Your search found 363 Results

  1. 1
    375676

    Aligning incentives, accerlerating impact. Next generation financing models for global health.

    Silverman R; Over M; Bauhoff S

    Washington, D.C., Center for Global Development, 2015. 68 p.

    Founded in 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) is one of the world’s largest multilateral health funders, disbursing $3-$4 billion a year across 100-plus countries. Many of these countries rely on Global Fund monies to finance their respective disease responses -- and for their citizens, the efficient and effective use of Global Fund monies can be the difference between life and death. Many researchers and policymakers have hypothesized that models tying grant payments to achieved and verified results -- referred to in this report as next generation financing models -- offer an opportunity for the Global Fund to push forward its strategic interests and accelerate the impact of its investments. Free from year-to-year disbursement pressure (like government agencies) and rigid allocation policies (like the World Bank’s International Development Association), the Global Fund is also uniquely equipped to push forward innovative financing models. But despite interest, the how of new grant designs remains a challenge. Realizing their potential requires technical know-how and careful, strategic decisionmaking that responds to specific country and epidemiological contexts -- all with little evidence or experience to guide the way. This report thus addresses the how of next generation financing models -- that is, the concrete steps needed to change the basis of payment from expenses to something else: outputs, outcomes, or impact. (Excerpts)
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  2. 2
    375674

    Designing contracts for the Global Fund: Lessons from the theory of incentives.

    Wren-Lewis L

    Washington, D.C., Center for Global Development, 2016 Feb. 38 p. (Center for Global Development Working Paper 425)

    This paper uses contract theory to suggest simple contract designs that could be used by the Global Fund. Using a basic model of procurement, we lay out five alternative options and consider when each is likely to be most appropriate. The rest of the paper then discusses how one can build a real-world contract from these theoretical foundations, and how these contracts should be adapted to different contexts when the basic assumptions do not hold. Finally, we provide a synthesis of these various results with the aim of guiding policy makers as to when and how ‘results-based’ incentive contracts can be used in practice.
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  3. 3
    378054
    Peer Reviewed

    Assessing the impact of defining a global priority research agenda to address HIV-associated tuberculosis.

    Odone A; Matteelli A; Chiesa V; Cella P; Ferrari A

    Tropical Medicine and International Health. 2016 Nov; 21(11):1420-1427.

    Objectives In 2010, the WHO issued 77 priority research questions (PRQs) to address HIV-associated TB. Objective of the this study was to assess the impact of defining the research agenda in stimulating and directing research around priority research questions. Methods We used number and type of scientific publications as a proxy to quantitatively assess the impact of research agenda setting. We conducted 77 single systematic reviews -one for every PRQ -building 77 different search strategies using PRQs’ keywords. Multivariate logistic regression models were applied to assess the quantity and quality of research produced over time and accounting for selected covariates. Results In 2009-2015, PRQs were addressed by 1631 publications (median: 11 studies published per PRQ, range 1-96). The most published area was ‘Intensified TB case finding’ (median: 23 studies/PRQ, range: 2-74). The majority (62.1%, n = 1013) were published as original studies, and more than half (58%, n = 585) were conducted in the African region. Original studies’ publication increased over the study period (P trend = <0.001). They focused more on the ‘Intensified TB case finding’ (OR = 2.17, 95% CI: 1.56-2.93) and ‘Drug-resistant TB and HIV infection’ (OR = 2.12, 95% CI: 1.47-3.06) areas than non-original studies. Original studies were published in journals of lower impact factor and received a smaller number of citations than non-original studies (OR = 0.54, 95% CI: 0.42-0.69). Conclusion The generation of evidence to address PRQs has increased over time particularly in selected fields. Setting a priority research agenda for HIV-associated TB might have positively influenced the direction and the conduct of research and contributed to the global response to such a major threat to health.
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  4. 4
    373335

    [The results of implementation of the International Bank for Reconstruction and Development Loan Project "Prevention, diagnosis, and treatment of tuberculosis and AIDS", a "tuberculosis" component]

    Tuberkulez I Bolezni Legkikh. 2010; (3):10-7.

