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The WHO/PEPFAR collaboration to prepare an operations manual for HIV prevention, care, and treatment at primary health centers in high-prevalence, resource-constrained settings: defining laboratory services.
American Journal of Clinical Pathology. 2009 Jun; 131(6):887-94.The expansion of HIV/AIDS care and treatment in resource-constrained countries, especially in sub-Saharan Africa, has generally developed in a top-down manner. Further expansion will involve primary health centers where human and other resources are limited. This article describes the World Health Organization/President's Emergency Plan for AIDS Relief collaboration formed to help scale up HIV services in primary health centers in high-prevalence, resource-constrained settings. It reviews the contents of the Operations Manual developed, with emphasis on the Laboratory Services chapter, which discusses essential laboratory services, both at the center and the district hospital level, laboratory safety, laboratory testing, specimen transport, how to set up a laboratory, human resources, equipment maintenance, training materials, and references. The chapter provides specific information on essential tests and generic job aids for them. It also includes annexes containing a list of laboratory supplies for the health center and sample forms.
A trickle or a flood: Commitments and disbursement for HIV / AIDS from the Global Fund, PEPFAR, and the World Bank’s Multi-Country AIDS Program (MAP).
[Washington, D.C.], Center for Global Development, HIV / AIDS Monitor, 2007 Mar 5. 26 p.This paper provides an analytical framework for understanding funders' disbursement policies and practices while also offering an overview of the total volume of resources being committed and disbursed by each funder. The analysis is focused on the global-level, but does provide brief country case studies to help understand some of the implications of these large inflows of funding for HIV/AIDS at the country-level. (excerpt)
Following the funding for HIV / AIDS: a comparative analysis of the funding practices of PEPFAR, the Global Fund and World Bank MAP in Mozambique, Uganda and Zambia.
[Washington, D.C.], Center for Global Development, HIV / AIDS Monitor, 2007 Oct 10.  p.Donor funding for HIV/AIDS has reached levels unprecedented in the history of global health: annual funding for AIDS in low- and middle-income countries increased 30-fold from 1996 to 2006, from US$ 300 million to US$ 8.9 billion. While funding remains far short of the estimated need, international donor commitments for HIV/AIDS are significant, and likely to be so, well into the future. The resources for AIDS are a topic of considerable interest and debate internationally, yet little is understood about how these resources are actually being spent, and whether they are being made available as efficiently and effectively as possible for the fight against AIDS. Through the lens of what is happening in several countries in sub-Saharan Africa, this paper examines the flow of resources from three of the world's largest AIDS donors: the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), and the World Bank's Multi-Country HIV/AIDS Program for Africa (MAP). Drawing on country-level research undertaken by collaborating local research organizations, we describe the levels and types of funding from these donors, and highlight the procedures through which funds are committed, released and accounted for in three countries in which all of the programs are active: Mozambique, Uganda, and Zambia. Through this close look at how money moves from donor to specific purposes, we describe bottlenecks and other difficulties in the disbursement of funds, document the way their disbursement systems attempt to build national capacity to fight AIDS, and identify specific ways in which the donor agencies could make the resources move more efficiently. (excerpt)
Handbook of supply management at first-level health care facilities. 1st version for country adaptation.
Geneva, Switzerland, WHO, 2006. 73 p. (WHO/HIV/2006.03)All first-level health care facilities, namely primary health care clinics and outpatient departments based in district hospitals, use medicines and related supplies. It takes a team effort to manage these supplies, involving all health care facility staff: doctors, nurses, health workers and storekeepers. This is especially true in small facilities with only one or two health workers. Each staff member should know how to manage all supplies at the health care facility correctly. Each staff member has an important role. The Handbook of Supply Management at First-Level Health Care Facilities describes all major medicines and supply management tasks, known as the standard procedures of medicines supply management at first-level health care facilities. Each chapter covers one major task, explains how the task fits into the process of maintaining a consistent supply of medicines, and recommends which standard procedures to use. Annexes at the back of the handbook contain various checklists and examples of forms which can be introduced as needed at your health care facility. This handbook is part of a package used in an integrated training and capacity-building course targeted at first-level health care facilities. It can be used in conjunction with the existing Integrated Management of Adult and Adolescent Illness (IMAI) strategy developed by WHO. It can also be used for basic training activities independent of IMAI training courses. (excerpt)
Bethesda, Maryland, University Research Company, Quality Assurance Project, 2004 Dec. 47 p. (QAP / WHO Field Report)The traditional approach to malaria diagnosis has been examination by microscope of a thick blood smear from the individual suspected of being infected. In an attempt to provide a more rapid alternative, companies worldwide have developed malaria rapid diagnostic tests (RDTs). Although RDTs can be effectively used in clinical settings by trained personnel, their greatest potential use is in rural areas with limited access to health and laboratory facilities. Using RDTs for diagnosis at the community level will shorten the delay between the onset of symptoms and the beginning of appropriate treatment. It will also slow development of resistance and lead to significant cost savings by avoiding unnecessary use of antimalarials. However, achieving a high level of sensitivity and specificity with RDTs in this context will require a product designed, labelled, and explained so that community health workers (CHWs) can use it accurately with minimal formal training and supervision. In partnership with theWHO Regional Office for the Western Pacific, the Quality Assurance Project (QAP) carried out quality-design research in the Philippines and the Lao People's Democratic Republic to develop and test a generic RDT job aid, mainly pictorial, that could be adapted with little modification for use with different RDT products and in different cultural settings by health workers with low literacy skills and with little or no prior training in product use. (author's)
Measurement and standardization protocols for anthropometry used in the construction of a new international growth reference.
