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BackgroundMeasuring the incidence of HIV and hepatitis C virus (HCV) infection among people who inject drugs (PWID) is key to track progress towards elimination. We aimed to summarise global data on HIV and primary HCV incidence among PWID and associations with age and sex or gender.MethodsIn this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies among PWID by searching MEDLINE, Embase, and PsycINFO, capturing studies published between Jan 1, 2000, and Dec 12, 2022, with no language or study design restrictions. We contacted authors of identified studies for unpublished or updated data. We included studies that estimated incidence by longitudinally re-testing people at risk of infection or by using assays for recent infection. We pooled incidence and relative risk (RR; young [generally defined as ≤25 years] vs older PWID; women vs men) estimates using random-effects meta-analysis and assessed risk of bias with a modified Newcastle-Ottawa scale. This study is registered with PROSPERO, CRD42020220884.FindingsOur updated search identified 9493 publications, of which 211 were eligible for full-text review. An additional 377 full-text records from our existing database and five records identified through cross-referencing were assessed. Including 28 unpublished records, 125 records met the inclusion criteria. We identified 64 estimates of HIV incidence (30 from high-income countries [HICs] and 34 from low-income or middle-income countries [LMICs]) and 66 estimates of HCV incidence (52 from HICs and 14 from LMICs). 41 (64%) of 64 HIV and 42 (64%) of 66 HCV estimates were from single cities rather than being multi-city or nationwide. Estimates were measured over 1987-2021 for HIV and 1992-2021 for HCV. Pooled HIV incidence was 1·7 per 100 person-years (95% CI 1·3-2·3; I2=98·4%) and pooled HCV incidence was 12·1 per 100 person-years (10·0-14·6; I2=97·2%). Young PWID had a greater risk of HIV (RR 1·5, 95% CI 1·2-1·8; I2=66·9%) and HCV (1·5, 1·3-1·8; I2=70·6%) acquisition than older PWID. Women had a greater risk of HIV (RR 1·4, 95% CI 1·1-1·6; I2=55·3%) and HCV (1·2, 1·1-1·3; I2=43·3%) acquisition than men. For both HIV and HCV, the median risk-of-bias score was 6 (IQR 6-7), indicating moderate risk.InterpretationAlthough sparse, available HIV and HCV incidence estimates offer insights into global levels of HIV and HCV transmission among PWID. Intensified efforts are needed to keep track of the HIV and HCV epidemics among PWID and to expand access to age-appropriate and gender-appropriate prevention services that serve young PWID and women who inject drugs.FundingCanadian Institutes of Health Research, Fonds de recherche du Québec-Santé, Canadian Network on Hepatitis C, UK National Institute for Health and Care Research, and WHO.

Scale-up of human immunodeficiency virus (HIV) testing and antiretroviral therapy (ART) for people living with HIV has been increasing in sub-Saharan Africa. As a result, areas with high HIV prevalence are finding a declining proportion of people testing positive in their national testing programmes. In eastern and southern Africa, where there are settings with adult HIV prevalence of 12% and above, the positivity from national HIV testing services has dropped to below 5%. Identifying those in need of ART is therefore becoming more costly for national HIV programmes. Annual target-setting assumes that national testing positivity rates approximate that of population prevalence. This assumption has generated an increased focus on testing approaches which achieve higher rates of HIV positivity. This trend is a departure from the provider-initiated testing and counselling strategy used early in the global HIV response. We discuss a new indicator, treatment-adjusted prevalence, that countries can use as a practical benchmark for estimating the expected adult positivity in a testing programme when accounting for both national HIV prevalence and ART coverage. The indicator is calculated by removing those people receiving ART from the numerator and denominator of HIV prevalence. Treatment-adjusted prevalence can be readily estimated from existing programme data and population estimates, and in 2019, was added to the World Health Organization guidelines for HIV testing and strategic information. Using country examples from Kenya, Malawi, South Sudan and Zimbabwe we illustrate how to apply this indicator and we discuss the potential public health implications of its use from the national to facility level. Le depistage du virus de l'immunodeficience humaine (VIH) et le