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Title: Use of and unmet need for injectable contraception.
Author: Family Health International [FHI]
Source: [Unpublished] 2009 Jun 8. 12 p.
Abstract: Understanding trends in contraceptive use and unmet need for family planning is critical to creating policies which respond to current gaps in service delivery and address future needs for services to meet existing and unmet demand. Creating non clinic-based mechanisms to deliver services has the potential to expand access to underserved populations and reduce pressure on weak health systems. This document examines patterns of the current use of and unmet demand for injectable services. Trends in use of clinic and non clinic-based services for injectables, differentials in injectable use by place of residence, and potential negative consequences of increased use of injectables are explored. Information described in this paper is intended to inform the Technical Consultation on Expanding Access to Injectable Contraception. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | TECHNICAL REPORT | DEMOGRAPHIC AND HEALTH SURVEYS | INJECTABLES | CONTRACEPTIVE USAGE | NEEDS | COMMUNITY-BASED DISTRIBUTION | CLINICAL DISTRIBUTION | PHARMACIES | CONTRACEPTIVE DISTRIBUTION | GEOGRAPHIC FACTORS | CONTRACEPTION CONTINUATION | Demographic Surveys | Population Dynamics | Demographic Factors | Population | Contraceptive Methods | Contraception | Family Planning | Economic Factors | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Health Facilities | Delivery of Health Care | Health
Document Number: 331836

2.
Peer Reviewed

Title: The free condom initiative: promoting condom availability and use in New York City.
Author: Renaud TC; Bocour A; Irvine MK; Bernstein KT; Begier EM; Sepkowitz KA; Kellerman SE; Weglein D
Source: Public Health Reports. 2009 Jul-Aug;124(4):481-9.
Abstract: In 2005, the New York City Department of Health and Mental Hygiene (DOHMH) made free condoms available to organizations through a Web-based ordering system. In 2006, we interviewed managers and patrons about free condom availability, acquisition, and use in venues where people at high risk for human immunodeficiency virus congregate. DOHMH condom distribution increased from 5.8 million in 2004 to 17.3 million in 2006. Overall, managers reported making condoms available at 76% (309/409) of high-priority venues, but only at 40% of gay bars. Among patrons who saw free condoms, 80% (280/351) reported taking them; 73% (205/280) of those who reported taking them also reported using them. A simple, Web-based ordering system dramatically increased condom distribution. In the venues we sampled, the majority of patrons acquired and used free condoms when available and visible, suggesting that increasing free condom availability may increase use. Special efforts are needed to ensure availability at gay bars.
Language: English
Keywords:
UNITED STATES OF AMERICA | NEW YORK | RESEARCH REPORT | URBAN POPULATION | CONDOMS | PROMOTION | PROGRAM EVALUATION | DISTRIBUTIONAL ACTIVITIES | CLINICAL DISTRIBUTION | COMMUNITY-BASED DISTRIBUTION | INTERNET | CONDOM USE | INTERVIEWS | Developed Countries | North America | Americas | Population Characteristics | Demographic Factors | Population | Barrier Methods | Contraceptive Methods | Contraception | Family Planning | Marketing | Economic Factors | Programs | Organization and Administration | Program Activities | Nonclinical Distribution | Information Networks | Communication | Risk Reduction Behavior | Behavior | Data Collection | Research Methodology
Document Number: 342144

3.
Title: Reproductive health-care provision in emergencies: preventing needless suffering.
Author: van Min M
Source: Forced Migration Review. 2009 Apr;(32):68-69.
Abstract: This article discusses the need for comprehensive reproductive health services in all situations to prevent unnecessary deaths. It opens with a gripping story of a woman in birth reaching a hospital too late and not equipped with the proper supplies. It argues that not enough emphasis is placed on RH supplies and services and talks about solutions to overcome these challenges.
Language: English
Keywords:
DEMOCRATIC REPUBLIC OF THE CONGO | RESEARCH REPORT | EQUIPMENT AND SUPPLIES | REPRODUCTIVE HEALTH | CLINICAL DISTRIBUTION | EMERGENCY SERVICES | MATERNAL HEALTH | LOGISTICS | PREVENTION AND CONTROL | DELIVERY OF HEALTH CARE | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Medical Procedures | Medicine | Health Services | Health | Distributional Activities | Program Activities | Programs | Organization and Administration | Management | Diseases
Document Number: 340195

Title: Checklist for screening clients who want to initiate combined oral contraceptives.
Author: Family Health International [FHI]
Source: Research Triangle Park, North Carolina, FHI, 2008. [3] p.
Abstract: Research findings have established that combined oral contraceptives (COCs) are safe and effective for use by most women, including those who are at risk of sexually transmitted infections (STIs) and those living with or at risk of HIV infection. However, for some women with certain medical conditions -- such as breast cancer, ischemic heart disease, or stroke -- COC use is not recommended. Women who wish to use COCs should therefore be screened for such medical conditions in order to determine if they are appropriate candidates for this method. Based on the recently revised recommendations from Medical Eligibility Criteria for Contraceptive Use (WHO, 2004; updated 2008), Family Health International (FHI) has developed a simple checklist for use by both clinical and nonclinical health care providers, including community-based distributors, to help screen clients who have made an informed decision to use COCs. The COC Checklist consists of 17 questions designed to identify medical conditions that would prevent safe COC use or require further screening. It also provides further guidance and directions based on clients' responses.
Language: English
Keywords:
GLOBAL | MANUAL | STANDARDS | PARAMEDICAL PERSONNEL | COMMUNITY WORKERS | WOMEN | CLIENTS | COUNSELING | CLINICAL DISTRIBUTION | SCREENING | ORAL CONTRACEPTIVES, COMBINED | SAFETY | BREASTFEEDING | TOBACCO USE | HEADACHE | DIABETES | TUBERCULOSIS | SIGNS AND SYMPTOMS | Research Methodology | Health Personnel | Delivery of Health Care | Health | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Clinic Activities | Distributional Activities | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Oral Contraceptives | Contraceptive Methods | Contraception | Family Planning | Public Health | Infant Nutrition | Nutrition | Behavior | Diseases | Infections
Document Number: 331507

