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The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis.
PloS One. 2018; 13(2):e0192910.BACKGROUND: Nearly a quarter of a million children have acquired HIV, prompting the implementation of new protocols-Option B and B+-for treating HIV+ pregnant women. While efficacy has been demonstrated in randomized trials, there is limited real-world evidence on the impact of these changes. Using longitudinal, routinely collected data we assessed the impact of the adoption of WHO Option B in Rwanda on mother to infant transmission. METHODS: We used interrupted time series analysis to evaluate the impact of Option B on mother-to-child HIV transmission in Rwanda. Our primary outcome was the proportion of HIV tests in infants with positive results at six weeks of age. We included data for 20 months before and 22 months after the 2010 policy change. RESULTS: Of the 15,830 HIV tests conducted during our study period, 392 tested positive. We found a significant decrease in both the level (-2.08 positive tests per 100 tests conducted, 95% CI: -2.71 to -1.45, p < 0.001) and trend (-0.11 positive tests per 100 tests conducted per month, 95% CI: -0.16 to -0.07, p < 0.001) of test positivity. This represents an estimated 297 fewer children born without HIV in the post-policy period or a 46% reduction in HIV transmission from mother to child. CONCLUSIONS: The adoption of Option B in Rwanda contributed to an immediate decrease in the rate of HIV transmission from mother to child. This suggests other countries may benefit from adopting these WHO guidelines.
International Journal of Health Planning and Management. 1998; 13:199-215.Although health care reforms have been implemented in both developed and developing countries since the 1980s, there has been little discussion of the historical, social and political contexts in which such reforms have taken place. Health care reforms in developing countries, for instance, have been an integral component of structural adjustment policies, yet scant attention has been paid to these connections nor to their implications. The basic assumptions behind the reforms, and in particular, the ideological underpinnings of health care reorganization, need to be taken into account when considering long-term strategies and policies to provide health services in developing countries. (author's)
Social Science and Medicine. 2003 Nov; 57(9):1547-1557.Spurred on by donors, a number of developing countries are in the midst of fundamental health and population sector reform. Focused on the performance-oriented norms of efficiency and effectiveness, reformers have paid insufficient attention to the process-oriented norms of sovereignty and democracy. As a result, citizens of sovereign states have been largely excluded from the deliberative process. This paper draws on political science and public administration theory to evaluate the Bangladeshi reform experience. It does so with reference to the norms of efficiency, effectiveness, sovereignty and democracy as a means of making explicit the values that need to be considered in order to make health and population sector reform a fair process. (author's)
Africa Recovery. 2003 Jul; 17(2):10-11.Concern is growing among governments, policymakers and civil society groups that the international community is sidelining African priorities as it focuses on the crisis in Iraq. "My appeal to the main donors is that while they should attend to the reconstruction of Afghanistan and Iraq, Africa is also in dire need of resources to get rid of poverty, to be able to get safe water, to get education and so on;' Ugandan Finance Minister Gerald Ssendaula said during a recent visit to Washington, DC. UN Deputy Emergency Relief Coordinator Carolyn McAskie rein- forced these concerns at a New York press conference in May. Drawing attention to Africa's "forgotten emergencies," she recalled that last year international donor focus was on Afghanistan, before that Kosovo and now Iraq. (excerpt)
East African Medical Journal. 2003 Jun; 80(6 Suppl):S1-S20.Health sector reform is 'a sustained process of fundamental changes in national health policy, institutional arrangements, etc. guided by government and designed to improve the functioning and performance of the health sector and, ultimately, the health status of the population'. All the forty six countries in the African Region of the World Health Organisation have embarked on one form of health sector reform or the other. The contexts and contents of their health reform programmes have varied from one country to another. Health reforms in the region have been influenced largely by the poor performance of the health systems, particularly with regard to the quality of health services. Most countries have taken due congnizance of the deficiencies on their health systems in the design of their health reform programmes and they have made some progress in the implementation of such programmes. Indeed, some countries have adopted sector-wide approaches (SWAps) in developing and implementing their health reform programmes. Since countries are at various stages of implementing their health reform programmes, there is a lot of potential for countries to learn from one another. This paper is a synthesis of the experiences of the countries of the Region in the development and implementation of their health sector reform programmes, it also highlights the future perspectives in this important area. (author's)
