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Uptake and predictors of early postnatal follow-up care amongst mother-baby pairs in South Africa: Results from three population-based surveys, 2010-2013.
Journal of Global Health. 2017 Dec; 7(2):021001.Background: Achieving World Health Organization (WHO) recommendations for postnatal care (PNC) within the first few weeks of life is vital to eliminating early mother-to-child transmission of HIV (MTCT) and improving infant health. Almost half of the annual global deaths among children under five occur during the first six weeks of life. This study aims to identify uptake of three PNC visits within the first six weeks of life as recommended by WHO among South African mother-infant pairs, and factors associated with uptake. Methods: We analyzed data from three facility-based, nationally representative surveys (2010, 2011/12 and 2012/13) primarily designed to determine the effectiveness of the South African program to prevent MTCT. This analysis describes the proportion of infants achieving the WHO recommendation of at least 3 PNC visits. Interviews from 27 699 HIV-negative and HIV-positive mothers of infants aged 4-8 weeks receiving their six week immunization were included in analysis. Data were analyzed using STATA 13.0 and weighted for sample ascertainment and South African live births. We fitted a multivariable logistic regression model to estimate factors associated with early PNC uptake. Results: Over half (59.6%, 95% confidence interval (CI) = 59.0-60.3) of mother-infant pairs received the recommended three PNC visits during the first 6 weeks; uptake was 63.1% (95% CI = 61.9-64.3) amongst HIV exposed infants and 58.1% (95% CI = 57.3-58.9) amongst HIV unexposed infants. Uptake of early PNC improved significantly with each survey, but varied significantly by province. Multivariable analysis of the pooled data, controlling for survey year, demonstrated that number of antenatal visits (4+ vs <4 Adjusted odds ratio (aOR) = 1.13, 95% CI = 1.04-1.23), timing of initial antenatal visits (=12 weeks vs >12 weeks, aOR = 1.13, 95% CI = 1.04-1.23), place of delivery (clinic vs hospital aOR = 1.5, 1.3-1.6), and infant HIV exposure (exposed vs unexposed aOR = 1.2, 95% CI = 1.1-1.2) were the key factors associated with receiving recommended PNC visits. Conclusions: Approximately 40% of neonates did not receive three or more postnatal care visits in the first 6 weeks of life from 2010-2013. To improve uptake of early PNC, early antenatal booking, more frequent antenatal care attendance, and attention to HIV negative women is needed.
Retrovirology. 2018 Apr 2; 15(1):29.Pre-exposure prophylaxis (PrEP) for HIV prevention has evolved significantly over the years where clinical trials have now demonstrated the efficacy of oral PrEP, and the field is scaling-up implementation. The WHO and UNAIDS have made PrEP implementation a priority for populations at highest risk, and several countries have developed guidelines and national plans accordingly, largely based on evidence generated by demonstration projects. PrEP presents the opportunity to change the face of HIV prevention by offering a new option for protection against HIV and disrupting current HIV prevention systems. Nevertheless, as with all new technologies, both practical and social requirements for implementation must be taken into account if there is to be sustained and widespread adoption, which will also apply to forthcoming prevention technologies. Defining and building success for PrEP within the scope of scale-up requires careful consideration. This review summarises where the PrEP field is today, lessons learned from the past, the philosophy and practicalities of how successful programming may be defined, and provides perspectives of costs and affordability. We argue that a successful PrEP programme is about effective intervention integration and ultimately keeping people HIV negative.
