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Virological failure and HIV type 1 drug resistance profiles among patients followed-up in private sector, Douala, Cameroon.
AIDS Research and Human Retroviruses. 2011 Feb; 27(2):221-30.The rate of virological failure was assessed in 819 patients followed up by the private sector of Douala, the economic capital of Cameroon, and treated according to the World Health Organization (WHO) recommendations. In addition, genotypic resistance testing was carried out in the subgroup of 75 selected patients representative of the 254 patients in virological and/or immunological failure receiving a first-line (83%) or second-line (17%) regimen. Overall, 36% of patients treated by antiretroviral drugs (ARV) were in virological failure, as assessed by plasma viral load above 3.7 log(10) copies/ml under treatment for more than 6 months. According to the immunological status, 17% of patients showed a CD4 T cell count under 200 cells/mm(3) and 37% under 350 cells/mm(3), indicating either ongoing immunorestoration or immunological failure under treatment. Twenty percent of patients in virological failure showed wild-type viruses susceptible to all ARV, likely indicating poor adherence. However, 80% of them displayed plasma virus resistant at least to one ARV drug, mostly to the nucleoside reverse transcriptase inhibitors (NRTIs) class (80%), followed by the non-NRTI class (76%) and the protease inhibitor class (19%), thus reflecting the therapeutic usage of ARV drugs in Cameroon as recommended by the WHO. Whereas the second-line regimen proposed by the 2009 WHO recommendations could be effective in more than 75% of patients in virological failure with resistant viruses, the remaining patients showed a resistance genotypic profile highly predictive of resistance to the usual WHO second-line regimen, including in some patients complex genotypic profiles diagnosed only by genotypic resistance tests. In conclusion, our observations highlight the absolute need for improving viral load assessment in resource-limited settings to prevent and/or monitor therapeutic failure.
Stakeholders' opinions and expectations of the Global Fund and their potential economic implications.
AIDS. 2008 Jul; 22 Suppl 1:S7-S15.OBJECTIVES: To analyse stakeholder opinions and expectations of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and to discuss their potential economic and financial implications. DESIGN: The Global Fund commissioned an independent study, the '360 degrees Stakeholder Survey', to canvas feedback on the organization's reputation and performance with an on-line survey of 909 respondents representing major stakeholders worldwide. We created a proxy for expectations based on categorical responses for specific Global Fund attributes' importance to the stakeholders and current perceived performance. METHODS: Using multivariate regression, we analysed 23 unfulfilled expectations related to: resource mobilization; impact measurement; harmonization and inclusion; effectiveness of the Global Fund partner environment; and portfolio characteristics. The independent variables are personal and regional-level characteristics that affect expectations. RESULTS: The largest unfulfilled expectations relate to: mobilization of private sector resources; efficiency in disbursing funds; and assurance that people affected by the three diseases are reached. Stakeholders involved with the fund through the country coordinating mechanisms, those working in multilateral organizations and persons living with HIV are more likely to have unfulfilled expectations. In contrast, higher levels of involvement with the fund correlate with fulfilled expectations. Stakeholders living in sub-Saharan Africa were less likely to have their expectations met. CONCLUSIONS: Stakeholders' unfulfilled expectations result largely from factors external to them, but also from factors over which they have influence. In particular, attributes related to partnership score poorly even though stakeholders have influence in that area. Joint efforts to address perceived performance gaps may improve future performance and positively influence investment levels and economic viability.
Public-private partnerships: Managing contracting arrangements to strengthen the Reproductive and Child Health Programme in India. Lessons and implications from three case studies.
Geneva, Switzerland, World Health Organization [WHO], 2007.  p.Strengthening management capacity and meeting the need for reproductive and child health (RCH) services is a major challenge for the national RCH program of India. Central and state governments are using multiple options to meet this challenge, responding to the complex issues in RCH, which include social, cultural and economic factors and reflect the immense geographical barriers to access for remote and rural population. Other barriers are also being addressed, including lessening financial burdens and creating public-private partnerships to expand access. For example, the National Rural Health Mission was initiated in order to focus on rural populations, although departments of health face a number of challenges in implementing this initiative. In this document, we focus on a key area: the development of management capacity for working with the private sector. We synthesize the lessons learnt from three case studies of public-private partnerships in RCH: two are state initiatives, in Gujarat and Andhra Pradesh, and the third is the national mother nongovernmental organization scheme. The case studies were conducted to determine how management capacity was developed in these three public-private partnerships in service delivery, by examining the structure and process of partnerships, understanding management capacity and competence in various public-private partnerships in RCH, and identifying the means for developing the management capacity of partners. (author's)
AIDS is not a business: A study in global corporate responsibility -- securing access to low-cost HIV medications.
