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Inter-rater Reliability and Validity of Good Pharmacy Practices Measures in Inspection of Public Sector Health Facility Pharmacies in Uganda [1]

The National Drug Authority (NDA) inspects and certifies private and public sector pharmacies in Uganda using an indicator-based inspection tool that measures adherence to good pharmacy practices (GPP). 67 measures identify the situation in the domains of premises, dispensing quality, stores management, and operating requirements. Although the GPP measures are well-recognized and used internationally, little is known about their validity and reliability. The study aimed to assess validity, which measures agreement of GPP measures between a gold standard inspector and NDA inspector and inter-rater reliability (IRR), which measures agreement among NDA inspectors, of GPP measures. We assessed validity and IRR by four teams of inspectors in eight government health facilities that represent three levels of care. Each team inspected two facilities, resulting in 24 total inspections. Our findings question the validity and reliability of many GPP inspection measures, particularly critical measures that greatly impact certification decision. This study demonstrates the need for assessments of, and interventions to improve, validity and reproducibility of GPP measures and inspections.

Understanding Country‐specific Determinants of Stillbirth Using Household Surveys: The Case of Afghanistan [2]

Stillbirth rates in Afghanistan have declined little in the past decade with no data available on key risk factors. Health care utilisation and maternal complications are important factors influencing pregnancy outcomes but rarely captured for stillbirth in national surveys from low‐ and middle‐income countries. The 2010 Afghanistan Mortality Survey (AMS) is one of few surveys with this information. We used data from the 2010 AMS that included a full pregnancy history and verbal autopsy. Our sample included the most recent live birth or stillbirth of 13 834 women aged 12‐49 years in the three years preceding the survey. The risk of stillbirth was increased among women in the Central Highlands and of Nuristani ethnicity. Women who did not receive antenatal care had three times increased risk of stillbirth, while high‐quality antenatal care was important for reducing the risk of intrapartum stillbirth. Bleeding, infection, headache, and reduced fetal movements were antenatal complications strongly associated with stillbirth. Reduced fetal movements in the delivery period increased stillbirth risk by almost seven. Facility births had a higher risk of stillbirths overall, but not for intrapartum stillbirths. Targeted interventions are needed to improve access and utilisation of services for high‐risk groups. Early detection of complications through improved quality of antenatal and obstetric care is imperative. We demonstrate the potential of household surveys to provide country‐specific evidence on stillbirth risk factors for LMICs where data are lacking.

Delays to Anti-tuberculosis Treatment Initiation among Cases on Directly Observed Treatment Short Course in Districts of Southwestern Ethiopia: A Cross Sectional Study [3]

A cross-sectional study was conducted among 735 new adult tuberculosis (TB) cases registered between January to December 2015 in 10 woredas, equivalent to districts, of southwestern Ethiopia. TB patients waited too long time to initiate anti-TB treatment, reflecting longer periods of morbidity and disease transmission. The delays are attributed to patient, disease and health system related factors. Hence, improving community awareness, and involving informal providers, health extension workers and TB treatment supporters can reduce the patient delay. Similarly, cough screening and improving diagnostic efficiencies of healthcare facilities should be in place to reduce provider delays.

Uptake and Correlates of HIV Testing among Men in Malawi: Evidence from a National Population–based Household Survey [4]

The aim of this study was to assess the uptake and determinants of HIV testing among men in Malawi. Secondary data analysis was conducted on cross–sectional household data for 7,478 men aged 15 to 54 years drawn from the 2015–16 Malawi Demographic and Health Survey. Overall, 69.9% of the participants had ever been tested for HIV. The results indicate that age, region of residence, marital status, coverage by health insurance, education and age at first sexual debut are significant predictors of HIV testing among men in Malawi. The findings suggest that HIV testing services and programmes need to target younger unmarried men aged 15–19 and men with low level or no education and expand HIV testing services to the central and southern regions of Malawi. Targeting the undiagnosed men living with HIV in a timely manner is a crucial and necessary step not only for achieving the UNAIDS 90–90–90 targets but for individuals to benefit from antiretroviral treatment and to sustainably reduce population–level HIV transmission.

