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AIDS. 2016 Nov 28; 30(18):2865-2873.OBJECTIVE: In 2015, the WHO recommended initiation of antiretroviral therapy (ART) in all HIV-positive patients regardless of CD4 cell count. We evaluated the cost-effectiveness of immediate versus deferred ART initiation among patients with CD4 cell counts exceeding 500cells/mul in four resource-limited countries (South Africa, Nigeria, Uganda, and India). DESIGN: A 5-year Markov model with annual cycles, including patients at CD4 cell counts more than 500 cells/mul initiating ART or deferring therapy until historic ART initiation criteria of CD4 cell counts more than 350 cells/mul were met. METHODS: The incidence of opportunistic infections, malignancies, cardiovascular disease, unscheduled hospitalizations, and death, were informed by the START trial results. Risk of HIV transmission was obtained from a systematic review. Disability weights were based on published literature. Cost inputs were inflated to 2014 US dollars and based on local sources. Results were expressed in cost per disability-adjusted life years averted and measured against WHO cost-effectiveness thresholds. RESULTS: Immediate initiation of ART is associated with a cost per disability-adjusted life years averted of -$317 [95% confidence interval (CI): -$796-$817] in South Africa; -$507 (95% CI: -$765-$837) in Nigeria; -$136 (-$382-$459) in Uganda; and -$78 (-$256-$374) in India. The results are largely driven by the impact of ART on reducing the risk of new HIV transmissions. CONCLUSIONS: In HIV-positive patients with CD4 counts above 500 cells/mul in the four studied countries, immediate initiation of ART versus deferred therapy until historic eligibility criteria are met is cost-effective and likely even cost-saving over time.
Estimating the value of point-of-care HPV testing in three low- and middle-income countries: a modeling study.
BMC Cancer. 2017 Nov 25; 17(1):791.BACKGROUND: Where resources are available, the World Health Organization recommends cervical cancer screening with human papillomavirus (HPV) DNA testing and subsequent treatment of HPV-positive women with timely cryotherapy. Newer technologies may facilitate a same-day screen-and-treat approach, but these testing systems are generally too expensive for widespread use in low-resource settings. METHODS: To assess the value of a hypothetical point-of-care HPV test, we used a mathematical simulation model of the natural history of HPV and data from the START-UP multi-site demonstration project to estimate the health benefits and costs associated with a shift from a 2-visit approach (requiring a return visit for treatment) to 1-visit HPV testing (i.e., screen-and-treat). We estimated the incremental net monetary benefit (INMB), which represents the maximum additional lifetime cost per woman that could be incurred for a new point-of-care HPV test to be cost-effective, depending on expected loss to follow-up between visits (LTFU) in a given setting. RESULTS: For screening three times in a lifetime at 100% coverage of the target population, when LTFU was 10%, the INMB of the 1-visit relative to the 2-visit approach was I$13 in India, I$36 in Nicaragua, and I$17 in Uganda. If LTFU was 30% or greater, the INMB values for the 1-visit approach in all countries was equivalent to or exceeded total lifetime costs associated with screening three times in a lifetime. At a LTFU level of 70%, the INMB of the 1-visit approach was I$127 in India, I$399 in Nicaragua, and I$121 in Uganda. CONCLUSIONS: These findings indicate that point-of-care technology for cervical cancer screening may be worthy of high investment if linkage to treatment can be assured, particularly in settings where LTFU is high.
New York, New York, UNICEF, 2017 Jul. 32 p.This report provides compelling new evidence that backs up an unconventional prediction UNICEF made in 2010: The higher cost of reaching the poorest children with life-saving, high-impact health interventions would be outweighed by greater results. This new study combines modelling and data from 51 countries. The results indicate that the number of lives saved by investing in the most deprived is almost twice as high as the number saved by equivalent investment in less deprived groups.
Geneva, Switzerland, WHO, 2015 Nov. 2 p. (Pre-Exposure Prophylaxis (PrEP); Policy Brief)This policy brief defines PrEP, presents the World Health Organization's current recommendations for PrEP use and the evidence for it, discusses PrEP's expected cost-effectiveness, and lists considerations for PrEP implementation.
[London, United Kingdom, IPPF], 2016. 21 p.Family planning is a critical, human rights-based, and cost-effective approach to climate change adaptation and resilience building. The aims of the paper are for national family planning advocates to be better placed to ensure: (a) national development (including climate change) planning processes include greater emphasis on family planning; and (b) more “climate change programmes” include family planning actions, therefore increasing overall investment and action in reproductive health. After defining “climate change” and introducing the United Nations Framework Convention on Climate Change, 10 arguments are summarised which national family planning advocates are encouraged to employ, to suit their national contexts, to further these aims.
