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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).

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.

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.

The USAID-funded African Strategies for Health (ASH) project undertook this childhood TB landscape analysis, to expand and centralize available information on childhood TB in Africa.

To better understand whether childhood TB guidelines can inform the roles and responsibilities of maternal and child health providers and to identify opportunities for strengthening them, USAID's Africa and Global Health Bureaus and the African Strategies for Health (ASH) project assessed existing childhood TB guidelines in 13 countries in Africa.

Postpartum hemorrhage is the leading cause of maternal mortality in low-income countries. Over the past decade, the use of misoprostol for the prevention of postpartum hemorrhage in developing countries has gained attention as an effective strategy in settings where skilled birth attendance is low, particularly at the community level.

Many children in sub-Saharan Africa die before their fifth birthday from preventable causes, including malaria, diarrhea, and pneumonia. Integrated community case management (iCCM) is an effective, equity-based strategy that aims to train, equip, and supervise community health workers to treat children for these diseases at the community level.

Significant global investment in preventative and life-saving interventions for children under five years of age has greatly contributed to the reduction of the global mortality rate by nearly half from 1990 to 2013.

Malaria remains a significant burden to health systems, especially in sub-Saharan Africa, which accounts for 90 percent of malaria-related deaths worldwide. Not all patients are able to access timely and quality malaria services. A key strategy to enhance the utilization, provision, and quality of malaria services is the use of both demand-side and supply-side financial incentives.

As Rwanda looks to sustain and build on its hard-earned gains in health, it faces a few vital constraints. Donor funding is declining and the Health Sector Strategic Plan III is underfunded with a likely gap of $372- $697 million. Private sector investment, which could potentially help fill this gap, is only 1.7 percent.

The African Strategies for Health project and MSH participated in the Financial Protection and Access to Care Workshop, held in Accra, Ghana February 15-19, 2016.

The African continent has perhaps seen the most pronounced movement towards regionalism. In Africa’s health sector, regional bodies—such as regional economic communities and inter-governmental institutions, as well as regional professional associations and regional networks—have become active contributors to the development and health agendas over the last 10 to 15 years.

In recent years, there has been a growing trend toward regionalization on the African continent, as integrated and cooperative efforts have created positive impact in political, economic, and social sectors. In Africa’s health sector, regional actors have become active contributors to development and health agendas.

In recent years, there has been a growing trend toward regionalization on the African continent. In Africa's health sector, regional actors have become active contributors to development and health agendas.

The African continent has seen pronounced movement toward regionalism in recent years to catalyze development and strengthen African integration and unity. Regional bodies are actively contributing to the development of many sectors, including health, which is increasingly recognized as essential to human and economic development in Africa.

Africa has seen a growing trend toward regionalism over the past 10 to 15 years, particularly in its health sector, as emerging health issues demand cross-border coordination and partnerships. Critical to an effective response to health issues is a strong health workforce.

Africa's health sector has seen a growing movement toward regionalism, as stakeholders increasingly work collaboratively and across national borders to advance health and development agendas. In the fight against malaria, strong partnerships across the continent have contributed to dramatic progress over the past 15 years. 

Maternal, newborn, and child health (MNCH) is a focal area for many regional bodies across Africa, as the continent currently accounts for more than 60 percent of all maternal deaths and almost half of all newborn and under-five deaths globally each year. Intergovernmental partnerships and crossborder collaboration add value to the fight to save the lives of moth

The African continent has seen pronounced movement toward regionalism in recent years. Regional bodies are actively contributing to the development of many sectors, including health.

Over the course of the project, African Strategies for Health, in support of USAID/Africa Bureau priorities, has engaged with thought leaders, innovators, and implementers on cutting-edge issues to build capacity and advance collaboration in the use of digital technology to improve health outcomes.

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