their household contacts in Northern Ethiopia. Results: Of 353 contacts screened, 41 (11%) were found to have presumptive TB. GeneXpert test done among 39 presumptive TB cases diagnosed 14 (35.9%) cases of TB (one being rifampicin resistant), whereas the number of TB cases diagnosed by microscopy was only 5 (12.8%): a 64.3% increased positivity rate by GeneXpert versus ZN microscopy. The number needed to screen and number needed to test to diagnose a single case of TB was significantly lower with the use of GeneXpert than ZN microscopy. Of 119 index TB cases, GeneXpert test revealed that 106 (89.1%) and 5 (4.2%) were positive for rifampicin sensitive and rifampicin resistant TB, respectively. GeneXpert test led to increased TB case detection among household contacts in addition to its advantage in the diagnosis of Rifampicin resistance among contacts and index TB cases. There should be a consideration in using GeneXpert MTB/RIF as a point of care TB testing tool among high risk groups.

This assessment of the Scaling Up Family Planning Initiative was conducted as part of USAID's Evidence Project. The Scaling Up Family Planning Initiative aimed to strengthen the public sector's ability to expand access to contraception and family planning services.

MSH Nigeria published this newsletter in July 2016. Newsletter Contents MSH Nigeria Presents 7 Posters at Intl. AIDS Conference MSH Pays Courtesy Call on the Minister of Health From the Country Rep  MSH Celebrates 10 Years of Health Impact in Nigeria CBHI Saves Baby Rosemary’s Life MSH Nigeria Receives Award of Excellence MSH Trains TBAs in Akwa Ibom State

On this page you can download previous versions of MSH’s Standard Terms and Conditions in English, French, Portuguese and Spanish. Purchase Orders are governed by whatever version of the terms and conditions was in effect on the date that the order was issued. To confirm which version of the terms and conditions applies to your Purchase Order check the ‘date issued’.

To enhance cross-country learning around maternal death surveillance and response (MDSR), African Strategies for Health developed two country-specific case studies which document MDSR implementation experiences in Burkina Faso and Malawi. These case studies were developed for inclusion in the WHO Global MDSR Implementation Report and can be accessed on the WHO website. 

As part of Committing to Child Survival: A Promise Renewed, a global effort to stop children from dying of causes that are easily prevented, African Strategies for Health (ASH) supported the government of Ethiopia, USAID and UNICEF to convene the African Leadership for Child Survival Call to Action meeting in Addis Ababa, Ethiopia, January 16-18, 2013. The meeting focused on:

These standards harmonize prevention, treatment and care provided throughout the region’s transport corridors, starting from the existing Cross Border Initiative roadside wellness centers.

This report documents key topics presented and discussed at the Integrated Disease Surveillance and Response 2013 Pre-Conference Workshop.

When planned and used appropriately, financial incentives have proven effective in improving utilization and quality of maternal and child care.

Health Care Financing Reform has allowed health facilities to retain and use their revenue for health service quality improvements. Hospitals and health centers in the three big regions started to retain revenue in 2005-2006, and now it is being rolled out to all regions as a national program. As a result of revenue retention, health facility budgets have improved significantly.

This report documents key points presented and discussed at the regional meeting “Scaling Up Mobile Technology Applications for Accelerating Progress on Ending Preventable Maternal and Child Deaths” held November 10, 2013 in Addis Ababa, Ethiopia on the fringes of the third International Conference on Family Planning.

In order for governments and organizations to adopt, implement, and scale up community health programs, knowledge of the wide typology of Community Health Worker (CHW) models and their associated incentive mechanisms is critical.

In Madagascar, community health workers play an essential part in improving access to quality health services in the context of a weak public sector and a severe shortage of trained healthcare workers.

The 2014 Ebola epidemic in West Africa is the largest in history. This brief summarizes information and communication technologies that have been used to optimize the Ebola response. It provides recommendations for policymakers and program managers seeking to deploy information and communication technology tools in outbreak settings that are applicable beyond the Ebola crisis.

The West African Abidjan to Lagos transport corridor crosses five countries through a densely populated and growing urban setting.

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