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Aunque se han hecho avances en el desarrollo y aplicación a gran escala de intervenciones eficaces contra la obesidad infantil, los retos siguen siendo importantes. Nuestro objetivo era comprender las causas del éxito de Estados Unidos y los países latinoamericanos en la implementación de políticas y programas (PYP) contra la obesidad e identificar oportunidades de mejora aplicando los principios de la ciencia de la implementación. Seleccionamos tres estudios de comparación de casos: (1) el etiquetado frontal en los envases de alimentos (México y Chile), (2) los programas de calles abiertas y calles para el juego (Colombia y Estados Unidos) y (3) la Iniciativa Hospital Amigo de los Niños (IHAN) (Brasil y Estados Unidos). Resumimos la información obtenida a través de diversas fuentes (publicaciones científicas, bibliografía gris y entrevistas a informadores clave) para describir las barreras, facilitadores y avances de las PYP en todas las dimensiones del marco RE-AIM. Una campaña de promoción basada en evidencias, junto con la voluntad de los poderes políticos y las evidencias sobre su impacto y sobre la posibilidad de implementarlas a mayor escala, fueron las claves del éxito del lanzamiento y aplicación de las PYP. Su diseño e implementación debían adaptarse a los distintos contextos. Se necesitan herramientas más potentes que permitan monitorear y evaluar los procesos y sus resultados, y también hacer un seguimiento de los indicadores de equidad para maximizar los beneficios de las PYP en la población. La ciencia de la implementación ofrece una importante contribución para cubrir lagunas de conocimiento y abrir un diálogo que mejore las políticas contra la obesidad. También ayudará a trasladar las lecciones aprendidas al resto del continente para que puedan utilizarse con fines de investigación y evaluación tanto durante la fase de desarrollo de las PYP como durante su aplicación y mantenimiento.

Introduction Adolescent HIV prevention and treatment is a high priority for youth healthcare in sub-Saharan Africa. Methods This study employed concept mapping to identify factors that impact the implementation of HIV prevention and intervention programs for adolescents in sub-Saharan Africa. Key stakeholders including researchers, policymakers, and non-governmental organization (NGO) personnel constituting membership of the NIH-sponsored Adolescent HIV Prevention and Treatment Implementation Science Alliance responded to the question: “In your experience, what factors have facilitated or hindered implementation of evidence-based HIV prevention or treatment for adolescents in sub-Saharan Africa?” Participants generated statements in response to the focus question, sorted them into thematically relevant groups, and rated each statement on its importance and changeability. Results Through data analyses and participant feedback, 15 distinct themes were derived. “Workforce/Workflow” and “HIV Stigma and Adolescent Development” were rated highest for importance, and “Threshold Conditions for Treatment” and “Structure of Implementation Efforts” were rated most changeable. Conclusions Understanding implementation science determinants and mechanisms can facilitate the uptake of successful implementation and sustainment strategies for the prevention and treatment of HIV in a given context. We placed determinants and mechanisms within the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to provide greater contextual integration with broader theories in implementation science. Implementers across multiple disciplines can use these findings to improve the scale-up of evidence-based practices for adolescent HIV prevention and treatment in sub-Saharan Africa. Implementation approaches that consider the determinants and mechanisms identified in this study and integrated in implementation frameworks will likely have utility for other health conditions and contexts.

