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1.
Title: Progress toward the 2012 measles elimination goal--Western Pacific Region, 1990-2008.
Author: Centers for Disease Control and Prevention (CDC)
Source: MMWR. Morbidity and Mortality Weekly Report. 2009 Jun 26;58(24):669-73.
Abstract: In 2003, the World Health Organization (WHO) Regional Committee of the Western Pacific Region (WPR) formally declared a measles elimination goal, and in 2005, the committee established a target date of 2012 for regional measles elimination. Key strategies recommended by WHO for achievement of measles elimination include 1) very high (>or=95%) vaccination coverage with 2 doses of measles-containing vaccine (MCV1 and MCV2) through routine vaccination and/or supplemental immunization activities (SIAs); 2) high-quality case-based measles surveillance; and 3) access to an accredited measles laboratory network for testing of suspected measles cases and identification of measles virus genotypes. This report describes progress toward measles elimination in the WPR through 2008. Measles likely has been eliminated or nearly eliminated in 24 of the 37 countries and areas in the WPR (referred to in this report as countries). However, large numbers of measles cases continue to be reported from several countries. During 2008, a total of 131,441 confirmed measles cases (98.4 per million population) were reported from China and 11,015 cases (86.1 per million population) from Japan, two countries that account for 82% of the region's population and >97% of its confirmed measles cases. Intensified efforts by WPR countries, particularly China and Japan, will be required to achieve the 2012 goal.
Language: English
Keywords:
OCEANIA | SUMMARY REPORT | INCIDENCE | MEASLES | VACCINES | IMMUNIZATION | PREVENTION AND CONTROL | MONITORING | SCREENING | Developing Countries | Measurement | Research Methodology | Viral Diseases | Diseases | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Primary Health Care | Evaluation | Examinations and Diagnoses
Document Number: 341752

Title: The logistics handbook: A practical guide for supply chain managers in family planning and health programs.
Author: John Snow [JSI]. DELIVER
Source: Arlington, Virginia, JSI, DELIVER, 2009 Jul. 182 p. (USAID Contract No. GPO-I-01-06-00007-00) Oringinally published in 2004.
Abstract: The Logistics Handbook includes the major aspects of logistics management with an emphasis on contraceptive supplies. The text should be helpful to managers who work with supplies every day as well as managers who assess and design logistics systems for entire programs. Policymakers may find the text useful in exploring the inputs needed to create an effective logistics system. Key terms and concepts are clearly defined and explained, and the design and implementation of management information systems and inventory control are discussed in detail. Storage and quality control practices are also discussed, and overviews of forecasting and procurement processes are included.
Language: English
Keywords:
DEVELOPING COUNTRIES | MANUAL | USAID | FAMILY PLANNING PROGRAMS | LOGISTICS | CONTRACEPTIVE METHODS | DRUGS | INFORMATION RETRIEVAL SYSTEMS | RECORDS | QUALITY CONTROL | MONITORING | STORAGE AND WAREHOUSES | IMPLEMENTATION | PLANNING | Government Agencies | Organizations | Political Factors | Sociocultural Factors | Family Planning | Management | Organization and Administration | Contraception | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Data Storage and Retrieval | Information Processing | Information | Evaluation | Programs
Document Number: 331681

Title: Community-based health workers can safely and effectively administer injectable contraceptives: Conclusions from a technical consultation.
Author: World Health Organization [WHO]; United States. Agency for International Development [USAID]; Family Health International [FHI]
Source: Research Triangle Park, North Carolina, FHI, 2009. 4 p.
Abstract: In June 2009, a technical consultation held at the World Health Organization (WHO) in Geneva concluded that evidence supports the introduction, continuation, and scale-up of community-based provision of progestin-only injectable contraceptives. The group of 30 technical and programme experts reviewed scientific and programmatic experience, which largely focused on the progestin-only injectable, depot-medroxyprogesterone acetate (DMPA). The experts found that community-based provision of progestin-only injectable contraceptives by appropriately trained community health workers (CHWs) is safe, effective, and acceptable. Such services should be part of a family planning programme offering a range of contraceptive methods. (Excerpt)
Language: English
Keywords:
GLOBAL | CONFERENCES AND CONGRESSES | COMMUNITY WORKERS | WHO | INJECTABLES | DEPO-PROVERA | NEEDS | SAFETY | CONTRACEPTION CONTINUATION | TRAINING ACTIVITIES | MONITORING | FAMILY PLANNING POLICY | Health Personnel | Delivery of Health Care | Health | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Economic Factors | Public Health | Contraceptive Usage | Training Programs | Education | Evaluation | Population Policy | Social Policy | Policy
Document Number: 331834

5.
Peer Reviewed

Title: HIV-1 genetic diversity and transmitted drug resistance in health care settings in Maputo, Mozambique.
Author: Bartolo I; Casanovas J; Bastos R; Rocha C; Abecasis AB; Folgosa E; Mondlane J; Manuel R; Taveira N
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Jul 1;51(3):323-31.
Abstract: OBJECTIVES: To characterize HIV-1 diversity and transmitted drug resistance in persons with access to care and treatment in Maputo, Mozambique. METHODS: Samples were collected in 2002-2004 from 144 drug-naive patients attending public hospitals and private clinics. Plasma viremia, CD4, and CD8 cell counts were determined for each patient. The Stanford Algorithm was used for resistance genotyping on pol sequences. Subtyping was done by phylogenetic analysis. RESULTS: Most patients had high viral load (mean, 5.0 log copies/mL) and low CD4 cell counts (median, 260 CD4 cells/microL). Protease and/or reverse transcriptase sequences were obtained from 104 (72%) samples. Patients harbored subtypes C (80.8%), G (3.8%), CRF37_cpx (6.7%), untypable (U) (1.0%), and recombinant strains (7.7%) comprising the A, C, D, F, and U clades. There were no major protease inhibitor resistance mutations. Mutations conferring resistance to the nucleoside/nucleotide reverse transcriptase inhibitors and/or nonnucleoside reverse transcriptase inhibitors were found in 4 (4/68; 5.9%) patients. Phylogenetic analysis suggested an imported origin for 2 resistant variants. CONCLUSIONS: The HIV-1 epidemic in Maputo is evolving rapidly in genetic complexity due to the recent introduction of all major subtypes and recombinant forms. Continued surveillance of drug resistance in treated and untreated populations is needed to prevent further transmission of HIV drug-resistant variants and maximize the efficacy of antiretroviral therapy in Maputo.
Language: English
Keywords:
MOZAMBIQUE | RESEARCH REPORT | SAMPLING STUDIES | CLIENTS | PERSONS LIVING WITH HIV/AIDS | HIV INFECTIONS | GENETICS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | DRUG RESISTANCE | MONITORING | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Biology | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation
Document Number: 342148

