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UNICEF's contribution to the adoption and implementation of option B+ for preventing mother-to-child transmission of HIV: a policy analysis.
Globalization and Health. 2018 Jun 1; 14(1):55.BACKGROUND: Between 2011 and 2013, global and national guidelines for preventing mother-to-child transmission (PMTCT) of HIV shifted to recommend Option B+, the provision of lifelong antiretroviral treatment for all HIV-infected pregnant women. METHODS: We aimed to analyse how Option B+ reached the policy agenda, and unpack the processes, actors and politics that explain its adoption, with a focus on examining UNICEF's contribution to these events. Analysis drew on published articles and other documentation, 30 key informants interviews with staff at UNICEF, partner organisations and government officials, and country case studies. Cameroon, India, South Africa and Zimbabwe were each visited for 5-8 days. Interview transcripts were analysed using Dedoose software, reviewed several times and then coded thematically. RESULTS: A national policy initiative in Malawi in 2011, in which the country adopted Option B+, rather than existing WHO recommended regimens, irrevocably placed the policy on the global agenda. UNICEF and other organisations recognised the policy's potential impact and strategically crafted arguments to support it, framing these around operational considerations, cost-effectiveness and values. As 'policy entrepreneurs', these organisations vigorously promoted the policy through a variety of channels and means, overcoming concerted opposition. WHO, on the basis of scanty evidence, released a series of documents towards the policy's endorsement, paving the way for its widespread adoption. National-level policy transformation was rapid and definitive, distinct from previous incremental policy processes. Many organisations, including UNICEF, facilitated these changes in country, acting individually, or in concert. CONCLUSIONS: The adoption of the Option B+ policy marked a departure from established processes for PMTCT policy formulation which had been led by WHO with the support of technical experts, and in which recommendations were developed following shifts in evidence. Rather, changes were spurred by a country-level initiative, and a set of strategically framed arguments that resonated with funders and country-level actors. This bottom-up approach, supported by normative agencies, was transformative. For UNICEF, alignment between the organisation's country focus and the policy's underpinning values, enabled it to work with partners and accelerate widespread policy change.
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.
[Quality of life and its related factors among HIV/AIDS patients from HIV serodiscordant couples in Zhoukou of Henan province].
Zhonghua Yu Fang Yi Xue Za Zhi [Chinese Journal of Preventive Medicine]. 2016 Apr; 50(4):339-45.OBJECTIVE: To investigate the quality of life and its related factors among HIV/AIDS patients from HIV serodiscordant couples in Zhoukou city of Henan province. METHODS: During January to May in 2015, by the convenience sample, World Health Organization Quality of Life Questionnaire for Brief Version (WHOQOL-BREF) (Chinese version) and a self-edited questionnaire were used to investigate 1 251 HIV/AIDS patients who were confirmed with HIV positive by local CDC, registered in"HIV serodiscordant family" and agreed to participate in a face-to-face interview with above 18 year-old based on the local CDC , township hospitals and village clinics of 9 counties and 1 district of Zhoukou city, excluding the HIV/AIDS patients who were in divorce, death by one side, unknowing about his HIV status, with mental illness and disturbance of consciousness, incorrectly understanding the content of the questionnaire, and reluctant to participate in this study. The scores of quality of life of physical, psychological, social relations, and environmental domain were calculated. The related factors of the scores of different domains were analyzed by Multiple Two Classification Unconditioned Logistic Regression. RESULTS: The scores of investigation objects in the physical, psychological, social relations, and environmental domain were 12.00+/- 2.02, 12.07 +/- 2.07, 11.87 +/- 1.99, and 11.09 +/- 1.84, respectively. The multiple Unconditioned Logistic Regression analysis indicated that age <40 years, on ART and no other sickness in last two weeks were beneficial factors associated with physical domain with OR (95%CI): 0.61 (0.35-1.06), 0.52 (0.30-0.90), and 1.66 (1.09-2.52), respectively. The possibility of no poverty and no other sickness in last two weeks increased to 0.15(0.09-0.26) and 1.57(1.06-2.33) times of those who was in poverty and with other sickness in last two weeks in physical domain. The possibility of participants who were below 40 years old and with children increased to 0.58 (0.34-0.98) and 0.37 (0.23-0.57) times of who were above 40 years old and without children in psychological domain. The factors of with AIDS related symptoms, no children and with other sickness in last two week were found to be significantly associated with environmental domain with OR (95%CI): 0.65 (0.48-0.88), 0.66 (0.51-0.85), and 0.65 (0.51-0.84), respectively . CONCLUSION: The scores of every domain of quality of life in HIV serodiscordant couples of Zhoukou city were good. Age, whether having AIDS related symptoms, whether to accept ART , children, status of poverty, and whether suffering from other diseases in last two weeks were the main factors associated with the quality of life.
