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HIV treatment as prevention: how scientific discovery occurred and translated rapidly into policy for the global response.
Health Affairs. 2012 Jul; 31(7):1439-49.In 2011 interim results of HIV Prevention Trials Network study 052, a National Institutes of Health study designed to test the effectiveness of antiretroviral treatment against the spread of HIV, were reported. These results showed that in a stable relationship in which one member of the couple was infected with HIV, treatment of the infected partner with antiretroviral drugs, combined with couples counseling and condom use, resulted in a 96 percent reduction in sexual transmission of HIV-1. This finding led to the use of antiretroviral treatment as a cornerstone of HIV prevention. Independent advisory committees of the President's Emergency Plan for AIDS Relief (PEPFAR) and the World Health Organization (WHO) have since issued analyses that set the stage for broader use of antiretroviral agents in treatment and prevention. This article describes the separate PEPFAR and WHO recommendations and outlines the design of prospective new trials to test how best to maximize the benefits of early treatment for prevention.
Challenges and priorities in the management of HIV/HBV and HIV/HCV coinfection in resource-limited settings.
Seminars In Liver Disease. 2012 May; 32(2):147-57.Liver disease due to chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infection is now emerging as an increasing cause of morbidity and mortality in human immunodeficiency virus- (HIV-) infected persons in resource-limited settings (RLS). Existing management guidelines have generally focused on care in tertiary level facilities in developed countries. Less than half of low-income countries have guidance, and in those that do, there are important omissions or disparities in recommendations. There are multiple challenges to delivery of effective hepatitis care in RLS, but the most important remains the limited access to antiviral drugs and diagnostic tests. In 2010, the World Health Assembly adopted a resolution calling for a comprehensive approach for the prevention, control, and management of viral hepatitis. We describe activities at the World Health Organization (WHO) in three key areas: the establishment of a global hepatitis Program and interim strategy; steps toward the development of global guidance on management of coinfection for RLS; and the WHO prequalification program of HBV and HCV diagnostic assays. We highlight key research gaps and the importance of applying the lessons learned from the public health scale-up of ART to hepatitis care. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Handbook for supporting the development of health system guidance. Supporting informed judgements for health system policies.
Basel, Switzerland, Swiss Tropical and Public Health Institute, 2011 Jul.  p.This handbook, commissioned by the WHO, describes the processes, approaches and outputs for developing health system guidance and is compliant with the existing ‘WHO handbook for guideline development’ (WHO Guidelines Review Committee (GRC)) and is the equivalent of the handbook to support the development of clinical guidelines for health systems guidance. It is based on a preliminary work that established the rationale and framework for health systems guidance and it is inspired by global trends encouraging to bridge the gap between research and policy and practice through knowledge translation. The handbook has been produced by a core team supported by the GRC staff, supported by a Task Force specifically set up for this project. The handbook deals with the process of developing full guidance, rather than the processes to adopt, adapt or endorse guidance developed by third parties. (Excerpt)
The World Health Organization-United Nations Population Fund Strategic Partnership Programme's implementation of family planning guidelines and tools in Asia-Pacific countries.
Journal of Obstetrics and Gynaecology Research. 2013 Apr; 39(4):825-830.AIM: The aim of this study was to assess the impact of the Strategic Partnership Programme, a collaboration between the World Health Organization and the United Nations Population Fund to improve evidence-based guidance for country programs through the introduction of selected practice guidelines to improve sexual and reproductive health. METHODS: Information for this report is from questionnaires sent to Ministries of Health in 2004 (baseline assessment) and in 2007 (assessment of outcome), annual country reports and personal communication with focal points from Ministries of Health and World Health Organization regional and country offices. RESULTS: Following the Strategic Partnership Programme, family planning guidance was used extensively to: formulate and update reproductive health policy; update standards and guidelines; improve training curricula; conduct training activities; develop advocacy and communication materials; and promote change in service. CONCLUSION: The Strategic Partnership Programme was successful in promoting the introduction of evidence-based guidelines for reproductive health in several Asian countries. The countries that adapted the family planning guidance observed an increase in demand for contraceptives commodities. (c) 2012 The Authors. Journal of Obstetrics and Gynaecology Research (c) 2012 Japan Society of Obstetrics and Gynecology.
