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National responses to global health targets: exploring policy transfer in the context of the UNAIDS '90-90-90' treatment targets in Ghana and Uganda.
Health Policy and Planning. 2018 Jan 1; 33(1):17-33.Global health organizations frequently set disease-specific targets with the goal of eliciting adoption at the national-level; consideration of the influence of target setting on national policies, program and health budgets is of benefit to those setting targets and those intended to respond. In 2014, the Joint United Nations Program on HIV/AIDS set ‘ambitious’ treatment targets for country adoption: 90% of HIV-positive persons should know their status; 90% of those on treatment; 90% of those achieving viral suppression. Using case studies from Ghana and Uganda, we explore how the target and its associated policy content have been adopted at the national level. That is whether adoption is in rhetoric only or supported by program, policy or budgetary changes. We review 23 (14 from Ghana, 9 from Uganda) national policy, operational and strategic documents for the HIV response and assess commitments to ‘90-90-90’. In-person semi-structured interviews were conducted with purposively sampled key informants (17 in Ghana, 20 in Uganda) involved in program-planning and resource allocation within HIV to gain insight into factors facilitating adoption of 90-90-90. Interviews were transcribed and analyzed thematically, inductively and deductively, guided by pre-existing policy theories, including Dolowitz and Marsh’s policy transfer framework to describe features of the transfer and the Global Health Advocacy and Policy Project framework to explain observations. Regardless of notable resource constraints, transfer of the 90-90-90 targets was evident beyond rhetoric with substantial shifts in policy and programme activities. In both countries, there was evidence of attempts to minimize resource constraints by seeking programme efficiencies, prioritization of program activities and devising domestic financing mechanisms; however, significant resource gaps persist. An effective health network, comprised of global and local actors, mediated the adoption and adaptation, facilitating a shift in the HIV program from ‘business as usual’ to approaches targeting geographies and populations.
Geneva, Switzerland, UNAIDS, 2017. 198 p. (UNAIDS/JC2900E)Since they were launched at the 20th International AIDS Conference in Melbourne, Australia, in 2014, the 90-90-90 targets have become a central pillar of the global quest to end the AIDS epidemic. The targets reflect a fundamental shift in the world’s approach to HIV treatment, moving it away from a focus on the number of people accessing antiretroviral therapy and towards the importance of maximising viral suppression among people living with HIV. This shift was driven by greater understanding of the benefits of viral suppression -- not only does treatment protect people living with HIV from AIDS-related illness, but it also greatly lowers the risk of transmitting the virus to others.
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.
Geneva, Switzerland, UNAIDS, 2016.  p.This report highlights best practices and provides examples of countries that are already coming close to achieving the 90–90–90 targets, which are that 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads. The report outlines steps that are needed to expedite gains towards each of the three 90s. Technological and service delivery innovations rapidly need to be brought to scale, communities must be empowered to lead the push to end the epidemic, new resources must be mobilized to reach the final mile of the response to HIV and steps must urgently be taken to eliminate social and structural barriers to service access.
Indian Pediatrics. 2015 Apr; 52(4):293-5.Add to my documents.
Geneva, Switzerland, UNAIDS, 2011 Aug.  p. (UNAIDS/ JC2112E)This report shows that these global commitments will be achieved only if the unique needs of young women and men are acknowledged, and their human rights fulfilled, respected, and protected. In order to reduce new HIV infections among young people, achieve the broader equity goals set out in the MDGs, and begin to reverse the overall HIV epidemic, HIV prevention and treatment efforts must be tailored to the specific needs of young people.
Policy requirements for HIV testing and counselling of infants and young children in health facilities.