Assessment of clinico-immunological profile of newly diagnosed HIV patients presenting to a teaching hospital of eastern India.
Indian Journal of Medical Research. 2014 Jun; 139(6):903-12.BACKGROUND & OBJECTIVES: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. METHODS: This cross-sectional, observational study was undertaken over a 12 month period at a tertiary referral hospital in eastern India. Three hundred sixty consecutive newly diagnosed HIV patients were selected for the study from the HIV clinic and medicine wards of this hospital. Demographic and clinical data and relevant laboratory investigations of the patients were recorded and analyzed. RESULTS: Mean age of patients was 36.38+/-10.62 yr, while 63.89 per cent were males. The main mode of transmission of HIV for males and females were unprotected exposure to commercial sex (139, 60.44%) and intercourse with HIV seropositive spouses (89, 68.46%), respectively. Fever (104, 28.89%), weight loss (103, 28.61%) and generalized weakness (80, 22.22%) were the predominant symptoms. Overall mean CD4 count was 176.04+/-163.49 cells/mul (males 142.19+/-139.33 cells/mul; females 235.92+/-185.11 cells/mul). Overall, 224 opportunistic infections were documented in 160 patients, opportunistic diarrhoea (44, 12.22%) and pulmonary tuberculosis (39, 10.83%) being the commonest. There were 83 and 133 patients in WHO clinical stages 3 and 4, respectively; 291 (80.83%) patients were eligible for initiation of first-line antiretrovirals at presentation. INTERPRETATION & CONCLUSIONS: Advanced immunodeficiency and burden of opportunistic infections characterize newly diagnosed HIV patients in eastern India. The physicians should keep in mind that these patients may have more than one clinical condition at presentation.
Towards the WHO target of zero childhood tuberculosis deaths: an analysis of mortality in 13 locations in Africa and Asia.
International Journal of Tuberculosis and Lung Disease. 2013 Dec; 17(12):1518-23.SETTING: Achieving the World Health Organization (WHO) target of zero paediatric tuberculosis (TB) deaths will require an understanding of the underlying risk factors for mortality. OBJECTIVE: To identify risk factors for mortality and assess the impact of human immunodeficiency virus (HIV) testing during anti-tuberculosis treatment in children in 13 TB-HIV programmes run by Medecins Sans Frontieres. DESIGN: In a retrospective cohort study, we recorded mortality and analysed risk factors using descriptive statistics and logistic regression. Diagnosis was based on WHO algorithm and smear microscopy. RESULTS: A total of 2451 children (mean age 5.2 years, SD 3.9) were treated for TB. Half (51.0%) lived in Asia, the remainder in sub-Saharan Africa; 56.0% had pulmonary TB; 6.4% were diagnosed using smear microscopy; 211 (8.6%) died. Of 1513 children tested for HIV, 935 (61.8%) were positive; 120 (12.8%) died compared with 30/578 (5.2%) HIV-negative children. Risk factors included being HIV-positive (OR 2.6, 95%CI 1.6-4.2), age <5 years (1.7, 95%CI 1.2-2.5) and having tuberculous meningitis (2.6, 95%CI 1.0-6.8). Risk was higher in African children of unknown HIV status than in those who were confirmed HIV-negative (1.9, 95%CI 1.1-3.3). CONCLUSIONS: Strategies to eliminate childhood TB deaths should include addressing the high-risk groups identified in this study, enhanced TB prevention, universal HIV testing and the development of a rapid diagnostic test.
