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Implementation of co-trimoxazole prophylaxis and isoniazid preventive therapy for people living with HIV
Date,Anand A; Vitoria,Marco; Granich,Reuben; Banda,Mazuwa; Fox,Mayada Youssef; Gilks,Charlie;
Bulletin of the World Health Organization , 2010, DOI: 10.1590/S0042-96862010000400010
Abstract: objective: to measure progress in implementing co-trimoxazole prophylaxis (ctxp) (trimethoprim plus sulfamethoxazole) and isoniazid preventive therapy (ipt) policy recommendations, identify barriers to the development of national policies and pinpoint challenges to implementation. methods: in 2007 we conducted by e-mail a cross-sectional survey of world health organization (who) hiv/aids programme officers in 69 selected countries having a high burden of infection with hiv or hiv-associated tuberculosis (tb). the specially-designed, self-administered questionnaire contained items covering national policies for ctxp and ipt in people living with hiv, current level of implementation and barriers to developing or implementing these policies. findings: the 41 (59%) respondent countries, representing all who regions, comprised 85% of the global burden of hiv-associated tb and 82% of the global burden of hiv infection. thirty-eight countries (93%) had an established national policy for ctxp, but only 66% of them (25/38) had achieved nationwide implementation. for ipt, 21 of 41 countries (51%) had a national policy but only 28% of them (6/21) had achieved nationwide implementation. despite significant progress in the development of ctxp policy, the limited availability of co-trimoxazole for this indication and inadequate systems to manage drug supply impeded nationwide implementation. inadequate intensified tuberculosis case-finding and concerns regarding isoniazid resistance were challenges to the development and implementation of national ipt policies. conclusion: despite progress in implementing who-recommended ctxp and ipt policies, these interventions remain underused. urgent steps are required to facilitate the development and implementation of these policies.
HIV Screening among TB Patients and Co-Trimoxazole Preventive Therapy for TB/HIV Patients in Addis Ababa: Facility Based Descriptive Study  [PDF]
Amenu Wesen Denegetu, Bethabile Lovely Dolamo
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086614
Abstract: Background Collaborative TB/HIV management is essential to ensure that HIV positive TB patients are identified and treated appropriately, and to prevent tuberculosis (TB) in HIV positive patients. The purpose of this study was to assess HIV case finding among TB patients and Co-trimoxazole Preventive Therapy (CPT) for HIV/TB patients in Addis Ababa. Methods A descriptive cross-sectional, facility-based survey was conducted between June and July 2011. Data was collected by interviewing 834 TB patients from ten health facilities in Addis Ababa. Both descriptive and inferential statistics were used to summarize and analyze findings. Results The proportion of TB patients who (self reported) were offered for HIV test, tested for HIV and tested HIV positive during their anti-TB treatment follow-up were; 87.4%, 69.4% and 20.2%; respectively. Eighty seven HIV positive patients were identified, who knew their status before diagnosed for the current TB disease, bringing the cumulative prevalence of HIV among TB patients to 24.5%. Hence, the proportion of TB patients who knew their HIV status becomes 79.9%. The study revealed that 43.6% of those newly identified HIV positives during anti-TB treatment follow-up were actually treated with CPT. However, the commutative proportion of HIV positive TB patients who were ever treated with CPT was 54.4%; both those treated before the current TB disease and during anti-TB treatment follow-up. Conclusions HIV case finding among TB patients and provision of CPT for TB/HIV co-infected patients needs boosting. Hence, routine offering of HIV test and provision of CPT for PLHIV should be strengthened in-line with the national guidelines.