    Due to the implementation of the International Bank for Reconstruction and Development (IBRD) loan project "Prevention, diagnosis, treatment of tuberculosis and AIDS", a "Tuberculosis" component that is an addition to the national tuberculosis control program in 15 subjects of the Russian Federation, followed up by the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences, the 2005-2008 measures stipulated by the Project have caused substantial changes in the organization of tuberculosis control: implementation of Orders Nos. 109, 50, and 690 and supervision of their implementation; modernization of the laboratories of the general medical network and antituberbulosis service (404 kits have been delivered for clinical diagnostic laboratories and 12 for bacteriological laboratories, including BACTEC 960 that has been provided in 6 areas); 91 training seminars have been held at the federal and regional levels; 1492 medical workers have been trained in the detection, diagnosis, and treatment of patients with tuberculosis; 8 manuals and guidelines have been prepared and sent to all areas. In the period 2005-2008, the tuberculosis morbidity and mortality rates in the followed-up areas reduced by 1.2 and 18.6%, respectively. The analysis of patient cohorts in 2007 and 2005 revealed that the therapeutic efficiency evaluated from sputum smear microscopy increased by 16.3%; there were reductions in the proportion of patients having ineffective chemotherapy (from 16.1 to 11.1%), patients who died from tuberculosis (from 11.6 to 9.9%), and those who interrupted therapy ahead of time (from 11.8 to 7.8%). Implementation of the IBR project has contributed to the improvement of the national strategy and the enhancement of the efficiency of tuberculosis control.
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  5. 5
    371803

    Working together with businesses. Guidance on TB and TB/HIV prevention, diagnosis, treatment and care in the workplace.

    Dias HM; Uplekar; Amekudzi K; Reid A; Hsu LN; Wilburn S; Mohaupt D

    Geneva, Switzerland, World Health Organization {WHO], 2012. 46 p.

    The corporate and business sector belong to a wide range of care providers that offer TB and HIV care to significant proportions of working populations. While considerable literature is now available on diverse public-private mix interventions for TB care and control, there is a dearth of documentation and updated guidance on business sector initiatives in TB care. To address the need for guiding principles to initiate and scale up the engagement of the business sector in TB and HIV care, the WHO in collaboration with ILO, UNAIDS and other partners conducted an assessment of business sector initiatives to address TB and TB/HIV, documented working examples on the ground, and organized an expert consultation to discuss and draw lessons from available evidence. The purpose of this document is to capitalize on the untapped potential of the business sector to respond to these two epidemics. Built on the 2003 guidelines on contribution of workplaces to TB control prepared jointly by the ILO and WHO, these guidelines should help capitalize on increased awareness about TB and HIV and their impact on businesses, and strengthen partnerships between national TB programmes, national HIV programmes, and the business sector to improve TB and HIV prevention, treatment and care activities. Existing guidance to facilitate business participation predominantly focuses on HIV. This document is therefore principally centred on TB prevention, treatment and care and it’s linkages with HIV. This document is designed to provide guidance to TB and HIV programme managers, employers, workers organizations, occupational health staff and other partners on the need and ways to work in partnership to design and implement workplace TB/HIV prevention, treatment and care programmes integrated with occupational health and HIV workplace programmes where relevant. (excerpt)
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  6. 6
    340330
    Peer Reviewed

    A number of factors explain why WHO guideline developers make strong recommendations inconsistent with GRADE guidance.

    Alexander PE; Gionfriddo MR; Li SA; Bero L; Stoltzfus RJ; Neumann I; Brito JP; Djulbegovic B; Montori VM; Norris SL; Schunemann HJ; Thabane L; Guyatt GH

    Journal of Clinical Epidemiology. 2016; 70:111-122.

    Objective: Many strong recommendations issued by the World Health Organization (WHO) are based on low- or very low-quality (low certainty) evidence (discordant recommendations). Many such discordant recommendations are inconsistent with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance. We sought to understand why WHO makes discordant recommendations inconsistent with GRADE guidance. Study Design and Setting: We interviewed panel members involved in guidelines approved by WHO (2007e2012) that included discordant recommendations. Interviews, recorded and transcribed, focused on use of GRADE including the reasoning underlying, and factors contributing to, discordant recommendations. Results: Four themes emerged: strengths of GRADE, challenges and barriers to GRADE, strategies to improve GRADE application, and explanations for discordant recommendations. Reasons for discordant recommendations included skepticism about the value of making conditional recommendations; political considerations; high certainty in benefits (sometimes warranted, sometimes not) despite assessing evidence as low certainty; and concerns that conditional recommendations will be ignored. Conclusion: WHO panelists make discordant recommendations inconsistent with GRADE guidance for reasons that include limitations in their understanding of GRADE. Ensuring optimal application of GRADE at WHO and elsewhere likely requires selecting panelists who have a commitment to GRADE principles, additional training of panelists, and formal processes to maximize adherence to GRADE principles. Copyright: 2016 Elsevier Inc.
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  7. 7
    369532
    Peer Reviewed

    Implementation and Operational Research: Implementation of the WHO 2011 Recommendations for Isoniazid Preventive Therapy (IPT) in Children Living With HIV/AIDS: A Ugandan Experience.