Geneva, Switzerland, WHO, 2010.  p.Currently, many opportunities to diagnose HIV infection in infants and children are missed within the health system. These opportunities for diagnosis of HIV arise at facilities providing services for antenatal care, prevention of mother-to-child transmission (PMTCT) of HIV, immunization, nutrition, inpatient admissions and within programmes for other vulnerable children. It is estimated that only 8% of HIV-exposed infants received early virological testing in 2008. Analysis of international cohort data confirms that very few HIV-infected infants are started on antiretroviral therapy, and those who do receive it, are started when they are already very sick, largely due to a delay in HIV testing. The benefits of expanded access to HIV testing and counselling for infants and children are numerous and include the following: early identification of HIV-infected infants and children as a first step to treatment and care; identification of HIV-exposed but uninfected infants, which facilitates follow-up care and prevention measures that will help to ensure that they remain uninfected and healthy; life-planning for parents and/or children who are HIV infected; and increased access to care and antiretroviral therapy for parents. Providing HIV testing for infants and children, however, presents unique challenges for policy-makers, programme managers and health-care providers. To address these challenges, WHO and the United Nations Children’s Fund (UNICEF), in consultation with the Interagency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers and their Children, have prepared this policy brief, which is in line with existing WHO technical recommendations, including guidance on provider-initiated HIV testing and counselling issued by WHO in 2007. The brief aims to outline key issues that should be addressed within national policy guidance to support country programming. It is designed to be used by country programmes and technical working groups as they review and develop policy and practice guidelines relevant to HIV testing for children. For the purposes of this brief, infants and children should be considered to include all children who are 14 years of age or younger. Specific attention should be given to those issues related to children below the age of 10 years. (Excerpt)
Arlington, Virginia, John Snow [JSI], AIDS Support and Technical Assistance Resources [AIDSTAR-One], 2009 Mar. 23 p. (USAID Contract No. GHH-I-00-07-00059-00; AIDSTAR-One Technical Brief)This brief describes WHO recommendations and provides links to useful resources for HIV / AIDS program implementers.
Teddington, United Kingdom, Tearfund, 2008 Jul. 44 p.This report provides an overview of PMTCT and is an attempt to explore what is working, and why, in scaling up access. The report captures innovative examples of successful programming and partnerships, while identifying challenges and bottlenecks that must be overcome if these countries are to meet their nationally set universal access targets by 2010. The research methodology used for this report was based on a desk review, interviews with key global informants (see Acknowledgements) and country case studies in Malawi, Nigeria and Zambia in early 2008. The in-country study included semi-structured interviews with representatives of government and nongovernmental organisations as well as focus group discussions with community representatives, participatory and observational methodologies. The main objectives of the research were to: 1) identify and conduct interviews with the key international and national stakeholders and explore the structure, components, implementation, co-ordination, financing, policies, and guidelines and monitoring system of the PMTCT programmes; 2) determine what was working well and why; and 3) identify specific bottlenecks, challenges and recommendations for progress. This report provides an overview of the perceptions of key experts and communities on PMTCT interventions and approaches, current global action and country progress.
Revista de Saude Publica / Journal of Public Health. 2006 Apr; 40 Suppl:109-119.The study evaluates the Brazilian response to the targets established by UNGASS for the prevention of HIV/AIDS. The analysis was based on national research, documents and information from the National Program for STD/AIDS and on state-level action plans and targets. Brazil relies on various prevention policies to attain the UNGASS targets proposed for 2005. These include: addressing discrimination issues, promotion of HIV testing, distribution of condoms, needle exchange programs, discussion of sexuality in schools, prevention initiatives for sex workers and homosexuals and prevention in the workplace. These have resulted in increases in testing and condom use. Various challenges are discussed, including: overcoming discontinuity in action plans (particularly with more vulnerable groups), training prevention teams, increasing monitoring of quantity and quality of preventative actions and overcoming regional, racial and gender inequalities. It is concluded that the right to prevention is not a priority for entities of social control, nor is it on the social movement agendas. This contrasts with the right to better HIV treatment. In order to increase the efficacy of these programs, it is suggested that they be understood and incorporated based on the promotion and guarantee of human rights, thereby advancing the ethical/political debate at local and national levels. (author's)
On the front line: a review of policies and programmes to address HIV / AIDS among peacekeepers and uniformed services.