Perceptions of Preventive Health Care and Healthy Lifestyle Choices for Low Income Families: A Qualitative Study  [PDF]
Sasha A. Fleary,Reynolette Ettienne-Gittens,Robert W. Heffer
ISRN Preventive Medicine , 2013, DOI: 10.5402/2013/189180
Abstract: This paper examines Head Start parents’ perceptions of preventive health and healthy lifestyle choices and Head Start administrators’ perceptions of the needs of parents they serve. To address the preventive health of the population, it is necessary that we explore perceptions, risks, and protective factors of preventive health. Focus groups were conducted with parents and administrators to elicit this information and to obtain suggestions for improving preventive health and healthy lifestyle choices among this group. Overall, nutrition and physical activity emerged as themes in parents’ definition of preventive health and healthy lifestyle choices. They further identified social support and education as major protective factors for engaging in preventive health and healthy lifestyle choices. Results of this study can be used to inform research and practice to develop interventions to increase preventive health and healthy lifestyle choices among low income families. 1. Introduction Low income persons in the USA are less likely to seek preventive health care and have low health literacy, which places them at risk for poorer health outcomes and increased use of treatment services [1–3]. Health literacy may impact on individual’s ability to successfully use the health care system and to engage in preventive care and disease management [4]. In the case of parents of young children, low health literacy may compromise their ability to seek or engage in preventive care for themselves and their children. According to the Institute of Medicine [1], older adults, racial and ethnic minorities, individuals with less than a 12th grade education, GED certificate recipients, nonnative English speakers, and individuals with low incomes are all more likely to have low health literacy. Individuals with these demographic characteristics are also more likely to be socially disadvantaged and thus further disadvantaged on health. Although a plethora of research exists on the effects of health literacy on adult health, relatively less research has been conducted to address the impact of parental health literacy on the health and well-being of children. Children, especially preschool-aged children, are vulnerable to their environment [5] and rely heavily on their parents to ensure their health and well-being. Based on the adult studies, therefore, parents’ health literacy is postulated to influence the preventive health measures parents pursue for their children. 2. The Head Start Program The Head Start Program was established in 1964 as part of the “war on poverty.” This
Political economy of tobacco control in low-income and middle-income countries: lessons from Thailand and Zimbabwe
Bulletin of the World Health Organization , 2000, DOI: 10.1590/S0042-96862000000700009
Abstract: crucial to the success of the proposed framework convention on tobacco control will be an understanding of the political and economic context for tobacco control policies, particularly in low-income and middle-income countries. policy studies in thailand and zimbabwe employed the analytical perspective of political economy and a research strategy that used political mapping, a technique for characterizing and evaluating the political environment surrounding a policy issue, and stakeholder analysis, which seeks to identify key actors and to determine their capacity to shape policy outcomes. these policy studies clearly revealed how tobacco control in low-income and middle-income countries is also being shaped by developments in the global and regional political economy. hence efforts to strengthen national control policies need to be set within the context of globalization and the international context. besides the transnational tobacco companies, international tobacco groups and foreign governments, international agencies and nongovernmental organizations are also playing influential roles. it cannot be assumed, therefore, that the tobacco control strategies being implemented in industrialized countries will be just as effective and appropriate when implemented in developing countries. there is an urgent need to expand the number of such tobacco policy studies, particularly in low-income and middle-income countries. comprehensive guidelines for tobacco policy analysis and research are required to support this process, as is a broader international strategy to coordinate further tobacco policy research studies at country, regional and global levels.