Title: Water safety plan manual: Step-by-step risk management for drinking-water suppliers.
Author: Bartram J; Corrales L; Davison A; Deere D; Drury D
Source: Geneva, Switzerland, World Health Organization [WHO], 2009. 101 p.
Abstract: The most effective means of consistently ensuring the safety of a drinking-water supply is through the use of a comprehensive risk assessment and risk management approach that encompasses all steps in water supply from catchment to consumer. In these Guidelines, such approaches are called water safety plans (WSPs). The aim of this Manual is to provide that practical guidance to facilitate WSP development focusing particularly on organized water supplies managed by a water utility or similar entity. (Excerpts)
Language: English
Keywords:
GLOBAL | MANUAL | CASE STUDIES | WATER SUPPLY | SAFETY | PLANNING | QUALITY CONTROL | RISK ASSESSMENT | STANDARDS | MONITORING | MANAGEMENT | PROCEDURES | Studies | Research Methodology | Natural Resources | Environment | Public Health | Health | Organization and Administration | Evaluation
Document Number: 331413

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Peer Reviewed

Title: Expanding antiretroviral options in resource-limited settings--a cost-effectiveness analysis.
Author: Bendavid E; Wood R; Katzenstein DA; Bayoumi AM; Owens DK
Source: Journal of Acquired Immune Deficiency Syndromes. 2009 Sep 1;52(1):106-13.
Abstract: BACKGROUND: Current World Health Organization (WHO) guidelines for treatment of HIV in resource-limited settings call for 2 antiretroviral regimens. The effectiveness and cost-effectiveness of increasing the number of antiretroviral regimens is unknown. METHODS: Using a simulation model, we compared the survival and costs of current WHO regimens with two 3-regimen strategies: an initial regimen of 3 nucleoside reverse transcriptase inhibitors followed by the WHO regimens and the WHO regimens followed by a regimen with a second-generation boosted protease inhibitor (2bPI). We evaluated monitoring with CD4 counts only and with both CD4 counts and viral load. We used cost and effectiveness data from Cape Town and tested all assumptions in sensitivity analyses. RESULTS: Over the lifetime of the cohort, 25.6% of individuals failed both WHO regimens by virologic criteria. However, when patients were monitored using CD4 counts alone, only 6.5% were prescribed additional highly active antiretroviral therapy due to missed and delayed detection of failure. The life expectancy gain for individuals who took a 2bPI was 6.7-8.9 months, depending on the monitoring strategy. When CD4 alone was available, adding a regimen with a 2bPI was associated with an incremental cost-effectiveness ratio of $2581 per year of life gained, and when viral load was available, the ratio was $6519 per year of life gained. Strategies with triple-nucleoside reverse transcriptase inhibitor regimens in initial therapy were dominated. Results were sensitive to the price of 2bPIs. CONCLUSIONS: About 1 in 4 individuals who start highly active antiretroviral therapy in sub-Saharan Africa will fail currently recommended regimens. At current prices, adding a regimen with a 2bPI is cost effective for South Africa and other middle-income countries by WHO standards.
Language: English
Keywords:
SOUTH AFRICA | RESEARCH REPORT | THEORETICAL MODELS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | ADMINISTRATION AND DOSAGE | COST EFFECTIVENESS | MONITORING | WHO | IMMUNOLOGICAL EFFECTS | LIFE EXPECTANCY | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Research Methodology | HIV Infections | Viral Diseases | Diseases | HIV | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Drugs | Evaluation Indexes | Quantitative Evaluation | Evaluation | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Immunity | Immune System | Physiology | Biology | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population
Document Number: 342908

Title: An assessment of the effectiveness of growth monitoring and promotion practices in the Lusaka district of Zambia.
Author: Charlton KE; Kawana BM; Hendricks MK
Source: Nutrition. 2009 Oct;25(10):1035-46.
Abstract: OBJECTIVE: We evaluated the effectiveness of the growth monitoring and promotion (GMP) program in Zambia. METHODS: A 3-mo prospective study of growth outcomes was undertaken at randomly selected health facilities and community posts within the Lusaka district. Children <2 y old (n=698) were purposively sampled from three health facilities (n=459) and four community posts (n=77) where health workers had undergone training in GMP and three health facilities where staff had not received training (n=162). Qualitative data on knowledge, attitudes, and practices of GMP were collected from health facility managers (n=6), health workers (n=35), and mothers whose children attended all follow-up visits (n=27). RESULTS: Anthropometric status of children in all groups deteriorated, with children at community posts having the worst outcomes (change in weight-for-age Z-score -0.8+/-0.7), followed by trained (-0.5+/-0.6) and untrained (-0.3+/-0.47; P<0.05) health facilities. A similar trend was seen for weight for length. The overall dropout rate was 74.1%. Weight-for-age Z-scores were higher at 1- and 2-mo follow-up visits for children who did not complete the study at trained health facilities and community posts compared with those who remained in the study. Mothers/caregivers identified GMP as important in attending the under-five clinic, associated their child's weight with overall health status, and expressed a willingness to comply with health workers' advice. However, health care providers were poorly motivated, inadequately supervised, and demonstrated poor practices. CONCLUSIONS: The GMP program in Lusaka is functioning suboptimally, even in facilities with trained staff.
Language: English
Keywords:
ZAMBIA | RESEARCH REPORT | MONITORING | CHILDREN | GROWTH | CHILD DEVELOPMENT | BODY WEIGHT | ANTHROPOMETRY | PROMOTION | PROGRAM EFFECTIVENESS | Developing Countries | Africa, Southern | Africa, Sub Saharan | Africa | Evaluation | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Biology | Physiology | Measurement | Research Methodology | Marketing | Economic Factors | Program Evaluation | Programs | Organization and Administration
Document Number: 342875

Title: Advances and future directions in HIV surveillance in low- and middle-income countries.
Author: Diaz T; Garcia-Calleja JM; Ghys PD; Sabin K
Source: Current Opinion In HIV and AIDS. 2009 Jul;4(4):253-9.
Abstract: PURPOSE OF REVIEW: To present recent advances in HIV/AIDS surveillance methods in low- and middle-income countries. RECENT FINDINGS: From 2001 to 2008, 30 low- and middle-income countries implemented national population-based surveys with HIV testing. Antenatal clinic HIV sentinel surveillance sites in sub-Saharan Africa increased from just over 1000 in 2003-2004 to almost 2500 in 2005-2006, becoming more representative of rural areas. Between 2003 and 2007, at least 122 behavioral surveys in low- and middle-income countries used respondent-driven sampling for surveillance among high-risk populations, although many countries with concentrated epidemics continue to have major sentinel surveillance gaps. Improvements have been made in modeling estimates of number of persons HIV infected, and systems are now in place to measure HIV drug resistance. However, the reliable monitoring of trends and the measuring of HIV incidence, morbidity, and mortality is still a challenge. SUMMARY: In the past 5 years, there have been substantial improvements in the quantity and quality of HIV surveillance studies, especially in the countries with high prevalence. Further efforts should be made in countries that lack fully implemented surveillance systems to improve HIV incidence, morbidity, and mortality surveillance and to use data more effectively.
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | RECOMMENDATIONS | HIV INFECTIONS | AIDS | EPIDEMICS | MONITORING | MORTALITY | PREVALENCE | HIV TESTING | DRUG RESISTANCE | INCIDENCE | Viral Diseases | Diseases | Evaluation | Population Dynamics | Demographic Factors | Population | Measurement | Research Methodology | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Treatment
Document Number: 342342

10.