Geneva, Switzerland, WHO, 2012.  p.This document has three broad aims. First, it seeks to unify the worlds of research and decision-making and connect the various disciplines of research that generate knowledge to inform and strengthen health systems. Second, the strategy contributes to a broader understanding of this field by clarifying the scope and role of HPSR. It provides insight into the dynamic processes through which HPSR evidence is generated and used in decision-making. Finally, it is hoped that this strategy will serve as an agent for change and calls for a more prominent role for HPSR at a time when the health systems mandate is evolving towards broader goals of universal health coverage and equity. This strategy on health policy and systems research is intended to augment and amplify WHO’s previous affirmations on the importance of health research, by explaining how this evolving field is sensitive and responsive to the needs of those who are responsible for the planning and performance of national health systems -- decision-makers, health practitioners, citizens and civil society.
Contemporary Politics. 2012 Jun; 18(2):186-199.Capacity-building has become a mainstay of many AIDS and public health programmes. This article examines its impact on civil society organisations and claims-making around citizenship, as these have been articulated through heterogeneous policy networks doing HIV prevention work. Drawing on a growing literature on the Foucauldian notions of biopower and governmentality, the genealogy of capacity-building as a globalised technology of governmentality is traced, examining its uses both at the international level and in Brazil. Brazilian civil society organisations have undoubtedly been transformed by their participation in networks carrying out capacity-building projects. While recognising these effects, the conflicts and productive tensions inherent to such networks are highlighted.
Social determinants of health: Outcome of the World Conference on Social Determinants of Health (Rio de Janeiro, Brazil, October 2011). Report by the Secretariat.
[Geneva, Switzerland], World Health Organization [WHO]. 2012 Mar 22.  p. (A65/16)In 2009, the Health Assembly adopted resolution WHA62.14 on reducing health inequities through action on the social determinants of health. It requested the Director-General to provide support to Member States in measures that included convening a global event, with the assistance of Member States, before the Sixty-fifth World Health Assembly in order to discuss renewed plans for redressing the alarming trends of health inequities through actions on the social determinants of health. This report describes the process and outcome of the resulting event, the World Conference on Social Determinants of Health (Rio de Janeiro, Brazil, 19-21 October 2011), and also summarizes progress on the implementation of resolution WHA62.14. (Excerpt)
Guidance for evidence-informed policies about health systems: Linking guidance development to policy development.
PLoS Medicine. 2012 Mar; 9(3):e1001186.Contextual factors are extremely important in shaping decisions about health systems, and policy makers need to work through all the pros and cons of different options before adopting specific health systems guidance. A division of labour between global guidance developers, global policy developers, national guidance developers, and national policy developers is needed to support evidence-informed policy-making about health systems. A panel charged with developing health systems guidance at the global level could best add value by ensuring that its output can be used for policy development at the global and national level, and for guidance development at the national level. Rigorous health systems analyses and political systems analyses are needed at the global and national level to support guideline and policy development. Further research is needed into the division of labour in guideline development and policy development and on frameworks for supporting system and political analyses. This is the second paper in a three-part series in PLoS Medicine on health systems guidance.
Food and Nutrition Bulletin. 2011 Jun; 32(2 Suppl):S115-27.BACKGROUND: Renewed Efforts Against Child Hunger (REACH) is the joint United Nations initiative to address Millennium Development Goal (MDG) 10, Target 3, i.e., to halve the proportion of underweight children under 5 years old by 2015. The United Nations Food and Agriculture Organization (FAO), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the World Food Programme (WFP), and the International Fund for Agricultural Development (IFAD) developed and tested a facilitation mechanism to act as a catalyst for scaling up multisectoral nutrition activities. OBJECTIVE: The UN-REACH partners developed pilot projects in Mauritania and Lao PDR from 2008 to 2010 and deployed facilitators to improve nutrition governance and coordination. Review missions were conducted in February 2011 to assess the REACH approach and what it achieved. METHODS: The UN review mission members reviewed documents, assessed policy and management indicators, conducted qualitative interviews, and discussed findings with key stakeholders, including the most senior UN nutrition directors from all agencies. RESULTS: Among other UN-REACH achievements, the Prime Minister of Mauritania agreed to preside over a new National Nutrition Development Council responsible for high-level decision-making and setting national policy objectives. REACH facilitated the completion of Lao's first national Nutrition Strategy and Plan of Action and formation of the multistakeholder Nutrition Task Force. During the REACH engagement, coordination, joint advocacy, situation analysis, policy development, and joint UN programming for nutrition were strengthened in Lao PDR and Mauritania. CONCLUSIONS: Improvements in the nutrition governance and management mechanisms in Mauritania and Lao PDR were observed during the period of REACH support through increased awareness of nutrition as a key development objective, establishment of governmental multisectoral coordinating mechanisms, improved government capacity, and new joint UN-government nutrition programming.