traitement antiretroviral (TAR) pour les personnes vivant avec le VIH ont connu un veritable essor en Afrique subsaharienne. Par consequent, les regions touchees par une forte prevalence du VIH detectent un pourcentage moins eleve de personnes testees positives dans leurs programmes de depistage nationaux. En Afrique orientale et australe, la ou certains endroits affichent une prevalence du VIH chez l'adulte egale ou superieure a 12%, le taux de positivite des services de depistage nationaux est passe sous la barre des 5%. Identifier les personnes necessitant un TAR devient donc plus couteux pour les programmes nationaux consacres au VIH. Pour definir les objectifs annuels, on part du principe que les taux de positivite nationaux se rapprochent du taux de prevalence au sein de la population. Cette supposition a oriente les demarches vers des methodes de depistage permettant d'obtenir des taux de positivite plus eleves; une tendance qui s'ecarte de la strategie des services de depistage et de conseil a l'initiative des prestataires, utilisee a l'aube de la lutte mondiale contre le VIH. Dans le present document, nous nous interessons a un nouvel indicateur, la prevalence ajustee sur le traitement. Cet indicateur peut servir de reference concrete pour les pays qui souhaitent evaluer le taux de positivite attendu chez l'adulte dans un programme de depistage, en tenant compte de la prevalence du VIH au niveau national ainsi que de la portee du TAR. Le calcul consiste a enlever les personnes recevant un TAR du numerateur et du denominateur de la prevalence du VIH. La prevalence ajustee sur le traitement peut aisement etre determinee en fonction des donnees de programme et estimations de population existantes. En 2019, elle a egalement ete ajoutee aux lignes directrices de l'Organisation mondiale de la Sante pour l'information strategique et le depistage du VIH. En nous inspirant d'exemples issus du Kenya, du Malawi, du Soudan du Sud et du Zimbabwe, nous expliquons comment employer cet indicateur et abordons les potentielles implications liees a son utilisation en matiere de sante publique, en partant du niveau national jusqu'aux etablissements. La ampliacion de las pruebas de deteccion del virus de la inmunodeficiencia humana (VIH) y del tratamiento antirretrovirico (TAR) para las personas infectadas por el VIH ha aumentado en el Africa subsahariana. En consecuencia, el porcentaje de personas que dan positivo en las pruebas de deteccion del VIH en los programas nacionales esta disminuyendo en las zonas con alta prevalencia del virus. En Africa meridional y oriental, donde hay entornos con una prevalencia del VIH en adultos del 12 % o superior, la tasa de positividad de los servicios nacionales de pruebas de deteccion del VIH ha descendido a menos del 5 %. Por lo tanto, la identificacion de las personas que necesitan TAR es cada vez mas costosa para los programas nacionales de VIH. El establecimiento de objetivos anuales supone que las tasas de positividad de las pruebas nacionales se aproximan a las de la prevalencia de la poblacion. Esta suposicion ha generado una mayor atencion a los enfoques de las pruebas que logran tasas mas altas de positividad del VIH. Esta tendencia se aleja de la estrategia del asesoramiento y las pruebas que iniciaron los proveedores y que se utilizo al principio de la respuesta mundial al VIH. Se analiza un nuevo indicador, la prevalencia ajustada segun el tratamiento, que los paises pueden emplear como punto de referencia practico para estimar la tasa de positividad esperada en adultos en un programa de pruebas de deteccion cuando se tiene en cuenta tanto la prevalencia nacional del VIH como la cobertura del TAR. El indicador se calcula eliminando del numerador y el denominador de la prevalencia del VIH a las personas que reciben TAR. La prevalencia ajustada segun el tratamiento se puede estimar con facilidad a partir de los datos de los programas existentes y de las estimaciones de poblacion, ademas, en 2019, se incluyo en las directrices de la Organizacion Mundial de la Salud para las pruebas de deteccion del VIH y en la informacion estrategica. A traves de ejemplos de paises como Kenia, Malaui, Sudan meridional y Zimbabue, se demuestra como aplicar este indicador y se discuten las posibles implicaciones para la salud publica de su uso desde el nivel nacional hasta el de los centros. [phrase omitted], Introduction Globally, there has been substantial scale-up of human immunodeficiency virus (HIV) testing services and antiretroviral therapy (ART), and it is now estimated that 78% (16 million) of the 20.6 [...]

