Your search found 14048 Results

  1. 51
    392520
    Peer Reviewed

    A Decade of Monitoring HIV Epidemics in Nigeria: Positioning for Post-2015 Agenda.

    Akinwande O; Bashorun A; Azeez A; Agbo F; Dakum P; Abimiku A; Bilali C; Idoko J; Ogungbemi K

    AIDS and Behavior. 2017 Jul; 21(Suppl 1):62-71.

    BACKGROUND: Nigeria accounts for 9% of the global HIV burden and is a signatory to Millennium Development Goals as well as the post-2015 Sustainable Development Goals. This paper reviews maturation of her HIV M&E system and preparedness for monitoring of the post-2015 agenda. METHODS: Using the UNAIDS criteria for assessing a functional M&E system, a mixed-methods approach of desk review and expert consultations, was employed. RESULTS: Following adoption of a multi-sectoral M&E system, Nigeria experienced improved HIV coordination at the National and State levels, capacity building for epidemic appraisals, spectrum estimation and routine data quality assessments. National data and systems audit processes were instituted which informed harmonization of tools and indicators. The M&E achievements of the HIV response enhanced performance of the National Health Management Information System (NHMIS) using DHIS2 platform following its re-introduction by the Federal Ministry of Health, and also enabled decentralization of data management to the periphery. CONCLUSION: A decade of implementing National HIV M&E framework in Nigeria and the recent adoption of the DHIS2 provides a strong base for monitoring the Post 2015 agenda. There is however a need to strengthen inter-sectoral data linkages and reduce the rising burden of data collection at the global level.
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  2. 52
    375858

    Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Trainees' handbook.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 199 p.

    The Trainees’ handbook is designed to train gynaecologists and non-specialist clinicians in performing colposcopy and treatment of cervical precancerous conditions so they can provide the necessary diagnostic and therapeutic services in a cervical cancer screening programme. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training programme on cervical cancer screening and treatment. The Trainees’ handbook contains different modules intended to assist trainees to develop their knowledge and learn the correct steps to perform colposcopy and treatment procedures. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. The structure and methodology of the training have been designed to impart knowledge in the most effective manner and have taken into consideration the overall training objectives, profiles of trainees and the expected learning outcomes. (Excerpt)
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  3. 53
    375857

    Cervical cancer screening and management of cervical pre-cancers. Training of health staff in colposcopy, LEEP and CKC. Facilitators' guide.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 118 p.

    This manual is an instruction guide for facilitators to provide competence based training to providers of colposcopy and treatment services in a cervical cancer screening programme. The training is intended to assist gynaecologists and non-specialist clinicians to learn and improve upon their skills to perform colposcopy and to treat cervical pre-cancers by excision methods. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training participants through interactive presentations, group discussions, role plays, clinical practice sessions, etc. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions and guidelines for assessment of trainees. The Trainees’ handbook contains different modules to assist trainees with step-by-step learning of colposcopy and treatment procedures. (Excerpt)
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  4. 54
    375856

    Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Trainees' handbook.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 171 p.

    The Trainees’ handbook is designed for paramedical workers, midwives, nurses and clinicians involved in cervical cancer screening to help them acquire the necessary skills to perform VIA, collect samples for HPV test and treat cervical pre-cancers by ablative methods. The publication of the World Health Organization guidance document Comprehensive cervical cancer control: A guide to essential practice, 2nd edition, 2014 has necessitated modifications in the existing training resources for cervical cancer screening and treatment. The new screening recommendations and management algorithms have been incorporated in the present Trainees’ handbook. The Trainees’ handbook contains guidelines and information intended to be used both by trainees and facilitators while participating in the structured training on cervical cancer screening and treatment. The handbook contains different modules to assist trainees to learn various screening and treatment procedures step- by-step and to comprehend their underlying principles. The modules contain checklists that serve as ready reckoners to develop skills in various procedures during clinical sessions. These checklists are also intended to be used by trainees during their post-training practice. (Excerpt)
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  5. 55
    375855

    Cervical cancer screening and management of cervical pre-cancers. Training of health staff in VIA, HPV detection test and cryotherapy -- Facilitators' guide.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 123 p.