Reproductive Health Matters. 2011 Nov; 19(38):197-207.In March 2009, UN member states met at the 53rd Commission on the Status of Women (CSW) to discuss the priority theme of "the equal sharing of responsibilities between women and men, including caregiving in the context of HIV/AIDS". This meeting focused the international community's attention on care issues and generated Agreed Conclusions that aimed to lay out a roadmap for care policy. I examine how the frame of "care" - a contested concept that has long divided feminist researchers and activists - operated in this site. Research involved a review of documentation related to the meeting and interviews with 18 participants. Using this research I argue that the frame of care united a range of groups, including conservative faith-based actors who have mobilized within the UN to roll back sexual and reproductive rights. This policy alliance led to important advances in the Agreed Conclusions, including strong arguments about the global significance of care, especially in relation to HIV; the need for a strong state role; and the value of caregivers' participation in policy debates. However, the care frame also constrained debate at the CSW, particularly about disability rights and variations in family formation. Those seeking to reassert sexual and reproductive rights are grappling with such limitations in a range of ways, and attention to their efforts and concerns can help us better understand the potentials and dangers for feminist intervention within global policy spaces. Copyright (c) 2010 UNRISD. Published by Elsevier Ltd. All rights reserved.
Southern Med Review. 2011 Dec; 4(2):15-21.Objectives: Although poor reproductive health constitutes a significant proportion of the disease burden in developing countries, essential medicines for reproductive health are often not available to the population. The objective was to analyze the guiding principles for developing national Essential Medicines Lists (EML). The second objective was to compare the reproductive health medicines included on these EMLs to the 2002 WHO/UNFPA list of essential drugs and commodities for reproductive health. Another objective was to compare the medicines included in existing international lists of medicines for reproductive health. Methods: The authors calculated the average number of medicines per clinical groups included in 112 national EMLs and compared these average numbers with the number of medicines per clinical group included on the WHO/UNFPA List. Additionally, they compared the content of the lists of medicines for reproductive health developed by various international agencies. Results: In 2003, the review of the 112 EMLs highlighted that medicines for reproductive health were not consistently included. The review of the international lists identified inconsistencies in their recommendations. The reviews' outcomes became the catalyst for collaboration among international agencies in the development of the first harmonized Interagency List of Essential Medicines for Reproductive Health. Additionally, WHO, UNFPA and PATH published guidelines to support the inclusion of essential medicines for reproductive health in national medicine policies and EMLs. The Interagency List became a key advocacy tool for countries to review their EMLs. In 2009, a UNFPA/WHO assessment on access to reproductive health medicines in six countries demonstrated that the major challenge was that the Interagency List had not been updated recently and was inconsistently used. Conclusion: The addition of cost-effective medicines for reproductive health to EMLs can result in enhanced equity in access to and cost containment of these medicines, and improve quality of care. Action is required to ensure their inclusion in national budget lines, supply chains, policies and programmatic guidance.
Future Oncology. 2011 Oct; 7(10):1213-1222.Cancer is a global problem accounting for almost 13% of all deaths worldwide. This equates to over 7 million people a year, more than is caused by HIV/AIDS, TB and malaria combined. Now is the time to strengthen the health systems of developing countries to deal with cancer, to avoid a future crisis similar to the HIV/AIDS pandemic. In this article we discuss the current state of cancer in the developing world, how we need to advocate for a change in cancer control policy with the governments of developing nations/transnational governmental bodies (e.g., the UN and WHO etc) and how we think cancer care could be improved in developing countries. We feel the only way to overcome the growing burden of cancer in the developing world is working in partnership with, nongovernmental organizations, international nongovernmental organizations, transnational governmental bodies and governmental bodies.
