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Mortality rates are high in antiretroviral therapy (ART) programmes in sub-Saharan Africa, especially during the first few months of treatment. Tuberculosis (TB) has been identified as a major underlying cause. Under routine programme conditions, between 5 and 40% of adult patients enrolling in ART services have a baseline diagnosis of TB. There is also a high TB incidence during the first few months of ART (much of which is prevalent disease missed by baseline screening) and long-term rates remain several-folds higher than background. We identify three groups of patients entering ART programmes for which different interventions are required to reduce TB-related deaths. First, diagnostic screening is needed in patients who have undiagnosed active TB so that timely anti-TB treatment can be started. This may be greatly facilitated by new diagnostic assays such as the Xpert MTB/RIF assay. Second, patients with a diagnosis of active TB need optimized case management, which includes early initiation of ART (with timing now defined by randomized controlled trials), trimethoprim-sulphamethoxazole prophylaxis and treatment of comorbidity. Third, all remaining patients who are TB-free at enrolment have high ongoing risk of developing TB and require preventive interventions, including optimized immune recovery (with ART ideally started early in the course of HIV infection), isoniazid preventive therapy and infection control to reduce infection risk. Further specific measures are needed to address multidrug-resistant TB (MDR-TB). Finally, scale-up of all these interventions requires nationally and locally tailored models of care that are patient-centred and provide integrated healthcare delivery for TB, HIV and other comorbidities.

Background and method: A cohort study using secondary data assessed associations between baseline characteristics and psychological sessions attended in young persons discharged from a Children and Young People's Mental Health Service in 2019. Results: There were 584 persons who attended a median of seven sessions. On multivariable regression analysis, males attended fewer sessions than females, young people from more affluent communities attended more sessions than those from poorer communities and those presenting with eating disorders and self‐harm in particular attended more sessions than those with anxiety. Conclusions: Addressing why these associations occur may improve mental health care in young persons. [ABSTRACT FROM AUTHOR]

Problem In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment. Approach In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme. Local setting Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics. Relevant changes By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system. Lessons learnt Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines. Probleme Au Malawi, en raison des contraintes du systeme de sante, seule une petite partie des personnes atteintes du virus de l'immunodeficience humaine (VIH) ayant besoin d'un traitement antiretroviral (TAR) immediat pouvaient en beneficier. Approche En 2004, le ministere de la Sante a lance des plans visant a elargir l'acces aux TAR dans tout le pays et a assurer l'accessibilite geographique equitable de ces traitements. La demarche s'est axee sur la sante publique, avec des formations et des traitements standardises ainsi qu'une supervision et un controle reguliers du programme. Environnement local Avant cette initiative, le Malawi comptait environ 930 000 personnes atteintes du VIH, dont 170 000 qui avaient besoin d'un TAR immediat. Environ 3000 patients etaient sous TAR, dans neuf cliniques. Changements significatifs En decembre 2015, au total, 872 567 patients avaient debute un TAR dans 716 cliniques, suivant les protocoles nationaux de traitement et dans le cadre du systeme normalise de suivi. Lecons tirees La forte mobilisation nationale a permis au ministere de la Sante de mettre en place un systeme uniformise afin d'elargir l'acces aux TAR et a fourni des points de reference pour sa mise en oeuvre sur le terrain. Les nouveaux systemes de formation du personnel et d'accreditation des etablissements de sante ont permis de partager les taches et de les decentraliservers les centres de sante peripheriques, tout en adoptant une demarche standardisee pour le commencement et le suivi des TAR. Les stocks de medicaments dans les etablissements ainsi que le respect des directives nationales en matiere de traitements ont ete assures grace a un systeme de supervision et de controle trimestriels qui integrait des aspects de recherche operationnelle. Situacion Las restricciones del sistema sanitario en Malawi dieron lugar a que unicamente una fraccion de las personas afectadas por el virus de la inmunodeficienda humana (VIH) con necesidades inmediatas de obtener un tratamiento antirretroviral (TAR) recibiera tratamiento. Enfoque En 2004, el Ministerio de Sanidad de Malawi lanzo planes para aumentar los TAR en todo el pais, adhiriendose al principio de equidad para garantizar el acceso geografico justo a la terapia. Se utilizo un enfoque de salud publica con una formacion y tratamiento estandarizados, asi como la supervision y control habituales del programa. Marco regional Antes del aumento, habia alrededor de 930 000 personas infectadas con VIH en Malawi, 170 000 de ellas con una necesidad inmediata de obtener TAR. Alrededor de 3 000 pacientes recibieron TAR en nueve clinicas. Cambios importantes En diciembre de 2015, de forma acumulativa, 872 567 pacientes comenzaron con TAR en 716 clinicas, siguiendo los protocolos de tratamiento nacionales y utilizando el sistema de supervision estandar. Lecciones aprendidas Un fuerte liderazgo nacional permitio al ministerio de sanidad implementar un sistema uniforme para aumentar los TAR y ofrecio referencias para su implementacion en el terreno. Los nuevos sistemas de formacion del personal y acreditacion de instalaciones sanitarias permitieron el reparto de tareas y la descentralizacion a los centros sanitarios perifericos, asi como un enfoque estandarizado para comenzar y supervisar los TAR. El sistema de supervision y control trimestral, al que se Incorporo una investigacion operativa, garantizo reservas de medicamentos en las instalaciones y el cumplimiento de las directrices nacionales para el tratamiento., Introduction Malawi is a low-income country with an estimated population of 16 million in 2012. (1) In 2004, approximately 930 000 Malawians were thought to be infected with human immunodeficiency [...]

Background: Nutrition education is used as a way of promoting lifelong healthy eating practices among school adolescents. There is limited published information on the impact of nutrition education programmes in India. Objectives: To assess the knowledge and practices of high school students with respect to healthy diets before and after a nutrition education programme. Design: Pre- and post-intervention questionnaire survey. Setting: Two private schools in Chennai city. Method: This study was conducted among adolescents studying in standard VIII and IX in two private schools in Chennai city. Nutrition education as lectures and interactive discussions were given to students one hour every week for a period of 10 weeks. Information on knowledge and attitude on healthy eating and dietary practices was collected before and after the nutrition education intervention using a questionnaire. Differences in knowledge, attitude and practice of students on healthy diet were measured using the chi[superscript 2] test with the level of significance "p" < 0.05. Results: A total of 181 students were involved in the study (response rate 92%). Following the nutrition education programme, satisfactory dietary knowledge significantly improved from 37% to 67% ("p" < 0.001). Similarly, students showing a positive attitude towards healthy diet increased from 18% to 40% ("p" < 0.001). The proportion of students taking soft drinks reduced from 20% to 10% ("p" < 0.01) and ingestion of fast food items through fast food restaurants reduced significantly. Conclusions: This short-term nutrition education programme brought significant improvements in dietary knowledge and reductions in soft drinks and fast foods consumption.