    Costenaro P; Massavon W; Lundin R; Nabachwa SM; Fregonese F; Morelli E; Alowo A; Nannyonga Musoke M; Namisi CP; Kizito S; Bilardi D; Mazza A; Cotton MF; Giaquinto C; Penazzato M

    Journal of Acquired Immune Deficiency Syndromes. 2016 Jan 1; 71(1):e1-8.

    BACKGROUND: Intensified tuberculosis (TB) case finding and isoniazid preventive therapy (IPT) are strongly recommended for children who are HIV infected. Data are needed to assess the feasibility of the WHO 2011 intensified tuberculosis case finding/IPT clinical algorithm. METHODS: Children who are HIV infected and attending Nsambya Home Care at Nsambya Hospital, Uganda, were screened for TB following WHO recommendations. IPT was given for 6 months after excluding TB. Factors associated with time to IPT initiation were investigated by multivariate Cox proportional hazard regression. Health care workers were interviewed on reasons for delay in IPT initiation. RESULTS: Among the 899 (49% male) children with HIV, 529 (58.8%) were screened for TB from January 2011 to February 2013. Children with active TB were 36/529 (6.8%), 24 (4.5%) were lost to follow-ups and 280 (52.9%) started IPT, 86/280 (30.7%) within 3 months of TB screening and 194/280 (69.3%) thereafter. Among the 529 children screened for TB, longer time to IPT initiation was independently associated with cough at TB screening (hazard ratio 0.62, P = 0.02, 95% confidence interval: 0.41 to 0.94). Four children (1% of those starting treatments) interrupted IPT because of a 5-fold increase in liver function measurements. In the survey, Health care workers reported poor adherence to antiretroviral therapy, poor attendance to periodic HIV follow-ups, and pill burden as the 3 main reasons to delay IPT. CONCLUSION: In resource-constrained settings, considerable delays in IPT initiation may occur, particularly in children with HIV who are presenting with cough at TB screening. The good safety profile of isoniazid in antiretroviral-therapy-experienced children provides further support to IPT implementation in this population.
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  8. 8
    383103
    Peer Reviewed

    [International financial cooperation in the fight against AIDS in Latin America and the Caribbean] La cooperacion financiera internacional para la lucha contra el SIDA en America Latina y el Caribe.

    Leyva-Flores R; Castillo JG; Servan-Mori E; Ballesteros ML; Rodriguez JF

    Cadernos De Saude Publica. 2014 Jul; 30(7):1571-6.

    This study analyzed the financial contribution by the Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria and its relationship to eligibility criteria for funding in Latin America and the Caribbean in 2002-2010. Descriptive analysis (linear regression) was conducted for the Global Fund financial contributions according to eligibility criteria (income level, burden of disease, governmental co-investment). Financial contributions totaled US$ 705 million. Lower-income countries received higher shares; there was no relationship between Global Fund contributions and burden of disease. The Global Fund's international financing complements governmental expenditure, with equity policies for financial allocation.
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  9. 9
    337537
    Peer Reviewed

    Strength of recommendations in WHO guidelines using GRADE was associated with uptake in national policy.

    Nasser SM; Cooke G; Kranzer K; Norris SL; Olliaro P; Ford N

    Journal of Clinical Epidemiology. 2015; [5] p.