: Introduction: As new antiretrovirals (ARVs), including long‐acting ARVs for treatment and prevention, are approved and introduced, surveillance during pregnancy must become the safety net for evaluating birth outcomes, especially those that are rare and require large numbers of observations. Historically, drug pharmacovigilance in pregnancy has been limited and fragmented between different data sources, resulting in inadequate data to assess risk. The International Maternal Pediatric Adolescent AIDS Clinical Trials Network and World Health Organization convened a Workshop which reviewed strengths and weaknesses of existing programs and discussed an improved framework to integrate existing safety data sources and promote harmonization and digitalization. Discussion: This paper highlights that although robust sources of safety data and surveillance programs exist, key challenges remain, including unknown denominators, reporting bias, under‐reporting (e.g. in voluntary registries), few data sources from resource‐limited settings (most are in North America and Europe), incomplete or inaccurate data (e.g. within routine medical records). However, recent experiences (e.g. with safety signals) and current innovations (e.g. electronic record use in resource‐limited settings and defining adverse outcomes) provide momentum and building blocks for a new framework for active surveillance of ARV safety in pregnancy. A public health approach should be taken using data from existing sources, including registries of pregnancy ARV exposure and birth defects; observational surveillance and cohort studies; clinical trials; and real‐world databases. Key facilitators are harmonization and standardization of outcomes, sharing of materials and tools, and data linkages between programs. Other key facilitators include the development of guidance to estimate sample size and duration of surveillance, ensuring strategic geographic diversity, bringing partners together to share information and engaging the community of women living with HIV. Conclusions: Looking ahead, critical steps to safely introduce new ARVs include (1) adopting harmonized standards for measuring adverse maternal, birth and infant outcomes; (2) establishing surveillance centres of excellence in areas with high HIV prevalence with harmonized data collection and optimized electronic health records linking maternal/infant data; and (3) creating targets and evaluation goals for reporting progress on implementation and quality of surveillance in pregnancy. The platform will be leveraged to ensure that appropriate contributions and strategic actions by relevant stakeholders are implemented., INTRODUCTION Data on new antiretroviral (ARV) drugs in pregnancy are often delayed until years after initial approval [1, 2]. Additionally, the most vulnerable period for adverse foetal effects is in [...]

Author(s): Paul R. De Lay 1,*, Adèle Benzaken 2, Quarraisha Abdool Karim 3,4, Sani Aliyu 5, Carolyn Amole 6, George Ayala 7, Kalipso Chalkidou 8, Judy Chang 9, Michaela Clayton [...]

Objective The Global Fund to Fight AIDS, Tuberculosis and Malaria is one of the largest funders to fight these diseases. This paper discusses the programmatic contribution of Global Fund-supported programmes towards achieving international targets and Millennium Development Goals, using data from Global Fund grants. Methodology Results until June 2006 of 333 grants supported by the Global Fund in 127 countries were aggregated and compared against international targets for HIV/AIDS, tuberculosis and malaria. Progress reports to the Global Fund secretariat were used as a basis to calculate results. Service delivery indicators for antiretrovirals (ARV) for HIV/AIDS, case detection under the DOTS strategy for tuberculosis (DOTS) and insecticide-treated nets (ITNs) for malaria prevention were selected to estimate programmatic contributions to international targets for the three diseases. Targets of Global Fund-supported programmes were projected based on proposals for Rounds 1 to 4 and compared to international targets for 2009. Findings Results for Global Fund-supported programmes total 544 000 people on ARV, 1.4 million on DOTS and 11.3 million for ITNs by June 2006. Global Fund-supported programmes contributed 18% of international ARV targets, 29% of DOTS targets and 9% of ITNs in sub-Saharan Africa by mid-2006. Existing Global Fund-supported programmes