    This manual is an instruction guide for facilitators to provide competence based training to providers for screening (with VIA or HPV test) and ablative treatment services in a cervical cancer screening programme. The training is intended to assist midwives, paramedical workers, nurses and clinicians to learn and improve upon their skills to perform counselling, screening tests and treatment. Facilitators are required to consult both the Facilitators’ guide and the Trainees’ handbook while training through interactive presentations, group discussions, role plays, simulated learning sessions, and clinical practice sessions. The Facilitators’ guide contains detailed training methodologies, structure of the individual training sessions, simulated learning sessions and guidelines for assessment of trainees. (Excerpt)
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  6. 56
    375854

    Cervical cancer screening and management of cervical pre-cancers. Training of community health workers.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 92 p.

    The training manual is designed to assist in building capacity of community health workers (CHWs) in educating women and community members on relevant aspects of cervical cancer prevention. The manual aims to facilitate improvement in communication skills of CHWs for promoting uptake of cervical cancer screening services in the community. The primary intention of this manual is to assist CHWs in spreading community awareness on cervical cancer prevention and establishing linkage between the community and available screening services. The information and instructions included in the manual can be used by both the facilitators and CHWs while participating in the training. The manual contains nine different sessions to assist CHWs to be acquainted with different aspects of cervical cancer prevention at the community level with focus on improving their communication skills. Each session contains key information in ‘question and answer’ format written in simple language so that CHWs can comprehend the contents better. At the end of each session, there are group activities like role plays, group discussion and games for active learning. These are intended to give opportunity to CHWs to learn by interacting with each other and also relate themselves with their roles and responsibilities at the community level. The manual includes ‘notes to the facilitator’ on how to conduct various sessions as per the given session plan. A set of ‘Frequently Asked Questions’ has been included to help the CHWs provide appropriate information to women and community members.
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  7. 57
    375853

    Cervical cancer screening and management of cervical pre-cancers. Trainees' handbook and facilitators' guide - Programme managers' manual.

    World Health Organization [WHO]. Regional Office for South-East Asia

    New Delhi, India, WHO, Regional Office for South-East Asia, 2017. 145 p.

    The training manual for programme managers is designed to build the capacity of professionals in managerial positions to develop cervical cancer screening programmes, plan implementation strategies and effectively manage the programme at the national or sub national levels. The guidelines and information included in the manual are intended to be used both by trainees and facilitators while participating in the structured training programme for programme managers. The manual contains different modules to assist trainees to be acquainted with different aspects of planning, implementing and monitoring of cervical cancer screening services. Considering the fact that programme managers need to understand cervical cancer screening in the broader perspective of the national cancer control programme (NCCP), modules describing the planning and implementation of NCCP are also included in the manual. The modules include relevant case studies from real screening programmes in different countries. The manual includes notes to facilitators on how to conduct the various training sessions as per the session plan. The detailed methodology of conducting trainee evaluation is also part of this manual.
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  8. 58
    375831

    Contraceptive method considerations for clients with HIV including those on ART: provider reference tool.

    FHI 360

    [Washington, D.C.], FHI 360, 2017 Nov. 2 p.

    This is an at-a-glance resource for clinical providers to determine whether clients with HIV, including those on antiretroviral therapy (ART), may initiate or continue using common contraceptive methods. This chart is based on the World Health Organization's Medical Eligibility Criteria for Contraceptive Use (2016). The tool provides foundational information for clinical providers on how the effectiveness of different types of hormonal contraceptive methods is affected by interaction with antiretroviral drugs. It also provides guidance on how to promote informed decision-making and help women with HIV who are taking antiretroviral drugs use their chosen hormonal contraceptive method successfully.
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  9. 59
    374799

    Achieving a future without child marriage: focus on West and Central Africa.

    UNICEF. Division of Data Research and Policy. Data and Analytics Section

    New York, New York, UNICEF, 2017. 6 p.