Health Policy and Planning. 2003; 18(3):249-260.India’s health system was designed in a different era, when expectations of the public and private sectors were quite different. India’s population is also undergoing transitions in the demographic, epidemiologic and social aspects of health. Disparities in life expectancy, disease, access to health care and protection from financial risks have increased. These factors are challenging the health system to respond in new ways. The old approach to national health policies and programmes is increasingly inappropriate. By analyzing interand intra-state differences in contexts and processes, we argue that the content of national health policy needs to be more diverse and accommodating to specific states and districts. More ‘splitting’ of India’s health policy at the state level would better address their health problems, and would open the way to innovation and local accountability. States further along the health transition would be able to develop policies to deal with the emerging epidemic of non-communicable diseases and more appropriate health financing systems. States early in the transition would need to focus on improving the quality and access of essential public health services, and empowering communities to take more ownership. Better ‘lumping’ of policy issues at the central level is also needed, but not in ways that have been done in the past. The central government needs to focus on overcoming the large inequalities in health outcomes across India, tackle growing challenges to health such as the HIV epidemic, and provide the much needed leadership on systemic issues such as the development of systems for quality assurance and regulation of the private sector. It also needs to support and facilitate states and districts to develop critical capacities rather than directly manage programmes. As India develops a more diverse set of state health policies, there will be more opportunities to learn what works in different policy environments. (author's)
Civil-Military Alliance Newsletter. 1996 Aug; 2(3):3-4.This article presents excerpts from a speech by Malawi’s First Vice President and Minister of Defence, the Right Honourable Justin C. Malewezi at the opening address to the policy workshop.
Summary measures of population health in the context of the WHO framework for health system performance assessment.
In: Summary measures of population health: concepts, ethics, measurement and applications, edited by C.J.L. Murray, J.A. Salomon, C.D. Mathers and A.D. Lopez. Geneva, Switzerland, World Health Organization [WHO], 2002. 1-11.This volume addresses the conceptual, ethical, empirical and technical challenges in summarizing the health of populations. This is critical for monitoring whether levels of population health are improving over time and for understanding why health differs across settings. At the same time, it is also important to recognize that improving population health is not the only goal of health policy and to understand the way health improvements interact with these other goals. For that reason, we briefly review the World Health Organization (WHO) framework for assessing the performance of health systems and the role of summary measures of population health (SMPH) in this framework. Following the recent peer review of the methodology used for health system performance by WHO (Anand et al. 2002), this framework will continue to evolve in response to the detailed recommendations of the scientific peer review group and to ongoing scientific debates and research. (excerpt)
Arlington, Virginia, John Snow [JSI], Family Planning Logistics Management [FPLM], 2000. x, 67 p. (USAID Contract No. CCP-C-00-95-00028-00)This report documents the status of technical assistance provided by the USAID-funded Family Planning Logistics Management project to the Bangladesh Family Planning Program in developing a countrywide contraceptive logistics system. A study conducted in November 1999 to evaluate the impact of technical assistance on logistics management and contraceptive security is detailed. The report concludes with findings from the study, lessons learned, and recommendations to continue improvements in the system. (author's)
Behavioral interventions for the prevention of sexual transmission of HIV. [Intervenciones conductuales para la prevención de la transmisión sexual del VIH]
Washington, D.C., Institute of Medicine, International Forum for AIDS Research, . 8 p.The fourth meeting of the International Forum for AIDS Research was organized around three overall objectives: a) to consider a model for categorizing behavioral interventions; b)to share information about current behavioral intervention programs in which IFAR members are involved; and c) to foster discussion about the adequacy of present strategies. The meeting began with an analytical phase that explored aspects of methodology, followed with presentations on selected programs, and concluded with a generic case study exercise that highlighted different social scientific perspectives on producing change in human behavior. (excerpt)