Climate change: time to "think family planning." A communications toolkit for family planning advocates.
[London, United Kingdom, IPPF], 2016. 9 p.This paper asserts that family planning is a critical, human rights-based, and cost-effective approach to climate change adaptation and resilience building. The aims of the paper are for national family planning advocates to be better placed to ensure: (a) national development plans (including climate change planning processes) include greater emphasis on voluntary family planning; and (b) more “climate change programmes” and strategies include family planning actions, therefore increasing overall investment and action in reproductive health. The accompanying policy paper summarises strategies which family planning advocates are encouraged to employ, to suit their national contexts, to further these aims. This Communications Toolkit summarises how those arguments can be edited into key messages and how those key messages can be used to reach advocacy targets in the run up to COP22, the next Climate Change Conference, to be held in Marrakech, Morocco, from 7 to 18 November 2016.
Policy brief on the case for investing in research to increase access to and use of contraception among adolescents.
Seattle, Washington, PATH, 2015 Mar. 4 p.This document outlines why governments and donors should invest now in research to help determine and implement the most effective and efficient ways to enable adolescents to access and use contraception. It summarizes the findings of a longer technical report.
Brazzaville, Republic of the Congo, WHO, Regional Office for Africa, 2017. 23 p. (Policy Brief)Community health worker (CHW) programmes have seen a renaissance in the last two decades and now many countries in Africa boast of such national or substantial sub-national programmes. The 2013 Third Global Forum on Human Resources for Health concluded that CHWs and other frontline primary health care workers “play a unique role and can be essential to accelerating MDGs and achieving UHC”, and called for their integration into national health systems. The Ebola virus disease (EVD) outbreak of 2014-2015 highlighted the imperative of ensuring the functioning of the health systems at the community level for both their day-to-day resilience and disaster preparedness. The purpose of this policy brief is to inform discussions and decisions in the World Health Organization (WHO) African Region on policies, strategies and programmes to increase access to primary health care (PHC) services and make progress towards universal health coverage (UHC) by expanding the implementation of scaled-up CHW programmes. This brief summarizes the existing evidence on CHW programmes with a focus on sub-Saharan Africa and offers a number of context-linked policy options for countries seeking to scale up and improve the effectiveness of their CHW programmes, particularly with regard to needs such as those of Guinea, Liberia and Sierra Leone, the three countries that were the most affected by the 2014-2015 EVD outbreak. For the purposes of this policy brief, a broad definition of CHW is used. CHWs are individuals “carrying out the functions related to health care delivery [who are] trained in some way in the context of the intervention [but have] no formal professional or paraprofessional certificated or degreed tertiary education [in a health-related field]”). WHO states that CHWs “should be members of the communities where they work, selected by the communities, answerable to the communities for their activities, and supported by the health system but not necessarily a part of its organization”. For the purposes of this brief, a working definition for a scaled-up CHW programme has been developed, where the term refers to a programme that is designed to be more than a pilot or demonstration project and has the intention of covering a substantial population size or geographic area, depending on the country’s context. (Excerpts)
Guidelines on HIV self-testing and partner notification: Supplement to consolidated guidelines on HIV testing services.
Geneva, Switzerland, WHO, 2016 Dec. 104 p.This supplement to the consolidated guidelines on HIV testing services released in 2015 includes new recommendations and additional guidance on HIV self-testing (HIV ST) and assisted HIV partner notification services (PNS) to the following groups: general populations; pregnant and postpartum women; couples and partners; adolescents (10–19 years) and young people (15–24 years); key populations; and vulnerable populations. The supplement will support countries, program managers, health workers, and other stakeholders in achieving the United Nations (UN) 90-90-90 global HIV targets -- and specifically the first target of diagnosing 90 percent of all people with HIV. The supplement aims to: Support the implementation and scale-up of ethical, effective, acceptable, and evidence-informed approaches to HIV ST and PNS; Support the routine offer of voluntary assisted HIV PNS as part of a public health approach to delivering HIV testing services (HTS); Provide guidance on how HIV ST and assisted HIV PNS could be integrated into both community- and facility-based HTS approaches and be tailored to specific population groups; Support the introduction of HIV ST as a formal HTS intervention using quality-assured, approved products; Position HIV ST and assisted HIV PNS as HTS approaches that will contribute to closing the testing gap and achieving the UN’s 90-90-90 and 2030 global goals.