Vaccine. 2016 Oct 10; 34(43):5144-5149.BACKGROUND: The African Region is set to achieving polio eradication. During the years of operations, the Polio Eradication Initiative [PEI] in the Region mobilized and trained tremendous amount of manpower with specializations in surveillance, social mobilization, supplementary immunization activities [SIAs], data management and laboratory staff. Systems were put in place to accelerate the eradication of polio in the Region. Standardized, real-time surveillance and response capacity were established. Many innovations were developed and applied to reaching people in difficult and security challenged terrains. All of these resulted in accumulation of lessons and best practices, which can be used in other priority public health intervention if documented. METHODS: The World Health Organization Regional Office for Africa [WHO/AFRO] developed a process for the documentation of these best practices, which was pretested in Uganda. The process entailed assessment of three critical elements [effectiveness, efficiency and relevance] five aspects [ethical soundness, sustainability, involvement of partners, community involvement, and political commitment] of best practices. A scored card which graded the elements and aspects on a scale of 0-10 was developed and a true best practice should score >50 points. Independent public health experts documented polio best practices in eight countries in the Region, using this process. The documentation adopted the cross-sectional design in the generation of data, which combined three analytical designs, namely surveys, qualitative inquiry and case studies. For the selection of countries, country responses to earlier questionnaire on best practices were screened for potential best practices. Another criterion used was the level of PEI investment in the countries. RESULTS: A total of 82 best practices grouped into ten thematic areas were documented. There was a correlation between the health system performances with DPT3 as proxy, level of PEI investment in countries with number of best practice. The application of the process for the documentation of polio best practices in the African Region brought out a number of advantages. The triangulation of data collected using multiple methods and the collection of data from all levels of the programme proved useful as it provided opportunity for data verification and corroboration. It also helped to overcome some of the data challenge. Copyright (c) 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.
The relative roles of ANC and EPI in the continuous distribution of LLINs: a qualitative study in four countries.
Health Policy and Planning. 2017 May 1; 32(4):467-475.Background: The continuous distribution of long-lasting insecticidal nets (LLINs) for malaria prevention, through the antenatal care (ANC) and the Expanded Programme on Immunizations (EPI), is recommended by the WHO to improve and maintain LLIN coverage. Despite these recommendations, little is known about the relative strengths and weaknesses of the ANC and EPI-based LLIN distribution. This study aimed to explore and compare the roles of the ANC and EPI for LLIN distribution in four African countries. Methods: In a qualitative evaluation of continuous distribution through the ANC and EPI, semi-structured, individual and group interviews were conducted in Kenya, Malawi, Mali, and Rwanda. Respondents included national, sub-national, and facility-level health staff, and were selected to capture a range of roles related to malaria, ANC and EPI programmes. Policies, guidelines, and data collection tools were reviewed as a means of triangulation to assess the structure of LLIN distribution, and the methods of data collection and reporting for malaria, ANC and EPI programmes. Results: In the four countries visited, distribution of LLINs was more effectively integrated through ANC than through EPI because of a) stronger linkages and involvement between malaria and reproductive health programmes, as compared to malaria and EPI, and b) more complete programme monitoring for ANC-based distribution, compared to EPI-based distribution. Conclusions: Opportunities for improving the distribution of LLINs through these channels exist, especially in the case of EPI. For both ANC and EPI, integrated distribution of LLINs has the potential to act as an incentive, improving the already strong coverage of both these essential services. The collection and reporting of data on LLINs distributed through the ANC and EPI can provide insight into the performance of LLIN distribution within these programmes. Greater attention to data collection and use, by both the global malaria community, and the integrated programmes, can improve this distribution channel strength and effectiveness.
Decreased emergence of HIV-1 drug resistance mutations in a cohort of Ugandan women initiating option B+ for PMTCT.
PloS One. 2017; 12(5):e0178297.BACKGROUND: Since 2012, WHO guidelines for the prevention of mother-to-child transmission (PMTCT) of HIV-1 in resource-limited settings recommend the initiation of lifelong antiretroviral combination therapy (cART) for all pregnant HIV-1 positive women independent of CD4 count and WHO clinical stage (Option B+). However, long-term outcomes regarding development of drug resistance are lacking until now. Therefore, we analysed the emergence of drug resistance mutations (DRMs) in women initiating Option B+ in Fort Portal, Uganda, at 12 and 18 months postpartum (ppm). METHODS AND FINDINGS: 124 HIV-1 positive pregnant women were enrolled within antenatal care services in Fort Portal, Uganda. Blood samples were collected at the first visit prior starting Option B+ and postpartum at week six, month six, 12 and 18. Viral load was determined by real-time RT-PCR. An RT-PCR covering resistance associated positions in the protease and reverse transcriptase HIV-1 genomic region was performed. PCR-positive samples at 12/18 ppm and respective baseline samples were analysed by next generation sequencing regarding HIV-1 drug resistant variants including low-frequency variants. Furthermore, vertical transmission of HIV-1 was analysed. 49/124 (39.5%) women were included into the DRM analysis. Virological failure, defined as >1000 copies HIV-1 RNA/ml, was observed in three and seven women at 12 and 18 ppm, respectively. Sequences were obtained for three and six of these. In total, DRMs were detected in 3/49 (6.1%) women. Two women displayed dual-class resistance against all recommended first-line regimen drugs. Of 49 mother-infant-pairs no infant was HIV-1 positive at 12 or 18 ppm. CONCLUSION: Our findings suggest that the WHO-recommended Option B+ for PMTCT is effective in a cohort of Ugandan HIV-1 positive pregnant women with regard to the low selection rate of DRMs and vertical transmission. Therefore, these results are encouraging for other countries considering the implementation of lifelong cART for all pregnant HIV-1 positive women.