Title: Checklist for screening clients who want to initiate DMPA (or NET-EN).
Author: Family Health International [FHI]
Source: Research Triangle Park, North Carolina, FHI, 2008. [3] p.
Abstract: Research findings have established that depot-medroxyprogesterone acetate (DMPA) and norethisterone enantate (NET-EN) are safe and effective for use by most women, including those who are at risk of sexually transmitted infections (STIs) and those living with or at risk of HIV infection. However, for some women, use of these injectables is not usually recommended due to the presence of certain medical conditions, such as breast cancer or most types of liver tumors. For this reason, women who wish to use DMPA must be screened for certain medical conditions in order to determine if they are appropriate candidates for this method. Based on the recently revised recommendations of the Medical Eligibility Criteria for Contraceptive Use (WHO, 2004; updated 2008), Family Health International (FHI) has developed a simple checklist for use by both clinical and nonclinical health care providers, including community-based distributors, to help screen clients who have made an informed decision to use DMPA. The DMPA Checklist consists of 14 questions designed to identify medical conditions that would prevent safe DMPA use or require further screening. It also provides further guidance and directions based on clients' responses.
Language: English
Keywords:
GLOBAL | MANUAL | STANDARDS | CLIENTS | PARAMEDICAL PERSONNEL | WOMEN | PERSONS LIVING WITH HIV/AIDS | MEDROXYPROGESTERONE ACETATE | CLINICAL DISTRIBUTION | NONCLINICAL DISTRIBUTION | SAFETY | SCREENING | BREASTFEEDING | TOBACCO USE | HEADACHE | DIABETES | TUBERCULOSIS | SIGNS AND SYMPTOMS | Research Methodology | Program Activities | Programs | Organization and Administration | Health Personnel | Delivery of Health Care | Health | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Family Planning | Distributional Activities | Public Health | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Infant Nutrition | Nutrition | Behavior | Infections
Document Number: 331508

Title: AWARENESS Project. Benin country report, 2002-2007.
Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project
Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [16] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00)
Abstract: Benin became the first African country to introduce the SDM when the Ministry of Health (MOH) and IRH agreed in December 2000 to conduct a pilot introduction study in two urban centers, Cotonou and Parakou. The study determined that strong demand for the method existed; that the SDM could be offered effectively through existing service delivery channels; that there was a high degree of acceptability and continuation of use; and that the SDM could be used correctly and consistently. The government requested IRH?s help to expand delivery of the method nationwide, an effort that began in December 2004. As service sites multiplied, Benin participated in other international, multisite studies, including a long-term (up to two-year) follow up of users and a study to determine the impact of social marketing campaigns on SDM use, particularly comparing pharmacy and clinic-based services. There was no significant difference in correct use between clients who obtained the SDM through clinics and those who obtained it in pharmacies. The government has included the SDM in national reproductive health norms, policies, and training protocols and materials. The AWARENESS Project, in collaboration with local partners, trained more than 600 providers countrywide, recording more than 12,000 SDM acceptors between 2004 and 2007. The SDM is currently offered in more than 150 public, community, and commercial sites in all 12 departments of the country. An evaluation of the integration process after three years showed that the SDM is well integrated into the health system, and was offered in all visited clinics, where 57% of providers had been trained on the SDM. The Benin program serves as a demonstration site for neighboring francophone countries. (excerpt)
Language: English
Keywords:
BENIN | TECHNICAL REPORT | FERTILITY AWARENESS | PILOT PROJECTS | INTEGRATED PROGRAMS | NONGOVERNMENTAL ORGANIZATIONS | FAITH-BASED ORGANIZATION | CLINICAL DISTRIBUTION | PHARMACY DISTRIBUTION | COMMUNITY-BASED DISTRIBUTION | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Family Planning, Behavioral Methods | Family Planning | Studies | Research Methodology | Programs | Organization and Administration | Organizations | Political Factors | Sociocultural Factors | Distributional Activities | Program Activities | Nonclinical Distribution
Document Number: 327616

Title: AWARENESS Project. Democratic Republic of Congo country report, 2003-2007.
Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project
Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [17] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00)
Abstract: In 2003, the USAID Mission and the National Reproductive Health Program (PNSR) invited IRH to introduce the SDM in the Democratic Republic of Congo (DRC). The strategy focused on training providers and integrating the SDM into existing clinic, community, and pharmacy services in Kinshasa, Lubumbashi, and Bukavu, and the rural area of Katako Kombe. By 2004, 14 organizations were able to offer the SDM. CycleBeads are included in the national list of essential medicines and the five-year contraceptive security plan. The SDM is part of in-service family planning training curricula. The PNSR is developing national norms and protocols and intends to include the SDM. IRH also worked with the MOH to incorporate the SDM into national policies and logistics and reporting systems. However, the lack of overall government norms and functioning distribution and reporting systems is an obstacle requiring more comprehensive attention than the AWARENESS Project could offer. The program leveraged significant resources, as most partners paid for their own training programs and CycleBeads. The Congolese program participated in a study to determine the impact of the social marketing campaign, a general evaluation of SDM integration in the DRC. Major findings from the simulated client study showed that 89% of clinic providers gave spontaneous information on the SDM as opposed to only 38% of pharmacists; confidentiality was observed in over 70% of both clinics and pharmacies; 96% of providers in clinics told clients that CycleBeads represent a woman?s cycle while only 35% of pharmacists did so; and 7% of clinic providers attempted to convince clients to use other methods of family planning as opposed to 23% of pharmacists. The success of recent initiatives in DRC to introduce the TDM through services of an faith-based organization (FBO) suggest that this method may also be an appropriate addition to family planning services. (excerpt)
Language: English
Keywords:
DEMOCRATIC REPUBLIC OF THE CONGO | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Developing Countries | Africa, Central | Africa, Sub Saharan | Africa | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities
Document Number: 327619

Title: AWARENESS Project. Ecuador country report, 2001-2007.
Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project
Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [13] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00)
Abstract: CEMOPLAF (the Centro M�dico de Orientaci�n y Planificaci�n) wanted to include SDM in its services in an effort to address unmet need. A pilot study showed a strong potential for the SDM to address this need and demonstrated feasibility of service provision in clinics and in the community. It also showed that clients were able to use the SDM correctly with a single counseling session. The longterm follow-up of pilot study participants continuing with the SDM demonstrated that while the majority of discontinuation during the first quarter of year one was due to cycles out of range; discontinuation during the second and third year had more to do with birth spacing and other life circumstances. Based on these results, CEMOPLAF provided training and technical input to its close partner, the MOH, and executed a social marketing program that introduced the SDM into pharmacies with mass media support. A study of the social marketing approach, conducted with the Population Council, showed awareness of the SDM increased from 4% to 34%, intention to use increased from 27% to 32%, demand for the SDM increased five-fold in pharmacies and clinics in one month during the mass media campaign, and both clinic-based providers and pharmacists provided correct information. CEMOPLAF used research results to advocate successfully for integrating the SDM into MOH norms and training curricula. Currently, the SDM is available in all CEMOPLAF and 11 MOH clinics in 11 of 22 departments. A number of local NGOs have also adopted the SDM. By including the SDM in national norms and the maternity program, the MOH committed to expanding the SDM to all its clinics by purchasing materials in exchange for training and technical assistance from CEMOPLAF. (excerpt)
Language: English
Keywords:
ECUADOR | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTION CONTINUATION | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Developing Countries | South America, Western | South America | Latin America | Americas | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities
Document Number: 327620