    West and Central Africa faces a unique set of challenges in its efforts to reduce the impact of child marriage – a high prevalence and slow rate of decline combined with a growing population of girls. This statistical snapshot showcases the latest data and puts forward recommendations on policy and actions to eliminate this practice.
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  10. 60
    375818

    WHO recommendations on antenatal care for a positive pregnancy experience: Ultrasound examination. Highlights and key messages from the World Health Organization’s 2016 Global Recommendations.

    World Health Organization [WHO]; Maternal and Child Survival Program [MCSP]

    Geneva, Switzerland, WHO, 2018 Jan. 4 p. (WHO/RHR/18.01; USAID Cooperative Agreement No. AID-OAA-A-14-00028)

    This brief highlights the WHO recommendation on routine antenatal ultrasound examination and the policy and program implications for translating this recommendation into action at the country level.
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  11. 61
    375817

    WHO recommendations on antenatal care for a positive pregnancy experience: Summary. Highlights and key messages from the World Health Organization’s 2016 Global Recommendations for Routine Antenatal Care.

    World Health Organization [WHO]; Maternal and Child Survival Program [MCSP]

    Geneva, Switzerland, WHO, 2018 Jan. 10 p. (WHO/RHR/18.02; USAID Cooperative Agreement No. AID-OAA-A-14-00028)

    This brief highlights the WHO’s 2016 ANC recommendations and offers countries policy and program considerations for adopting and implementing the recommendations. The recommendations include universal and context-specific interventions. The recommended interventions span five categories: routine antenatal nutrition, maternal and fetal assessment, preventive measures, interventions for the management of common physiologic symptoms in pregnancy, and health system-level interventions to improve the utilization and quality of ANC.
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  12. 62
    375813

    State of health inequality, Indonesia.

    World Health Organization [WHO]; Indonesia. Ministry of Health

    Geneva, Switzerland, WHO, 2017. 184 p. (Interactive Visualization of Health Data)

    In order to reduce health inequalities and identify priority areas for action to move towards universal health coverage, governments first need to understand the magnitude and scope of inequality in their countries. From April 2016 to October 2017, the Indonesian Ministry of Health, WHO, and a network of stakeholders assessed country-wide health inequalities in 11 areas, such as maternal and child health, immunization coverage and availability of health facilities. A key output of the monitoring work is a new report called State of health inequality: Indonesia, the first WHO report to provide a comprehensive assessment of health inequalities in a Member State. The report summarizes data from more than 50 health indicators and disaggregates it by dimensions of inequality, such as household economic status, education level, place of residence, age or sex. This report showcases the state of inequality in Indonesia, drawing from the latest available data across 11 health topics (53 health indicators), and eight dimensions of inequality. In addition to quantifying the magnitude of health inequality, the report provides background information for each health topic, and discusses priority areas for action and policy implications of the findings. Indicator profiles illustrate disaggregated data by all applicable dimensions of inequality, and electronic data visuals facilitate interactive exploration of the data. This report was prepared as part of a capacity-building process, which brought together a diverse network of stakeholders committed to strengthening health inequality monitoring in Indonesia. The report aims to raise awareness about health inequalities in Indonesia, and encourage action across sectors. The report finds that the state of health and access to health services varies throughout Indonesia and identifies a number of areas where action needs to be taken. These include, amongst others: improving exclusive breastfeeding and childhood nutrition; increasing equity in antenatal care coverage and births attended by skilled health personnel; reducing high rates of smoking among males; providing mental health treatment and services across income levels; and reducing inequalities in access to improved water and sanitation. In addition, the availability of health personnel, especially dentists and midwives, is insufficient in many of the country’s health centres. Now the country is using these findings to work across sectors to develop specific policy recommendations and programmes, such as the mobile health initiative in Senen, to tackle the inequalities that have been identified.
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  13. 63
    391438
    Peer Reviewed

    Effectiveness of the WHO Safe Childbirth Checklist program in reducing severe maternal, fetal, and newborn harm in Uttar Pradesh, India: study protocol for a matched-pair, cluster-randomized controlled trial.

