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Towards universal access: scaling up priority HIV / AIDS interventions in the health sector. Progress report, April 2007.
Geneva, Switzerland, WHO, 2007 Apr. 88 p.Drawing on lessons from the scale-up of HIV interventions over the last few years, WHO, as the UNAIDS cosponsor responsible for the health sector response to HIV/AIDS, has established priorities for its technical work and support to countries on the basis of the following five Strategic Directions, each of which represents a critical area where the health sector must invest if significant progress is to be made towards achieving universal access. Enabling people to know their HIV status; Maximizing the health sector's contribution to HIV prevention; Accelerating the scale-up of HIV/AIDS treatment and care; Strengthening and expanding health systems; Investing in strategic information to guide a more effective response. In this context, WHO undertook at the World Health Assembly in May 2006 to monitor and evaluate the global health sector response in scaling up towards universal access and to produce annual reports. This first report addresses progress in scaling up the following health sector interventions. Antiretroviral therapy; Prevention of mother-to-child transmission of HIV (PMTCT); HIV testing and counseling; Interventions for injecting drug users (IDUs); Control of sexually transmitted infections (STIs) to prevent HIV transmission; Surveillance of the HIV/AIDS epidemic. (excerpt)
Lancet. 2007 May 26; 369(9575):1768-1769.In today's Lancet, Steven Radelet and Bilal Siddiqi examine the associations between evaluation scores assigned by the Global Fund to Fight AIDS, Tuberculosis and Malaria to recipient countries and characteristics of grants and countries. This analysis complements a previous look at the capacity of recipient countries to disburse Global Fund money. The selection of the outcome variable-grant scores and disbursement rates-differed, but both analyses included several common programmatic and country-specific variables. Both studies found that poor countries are not disadvantaged compared with middle-income recipients in terms of performance. The fundamental question for both studies, however, is what does the selected outcome variable measure. Grant performance scores from the Global Fund have several limitations. First, the recipients define the numerical targets for each quarter for the progress indicators. The scores do not allow for comparisons of progress across recipients compared with baseline. An A recipient has not necessarily increased coverage of key interventions more than a B1 recipient. Category A represents grants reaching or exceeding expectations, whereas B1 covers grants that have adequate performance. Second, validation of reported progress against programmatic benchmarks is inherently difficult in countries with weak health-information systems. Progress on delivery of interventions has not been assessed with population-based measurements of the delivery of the interventions funded by the grants, but rather on more upstream processes or provider-based data-collection mechanisms. Third, the evaluation process is not entirely independent and includes progress monitoring by local agents selected by the Fund. (excerpt)
Emerging Infectious Diseases. 2006 Sep; 12(9):1311-1318.Most high-income countries implement tuberculosis (TB) infection control programs to reduce the risk for nosocomial transmission. However, such control programs are not routinely implemented in India, the country that accounts for the largest number of TB cases in the world. Despite the high prevalence of TB in India and the expected high probability of nosocomial transmission, little is known about nosocomial and occupational TB there. The few available studies suggest that nosocomial TB may be a problem. We review the available data on this topic, describe factors that may facilitate nosocomial transmission in Indian healthcare settings, and consider the feasibility and applicability of various recommended infection control interventions in these settings. Finally, we outline the critical information needed to effectively address the problem of nosocomial transmission of TB in India. (author's)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 2004. 44 p.This framework, which draws on the Global strategic framework to reduce the burden of TB/HIV and on the Guidelines for phased implementation of collaborative TB and HIV activities, was developed based on the following two premises. First, the National TB Programme (NTP) needs to address the impact of HIV, i.e. higher caseload of TB and increasing drug-resistant TB, and to mobilize resources related to TB/HIV activities. Second, the National AIDS Programme (NAP) needs to prolong the life and reduce the suffering of PHA through better management of TB, and to mobilize resources for TB/HIV. The Regional framework is built on the strengths of the individual National TB and AIDS Programmes, and identifies areas in which both programmes complement each other in addressing TB/HIV. This approach is considered useful, not only for countries with a relatively high prevalence of HIV, such as Cambodia, but also for most of countries in the Region that are faced with a relatively low prevalence of HIV. The scope of the Regional framework comprises interventions against tuberculosis (intensified case- finding and cure and tuberculosis preventive treatment) and interventions against HIV (and therefore indirectly against tuberculosis), e.g. comprehensive prevention, care and support, including condoms, sexually transmitted infection (STI) treatment, safe injecting drug use (IDU) and antiretroviral (ARV) treatment. Key components of the Regional framework are: surveillance; diagnosis and referral, including voluntary counselling and testing (VCT) for HIV; interventions; and, areas of collaboration. The framework outlines the roles of the individual TB and HIV/AIDS programmes (i.e. “who does what”) and provides examples of how to operationalize the different components. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, 2000.  p.Mission statement: to significantly reduce morbidity and mortality due to tuberculosis by promoting accessibility and sustainability of the DOTS strategy as part of health system development. The objectives of the Stop TB special project in the Western Pacific are to: reduce the prevalence and mortality of tuberculosis in the Region by half within ten years (by 2010); and ensure that the DOTS strategy is incorporated into country plans for health sector development. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, Stop TB, 2004.  p.Globally, over 98% of the deaths caused by tuberculosis (TB) annually are in developing countries. Within the Western Pacific Region, the seven countries that account for 94% of the TB prevalence are low or lower middle-income economies. Within countries, as well, poor and marginalized communities suffer disproportionately from TB. Importantly, TB affects the most economically and socially productive age group, as 77% of TB deaths occur within the ages of 15 – 54. This evidence points to the important relationship between poverty and TB. The deprivation associated with poverty, such as overcrowding, poor ventilation and malnutrition, increases the rate of transmission and progression from infection to disease. In turn, the costs of TB can further impoverish poor households. This is because poor households must dedicate a larger proportion of their income to meet the direct and indirect costs of seeking TB care than the non-poor. The opportunity costs are likewise higher for the poor than non-poor. For the poor, a decrease in productivity or an increase in time away from work because of illness leads to a reduction in income. Moreover, coping mechanisms employed by poor households during periods of illness may reduce household productivity in the long-term. TB has important social costs as well, which are more likely to affect women with TB than men. For example, stigma and isolation resulting from TB can reduce an individual's social position. (excerpt)
Manila, Philippines, WHO, Regional Office for the Western Pacific, Stop TB, 2000.  p.In recognition of the tuberculosis problem in the Pacific islands, the Secretariat of the Pacific Community (SPC), in collaboration with WHO and with support from the New Zealand Official Development Assistance (NZODA), established a Pacific Regional Tuberculosis Control Project in 1998, to address tuberculosis crisis in four Pacific island countries. The Regional Stop TB special project aims to generate social and political commitment to tuberculosis control. The first step of the Stop TB special project, the first meeting of a Technical Advisory Group (TAG) to Stop TB in the Western Pacific Region, was held in February 2000. The meeting focused on reviewing and endorsing the Regional strategic plan, including regional objectives and targets, and collaboration with partners to reach the Regional targets for the special project. The Regional strategic plan emphasizes activities to expand DOTS in the context of health system development, surveillance, laboratory services, supporting activities and estimated budget requirements. (excerpt)
Geneva, Switzerland, UNAIDS, 2004 Sep. 217 p. (UNAIDS/04.35E)This progress report summarizes the achievements of the Country and Regional Support Department in 2003 and presents selected highlights in greater detail. The first section outlines the strategic framework for action, Directions for the Future, the status of its implementation, the associated capacity strengthening of UNAIDS at country level, and challenges for 2004 and the next biennium. Text boxes in this section highlight “UNAIDS corporate tools” employed to implement the strategic framework. The second section reviews the Country and Regional Support Department’s efforts to translate global initiatives into results at country level. UNAIDS is involved in numerous global initiatives, three, which required particular involvement of UNAIDS resources at country level, are highlighted here. The third section reviews regional progress towards implementing the strategic framework for action. The examples cited, whilst not being an exhaustive review of country work, illustrate how UNAIDS has worked as a catalyst for national AIDS response. This report concludes with a collection of two-page country situation and progress summaries from 70 of the 134 countries with the UN Theme Groups on HIV/AIDS. (excerpt)
Human development report 2003. Millennium Development Goals: a compact among nations to end human poverty.