Piloting L3M for child marriage: Experience in monitoring results in equity systems (MoRES) in Bangladesh.
Bethesda, Maryland, Abt Associates Inc., Health Finance & Governance Project, 2014 Sep. 100 p.Monitoring Results for Equity Systems (MoRES) is UNICEF’s global monitoring framework that was recently introduced in Bangladesh and other countries. MoRES proposes a hierarchy of information to facilitate the monitoring and evaluation of UNICEF programs. Level 1 corresponds to a situational analysis, which intends to identify the major bottlenecks and barriers to the achievement of UNICEF goals. Level 2 creates a routine approach for monitoring implementation of UNICEF programs. Level 3-which is the subject of this report-monitors the extent to which UNICEF programs contribute to reductions in the barriers and bottlenecks identified in Level 1. Finally, Level 4 monitoring measures the impact of UNICEF programs on the broader goals. The level 3 monitoring approach (L3M) pilot for child marriage described in this report focuses on examining how two of UNICEF’s Child Protection activities -adolescent stipends and conditional cash transfers - contribute to reductions in three priority bottlenecks: social norms, financial access, and legislation/policy. The pilot contributes the methodology and content required for UNICEF to conduct regular, routine monitoring of its Child Protection Program, as part of an office-wide L3M exercise at UNICEF-Bangladesh. (excerpt)
Brazzaville, Republic of the Congo, WHO, Regional Office for Africa, 2017. 23 p. (Policy Brief)Community health worker (CHW) programmes have seen a renaissance in the last two decades and now many countries in Africa boast of such national or substantial sub-national programmes. The 2013 Third Global Forum on Human Resources for Health concluded that CHWs and other frontline primary health care workers “play a unique role and can be essential to accelerating MDGs and achieving UHC”, and called for their integration into national health systems. The Ebola virus disease (EVD) outbreak of 2014-2015 highlighted the imperative of ensuring the functioning of the health systems at the community level for both their day-to-day resilience and disaster preparedness. The purpose of this policy brief is to inform discussions and decisions in the World Health Organization (WHO) African Region on policies, strategies and programmes to increase access to primary health care (PHC) services and make progress towards universal health coverage (UHC) by expanding the implementation of scaled-up CHW programmes. This brief summarizes the existing evidence on CHW programmes with a focus on sub-Saharan Africa and offers a number of context-linked policy options for countries seeking to scale up and improve the effectiveness of their CHW programmes, particularly with regard to needs such as those of Guinea, Liberia and Sierra Leone, the three countries that were the most affected by the 2014-2015 EVD outbreak. For the purposes of this policy brief, a broad definition of CHW is used. CHWs are individuals “carrying out the functions related to health care delivery [who are] trained in some way in the context of the intervention [but have] no formal professional or paraprofessional certificated or degreed tertiary education [in a health-related field]”). WHO states that CHWs “should be members of the communities where they work, selected by the communities, answerable to the communities for their activities, and supported by the health system but not necessarily a part of its organization”. For the purposes of this brief, a working definition for a scaled-up CHW programme has been developed, where the term refers to a programme that is designed to be more than a pilot or demonstration project and has the intention of covering a substantial population size or geographic area, depending on the country’s context. (Excerpts)
The effectiveness of the WHO training course on complementary feeding counseling in a primary care setting, Ismailia, Egypt.