Washington, D.C., World Bank, 2015. 32 p.The adolescent girl’s initiative (AGI) was motivated by the idea that vocational training and youth employment programs tailored to the needs of girls and young women can improve the economic empowerment and agency. By putting that idea into practice in a number of ways, the AGI pilots are making it possible to learn about the demand for such programs and whether in their current form they are a feasible and (in some cases) cost-effective means of meeting their objectives. Adolescent females in lower-income countries face a difficult environment in their path toward economic empowerment, a critical dimension of adulthood. Females, especially from low-income countries, want to participate in programs to support their economic empowerment. Effective programs shared certain features that made it possible for them to reach adolescent girls and young women and successfully assess and impart the skills that they needed.
What can we learn from nutrition impact evaluations? Lessons from a review of interventions to reduce child malnutrition in developing countries.
Washington, D.C., World Bank, 2010 Aug.  p.This paper reviews recent impact evaluations of interventions and programs to improve child anthropometric outcomes- height, weight, and birth weight-with an emphasis on both the findings and the limitations of the literature and on understanding what might happen in a non-research setting. It further reviews the experience and lessons from evaluations of the impact of the World Bank-supported programs on nutrition outcomes. Specifically, the review addresses the following four questions: 1) what can be said about the impact of different interventions on children's anthropometric outcomes? 2) How do these findings vary across settings and within target groups, and what accounts for this variability? 3) What is the evidence of the cost-effectiveness of these interventions? 4) What have been the lessons from implementing impact evaluations of Bank-supported programs with anthropometric impacts? Although many different dimensions of child nutrition could be explored, this report focuses on child anthropometric outcomes-weight, height, and birth weight. These are the most common nutrition outcome indicators in the literature and the ones most frequently monitored by national nutrition programs supported by the World Bank. Low weight for age (underweight) is also the indicator for one of the Millennium Development Goals.
State of world population 2012. By choice, not by chance. Family planning, human rights and development.
New York, New York, United Nations Population Fund [UNFPA], 2012 Nov 14. 140 p.All human beings – regardless of age, sex, race or income – are equal in dignity and rights. Yet 222 million women in developing countries are unable to exercise the human right to voluntary family planning. This flagship report analyzes data and trends to understand who is denied access and why. It examines challenges in expanding access to family planning. And it considers the social and economic impact of family planning as well as the costs and savings of making it available to everyone who needs it. The report asserts that governments, civil society, health providers and communities have the responsibility to protect the right to family planning for women across the spectrum, including those who are young or unmarried. Nevertheless, the report finds that financial resources for family planning have declined and contraceptive use has remained mostly steady. In 2010, donor countries fell $500 million short of their expected contribution to sexual and reproductive health services in developing countries. Contraceptive prevalence has increased globally by just 0.1 per cent per year over the last few years.
Reproductive, maternal, newborn, and child health. Disease control priorities. Third edition. Volume 2.
Washington, D.C., World Bank Group, 2016.  p.The Russian Federation's population has been declining since 1992, but recently the decline appears to be over. Although fertility has risen since the 2007 introduction of the family policy package, which focused on stimulating second and higher-order births, total fertility rates still remain significantly below replacement rate. Unlike some Western European countries, low overall fertility in Russia can be explained predominantly by a high prevalence of one-child families, despite the two-child ideal family size reported by the majority of Russians. This paper examines the correlates of Russian first-time mothers' desire and decision to have a second child. Using the 2004–12 waves of the Russia Longitudinal Monitoring Survey, the study focuses on the motherhood-career trade-off as a potential obstacle to higher fertility in Russia. The preliminary results indicate that among Russian first-time mothers, being in stable employment is positively associated with the likelihood of having a second child. Moreover, the desire to have a second child is positively associated with the first child attending formal childcare, which suggests that the availability, affordability, and quality of such childcare can be important for promoting fertility. These results are broadly consistent with previous studies in other European countries that indicate that the ability of mothers to combine work and family has important implications for fertility, and that pro-natalist policies focusing on childcare accessibility can offer the greatest payoffs. In addition to these factors, better housing conditions, being married, having an older child, and having a first-born boy are also positively associated with having a second child.
Lancet. 2016 Jan 30; 387:416.If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics. For while “breast is best” for lifelong health, it is also excellent economics. Breastfeeding is a child's first inoculation against death, disease, and poverty, but also their most enduring investment in physical, cognitive, and social capacity. The evidence on breastfeeding leaves no doubt that it is a smart and cost-effective investment in a more prosperous future. Let’s ensure that every child -- and every nation -- can reap the benefits of breastfeeding. (Excerpts) Copyright © 2016 Elsevier Ltd.
