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In this commentary, the authors discuss why integrating HIV testing, treatment and care into child survival platforms is important, as well as its potential to advance progress towards global targets that call for, by 2020, 90% of children living with HIV to know their status, 90% of those diagnosed to be on treatment and 90% of those on treatment to be virally suppressed (90-90-90). Integration is critical in improving health outcomes and efficiency gains. In children, integration of HIV in programmes such as immunization and nutrition has been associated with an increased uptake of HIV infant testing. Integration is increasingly recognized as a case-finding strategy for children missed from prevention of mother-to-child transmission programmes and as a platform for diffusing emerging technologies such as point-of-care diagnostics. These support progress towards the 90-90-90 targets by providing a pathway for early identification of HIV-infected children with co-morbidities, prompt initiation of treatment and improved survival. There are various promising practices that have demonstrated HIV outcomes; however, few have documented the benefits of integration on child survival interventions. The Double Dividend framework is well positioned to address the bidirectional impacts for both programmes.

Assessing the state of country readiness for the introduction of new, child-friendly anti-tuberculosis formulations can highlight potential bottlenecks, facilitate early planning, and accelerate access to appropriate treatment for children with tuberculosis (TB). To understand pathways and potential obstacles to the introduction of new pediatric formulations, we performed a desk review of key policy documents and conducted 146 stakeholder interviews in 19 high-burden countries. Issuance of World Health Organization (WHO) guidance serves as the trigger for considering adoption in most countries; however, the degree of alignment with WHO recommendations and duration ofintroduction processes vary. Endorsement by experts and availability of local evidence are leading criteria for adoption in upper-middle- and high-income countries. Ease of administration, decreased pill burden, and reduced treatment costs are prioritized in low- and lower-middle-income settings. Countries report an average of 10 steps on the path to new treatment introduction, with core steps taking between 18 and 71 months. The process of new treatment introduction is complicated by diverse country processes, adoption criteria, and evidence requirements. Challenges differ between low- and middle-to-high-income countries. Responsiveness to the unique hurdles faced across settings is important in ensuring a sustainable market for improved pediatric anti-tuberculosis treatment.

The community-based health insurance (CBHI) scheme launched by the Government of Rwanda (GoR) reached 91% of the population in 2010, starting from 7% in 2003. Initially, all CBHI members paid the same fees, regardless of their personal income, and the poorest citizens faced challenges in paying premiums (almost US$1.50 per person). A mechanism was thus urgently needed to guarantee access to health care for the most vulnerable and promote equity among members. The GoR decided to introduce a stratification system based on the socioeconomic status of the population. Together with partners, including the Integrated Health Systems Strengthening Project (IHSSP), the GoR developed a national database that stratifies Rwandan citizens by income. To date, more than 10 million residents’ records, representing 96% of Rwanda’s population, have been entered into the database. This database helped identify the most vulnerable based on socioeconomic status (about 25% of the population). Identification of the poorest among the population has allowed an increase in CBHI funds due to identification of individuals who have a greater capacity to pay. The database thus improved the financial viability and management capacity of the CBHI scheme.

Improving governance is one of the essential elements of realizing the dream of a strong health system achieving greater health impact. Good governance enables the effective use of medicines, information, human resources, and finances to deliver better health service performance and better health outcomes.

In 2015, MSH’S projects reached more than 84.2m people worldwide. Since 2012, MSH has contributed to saving more than 500,000 lives and has trained more than 107,000 people - from health officials to frontline health workers.   

This systematic review (Jan. 2003-Dec. 2014) synthesized evidence on interventions that have directly reduced mortality in high-HIV-prevalence populations. Antiretroviral therapy (ART)was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and treatment.

The five-year Program to Build Leadership and Accountability in Nigeria's Health System (PLAN-Health) is funded by the US Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR) and implemented by MSH.

The five-year Program to Build Leadership and Accountability in Nigeria's Health System (PLAN-Health) is funded by the US Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR), and is implemented by MSH.

Akwa Ibom ranks sixth out of Nigeria’s 36 states for the highest number of people living with HIV in the country. The 2012 National AIDS and Reproductive Health Survey showed the state as having a prevalence rate of 6.5 percent. Providing equitable services and interventions to address the HIV burden in Akwa Ibom State is a health management emergency.