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S27-S36.Thorough training, continuous standardization, and close monitoring of the adherence to measurement procedures during data collection are essential for minimizing random error and bias in multicenter studies. Rigorous anthropometry and data collection protocols were used in the WHO Multicentre Growth Reference Study to ensure high data quality. After the initial training and standardization, study teams participated in standardization sessions every two months for a continuous assessment of the precision and accuracy of their measurements. Once a year the teams were restandardized against the WHO lead anthropometrist, who observed their measurement techniques and retrained any deviating observers. Robust and precise equipment was selected and adapted for field use. The anthropometrists worked in pairs, taking measurements independently, and repeating measurements that exceeded preset maximum allowable differences. Ongoing central and local monitoring identified anthropometrists deviating from standard procedures, and immediate corrective action was taken. The procedures described in this paper are a model for research settings. (author's)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S37-S45.The objective of the Motor Development Study was to describe the acquisition of selected gross motor milestones among affluent children growing up in different cultural settings. This study was conducted in Ghana, India, Norway, Oman, and the United States as part of the longitudinal component of the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS). Infants were followed from the age of four months until they could walk independently. Six milestones that are fundamental to acquiring self-sufficient erect locomotion and are simple to evaluate were assessed: sitting without support, hands-and-knees crawling, standing with assistance, walking with assistance, standing alone, and walking alone. The information was collected by both the children's caregivers and trained MGRS fieldworkers. The caregivers assessed and recorded the dates when the milestones were achieved for the first time according to established criteria. Using standardized procedures, the fieldworkers independently assessed the motor performance of the children and checked parental recording at home visits. To ensure standardized data collection, the sites conducted regular standardization sessions. Data collection and data quality control took place simultaneously. Data verification and cleaning were performed until all queries had been satisfactorily resolved. (author's)
Geneva, Switzerland, WHO, 2004 Jan. 70 p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 2; WHO/CDS/IMAI/2004.2)The IMAI guidelines are aimed at first-level facility health workers and lay providers in low-resource settings. These health workers and lay providers may be working in a health centre or as part of a clinical team at the district clinic. The clinical guidelines have been simplified and systematized so that they can be used by nurses, clinical aids, and other multi-purpose health workers, working in good communication with a supervising MD/MO at the district clinic. The adherence, education and psychosocial support guidelines are aimed at delivery by lay providers or health workers after training in counselling skills. This module is designed to be used both as learning aid (during training) and as a job aid. This module cross-references the IMAI Acute Care guidelines (which includes management of opportunistic infections and when to suspect TB and HIV) and Palliative Care: Symptom Management and End-of-Life Care. If these are not available, national guidelines for the acute care of adults and palliative care can be substituted. (excerpt)
Geneva, Switzerland, WHO, 2004 Jan. 118 p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 1; WHO/CDS/IMAI/2004.1)The IMAI guidelines are aimed at first-level facility health workers and lay providers in low-resource settings. These health workers and lay providers may be working in a health centre or as part of a clinical team at the district clinic. The clinical guidelines have been simplified and systematized so that they can be used by nurses, clinical aids, and other multi-purpose health workers, working in good communication with a supervising MD/MO at the district clinic. Acute Care presents a syndromic approach to the most common adult illnesses including most opportunistic infections. Instructions are provided so the health worker knows which patients can be managed at the first-level facility and which require referral to the district hospital or further assessment by a more senior clinician. Preparing first-level facility health workers to treat the common, less severe opportunistic infections will allow them to stabilize many clinical stage 3 and 4 patients prior to ARV therapy without referral to the district. (excerpt)
Geneva, Switzerland, WHO, .  p. (Integrated Management of Adolescent and Adult Illness [IMAI] No. 2; WHO/CDS/IMAI/2004.2)These principles can be used in managing many diseases or risk conditions. 1. Develop a treatment partnership with your patient. 2. Focus on your patient’s concerns and priorities. 3. Use the 5 A’s: Assess, Advise, Agree, Assist, Arrange. 4. Educate patient on disease and support patient self-management. 5. Organize proactive follow-up. 6. Involve “expert patients,” peer educators and support staff in your health facility. 7. Link the patient to community-based resources and support. 8. Use written information—registers, Treatment Plan, treatment cards and written information for patients—to document, monitor, and remind. 9. Work as a clinical team. 10. Assure continuity of care. (excerpt)