Turning gender and HIV commitments into action for results: an update on United Nations interagency activities on women, girls, gender equality and HIV.
[Geneva, Switzerland], UNAIDS, 2009 Dec. 4 p.In September 2000, 189 UN Member States committed to achieving the Millennium Development Goals (MDGs) by 2015. Among these goals is a commitment to promoting gender equality and empowering women and combating HIV, malaria, and other diseases. Today, almost 10 years on, addressing gender inequality and AIDS remains the most significant challenge to achieving the MDGs, as well as broader health, human rights, and development goals. This update highlights key 2009 interagency initiatives, all of which operate at the intersection of gender equality, women's empowerment, and HIV.
Zhonghua Liu Xing Bing Xue Za Zhi / Chinese Journal of Epidemiology. 1997 Oct; 18(5):309-311.Global HIV infection and AIDS: according to WHO estimates, by mid 1996 there were 7 million cumulative AIDS cases. Today the number of people infected with HIV is even more alarming: roughly 21.8 million, of those 42% are women. By the year 2000 there will be between 40 and 50 million cases. Each day about 8,500 additional people are infected with AIDS; one can say the situation is grim. Currently, the AIDS and HIV epidemic regions are shifting, they have gradually moved from the original sites of North America and West Europe toward the mass populations of developing countries in Asia, Africa, and Latin America. In the Asian region which contains about 60% of the world's population, beginning in 1988, with Thailand and India at the center, an exploding epidemic has taken shape. Recent materials indicate, those infected with HIV in Thailand exceed 700,000, over 2 million in India, and the HIV epidemic has already spread to the near neighbors Burma, southern China, Cambodia, Malaysia and Vietnam. With the accumulation of molecular epidemiology research materials, the complete picture of the causes and characteristics of this massive epidemic happening in the Asian region is gradually becoming clear. (excerpt)
Bangkok, Thailand, UNESCO, Asia and Pacific Regional Bureau for Education, 2002. 101 p.The inventory has been grouped by types of materials which include the following: Guideline materials; Curriculum; Teaching materials; Learning materials; Resource/reading materials; Training materials; Support audio-visual materials. Under each of these types of materials are sub-groups by themes or topics such as those dealing with care and counselling; information, education and communication, programme development, AIDS curriculum, life skills, adolescent reproductive health, prevention and care, training, peer education, and the like. However, in addition to accessing the various teaching/learning materials by types, the documents can also be retrieved by target audience, educational level, introduction methods, methodologies, objectives or specific uses, and geographical coverage through the help of the indexes found at the end of the inventory. (excerpt)
Washington, D.C., PSI, 2001 Jul.  p. (PSI Profile)This document looks into the advocacy efforts of Population Services International (PSI) in preventing HIV/AIDS in Myanmar. It describes the condom social marketing programs initiated by PSI/Myanmar and UN partners. It also summarizes the long-term strategy that has enabled PSI in leveraging small amounts of funding for maximum program impact and cost-efficiency.
Consultative meeting on accelerating the development of an HIV / AIDS vaccine for developing countries: issues and options for the World Bank, World Bank New Delhi office, New Delhi, India, Wednesday 18 August 1999.