The 2019 UN High-level Meeting on Universal Health Coverage [5]

In their discussion of universal health coverage (UHC), the Editors (Jan 5, p 1) rightly state that “simply convening a UN high-level meeting is not enough” to achieve UHC. The Civil Society Engagement Mechanism for UHC2030 (CSEM) strongly agrees and is concerned that, without a radically different approach, the meeting will be a business-as-usual global health event. We are concerned that speakers at the high-level meeting on UHC on Sept 23, 2019, will declare support for UHC and leaving no one behind, but will not be held to account for their contradictory policies and actions. Bilateral and multilateral donors, and the intentions of the Sustainable Development Goals 3 Global Action Plan, will be applauded without scrutiny of stagnating aid that is tied to disease-specific priorities, thereby limiting the funding for and focus on primary health care. Participants will propose inclusion of the private sector without mitigating the inequality that the private sector drives.

Sharing Knowledge for Policy Action in Low- and Middle-income Countries: A Literature Review of Managed Entry Agreements [6]

Managed entry agreements (MEAs)—a type of formal institutional arrangement between pharmaceutical companies and payers for sharing the risk with respect to the introduction of new pharmaceutical technologies—may expand access to new pharmaceutical technologies for non-communicable diseases. Although common in high-income countries (HICs), there is limited evidence of their use in low- and middle-income countries (LMICs). This article aims to document international experiences of countries implementing MEAs and potential barriers and facilitators for their use in LMICs. We reviewed published literature sources on MEAs over the past 10 years considering peer-reviewed publications and gray literature data. While the use of MEAs in LMICs is very limited, this could be the result of limited empirical evidence on its use and possibly due to the use of a different taxonomy for describing MEAs in these settings. Since there is limited evidence on their use in LMICs, the identified cases of implementation in HICs may serve to inform the interest on MEAs in resource limited settings. Therefore, further research in this field especially in the context of LMICs may be of value for the global community as all countries are embarking into fairer and sustainable Universal Health Coverage.

HIV and cART-Associated Dyslipidemia among HIV-Infected Children [7]

Persistent dyslipidemia in children is associated with risks of cardiovascular accidents and poor combination antiretroviral therapy (cART) outcome. We report on the first evaluation of prevalence and associations with dyslipidemia due to HIV and cART among HIV-infected Ethiopian children. High prevalence of cART-associated dyslipidemia, particularly low HDLc and hypertriglyceridemia, was observed among treatment-experienced HIV-infected children. The findings underscore the need for regular follow-up of children on cART for lipid abnormalities.

Institutionalizing Infection Prevention and Control in a TB and Lung Disease Hospital in Bangladesh [8]

TB infection prevention and control (IPC) is an important strategy to prevent disease transmission—it is a combination of measures to minimize the risk of transmission from a TB case to other patients, health care providers, and the wider population.

Patient enrollment in shorter treatment regimen under national DR-TB Program: Lessons from Bangladesh [10]

Bangladesh is one of the world’s high MDR-TB burden countries. According to the WHO, the MDR-TB burden is 1.6% among new cases and 29% among retreatment cases. The longer duration of MDR-TB treatment regimens and the toxicity of certain agents discourage many patients from completing treatment.

Institutionalizing a prefabricated Bio-Safety Level-3 laboratory: Lessons from Bangladesh [12]

In collaboration with the National TB Control Program (NTP) in Bangladesh, the USAID-funded Challenge TB established a high-quality Bio-Safety Level-3 Laboratory (BSL-3 lab) in Sylhet to accelerate TB and DR-TB diagnosis and treatment in the northeast region of the country. The BSL-3 lab, the highest level of safety of its type in Bangladesh, provides rapid and quality services.