    Semrau KE; Hirschhorn LR; Kodkany B; Spector JM; Tuller DE; King G; Lipsitz S; Sharma N; Singh VP; Kumar B; Dhingra-Kumar N; Firestone R; Kumar V; Gawande AA

    Trials. 2016 Dec 7; 17(1):576.

    BACKGROUND: Effective, scalable strategies to improve maternal, fetal, and newborn health and reduce preventable morbidity and mortality are urgently needed in low- and middle-income countries. Building on the successes of previous checklist-based programs, the World Health Organization (WHO) and partners led the development of the Safe Childbirth Checklist (SCC), a 28-item list of evidence-based practices linked with improved maternal and newborn outcomes. Pilot-testing of the Checklist in Southern India demonstrated dramatic improvements in adherence by health workers to essential childbirth-related practices (EBPs). The BetterBirth Trial seeks to measure the effectiveness of SCC impact on EBPs, deaths, and complications at a larger scale. METHODS/DESIGN: This matched-pair, cluster-randomized controlled, adaptive trial will be conducted in 120 facilities across 24 districts in Uttar Pradesh, India. Study sites, identified according to predefined eligibility criteria, were matched by measured covariates before randomization. The intervention, the SCC embedded in a quality improvement program, consists of leadership engagement, a 2-day educational launch of the SCC, and support through placement of a trained peer "coach" to provide supportive supervision and real-time data feedback over an 8-month period with decreasing intensity. A facility-based childbirth quality coordinator is trained and supported to drive sustained behavior change after the BetterBirth team leaves the facility. Study participants are birth attendants and women and their newborns who present to the study facilities for childbirth at 60 intervention and 60 control sites. The primary outcome is a composite measure including maternal death, maternal severe morbidity, stillbirth, and newborn death, occurring within 7 days after birth. The sample size (n = 171,964) was calculated to detect a 15% reduction in the primary outcome. Adherence by health workers to EBPs will be measured in a subset of births (n = 6000). The trial will be conducted in close collaboration with key partners including the Governments of India and Uttar Pradesh, the World Health Organization, an expert Scientific Advisory Committee, an experienced local implementing organization (Population Services International, PSI), and frontline facility leaders and workers. DISCUSSION: If effective, the WHO Safe Childbirth Checklist program could be a powerful health facility-strengthening intervention to improve quality of care and reduce preventable harm to women and newborns, with millions of potential beneficiaries. TRIAL REGISTRATION: BetterBirth Study Protocol dated: 13 February 2014; ClinicalTrials.gov: NCT02148952 ; Universal Trial Number: U1111-1131-5647.
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  14. 64
    391434

    Quality of care in women's, children's, and adolescent health. Methods for assessing evaluation and implementation in West Africa. Experience in the Cote d'Ivoire. Qualite des soins en SMNI. Methodologie de l'evaluation et mise en pratique en Afrique de l'Ouest. A propos de l'experience de la Cote d'Ivoire.

    Guie YP; Cisse L; Saki-Nekouressi G; Bucagu M; Landrivon G; Agbodjan-Prince O

    Medecine et Sante Tropicales. 2016 Nov 1; 26(4):357-362.

    A tool developed by WHO was used to assess the quality of care for mothers, newborns, and children in some healthcare facilities in French-speaking Africa; this study led to the development of recommendations for the implementation of actions intended to resolve the problems observed and to optimize patient management. We report here the experience of the maternity units of the university hospital center of Treichville, in Abidjan, discuss the presentation of the results of the assessment, and make some recommendations as part of an action program. The experience of the monthly review of referred cases is also reported.
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  15. 65
    391429
    Peer Reviewed

    MSW student perceptions of sexual health as relevant to the profession: Do social work educational experiences matter?

    Winter VR; O'Neill E; Begun S; Kattari SK; McKay K

    Social Work In Health Care. 2016 Sep; 55(8):614-34.