Journal of Business Ethics. 2007 Jun; 73(1):65-75.At the end of the 1990s, Brazil was faced with a potentially explosive HIV/AIDS epidemic. Through an innovative and multifaceted campaign, and despite initial resistance from multinational pharmaceutical companies, the government of Brazil was able to negotiate price reductions for HIV medications and develop local production capacity, thereby averting a public health disaster. Using interview data and document analysis, the authors show that the exercise of corporate social responsibility can be viewed in practice as a dynamic negotiation and an interaction between multiple actors. Action undertaken in terms of voluntary CSR alone may be insufficient. This finding highlights the importance of a strong role for national governments and international organizations to pressure companies to perform better. (author's)
Bulletin of the World Health Organization. 2007 Aug; 85(8):586-592.WHO's new Global Plan to Stop TB 2006-2015 advises countries with a high burden of tuberculosis (TB) to expand case-finding in the private sector as well as services for patients with HIV and multidrug-resistant TB (MDR-TB). The objective of this study was to evaluate these strategies in Thailand using data from the Thailand TB Active Surveillance Network, a demonstration project begun in 2004. In October 2004, we began contacting public and private health-care facilities monthly to record data about people diagnosed with TB, assist with patient care, provide HIV counselling and testing, and obtain sputum samples for culture and susceptibility testing. The catchment area included 3.6 million people in four provinces. We compared results from October 2004-September 2005 (referred to as 2005) to baseline data from October 2002-September 2003 (referred to as 2003). In 2005, we ascertained 5841 TB cases (164/100 000), including 2320 new smear-positive cases (65/100 000). Compared with routine passive surveillance in 2003, active surveillance increased reporting of all TB cases by 19% and of new smear-positive cases by 13%. Private facilities diagnosed 634 (11%) of all TB cases. In 2005, 1392 (24%) cases were known to be HIV positive. The proportion of cases with an unknown HIV status decreased from 66% (3226/4904) in 2003 to 23% (1329/5841) in 2005 (P< 0.01). Of 4656 pulmonary cases, mycobacterial culture was performed in 3024 (65%) and MDR-TB diagnosed in 60 (1%). In Thailand, piloting the new WHO strategy increased case-finding and collaboration with the private sector, and improved HIV services for TB patients and the diagnosis of MDR-TB. Further analysis of treatment outcomes and costs is needed to assess this programme's impact and cost effectiveness. (author's)
Social Science and Medicine. 2007 Jan; 64(2):287-291.This article builds on a previous study which found low numbers of patent applications for HIV antiretroviral drugs in African countries. A high level of variation was noted across individual countries, and consequently, the present study has sought to account for sources of the variation through statistical analyses. First, a correlation between the number of patents and HIV infection rate was observed (r = 0.448, p < 0.001). T-tests identified significantly higher numbers of patents in national members of two intellectual property organizations (IPOs)--African Regional Intellectual Property Orginisation (ARIPO) and the Organisation Africaine de la Proprie´ te´ Intellectualle (OAPI)--than in countries who did not belong to an intellectual property organization. The relationship between IPO membership and number of patents was also statistically significant in a multivariate Poisson regression. These findings demonstrate that higher numbers of patents are found in countries where they are more easily filed. This has important policy implications given the worldwide trend toward increased recognition of pharmaceutical patents. (author's)
Building effective public-private partnerships: experiences and lessons from the African Comprehensive HIV / AIDS Partnerships (ACHAP).