Title: AWARENESS Project. Guatemala country report, 2002-2007.
Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project
Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Jan. [21] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00)
Abstract: With a population of 12 million, Guatemala is the largest country in Central America. Contraceptive prevalence in 2002 was relatively low, at 43% for women aged 15-49, and was even lower among rural (under 35%) and indigenous women (24%). In 2002, the Ministry of Health (MOH) and the Social Security Institute (IGGS) requested assistance from the AWARENESS Project to expand contraceptive choice through the integration of fertility awareness-based methods (FAM) into the method mix. The program functioned in USAID priority zones including the largely indigenous departments of the Altiplano (Quetzaltenango, Solola, and Huehuetenango), Santa Rosa, Chimaltenango, and Alta Verapaz. It focused primarily on building evidence for the future scale-up of the Standard Days Method� (SDM), while also assessing the effectiveness and feasibility of the TwoDay Method � (TDM). IRH used a diversified strategy to build the evidence base for FAM and subsequently establish the necessary support and conditions for scale up. With approximately 200 trainers and 2000 trained SDM providers, Guatemala has substantial capacity for offering SDM services. In the last three years, more than 13,000 women began using the SDM, most of whom previously had not used family planning. The SDM also is supported in norms and gradually is being included in management information and logistics systems, pre- and in-service training, and communication strategies. (excerpt)
Language: English
Keywords:
GUATEMALA | TECHNICAL REPORT | FERTILITY AWARENESS | FAMILY PLANNING, BEHAVIORAL METHODS | CONTRACEPTIVE METHOD ACCEPTABILITY | INTEGRATED PROGRAMS | FAMILY PLANNING TRAINING | FAMILY PLANNING PROGRAMS | GOVERNMENT PROGRAMS | SOCIAL MARKETING | CLINICAL DISTRIBUTION | Central America | Latin America | Americas | Developing Countries | Family Planning | Family Planning, Behavioral Methods | Contraceptive Usage | Contraception | Programs | Organization and Administration | Training Programs | Education | Marketing | Economic Factors | Distributional Activities | Program Activities
Document Number: 327621

10.

Title: Social marketing final report: three country overview.
Author: Georgetown University. Institute for Reproductive Health. AWARENESS Project
Source: Washington, D.C., Georgetown University, Institute for Reproductive Health, 2008 Mar. [40] p. (USAID Cooperative Agreement No. HRN-A-00-97-00011-00)
Abstract: While unmet need is growing in sub-Saharan Africa, where contraceptive prevalence is lowest, unmet need remains even in countries where contraceptive prevalence is high, such as in Latin America. Due to rapid growth in the population and increase in the numbers of couples interested in planning and spacing births, reproductive health programs in developing countries face a major challenge: to provide a greater variety of products and services to a rapidly increasing number of users. This challenge must be met in the context of stagnant or decreasing donor funding for contraception. Thus, efforts to meet this unmet need must involve cost-effectively expanding options and access to couples. Social marketing concepts have been successfully applied to increase access and use of many modern contraceptives. The present study was conducted to research the potential of socially-marketing the Standard Days Method� (SDM) in three countries: Ecuador, Benin and the Democratic Republic of the Congo (DRC). The impact of mass media campaigns on knowledge, sales and distribution of the SDM, quality of information provided by pharmacists and providers, and correct use by pharmacy and clinic SDM users was assessed. The aim of the study was to answer the following research questions: What is the impact of a mass media campaign on knowledge, attitudes, sales and free distribution of the SDM?; Can pharmacists and health providers provide high quality information about the SDM?; How do characteristics of women who purchase the SDM from pharmacies compare with those obtain it at a lower or no cost from a clinic?; Can women who purchase the SDM from a pharmacy use the method correctly? (excerpt)
Language: English
Keywords:
AFRICA, SUB SAHARAN | LATIN AMERICA | EVALUATION REPORT | CROSS-CULTURAL COMPARISONS | KAP SURVEYS | WOMEN IN DEVELOPMENT | SOCIAL MARKETING | FERTILITY AWARENESS | COST EFFECTIVENESS | MASS MEDIA | FAMILY PLANNING EDUCATION | PHARMACY DISTRIBUTION | CLINICAL DISTRIBUTION | CONTRACEPTIVE EFFECTIVENESS | Africa | Developing Countries | Americas | Evaluation | Comparative Studies | Studies | Research Methodology | Surveys | Sampling Studies | Economic Development | Economic Factors | Marketing | Family Planning | Evaluation Indexes | Quantitative Evaluation | Communication | Education | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Contraception
Document Number: 327650

11.
Title: An enduring role: The continuing need for a robust family planning clinic system.
Author: Gold RB
Source: Guttmacher Policy Review. 2008 Winter;11(1):6-10.
Abstract: Since the 1970s, publicly subsidized, specialized clinics have played a critical role in providing family planning counseling, contraceptive services and closely related preventive health care to young and low-income women at risk of uninfected pregnancy. Currently, nearly 7,700 family planning clinics serve about seven million women annually. Taken together, the clinic system is a major U.S. preventive health care provider and a significant contributor to the nation's health: One in every four women who obtains a contraceptive service in the country does so at a family planning clinic, as does one in three women who obtains an STI service and one in six who obtains either a Pap test or pelvic exam. (excerpt)
Language: English
Keywords:
UNITED STATES OF AMERICA | CRITIQUE | EVALUATION | WOMEN | FAMILY PLANNING CENTERS | FAMILY PLANNING CLINIC ATTENDANCE | CLINICAL DISTRIBUTION | CONTRACEPTIVE DISTRIBUTION | HEALTH INSURANCE | PUBLIC ASSISTANCE | PROGRAM ACCESSIBILITY | UTILIZATION OF HEALTH CARE | COST EFFECTIVENESS | CONFIDENTIAL INFORMATION | QUALITY OF HEALTH CARE | Developed Countries | North America | Americas | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Family Planning Program Evaluation | Family Planning Programs | Family Planning | Distributional Activities | Program Activities | Programs | Organization and Administration | Financial Activities | Economic Factors | Government Financing | Program Evaluation | Health Services | Evaluation Indexes | Quantitative Evaluation | Ethics | Sociocultural Factors | Health Services Evaluation
Document Number: 325582

12.

13.