Journal of the Egyptian Public Health Association. 2014 Apr; 89(1):1-8.BACKGROUND: The adequacy and timing of complementary feeding of the breastfed child are critical for optimal child growth and development.Considerable efforts have been made to improve complementary feeding in the first 2 years of life. One of them was the WHO complementary feeding counseling course (CFC). OBJECTIVES: To evaluate the effectiveness of the WHO CFC on knowledge and counseling abilities of primary healthcare physicians; on caretaker's knowledge and adherence to physicians' recommendations and their feeding practices; and on children's growth. PARTICIPANTS AND INTERVENTIONS: A single-blinded randomized-controlled study was carried out in 40 primary healthcare centers divided into matched pairs according to their location, either in rural or urban areas, and training of the selected physicians on integrated management of childhood illness. One center from each pair was selected randomly for its physician to receive CFC training in nutrition counseling and the matched center was selected as a control. Forty primary healthcare center physicians and 480 mother-child (6-18 months) pairs were included in the study. The mother-child pairs recruited were visited at home within 2 weeks, 90, and 180 days after the initial consultation with trained health workers. Special questionnaires were used to collect information on healthcare providers' knowledge of nutrition counseling and practice (counseling skills); maternal knowledge of basic nutrition-counseling recommendations, maternal compliance with the recommended feeding practice; child dietary intake; and gains in weight and length. RESULTS: CFC-trained physicians were more likely to engage in nutrition counseling and to deliver more appropriate advice. This was reflected in improvements in maternal recall of complementary feeding messages, which were higher in the intervention group compared with the control group. Six months after the consultation, children in the intervention group had significantly greater weight gains compared with the control group (0.96 vs. 0.78 kg; P=0.038). Children in the intervention group, who were 12-18 months of age at the time of recruitment, had significantly less faltering in length gain compared with the control group (height/age Z-score; 0.23 vs. 0.04; P=0.004). CONCLUSION AND RECOMMENDATIONS: Nutrition counseling training improved counseling abilities of primary healthcare physicians and led to improvements in mothers' knowledge and practices of complementary feeding. In turn, this led to improved growth of children. We recommend wide and regular utilization of the CFC course to improve the knowledge and skills of health workers who provide counseling to mothers for complementary feeding.
Paris, France, UNESCO, 2010. 72 p.This booklet identifies the key characteristics of efficient and effective HIV prevention in a user-friendly and accessible format. It explains how programme implementers and project managers can apply, integrate and institutionalize these characteristics in planning and implementing HIV and AIDS responses. The booklet targets programme implementers and project managers developing and implementing activities (largely in the area of HIV prevention) within UNESCO. However, it will also be useful to other stakeholders undertaking similar work, including technical staff, programme implementers and managers in ministries involved in the AIDS response, UN and other development partners, and civil society. As a quick reference guide, users can find out about the key characteristics of a specific approach, check on definitions, identify tools to help put the approach into practice. It is not intended to substitute for the vast amount of existing literature in these areas. Rather, it guides users through the literature via web links and additional reference material for further exploration.
Essential nutrition actions: Improving maternal, newborn, infant and young child health and nutrition.
Geneva, Switzerland, WHO, 2013.  p.This document provides a compact summary of WHO guidance on nutrition interventions targeting the first 1000 days of life. Focusing on this package of essential nutrition actions, policy-makers could reduce infant and child mortality, improve physical and mental growth and development, and improve productivity. Part I presents the interventions currently recommended by WHO, summarizes the rationale and the evidence for each, and describes the actions required to implement them. The document uses a life-course approach, from pre-conception throughout the first two years of life. Part II provides an analysis of community-based interventions aimed at improving nutrition and indicates how effective interventions can be delivered in an integrated fashion. It shows how the ENAs described in the first part have been implemented in large-scale programmes in various settings, what the outcomes have been, and to examine the evidence for attribution of changes in nutritional outcomes to programme activities. Some background on the evolution of programmatic evidence is given, and implications for the future are drawn. (Excerpts)
New York, New York, World Youth Alliance, .  p.The World Youth Alliance’s White Paper on HIV / AIDS proposes evidence-based and person-centered treatment, such as the provision of antiretroviral drugs, and prevention strategies, such as a reduction in concurrent partners and a delay in sexual debut. These strategies reflect the capacity of the person to make responsible decisions and to stop the high-risk behavior that exposes him or her to HIV. The paper ends with an evaluation of UNAIDS' harm reduction strategies and a call for UNAIDS to start emphasizing a person-centered response that reflects science and culture.