    Objectives: This study assesses the extent to which the strength of a recommendation in a World Health Organization (WHO) guideline affects uptake of the recommendation in national guidelines. Study Design and Setting: The uptake of recommendations included in HIV and TB guidelines issued by WHO from 2009 to 2013 was assessed across guidelines from 20 low- and middle-income countries in Africa and Southeast Asia. Associations between characteristics of recommendations (strength, quality of the evidence, type) and uptake were assessed using logistic regression. Results: Eight WHO guidelines consisting of 109 strong recommendations and 49 conditional ecommendations were included, and uptake assessed across 44 national guidelines (1,255 recommendations) from 20 countries. Uptake of WHO recommendations in national guidelines was 82% for strong recommendations and 61% for conditional recommendations. The odds of uptake comparing strong recommendations and conditional recommendations was 1.9 (95% confidence interval: 1.4, 2.7), after adjustment for quality of evidence. Higher levels of evidence quality were associated with greater uptake, independent of recommendation strength. Conclusion: Guideline developers should be confident that conditional recommendations are frequently adopted. The fact that strong recommendations are more frequently adopted than conditional recommendations underscores the importance of ensuring that such recommendations are justified.
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  10. 10
    335970

    The gap report.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 2014 Jul. [422] p. (UNAIDS / JC2656)

    How do we close the gap between the people moving forward and the people being left behind? This was the question we set out to answer in the UNAIDS Gap report. Similar to the Global report, the goal of the Gap report is to provide the best possible data, but, in addition, to give information and analysis on the people being left behind. A new report by UNAIDS shows that 19 million of the 35 million people living with HIV globally do not know their HIV-positive status. The UNAIDS Gap report shows that as people find out their HIV-positive status they will seek life-saving treatment. In sub-Saharan Africa, almost 90% of people who tested positive for HIV went on to access antiretroviral therapy (ART). Research shows that in sub-Saharan Africa, 76% of people on ART have achieved viral suppression, whereby they are unlikely to transmit the virus to their sexual partners. New data analysis demonstrates that for every 10% increase in treatment coverage there is a 1% decline in the percentage of new infections among people living with HIV. The report highlights that efforts to increase access to ART are working. In 2013, an additional 2.3 million people gained access to the life-saving medicines. This brings the global number of people accessing ART to nearly 13 million by the end of 2013. Based on past scale-up, UNAIDS projects that as of July 2014 as many as 13 950 296 people were accessing ART. By ending the epidemic by 2030, the world would avert 18 million new HIV infections and 11.2 million AIDS-related deaths between 2013 and 2030.
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  11. 11
    336146
    Peer Reviewed

    Towards the WHO target of zero childhood tuberculosis deaths: an analysis of mortality in 13 locations in Africa and Asia.

    Russell GK; Merle CS; Cooke GS; Casas EC; Silveira da Fonseca M; du Cros P

    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.
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  12. 12
    365223
    Peer Reviewed

    Improving tuberculosis screening and isoniazid preventive therapy in an HIV clinic in Addis Ababa, Ethiopia.

    Zaeh S; Kempker R; Stenehjem E; Blumberg HM; Temesgen O; Ofotokun I; Tenna A

    International Journal of Tuberculosis and Lung Disease. 2013 Nov; 17(11):1396-401.

    BACKGROUND: The World Health Organization (WHO) recommends active tuberculosis (TB) case finding among people living with human immunodeficiency virus (HIV) in resource-limited settings using a symptom-based algorithm; those without active TB disease should be offered isoniazid preventive therapy (IPT). OBJECTIVE: To evaluate rates of adherence to WHO recommendations and the impact of a quality improvement intervention in an HIV clinic in Addis Ababa, Ethiopia. DESIGN: A prospective study design was utilized to compare TB symptom screening and IPT administration rates before and after a quality improvement intervention consisting of 1) educational sessions, 2) visual reminders, and 3) use of a screening checklist. RESULTS: A total of 751 HIV-infected patient visits were evaluated. The proportion of patients screened for TB symptoms increased from 22% at baseline to 94% following the intervention (P < 0.001). Screening rates improved from 51% to 81% (P < 0.001) for physicians and from 3% to 100% (P < 0.001) for nurses. Of the 281 patients with negative TB symptom screens and eligible for IPT, 4% were prescribed IPT before the intervention compared to 81% after (P < 0.001). CONCLUSIONS: We found that a quality improvement intervention significantly increased WHO-recommended TB screening rates and IPT administration. Utilizing nurses can help increase TB screening and IPT provision in resource-limited settings.
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  13. 13
    362801
    Peer Reviewed

    Evaluation of the impact of immediate versus WHO recommendations-guided antiretroviral therapy initiation on HIV incidence: the ANRS 12249 TasP (Treatment as Prevention) trial in Hlabisa sub-district, KwaZulu-Natal, South Africa: study protocol for a cluster randomised controlled trial.