    Many social work clients are at an increased risk for negative outcomes related to sexual behavior, including unwanted pregnancies and sexually transmitted infections (STIs). However, there is a dearth of literature on social work student experiences with these topics in social work classrooms and their perceptions about the topic's relevance to their practice. The purpose of this study is to explore relationships between experiences with STIs and contraception as topics in social work education and practica experiences on student perceptions toward sexual health as a relevant topic for social work. Among a national sample of MSW students (N = 443), experiences with STIs and contraception as topics in practica was significantly related to perceptions toward sexual health's relevance to social work. Findings and implications are discussed.
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  16. 66
    391181
    Peer Reviewed

    The continuum of HIV care in South Africa: implications for achieving the second and third UNAIDS 90-90-90 targets.

    Takuva S; Brown AE; Pillay Y; Delpech V; Puren AJ

    AIDS. 2017 Feb 20; 31(4):545-552.

    BACKGROUND: We characterize engagement with HIV care in South Africa in 2012 to identify areas for improvement towards achieving global 90-90-90 targets. METHODS: Over 3.9 million CD4 cell count and 2.7 million viral load measurements reported in 2012 in the public sector were extracted from the national laboratory electronic database. The number of persons living with HIV (PLHIV), number and proportion in HIV care, on antiretroviral therapy (ART) and with viral suppression (viral load <400 copies/ml) were estimated and stratified by sex and age group. Modified Poisson regression approach was used to examine associations between sex, age group and viral suppression among persons on ART. RESULTS: We estimate that among 6511 000 PLHIV in South Africa in 2012, 3300 000 individuals (50.7%) accessed care and 32.9% received ART. Although viral suppression was 73.7% among the treated population in 2012, the overall percentage of persons with viral suppression among all PLHIV was 23.8%. Linkage to HIV care was lower among men (38.5%) than among women (57.2%). Overall, 47.1% of those aged 0-14 years and 47.0% of those aged 15-49 years were linked to care compared with 56.2% among those aged above 50 years. CONCLUSION: Around a quarter of all PLHIV have achieved viral suppression in South Africa. Men and younger persons have poorer linkage to HIV care. Expanding HIV testing, strengthening prompt linkage to care and further expansion of ART are needed for South Africa to reach the 90-90-90 target. Focus on these areas will reduce the transmission of new HIV infections and mortality in the general population.
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  17. 67
    391126
    Peer Reviewed

    Shortages of benzathine penicillin for prevention of mother-to-child transmission of syphilis: An evaluation from multi-country surveys and stakeholder interviews.

    Nurse-Findlay S; Taylor MM; Savage M; Mello MB; Saliyou S; Lavayen M; Seghers F; Campbell ML; Birgirimana F; Ouedraogo L; Newman Owiredu M; Kidula N; Pyne-Mercier L

    PLoS Medicine. 2017 Dec; 14(12):e1002473.

    BACKGROUND: Benzathine penicillin G (BPG) is the only recommended treatment to prevent mother-to-child transmission of syphilis. Due to recent reports of country-level shortages of BPG, an evaluation was undertaken to quantify countries that have experienced shortages in the past 2 years and to describe factors contributing to these shortages. METHODS AND FINDINGS: Country-level data about BPG shortages were collected using 3 survey approaches. First, a survey designed by the WHO Department of Reproductive Health and Research was distributed to 41 countries and territories in the Americas and 41 more in Africa. Second, WHO conducted an email survey of 28 US Centers for Disease Control and Prevention country directors. An additional 13 countries were in contact with WHO for related congenital syphilis prevention activities and also reported on BPG shortages. Third, the Clinton Health Access Initiative (CHAI) collected data from 14 countries (where it has active operations) to understand the extent of stock-outs, in-country purchasing, usage behavior, and breadth of available purchasing options to identify stock-outs worldwide. CHAI also conducted in-person interviews in the same 14 countries to understand the extent of stock-outs, in-country purchasing and usage behavior, and available purchasing options. CHAI also completed a desk review of 10 additional high-income countries, which were also included. BPG shortages were attributable to shortfalls in supply, demand, and procurement in the countries assessed. This assessment should not be considered globally representative as countries not surveyed may also have experienced BPG shortages. Country contacts may not have been aware of BPG shortages when surveyed or may have underreported medication substitutions due to desirability bias. Funding for the purchase of BPG by countries was not evaluated. In all, 114 countries and territories were approached to provide information on BPG shortages occurring during 2014-2016. Of unique countries and territories, 95 (83%) responded or had information evaluable from public records. Of these 95 countries and territories, 39 (41%) reported a BPG shortage, and 56 (59%) reported no BPG shortage; 10 (12%) countries with and without BPG shortages reported use of antibiotic alternatives to BPG for treatment of maternal syphilis. Market exits, inflexible production cycles, and minimum order quantities affect BPG supply. On the demand side, inaccurate forecasts and sole sourcing lead to under-procurement. Clinicians may also incorrectly prescribe BPG substitutes due to misperceptions of quality or of the likelihood of adverse outcomes. CONCLUSIONS: Targets for improvement include drug forecasting and procurement, and addressing provider reluctance to use BPG. Opportunities to improve global supply, demand, and use of BPG should be prioritized alongside congenital syphilis elimination efforts.
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  18. 68
    391108
    Peer Reviewed