Indian Journal of Medical Research. 2012 Sep; 136(3):370-1.Add to my documents.
Washington, D.C., World Bank, 2011.  p.This book offers an accessible introduction to the topic of impact evaluation and its practice in development. Although the book is geared principally toward development practitioners and policy makers, we trust that it will be a valuable resource for students and others interested in impact evaluation. Prospective impact evaluations assess whether or not a program has achieved its intended results or test alternative strategies for achieving those results. We consider that more and better impact evaluations will help strengthen the evidence base for development policies and programs around the world. Our hope is that if governments and development practitioners can make policy decisions based on evidence -- including evidence generated through impact evaluation -- development resources will be spent more effectively to reduce poverty and improve people's lives. The three parts in this handbook provide a nontechnical introduction to impact evaluations, discussing what to evaluate and why in part 1; how to evaluate in part 2; and how to implement an evaluation in part 3. These elements are the basic tools needed to successfully carry out an impact evaluation. The approach to impact evaluation in this book is largely intuitive, and we attempt to minimize technical notation. We provide the reader with a core set of impact evaluation tools -- the concepts and methods that underpin any impact evaluation -- and discuss their application to real-world development operations. The methods are drawn directly from applied research in the social sciences and share many commonalities with research methods used in the natural sciences. In this sense, impact evaluation brings the empirical research tools widely used in economics and other social sciences together with the operational and political-economy realities of policy implementation and development practice. (Excerpt)
Monitoring equity in access to AIDS treatment programmes: a review of concepts, models, methods and indicators.
Geneva, Switzerland, WHO, 2010.  p.The World Health Organization (WHO) and the Regional Network for Equity in Health in East and Southern Africa (EQUINET) through REACH Trust Malawi and Training and Research Support Centre (TARSC) developed this review. It provides a practical resource for programme managers, health planning departments, evaluation experts and civil society organizations working on health systems and HIV / AIDS programmes at sub-national, national and regional levels in East and Southern Africa. Many of the orientations and tools in this document were developed through a wide consultation process, starting in 2003. We draw on the broader analysis of health equity advanced by EQUINET, as well as evidence from five background studies on equity and health systems impacts of ART programming in East and Southern Africa which were supported by EQUINET, TARSC and DFID (available at www. equinetafrica.org). (Excerpt)
The Global Fund 2010: Innovation and impact. Global Fund-supported programs saved an estimated 4.9 million lives by the end of 2009.
Geneva, Switzerland, Global Fund to Fight AIDS, Tuberculosis and Malaria, 2010 Mar.  p.The substantial increase in resources dedicated to health through overseas development assistance and other sources during the past years has begun to change the trajectory of AIDS, tuberculosis (TB) and malaria, and more broadly, of the major health problems that low- and middle-income countries have been confronted with. The results and emerging signs of impact presented in this report paint a hopeful and encouraging picture. Ten years ago, virtually no one living with AIDS in low- and middle-income countries was receiving lifesaving antiretroviral therapy (ART), although it had been available since 1996 in high-income countries. At the end of 2008, over 4 million people had gained access to AIDS treatment, representing over 40 percent of those in need. AIDS mortality has since decreased in many high-burden countries. For example, in Ethiopia’s capital, Addis Ababa, the rollout of ART has led to a decline of about 50 percent in adult AIDS deaths over a period of five years.
Strategic considerations for strengthening the linkages between family planning and HIV / AIDS policies, programs, and services.
Geneva, Switzerland, WHO, 2009. 31 p.Many governmental and nongovernmental public health agencies are pursuing and, in some cases, scaling up programs that integrate family planning (FP) and HIV services. In response to calls from public-health decision makers for guidance on FP / HIV integration, the World Health Organization, the U.S. Agency for International Development, and Family Health International developed Strategic Considerations for Strengthening the Linkages between Family Planning and HIV / AIDS Policies, Programs, and Services. The partners drew from publications, the recommendations of more than 100 experts in FP and HIV / AIDS, and lessons learned from field experience. The document is designed to help program planners, implementers, and managers -- including government officials and other country-level stakeholders -- make appropriate decisions about whether to pursue the integration of FP and HIV services. It also explains how to pursue integration in a strategic and systematic manner, in order to achieve maximum public health benefit.