    Iwuji CC; Orne-Gliemann J; Tanser F; Boyer S; Lessells RJ; Lert F; Imrie J; Barnighausen T; Rekacewicz C; Bazin B; Newell ML; Dabis F

    Trials. 2013; 14:230.

    BACKGROUND: Antiretroviral therapy (ART) suppresses HIV viral load in all body compartments and so limits the risk of HIV transmission. It has been suggested that ART not only contributes to preventing transmission at individual but potentially also at population level. This trial aims to evaluate the effect of ART initiated immediately after identification/diagnosis of HIV-infected individuals, regardless of CD4 count, on HIV incidence in the surrounding population. The primary outcome of the overall trial will be HIV incidence over two years. Secondary outcomes will include i) socio-behavioural outcomes (acceptability of repeat HIV counselling and testing, treatment acceptance and linkage to care, sexual partnerships and quality of life); ii) clinical outcomes (mortality and morbidity, retention into care, adherence to ART, virologic failure and acquired HIV drug resistance), iii) cost-effectiveness of the intervention. The first phase will specifically focus on the trial's secondary outcomes. METHODS/DESIGN: A cluster-randomised trial in 34 (2 x 17) clusters within a rural area of northern KwaZulu-Natal (South Africa), covering a total population of 34,000 inhabitants aged 16 years and above, of whom an estimated 27,200 would be HIV-uninfected at start of the trial. The first phase of the trial will include ten (2 x 5) clusters. Consecutive rounds of home-based HIV testing will be carried out. HIV-infected participants will be followed in dedicated trial clinics: in intervention clusters, they will be offered immediate ART initiation regardless of CD4 count and clinical stage; in control clusters they will be offered ART according to national treatment eligibility guidelines (CD4 <350 cells/muL, World Health Organisation stage 3 or 4 disease or multidrug-resistant/extensively drug-resistant tuberculosis). Following proof of acceptability and feasibility from the first phase, the trial will be rolled out to further clusters. DISCUSSION: We aim to provide proof-of-principle evidence regarding the effectiveness of Treatment-as-Prevention in reducing HIV incidence at the population level. Data collected from the participants at home and in the clinics will inform understanding of socio-behavioural, economic and clinical impacts of the intervention as well as feasibility and generalizability. TRIAL REGISTRATION: Clinicaltrials.gov: NCT01509508; South African Trial Register: DOH-27-0512-3974.
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  14. 14
    335339

    Global report: UNAIDS report on the global AIDS epidemic 2013.

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 2013. [198] p.

    The 2013 report on the global AIDS epidemic contains the latest data on numbers of new HIV infections, numbers of people receiving antiretroviral treatment, AIDS-related deaths and HIV among children. This report, which follows the endorsement of the 2011 United Nations Political Declaration on HIV and AIDS outlining global targets to achieve by 2015, summarizes progress towards 10 key targets and reviews commitments and future steps. While recognizing significant achievements, UNAIDS warns of slowing progress in meeting some targets. In 2012, there were 35 million people living with HIV (PLHIV), and 2.3 million new infections-a 33 percent decrease from 2001, including significant reductions in new infections among children. More people than ever are on antiretroviral therapy (ART). Twenty-six countries have achieved the global target of halving sexual HIV transmission by 2015, but other countries are not on track to meet this target, hence the need to enhance prevention efforts. Globally, countries have made limited progress in reducing HIV transmission by 50 percent among people who inject drugs. While ART coverage is high, and approaching the target of 15 million PLHIV on treatment, coverage in low- and middle-income countries represented only 34 percent of 28 million eligible PLHIV in 2013. Stigma, discrimination and criminalization towards PLHIV continue; specifically, 60 percent of countries report laws that inhibit access to HIV services by key populations. The results of this report should be used by countries to refocus and maintain their commitments. The authors urged strengthened global commitment to achieve the goal of zero new HIV infections, discrimination, and AIDS-related deaths.
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  15. 15
    361377
    Peer Reviewed

    Routine vaccination coverage in low- and middle-income countries: further arguments for accelerating support to child vaccination services.

    Tao W; Petzold M; Forsberg BC

    Global Health Action. 2013; 6:20343.