Translating research into policy: lessons learned from eclampsia treatment and malaria control in three southern African countries
Godfrey Woelk, Karen Daniels, Julie Cliff, Simon Lewin, Esperan?a Sevene, Benedita Fernandes, Alda Mariano, Sheillah Matinhure, Andrew D Oxman, John N Lavis, Cecilia Lundborg
Health Research Policy and Systems , 2009, DOI: 10.1186/1478-4505-7-31
Abstract: We used a qualitative case-study methodology to explore the policy making process. We carried out key informants interviews with a range of research and policy stakeholders in each country, reviewed documents and developed timelines of key events. Using an iterative approach, we undertook a thematic analysis of the data.Prior experience of particular interventions, local champions, stakeholders and international networks, and the involvement of researchers in policy development were important in knowledge translation for both case studies. Key differences across the two case studies included the nature of the evidence, with clear evidence of efficacy for MgSO4 and ongoing debate regarding the efficacy of bed nets compared with spraying; local researcher involvement in international evidence production, which was stronger for MgSO4 than for malaria vector control; and a long-standing culture of evidence-based health care within obstetrics. Other differences were the importance of bureaucratic processes for clinical regulatory approval of MgSO4, and regional networks and political interests for malaria control. In contrast to treatment policies for eclampsia, a diverse group of stakeholders with varied interests, differing in their use and interpretation of evidence, was involved in malaria policy decisions in the three countries.Translating research knowledge into policy is a complex and context sensitive process. Researchers aiming to enhance knowledge translation need to be aware of factors influencing the demand for different types of research; interact and work closely with key policy stakeholders, networks and local champions; and acknowledge the roles of important interest groups.The evidence-based medicine approach, which focused initially on clinical decision-making, has more recently been extended to policy and management decisions, where it is sometimes referred to as 'evidence-based' or 'evidence-informed' policy making [1-3]. Increasingly, the use of glob
The use of private-sector contracts for primary health care: theory, evidence and lessons for low-income and middle-income countries
Bulletin of the World Health Organization , 2000, DOI: 10.1590/S0042-96862000000600014
Abstract: contracts for the delivery of public services are promoted as a means of harnessing the resources of the private sector and making publicly funded services more accountable, transparent and efficient. this is also argued for health reforms in many low- and middle-income countries, where reform packages often promote the use of contracts despite the comparatively weaker capacity of markets and governments to manage them. this review highlights theories and evidence relating to contracts for primary health care services and examines their implications for contractual relationships in low- and middle-income countries.
Translating Words, Translating Cultures
Richard Whitaker
Akroterion , 2012, DOI: 10.7445/46-0-125
Abstract: What exactly does (or should) translation from one language into another try to do? Attempt to convey to readers of the target language (the language into which one is translating) something of the strangeness, difference and historicity of the original in the source language (the language from which one is translating)? Or must translation try to bridge the gap between source and target language, by rendering the original in a thoroughly contemporary style and diction, as if this were a work being written now for the first time? And related to these the further questions: how closely should a translation render the genre, language, metre, style and content of the original? How far can a translation depart from the original without ceasing to be a translation – in other words, where is one to situate the border between “translation”, “version” and “adaptation”?
Strengthening preventive care programs: a permanent challenge for healthcare systems; lessons from PREVENIMSS México
Gonzalo Gutiérrez, Ricardo Pérez-Cuevas, Santiago Levy, Hortensia Reyes, Benjamín Acosta, Sonia Cantón, Onofre Mu?oz
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-417
Abstract: From 2003 to 2006, four nation-wide cross-sectional probabilistic population based surveys were conducted using a four stage sampling design. Thirty thousand households were visited in each survey. The number of IMSS members interviewed ranged from 79,797 respondents in 2003 to 117,036 respondents in 2006.The four surveys showed a substantial increase in coverage indicators for each age group: children, completed schemes of vaccination (> 90%), iron supplementation (17.8% to 65.5%), newborn screening for metabolic disorders (60.3% to 81.6%). Adolescents, measles - rubella vaccine (52.4% to 71.4%), hepatitis vaccine (9.3% to 46.2%), use of condoms (17.9% to 59.9%). Women, measles-rubella vaccine (28.5% to 59-2%), cervical cancer screening (66.7% to 75%), breast cancer screening (> 2.1%). Men, type 2 diabetes screening (38.6% to 57.8%) hypertension screening (48-4% to 64.0%). Older adults, pneumococcal vaccine (13.2% to 24.9%), influenza vaccine (12.6% to 52.9) Regarding the unmet needs, the prevalence of anemia in children was 30% and a growing prevalence of overweight and obesity, type 2 diabetes, and hypertension was found in men, women and older adults.PREVENIMSS showed an important increase in the coverage of preventive services and stressed the magnitude of the old and new challenges that this healthcare system faces. The unsolved problems such as anemia, and the emerging ones such as overweight, obesity, among others, point out the need to strength preventive care through designing and implementing innovative programs aimed to attain effective coverage for those conditions in which prevention obtains substandard results.It has been a long-standing fact that curative care receives most of the healthcare budgets [1]; however, preventive care is receiving further attention from scholars, politicians and decision makers given its effectiveness on people's health and its long-term effect on social expectancies and well-being [2] Current emphasis has shifted toward c