Title: Community-based distribution of DMPA: the Nakasongola project, Uganda.
Author: Uganda. Ministry of Health; Family Health International [FHI]
Source: Kampala, Uganda, Ministry of Health, 2007 Jan. [2] p. (Brief No. 5)
Abstract: A 2004 study conducted in the Nakasongola district of Uganda demonstrated the safety, quality, and feasibility of community-based distribution (CBD) of depotmedroxyprogesterone acetate (DMPA or Depo-Provera) by community reproductive health workers (CRHWs). CBD of DMPA appeared to be as safe as provision by clinic-based nurses. Women who received DMPA from community reproductive health workers were as satisfied as women who received DMPA from clinics and, in fact, seemed to prefer CBD to clinic-based provision, as indicated by difficulty recruiting clinic-based clients for the study. Nakasongola, a rural district two hours north of Uganda's capital, Kampala, has a total fertility rate (average number of children per woman) of 7, which is similar to Uganda's overall rate of 6.9, but a contraceptive prevalence rate of only 3 to 5 percent, which is much lower than Uganda's overall rate of 17 percent. Since the late 1990s, almost 100 community reproductive health workers (CRHWs) have been providing free contraceptive services and products (condoms and pills) to the women of Nakasongola district, under the supervision of 15 Save the Children field supervisors. (excerpt)
Language: English
Keywords:
UGANDA | SUMMARY REPORT | COMPARATIVE STUDIES | FAMILY PLANNING PROGRAMS | DEPO-PROVERA | COMMUNITY-BASED DISTRIBUTION | CLINICAL DISTRIBUTION | CONTRACEPTIVE SAFETY | CONTRACEPTIVE METHOD ACCEPTABILITY | CONTRACEPTION CONTINUATION | TRAINING ACTIVITIES | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Contraception | Nonclinical Distribution | Distributional Activities | Program Activities | Programs | Organization and Administration | Safety | Public Health | Health | Contraceptive Usage | Training Programs | Education
Document Number: 316345

14.

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Peer Reviewed

Title: Community coverage of an antimalarial combination of artesunate and amodiaquine in Makamba Province, Burundi, nine months after its introduction.
Author: Gerstl S; Cohuet S; Edoh K; Brasher C; Lesage A
Source: Malaria Journal. 2007 Jul 18;6(1):94.
Abstract: In 2003, artesunate-amodiaquine (AS+AQ) was introduced as the new first-line treatment for uncomplicated malaria in Burundi. After confirmed diagnosis, treatment was delivered at subsidized prices in public health centres. Nine months after its implementation a study was carried out to assess whether children below five years of age with uncomplicated malaria were actually receiving AS+AQ. A community-based study was conducted in Makamba province. Randomly selected households containing one or more children under five with reported fever onset within fourteen days before the study date were eligible. Case-management information was collected based on caregiver recall. A case definition of symptomatic malaria from observations of children presenting a confirmed malaria episode on the day of the survey was developed. Based on this definition, those children who had probable malaria among those with fever onset in the 14 days prior to the study were identified retrospectively. Treatment coverage with AS+AQ was then estimated among these probable malaria cases. Out of 195 children with fever on the day of the study, 92 were confirmed as true malaria cases and 103 tested negative. The combination of 'loss of appetite', 'sweating', 'shivering' and 'intermittent fever' yielded the highest possible positive predictive value, and was chosen as the case definition of malaria. Out of 526 children who had had fever 14 days prior to the survey, 165 (31.4%) were defined as probable malaria cases using this definition. Among them, 20 (14.1%) had been treated with AS+AQ, 10 with quinine (5%), 68 (41%) received non-malaria treatments, and 67 got traditional treatment or nothing (39.9%). Most people sought treatment from public health centres (23/99) followed by private clinics (15/99, 14.1%). The median price paid for AS+AQ was 0.5 US$. AS+AQ was the most common treatment for patients with probable malaria at public health centres, but coverage was low due to low health centre utilisation and apparently inappropriate prescribing. In addition, AS+AQ was given to patients at a price ten times higher than the subsidized price. The availability and proper use of ACTs should be monitored and maximized after their introduction in order to have a significant impact on the burden of malaria. (author's)
Language: English
Keywords:
BURUNDI | EVALUATION REPORT | CLINICAL RESEARCH | COMMUNITY | CHILDREN | MALARIA PREVENTION | DRUGS | COMMUNITY HEALTH SERVICES | CLINICAL DISTRIBUTION | UTILIZATION OF HEALTH CARE | USER COMPLIANCE | Africa, Central | Africa, Sub Saharan | Africa | Developing Countries | Evaluation | Research Methodology | Residence Characteristics | Population Distribution | Geographic Factors | Population | Youth | Age Factors | Population Characteristics | Demographic Factors | Malaria | Parasitic Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Primary Health Care | Distributional Activities | Program Activities | Programs | Organization and Administration | Behavior
Document Number: 318823

16.

Peer Reviewed

Title: Increasing coverage and decreasing inequity in insecticide-treated bed net use among rural Kenyan children.
Author: Noor AM; Amin AA; Akhwale WS; Snow RW
Source: PLoS Medicine. 2007 Aug;4(8):e255.
Abstract: Inexpensive and efficacious interventions that avert childhood deaths in sub-Saharan Africa have failed to reach effective coverage, especially among the poorest rural sectors. One particular example is insecticide-treated bed nets (ITNs). In this study, we present repeat observations of ITN coverage among rural Kenyan homesteads exposed at different times to a range of delivery models, and assess changes in coverage across socioeconomic groups. We undertook a study of annual changes in ITN coverage among a cohort of 3,700 children aged 0-4 y in four districts of Kenya (Bondo, Greater Kisii, Kwale, and Makueni) annually between 2004 and 2006. Cross-sectional surveys of ITN coverage were undertaken coincidentally with the incremental availability of commercial sector nets (2004), the introduction of heavily subsidized nets through clinics (2005), and the introduction of free mass distributed ITNs (2006). The changing prevalence of ITN coverage was examined with special reference to the degree of equity in each delivery approach. ITN coverage was only 7.1% in 2004 when the predominant source of nets was the commercial retail sector. By the end of 2005, following the expansion of heavily subsidized clinic distribution system, ITN coverage rose to 23.5%. In 2006 a large-scale mass distribution of ITNs was mounted providing nets free of charge to children, resulting in a dramatic increase in ITN coverage to 67.3%. With each subsequent survey socioeconomic inequity in net coverage sequentially decreased: 2004 (most poor [2.9%] versus least poor [15.6%]; concentration index 0.281); 2005 (most poor [17.5%] versus least poor [37.9%]; concentration index 0.131), and 2006 with near-perfect equality (most poor [66.3%] versus least poor [66.6%]; concentration index 0.000). The free mass distribution method achieved highest coverage among the poorest children, the highly subsidised clinic nets programme was marginally in favour of the least poor, and the commercial social marketing favoured the least poor. Rapid scaling up of ITN coverage among Africa's poorest rural children can be achieved through mass distribution campaigns. These efforts must form an important adjunct to regular, routine access to ITNs through clinics, and each complimentary approach should aim to make this intervention free to clients to ensure equitable access among those least able to afford even the cost of a heavily subsidized net. (author's)
Language: English
Keywords:
KENYA | RESEARCH REPORT | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | COMPARATIVE STUDIES | HOUSEHOLDS | BED NETS | PESTICIDES | PREVALENCE | PRIVATE SECTOR | INCOME | DISTRIBUTIONAL ACTIVITIES | CLINICAL DISTRIBUTION | Developing Countries | Africa, Eastern | Africa, Sub Saharan | Africa | Research Methodology | Studies | Family and Household | Sociocultural Factors | Parasite Control | Public Health | Health | Ingredients and Chemicals | Measurement | Macroeconomic Factors | Economic Factors | Socioeconomic Factors | Program Activities | Programs | Organization and Administration
Document Number: 319484