New York, New York, Oxford University Press, 2003. xv, 367 p.The central part of this Report is devoted to assessing where the greatest problems are, analysing what needs to be done to reverse these setbacks and offering concrete proposals on how to accelerate progress everywhere towards achieving all the Goals. In doing so, it provides a persuasive argument for why, even in the poorest countries, there is still hope that the Goals can be met. But though the Goals provide a new framework for development that demands results and increases accountability, they are not a programmatic instrument. The political will and good policy ideas underpinning any attempt to meet the Goals can work only if they are translated into nationally owned, nationally driven development strategies guided by sound science, good economics and transparent, accountable governance. That is why this Report also sets out a Millennium Development Compact. Building on the commitment that world leaders made at the 2002 Monterrey Conference on Financing for Development to forge a “new partnership between developed and developing countries”—a partnership aimed squarely at implementing the Millennium Declaration—the Compact provides a broad framework for how national development strategies and international support from donors, international agencies and others can be both better aligned and commensurate with the scale of the challenge of the Goals. And the Compact puts responsibilities squarely on both sides: requiring bold reforms from poor countries and obliging donor countries to step forward and support those efforts. (excerpt)
BMC International Health and Human Rights. 2003; 3(1): p..Background: Although a grossly disproportionate burden of disease from HIV/AIDS, TB and malaria remains in the Global South, these infectious diseases have finally risen to the top of the international agenda in recent years. Ideal strategies for combating these diseases must balance the advantages and disadvantages of 'vertical' disease control programs and 'horizontal' capacity-building approaches. Discussion: The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) represents an important step forward in the struggle against these pathogens. While its goals are laudable, significant barriers persist. Most significant is the pitiful lack of funds committed by world governments, particularly those of the very G8 countries whose discussions gave rise to the Fund. A drastic scaling up of resources is the first clear requirement for the GFATM to live up to the international community's lofty intentions. A directly related issue is that of maintaining a strong commitment to the treatment of the three diseases along with traditional prevention approaches, with the ensuing debates over providing affordable access to medications in the face of the pharmaceutical industry's vigorous protection of patent rights. Summary: At this early point in the Fund's history, it remains to be seen how these issues will be resolved at the programming level. Nevertheless, it is clear that significant structural changes are required in such domains as global spending priorities, debt relief, trade policy, and corporate responsibility. HIV/AIDS, tuberculosis and malaria are global problems borne of gross socioeconomic inequality, and their solutions require correspondingly geopolitical solutions. (author's)
Bulletin of the World Health Organization. 2002; 80(6):437-44.The objective of this study is to determine the scale of the tuberculosis (TB) problem facing the international Stop TB Partnership by measuring the gap between present rates of case detection and treatment success, and the global targets (70% and 85%, respectively) to be reached by 2005 under the WHO Directly Observed Treatment, Short-Course (DOTS) strategy. The authors analyzed case notifications submitted annually to WHO from up to 202 (of 210) countries and territories between 1980 and 2000, and the results of treatment for patients registered between 1994 and 1999. Many of the 148 national DOTS programs in existence by the end of 2000 have shown that they can achieve high treatment success rates, close to or exceeding the target of 85%. However, the authors estimate that only 27% of all new smear-positive cases that arose in 2000 were notified under DOTS, and only 19% were successfully treated. The increment in case-finding has been steady at about 133,000 additional smear-positive cases in each year since 1994. In the interval 1999-2000, more than half of the extra cases notified under DOTS were in Ethiopia, India, Myanmar, the Philippines, and South Africa. With the current rate of progress in DOTS expansion, the target of 70% cases detection will not be reached until 2013. To reach this target by 2005, DOTS programs must find an additional 333,000 cases each year. The challenge now is to show that DOTS expansion in the major endemic countries can significantly accelerate case finding while maintaining high cure rates. (author's)