Lessons to be Learned from Natural Control of HIV – Future Directions, Therapeutic, and Preventive Implications  [PDF]
David Shasha
Frontiers in Immunology , 2013, DOI: 10.3389/fimmu.2013.00162
Abstract: Accumulating data generated from persons who naturally control HIV without the need for antiretroviral treatment has led to significant insights into the possible mechanisms of durable control of AIDS virus infection. At the center of this control is the HIV-specific CD8 T cell response, and the basis for this CD8-mediated control is gradually being revealed. Genome wide association studies coupled with HLA sequence data implicate the nature of the HLA-viral peptide interaction as the major genetic factor modulating durable control of HIV, but host genetic factors account for only around 20% of the variability in control. Other factors including specific functional characteristics of the TCR clonotypes generated in vivo, targeting of vulnerable regions of the virus that lead to fitness impairing mutations, immune exhaustion, and host restriction factors that limit HIV replication all have been shown to additionally contribute to control. Moreover, emerging data indicate that the CD8+ T cell response may be critical for attempts to purge virus infected cells following activation of the latent reservoir, and thus lessons learned from elite controllers (ECs) are likely to impact the eradication agenda. On-going efforts are also needed to understand and address the role of immune activation in disease progression, as it becomes increasingly clear that durable immune control in ECs comes at a cost. Taken together, the research achievements in the attempt to unlock the mechanisms behind natural control of HIV will continue to be an important source of insights and ideas in the continuous search after an effective HIV vaccine, and for the attempts to achieve a sterilizing or functional cure in HIV positive patients with progressive infection.
Improving Outcomes from Breast Cancer in a Low-Income Country: Lessons from Bangladesh  [PDF]
H. L. Story,R. R. Love,R. Salim,A. J. Roberto,J. L. Krieger,O. M. Ginsburg
International Journal of Breast Cancer , 2012, DOI: 10.1155/2012/423562
Abstract: Women in low- and middle-income countries (LMICs) have yet to benefit from recent advances in breast cancer diagnosis and treatment now experienced in high-income countries. Their unique sociocultural and health system circumstances warrant a different approach to breast cancer management than that applied to women in high-income countries. Here, we present experience from the last five years working in rural Bangladesh. Case and consecutive series data, focus group and individual interviews, and clinical care experience provide the basis for this paper. These data illustrate a complex web of sociocultural, economic, and health system conditions which affect womens’ choices to seek and accept care and successful treatment. We conclude that health system, human rights, and governance issues underlie high mortality from this relatively rare disease in Bangladesh. 1. Introduction The US-based National Comprehensive Cancer Network guidelines for breast cancer management specifically state that even under the best of circumstances “there is not a single clinical situation in which the treatment of breast cancer has been optimized with respect to either maximizing cure or minimizing toxicity and disfigurement” [1]. In low- and middle-income countries with far fewer resources than the US, the circumstances are compounded by multiple factors associated with increased mortality for this disease [2]. Addressing and remedying these inequities requires an exploration into the unique circumstances surrounding the complex barriers women face in receiving information, accurate and timely diagnosis, and effective treatment critical to reducing breast cancer morbidity and mortality [3]. For the past five years, beginning with work to recruit women to a clinical trial of treatment for metastatic breast cancer, we have been increasing our efforts to understand what is happening to women with breast cancer in the Khulna Division of Bangladesh. Our experience calls into question the application of common high-income country models and strategies in such settings. 2. Bangladesh Understanding barriers to improving outcomes from breast cancer begins with an appreciation of the broader sociocultural context in which women live. We present our experience in Bangladesh as the backdrop for this exploration. Bangladesh is located in Southern Asia, between India and Myanmar, and borders the Bay of Bengal to the south (Figure 1). It is the seventh most populous country in the world; a country of nearly 160 million people (approximately half the population of the US) in an area half
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