Introduction of New Pediatric TB Drug Formulations in Ethiopia [14]

Tuberculosis is a major cause of morbidity and mortality among children. In Ethiopia, more than 15,000 pediatric, drug-sensitive TB cases were reported in 2017 and 2018. Until recently there were no appropriately dosed TB medicines for children.

Clinical and Financial Implications of Medicine Consumption Patterns at a Leading Referral Hospital in Kenya to Guide Future Planning of Care [16]

In Kenyatta National Hospital, a leading hospital in Kenya, over 30% of expenditure is currently allocated to medicines, and this needs to be optimally managed. We used inventory control techniques, ABC (Always, Better, and Control), VEN (Vital, Essential, and Non-essential) and ABC-VEN matrix analyses to study drug expenditure patterns. Of an average of 811 medicine types procured annually, 80% were formulary drugs and 20% were non-formulary. Class A medicines constituted 13.2–14.2% of different medicines procured each year but accounted for an average of 80% of total annual drug expenditure. Class B medicines constituted 15.9–17% of all the drugs procured yearly but accounted for 15% of the annual expenditure, whilst Class C medicines constituted 70% of total medicines procured but only 5% of the total expenditure. Vital and essential medicines consumed the highest percentage of drug expenditure. ABC-VEN categorization showed that an average of 31% of medicine types consumed an average of 85% of total drug expenditure. Therapeutic category and morbidity patterns analysis showed a mismatch between drug expenditure and morbidity patterns in over 85% of the categories. We concluded that Class A medicines are few but consume the largest proportion of hospital drug expenditure. Vital and essential items account for the highest drug expenditure, and need to be carefully managed. ABC-VEN categorization identified medicines where major savings could potentially be made helped by therapeutic category and morbidity pattern analysis. There was a high percentage of non-formulary items, which needs to be addressed. Inventory control techniques should be applied routinely to optimize medicine use within available budgets, especially in low- and middle-income countries.

A Systematic Review of the Effectiveness of Strategies to Improve Health Care Provider Performance in Low- and Middle-income Countries: Methods and Descriptive Results [17]

he Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of the effectiveness and cost of strategies to improve HCP performance in low- and middle-income countries. We present the HCPPR’s methods, describe methodological and contextual attributes of included studies, and examine time trends of study attributes. We screened 105,299 citations and included 824 reports from 499 studies of 161 intervention strategies. Most strategies had multiple components and were tested by only one study each. Studies were from 79 countries and had diverse methodologies, settings, HCP types, work environments, and health conditions. Training, supervision, and patient and community supports were the most commonly evaluated strategy components. Studies have reported on the efficacy of many strategies to improve HCP performance in LMICs. However, most studies have important methodological limitations.

Using WISN to Address Nurse-Midwife Shortages in Baringo County, Kenya [18]

Achieving the best health outcomes possible requires a well-trained, adequately staffed, equitably distributed, and highly motivated workforce to provide services, especially in challenging circumstances.However, many health facilities in rural and hard-to-reach areas of Kenya lack enough staff to meet the surrounding population’s health care needs. Recognizing the need to est

Implementation and effectiveness of free health insurance for the poor pregnant women in Tanzania: A mixed methods evaluation [20]

This study used a mixed methods evaluation to determine the effect of a targeted health insurance scheme on access to affordable quality maternal and child care, and assess implementation fidelity and how this affected programme outcomes. A total of 90 in-depth interviews (IDIs) and five focus group discussions were conducted among respondents from management, facility and community. The scheme achieved high coverage among the target population and reduced the amount paid for antenatal and delivery care; however, there was no effect on service coverage and limited effects on quality of care. Better communication of programme benefits is needed to enhance effects together with integration of such schemes within existing purchasing mechanisms and in financially decentralised health systems.