Introduction HIV continues to devastate the adolescent population in sub‐Saharan Africa (SSA). The complex array of interpersonal, social, structural and system‐level obstacles specific to adolescents have slowed progress in prevention and treatment of HIV in this population. The field of implementation science holds promise for addressing these challenges. Discussion There is growing consensus that enhanced interactions between researchers and users of scientific evidence are important and necessary to tackle enduring barriers to implementation. In 2017, the Fogarty International Center launched the Adolescent HIV Prevention and Treatment Implementation Science Alliance (AHISA) to promote communication and catalyse collaboration among implementation scientists and implementers to enhance the cross‐fertilization of insights as research advances and the implementation environment evolves. This network has identified key implementation science questions for adolescent HIV, assessed how members’ research is addressing them, and is currently conducting a concept mapping exercise to more systematically identify implementation research priorities. In addition, AHSA pinpointed common challenges to addressing these questions and discussed their collective capacity to conduct implementation science using the shared learning approach of the network. Specifically, AHISA addresses challenges related to capacity building, developing mentorship, engaging stakeholders, and involving adolescents through support for training efforts and funding region‐/country‐specific networks that respond to local issues and increase implementation science capacity across SSA. Conclusions Innovative platforms, like AHISA, that foster collaborations between implementation science researchers, policymakers and community participants to prioritizes research needs and identify and address implementation challenges can speed the translation of effective HIV interventions to benefit adolescent health.

Objective The remarkable progress made in confronting the global HIV epidemic offers a unique opportunity to address the increasing threat of noncommunicable diseases (NCDs). However, questions remain about how to enhance the HIV platforms to deliver integrated HIV and NCD care to people living with HIV (PLHIV) in sub-Saharan Africa (SSA). We aimed to develop a priority research agenda to advance this effort. Methods Researchers, policymakers, and implementers from the United States and SSA conducted three scoping reviews on HIV/NCD prevention and care focused on clinical, health system, and community levels. Based on the review findings and expert inputs, we conducted iterative consensus-development activities to generate a prioritized research agenda. Results Population-level data on NCD prevalence among PLHIV in SSA are sparse. The review identified NCD screening and management approaches that could be integrated into HIV programs in SSA. However, few studies focused on the effectiveness, cost, and best practices for integrated chronic care platforms, making it difficult to derive policy recommendations. To address these gaps, we propose a prioritized research agenda focused on developing evidence-based service delivery models, increasing human capacity through workforce education, generating data through informatics platforms and research, managing the medication supply chain, developing new financing and sustainability models, advancing research-informed policy, and addressing other crosscutting health system issues. Conclusion Based on collaborative, interdisciplinary efforts, a research agenda was developed to provide guidance that advances efforts to adapt the current health system to deliver integrated chronic care for PLHIV and the population at large.

OBJECTIVE: To appropriately identify and treat noncommunicable diseases (NCDs) among persons living with HIV (PLHIV) in low-and-middle-income countries (LMICs), it is imperative to understand the burden of NCDs among PLHIV in LMICs and the current management of the diseases. DESIGN: Systematic review and meta-analysis. METHODS: We examined peer-reviewed literature published between 1 January 2010 and 31 December 2016 to assess currently available evidence regarding HIV and four selected NCDs (cardiovascular disease, cervical cancer, depression, and diabetes) in LMICs with a focus on sub-Saharan Africa. The databases, PubMed/MEDLINE, Cochrane Review, and Scopus, were searched to identify relevant literature. For conditions with adequate data available, pooled estimates for prevalence were generated using random fixed effects models. RESULTS: Six thousand one hundred and forty-three abstracts were reviewed, 377 had potentially relevant prevalence data and 141 were included in the summary; 57 were selected for quantitative analysis. Pooled estimates for NCD prevalence were hyper-tension 21.2% (95% CI 16.3–27.1), hypercholesterolemia 22.2% (95% CI 14.7–32.1), elevated low-density lipoprotein 23.2% (95% CI 15.2–33.6), hypertriglyceridemia 27.2% (95% CI 20.7–34.8), low high-density lipoprotein 52.3% (95% CI 35.6–62.8), obesity 7.8% (95% CI 4.3–13.9), and depression 24.4% (95% CI 12.5–42.1). Invasive cervical cancer and diabetes prevalence were 1.3–1.7 and 1.3–18%, respectively. Few NCD-HIV integrated programs with screening and management approaches that are contextually appropriate for resource-limited settings exist. CONCLUSION: Improved data collection and surveillance of NCDs among PLHIV in LMICs are necessary to inform integrated HIV/NCD care models. Although efforts to integrate care exist, further research is needed to optimize the efficacy of these programs.