More than 100 countries are in the process of adopting or embarking on universal health coverage (UHC) and health reform strategies, such as pro-poor national insurance and decentralization.

More than 50 MSH staff from the home and country offices traveled to Cape Town, South Africa to participate in the 46th Union World Conference on Lung Health December 2-6, 2015. MSH, along with the USAID-funded, MSH-led Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program, co-hosted four workshops, and presented 22 posters, 7 oral presentations and 7 symposiums.

MSH mobilizes communities, including community health workers, health officials, and religious and traditional leaders to support increased access to and use of family planning and reproductive health services, including prevention and treatment of cervical cancer.

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

HIV prevalence is disproportionately high among sex workers and long distance truck drivers compared to the general population, both globally and in the Southern African region.

While measurement and attribution of maternal mortality is challenging, available evidence indicates that HIV-infected pregnant and postpartum women have an increased risk of death compared to their uninfected peers.

In 2014, the budget for high cost drugs in the Dominican Republic was USD 107 million, accounting for 51% of the Ministry of Health (MoH) budget for medicines. Resources allocated for the 2015 budget were USD 49 million, leaving a shortfall of USD 62 million. The MoH requested technical assistance from the USAID-funded SIAPS project to conduct an evidence based analysis of the 98 products included in the list.

The aim of this study was to assess the prevalence of MDR-TB and associated risk factors in West Armachiho and Metema districts of North Gondar. A cross-sectional study was conducted between February 1 and June 25, 2014. A total of 124 consecutive smear-positive pulmonary TB patients were included in the study. Socio-demographic and possible risk factor data were collected using a semi-structured questionnaire. Drug susceptibility testing was first performed for rifampicin using GeneXpert MTB/RIF. For those rifampicin resistant strains, drug susceptibility testing was performed for both isoniazid and rifampicin to identify MDR-TB. Of 124 smear-positive pulmonary TB patients, 117 (94.4 %) were susceptible to rifampicin, while 7 (5.7 %) were confirmed to be resistant to rifampicin and isoniazid. History of previous treatment was significantly associated with MDR-TB. Maximizing early case detection and treatment, strengthening TB infection control activities and proper implementation of DOTS are recommended to reduce the burden of MDR-TB.

This hospital-based study aimed to examine patient and primary healthcare factors and stage at diagnosis in women with cervical cancer in Northern Uganda in order to identify factors associated with advanced stages, to inform policies to improve survival from cervical cancer in low income and middle income countries. Of 166 patients attending care, 149 were enrolled and analysed. Most women were diagnosed at stages III (45%) or IV (21%). Understanding individual patient factors, patients' behavioural characteristics and healthcare factors associated with advanced stage at diagnosis is essential for targeted effective public health interventions to promote prompt health seeking, diagnosis at early stage and improved survival from cervical cancer.

The Government of Cameroon and its partners have made major investments in the last decade in prevention, treatment, and care of HIV-infected patients. However, unmet need for antiretroviral therapy (ART) among HIV-positive pregnant women remains high at 66%. Critical to satisfying this need is ensuring adequate availability of prevention of mother-to-child transmission (PMTCT) commodities for rollout of new Option B+ guidelines. This study examines options for improving the supply and availability of these commodities. Supply chain operational data was collected in July 2014 from central (CENAME) and 4 regional warehouses (CAPRs); 10 district stores; and 30 service delivery points (SDPs), including ART and PMTCT sites. The study also included seven central private-sector logistics firms. In addition, SC cost data was obtained from CENAME and CAPRs financial statements. Data collected served for analysis of three options to improve effectiveness of delivering PMTCT commodities. Asset utilization within the cost recovery system ranged between 73% and 89% while inventory turnover was at 1.5. Therefore, a reliable supply of medicines to SDPs is ensured. However, for PMTCT and ART commodities, distribution to the SDPs was unreliable (in 2013, 40% of prescriptions remained unfilled). Meanwhile, results of the options analysis indicated that the model of CAPRs delivering PMTCT commodities to SDPs was the most desirable. Although the distance traveled was higher, the need for network storage space was minimal. Moreover, its total cost and human resource requirements were more favorable. As a result of disseminating the findings, the Ministry of Health adopted Option 2.