    Progress Toward Eliminating Mother to Child Transmission of HIV in Kenya: Review of Treatment Guideline Uptake and Pediatric Transmission at Four Government Hospitals Between 2010 and 2012.

    Finocchario-Kessler S; Clark KF; Khamadi S; Gautney BJ; Okoth V; Goggin K

    AIDS and Behavior. 2016 Nov; 20(11):2602-2611.

    We analyzed prevention of mother-to-child transmission (PMTCT) data from a retrospective cohort of n = 1365 HIV+ mothers who enrolled their HIV-exposed infants in early infant diagnosis services in four Kenyan government hospitals from 2010 to 2012. Less than 15 and 20 % of mother-infant pairs were provided with regimens that met WHO Option A and B/B+ guidelines, respectively. Annually, the gestational age at treatment initiation decreased, while uptake of Option B/B+ increased (all p's < 0.001). Pediatric HIV infection was halved (8.6-4.3 %), yet varied significantly by hospital. In multivariable analyses, HIV-exposed infants who received no PMTCT (AOR 4.6 [2.49, 8.62], p < 0.001), mixed foods (AOR 5.0 [2.77, 9.02], p < 0.001), and care at one of the four hospitals (AOR 3.0 [1.51, 5.92], p = 0.002) were more likely to be HIV-infected. While the administration and uptake of WHO PMTCT guidelines is improving, an expanded focus on retention and medication adherence will further reduce pediatric HIV transmission.
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  19. 69
    391053
    Peer Reviewed

    Initiation of antiretroviral therapy based on the 2015 WHO guidelines.

    Kuznik A; Iliyasu G; Habib AG; Musa BM; Kambugu A; Lamorde M

    AIDS. 2016 Nov 28; 30(18):2865-2873.

    OBJECTIVE: In 2015, the WHO recommended initiation of antiretroviral therapy (ART) in all HIV-positive patients regardless of CD4 cell count. We evaluated the cost-effectiveness of immediate versus deferred ART initiation among patients with CD4 cell counts exceeding 500cells/mul in four resource-limited countries (South Africa, Nigeria, Uganda, and India). DESIGN: A 5-year Markov model with annual cycles, including patients at CD4 cell counts more than 500 cells/mul initiating ART or deferring therapy until historic ART initiation criteria of CD4 cell counts more than 350 cells/mul were met. METHODS: The incidence of opportunistic infections, malignancies, cardiovascular disease, unscheduled hospitalizations, and death, were informed by the START trial results. Risk of HIV transmission was obtained from a systematic review. Disability weights were based on published literature. Cost inputs were inflated to 2014 US dollars and based on local sources. Results were expressed in cost per disability-adjusted life years averted and measured against WHO cost-effectiveness thresholds. RESULTS: Immediate initiation of ART is associated with a cost per disability-adjusted life years averted of -$317 [95% confidence interval (CI): -$796-$817] in South Africa; -$507 (95% CI: -$765-$837) in Nigeria; -$136 (-$382-$459) in Uganda; and -$78 (-$256-$374) in India. The results are largely driven by the impact of ART on reducing the risk of new HIV transmissions. CONCLUSIONS: In HIV-positive patients with CD4 counts above 500 cells/mul in the four studied countries, immediate initiation of ART versus deferred therapy until historic eligibility criteria are met is cost-effective and likely even cost-saving over time.
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  20. 70
    391046
    Peer Reviewed