Social Science and Medicine. 2006 Jul; 63(2):397-408.This paper examines the processes for building highly collaborative public--private partnerships for public health, with a focus on the efforts to manage the complex relationships that underlie these partnerships. These processes are analyzed for the African Comprehensive HIV/AIDS Partnerships (ACHAP), a 5-year partnership (2001--2005) between the government of Botswana, Merck & Co., Inc. (and its company foundation), and the Bill & Melinda Gates Foundation. ACHAP is a highly collaborative initiative. The ACHAP office in Botswana engages intensively (on a daily basis) with the government of Botswana (an ACHAP partner and ACHAP's main grantee) to support HIV/AIDS control in that country, which had an adult prevalence of 38.5% HIV infection in 2000 when ACHAP was being established. The paper discusses the development of ACHAP in four stages: the creation of ACHAP, the first year, the second and third years, and the fourth year. Based on ACHAP's experiences over these four years, the paper identifies five lessons for managing relationships in highly collaborative public--private partnerships for public health. (author's)
Geneva, Switzerland, Joint United Nations Programme on HIV / AIDS [UNAIDS], 2000 Nov. 49 p. (UNAIDS Best Practice Collection Key Material; UNAIDS/00.37E)Condom Social Marketing: Selected Case Studies presents six applications of different social marketing techniques drawn from among on-going projects in developing countries in the field of reproductive health and prevention of HIV/AIDS and STDs. Individually they illustrate different, real- life approaches to condom promotion through social marketing in response to particular challenges and needs. All describe activities from which significant lessons may be learned. In addition, they demonstrate the flexibility of social marketing and how the technique can be adapted to deal with differing situations and constraints. The booklet is intended mainly for distribution to individuals and organizations, from both the public and private sectors, who are interested in learning more about social marketing, and how its concepts and techniques can be applied in response to the spread of HIV/AIDS and STDs, particularly in developing countries. It is also intended to provide basic information, as an aid to training, programme planning and related activities. (excerpt)
Investing in a comprehensive health sector response to HIV / AIDS. Scaling up treatment and accelerating prevention. WHO HIV / AIDS plan, January 2004 - December 2005.
Geneva, Switzerland, WHO, 2004. 72 p.This document discusses the context for the work being undertaken in WHO’s HIV/AIDS programme. It analyses the epidemiological situation and includes the most recent estimates of antiretroviral coverage, the global strategic framework and current challenges to translating this into results at the country level (Section 1 – Background). Section 2 describes the comparative advantages offered by WHO, the functional areas of activity within the HIV/AIDS area of work for 2004–2005 and the specific focus of the programme on scaling up antiretroviral therapy and accelerating HIV prevention. Section 3 describes how WHO is structured and how resources and capacity are being reoriented to support country-level action. Section 4 illustrates how WHO works within the United Nations system and with other partners. Section 5 outlines the resources required in 2004–2005 for WHO to accomplish its stated contribution to HIV/AIDS. Section 6 describes the mechanisms for technical and managerial oversight of the HIV/AIDS programme. The WHO HIV/AIDS Plan is not a detailed work plan. Rather, it provides an overall framework to guide the departments responsible for HIV/AIDS in preparing such work plans at the country, regional and headquarters levels of WHO. These work plans are now being developed and will define the specific tasks and activities required to bring the WHO HIV/AIDS Plan to fruition, together with timelines and resource requirements. Joint planning sessions between headquarters, regional and country offices integrate the work of the three levels to ensure that all priority needs are addressed and that gaps in resources are identified. (excerpt)
Intermediating development assistance in health: prospects for organizing a public/private investment portfolio.
Washington, D.C., Family Health, 1980 July 23. 162 p.The objective of this study is to identify and assess the potential role of intermediary organizations in furthering AID health assistance objectives. The 1st section of this report is an introduction to the potential roles of intermediaries through health assistance via the private voluntary community. A background of the private voluntary organizations is discussed along with some of the constraints that may impede their activity, such as competing interests, values and priorities. The following section defines what is and should be an intermediary organization along with examples of certain functions involved; a discussion of the experience of AID in the utilization of intermediaries follows. 3 models of utilization of intermediaries are analyzed according to the rationale involved, strategy, advantages and constraints. The 3rd section attempts to define and identify AID's needs for programming its health assistance in regard to primary health care, water and sanitation, disease control and health planning. A detailed analysis of the potential roles of intermediary organizations is discussed in reference to policy development, project development and design, project implementation, research, training and evaluation. The 4th section identifies the programming strengths and interests among listed private voluntary organizations in the US. The 5th section discusses the potential of intermediaries in health assistance in reference to the options for funding them in health and the constraints to direct AID funding of intermediary organizations. The last section discusses a series of recommendations made in regard to the development and funding of an international effort to marshall private resources in support of health assistance. Problems and constraints, as well as resources and opportunities, for the development of this international effort are further discussed.