Geneva, Switzerland, WHO, 2015 Sep.  p. (Guidelines)This early-release guideline makes available two key recommendations that were developed during the revision process in 2015. First, antiretroviral therapy (ART) should be initiated in everyone living with HIV at any CD4 cell count. Second, the use of daily oral pre-exposure prophylaxis (PrEP) is recommended as a prevention choice for people at substantial risk of HIV infection as part of combination prevention approaches. The first of these recommendations is based on evidence from clinical trials and observational studies released since 2013 showing that earlier use of ART results in better clinical outcomes for people living with HIV compared with delayed treatment. The second recommendation is based on clinical trial results confirming the efficacy of the ARV drug tenofovir for use as PrEP to prevent people from acquiring HIV in a wide variety of settings and populations. The recommendations in this guideline will form part of the revised consolidated guidelines on the use of ARV drugs for treating and preventing HIV infection to be published by WHO in 2016. The full update of the guidelines will consist of comprehensive clinical recommendations together with revised operational and service delivery guidance to support implementation.
Geneva, Switzerland, UNAIDS, 2015  p. (UNAIDS 2015 - Reference; UNAIDS / JC2765)Implementing PrEP poses new challenges in planning, managing and funding combination prevention. Realizing the promise of PrEP will require governments, funders, civil society and other stakeholders to join forces to systematically address them–licensing antiretroviral medicines for PrEP use, setting priorities for locations and populations for implementation, making services user-friendly and ensuring adherence. These efforts are worthwhile based on their contribution to achieving the global targets of less than 500 000 people annually acquiring HIV in 2020 and the end of AIDS as a public health threat by 2030.
Arlington, Virginia, JSI, DELIVER, 2013 Jan.  p.This brief describes the evolution of contraceptive procurement in the Latin America and Caribbean (LAC) region, highlighting how LAC countries monitored and evaluated key data when making performance improvements. By introducing and monitoring key indicators, they were able to smooth the procurement process and improve procurement performance.
Larval source management: a supplementary measure for malaria vector control. An operational manual.
Geneva, Switzerland, WHO, 2013.  p.Larval source management (LSM) refers to the targeted management of mosquito breeding sites, with the objective to reduce the number of mosquito larvae and pupae. When appropriately used, LSM can contribute to reducing the numbers of both indoor and out-door biting mosquitoes, and -- in malaria elimination phase -- it can be a useful addition to programme tools to reduce the mosquito population in remaining malaria ‘hotspots’. This operational manual has been designed primarily for National Malaria Control Programmes as well as field personnel. It will also be of practical use to specialists working on public health vector control, and malaria programme specialists working with bilateral donors, funders and implementation partners. It has been written by senior public health experts of the malaria vector control community under the guidance of the WHO Global Malaria Programme. The manual’s three main chapters provide guidance on: the selection of larval control interventions, the planning and management of larval control programmes, and detailed guidance on conducting these programmes. The manual also contains a list of WHOPES-recommended formulations, standard operating procedures for larviciding, as well as a number of country case studies.
Global health and the new bottom billion. What do shifts in global poverty and the Global Disease Burden mean for GAVI and the Global Fund?
Washington, D.C., Center for Global Development, 2011 Oct.  p. (Center for Global Development Working Paper No. 270)After a decade of rapid growth in average incomes, many countries have attained middle-income country (MIC) status. At the same time, the total number of poor people hasn’t fallen as much as one might expect and, as a result, most of the world’s poor now live in MICs. In fact, there are up to a billion poor people or a ‘new bottom billion’ living not in the world’s poorest countries but in MICs. Not only has the global distribution of poverty shifted to MICs, so has the global disease burden. This paper examines the implications of this ‘new bottom billion’ for global health efforts and recommends a tailored middle-income strategy for the Global Fund and GAVI. The paper describes trends in the global distribution of poverty, preventable infectious diseases, and health aid response to date; revisits the rationale for health aid through agencies like GAVI and the Global Fund; and proposes a new MIC strategy and components, concluding with recommendations.
Alternative antiretroviral monitoring strategies for HIV-infected patients in east Africa: opportunities to save more lives?