17.

Peer Reviewed

Title: Impact of drug classes and treatment availability on the rate of antiretroviral treatment change in the TREAT Asia HIV Observational Database (TAHOD).
Author: Srasuebkul P; Calmy A; Zhou J; Kumarasamy N; Law M
Source: AIDS Research and Therapy. 2007 Sep 17;4(1):18.
Abstract: It is critical to understand the pattern of ART prescription in different regions of the world as ART procurement needs to be anticipated. We aimed at exploring rates and predictors of ART combination changes in clinical practice in Treat Asia HIV Observational Database (TAHOD). Rates of ART changes were examined in patients who started first line triple or more ART combination in TAHOD, and had at least 1 follow-up visit. Rates of ART changes were summarised per follow-up year, and factors associated with changes assessed using random-effect Poisson regression. The Kaplan-Meier method was used to determine durations of patients in their first, second and third regimen. A total of 1846 patients initiated an ART combination with at least three drugs. Median follow up time for the first treatment was 3.2 years. The overall rate of ART change was 29 per 100-person-year. In univariate analyses, rate of treatment change was significantly associated with exposure category, the country income category,the drug class combination, calendar year and the number of combinations. In multivariate analysis, compared to d4T/3TC/NVP, starting ART with another NNRTI-containing regimen, with PI only or with a triple NRTI regimen was associated with a higher risk of combination change (relative risk (RR) 1.6 (95% CI 1.64 - 1.96), p less than 0.001, RR 3.39 (2.76 - 4.16) p less than 0.001, RR 6.37 (4.51 - 9.00), p less than 0.001). Being on a second or a third combination regimen was also associated with a decreased rate of ART change, compared with first ART combination (RR 0.82 (0.68 - 0.99), p = 0.035, RR 0.77 (0.61 - 0.97), p = 0.024). Sites with fewer than 12 drugs used had an increased rate of treatment changes (1.31 (1.13 - 1.51), p less than 0.001). Injecting drug users, and other/unknown exposure was found to increase rate of treatment change (1.24 (1.00 - 1.54), p = 0.055). Percentages of patients who stopped treatment due to adverse events were 31, 27 and 32 in 1st, 2nd and 3rd treatment combinations, respectively. Our study suggests that drug availability impacts on ART prescription patterns. Our data, reflecting real clinic use in Asia, suggest that around half of all patients require second combination ART by 3 years after treatment initiation. (author's)
Language: English
Keywords:
ASIA, SOUTHERN | ASIA, SOUTHWESTERN | RESEARCH REPORT | ANTIRETROVIRAL THERAPY | PRESCRIPTIONS | HIV | TREATMENT | CLINICAL DISTRIBUTION | Developing Countries | Asia | HIV Infections | Viral Diseases | Diseases | Distributional Activities | Program Activities | Programs | Organization and Administration | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health
Document Number: 314224

18.

Peer Reviewed

Title: [Family planning in Brazil today: an analysis of recent research] Atencao ao planejamento familiar no Brasil hoje: reflexoes sobre os resultados de uma pesquisa.
Author: Osis MJ; Faundes A; Makuch MY; Mello MD; de Sousa MH
Source: Cadernos de Saude Publica. 2006 Nov;22(11):2481-2490.
Abstract: This two-component study (descriptive cross-sectional and qualitative) assessed the availability of contraceptives in primary care clinics in Brazilian municipalities. The family planning program was also analyzed as part of the country's Family Health Strategy. Phone interviews were held with local health managers to obtain information on contraceptive supply in a selected sample of municipalities. Four municipalities were selected and visited for the qualitative analysis, using direct observation and semi-structured interviews with health professionals and managers. Descriptive statistical and multiple logistic regression analyses were performed. Content analysis technique was used for qualitative data. According to the results, family planning activities are often not integrated with other health activities. Health professionals and managers failed to understand family planning as part of primary health care and felt unable to assist patients. Family planning in Brazil is marked by the unavailability of contraceptives in public health programs. (author's)
Language: Portuguese
Keywords:
BRAZIL | LITERATURE REVIEW | CROSS SECTIONAL ANALYSIS | KAP SURVEYS | STATISTICAL REGRESSION | QUALITATIVE RESEARCH | HEALTH PERSONNEL | ADMINISTRATIVE PERSONNEL | CLINICAL DISTRIBUTION | CONTRACEPTIVE AVAILABILITY | INTEGRATED PROGRAMS | PRIMARY HEALTH CARE | South America, Eastern | South America | Latin America | Americas | Developing Countries | Research Methodology | Surveys | Sampling Studies | Studies | Data Analysis | Delivery of Health Care | Health | Organization and Administration | Distributional Activities | Program Activities | Programs | Contraception | Family Planning | Health Services
Document Number: 313096

19.