Geneva, Switzerland, UNAIDS, 2011 Oct.  p. (UNAIDS Issues Brief; UNAIDS Policy Document; UNAIDS/JC2244E)Over the past 30 years there have been tremendous gains in the global HIV response, but until now there has been only limited systematic effort to match needs with investments. The result is often a mismatch of the two, and valuable resources are stretched inefficiently across many objectives. To achieve an optimal HIV response, countries and their international partners must adopt a more strategic approach to investments. In June 2011 a policy paper was published in The Lancet (Schwartländer et al) that laid out a new framework for investment for the global HIV response. The new framework is based on existing evidence of what works in HIV prevention, treatment, care and support. It is intended to facilitate more focused and strategic use of scarce resources. Modelling of the framework’s impact shows that its implementation would avert 12.2 million new infections and 7.4 million AIDS-related deaths between 2011 and 2020. This modelling also indicates that implementation of the investment framework is highly cost-effective, with additional investment largely offset by savings in treatment costs alone, and enabling the HIV response to reach an inflection point in both investments and rates of HIV infection. (Excerpts)
Combination HIV prevention: Tailoring and coordinating biomedical, behavioural and structural strategies to reduce new HIV infections. A UNAIDS discussion paper.
Geneva, Switzerland, UNAIDS, 2010 Sep.  p. (UNAIDS Discussion Paper No. 10; UNAIDS - JC2007)This discussion paper summarizes the approach to HIV prevention programming known as “combination prevention” that UNAIDS recommends to achieve the greatest and most lasting impact on reducing HIV incidence and on improving the well-being of affected communities around the world.
Bulletin of the World Health Organization. 2010 Oct 1; 88(10):718-718A.Add to my documents.
Geneva, Switzerland, UNAIDS, 2011 Jun.  p. (UNAIDS / JC2141E)This publication describes how the Joint United Nations Programme on HIV / AIDS (UNAIDS) partners with country partners and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to strengthen the global response to AIDS and to accelerate progress towards universal access to HIV prevention, treatment, care and support, and the achievement of the Millennium Development Goals (MDGs).
Geneva, Switzerland, UNAIDS, 2011 Aug.  p. (UNAIDS/ JC2112E)This report shows that these global commitments will be achieved only if the unique needs of young women and men are acknowledged, and their human rights fulfilled, respected, and protected. In order to reduce new HIV infections among young people, achieve the broader equity goals set out in the MDGs, and begin to reverse the overall HIV epidemic, HIV prevention and treatment efforts must be tailored to the specific needs of young people.
Bangkok, Thailand, UNAIDS, Regional Support for Asia and the Pacific, 2011.  p. (UNAIDS / 11.05E)This report provides the most up to date information on the HIV epidemic in the region in 2011. While the region has seen impressive gains -- including a 20% drop in new HIV infections since 2001 and a three-fold increase in access to antiretroviral therapy since 2006 -- progress is threatened by an inadequate focus on key populations at higher risk of HIV infection and insufficient funding from both domestic and international sources.
26th Meeting of the UNAIDS Programme Coordinating Board, Geneva, Switzerland, 22-24 June 2010. Thematic Segment: Sexual and Reproductive Health (SRH) services with HIV interventions in practice. Background paper.
[Geneva, Switzerland], UNAIDS, 2010 Jun 3.  p. (UNAIDS/PCB(26))This paper sets out to foster a common understanding of the conceptual basis and key principles for linking SRH and HIV; situate the linkages agenda in the current development environment; present the evidence to-date; articulate the full scope of linkages embedded in human rights, provide illustrative practical country experiences with integrated services; and stimulate frank discussion on how to strengthen linkages and sustain the momentum. (Excerpt)
Making reproductive rights and sexual and reproductive health a reality for all. Reproductive rights and sexual and reproductive health framework.
New York, New York, UNFPA, 2008 May.  p.The Reproductive rights and sexual and reproductive health (SRH) framework has been developed to provide overall guidance and a cohesive- Fund-wide response for implementing the Reproductive Health and Rights elements of the UNFPA Strategic plan 2008-2011. The framework builds on the goals of the International Conference on Population and Development (ICPD), 1994; the Millennium Summit, 2000, with its adoption of the Millennium Development Goals (MDGs); the 2005 World Summit; and the addition, in 2007, of the goal of universal access to reproductive health to MDG 5, for improving maternal health. This includes two parts: the first provides a snapshot of the progress achieved since ICPD, identifies major remaining gaps and priorities and outlines principles and approaches for programme planning and implementation. The second part identifies key priorities and specific strategies for each of the SRH-related strategic plan outcomes. (Excerpt)
Geneva, Switzerland, WHO, 2011.  p.This tool, developed in collaboration between WHO, the Office of the High Commissioner for Human Rights (OHCHR) and the Swedish International Development Cooperation Agency (Sida) is designed to support countries to strengthen national health strategies by applying human rights and gender equality commitments and obligations. The tool poses critical questions to identify gaps and opportunities in the review or reform of health sector strategies.