The neglected tropical diseases (NTDs) are the most common infections of humans in sub-Saharan Africa. Virtually all of the population living below the World Bank poverty figure is affected by one or more NTDs. New evidence indicates a high degree of geographic overlap between the highest-prevalence NTDs (soil-transmitted helminths, schistosomiasis, onchocerciasis, lymphatic filariasis, and trachoma) and malaria and HIV, exhibiting a high degree of co-infection. Recent research suggests that NTDs can affect HIV and AIDS, tuberculosis (TB), and malaria disease progression. A combination of immunological, epidemiological, and clinical factors can contribute to these interactions and add to a worsening prognosis for people affected by HIV/AIDS, TB, and malaria. Together these results point to the impacts of the highest-prevalence NTDs on the health outcomes of malaria, HIV/AIDS, and TB and present new opportunities to design innovative public health interventions and strategies for these "big three" diseases. This analysis describes the current findings of research and what research is still needed to strengthen the knowledge base of the impacts of NTDs on the big three.

Early detection and treatment of multidrug-resistant tuberculosis (MDR-TB) is an urgent global priority. Identifying and tracing close contacts of patients with MDR-TB could be a feasible strategy to achieve this goal. However, there is limited experience with contact tracing among patients with drug-resistant tuberculosis both globally and in Ethiopia. Here we present findings on the extent of screening symptomatic contacts and its yield in a tetrtiary hospital in a major urban setting in Ethiopia. Symptomatic household contacts were identified in 29 (5.7%) of 508 index cases treated at the hospital. There were a total of 155 family members in the households traced of whom 16 (10%) had confirmed MDR-TB. At least 1 confirmed MDR-TB case was identified in 15 (51.7%) of the 29 traced households. Tracing symptomatic contacts of MDR-TB cases could be a high yield strategy for early detection and treatment of MDR-TB cases in the community. The approach should be promoted for wider adoption and dissemination.

In 2010, the Ministry of Health (MoH) asked USAID for technical assistance to implement interventions to improve the HIV/AIDS supply chain system. Assessments revealed that fragmentation of the pharmaceutical system contributed to stock-outs and expiration of antiretroviral (ARVs) and other medicines and supplies used by disease control programs. The implementation of an integrated system was proposed as the most efficient and sustainable alternative to confront the HIV/AIDS pharmaceutical supply problems.

Since 2004 public provision of ARVs in the Dominican Republic has been funded, by the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). Until 2009 there was a gross correspondence between the increase in the number of treated cases and the funding. From 2009 to 2012, however, the number of cases grew at an average rate of 33.4% (2,958 cases) per year, whereas funding experienced an average decrease of 21.7% (965,382 USD) per year. In 2012, the Ministry of Health (MoH) carried out the first national quantification exercise for the 2013 procurement of medicines, under a standard forecasting methodology.

In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013-2025. We used adapted Child Health and Nutrition Research Initiative methods for this prioritization exercise. We identified and approached the 200 most productive researchers and 400 program experts, and 132 of them submitted research questions. These were collated into a set of 205 research questions, sent for scoring to the 600 identified experts, and assessed and scored by 91 experts. Nine out of top ten identified priorities were in the domain of research on improving delivery of known interventions, with simplified neonatal resuscitation program and clinical algorithms and improved skills of community health workers leading the list. The top 10 priorities in the domain of development were led by ideas on improved Kangaroo Mother Care at community level, how toimprove the accuracy of diagnosis by community health workers, and perinatal audits. The 10 leading priorities for discovery research focused on stable surfactant with novel modes of administration for preterm babies, ability to diagnose fetal distress and novel tocolytic agents to delay or stop preterm labour. These findings will assist both donors and researchers in supporting and conducting research to close the knowledge gaps for reducing neonatal mortality, morbidity and long term impairment.

Forecasting Consumption of Select Reproductive, Maternal, Newborn and Child Health Commodities This guide will assist program managers, service providers, and technical experts when conducting a quantification of commodity needs for the 13 reproductive, maternal, newborn, and child health commodities prioritized by the UN Commission on Life-Saving Commodities for Women and Children.

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