    Has the phasing out of stavudine in accordance with changes in WHO guidelines led to a decrease in single-drug substitutions in first-line antiretroviral therapy for HIV in sub-Saharan Africa?

    Brennan AT; Davies MA; Bor J; Wandeler G; Stinson K; Wood R; Prozesky H; Tanser F; Fatti G; Boulle A; Sikazwe I; Wool-Kaloustian K; Yuannoutsos C; Leroy V; de Rekeneire N; Fox MP

    AIDS. 2017 Jan 2; 31(1):147-157.

    OBJECTIVE: We assessed the relationship between phasing out stavudine in first-line antiretroviral therapy (ART) in accordance with WHO 2010 policy and single-drug substitutions (SDS) (substituting the nucleoside reverse transcriptase inhibitor in first-line ART) in sub-Saharan Africa. DESIGN: Prospective cohort analysis (International epidemiological Databases to Evaluate AIDS-Multiregional) including ART-naive, HIV-infected patients aged at least 16 years, initiating ART between January 2005 and December 2012. Before April 2010 (July 2007 in Zambia) national guidelines called for patients to initiate stavudine-based or zidovudine-based regimen, whereas thereafter tenofovir or zidovudine replaced stavudine in first-line ART. METHODS: We evaluated the frequency of stavudine use and SDS by calendar year 2004-2014. Competing risk regression was used to assess the association between nucleoside reverse transcriptase inhibitor use and SDS in the first 24 months on ART. RESULTS: In all, 33 441 (8.9%; 95% confience interval 8.7-8.9%) SDS occurred among 377 656 patients in the first 24 months on ART, close to 40% of which were amongst patients on stavudine. The decrease in SDS corresponded with the phasing out of stavudine. Competing risks regression models showed that patients on tenofovir were 20-95% less likely to require a SDS than patients on stavudine, whereas patients on zidovudine had a 75-85% decrease in the hazards of SDS when compared to stavudine. CONCLUSION: The decline in SDS in the first 24 months on treatment appears to be associated with phasing out stavudine for zidovudine or tenofovir in first-line ART in our study. Further efforts to decrease the cost of tenofovir and zidovudine for use in this setting is warranted to substitute all patients still receiving stavudine.
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  21. 71
    390869
    Peer Reviewed

    Female genital mutilation as an issue of gender disparity in the 21st century: Leveraging opportunities to reverse current trends.

    Ayele W; Lulseged S

    Ethiopian Medical Journal. 2016 Jul; 54(3):107-108.

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  22. 72
    391293
    Peer Reviewed

    Allocation of antiretroviral drugs to HIV-infected patients in Togo: Perspectives of people living with HIV and healthcare providers.

    Kpanake L; Sorum PC; Mullet E

    Journal of Medical Ethics. 2017 Dec; 43(12):845-851.

    Aim To explore the way people living with HIV and healthcare providers in Togo judge the priority of HIV-infected patients regarding the allocation of antiretroviral drugs. Method From June to September 2015, 200 adults living with HIV and 121 healthcare providers living in Togo were recruited for the study. They were presented with stories of a few lines depicting the situation of an HIV-infected patient and were instructed to judge the extent to which the patient should be given priority for antiretroviral drugs. The stories were composed by systematically varying the levels of four factors: (a) the severity of HIV infection, (b) the financial situation of the patient, (c) the patient's family responsibilities and (d) the time elapsed since the first consultation. Results Five clusters were identified: 65% of the participants expressed the view that patients who are poor and severely sick should be treated as a priority, 13% prioritised treatment of patients who are poor and parents of small children, 12% expressed the view that the poor should be treated as a priority, 4% preferred that the sickest be treated as a priority and 6% wanted all patients to get treatment. Conclusions WHO's guideline regarding antiretroviral therapy allocation (the sickest first as the sole criterion) currently in use in many African countries does not reflect the preferences of Togolese people living with HIV. For most HIV-infected patients in Togo, patients who cannot get treatment on their own should be treated as a priority.
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  23. 73
    391269
    Peer Reviewed

    Prevalence and predictors of late presentation for HIV care in South Africa.