[Unpublished] 1999. 11 p.Because of the profound economic impact of AIDS, the World Bank considers AIDS as a core economic development issue and has made a major commitment to continue and expand lending for AIDS prevention and care. In addition, an internal Task Force is exploring innovative ways that the Bank can stimulate rapid development of an AIDS vaccine that will be effective and affordable in low-income countries. Representatives of the Bank's AIDS Vaccine Task Force and the New Delhi Office met with Indian policy-makers on August 18 to share the findings of the Task Force and to solicit the policy-makers' views on how the Bank can accelerate AIDS vaccine development in India and globally. The participants felt that a strategic plan for development of an AIDS vaccine in India should be part of the overall national AIDS control strategy. The World Bank can assist in this program through future lending for vaccine research and development; International Finance Corporation financing of improvements and expansion of vaccine production; and technical assistance in the design of studies of Indian industry's perspectives on AIDS vaccines and of the potential public and private demand. (author's)
India, World Bank health chiefs meet. Lenders confer with developing - world leaders on vaccine program.
GLOBAL HEALTH COUNCIL'S GLOBAL AIDS PROGRAM NEWSLETTER. 1999 Oct-Nov; (58):17.Policymakers, donors, and nongovernmental organizations met in New Delhi, India in August to discuss how the World Bank (WB) can hasten the development of an affordable and effective AIDS vaccine. The meeting sought the advice and views of development partners on effective, feasible, and affordable mechanisms that can be supported by the WB. Participants requested the continued financial assistance of the WB in the development of an AIDS vaccine for low-income countries. This request was made in view of the minimal global spending on AIDS research and development, which is spent primarily on vaccines designed for, industrialized countries. Prior to the meeting, consultative meetings were held in Paris, Thailand and South Africa concerning how the WB could encourage greater private investments in AIDS vaccine and how to collaborate efforts with other international partners. The WB has a vital interest in preventing the spread of HIV/AIDS, and has lent nearly US$1 billion for 81 HIV/AIDS projects in 51 countries since 1986.
AIDS WEEKLY PLUS. 1999 Sep 6; 10-1.The AIDS Vaccine Task Force launched by the World Bank seeks the advice and views of its development partners on the effectiveness, feasibility, and appropriateness of the different mechanisms that the World Bank could support to accelerate an AIDS vaccine. The Task Force considers two major routes: 1) to "push" private research and development (R&D) by subsidizing vaccine trials or reducing the risks involved in the development; and 2) to "pull" greater R&D investment by demonstrating or assuring a future market for an AIDS vaccine in developing countries. The World Bank continues to invest in programs related to the HIV prevention, strengthening of health care systems and bringing the HIV/AIDS epidemic in the dialogue with partner government and organizations.
Issues related to scientific, technical, population, and behavioral preparation in WHO-selected sites.
In: International Symposium on Biomedical Research Issues of HIV Infection in Thailand. Bangkok, Thailand, January 31 - February 2, 1994. Sponsors: Thailand Health Research Institute, Harvard AIDS Institute, Ministry of Public Health of Thailand, Center for Vaccine Development, Mahidol University. Cambridge, Massachusetts, Harvard AIDS Institute, 1994. 23-4.For the past three years, the World Health Organization (WHO) has been working with national authorities and scientists from the four countries which have been identified as appropriate for the establishment of WHO-sponsored sites for HIV vaccine evaluation: Brazil, Rwanda, Thailand, and Uganda. National plans for HIV vaccine development and evaluation have been prepared by the countries and endorsed by the WHO. The plans detail the national policy and nationally acceptable guidelines for the approval and initiation of HIV vaccine-related activities. They provide specific recommendations for the selection of participating institutions, for interactions with other national and international AIDS research programs, for infrastructure strengthening, and for training and specific research activities. In preparation for phase III vaccine efficacy trials, the following priority research areas have been identified: virologic, clinical, epidemiologic, and sociobehavioral research. Research in these areas is discussed. It is also important to develop a comprehensive public information strategy to help maintain community support and political commitment. Finally, trials must be conducted with only the highest ethical standards.