INTEGRATION. 1991 Sep; (29):6-7.Providing resources for family planning programs in the USSR, where an extremely high rate of abortions threatens the lives of women, will require a multi-sectoral approach involving the government, international agencies, and the private sector. Every year, some 10-13 million of the USSR's 70 million women of fertile age undergo an abortion (only 7 million of the abortions every year are considered legal). A recent report indicates that only 15-18% of Soviet women have not had at least one abortion in their lifetimes. A result of the high rate of illegal abortions, morbidity and mortality affects many Soviet mothers. Additionally, infant mortality rates is as high as 58.5% in some areas of the USSR, a figure similar to that found in developing countries. Knowledge of modern contraception is high, but use remains low. This is due primarily to the lack of contraceptive availability. IUD's injectables, implants, and oral contraceptives are scarce. And even when oral contraceptives are available, few women opt for this method, due to the rampant misinformation and exaggeration concerning its side-effects. While the USSR does produce condoms, their quality is poor. Part of the solution to the lack of available contraception rests in the transition to a market economy. As the demand for these services increases, the market will begin meeting this demand. The government also has a important role to play, which includes the provision of information, medical and paramedical education, sex education, and service delivery. And international agencies will need to provide the necessary technical assistance.
[Unpublished] 1991. Presented at the Demographic and Health Surveys World Conference, Washington, D.C., August 5-7, 1991. 22 p.A supply-demand approach is used to estimate total and unmet demand for family planning in Indonesia over the last decade. The 1976 Indonesia Fertility Survey, the 1983 Contraceptive Prevalence Survey, and the 1987 National Contraceptive Prevalence Survey form the database used in the study. Women under consideration have been married once, are aged 35-44, have husbands who are still alive, have had at least 2 live births, and had no births before marrying. High demand was found for family planning services, with the proportion of current users and women with unmet demand accounting for over 85% of the population. Marked improvement in contraceptive practice may be achieved by targeting programs to these 2 groups. Attention to unmotivated women is not of immediate concern. Women in need of these services are largely rural and uneducated. Programs will, therefore, require subsidization. The government should gradually and selectively further introduce self-sufficient family planning programs. User fees and private employer service provision to employees are program options to consider. Reducing the contraceptive use drop-out rate from its level of 47% is yet another approach to increase contraceptive prevalence in Indonesia. 33% drop out due to pregnancy, 26% from health problems, 10% because of method failure, 10% from inconveniences and access, and 21% from other causes. Improving service quality could dramatically reduce the degree of drop-outs.
International Journal of Health Services. 1986; 16(1):121-39.This article analyzes the patterns of health sector aid to India since 1947, summarizing criticisms such as the extension of dependency relationships, inappropriate use of techniques and models (maintenance costs of large projects are often too high for poor undeveloped countries), and Malthusianism in population programs. The major source of foreign assistance has been the US, amounting to US$107 million from 1950-1973; this figure is broken down to detail which foundations and agencies provided assistance, and how much, over this time period. Foreign assistance for family planning is also discussed. Most health policies adopted in India today predate independence and were present in plans established by the British. New patterns in health aid are described, such as funding made available in local currency to be spent on primary care and especially maternal and child health. The focus of foreign aid has been preventive in emphasis and oriented towards the primary care sector. In some periods it has contributed a substantial share of total public sector expenditures, and in some spheres, it has played a major role, particularly the control of communicable diseases. However, the impact of less substantial sums going to prestige medical colleges or to population control programs should not be ignored. Several aid categories have been of dubious origin (PL-480 counterpart funds and US food surpluses as the prime examples). However, the new health aid programs do not deserve the ready dismissal they have received in some quarters.
Research on the regulation of human fertility: needs of developing countries and priorities for the future, Vol. 2, Background documents.
Copenhagen, Denmark, Scriptor, 1983. 2 986 p.Volume 2 of papers from an international symposium starts with chapter 7--available methods of fertility regulation; problems encountered in family planning programs of developing countries. Natural family planning is discussed here, as well as contraceptives and male and female sterilization. Chapter 8 covers research problems with regard to epidemiological, service, and psychosocial aspects of fertility regulation. Family planning is stressed in this chapter. Chapter 9 discusses future methods of fertility regulation: progress in selected areas. New contraceptive agents are discussed, such as luteinizing hormone releasing hormone and its analogues, gossypol for men, and immunological methods of fertility regulation. Chapter 10 also discusses future methods of fertility regulation, but from the point of view of research needs and priorities as viewed by program directors and advisers. Views and research priorities of the Population Council, and the Indian Council of Medical Research are given. Research needs and priorities in China are discussed, as is the role of the World Health Organization's Special Program of Reseach, Development and Reserch Training in Human Reproduction. Lastly, chapter 11 covers the role of governments, agencies and industry in reseach on fertility regulation. The role of the Agency for International Development, the US National Institutes of Health; and the World Bank, among others, are discussed.
