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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.

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.

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.

Multigram drug depot systems for extended drug release could transform our capacity to effectively treat patients across a myriad of diseases. For example, tuberculosis (TB) requires multimonth courses of daily multigram doses for treatment. To address the challenge of prolonged dosing for regimens requiring multigram drug dosing, we developed a gastric resident system delivered through the nasogastric route that was capable of safely encapsulating and releasing grams of antibiotics over a period of weeks. Initial preclinical safety and drug release were demonstrated in a swine model with a panel of TB antibiotics. We anticipate multiple applications in the field of infectious diseases, as well as for other indications where multigram depots could impart meaningful benefits to patients, helping maximize adherence to their medication.

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.

Unique identification is essential to progress toward meeting PEPFAR’s 95-95-95 goal. For people living with HIV, better program management means more timely testing and promotes continuity of service for lifesaving sustained ART. Providers can assess treatment regimens and their effectiveness toward achieving viral suppression.

Over the past two decades, Rwanda has realized impressive declines in preventable child and maternal mortality, serving as an example of what is possible through committed, collective action.

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.

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.

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 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. 

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.

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.

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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.

Request for Proposals RFP-BD-2019-008

Annex A_Vendor Response Format

Annex B_Budget Template

Annex C Budget Narrative Template

Annex D Biographical Data Form (AID Form 1420)

Annex E MSH Pre-Award Survey

Annex E.a. DUNS Instructions

Clean water, nutritious food, and a hygienic environment— these are the building blocks of health for any community. Yet, these necessities are out of reach for many families in low-resource environments. As a result, malnutrition contributes to 45 percent of childhood deaths worldwide.

Procurement Notice

Management Sciences for Health (MSH) is seeking proposals for technical assistance (TA). This TA is intended to support planned activities under the Sector-Wide Program Management and Monitoring (SWPMM) Operational Plan (OP) under the Health Services Division (HSD), Ministry of Health & Family Welfare (MOHFW).

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