Title: Haiti: Going to scale with a performance incentive model.
Author: Eichler R; Auxila P; Antoine U; Desmangles B
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :165-188.
Abstract: Rewarding NGOs for increasing access to a package of basic services and paying them for achieving population-based performance targets can result in significant increases in essential services such as immunizations and assisted deliveries. Paying NGOs for results strengthens institutional capacity to deliver services from the bottom up. Changes in the design throughout the six years offer lessons for other contexts.
Language: English
Keywords:
HAITI | RESEARCH REPORT | PILOT PROJECTS | MATERNAL HEALTH | CHILD HEALTH | REPRODUCTIVE HEALTH | FAMILY PLANNING | MEASUREMENT | PERFORMANCE IMPROVEMENT | PROGRAM ACTIVITIES | NONGOVERNMENTAL ORGANIZATIONS | ORGANIZATION AND ADMINISTRATION | PROGRAM EVALUATION | MONITORING | Developing Countries | Caribbean | Americas | Studies | Research Methodology | Health | Management | Programs | Organizations | Political Factors | Sociocultural Factors | Evaluation
Document Number: 331456

11.

Title: Making payment for performance work.
Author: Eichler R; Levine R
Source: In: Performance incentives for global health: potential and pitfalls [by] Rena Eichler, Ruth Levine and the Performance-Based Incentives Working Group. Washington, D.C., Center for Global Development, 2009. :51-78.
Abstract: Here we discuss key issues to consider when designing and the steps to implementing a performance incentives program. Among our examples are those that went wrong as well as those that went right, because valuable lessons can be learned from each. While some of the issues may seem complicated, it is not necessary to get all the details right at the outset: refinements can and should be introduced along the way. Fundamentally different from many traditional approaches to improving the delivery of health services, performance incentives are about establishing what the results should be and then letting the key actors -- the patients, the providers -- figure out how to achieve them. Along the way, learning and fine-tuning are part and parcel of the process. (Excerpt)
Language: English
Keywords:
DEVELOPING COUNTRIES | LITERATURE REVIEW | PERFORMANCE IMPROVEMENT | INCENTIVES | HEALTH SERVICES | QUALITY OF HEALTH CARE | WAGES | DELIVERY OF HEALTH CARE | MONITORING | EVALUATION | HEALTH SERVICES ADMINISTRATION | Management | Organization and Administration | Policy | Political Factors | Sociocultural Factors | Health | Health Services Evaluation | Program Evaluation | Programs | Macroeconomic Factors | Economic Factors
Document Number: 331463

12.
Title: Reaching every district - development and testing of a health micro-planning strategy for reaching difficult to reach populations in Mongolia.
Author: Enkhtuya B; Badamusuren T; Dondog N; Khandsuren L; Elbegtuya N; Jargal G; Surenchimeg V; Grundy J
Source: Rural and Remote Health. 2009 Apr-Jun;9(2):1045.
Abstract: CONTEXT: Since the 1990s, Mongolia has undergone a rapid social and economic transition with migration to the urban areas of the national capital Ulaanbaatar. The main reasons for the migration are social sector decline in rural areas and the potential for employment opportunities in urban areas. There are also new internal patterns of migration in rural and remote areas relating to recent developments in the economic sector. Despite recent innovations in health system management in Mongolia, in some urban and rural and remote locations health services are not sufficiently accessed by the most socially and economically disadvantaged populations. These concerns provided the motivation for the Ministry of Health of Mongolia and development partners to attempt to access the most difficult to reach populations through the development of a micro-planning process referred to as the 'Reaching Every District strategy' (RED). This article describes and analyses RED micro-planning processes and content, and highlights the lessons learned. The main source of data for this planning system development was in the development and testing of the micro-planning process in Byanzurkh District, Ulaanbaatar in June 2008. INTERVENTION: The principal intervention developed and trialed was a health micro-planning strategy for improved access to immunization and maternal and child health services for difficult to reach populations. The planning methodology was a problem-solving approach progressing from health mapping to barrier analysis, to activity planning and costing and finally to monitoring and evaluation. LESSONS LEARNED: Main success factors in the development of the planning methodology were the use of barrier analysis and mapping approaches for data analysis and problem solving at the local level, and re-orientation of management approaches from 'inspection' to supportive supervision. Additionally, although the RED strategy is intended to be an immunization-specific intervention internationally, evidence from the development and trial of the process in Mongolia indicates its potential for wider health systems applications. This is particularly so for detecting and responding to the maternal and child health service needs of the more difficult to reach sub-populations.
Language: English
Keywords:
MONGOLIA | RESEARCH REPORT | CHILDREN | CHILD SURVIVAL | CHILD HEALTH | IMMUNIZATION | HEALTH SERVICES | PLANNING | MONITORING | Developing Countries | Asia, Northern | Asia | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Survivorship | Length of Life | Mortality | Population Dynamics | Health | Primary Health Care | Delivery of Health Care | Organization and Administration | Evaluation
Document Number: 341537

13.