    Fomundam HN; Tesfay AR; Mushipe SA; Mosina MB; Boshielo CT; Nyambi HT; Larsen A; Cheyip M; Getahun A; Pillay Y

    South African Medical Journal. 2017 Nov 27; 107(12):1058-1064.

    Background. Many people living with HIV in South Africa (SA) are not aware of their seropositive status and are diagnosed late during the course of HIV infection. These individuals do not obtain the full benefit from available HIV care and treatment services. Objectives. To describe the prevalence of late presentation for HIV care among newly diagnosed HIV-positive individuals and evaluate sociodemographic variables associated with late presentation for HIV care in three high-burden districts of SA. Methods. We used data abstracted from records of 8 138 newly diagnosed HIV-positive individuals in 35 clinics between 1 June 2014 and 31 March 2015 to determine the prevalence of late presentation among newly diagnosed HIV-positive individuals in selected high-prevalence health districts. Individuals were categorised as ‘moderately late’, ‘very late’ or ‘extremely late’ presenters based on specified criteria. Descriptive analysis was performed to measure the prevalence of late presentation, and multivariate regression analysis was conducted to identify variables independently associated with extremely late presentation. Results. Overall, 79% of the newly diagnosed cases presented for HIV care late in the course of HIV infection (CD4+ count =500 cells/ µL and/or AIDS-defining illness in World Health Organization (WHO) stage III/IV), 19% presented moderately late (CD4+ count 351 -500 cells/µL and WHO clinical stage I or II), 27% presented very late (CD4+ count 201 - 350 cells/µL or WHO clinical stage III), and 33% presented extremely late (CD4+ count =200 cells/µL and/or WHO clinical stage IV) for HIV care. Multivariate regression analysis indicated that males, non-pregnant women, individuals aged >30 years, and those accessing care in facilities located in townships and inner cities were more likely to present late for HIV care. Conclusions. The majority of newly diagnosed HIV-positive individuals in the three high-burden districts (Gert Sibande, uThukela and City of Johannesburg) presented for HIV care late in the course of HIV infection. Interventions that encourage early presentation for HIV care should be prioritised in SA and should target males, non-pregnant women, individuals aged >30 years and those accessing care in facilities located in inner cities and urban townships.
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  24. 74
    375798

    International technical guidance on sexuality education. An evidence-informed approach. Revised edition.

    UNESCO. Education Sector

    Paris, France, UNESCO, 2018. 139 p.

    The fully revised UN International technical guidance on sexuality education advocates for quality comprehensive sexuality education (CSE) to promote health and well-being, respect for human rights and gender equality, and empowers children and young people to lead healthy, safe and productive lives.It is a technical tool that presents the evidence base and rationale for delivering CSE to young people in order to achieve the global Sustainable Development Goals, among which are SGD3 for Health, SDG4 for Quality Education and SDG5 for Gender Equality.
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  25. 75
    375796

    World malaria report 2017.

    World Health Organization [WHO]

    Geneva, Switzerland, WHO, 2017. 196 p.

    The World malaria report, published annually, provides a comprehensive update on global and regional malaria data and trends. The latest report, released on 29 November 2017, tracks investments in malaria programmes and research as well as progress across all intervention areas: prevention, diagnosis, treatment and surveillance. It also includes dedicated chapters on malaria elimination and on key threats in the fight against malaria. The report is based on information received from national malaria control programmes and other partners in endemic countries; most of the data presented is from 2016.
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