Improving effectiveness and outcomes for the poor in health, nutrition, and population: an evaluation of World Bank Group support since 1997.
Washington, D.C., World Bank, Independent Evaluation Group, 2009.  p.The World Bank Group’s support for health, nutrition, and population (HNP) has been sustained since 1997 -- totaling $17 billion in country-level support by the World Bank and $873 million in private health and pharmaceutical investments by the International Finance Corporation (IFC) through mid-2008. This report evaluates the efficacy of the Bank Group’s direct support for HNP to developing countries since 1997 and draws lessons to help improve the effectiveness of this support.
Ambulatory Pediatrics. 2008 Sep-Oct; 8(5):300-304.Background.-Ninety-nine percent of the 4 million neonatal deaths per year occur in developing countries. The World Health Organization (WHO) Essential Newborn Care (ENC) course sets the minimum accepted standard for training midwives on aspects of infant care (neonatal resuscitation, breastfeeding, kangaroo care, small baby care, and thermoregulation), many of which are provided by the mother. Objective.-The aim of this study was to determine the association of ENC with all-cause 7-day (early) neonatal mortality among infants of less educated mothers compared with those of mothers with more education. Methods.-Protocol- and ENC-certified research nurses trained all 123 college-educated midwives from 18 low-risk, first-level urban community health centers (Zambia) in data collection (1 week) and ENC (1 week) as part of a controlled study to test the clinical impact of ENC implementation. The mothers were categorized into 2 groups, those who had completed 7 years of school education (primary education) and those with 8 or more years of education. Results.-ENC training is associated with decreases in early neonatal mortality; rates decreased from 11.2 per 1000 live births pre- ENC to 6.2 per 1000 following ENC implementation (P <.001). Prenatal care, birth weight, race, and gender did not differ between the groups. Mortality for infants of mothers with 7 years of education decreased from 12.4 to 6.0 per 1000 (P < .0001) but did not change significantly for those with 8 or more years of education (8.7 to 6.3 per 1000, P ¼.14). Conclusions.-ENC training decreases early neonatal mortality, and the impact is larger in infants of mothers without secondary education. The impact of ENC may be optimized by training health care workers who treat women with less formal education.
Summary report of the Expert Group Consultation on Tracking and Monitoring Gender Equality and HIV / AIDS in Aid Effectiveness.
In: Making aid more effective: Promoting better monitoring and tracking of gender equality in HIV and AIDS responses, edited by Robert Carr. New York, New York, United Nations Development Fund for Women [UNIFEM], 2008. 23-32.This chapter presents document highlights from an Expert Group Consultation convened by UNIFEM in collaboration with the European Commission to identify approaches to ensure that the aid effectiveness agenda promotes greater action on, and investment in, reducing HIV and AIDS among women. The consultation provided an opportunity to discuss how to make aid more effective in addressing the gender dimensions of the epidemic through the tracking of financing for gender equality in the response to HIV and identifying, reviewing and refining key programme indicators. Experts examined how and where gender equality and HIV are being woven into the aid effectiveness agenda, drawing on country examples and existing efforts. They also made recommendations for advocacy to ensure that aid is 'effective' for women. More importantly, this convening of experts provided an opportunity to examine strategies and tools to support nationally driven processes of tracking and monitoring progress to reduce HIV infections among women by improving their access to sexual and reproductive health and rights and by reducing violence they face. (Excerpt)
Nature. 2008 Jul 31; 454(7204):551.The fight against AIDS is losing ground, but the current spate of mud-slinging is far from helpful. The global conversation about AIDS is beginning to sound like a high-decibel exercise in finger-pointing and blame. This dangerous trend should be on the minds of the thousands of attendees convening in Mexico City this weekend for the XVII International AIDS Conference. Thirty-three million people around the world are HIV-positive, and more than 6,800 become infected every day. Tests on microbicides and vaccines have failed, and have put some volunteers at greater risk of HIV infection. Yet critics are attacking the very programmes and people trying to solve these problems, with some even calling for an end to government spending on the search for a vaccine. This is an overreaction. As many scientists point out, the search for a malaria vaccine has seen dozens of failed trials, whereas only three AIDS vaccines have so far been tested in efficacy studies. What is needed are better vaccine candidates to test, so it makes sense that the major backers of HIV vaccine trials, including the US National Institutes of Health, are now focusing on the basic research that could help the field move forward. Meanwhile, two books published last year claim that the United Nations AIDS programme, UNAIDS, has led an ineffective, politically motivated response to the disease and has distorted statistics in an effort to garner more money. And critics such as Roger England, who runs a small think tank in Grenada, argue that spending on AIDS has distorted poor countries' priorities