have agreed targets that are projected to account for 19% of the international target for ARV delivery expected for 2009, 28% of the international target for DOTS and 84% of ITN targets in sub-Saharan Africa. Conclusion Global Fund-supported programmes have already contributed substantially to international targets by mid-2006, but there is a still significant gap. Considerably greater financial support is needed, particularly for HIV, in order to achieve international targets for 2009. Resume Contribution des programmes finances par le Fonds mondial contre le SIDA, la tuberculose et le paludisme a la realisation des objectifs internationaux et de ceux du Millenaire pour le developpement : analyse initiale Objectif Le Fonds mondial contre le SIDA, la tuberculose et le paludisme est I'une des principales sources de financement de la lutte contre ces maladies. Le present article evalue, a partir de donnees tirees des attributions de subventions par le Fonds, la contribution des programmes que cet organisme finance la realisation des objectifs internationaux et des objectifs du Millenaire pour le developpement. Methodologie Les donnees concernant les 333 subventions, beneficiant a 127 pays, financees jusqu'en juin 2006 par le Fonds ont ete agregees et comparees aux objectifs internationaux relatifs au VIH/sida, a la tuberculose et au paludisme. Les rapports d'activite adresses au secretariat du Fonds mondial ont ete utilises comme base pour determiner les resultats des programmes. Des indicateurs mesurant la prestation de services [delivrance d'antiretroviraux (ARV)] dans le cas du VIH/sida, la detection des cas dans le cadre de la strategie DOTS contre la tuberculose et I'equipement en moustiquaires impregnees d'insecticide (MEI) dans la prevention du paludisme) ont ete selectionnes pour estimer les contributions programmatiques aux objectifs internationaux pour ces trois maladies. Des projections des objectifs des programmes finances par le Fonds mondial ont ete etablies partir des propositions examinees dans le cadre des series I et 2 de soumissions de propositions et comparees aux objectifs internationaux pour 2009. Resultats Au total, en juin 2006, les programmes finances par le Fonds mondial ont perrnis de fournir desARV a 544 000 personnes et de faire beneficier 1,4 millions d'autres de la strategie DOTS et 11,3 d'autres encore de moustiquaires impregnees d'insecticide. Ces programmes ont contribue pour 18 % a la realisation des objectifs internationaux relatifs aux ARV, pour 29 % a celle des objectifs DOTS et pour 9 % a celle des objectifs relatifs aux rnoustiquaires impregnees d'insecticide en Afrique sub-saharienne pour mi-2006. Les programmes finances par le Fonds existants ont des objectifs en accord avec ces chiffres, qui, projetes, representent environ 19 % de l'objectif international concernant la delivrance d'ARV attendue pour 2009, 28 % de celui relatif a la strategie DOTS et 84 % de celui s'appliquant aux MEI en Afrique sub-saharienne. Conclusion Les programmes finances par le Fonds mondial ont aussi deja contribue substantiellement a la realisation des objectifs internationaux pour mi-2006, mais un ecart notable subsiste avec la realisation totale de ces objectifs. Un appui financier considerablement plus important est necessaire, notamment dans le cas du VIHlsida, pour atteindre les objectifs internationaux relatifs a 2009. Resumen Contribucion de los programas apoyados por el Fondo Mundial a las metas internacionales y los Objetivos de Desarrollo del Milenio: un primer analisis Objetivo El Fondo Mundial de Lucha contra el SIDA, la Tuberculosis y la Malaria es uno de los mayores financiadores de la lucha contra esas enfermedades. En este articulo se examina la contribucion de los programas apoyados por el Fondo Mundial al Iogro de las metas internacionales y los Objetivos de Desarrollo del Milenio, empleando datos de las subvenciones concedidas por dicho Fondo. Metodos Se procedio a agregar los resultados Iogrados hasta junio de 2006 mediante 333 subvenciones apoyadas por el Fondo Mundial en 127 paises, para compararlos con las metas internacionales en materia de VIH/SIDA, tuberculosis y malaria. Los informes sobre los progresos realizados enviados a la secretaria del Fondo Mundial se usaron como base para calcular los resultados. Se seleccionaron indicadores de prestacion de servicios relacionados con la administracion de antirretrovirales (ARV) contra