Title: Random behaviour or rational choice? Family planning, teenage pregnancy and sexually transmitted infections.
Author: Paton D
Source: Sex Education. 2006 Aug;6(3):281-308.
Abstract: Rational choice models of teenage sexual behaviour lead to radically different predictions than do models that assume such behaviour is random. Existing empirical evidence has not been able to distinguish conclusively between these competing models. I use regional data from England between 1998 and 2001 to examine the impact of recent increases in access to family planning on teenage pregnancy and sexually transmitted infection diagnosis rates. I find consistent evidence that access to family planning services is not associated with reductions in teenage pregnancy rates. I also find consistent evidence that increased promotion of emergency birth control in youth family planning clinics has not affected the relationship between clinic services and teenage pregnancy rates, but has significantly worsened the relationship between clinic services and teenage sexually transmitted infection diagnosis rates. Most of the observed relationships are inconsistent, with teenage sexual behaviour being the result of a random decision-making process. (author's)
Language: English
Keywords:
UNITED KINGDOM | RESEARCH REPORT | MATHEMATICAL MODEL | ADOLESCENTS, FEMALE | ADOLESCENT PREGNANCY | SEXUALLY TRANSMITTED DISEASE PREVENTION | CONTRACEPTIVE USAGE | FAMILY PLANNING PROGRAMS | PROGRAM ACCESSIBILITY | PREGNANCY RATE | EMERGENCY CONTRACEPTION | CONTRACEPTIVE AVAILABILITY | CLINICAL DISTRIBUTION | CONTRACEPTIVE DISTRIBUTION | DECISION MAKING | Developed Countries | United Kingdom | Europe, Western | Europe | Theoretical Models | Research Methodology | Adolescents | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Reproductive Behavior | Fertility | Population Dynamics | Sexually Transmitted Diseases | Reproductive Tract Infections | Infections | Diseases | Contraception | Family Planning | Program Evaluation | Programs | Organization and Administration | Fertility Measurements | Distributional Activities | Program Activities | Behavior
Document Number: 321480

20.

Title: Joint Civil Society Monitoring Forum. Report on the 5th JCSMF meeting held on the 29 August 2005, Khayelitsha, Western Cape.
Author: Joint Civil Society Monitoring Forum [JCSMF]
Source: [Unpublished] 2005. 8 p.
Abstract: The 5th meeting of the forum focused on reviewing the progress in each province and nationally in the provision of HIV treatment, and sought to reflect on progress in the light of the need for Antiretroviral therapy (ART) in each province. The Forum members had noted the encouraging increase in access to ART over the previous year, but felt that there were large inter-provincial discrepancies, and that it would be of value to take stock of progress on a province-by-province basis during the 5th meeting. The meeting was attended by over 20 organisations. The holding of the meeting in the HIV clinic at Site B, Khayelitsha, was symbolic as this was one of the first clinics to provide ART as part of a free routine service in the public sector. The meeting began with Dr Goemaere explaining how the service had evolved over time, through to the recent move to a new building where care for tuberculosis and HIV are delivered as a single integrated service. Formal apologies were received from the office of the National Minister of Health, the Deputy National Minister of Health and the Western Cape Minister of Health. In the light however of requests from the national department of health (NDoH) to be able to attend the JCSMF meetings in order to respond to some of the issues raised in previous meetings, forum members noted the failure of a single official from the NDoH to attend the meeting in spite of numerous invitations and prior telephonic confirmation. The Forum reiterated its wish to work with government in making the programme a success. (excerpt)
Language: English
Keywords:
SOUTH AFRICA | PROGRESS REPORT | EVALUATION | PERSONS LIVING WITH HIV/AIDS | MONITORING | ANTIRETROVIRAL THERAPY | AIDS PREVENTION | PROGRAM ACCESSIBILITY | DELIVERY OF HEALTH CARE | NEEDS ASSESSMENT | CLINICAL DISTRIBUTION | REFERRAL AND CONSULTATION | PREVENTION OF MOTHER-TO-CHILD TRANSMISSION | HIV PREVENTION | HEALTH SERVICES ADMINISTRATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | HIV | AIDS | Program Evaluation | Programs | Organization and Administration | Health | Distributional Activities | Program Activities | Disease Transmission Control | Prevention and Control | Management
Document Number: 321271

21.

22.

Title: Innovative models of antiretroviral therapy in KwaZulu-Natal, South Africa.
Author: Zuber A; Deghaye N; Pawinski R
Source: Congella, South Africa, University of KwaZulu-Natal, Nelson R. Mandela School of Medicine, Enhancing Care Initiative KZN Plus, 2005 Sep. 19 p.
Abstract: The Enhancing Care Initiative KwaZulu-Natal Plus (ECI KZN PLUS) based at the Nelson R. Mandela School of Medicine, funded by the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM), are implementing Clinical Diploma and Masters in HIV/AIDS Management. The course is aimed at health professionals (mainly doctors and nurses) directly involved with the implementation of the National Comprehensive HIV and AIDS Care and Treatment Plan for South Africa. The course, presented from the Doris Duke Medical Research Institute at the Nelson R. Mandela School of Medicine, is transmitted via videoconference to students at Grey's Hospital (Pietermaritzburg), Ngwelezane Hospital (Empangeni) and Madadeni Hospital (Newcastle). This model of teaching has to date provided over 57,000 CPD hours of teaching, and trained health professionals to provide 50,000 patients on ART. During the module "Introduction to Adult ARV", the course organizers invited four antiretroviral therapy (ART) implementation sites from various parts of KwaZulu-Natal to present their innovative models of comprehensive HIV/AIDS management, including HAART. The sites included hospitals in both rural and urban areas. The following is a descriptive account of these implementation models, based on the presentations by the team leaders (and follow-up research by Health Systems Trust), highlighting the innovative strategies each site has developed, ways in which challenges were overcome, and remaining challenges they face in providing care. (excerpt)
Language: English
Keywords:
SOUTH AFRICA | PROGRESS REPORT | EXPERIMENTAL MODELS | PERSONS LIVING WITH HIV/AIDS | HEALTH PERSONNEL | SUPPORT GROUPS | COUNSELORS | ANTIRETROVIRAL THERAPY | HEALTH AND WELFARE PLANNING | AIDS PREVENTION | DELIVERY OF HEALTH CARE | USER COMPLIANCE | GOVERNMENT FINANCING | CLINICAL DISTRIBUTION | CLINIC ACTIVITIES | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | HIV Infections | Viral Diseases | Diseases | Health | Social Networks | Friends and Relatives | Family and Household | Sociocultural Factors | Counseling | Program Activities | Programs | Organization and Administration | HIV | Social Planning | Economic Factors | AIDS | Behavior | Financial Activities | Distributional Activities
Document Number: 321270

23.
Peer Reviewed

Title: Nurse prescribing for contraceptive care and sexual health.
Author: Campbell P
Source: Journal of Family Planning and Reproductive Health Care. 2004;30(4):255-256.
Abstract: The Royal College of Nursing first proposed that nurses should be able to prescribe the combined pill in 1975. It has taken almost 30 years for this idea to become reality. The authority to prescribe represents much more than the right to sign for a plan of treatment or care. It also signifies an ability to assess, diagnose and evaluate. The advent of nurse prescribing is therefore a significant milestone in nursing history. Nurses working in family planning clinics (FPCs) who opt to become prescribers will be liberated to initiate all types of contraception � from combined oral contraceptive pills, progestogen-only pills, injectables to intrauterine devices/systems � from the Nurse Prescribers� Extended Formulary. (excerpt)
Language: English
Keywords:
UNITED KINGDOM | FAMILY PLANNING CENTERS | NURSES AND NURSING | CONTRACEPTIVE DISTRIBUTION | CLINICAL DISTRIBUTION | Developed Countries | Europe, Western | Europe | Health Facilities | Delivery of Health Care | Health | Health Personnel | Distributional Activities | Program Activities | Programs | Organization and Administration
Document Number: 275667