and weakened their health systems. England proposes that UNAIDS be shut down, and the money spent on AIDS programmes shifted to general funding for health systems. Amid the debate on these questions, the founding director of UNAIDS, Peter Piot, announced in April that he would step down at the end of this year, throwing the agency into uncertainty at a crucial time. There is no doubt that many poor countries' health systems are struggling, but it is wrong to say that AIDS aid is responsible. In fact, AIDS programmes have shown how poor countries can use new models to deliver needed care, for instance by providing antiretroviral treatments effectively, putting to rest claims that the costly drugs could not be used correctly outside resource-rich nations. It is also wrong to assume that governments will spend money effectively to fight AIDS if given funds to support health systems overall, as England suggests. Today, many strategies for delivering AIDS treatment target groups such as women, homosexuals and intravenous drug users that have been ignored by governments in the past - neglect that fuelled the spread of the disease. More money should be spent on both AIDS and strengthening health-care systems. And this will be possible if donor governments live up to their promises, such as the pledges of general and disease-specific aid to Africa that were repeated this July at the G8 meeting in Japan. On that front, it is heartening that the US House and Senate have reauthorized $48 billion for the President's Emergency Plan for AIDS Relief ($9 billion of which is for fighting malaria and tuberculosis). If President Bush signs the bill as expected, the programme will also permit the US government to reverse the shameful and embarrassing policy that bans travellers with HIV from entering the country. That might serve as an example to other governments that still sanction discrimination against those who are HIV-positive. The world is still far from achieving the goal adopted in 2000 by UN member states, which pledged to provide universal access to AIDS treatment by 2010. Three million people now receive lifesaving antiretroviral drugs, but 70% of those in low- to middle-income countries who need them don't get them. Indeed, the example of wealthy nations themselves shows what happens when they lose focus on AIDS. In the United States, for instance, reports now indicate that HIV infection rates have begun to rise in Latinos and young gay men. The activists and scientists about to meet in Mexico City must demand that leaders keep their eye on the ball. The world now has models for providing treatment and care in the places that sorely need it, and is in a position to make more tangible gains against AIDS. This is no time to backslide, and the Mexico City meeting must deliver this message loud and clear. (full-text)
Obstetrics and Gynecology. 2007 Nov; 110(5):1017-1018.Between the 1970s and 1990s, the World Health Organization promoted traditional birth attendant (TBA) training as one strategy to reduce maternal and neonatal mortality. To date, evidence in support of TBA training remains limited and conflicting. The objectives were to assess effects of TBA training on health behaviors and pregnancy outcomes. We searched the Trials Registers of the Cochrane Pregnancy and Childbirth Group and Cochrane Effective Practice and Organisation of Care Group (EPOC) (June 2006); electronic databases representing fields of education, social, and health sciences (inception to June 2006); the internet; and contacted experts. Published and unpublished randomized controlled trials (RCT), controlled before/after and interrupted time series studies comparing trained and untrained TBAs or women cared for/living in areas served by TBAs. Three authors independently assessed study quality and extracted data. Four studies, involving over 2,000 TBAs and nearly 27,000 women, are included. One cluster-randomized trial found significantly lower rates in the intervention group regarding stillbirths (adjusted odds ratio [OR] 0.69, 95% confidence interval [CI] 0.57-0.83, P less than .001), perinatal death rate (adjusted OR 0.70, 95% CI 0.59-0.83, P less than .001) and neonatal death rate (adjusted OR 0.71, 95% CI 0.61-0.82, P less than .001). Maternal death rate was lower but not significant (adjusted OR 0.74, 95% CI 0.45-1.22, P=.24) while referral rates were significantly higher (adjusted OR 1.50, 95% CI 1.18-1.90, P less than .001). A controlled before/after study among women who were referred to a health service found perinatal deaths decreased in both intervention and control groups, with no significant difference between groups (OR 1.02, 95% CI 0.59-1.76, P=.95). Similarly, the mean number of monthly referrals did not differ between groups (P=.321). One RCT found a significant difference in advice about introduction of complementary foods (OR 2.07, 95% CI 1.10-3.90, P=.02) but no significant difference for immediate feeding of colostrum (OR 1.37, 95% CI 0.62-3.03, P=.44). Another RCT found no significant differences in frequency of postpartum hemorrhage (OR 0.94, 95% CI 0.76-1.17, P=.60) among women cared for by trained versus TBAs. The potential of TBA training to reduce peri-neonatal mortality is promising when combined with improved health services. However, the number of studies meeting the inclusion criteria is insufficient to provide the evidence base needed to establish training effectiveness. (author's)
Supporting civil society organisations to reach key populations in the Latin American and Caribbean region. A look at HIV / AIDS projects financed by the World Bank.