Title: Infodemiology and infoveillance: Framework for an emerging set of public health informatics methods to analyze search, communication and publication behavior on the Internet [editorial]
Author: Eysenbach G
Source: Journal of Medical Internet Research. 2009;11(1):e11.
Abstract: Infodemiology can be defined as the science of distribution and determinants of information in an electronic medium, specifically the Internet, or in a population, with the ultimate aim to inform public health and public policy. Infodemiology data can be collected and analyzed in near real time. Examples for infodemiology applications include: the analysis of queries from Internet search engines to predict disease outbreaks (eg. influenza); monitoring peoples' status updates on microblogs such as Twitter for syndromic surveillance; detecting and quantifying disparities in health information availability; identifying and monitoring of public health relevant publications on the Internet (eg. anti-vaccination sites, but also news articles or expert-curated outbreak reports); automated tools to measure information diffusion and knowledge translation, and tracking the effectiveness of health marketing campaigns. Moreover, analyzing how people search and navigate the Internet for health-related information, as well as how they communicate and share this information, can provide valuable insights into health-related behavior of populations. Seven years after the infodemiology concept was first introduced, this paper revisits the emerging fields of infodemiology and infoveillance and proposes an expanded framework, introducing some basic metrics such as information prevalence, concept occurrence ratios, and information incidence. The framework distinguishes supply-based applications (analyzing what is being published on the Internet, eg. on Web sites, newsgroups, blogs, microblogs and social media) from demand-based methods (search and navigation behavior), and further distinguishes passive from active infoveillance methods. Infodemiology metrics follow population health relevant events or predict them. Thus, these metrics and methods are potentially useful for public health practice and research, and should be further developed and standardized. (Author's abstract)
Language: English
Keywords:
CANADA | CRITIQUE | EPIDEMIOLOGY | INFORMATION DISTRIBUTION | INFORMATION RETRIEVAL SYSTEMS | INTERNET | INFLUENZA | MONITORING | COMMUNICATION | PUBLIC HEALTH | Developed Countries | North America, Northern | Americas | Health | Data Storage and Retrieval | Information Processing | Information | Information Networks | Viral Diseases | Diseases | Evaluation
Document Number: 331416

14.

Peer Reviewed

Title: Rates of serious infection after changes in regimens for medical abortion.
Author: Fjerstad M; Trussell J; Sivin I; Lichtenberg ES; Cullins V
Source: New England Journal of Medicine. 2009 Jul 9;361(2):145-51.
Abstract: BACKGROUND: From 2001 through March 2006, Planned Parenthood health centers throughout the United States provided medical abortion (abortion by means of medication) principally by a regimen of oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In response to concern about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration from vaginal to buccal and required either routine provision of antibiotics or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine treatment with antibiotics for all medical abortions. METHODS: We performed a retrospective analysis assessing the rates of serious infection after medical abortion during a time when misoprostol was administered vaginally (through March 2006), as compared with rates after a change to buccal administration of misoprostol and after initiation of additional infection-reduction measures. RESULTS: Rates of serious infection dropped significantly after the joint change to buccal misoprostol from vaginal misoprostol and to either testing for sexually transmitted infection or routine provision of antibiotics as part of the medical abortion regimen. The rate declined 73%, from 0.93 per 1000 abortions to 0.25 per 1000 (absolute reduction, 0.67 per 1000; 95% confidence interval [CI], 0.44 to 0.94; P<0.001). The subsequent change to routine provision of antibiotics led to a further significant reduction in the rate of serious infection - a 76% decline, from 0.25 per 1000 abortions to 0.06 per 1000 (absolute reduction, 0.19 per 1000; 95% CI, 0.02 to 0.34; P=0.03). CONCLUSIONS: The rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with routine administration of antibiotics.
Language: English
Keywords:
UNITED STATES OF AMERICA | RESEARCH REPORT | RETROSPECTIVE STUDIES | STATISTICAL STUDIES | ABORTION | RU-486 | MISOPROSTOL | ADMINISTRATION AND DOSAGE | STANDARDS | INFECTION PREVENTION | ANTIBIOTICS | MONITORING | Developed Countries | North America | Americas | Studies | Research Methodology | Fertility Control, Postconception | Family Planning | Hormone Antagonists | Hormones | Endocrine System | Physiology | Biology | Prostaglandins, Synthetic | Prostaglandins | Drugs | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Infections | Diseases | Evaluation
Document Number: 342147 Notification

15.

16.

Peer Reviewed

Title: Loss of population levels of immunity to malaria as a result of exposure-reducing interventions: consequences for interpretation of disease trends.
Author: Ghani AC; Sutherland CJ; Riley EM; Drakeley CJ; Griffin JT; Gosling RD; Filipe JA
Source: PLoS One. 2009;4(2):e4383.
Abstract: BACKGROUND: The persistence of malaria as an endemic infection and one of the major causes of childhood death in most parts of Africa has lead to a radical new call for a global effort towards eradication. With the deployment of a highly effective vaccine still some years away, there has been an increased focus on interventions which reduce exposure to infection in the individual and -by reducing onward transmission-at the population level. The development of appropriate monitoring of these interventions requires an understanding of the timescales of their effect. METHODS & FINDINGS: Using a mathematical model for malaria transmission which incorporates the acquisition and loss of both clinical and parasite immunity, we explore the impact of the trade-off between reduction in exposure and decreased development of immunity on the dynamics of disease following a transmission-reducing intervention such as insecticide-treated nets. Our model predicts that initially rapid reductions in clinical disease incidence will be observed as transmission is reduced in a highly immune population. However, these benefits in the first 5-10 years after the intervention may be offset by a greater burden of disease decades later as immunity at the population level is gradually lost. The negative impact of having fewer immune individuals in the population can be counterbalanced either by the implementation of highly-effective transmission-reducing interventions (such as the combined use of insecticide-treated nets and insecticide residual sprays) for an indefinite period or the concurrent use of a pre-erythrocytic stage vaccine or prophylactic therapy in children to protect those at risk from disease as immunity is lost in the population. CONCLUSIONS: Effective interventions will result in rapid decreases in clinical disease across all transmission settings while population-level immunity is maintained but may subsequently result in increases in clinical disease many years later as population-level immunity is lost. A dynamic, evolving intervention programme will therefore be necessary to secure substantial, stable reductions in malaria transmission.
Language: English
Keywords:
AFRICA | RESEARCH REPORT | MATHEMATICAL MODEL | MALARIA | TIME FACTORS | EXPOSURE | TRANSMISSION | INTERVENTIONS | MONITORING | PROGRAM EVALUATION | Developing Countries | Theoretical Models | Research Methodology | Parasitic Diseases | Diseases | Population Dynamics | Demographic Factors | Population | Risk Factors | Health | Infections | Programs | Organization and Administration | Evaluation
Document Number: 331039

17.