24.
Peer Reviewed

Title: Emergency contraception: prescribing practices of general internists compared with other primary care physicians.
Author: Chuang CH; Waldman LJ; Freund KM; Ash AS
Source: Contraception. 2004 Jan;69(1):43-45.
Abstract: Primary care physicians of all specialties should be familiar with prescribing emergency contraception (EC). We conducted a mail survey of 282 randomly sampled physicians in general internal medicine (31%), family medicine (34%) and obstetrics-gynecology (35%). Experience with prescribing EC significantly differed by specialty (63% of general internists, 76% of family physicians, and 94% of obstetrician-gynecologists, p < 0.0001). Controlling for year of graduation, gender, religion and practice location, family physicians [adjusted odds ratio (OR): 2.5, 95% confidence interval (CI): 1.2�5.2] and obstetrician-gynecologists (adjusted OR: 11.2, 95% CI: 4.0 �31.3) were still significantly more likely to have ever prescribed EC than general internists. Efforts to increase awareness and knowledge of EC should be aimed at general internists since they provide primary care for many reproductive age women. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | MASSACHUSETTS | RESEARCH REPORT | SURVEYS | PHYSICIANS | EMERGENCY CONTRACEPTION | PRESCRIPTIONS | CLINICAL DISTRIBUTION | GENDER ISSUES | RELIGION | GEOGRAPHIC FACTORS | Developed Countries | North America | Americas | Sampling Studies | Studies | Research Methodology | Health Personnel | Delivery of Health Care | Health | Contraception | Family Planning | Distributional Activities | Program Activities | Programs | Organization and Administration | Population
Document Number: 189964

25.
Peer Reviewed

Title: Antiretrovirals give new hope and new life to South Africans.
Author: Kapp C
Source: Lancet. 2004 May 22;363(9422):1710.
Abstract: The GF Jooste hospital stands as testimony to South Africa�s past health-policy failings and offers a glimmer of hope for the future. Situated a stone�s throw from Cape Town�s thriving international airport, the hospital serves an estimated 1�5 million people in the city�s most violent and impoverished townships. The average age of death of female patients on the 84-bed medical wards is 35, with males just over 40. Some 60% of all patient deaths are HIV-related, often due to tuberculosis complications. The hospital deals with 6000�7000 casualty cases each month�mostly from doctors�and many of the sick have to wait more than 24 hours for a free bed. A high local incidence of hypertension and diabetes adds to the problems, according to Vanessa Burch, head of the medical unit. But a short distance away from the chaotic triage centre, is a quiet, tastefully decorated haven that dispenses antiretroviral drugs to a small but growing number of AIDS patients. The clinic, which opened last December thanks to a grant from the Nelson Mandela Foundation and the South African Medical Association, is currently treating about more than 90 phase IV patients and accepts new admissions by the week. (excerpt)
Language: English
Keywords:
SOUTH AFRICA | PROGRESS REPORT | PERSONS LIVING WITH HIV/AIDS | HOSPITAL PERSONNEL | FOUNDATIONS | GOVERNMENT PROGRAMS | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | CLINICAL DISTRIBUTION | HOSPITALS | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | Health Personnel | Delivery of Health Care | Health | Organizations | Programs | Organization and Administration | Treatment | HIV | Distributional Activities | Program Activities | Health Facilities
Document Number: 192808

26.
Peer Reviewed

Title: State of the art in hormonal contraception: an overview.
Author: Mishell DR Jr
Source: American Journal of Obstetrics and Gynecology. 2004 Apr;190(4 Suppl 1):S1-S4.
Abstract: In June 2001, together with an esteemed group of colleagues, I had the opportunity to preside over a 2-day conference presented by the National Institute of Child Health and Human Development that focused on ��Preventing Unintended Pregnancy: Advances in Hormonal Contraception.�� This conference was a well-timed update of a similar program that took place in 1993. In the 8 years since that conference, there have been a number of major advances in the area of contraception. These advances include the introduction of new formulations of oral contraceptives, continued development of existing injectable and implantable delivery methods, and the development and approval of 2 novel delivery systems of contraceptive steroids. The 2001 conference provided a format for the presentation and discussion of these advances, and other important issues that impact both clinicians and patients. Both groups wish to have additional, effective, and safe methods of contraception that are easy to use. (author's)
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | PREGNANCY, UNPLANNED | CLINICAL DISTRIBUTION | ORAL CONTRACEPTIVES | INJECTABLES | CONTRACEPTIVE IMPLANTS | EMERGENCY CONTRACEPTION | Developed Countries | North America | Americas | Reproductive Behavior | Fertility | Population Dynamics | Demographic Factors | Population | Distributional Activities | Program Activities | Programs | Organization and Administration | Contraceptive Methods | Contraception | Family Planning
Document Number: 191900

27.

Peer Reviewed

Title: Provision of family planning services in Lesotho.
Author: Tuoane M; Madise NJ; Diamond I
Source: International Family Planning Perspectives. 2004 Jun;30(2):77-86.
Abstract: One of Lesotho's population goals is to achieve replacement-level fertility by 2011, but the contraceptive prevalence rate of 41% is considerably below the target of 70-75%. A situation analysis framework was used to assess family planning providers' readiness to provide services and women's perceptions of service delivery. Data were collected in 1997-1998 through surveys of 38 service delivery points and 52 providers, and focus group discussions with 50 women. Most facilities were open five days a week, during working hours; closure during lunchtime and on weekends restricted access by employed people. There were no clear guidelines on the provision of family planning methods, and providers created their own rules and restrictions. Some women were discouraged by provider bias, lack of visual privacy and recurrent shortages of their preferred brand of pills. Although the government had a uniform pricing policy for contraceptive methods, costs varied and generally were higher in rural than in urban areas. In rural areas, transportation costs increased the overall cost of using family planning methods. Expanding women's access to service sites, developing guidelines for family planning providers and ensuring that standard prices are adopted should be government priorities if contraceptive prevalence is to increase. (author's)
Language: English
Keywords:
LESOTHO | RESEARCH REPORT | CONTRACEPTIVE PREVALENCE | ZERO POPULATION GROWTH | FAMILY PLANNING CENTERS | CLINICAL DISTRIBUTION | PROGRAM ACCESSIBILITY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Contraceptive Usage | Contraception | Family Planning | Population Size | Population Dynamics | Demographic Factors | Population | Health Facilities | Delivery of Health Care | Health | Distributional Activities | Program Activities | Programs | Organization and Administration | Program Evaluation
Document Number: 194268

28.