    BACKGROUND AND OBJECTIVE: The Expanded Programme on Immunization was introduced by the World Health Organization (WHO) in all countries during the 1970s. Currently, this effective public health intervention is still not accessible to all. This study evaluates the change in routine vaccination coverage over time based on survey data and compares it to estimations by the WHO and United Nations Children's Fund (UNICEF). DESIGN: Data of vaccination coverage of children less than 5 years of age was extracted from Demographic and Health Surveys (DHS) conducted in 71 low- and middle-income countries during 1986-2009. Overall trends for vaccination coverage of tuberculosis, diphtheria, tetanus, pertussis, polio and measles were analysed and compared to WHO and UNICEF estimates. RESULTS: From 1986 to 2009, the annual average increase in vaccination coverage of the studied diseases ranged between 1.53 and 1.96% units according to DHS data. Vaccination coverage of diphtheria, tetanus, pertussis, polio and measles was all under 80% in 2009. Non-significant differences in coverage were found between DHS data and WHO and UNICEF estimates. CONCLUSIONS: The coverage of routine vaccinations in low- and middle-income countries may be lower than that previously reported. Hence, it is important to maintain and increase current vaccination levels.
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  16. 16
    360516
    Peer Reviewed

    Scale-up of TB and HIV programme collaborative activities in Zambia - a 10-year review.

    Kapata N; Chanda-Kapata P; Grobusch MP; O'Grady J; Schwank S; Bates M; Jansenn S; Mwinga A; Cobelens F; Mwaba P; Zumla A

    Tropical Medicine and International Health. 2012 Jun; 17(6):760-6.

    OBJECTIVE: To review the activities, progress, achievements and challenges of the Zambia Ministry of Health tuberculosis (TB)/HIV collaborative activities over the past decade. METHODS: Analysis of Zambia Ministry of Health National TB and HIV programme documents and external independent programme review reports pertaining to 2000-2010. RESULTS: The number of people testing for HIV increased from 37 557 persons in 2003 to 1 327 995 persons in 2010 nationally. Those receiving anti-retroviral therapy (ART) increased from 143 in 2003 to 344 304 in 2010. The national HIV prevalence estimates declined from 14.3% in 2001 to 13.5% in 2009. The proportion of TB patients being tested for HIV increased from 22.6% in 2006 to 84% in 2010 and approximately 70% were HIV positive. The proportion of the HIV-infected TB patients who: (i) started on ART increased from 38% in 2006 to 50% in 2010; (ii) commenced co-trimoxazole preventive therapy (CPT) increased from 31% in 2006 to 70% in 2010; and (iii) were successfully treated increased to an average of 80% resulting in decline of deaths from 13% in 2006 to 9% in 2010. CONCLUSIONS: The scale-up of TB/HIV collaborative programme activities in Zambia has steadily increased over the past decade resulting in increased testing for TB and HIV, and anti-retroviral (ARV) rollout with improved treatment outcomes among TB patients co-infected with HIV. Getting service delivery points to adhere to WHO guidelines for collaborative TB/HIV activities remains problematic, especially those meant to reduce the burden of TB in people living with HIV/AIDS (PLWHA). (c) 2012 Blackwell Publishing Ltd.
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  17. 17
    356537
    Peer Reviewed

    Performance of the new WHO diagnostic algorithm for smear-negative pulmonary tuberculosis in HIV prevalent settings: a multisite study in Uganda.

    Alamo ST; Kunutsor S; Walley J; Thoulass J; Evans M; Muchuro S; Matovu A; Katabira E

    Tropical Medicine and International Health. 2012 Jul; 17(7):884-95.

    OBJECTIVE: To compare the performance of the new WHO (2007) diagnostic algorithm for pulmonary tuberculosis (PTB) in high HIV prevalent settings (WHO07) to the WHO 2003 guidelines used by the Ugandan National Tuberculosis Program (UgWHO03). METHODS: A prospective observational cohort design was used at Reach Out Mbuya Parish HIV/AIDS Initiative, an urban slum community-based AIDS Service Organisation (ASO) and Kayunga Rural District Government Hospital. Newly diagnosed and enrolled HIV-infected patients were assessed for PTB. Research staff interviewed patients and staff and observed operational constraints. RESULTS: WHO07 reduced the time to diagnosis of smear-negative PTB with increased sensitivity compared with the UgWHO03 at both sites. Time to diagnosis of smear-negative PTB was significantly shorter at the urban ASO than at the rural ASO (12.4 vs. 28.5 days, P = 0.003). Diagnostic specificity and sensitivity [95% confidence intervals (CIs)] for smear-negative PTB were higher at the rural hospital compared with the urban ASO: [98% (93-100%) vs. 86% (77-92%), P = 0.001] and [95% (72-100%) vs. 90% (54-99%), P > 0.05], respectively. Common barriers to implementation of algorithms included failure by patients to attend follow-up appointments and poor adherence by healthcare workers to algorithms. CONCLUSION: At both sites, WHO07 expedited diagnosis of smear-negative PTB with increased diagnostic accuracy compared with the UgWHO03. The WHO07 expedited diagnosis more at the urban ASO but with more diagnostic accuracy at the rural hospital. Barriers to implementation should be taken into account when operationalising these guidelines for TB diagnosis in resource-limited settings. (c) 2012 Blackwell Publishing Ltd.
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  18. 18
    334036