Title: Monitoring HIV epidemics: declines in prevalence do not always mean good news [editorial]
Author: Hallett T
Source: AIDS. 2009 Jan 2;23(1):131-2.
Abstract: The future of HIV epidemic monitoring is likely to rely on HIV prevalence for many years to come. After years of intensive research, direct measurements of incidence in local cohort studies are becoming less and less representative of whole countries, and assays that discriminate recent infections in cross-sectional serosurveys have been shown to be unreliable in African countries without calibration. Antiretroviral therapy will add a further layer of complexity, as longer survival times will tend to increase HIV prevalence; so that upturns in epidemics may not indicate increased risk behaviour, and stable prevalence rates could mask substantial reductions in incidence. It will, therefore, be essential to make maximum use of mathematical modelling in the interpretation of trends in HIV prevalence. To be conservative and defensible, these modelsmust reasonably account for all other potential sources of natural changes in epidemics, so that the contribution of actual reductions in risk-if any-can be resolved. And only from that starting point, can the important investigations into the proximal and distal causes and reasons for the behaviour changes begin. (excerpt)
Language: English
Keywords:
AFRICA, SUB SAHARAN | METHODOLOGICAL STUDIES | EPIDEMIOLOGIC METHODS | MATHEMATICAL MODEL | EVALUATION INDEXES | COHORT ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | MONITORING | HIV INFECTIONS | EPIDEMIOLOGY | EPIDEMICS | RELIABILITY | VALIDITY | ERROR SOURCES | Africa | Developing Countries | Research Methodology | Theoretical Models | Quantitative Evaluation | Evaluation | Persons Living With HIV/AIDS | Viral Diseases | Diseases | Measurement | Public Health | Health
Document Number: 330256

18.

Title: Interim data monitoring to enroll higher-risk participants in HIV prevention trials.
Author: Halpern V; Obunge O; Ogunsola F; Otusanya S; Umo-Otong J; Wang CH; Mehta N
Source: BMC Medical Research Methodology. 2009;9:44.
Abstract: BACKGROUND: Lower-than-expected incidence of HIV undermines sample size calculations and compromises the power of a HIV prevention trial. We evaluated the effectiveness of interim monitoring of HIV infection rates and on-going modification of recruitment strategies to enroll women at higher risk of HIV in the Cellulose Sulfate Phase III study in Nigeria. METHODS: We analyzed prevalence and incidence of HIV and other sexually transmitted infections, demographic and sexual behavior characteristics aggregated over the treatment groups on a quarterly basis. The site investigators were advised on their recruitment strategies based on the findings of the interim analyses. RESULTS: A total of 3619 women were screened and 1644 enrolled at the Ikeja and Apapa clinics in Lagos, and at the Central and Peripheral clinics in Port Harcourt. Twelve months after study initiation, the overall incidence of HIV was less than one-third of the pre-study assumption, with rates of HIV that varied substantially between clinics. Due to the low prevalence and incidence rates of HIV, it was decided to close the Ikeja clinic in Lagos and to find new catchment areas in Port Harcourt. This strategy was associated with an almost two-fold increase in observed HIV incidence during the second year of the study. CONCLUSION: Given the difficulties in estimating HIV incidence, a close monitoring of HIV prevalence and incidence rates during a trial is warranted. The on-going modification of recruitment strategies based on the regular analysis of HIV rates appeared to be an efficient method for targeting populations at greatest risk of HIV infection and increasing study power in the Nigeria trial. TRIAL REGISTRATION: The trial was registered with the ClinicalTrials.gov registry under #NCT00120770 http://clinicaltrials.gov/ct2/show/NCT00120770.
Language: English
Keywords:
NIGERIA | RESEARCH REPORT | CLINICAL TRIALS | DATA ANALYSIS | WOMEN | RECRUITMENT ACTIVITIES | HIV INFECTIONS | INCIDENCE | PREVALENCE | MONITORING | SEXUALLY TRANSMITTED DISEASES | SEX BEHAVIOR | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Clinical Research | Research Methodology | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | Viral Diseases | Diseases | Measurement | Evaluation | Reproductive Tract Infections | Infections | Behavior
Document Number: 342632

19.

Title: Dried blood spots versus plasma for the quantification of HIV-1 RNA using the manual (PCR-ELISA) amplicor monitor HIV-1 version 1.5 assay in Yaounde, Cameroon.
Author: Ikomey GM; Atashili J; Okomo-Assoumou MC; Mesembe M; Ndumbe PM
Source: Journal of the International Association of Physicians in AIDS Care. 2009 May-Jun;8(3):181-4.
Abstract: OBJECTIVES: Considering the recent accrued need for viral load quantification in resource-limited settings, this study evaluated the use of dried blood spots (DBS) compared to plasma as a means of sample collection and storage for HIV-1 RNA quantification using a non-automated assay. METHODS: Venous blood was collected from 60 consenting HIV-1-positive patients, plasma separated within 4 hours, and stored at -20 degrees C. Venous blood, 50 microL, was blotted on 4 designated areas of Whatman filter paper and air-dried at room temperature for 2 hours. RESULTS: There was a strong statistically significant correlation between HIV-1 RNA viral load using plasma and DBS (r = .955, P < .001). On average plasma viral loads were only slightly higher than DBS viral loads (mean difference: 0.06 log(10) copies/mL). CONCLUSION: Even when using an entirely manual HIV-quantification assay, DBS may provide a reliable, cost-effective method for sample collection and storage for HIV-1 RNA quantification in resource-limited settings.
Language: English
Keywords:
CAMEROON | RESEARCH REPORT | COMPARATIVE STUDIES | PERSONS LIVING WITH HIV/AIDS | CLIENTS | HEMATOLOGIC TESTS | MONITORING | LABORATORY PROCEDURES | COST EFFECTIVENESS | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | Laboratory Examinations and Diagnoses | Examinations and Diagnoses | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Evaluation | Evaluation Indexes | Quantitative Evaluation
Document Number: 342457

20.

Title: Patterns of postnatal growth in HIV-infected and HIV-exposed children.
Author: Isanaka S; Duggan C; Fawzi WW
Source: Nutrition Reviews. 2009 Jun;67(6):343-59.
Abstract: HIV infection can contribute to disturbances in both linear growth and weight gain in early childhood, with disturbances often apparent as early as 3 months of age. There is little evidence for a difference in the early growth of HIV-exposed but uninfected children compared to healthy controls. Owing to the close association of growth with immune function and clinical progression, an understanding of growth patterns may be an important tool to ensure the provision of appropriate care to HIV-infected and exposed children. Timely growth monitoring may be used to improve the clinical course and quality of life of these children.
Language: English
Keywords:
AFRICA, SUB SAHARAN | RESEARCH REPORT | LONGITUDINAL STUDIES | CHILDREN | PERSONS LIVING WITH HIV/AIDS | EXPOSURE | HIV INFECTIONS | GROWTH | CHILD DEVELOPMENT | QUALITY OF LIFE | MONITORING | BODY WEIGHT | Africa | Developing Countries | Studies | Research Methodology | Youth | Age Factors | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Risk Factors | Health | Biology | Social Welfare | Economic Factors | Evaluation | Physiology
Document Number: 342157