Washington, D.C., Focus International, Inc; May 11, 1979. 95 p.Findings from an investigation into evaluation of development activities designed to affect women in the 3rd World are presented. The methodology used in the investigation is described. Organizations reviewed are AID/Africa, AID/Asia, AID/Latin America and the Carribbean Bureau, AID/Near East, AID/Agency-wide projects, Inter-American Foundation, Peace Corps, World Bank, private and voluntary organizations and Canadian organizations. The scope of women in development activities is discussed and constraints to evaluations of projects designed to benefit women are examined. Evaluation activities by the organizations reviewed are summarized. Activities related to the issues raised in the investigation are discussed. Conclusions are drawn and recommendations are made regarding the need for a minimum data set, evaluation criteria, social analysis, coordination of women in development concerns within AID, information systems and policy related research findings. Profiles of development projects which identify women as beneficiaries and which have been evaluated are presented. AID profiles include 11 projects in Africa, 2 in Asia, 11 in Latin America and the Carribbean, 3 in the Near East and 6 Agency-wide projects. 10 projects undertaken by private and voluntary organizations and 1 funded by the Central America and Carribbean regional office of the Inter-American Foundation area also profiled. The following information is included in the profiles: project title and coding number, goegraphic area, sector addressed by the project, total cost and source of funds, duration, beneficiaries, purpose, organizational structure, summary evaluative statement, documentation.
Columbis, Ohio, Ohio State University, Department of Geography, (1977). (Studies in the Diffusion of Innovation Discussion Paper No. 37) 24 pThe supply side of family planning spread in the U.S. is studied by examination of the diffusion of Planned Parenthood affiliates in this country. This diffusion is an example of nonprofit-motivated polynuclear diffusion with central propagator support. Such diffusion was key to increasing availability of and information regarding family planning services. The temporal pattern of the diffusion followed the process outlined: high growth from 1916-1939, very slow growth from 1940-1960, and high growth from 1961-1973. This process was initiated in response to birth rate changes and other social events, governmental initiative, and organizational changes within the central propagator. The diffusion spread from the largest cities to surrounding communities, and from north and east to west and south. The number of women in the 15-44 age group and the number of these women ever-married were 2 specific variables of importance in the spread; median family income and median school years completed for the 3rd organizational period were variables of importance in the organizing capacity of the diffusion.
In: Diczfalusy E, Diczfalusy A, ed. Research on the regulation of human fertility: needs of developing countries and priorities for the future, Vol. 2. Background documents. Copenhagen, Denmark, Scriptor, 1983. 901-10.The role of governments in research on fertility regulation is to support, finance, coordinate, legislate and take regulatory action necessary to assure the development of new and improved contraceptive technologies. The major advances in contraceptive technology in the 1940s and 1950s were made possible by funding support from industry and private foundations. In the late 1960s government funding, particularly in the US, assumed an increasingly important role. During this same time, 2 UN organizations were formed in addition to several nonprofit institutions whose purpose was to promote research on fertility regulation for developing countries. Worldwide funding for research and training in human reproduction peaked in 1972-1973 at around US 100 million with 20-25% allocated for research on fertility regulation. The level of funding has since declined, most markedly the contribution from private industry. The funding needs for research on human reproduction, including fertility regulation, are in excess of present levels. Funding requirements may be 3-7 times higher than current levels. The prospects for future funding are not optimistic. However, it is hoped that the increased informational focus on parliamentarians and the 1984 World Population Conference will contribute to a reversal of this current trend in decreasing funding levels. The increased emphasis on safety and efficacy of new drugs and devices has lengthened the time between the development of a product and the approval for marketing. The 6 to 8 years between the granting of a patent to the marketing of a product has decreased active patent life. This, together with problems of product liability, has contributed to the declined in industrial investment in research and development on fertility regulating agents. The need for a global institution to establish standards for new contraceptive products is advocated, and WHO should be responsible. Patent laws should be eased. (author's modified)