Title: No product? No program! The importance of HIV / AIDS commodity security.
Author: Wright C
Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2004. [6] p. (USAID Contract No. HRN-C-00-00-00010-00)
Abstract: Picture this: An AIDS treatment clinic in a district hospital in East Africa, in October 2005. The country has benefited from the World Bank's Multicountry HIV/AIDS Program (MAP) and the first round of Global Fund grants, the Clinton Foundation has procured an initial supply of antiretroviral drugs (ARVs), and USAID and other bilateral donors have contributed significant technical assistance. The country has a national policy for testing protocols, standard treatment guidelines have been developed for antiretroviral therapy (ART), ARVs have been added to the list of essential drugs, service providers have been trained, and behavior change efforts have encouraged people in the area to be tested for HIV. The district hospital has long provided voluntary counseling and testing (VCT) and palliative care for AIDS patients. In 2003, they began offering services for preventing mother-to-child transmission (PMTCT) for pregnant mothers and their families. Ten months ago, the clinic staff were trained and ready to provide ART, the medicines and supplies were fully stocked, and the clinic began offering ART through its HIV care and treatment clinic to any qualified person in their catchment area. It was a success story for the country's scale-up efforts. Uptake was greater than expected as more and more people heard that AIDS might not be a death sentence. Demand for ART services rose quickly, until nearly a thousand people were receiving ARV drugs. Then the supplies began to run out. First, the laboratory reagents needed for testing were dwindling, and then the test kits. Initially, the clinicians thought these shortages were temporary. But soon their emergency orders were only partially filled. As the supplies of ARVs diminished, the district pharmacist made an urgent phone call to the National Medical Store (NMS). The NMS clerk told her that the NMS was rationing the limited supplies of ARVs still in stock, and the remaining test kits had expired. The whole country was facing the same problem. As the threat of ARV drug stockouts loomed, so did the threat that thousands of patients would develop drug resistance�or even die�because their treatment had been interrupted. (excerpt)
Language: English
Keywords:
AFRICA, EASTERN | FUNDS | CLINICAL DISTRIBUTION | HIV INFECTIONS | AIDS | ANTIRETROVIRAL DRUGS | ANTIRETROVIRAL THERAPY | NEEDS ASSESSMENT | PROGRAM SUSTAINABILITY | PROGRAM EVALUATION | Developing Countries | Africa, Sub Saharan | Africa | Financial Activities | Economic Factors | Distributional Activities | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Treatment | HIV | Evaluation
Document Number: 274672

29.

Peer Reviewed

Title: From home to clinic and from family planning to family health: client and community responses to health sector reforms in Bangladesh.
Author: Bates LM; Islam MK; Al-Kabir A; Schuler SR
Source: International Family Planning Perspectives. 2003 Jun;29(2):88-94.
Abstract: Debates about the future of Bangladesh�s government health program are not happening in an empirical vacuum; there is relevant evidence to be gleaned from the NGOs� experience. In this comment, we highlight some of the lessons learned from the NGO process that may inform the critical decisions and processes ahead as the government designs and implements reforms under the HNPSP. Our recommendations are based on data from a recently completed three-year, multimethod, qualitative study examining NGO program implementation, and the ways in which clients, communities and program staff have responded to policy changes and adapted to new service delivery norms and practices. For our study, we collected data from five USAID�run NGO sites, two urban and three rural, from January 1998 through July 2000 (with retrospective questions about the time frame prior to and during the initial transition period, which began in 1997). This comment is based on data from approximately 500 in-depth, semistructured interviews conducted with clients, clinic staff and community members (which included some husbands of female clients). (excerpt)
Language: English
Keywords:
BANGLADESH | CRITIQUE | RECOMMENDATIONS | INTERVIEWS | CLIENTS | COMMUNITY | FAMILY PLANNING PERSONNEL | FRIENDS AND RELATIVES | FAMILY PLANNING PROGRAMS | CLINICAL DISTRIBUTION | NONGOVERNMENTAL ORGANIZATIONS | DISTRIBUTIONAL ACTIVITIES | NONCLINICAL DISTRIBUTION | CHANGES | Asia, Southern | Asia | Developing Countries | Data Collection | Research Methodology | Program Activities | Programs | Organization and Administration | Residence Characteristics | Population Distribution | Geographic Factors | Population | Family Planning | Family and Household | Organizations | Social Change
Document Number: 180147

30.
Title: Zimbabwe. Antiretroviral therapy program: issues and opportunities for initiation and expansion.
Author: Noguera M; Alt D; Hirschhorn L; Maponga C; Osewe P
Source: Arlington, Virginia, John Snow [JSI], DELIVER, 2003 Feb. [124] p. (USAID Contract No. HRN-C-00-00-00010-00)
Abstract: The purpose of the assessment was to assist the Ministry of Health and Child Welfare (MOHCW) in identifying the major issues that need to be addressed to support initiation and expansion of ART services in the country. The assessment focused on two areas: logistical requirements for ensuring a reliable and consistent supply of quality antiretroviral drugs (ARVs) and related commodities, and infrastructure and personnel requirements necessary to ensure their safe and effective use by patients. The assessment findings and recommendations are intended to be used by the MOHCW in furthering the development, initiation, and expansion of the national ART program. This report presents the assessment team�s findings and recommendations. Approximately 120 people from 40 different public and private sector organizations were interviewed, representing a wide range of different �stakeholders� involved in various aspects of HIV/AIDS care in the country. Field visits were also made to 10 public sector facilities to review how they currently manage HIV/AIDS-related products and services. The services covered included voluntary counseling and testing (VCT), prevention of mother-to-child transmission (PMTCT), home-based care for HIV-related illnesses, management of opportunistic infections, sexually transmitted infections (STIs), and tuberculosis (TB) diagnosis and treatment. Only one of the facilities visited was already providing ART. Among the organizations interviewed, five corporations are currently, or are actively considering, providing ART to their employees. In addition, people living with HIV/AIDS (PLWH/A) were interviewed in two settings for this report. (excerpt)
Language: English
Keywords:
ZIMBABWE | SUMMARY REPORT | CLINICAL DISTRIBUTION | HIV INFECTIONS | AIDS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | DELIVERY OF HEALTH CARE | HEALTH SERVICES | TREATMENT | EQUIPMENT AND SUPPLIES | IMPLEMENTATION | PROGRAM EVALUATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Distributional Activities | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | HIV | Health
Document Number: 274673


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