21.
Title: Seropositivity for Listeria monocytogenes in women with spontaneous abortion: a case-control study in Iran.
Author: Jamshidi M; Jahromi AS; Davoodian P; Amirian M; Zangeneh M; Jadcareh F
Source: Taiwanese Journal of Obstetrics and Gynecology. 2009 Mar;48(1):46-8.
Abstract: OBJECTIVE: There are many studies supporting the role of certain asymptomatic infections such as Listeria monocytogenes (L. monocytogenes) in spontaneous abortion. In some cases, latent listeriosis may complicate the pregnancy, and serologic tests can, therefore, be used to detect the disease. This study was designed to assess the relationship between seropositivity for L. monocytogenes and spontaneous abortion. MATERIALS AND METHODS: A total of 250 women with previous spontaneous abortion and a control group of 200 women with normal full-term deliveries entered the study as case and control groups, respectively. Demographic characteristics were recorded for each subject, and serum samples were obtained from all participants. All serum samples were examined using the indirect immunofluorescence antibody test for L. monocytogenes antibody. Data was analyzed using Chi-squared and t tests. RESULTS: The average age of participants was 25.6 +/- 7.6 years in cases and 25.3 +/- 6.5 years in controls. Eighty-nine (35.6%) of the cases with abortion and 35 (17.5%) of the control group were positive for L. monocytogenes antibody (p = 0.001). No relationship was observed between the number of pregnancies and infection with L. monocytogenes (p = 0.4), or between the number of previous abortions and L. monocytogenes seropositivity (p = 0.2). CONCLUSION: We suggest monitoring L. monocytogenes seroprevalence in pregnant women at high risk of threatened abortion, and further microbiological assessment of symptomatic women for detection of L. monocytogenes and insidious infection.
Language: English
Keywords:
IRAN | RESEARCH REPORT | CASE STUDIES | WOMEN | ABORTION, SPONTANEOUS | PREGNANCY | MONITORING | INFECTIONS | TESTING | Middle East | Developing Countries | Studies | Research Methodology | Demographic Factors | Population | Pregnancy Complications | Diseases | Reproduction | Evaluation | Measurement
Document Number: 342081

22.

Title: Abuse of HIV/AIDS-relief funds in Mozambique.
Author: Johnson P
Source: Lancet Infectious Diseases. 2009 Sep;9(9):523-4.
Abstract: This letter discusses the increase in corruption in Mozambique with the millions of dollars in funds from US President's Emergency Plan for AIDS Relief. It explains that the corruption results in identity theft of HIV-positive people for their benefits, prevention programme funds being pocketed, as well as an inaccurate picture of progress in HIV/AIDS prevention results.
Language: English
Keywords:
MOZAMBIQUE | CRITIQUE | HIV PREVENTION | FINANCIAL ACTIVITIES | PROGRAM ACTIVITIES | MONITORING | EVALUATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | Economic Factors | Programs | Organization and Administration
Document Number: 342724

23.

Peer Reviewed

Title: Cesarean delivery surveillance system at a maternity hospital in Kabul, Afghanistan.
Author: Kandasamy T; Merialdi M; Guidotti RJ; Betran AP; Harris-Requejo J
Source: International Journal of Gynecology and Obstetrics. 2009;104:14-17.
Abstract: Objective: To use an active facility-based maternal and newborn surveillance system to describe cesarean delivery practices and outcomes in a resource-poor setting. Methods: Using data from operating room logbooks, 392 cesarean deliveries were evaluated between April 1 and June 30 2006 at a large public maternity hospital in Kabul, Afghanistan. Results: The perinatal mortality rate was 89 per 1000 births: 57% antepartum and 37% intrapartum stillbirths. Fetuses with normal birth weight comprised 85% of intrapartum stillbirths. Obstructed labor, uterine rupture, and malpresentation accounted for more than 50% of perinatal deaths. The cesarean delivery rate was 10.2% and there were 2 maternal deaths. Conclusion: The high percentage of intrapartum stillbirths among normal birth weight fetuses suggests a need for improved labor monitoring and surgical obstetric practices. The use of a facility-based perinatal surveillance system is critical in guiding such quality assurance initiatives.
Language: English
Keywords:
AFGHANISTAN | RESEARCH REPORT | DATA COLLECTION | CESAREAN SECTION | HOSPITALS | MONITORING | OBSTETRICS | ANESTHESIA | QUALITY OF HEALTH CARE | PERINATAL MORTALITY | MATERNAL MORTALITY | FETAL DEATH | BIRTH WEIGHT | Asia, Southern | Asia | Developing Countries | Research Methodology | Obstetrical Surgery | Surgery | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Health Facilities | Evaluation | Health Services Evaluation | Program Evaluation | Programs | Organization and Administration | Mortality | Population Dynamics | Demographic Factors | Population | Body Weight | Physiology | Biology
Document Number: 340226

24.

Peer Reviewed

Title: Misclassification of first-line antiretroviral treatment failure based on immunological monitoring of HIV infection in resource-limited settings.
Author: Kantor R; Diero L; Delong A; Kamle L; Muyonga S; Mambo F; Walumbe E; Emonyi W; Chan P; Carter EJ; Hogan J; Buziba N
Source: Clinical Infectious Diseases. 2009 Aug 1;49(3):454-62.
Abstract: BACKGROUND: The monitoring of patients with human immunodeficiency virus (HIV) infection who are treated with antiretroviral medications in resource-limited settings is typically performed by use of clinical and immunological criteria. The early identification of first-line antiretroviral treatment failure is critical to prevent morbidity, mortality, and drug resistance. Misclassification of failure may result in premature switching to second-line therapy. METHODS: Adult patients in western Kenya had their viral loads (VLs) determined if they had adhered to first-line therapy for >6 months and were suspected of experiencing immunological failure (ie, their CD4 cell count decreased by 25% in 6 months). Misclassification of treatment failure was defined as a 25% decrease in CD4 cell count with a VL of <400 copies/mL. Logistic and tree regressions examined relationships between VL and 4 variables: CD4 T cell count (hereafter CD4 cell count), percentage of T cells expressing CD4 (hereafter CD4 cell percentage), percentage decrease in the CD4 T cell count (hereafter CD4 cell count percent decrease), and percentage decrease in the percentage of T cells expressing CD4 (hereafter CD4% percent decrease). RESULTS: There were 149 patients who were treated for 23 months; they were identified as having a 25% decrease in CD4 cell count (from 375 to 216 cells/microL) and a CD4% percent decrease (from 19% to 15%); of these 149 patients, 86 (58%) were misclassified as having experienced treatment failure. Of 42 patients who had a 50% decrease in CD4 cell count, 18 (43%) were misclassified. In multivariate logistic regression, misclassification odds were associated with a higher CD4 cell count, a shorter duration of therapy, and a smaller CD4% percent decrease. By combining these variables, we may be able to improve our ability to predict treatment failure. CONCLUSIONS: Immunological monitoring as a sole indicator of virological failure would lead to a premature switch to valuable second-line regimens for 58% of patients who experience a 25% decrease in CD4 cell count and for 43% patients who experience a 50% decrease in CD4 cell count, and therefore this type of monitoring should be reevaluated. Selective virological monitoring and the addition of indicators like trends CD4% percent decrease and duration of therapy may systematically improve the identification of treatment failure. VL testing is now mandatory for patients suspected of experiencing first-line treatment failure within the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya, and should be considered in all resource-limited settings.
Language: English
Keywords:
KENYA | RESEARCH REPORT | CLASSIFICATION | STATISTICAL REGRESSION | ADULTS | CLIENTS | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | IMMUNOLOGICAL EFFECTS | MONITORING | ANTIRETROVIRAL DRUGS | TIME FACTORS | DRUG RESISTANCE | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Research Methodology | Data Analysis | Age Factors | Population Characteristics | Demographic Factors | Population | Program Activities | Programs | Organization and Administration | HIV Infections | Viral Diseases | Diseases | HIV | Immunity | Immune System | Physiology | Biology | Evaluation | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Population Dynamics
Document Number: 342630