Copenhagen, Denmark, UNAIDS, Office on AIDS, Security and Humanitarian Response, 2003 Aug.  p. (UNAIDS Series: Engaging Uniformed Services in the Fight against HIV / AIDS; UNAIDS/03.44E)This initiative focuses on mitigating the impact of HIV/AIDS in three core areas: International security, with the focus on supporting HIV/AIDS interventions within United Nations peacekeeping operations; National security, targeting uniformed services with particular emphasis on young recruits, future peacekeepers and demobilizing personnel; Humanitarian response, which focuses on vulnerable populations in crisis settings and humanitarian workers. As part of its national security initiative, UNAIDS SHR, in collaboration with UN Theme Groups, is providing support to countries for the development and/or strengthening of national responses targeting national uniformed services and, in particular, young recruits, demobilized personnel and peacekeepers. Approximately 45 countries worldwide are currently supported through the Initiative on HIV/AIDS and Security. (excerpt)
Geneva, Switzerland, ILO, 2005. 60 p. (TMEHS/2005)These guidelines are the product of collaboration between the International Labour Organization and the World Health Organization. In view of their complementary mandates, long-standing and close cooperation in the area of occupational health, and their more recent partnership as co-sponsors of UNAIDS, the ILO and the WHO decided to join forces in order to assist health services in building their capacities to provide their workers with a safe, healthy and decent working environment, as the most effective way both to reduce transmission of HIV and other blood-borne viruses and to improve the delivery of care to patients. This is essential when health service workers have not only to deliver normal health-care services but also to provide HIV/AIDS services and manage the long-term administration and monitoring of anti-retroviral treatments (ART) at a time when, in many countries, they are themselves decimated by the epidemic. (excerpt)
UN Chronicle. 2002 Sep-Nov; 39(3): p.The United Nations has helped launch a HIV/AIDS public awareness campaign in East Timor. The awareness drive will also promote ongoing HIV/AIDS initiatives by the Government, UN agencies and non-governmental organizations. East Timor's Ministry of Health also initiated priority short-term interventions among marginalized youth and sex workers. The stakeholders are now working on an HIV-testing and counselling policy, a national HIV/AIDS situation assessment and a national strategic plan. The Catholic Church has also established a programme aimed at raising awareness through health clinics run by the international NGO Caritas. (excerpt)
Copenhagen, Denmark, UNAIDS, 2003. 6 p.The Security Council Resolution 1308, adopted on 17 July 2000, addresses the linkages between HIV/AIDS, peace and security. Following up on the implementation of the Resolution, the President of the Security Council (Angola) invited the Executive Director of UNAIDS and the Under-Secretary-General for Peacekeeping Operations once again to provide oral reports on 17th of November 2003 on progress in implementing the Resolution. All 15 Security Council members made statements and comments following the briefings by DPKO and UNAIDS, marking a growing commitment to the issue of HIV/AIDS and peace and security. The Council members endorsed and expressed full support for the collaboration between UNAIDS and DPKO in supporting Governments in the development of policies, strategies and programmes to address HIV/AIDS in this context. All delegations welcomed the reports and expressed their satisfaction with progress to date, including the development of UNAIDS technical materials, with special emphasis on the Peer Education Kit for Uniformed Services and the placement of HIV/AIDS policy advisers or focal points at peacekeeping missions. Several delegations praised the efforts made in providing voluntary and confidential counseling and testing facilities at mission level. Some members called for solid monitoring and evaluation mechanisms and there was a request for an assessment of the link between human security and HIV/AIDS. Due to the importance of this issue the Security Council has requested one substantive report from UNAIDS, DPKO and their partners on the progress made to address HIV/AIDS in the context of peace and security, along with suggestions for future action. SHR is working closely with DPKO on the development of this report which will form the basis of a more in-depth discussion on these issues in the Security Council in 2004. (excerpt)
Geneva, Switzerland, UNAIDS, 2003. Prepared for the 2nd Meeting of the UNAIDS Global Reference Group on HIV / AIDS and Human Rights, August 25-27, 2003. 3 p.Over 20 years ago, policy and programmatic approaches to HIV testing emerged in a context of great fear about HIV/AIDS and about how to prevent HIV infected individuals from transmitting the virus. As testing methods were developed, HIV testing assumed an important role in epidemiological surveillance, and as treatment became available, on individual testing for clinical purposes. Yet, as national responses to the emerging epidemics unfolded, numerous States argued that the protection of public health warranted compulsory testing requirements of certain populations considered to be “high risk”, mandatory testing for access to certain goods and services, named reporting of those found to be infected and sometimes contact tracing and mandatory notification of partners, family, employers or community members. The realities of stigma, discrimination and the neglect of human rights protections were recognized to keep people away from prevention and care, and creating fertile ground for people not to get tested and, unaware of their HIV status, to further spread the virus. This recognition lead to a bridge between those concerned with human rights protections and those concerned with public health imperatives. Over time, the components of supportive testing became clearer, the concept of voluntary counseling and testing (VCT) was promulgated and policy direction from GPA/WHO centered on making voluntary counseling and testing an important focus of all national responses to the HIV/AIDS epidemics. This policy, further elaborated by WHO and UNAIDS remains in place today. (excerpt)
HIV testing of specific populations: recruits of the armed forces. Issue paper: 3rd Meeting, UNAIDS Global Reference Group on HIV / AIDS and Human Rights, 28-30 January 2004.
