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Access to antiretroviral treatment has expanded rapidly in South Africa, making it the country in the world with the largest treatment program. As antiretroviral treatment coverage continues to rise in resource-constrained settings, effective community-based adherence support interventions are of central importance in ensuring the long-term sustainability of treatment. This paper reports the findings from a randomized control trial of a peer adherence and nutritional support program implemented in a public health care setting in South Africa's antiretroviral treatment program. The analysis assesses the impact of these peer adherence and nutritional support interventions on self-reported adherence, timeliness of clinic and hospital visits, and immunologic response to antiretroviral treatment. Peer adherence and nutritional support improved the timeliness of adults' clinic and hospital visits for routine follow-up while on antiretroviral treatment. Peer adherence support impacted positively on immunologic response to antiretroviral treatment. Scale-up of effective and sustainable community-based, peer-driven adherence and nutritional support interventions should form part of the United Nations AIDS Treatment 2.0 strategy's community mobilization and health system strengthening pillar.
As access to antrietroviral medicines (ARVs) becomes assured, the world needs to place equal effort in ensuring that every antiretroviral therapy (ART) patient receives adequate adherence support. Adherence, the extent to which patients follow the instructions they are given for prescribed treatments, is important, as only through uninterrupted treatment are patients likely to receive sufficient medicine and prevent the generation of drug-resistance. The authors of this book report on the experiences from successful treatment programmes in three countries in sub-Saharan Africa at the forefront of the roll-out of ARVs. The voices of the patients, their families, community members and the health workers who care for them have been reported faithfully. They speak of the impact of ART on their daily lives and of the key challenges involved in sustaining the necessary high level of adherence to treatment. Their real life experience is valid and needs to be considered by health programme managers who are planning the expansion of ARV treatment programmes.
This second edition of the book provides up-to-date information on new drugs, new proven HIV prevention interventions, a new chapter on positive prevention, and current HIV epidemiology. This definitive text covers all aspects of HIV/AIDS in South Africa, from basic science to medicine, sociology, economics and politics. It has been written by a highly respected team of South African HIV/AIDS experts and provides a thoroughly researched account of the epidemic in the region.
These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.
Annotation A report from the front lines of the war against the most deadly epidemics of our times, by a physician-anthropolpgist who has for over 15 years sought to serve the poor of rural Haiti and other settings in the Americas.
When working with countries to measure and compare health systems functioning, it is important to strike a good balance between avoiding blueprints that do not allow for country contexts and specificities while also encouraging a degree of standardization that enables comparisons within and between countries as well as over time. Standardized indicators allow comparisons between countries and can help mutual learning, including the identification of bottlenecks and the sharing of lessons learned. This handbook does not attempt to cover all components of the health system or deal with the various monitoring and evaluation frameworks. Instead, it is structured around the WHO framework that describes health systems in terms of six core components or "building blocks": service delivery, health workforce, health information systems, medical products, vaccines and technologies, financing and leadership/governance. The selection of indicators was guided by the need to detect change and show progress in health systems strengthening. Indicators relate to both the level and distribution of inputs and outputs. While the focus is on low- and middle-income countries, experiences from high-income countries are also used to guide the development of measurement systems. Each section has proposed core indicators that all countries are encouraged to collect, plus a wider set of indicators that users can choose or modify as needed. It is anticipated that the core indicators will enable the production of country "dashboards" that contain the instruments by which health systems trends can be regularly monitored and compared. Countries should integrate new indicators with existing indicators of their health sector and statistical strategies and plans. Health systems monitoring should also be seen in the context of the indicators' impact on access to priority health services and their contribution to reaching the Millennium Development Goals (MDGs). The handbook is divided into six sections, each of which covers one health system component or building block and is set out along the following lines: -introduction to the component and related indicators; -description of possible sources of information and available measurement strategies; -proposed "core indicators", supplemented, where necessary, by additional indicators that may be used depending on the country health system attributes and needs.
Ten years in public health 2007-2017 chronicles the evolution of global public health over the decade that Margaret Chan served as Director-General at the World Health Organization. This series of chapters evaluates successes setbacks and enduring challenges during the decade. They show what needs to be done when progress stalls or new threats emerge. The chapters show how WHO technical leadership can get multiple partners working together in tandem under coherent strategies. The importance of country leadership and community engagement is stressed repeatedly throughout the chapters. Together we have made tremendous progress. Health and life expectancy have improved nearly everywhere. Millions of lives have been saved. The number of people dying from malaria and HIV has been cut in half. WHO efforts to stop TB saved 49 million lives since the start of this century. In 2015 the number of child deaths dropped below 6 million for the first time a 50% decrease in annual deaths since 1990. Every day 19 000 fewer children die. We are able to count these numbers because of the culture of measurement and accountability instilled in WHO. These chapters tell a powerful story of global challenges and how they have been overcome. In a world facing considerable uncertainty international health development is a unifying – and uplifting – force for the good of humanity.
This stimulating open access volume details the innovative work of the Pan Institution Network for Global Health in creating collaborative research-based answers to large-scale health issues. Equitable partnerships among member universities representing North America, Africa, Asia, and Europe reverse standard cross-national dynamics to develop locally relevant responses to health challenges as well as their underlying disparities. Case studies focusing on multiple morbidities and effects of urbanization on health illustrate open dialogue in addressing HIV, maternal/child health, diabetes, and other major concerns. These instructive examples model collaborations between global North and South as meaningful steps toward the emerging global future of public health. Included in the coverage: Building sustainable networks: introducing the Pan Institution Network for Global Health Fostering dialogues in global health education: a graduate and undergraduate approach Provider workload and multiple morbidities in the Caribbean and South Africa Project Redemption: conducting research with informal workers in New York City Partnership and collaboration in global health: valuing reciprocity Global Health Collaboration will interest faculty working within the field of global health; scholars within public health, health policy, and cognate disciplines; as well as administrators looking to develop international university partnerships around global health and graduate students in the areas of global health, health administration, and public health and related social sciences (e.g., sociology, anthropology, demography).