Journal of the International AIDS Society. 2011; 14:38.BACKGROUND: Updated World Health Organization guidelines have amplified debate about how resource constraints should impact monitoring strategies for HIV-infected persons on combination antiretroviral therapy (cART). We estimated the incremental benefit and cost effectiveness of alternative monitoring strategies for east Africans with known HIV infection. METHODS: Using a validated HIV computer simulation based on resource-limited data (USAID and AMPATH) and circumstances (east Africa), we compared alternative monitoring strategies for HIV-infected persons newly started on cART. We evaluated clinical, immunologic and virologic monitoring strategies, including combinations and conditional logic (e.g., only perform virologic testing if immunologic testing is positive). We calculated incremental cost-effectiveness ratios (ICER) in units of cost per quality-adjusted life year (QALY), using a societal perspective and a lifetime horizon. Costs were measured in 2008 US dollars, and costs and benefits were discounted at 3%. We compared the ICER of monitoring strategies with those of other resource-constrained decisions, in particular earlier cART initiation (at CD4 counts of 350 cells/mm3 rather than 200 cells/mm3). RESULTS: Monitoring strategies employing routine CD4 testing without virologic testing never maximized health benefits, regardless of budget or societal willingness to pay for additional health benefits. Monitoring strategies employing virologic testing conditional upon particular CD4 results delivered the most benefit at willingness-to-pay levels similar to the cost of earlier cART initiation (approximately $2600/QALY). Monitoring strategies employing routine virologic testing alone only maximized health benefits at willingness-to-pay levels (> $4400/QALY) that greatly exceeded the ICER of earlier cART initiation. CONCLUSIONS: CD4 testing alone never maximized health benefits regardless of resource limitations. Programmes routinely performing virologic testing but deferring cART initiation may increase health benefits by reallocating monitoring resources towards earlier cART initiation.
Technical support facilities: Helping to build an efficient and sustainable AIDS response. UNAIDS TSF 5 years report, 2011.
Geneva, Switzerland, UNAIDS, 2011 Oct.  p. (UNAIDS / JC2167E)This report highlights the role that the Technical Support Facilities (TSF) have played in Africa and Asia to strengthen countries capacities to fund, plan, manage and coordinate effective, larger scale HIV programs. Established by UNAIDS in 2005, the TSFs have provided support to over 70 countries through 50,000 days of technical assistance and capacity development.
26th Meeting of the UNAIDS Programme Coordinating Board, Geneva, Switzerland, 22-24 June 2010. Thematic Segment: Sexual and Reproductive Health (SRH) services with HIV interventions in practice. Background paper.
[Geneva, Switzerland], UNAIDS, 2010 Jun 3.  p. (UNAIDS/PCB(26))This paper sets out to foster a common understanding of the conceptual basis and key principles for linking SRH and HIV; situate the linkages agenda in the current development environment; present the evidence to-date; articulate the full scope of linkages embedded in human rights, provide illustrative practical country experiences with integrated services; and stimulate frank discussion on how to strengthen linkages and sustain the momentum. (Excerpt)
Washington, D.C., World Bank, 2011.  p.This book offers an accessible introduction to the topic of impact evaluation and its practice in development. Although the book is geared principally toward development practitioners and policy makers, we trust that it will be a valuable resource for students and others interested in impact evaluation. Prospective impact evaluations assess whether or not a program has achieved its intended results or test alternative strategies for achieving those results. We consider that more and better impact evaluations will help strengthen the evidence base for development policies and programs around the world. Our hope is that if governments and development practitioners can make policy decisions based on evidence -- including evidence generated through impact evaluation -- development resources will be spent more effectively to reduce poverty and improve people's lives. The three parts in this handbook provide a nontechnical introduction to impact evaluations, discussing what to evaluate and why in part 1; how to evaluate in part 2; and how to implement an evaluation in part 3. These elements are the basic tools needed to successfully carry out an impact evaluation. The approach to impact evaluation in this book is largely intuitive, and we attempt to minimize technical notation. We provide the reader with a core set of impact evaluation tools -- the concepts and methods that underpin any impact evaluation -- and discuss their application to real-world development operations. The methods are drawn directly from applied research in the social sciences and share many commonalities with research methods used in the natural sciences. In this sense, impact evaluation brings the empirical research tools widely used in economics and other social sciences together with the operational and political-economy realities of policy implementation and development practice. (Excerpt)
Monitoring antiretroviral therapy in resource-limited settings: balancing clinical care, technology, and human resources.
Current HIV / AIDS Reports. 2010 Aug; 7(3):168-74.Due to the rapid expansion of first-line antiretroviral therapy in resource-limited settings (RLS), increasing numbers of people are living with HIV for prolonged periods of time. Treatment programs must now decide how to balance monitoring costs necessary to maximize health benefits for those already on treatment with the continued demand to initiate more patients on first-line treatment. We review currently available evidence related to monitoring strategies in RLS and discuss their implications on timing of switching to second-line treatment, development of HIV resistance, and clinical outcome.
Washington, D.C., World Bank, 2004.  p.This report’s central message is that well-designed evaluations, conducted at the right time and developed in close consultation with intended users, can be a highly cost-effective way to improve the performance of development interventions. It includes eight case studies of evaluations that were utilized for improving programs and increasing effectiveness.