    World Health Organization's 2010 recommendations for HIV treatment: Natiional guideline revision challenges and lessons learned.

    Rossi V; Ojikutu B; Hirschhorn L

    Arlington, Virginia, John Snow [JSI], AIDS Support and Technical Assistance Resources [AIDSTAR-One], 2012 Feb. [26] p. (Technical Brief; USAID Contract No. GHH-I-00–07–00059–00)

    In 2010, the World Health Organization released revised recommendations for adult and adolescent HIV treatment. This technical brief provides HIV policy makers and program managers with a point of reference as they adapt and implement revised national HIV treatment guidelines. Approaches that worked well, challenges and lessons learned from Sub-Saharan Africa, Latin America, and South-East Asia are highlighted. Links to key resources for countries revising guidelines and implementing revisions are also provided.
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  19. 19
    333820

    Investing in communities: annual review 2011.

    International HIV / AIDS Alliance

    [Hove, United Kingdom], International HIV / AIDS Alliance, 2012 Jun. [19] p.

    Our vision is a world in which people do not die of aids. For us, this means a world in which communities: have brought HIV under control by preventing its transmission; enjoy better health; and can fully exercise their human rights. Our mission is to support community action to prevent HIV infection, meet the challenges of AIDS, and build healthier communities.We take great pride investing in a community-based response that understands what works in a local context, and that is strengthened by learning from a global partnership of national organisations. In 2011 this approach enabled us to reach 2.8 million people.
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  20. 20
    351595
    Peer Reviewed

    [Clinical, epidemiological and microbiological characteristics of a cohort of pulmonary tuberculosis patients in Cali, Colombia] Caracteristicas clinicas, epidemiologicas y microbiologicas de una cohorte de pacientes con tuberculosis pulmonar en Cali, Colombia.

    Rojas CM; Villegas SL; Pineros HM; Chamorro EM; Duran CE; Hernandez EL; Pacheco R; Ferro BE

    Biomedica. 2010 Oct-Dec; 30(4):482-91.

    INTRODUCTION: The World Health Organization recommended strategy for global tuberculosis control is a short-course, clinically administered treatment, This approach has approximately 70% coverage in Colombia. OBJECTIVE: The clinical, epidemiological and microbiological characteristics along with drug therapy outcomes were described in newly diagnosed, pulmonary tuberculosis patients. MATERIALS AND METHODS: This was a descriptive study, conducted as part of a multicenter clinical trial of tuberculosis treatment. A cohort of 106 patients with pulmonary tuberculosis were recruited from several public health facilities in Cali between April 2005 and June 2006. Sputum smear microscopy, culture, drug susceptibility tests to first-line anti-tuberculosis drugs, chest X- ray and HIV-ELISA were performed. Clinical and epidemiological information was collected for each participant. Treatment was administered by the local tuberculosis health facility. Food and transportation incentives were provided during a 30 month follow-up period. RESULTS: The majority of patients were young males with a diagnostic delay longer than 9 weeks and a high sputum smear grade (2+ or 3+). The initial drug resistance was 7.5% for single drug treatment and 1.9% for multidrug treatments. The incidence of adverse events associated with treatment was 8.5%. HIV co-infection was present in 5.7% of the cases. Eighty-six percent of the patients completed the treatment and were considered cured. The radiographic presentation varied within a broad range and differed from the classic progression to cavity formation. CONCLUSION: Delay in tuberculosis diagnosis was identified as a risk factor for treatment compliance failure. The study population had similar baseline epidemiologic characteristics to those described in other cohort studies.
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  21. 21
    333446

    Ten targets: 2011 United Nations General Assembly Political Declaration on HIV / AIDS: Targets and elimination commitments.