[Brighton, United Kingdom], International HIV / AIDS Alliance, 2006. 52 p.The purpose of this study is to assess the extent to which World Bank financed projects are supporting civil society organisations (CSOs) to reach four key populations (men who have sex with men (MSM), sex workers (SW), intravenous drug users (IDUs) and persons living with HIV/AIDS (PLWHA) in the Latin American and Caribbean (LAC) region. The study refers to the first three key populations (KPs) as 'at-risk KPs' when discussing KPs who may or may not be HIV infected. The study has two main outputs: an initial mapping of World Bank financed AIDS prevention and control projects in LAC and the role of CSOs and KPs in those projects; identification of factors that impede or facilitate CSO access to World Bank resources that target KPs. The International HIV/AIDS Alliance has commissioned this study to improve understanding of the dynamics at the country level with World Bank financed projects concerning CSOs and KPs. (excerpt)
Forced Migration Review. 2007 Dec; (29):72.The Norwegian Refugee Council (NRC) strongly believes that the Cluster Approach holds promise for improving the international response to internal displacement. The approach represents a serious attempt by the UN, NGOs, international organisations and governments to address critical gaps in the humanitarian system. We want this reform effort to succeed and to play an active role in northern Uganda to support the work of the clusters and improve their effectiveness. (excerpt)
Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries.
Bulletin of the World Health Organization. 2008 Jan; 86(1):57-62.Ambitious goals for paediatric AIDS control have been set by various international bodies, including a 50% reduction in new paediatric infections by 2010. While these goals are clearly appropriate in their scope, the lack of clarity and consensus around how to monitor the effectiveness of programmes to prevent mother-to-child HIV transmission (PMTCT) makes it difficult for policy-makers to mount a coordinated response. In this paper, we develop the case for using population HIV-free child survival as a gold standard metric to measure the effectiveness of PMTCT programmes, and go on to consider multiple study designs and source populations. Finally, we propose a novel community survey-based approach that could be implemented widely throughout the developing world with minor modifications to ongoing Demographic and Health Surveys. (author's)
Treatment outcome of new pulmonary tuberculosis in Guangzhou, China 1993 -- 2002: A register-based cohort study.
BMC Public Health. 2007 Nov 29; 7:344.Completion of treatment for tuberculosis (TB) is of utmost priority of TB control programs. The aims of this study were to evaluate the treatment outcome of TB cases registered in Guangzhou during the period 1993-2002, and to identify factors associated with treatment success. Two (of eight) districts in Guangzhou were selected randomly as objects of study and their surveillance database was analyzed to assess the treatment outcome and identify factors associated with treatment success for TB cases registered in Guangzhou. Six treatment outcome criteria were assessed based on guidelines set by the World Health Organization (WHO). Logistic regression was used to estimate risk factors for treatment outcome. A total of 6743 pulmonary tuberculosis cases (4903 males, 1840 females) were included in this study. The treatment success rate (including cured and complete treatment) was 88% (95%CI 87%-89%). One hundred and eight-six (2.8%) patients died and 401 (5.9%) patients defaulted treatment. In multivariate analysis, treatment success was found to be associated with young age, lack of cavitation and compliance with treatment. The total treatment success rate in the current study was similar to the WHO target for all smear positive cases, while the failure rate and the default rate in 2002 were slightly higher. Good care of elderly patients, early diagnosis of cavitation and compliance with treatment could improve the success rate of TB treatment. (author's)