25.

Peer Reviewed

Title: Fourteen years of surveillance of HIV-1 prevalence among pregnant women attending antenatal care clinics in western Uganda.
Author: Kipp W; Chapman E; Jhangri GS; Veugelers P; Kilian A; Rubaale T; Kabagambe G
Source: International Journal of STD and AIDS. 2009 Jul;20(7):499-502.
Abstract: This study monitored long-term temporal trends in HIV-1 prevalence in antenatal clinic attendees living in western Uganda. Semi-annual data collection was done from 1991 to 2004. For each woman the following data were recorded: HIV-1 status, age, educational status, marital status, occupation and parity. The results show that the overall HIV-1 prevalence was 15.3% during the entire time period (urban 21.3%, semi-urban 12.7% and rural 7.1%). Between 1991 and 2004, we observed a gradual decline in the HIV-1 prevalence. The decline was most pronounced in urban women aged 15-19 years old and least pronounced in rural women aged 20-24 years. Women above 25 years of age did not show any decline in HIV-1 prevalence over time. The declining HIV-1 prevalence in the younger age groups (15-24 years) likely represents a declining risk for acquiring HIV infection as we have previously shown in the urban sub-sample of this data set.
Language: English
Keywords:
UGANDA | RESEARCH REPORT | SAMPLING STUDIES | DATA ANALYSIS | PREGNANT WOMEN | HIV INFECTIONS | PREVALENCE | ANTENATAL CARE | MONITORING | AGE FACTORS | TIME FACTORS | Africa, Eastern | Africa, Sub Saharan | Africa | Developing Countries | Studies | Research Methodology | Population Characteristics | Demographic Factors | Population | Viral Diseases | Diseases | Measurement | Maternal Health Services | Maternal-Child Health Services | Primary Health Care | Health Services | Delivery of Health Care | Health | Evaluation | Population Dynamics
Document Number: 342826

26.
Peer Reviewed

Title: Marked increase in child survival after four years of intensive malaria control.
Author: Kleinschmidt I; Schwabe C; Benavente L; Torrez M; Ridl FC; Segura JL; Ehmer P; Nchama GN
Source: American Journal of Tropical Medicine and Hygiene. 2009 Jun;80(6):882-8.
Abstract: In malaria-endemic countries in Africa, a large proportion of child deaths are directly or indirectly attributable to infection with Plasmodium falciparum. Four years after high coverage, multiple malaria control interventions were introduced on Bioko Island, Equatorial Guinea, changes in infection with malarial parasites, anemia, and fever history in children were estimated and assessed in relation to changes in all-cause under-5 mortality. There were reductions in prevalence of infection (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.2-0.46), anemia (OR = 0.11, 95% CI = 0.07-0.18), and reported fevers (OR = 0.41, 95% CI = 0.22-0.76) in children. Under-5 mortality fell from 152 per 1,000 births (95% CI = 122-186) to 55 per 1,000 (95% CI = 38-77; hazard ratio = 0.34 [95% CI = 0.23-0.49]). Effective malaria control measures can dramatically increase child survival and play a key role in achieving millennium development goals.
Language: English
Keywords:
EQUATORIAL GUINEA | RESEARCH REPORT | SAMPLING STUDIES | CHILD SURVIVAL | INTERVENTIONS | MALARIA PREVENTION | ANTIMALARIAL DRUGS | PESTICIDES | BED NETS | IEC | MONITORING | CHILD MORTALITY | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Studies | Research Methodology | Survivorship | Length of Life | Mortality | Population Dynamics | Demographic Factors | Population | Programs | Organization and Administration | Malaria | Parasitic Diseases | Diseases | Ingredients and Chemicals | Parasite Control | Public Health | Health | Program Activities | Evaluation
Document Number: 341764

27.

Peer Reviewed

Title: Low levels of antiretroviral-resistant HIV infection in a routine clinic in Cameroon that uses the World Health Organization (WHO) public health approach to monitor antiretroviral treatment and adequacy with the WHO recommendation for second-line treatment.
Author: Kouanfack C; Montavon C; Laurent C; Aghokeng A; Kenfack A; Bourgeois A; Koulla-Shiro S; Mpoudi-Ngole E; Peeters M; Delaporte E
Source: Clinical Infectious Diseases. 2009 May 1;48(9):1318-22.
Abstract: A cross-sectional study, performed at a routine human immunodeficiency virus (HIV)/AIDS clinic in Cameroon that uses the World Health Organization public health approach, showed low rates of virological failure and drug resistance at 12 and 24 months after initiation of antiretroviral therapy. Importantly, the cross-sectional study also showed that the World Health Organization recommendation for second-line treatment would be effective in almost all patients with HIV drug resistance mutations.
Language: English
Keywords:
CAMEROON | RESEARCH REPORT | SUMMARY REPORT | EPIDEMIOLOGIC METHODS | CLINICAL RESEARCH | CROSS SECTIONAL ANALYSIS | PERSONS LIVING WITH HIV/AIDS | PREVALENCE | DRUG RESISTANCE | ANTIRETROVIRAL THERAPY | HIV INFECTIONS | WHO | MONITORING | STANDARDIZATION | CHROMOSOME ABNORMALITIES | Developing Countries | Africa, Western | Africa, Sub Saharan | Africa | Research Methodology | Viral Diseases | Diseases | Measurement | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | HIV | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Evaluation | Data Adjustment | Neonatal Diseases and Abnormalities
Document Number: 341154

28.