Geneva, Switzerland, WHO, 1996.  p. (WHO/FRH/MSM/96.8)A Technical Working Group on Antenatal Care was convened in Geneva, 31 October - 4 November 1994, by the World Health Organization. The original objectives of the Technical Working Group were: 1. To review current antenatal care practices and make recommendations for the identification of high-risk pregnancies and their management, taking into account the timing of the pregnancy, resources available, and skills of the health worker; 2. To draw up recommendations on antenatal care and specifically outline the tasks and procedures health workers are expected to perform at different levels of the health care system; 3. To review the basic equipment, procedures, and supplies used in antenatal care from the point of view of cost, maintenance, scientific validity, and skills required to employ them appropriately; 4. To examine how to optimize antenatal care in terms of clinical tasks and procedures in relationship to the timing of the visits, distance to referral centres, and frequency of attendance. (excerpt)
New York, New York, United Nations, 1996. iv, 218 p. (A/CONF.177/20/Rev.1)The report of the Fourth World Conference on Women held in Beijing in September 1995 contains materials on conference preparations, agenda, and proceedings. The report's first chapter presents the full texts of the Beijing Declaration and Platform for Action. The Platform includes a mission statement, sections describing the global framework and critical areas of concern, 12 strategic objectives and accompanying lists of actions to be taken by specified agencies, and descriptions of institutional and financial arrangements. The strategic objectives concern women and poverty, education and training, health, violence, armed conflict, the economy, power and decision-making, institutional mechanisms for advancement of women; human rights, the media, the environment, and the girl child. Chapter 2 provides information on pre-conference consultations, attendance, conference opening and election of officers, adoption of rules of procedure and agenda, and organization of work. Chapter 3 lists statements of conference participants and the sessions at which they occurred. The report of the main committee regarding organization of work and consideration of the draft platform for action and declaration is presented in chapter 4. Chapter 5 describes adoption of the Declaration and Platform for Action and presents the statements of reservation and interpretation made by several countries. The final three chapters concern the report of the credentials committee, adoption of the conference report, and closure.
[Unpublished] 1986 Jun 5. 3 p.By 1986 Norplant had undergone 10 years of clinical trials and had been used by more than 30,000 women in 25 countries. The contraceptive implant achieved effectiveness and continuation rates which equalled or exceeded all other forms of reversible contraception. The advantages of Norplant include the facts that it contains no estrogen, it is coitus-independent, it provides five years of protection in one simple procedure, and discontinuation is associated with a rapid return of fertility. The disadvantages are that a minor surgical procedure is required for insertion and removal and that menstrual patterns may be altered. The UN Population Fund issued the following guidelines to insure that clinical trials and introduction of Norplant proceed in the best manner possible: 1) such projects should be undertaken only with the full consent of the government involved as indicated in a formal agreement; 2) projects should be carried out in association with an executing agency such as the Population Council, one of the Population Council's Norplant introduction subcontractors, or the World Health Organization; 3) the executing agency will implement all inputs and activities involved in the clinical trials and/or introduction; 4) projects should be accompanied by widespread dissemination of full and accurate information about the method; and 5) projects should be accompanied by user attitude surveys.
AFRICA HEALTH. 1992 Jul; 14(5):10-1.An update on clinical aspects of HIV in africa highlights new proposed clinical definitions of adult AIDS and of tuberculosis in HIV+ adults, and staging of adult HIV infection. The 1986 WHO clinical definition of AIDS has been widely used in Africa, but now research suggests that this definition has several limitations: the definition will pick up several unrelated diseases such as diabetes mellitus and renal failure. It does not ascertain cases of AIDS marked by nonopportunistic infections. Most persons with pulmonary tuberculosis may be wrongly diagnosed with AIDS by this definition. The study showed that the WHO clinical definition has good specificity and positive predictive value for HIV+ people, but its positive predictive value fell to 30% in identifying people with AIDS in Africa. New definitions should take into account any serious morbidity, tuberculosis, neurological disease, both endemic localized Kaposi's, and aggressive typical Kaposi's sarcoma, and HIV serological testing. Tuberculosis is a problem because few HIV+ people suspected of having pulmonary TB (sputum-negative TB) actually have it based on bronchoscopy, while HIV+ persons with TB experience high mortality, often from pyogenic bacteremia. HIV+ persons with TB suffer high rates of relapse, possibly related to insufficient drug treatment or reinfection. 1 study showed that 6 months of isoniazid significantly improved incidence of TB over 30 months of follow-up. Staging of AIDS in Africa based on degree of immunosuppression was proposed as: 1) clinically inapparent HIV infection marked by pulmonary TB, soft tissue infections, and community acquired pneumonia; 2) lymphadenopathy, oral thrush, widespread pruritic maculopapular rash, herpes zoster, enteric illness, dysentery, and Kaposi's sarcoma; and 3) HIV wasting syndrome, chronic pulmonary disease, meningitis, and fever of unknown origin.