A Four-year Trend in Pulmonary Bacteriologically Confirmed Tuberculosis Case Detection in Kampala, Uganda [21]

A retrospective analysis of diagnosis smear results of PBC TB patients in Kampala District registered between January 2012 and December 2015 at 65 TB diagnosis and treatment units (DTUs) was done. Of the 10,404 records, 6551 (63.0%) belonged to PBC TB patients, 3734 (57.0%) of whom were male. From 2012 through 2015, there was a statistically significant increase in PBC TB patients enrolled on anti-TB treatment from 1389 to 2194. The percentage of HIV positive co-infected PBC TB patients diagnosed decreased from 597 (43%) to 890 (40.6%) within same period. Linkage to HIV care improved from 229 (34.4%) in 2012 to 464 (52.1%) in 2015. The treatment success rate for PBC TB patients improved from 69% in 2012 to 75.5% by the end of 2015 with an improvement in the cure rate from 52.3% to 62%. There was a significant decrease in TB related mortality from 8.9 to 6.4%. The proportion of diagnosed PBC TB patients increased from 2012 to 2015. PBC TB patients diagnosed with 3+ smear positivity grading results consistently contributed to the highest proportion of diagnosed PBC TB patients from 2012 to 2015. This could be due to the delay in diagnosis of TB patients because of late presentation of patients to clinics.

Pregnancy Intention and Contraceptive Use among HIV-positive Malawian Women at 4-26 Weeks Post-partum: A Nested Cross-sectional Study [22]

We investigated factors associated with unintended index pregnancy, unmet contraceptive need, future pregnancy intention and current contraceptive use among Malawian women living with HIV in the Option B+ era. Women who tested HIV positive at 4–26 weeks postpartum were enrolled into a cross-sectional study at high-volume under-5 clinics. We enrolled 578 HIV-positive women between May 2015-May 2016; median maternal age was 28 years (y), median parity was 3 deliveries, and median infant age was 7 weeks. Overall, 41.8% women reported unintended index pregnancy, of whom 35.0% reported unmet contraceptive need and 65.0% contraceptive failure. High prevalence of unintended index pregnancy and unmet contraceptive need among HIV-positive women highlight the need for improved access to contraceptives. To help achieve reproductive goals and elimination of MTCT of HIV, integration of family planning into HIV care should be strengthened to ensure women have timely access to a wide range of family planning methods with low failure risk.

Provider Barriers to the Uptake of Isoniazid Preventive Therapy among People Living with HIV in Ethiopia [23]

This study examined provider barries to uptake of isoniazid preventive therapy (IPT) at 67 government health facilities providing tuberculosis (TB) and human immunodeficiency virus (HIV) services across Ethiopia. Clinician impression that ruling out active TB among HIV patients is difficult was found to be a significant barrier to IPT uptake. Continued advancement of IPT relies greatly on improving the ability of providers to determine IPT eligibility and more confidently care for patients on IPT. Improved clinician support and training as well as development of new TB diagnostic technologies could impact IPT utilization among providers.

Preventive Treatment Demonstration in Bangladesh [24]

The primary mode for the spread of TB is person to person, and it is estimated that a person with TB can infect up to 15 individuals each year until that patient starts treatment and is rendered non-infectious. The USAID-funded Challenge TB project implemented a demonstration initiative that provided preventive treatment for household contacts of TB patients.

Annex A_Vendor Response Format [26]

Annex A_Vendor Response Format

Annex B_Budget Template [27]

Annex B_Budget Template

Annex C Budget Narrative Template [28]

Annex C Budget Narrative Template

Annex D Biographical Data Form (AID Form 1420) [29]

Annex D Biographical Data Form (AID Form 1420)

Annex E MSH Pre-Award Survey [30]

Annex E MSH Pre-Award Survey

Annex E.a. DUNS Instructions [31]