Peer Reviewed

Title: Weight gain at 3 months of antiretroviral therapy is strongly associated with survival: evidence from two developing countries.
Author: Madec Y; Szumilin E; Genevier C; Ferradini L; Balkan S; Pujades M; Fontanet A
Source: AIDS. 2009 Apr 27;27(7):853-61.
Abstract: BACKGROUND: In developing countries, access to laboratory tests remains limited, and the use of simple tools such as weight to monitor HIV-infected patients treated with antiretroviral therapy should be evaluated. METHODS: Cohort study of 2451 Cambodian and 2618 Kenyan adults who initiated antiretroviral therapy between 2001 and 2007. The prognostic value of weight gain at 3 months of antiretroviral therapy on 3-6 months mortality, and at 6 months on 6-12 months mortality, was investigated using Poisson regression. RESULTS: Mortality rates [95% confidence interval (CI)] between 3 and 6 months of antiretroviral therapy were 9.9 (7.6-12.7) and 13.5 (11.0-16.7) per 100 person-years in Cambodia and Kenya, respectively. At 3 months, among patients with initial body mass index less than or equal to 18.5 kg/m (43% of the study population), mortality rate ratios (95% CI) were 6.3 (3.0-13.1) and 3.4 (1.4-8.3) for those with weight gain less than or equal to 5 and 5-10%, respectively, compared with those with weight gain of more than 10%. At 6 months, weight gain was also predictive of subsequent mortality: mortality rate ratio (95% CI) was 7.3 (4.0-13.3) for those with weight gain less than or equal to 5% compared with those with weight gain of more than 10%. CONCLUSION: Weight gain at 3 months is strongly associated with survival. Poor compliance or undiagnosed opportunistic infections should be investigated in patients with initial body mass index less than or equal to 18.5 and achieving weight gain less than or equal to 10%.
Language: English
Keywords:
CAMBODIA | KENYA | RESEARCH REPORT | STATISTICAL REGRESSION | ADULTS | PERSONS LIVING WITH HIV/AIDS | CLIENTS | ANTIRETROVIRAL THERAPY | MONITORING | BODY WEIGHT | MORTALITY | Developing Countries | Asia, Southeastern | Asia | Africa, Eastern | Africa, Sub Saharan | Africa | Data Analysis | Research Methodology | Age Factors | Population Characteristics | Demographic Factors | Population | HIV Infections | Viral Diseases | Diseases | Program Activities | Programs | Organization and Administration | HIV | Evaluation | Physiology | Biology | Population Dynamics
Document Number: 341950

29.

Title: A review of the evidence developed for a technical consultation on expanding access to injectable contraception.
Author: Malarcher S
Source: [Research Triangle Park, North Carolina], Family Health International [FHI], 2009 Jun. 48 p.
Abstract: The document was prepared to facilitate deliberations for the Technical Consultation on Expanding Access to Injectable Contraceptives sponsored by the World Health Organization, the United States Agency for International Development, and Family Health International, scheduled to be held from 15-17 June 2009 in Geneva, Switzerland. This document summarizes the results of a literature review conducted to identify research evidence and program experience relevant to the objectives of the Technical Consultation: To review systematically the evidence and programmatic experience on interventions designed to expand access to / provision of contraceptive injectables, focusing on non clinic-based services and programs; To reach conclusions on issues: (a) for which evidence is consistent and strong; (b) for which evidence is mixed; and (c) for which evidence is marginal or entirely lacking and, thus requires additional research; To document discussions and conclusions of the Consultation, including policy and program implications, and to disseminate these widely. Use of community-based injectable services was significant in all studies reviewed. This evidence suggests that community-based delivery of injectable services by CHW is acceptable in a wide variety of settings. (Excerpts)
Language: English
Keywords:
GLOBAL | LITERATURE REVIEW | WHO | INJECTABLES | DEPO-PROVERA | NEEDS | SAFETY | CONTRACEPTIVE USAGE | PROGRAM ACCESSIBILITY | CONTRACEPTION CONTINUATION | CONTRACEPTIVE AGENTS, SIDE EFFECTS | TRAINING ACTIVITIES | COUNSELING | MONITORING | UN | International Agencies | Organizations | Political Factors | Sociocultural Factors | Contraceptive Methods | Contraception | Family Planning | Medroxyprogesterone Acetate | Contraceptive Agents, Progestin | Contraceptive Agents, Female | Contraceptive Agents | Economic Factors | Public Health | Health | Program Evaluation | Programs | Organization and Administration | Training Programs | Education | Clinic Activities | Program Activities | Evaluation
Document Number: 331835

30.

Peer Reviewed

Title: Viraemia and HIV-1 drug resistance mutations among patients receiving antiretroviral treatment in Mozambique.
Author: Maldonado F; Biot M; Roman F; Masquelier C; Anapenge M; Bastos R; Chuquela HC; Arendt V; Schmit JC; Zachariah R
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene. 2009 Jun;103(6):607-12.
Abstract: This study was conducted among individuals taking first-line antiretroviral treatment (ART) for at least 12 months under programme conditions in Maputo, Mozambique in order to report on the level of detectable viraemia and the proportion and types of drug resistance mutations among those with detectable viral loads. HIV-1 RNA viral load levels (lower detection limit <50 copies/ml) were measured, and resistance mutations were sequenced. One hundred and forty-nine consecutive patients (69% females, median age 36 years) were included after a mean follow-up time of 23 months. One hundred and seven (72%; 95% CI 64-79) had undetectable viral load, while in 42 (28%, 95% CI 21-36) viral load was detectable (range 50-58884 copies/ml). From 15 patients with viral load >1000 copies/ml, 12 viruses were sequenced: eight were C subtypes and four were circulating recombinant forms (CRF08). Eight (5%; 95% CI 2-9) patients with detectable viral load had one or more major resistance mutations. Nucleoside reverse transcriptase inhibitor (NRTI) and non-NRTI mutations were observed. There were no major mutations for resistance to protease inhibitors. In Maputo, the level of detectable viraemia is reassuringly low. While embarking on ART scale-up, wider surveillance is warranted to monitor programme quality and limit the development of drug resistance, which remains a major potential challenge for the future of ART in Africa.
Language: English
Keywords:
MOZAMBIQUE | RESEARCH REPORT | PERSONS LIVING WITH HIV/AIDS | ANTIRETROVIRAL THERAPY | ANTIRETROVIRAL DRUGS | USER COMPLIANCE | HIV | DRUG RESISTANCE | MONITORING | PROGRAM EVALUATION | Africa, Southern | Africa, Sub Saharan | Africa | Developing Countries | HIV Infections | Viral Diseases | Diseases | Treatment | Medical Procedures | Medicine | Health Services | Delivery of Health Care | Health | Behavior | Evaluation | Programs | Organization and Administration
Document Number: 342756


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