Consultation on strategic information and HIV prevention among most-at-risk adolescents. 2-4 September 2009, Geneva. Consultation report.
New York, New York, UNICEF, 2010. 65 p.The Consultation on Strategic Information and HIV Prevention among Most-at-Risk Adolescents (MARA) focused on experiences in countries where HIV infection is concentrated among men who have sex with men (MSM), injecting drug users (IDUs), and those who sell sex. The meeting facilitated the exchange of information across regions on country-level data collection regarding MARA; identified ways to use strategic information to improve HIV prevention among MARA; and suggested ways to build support for MARA programming among decision-makers.
Priorities for research on equity and health: Implications for global and national priority setting and the role of WHO to take the health equity research agenda forward. Final report.
Geneva, Switzerland, World Health Organization [WHO], 2010 Nov.  p.The current issues paper was commissioned by the Equity Analysis and Research Unit of WHO, Geneva, to update the advice provided in 2005. It sets forth the broad parameters for a global research agenda on equity and health, taking stock of contemporary efforts, stakeholder discussions, relevance to Member States and expected innovations. Organised in three sections (Background, Research priorities, and Next steps), this paper aims to stimulate further thinking, debate and refinement of strategic approaches focussing WHO support and collaborations to advance global research on equity and health. It is not a comprehensive review of research in the area of equity and health, nor of approaches to support research policies and their implementation in this area. Key strategic issues on which this paper aims to stimulate discussion are: 1. Based on recommendations and learning from the Commission on Social Determinants of Health, the Knowledge Networks set up to support the CSDH, and other contemporary efforts, what areas of research could WHO concentrate support on to best advance greater health equity? 2. What aspects of research, including the development of concepts, methods, norms and standards, and synthesis approaches could best benefit from global collaboration? 3. How can WHO support and guide collaborations to maximise the relevance of global research on equity and health to specific countries and sub-populations; and 4. What core strategies and innovative opportunities could increase research collaborations and the uptake of research, involving a wider range of investigators, institutions and civil society organisations from low- and middle-income countries? (Excerpts)
Washington, D.C., World Bank, 2011.  p. (Directions in Development)The past half-century has seen enormous changes in the demographic makeup of Latin America and the Caribbean (LAC). In the 1950s, LAC had a small population of about 160 million people, less than today's population of Brazil. Two-thirds of Latin Americans lived in rural areas. Families were large and women had one of the highest fertility rates in the world, low levels of education, and few opportunities for work outside the household. Investments in health and education reached only a small fraction of the children, many of whom died before reaching age five. Since then, the size of the LAC population has tripled and the mostly rural population has been transformed into a largely urban population. There have been steep reductions in child mortality, and investments in health and education have increased, today reaching a majority of children. Fertility has been more than halved and the opportunities for women in education and for work outside the household have improved significantly. Life expectancy has grown by 22 years. Less obvious to the casual observer, but of significance for policy makers, a population with a large fraction of dependent children has evolved into a population with fewer dependents and a very large proportion of working-age adults. This overview seeks to introduce the reader to three groups of issues related to population aging in LAC. First is a group of issues related to the support of the aging and poverty in the life cycle. Second is the question of the health transition. Third is an understanding of the fiscal pressures that are likely to accompany population aging and to disentangle the role of demography from the role of policy in that process.
Geneva, Switzerland, World Health Organization [WHO], Alliance for Health Policy and Systems Research, 2009.  p.Over 2008, wide global consultation revealed considerable interest and frustration among researchers, funders and policy-makers around our limited understanding of what works in health systems strengthening. In this current Flagship Report we introduce and discuss the merits of employing a systems thinking approach in order to catalyze conceptual thinking regarding health systems, system-level interventions, and evaluations of health system strengthening. The Report sets out to answer the following broad questions: What is systems thinking and how can researchers and policy-makers apply it? How can we use this perspective to better understand and exploit the synergies among interventions to strengthen health systems? How can systems thinking contribute to better evaluations of these system-level interventions? This Report argues that a stronger systems perspective among designers, implementers, stewards and funders is a critical component in strengthening overall health-sector development in low- and middle-income countries. (Excerpt)