To synthesize published literature on noncommunicable disease (NCD) behavior change communication (BCC) interventions in sub-Saharan Africa (SSA) among persons living with HIV (PLHIV) and in the general population to inform efforts to adopt similar HIV and NCD BCC intervention activities.We conducted a literature review of NCD BCC interventions and included 20 SSA-based studies. Inclusion criteria entailed describing a BCC intervention targeting any four priority NCDs (cardiovascular disease, type 2 diabetes, cervical cancer, and depression) or both HIV and any of the NCDs. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework was used to assess potential public health impact of these studies. We also solicited expert opinions from 10 key informants on the topic of HIV/NCD health promotion in five SSA countries.The BCC interventions reviewed targeted multiple parts of the HIV and NCD continuum at both individual and community levels. Various strategies (i.e. health education, social marketing, motivational interviewing, mobile health, and peer support) were employed. However, few studies addressed more than one dimension of the RE-AIM framework. Opinions solicited from the key informants supported the feasibility of integrating HIV and NCD BCC interventions in SSA potentially improving access, service provision and service demand, especially for marginalized and vulnerable populations.Although HIV/NCD integration can improve effectiveness of preventive services at individual and community levels, potential public health impact of such approaches remain unknown as reach, adoptability, and sustainability of both integrated and nonintegrated NCD BCC approaches published to date have not been well characterized.

Objective To describe available models of HIV and noncommunicable disease (NCD) care integration in sub-Saharan Africa (SSA). Design Narrative review of published articles describing various models of HIV and NCD care integration in SSA. Results We identified five models of care integration across various SSA countries. These were integrated community-based screening for HIV and NCDs in the general population; screening for NCDs and NCD risk factors among HIV patients enrolled in care; integration of HIV and NCD care within clinics; differentiated care for patients with HIV and/or NCDs; and population healthcare for all. We illustrated these models with descriptive case studies highlighting the lessons learned and evidence gaps from the various models. Conclusion Leveraging existing HIV infrastructure for NCD care is feasible with various approaches possible depending on available program capacity. Process and clinical outcomes for existing models of care integration are not yet described but are urgently required to further advise policy decisions on HIV/NCD care integration.

Background: In Haiti and other countries, large-scale investments in school feeding programs have been made with marginal evidence of nutrition outcomes. Objective: We aimed to examine the effectiveness of a fortified ready-to-use supplementary food (RUSF), Mamba, on reduced anemia and improved body composition in school-aged children compared to an unfortified cereal bar, Tablet Yo, and control groups. Methods: A cluster, randomized trial with children ages 3‐13 y (n = 1167) was conducted in the north of Haiti. Six schools were matched and randomized to the control group, Tablet Yo group (42 g, 165 kcal), or Mamba group (50 g, 260 kcal, and >75% of the RDA for critical micronutrients). Children in the supplementation groups received the snack daily for 100 d, and all were followed longitudinally for hemoglobin concentrations, anthropometry, and bioelectrical impedance measures: baseline (December 2012), midline (March 2013), and endline (June 2013). Parent surveys were conducted at baseline and endline to examine secondary outcomes of morbidities and dietary intakes. Longitudinal regression modeling using generalized least squares and logit with random effects tested the main effects. Results: At baseline,14.0%of children werestunted, 14.5% underweight, 9.1% thin, and73% anemic. Fat masspercentage (mean 6 SD) was 8.1% 6 4.3% for boys and 12.5% 6 4.4% for girls. In longitudinal modeling, Mamba supplementation increased body mass index z score (regression coefficient 6 SEE) 0.25 6 0.06, fat mass 0.45 6 0.14 kg, and percentage fat mass 1.28% 6 0.27% compared with control at each time point (P < 0.001). Among boys, Mamba increased fat mass (regression coefficient 6 SEE) 0.73 6 0.19 kg and fat-free mass 0.62 6 0.34 kg compared with control (P < 0.001). Mamba reduced the odds of developing anemia by 28% compared to control (adjusted OR: 0.72; 95% CI: 0.57, 0.91; P

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.