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2004. 6 p.In 2001, the United Nations Security Council established an Expert Panel to study the issue of whether the UN should institute HIV testing of peacekeeping personnel. This article, based on a 9 July 2002 presentation to the 14th International AIDS Conference, reports on the findings of a paper prepared for the Expert Panel by the Canadian HIV/AIDS Legal Network. The paper examined whether it is permissible for the UN to implement mandatory HIV testing of its peacekeeping personnel, and whether HIV-positive UN peacekeeping personnel should be excluded or restricted from service on the basis of their HIV status or HIV disease progression. The article describes some of the court cases in which these issues have been considered; discusses the importance of analyzing such issues in the context of a human rights–based approach to the pandemic; and formulates a series of key principles for guiding UN decision-making. The article concludes that a policy of mandatory HIV testing for all UN peacekeeping personnel cannot be justified on the basis that it is required in order to assess their physical and mental capacity for service; that HIV-positive peacekeeping personnel cannot be excluded from service based on their HIV status alone, but only on their ability to perform their duties; and that the UN cannot resort to mandatory HIV testing for all UN peacekeeping personnel to protect the health and safety of HIV-negative personnel unless it can demonstrate that alternatives to such a policy would not reduce the risk sufficiently. In the end, the Expert Panel unanimously rejected mandatory testing and instead endorsed voluntary HIV counselling and testing for UN peacekeeping personnel. (excerpt)
BMJ. British Medical Journal. 2004 Apr 24; 328(7446): p..The Chinese government is to offer free HIV tests and treatments to those who cannot afford to pay. The policy includes free antiretroviral drugs, testing, prevention of mother to child transmission, and schooling of orphans. Joel Rehnstrom, country coordinator of UNAIDS China, said he was “very encouraged by the commitment of central government in China to provide free testing and treatment.” He added, however, that there would no doubt be setbacks: “I believe it will be an enormous challenge to provide free testing and treatment across China. My sense is that every country in the world should probably have woken up earlier to HIV/AIDS. China is no exception.” UNAIDS (the Joint United Nations Programme on HIV/AIDS) has been involved with the scheme, including the development of guidelines for testing, voluntary counselling, and antiretroviral treatment. According to the state controlled Chinese media, the central government will fund the scheme in areas with a high prevalence of HIV—for example, Yunnan and Sichuan in the south west. Areas not covered by central government will be funded by local governments. (excerpt)
New York Times. 2004 Feb 10;  p..Of all the mind-numbing statistics about H.I.V. and AIDS, the most staggering — and important — is this: 95 percent of those infected worldwide do not know they are harboring the most deadly virus in history, and are therefore spreading it, however unintentionally. The primary reason for this is that routine AIDS testing is virtually absent in most countries during the long period — it averages eight years — when people don't know they have the disease because they have no visible symptoms. Having just visited four African nations as part of a delegation led by Tommy Thompson, the secretary of health and human services, we fear that no amount of money — not even the $2.8 billion proposed in the administration's budget last week — will be enough to bring the disease under control until we focus on testing, the missing front in the battle against AIDS. Even in places that have been able to make headway in prevention and treatment, the lack of testing continues to undermine overall progress. (excerpt)
Geneva, Switzerland, UNAIDS, 1997 Aug. 2 p. (UNAIDS 97.2)This statement summarizes UNAIDS' position on HIV testing and counseling issues related to HIV testing. It is addressed to national authorities and is meant to facilitate the development or strengthening of national policies on the subject. (excerpt)