    United Nations. General Assembly

    Geneva, Switzerland, UNAIDS, 2011. [3] p.

    Ten targets in the campaign to achieve universal access to HIV prevention, treatment, care and support by 2015 are listed. Targets include: Reduce sexual transmission of HIV by 50% by 2015; Reduce transmission of HIV among people who inject drugs by 50% by 2015; Eliminate new HIV infections among children by 2015 and substantially reduce AIDS-related maternal deaths; Reach 15 million people living with HIV with lifesaving antiretroviral treatment by 2015; Reduce tuberculosis deaths in people living with HIV by 50 percent by 2015; Close the global AIDS resource gap by 2015 and reach annual global investment of US$22-24 billion in low- and middle-income countries; Eliminate gender inequalities and gender-based abuse and violence and increase the capacity of women and girls to protect themselves from HIV; Eliminate stigma and discrimination against people living with and affected by HIV through promotion of laws and policies that ensure the full realization of all human rights and fundamental freedoms; Eliminate HIV-related restrictions on entry, stay and residence; Eliminate parallel systems for HIV-related services to strengthen integration of the AIDS response in global health and development efforts.
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  22. 22
    349236
    Peer Reviewed

    Increased resources for the Global Fund, but pledges fall short of expected demand.

    Kazatchkine MD

    Lancet. 2010 Oct 30; 376(9751):1439-40.

    This commentary discusses how the pledges to the Global Fund to Fight AIDS, Tuberculosis and Malaria from countries, the private sector, and innovative funding sources have fallen short of the demand estimates, despite the pledged sum being the largest amount ever mobilized for global health. The US $11.7 billion pledge for the 2011-2013 time range is an increase of more than 20% over 2007-2010 and will go toward maintaining programs at their current scale and support further significant expansion of health services in many countries. It explains that the shortfall to meet the $13 billion will result in challenging decisions about which new programs to support and a slower rate of scale-up for new programs.
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  23. 23
    333337

    Getting to zero: 2011-2015 strategy, Joint United Nations Programme on HIV / AIDS (UNAIDS).

    Joint United Nations Programme on HIV / AIDS [UNAIDS]

    Geneva, Switzerland, UNAIDS, 2010 Dec. [64] p. (UNAIDS/10.12E/JC2034E)

    This Strategy has been developed through wide consultation, informed by the best evidence and driven by a moral imperative to achieve universal access to HIV prevention, treatment, care and support and the Millennium Development Goals.
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  24. 24
    339305

    Engaging informal providers in TB control: what is the potential in the implementation of the WHO stop TB strategy? a discussion paper.

    Kaboru B; Uplekar M; Lonnroth K

    World Health and Population. 2011; 12(4):5-13.

    The World Health Organization (WHO) Stop TB Strategy calls for involvement of all healthcare providers in tuberculosis (TB) control. There is evidence that many people with TB seek care from informal providers before or after diagnosis, but very little has been done to engage these informal providers. Their involvement is often discussed with regard to DOTS (directly observed treatment - short course), rather than to the implementation of the comprehensive Stop TB Strategy. This paper discusses the potential contribution of informal providers to all components of the WHO Stop TB Strategy, including DOTS, programmatic management of multi-drug-resistant TB (MDR-TB), TB/HIV collaborative activities, health systems strengthening, engaging people with TB and their communities, and enabling research. The conclusion is that with increased stewardship by the national TB program (NTP), informal providers might contribute to implementation of the Stop TB Strategy. NTPs need practical guidelines to set up and scale up initiatives, including tools to assess the implications of these initiatives on complex dimensions like health systems strengthening.
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  25. 25
    346982
    Peer Reviewed

    Tuberculosis and HIV: time for an intensified response.

    Ghebreyesus TA; Kazatchkine M; Sidibe M; Nakatani H

    Lancet. 2010 May 22; 375(9728):1757-8.

    This article describes several urgent actions that are needed to promote rapid scale-up of effective and integrated services for tuberculosis and HIV and to tackle the factors that increase vulnerability and put people at risk of HIV-related tuberculosis. These include: bold national leadership, health system restructuring to foster greater integration of tuberculosis and HIV services that provide routine tuberculosis screening, treatment, and prevention to people living with HIV; and to offer HIV counseling and testing to all patients with signs and symptoms of tuberculosis, decentralized care to ensure improved access, investment in new tools and better use of existing tools, and global leadership from donors, countries of the global south, and key health agencies.
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