Annex E.a. DUNS Instructions

Pages

Links
[1] https://www.msh.org/resources/inter-rater-reliability-and-validity-of-good-pharmacy-practices-measures-in-inspection-of?page=32
[2] https://www.msh.org/resources/understanding-country%E2%80%90specific-determinants-of-stillbirth-using-household-surveys-the-case?page=32
[3] https://www.msh.org/resources/delays-to-anti-tuberculosis-treatment-initiation-among-cases-on-directly-observed?page=32
[4] https://www.msh.org/resources/uptake-and-correlates-of-hiv-testing-among-men-in-malawi-evidence-from-a-national?page=32
[5] https://www.msh.org/resources/the-2019-un-high-level-meeting-on-universal-health-coverage?page=32
[6] https://www.msh.org/resources/sharing-knowledge-for-policy-action-in-low-and-middle-income-countries-a-literature-review?page=32
[7] https://www.msh.org/resources/hiv-and-cart-associated-dyslipidemia-among-hiv-infected-children?page=32
[8] https://www.msh.org/resources/institutionalizing-infection-prevention-and-control-in-a-tb-and-lung-disease-hospital-in?page=32
[9] https://www.msh.org/resources/institutionalizing-infection-prevention-and-control-in-a-tb-and-lung-disease-hospital-in
[10] https://www.msh.org/resources/patient-enrollment-in-shorter-treatment-regimen-under-national-dr-tb-program-lessons-from?page=32
[11] https://www.msh.org/resources/patient-enrollment-in-shorter-treatment-regimen-under-national-dr-tb-program-lessons-from
[12] https://www.msh.org/resources/institutionalizing-a-prefabricated-bio-safety-level-3-laboratory-lessons-from-bangladesh?page=32
[13] https://www.msh.org/resources/institutionalizing-a-prefabricated-bio-safety-level-3-laboratory-lessons-from-bangladesh
[14] https://www.msh.org/resources/introduction-of-new-pediatric-tb-drug-formulations-in-ethiopia?page=32
[15] https://www.msh.org/resources/introduction-of-new-pediatric-tb-drug-formulations-in-ethiopia
[16] https://www.msh.org/resources/clinical-and-financial-implications-of-medicine-consumption-patterns-at-a-leading-0?page=32
[17] https://www.msh.org/resources/a-systematic-review-of-the-effectiveness-of-strategies-to-improve-health-care-provider?page=32
[18] https://www.msh.org/resources/using-wisn-to-address-nurse-midwife-shortages-in-baringo-county-kenya?page=32
[19] https://www.msh.org/resources/using-wisn-to-address-nurse-midwife-shortages-in-baringo-county-kenya
[20] https://www.msh.org/resources/implementation-and-effectiveness-of-free-health-insurance-for-the-poor-pregnant-women-in?page=32
[21] https://www.msh.org/resources/a-four-year-trend-in-pulmonary-bacteriologically-confirmed-tuberculosis-case-detection-in?page=32
[22] https://www.msh.org/resources/pregnancy-intention-and-contraceptive-use-among-hiv-positive-malawian-women-at-4-26-weeks?page=32
[23] https://www.msh.org/resources/provider-barriers-to-the-uptake-of-isoniazid-preventive-therapy-among-people-living-with?page=32
[24] https://www.msh.org/resources/preventive-treatment-demonstration-in-bangladesh?page=32
[25] https://www.msh.org/resources/preventive-treatment-demonstration-in-bangladesh
[26] https://www.msh.org/resources/annex-avendor-response-format?page=32
[27] https://www.msh.org/resources/annex-bbudget-template?page=32
[28] https://www.msh.org/resources/annex-c-budget-narrative-template?page=32
[29] https://www.msh.org/resources/annex-d-biographical-data-form-aid-form-1420?page=32
[30] https://www.msh.org/resources/annex-e-msh-pre-award-survey?page=32
[31] https://www.msh.org/resources/annex-ea-duns-instructions?page=32
[32] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial
[33] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=31
[34] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=28
[35] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=29
[36] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=30
[37] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=33
[38] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=34
[39] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=35
[40] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=36
[41] https://www.msh.org/resources/supporting-infection-prevention-and-control-and-optimizing-the-use-of-antimicrobial?page=58