el VIH/SIDA, la deteccion de casos en el marco de la estrategia DOTS para la tuberculosis y el uso de mosquiteros tratados con insecticida (MTI) para prevenir la malaria a fin de estimar las contribuciones programaticas alas metas internacionales establecidas para esas tres enfermedades. Ademas, se proyectaron las metas de los programas apoyados por el Fondo Mundial considerando las propuestas presentadas en las rondas 1 a 4, comparandolas con las metas internacionales para 2009. Resultados Los resultados de los programas apoyados por el Fondo Mundial totalizan 544 000 personas sometidas a ARV, 1,4 millones tratadas con DOTS y 11,3 millones protegidas por MTI a junio de 2006. Los programas apoyados por el Fondo Mundial habian contribuido asi al 18% de las metas internacionales fijadas para el tratamiento ARV, el 29% de las metas relacionadas con el DOTS y el 9% de los MTI en el Africa subsahariana a mediados de 2006. Los programas actualmente apoyados por el Fondo Mundial ban acordado metas que segun se calcula representaran un 19% de la meta internacional para la administracion de ARV prevista para 2009, el 28% de la meta internacional fijada para el DOTS y el 84% de la meta de MTI en el Africa subsahariana. Conclusion A mediados de 2006 los programas apoyados por el Fondo Mundial habian contribuido ya sustancialmente a propiciar las metas internacionales, pero sigue habiendo un importante desfase. A fin de alcanzar las metas internacionales fijadas para 2009, se necesita un apoyo financiero considerablemente mayor, en particular contra el VIH. [TEXT NOT REPRODUCIBLE IN ASCII.], Objective Various international partners have committed to efforts to reach treatment and prevention targets for HIV/AIDS, tuberculosis (TB) and malaria. "Ihese targets contribute to the Millennium Development Goals (MDGs) adopted [...]

There have been significant increases in development finance since 2000, particularly for health [1,2]. As country programs put this money to work, important lessons and challenges on how to make [...]

In 2016, Asia and Pacific countries endorsed action plans for reaching viral hepatitis elimination targets set in the Global Health Sector Strategy (GHSS) for Viral Hepatitis 2016-2021. We examine the region's progress by modelling disease burden and constructing the cascade of care. Between 2015 and 2020, chronic HBV prevalence declined from 4.69% to 4.30%, and HCV prevalence declined from 0.64% to 0.58%. The region achieved the 2020 target of 30% incidence reduction for HBV, whereas HCV incidence declined by 6%. Hepatocellular carcinoma incidence for HBV and HCV increased by 9% and 7%, respectively. Liver-related deaths from HBV rose by 8%, and mortality attributable to HCV plateaued. Large testing and treatment gaps remained in 2019: only 13% of chronic HBV infections were diagnosed and 25% treated; 21% of chronic HCV infection were diagnosed and 11% treated. Viral hepatitis must become national priority with adequate funding to reach elimination goals by 2030. [ABSTRACT FROM AUTHOR]

In 2016, Asia and Pacific countries endorsed action plans for reaching viral hepatitis elimination targets set in the Global Health Sector Strategy (GHSS) for Viral Hepatitis 2016‐2021. We examine the region's progress by modelling disease burden and constructing the cascade of care. Between 2015 and 2020, chronic HBV prevalence declined from 4.69% to 4.30%, and HCV prevalence declined from 0.64% to 0.58%. The region achieved the 2020 target of 30% incidence reduction for HBV, whereas HCV incidence declined by 6%. Hepatocellular carcinoma incidence for HBV and HCV increased by 9% and 7%, respectively. Liver‐related deaths from HBV rose by 8%, and mortality attributable to HCV plateaued. Large testing and treatment gaps remained in 2019: only 13% of chronic HBV infections were diagnosed and 25% treated; 21% of chronic HCV infection were diagnosed and 11% treated. Viral hepatitis must become national priority with adequate funding to reach elimination goals by 2030. [ABSTRACT FROM AUTHOR]

Author(s): Vincent Habiyambere 1,*, Nathan Ford 1, Daniel Low-Beer 1, John Nkengasong 2, Anita Sands 1, Mercedes Pérez González 1, Paula Fernandes 3, Ekaterina Milgotina 3 Introduction The ambitious Joint [...], Background The Joint United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 targets have reinforced the importance of functioning laboratory services to ensure prompt diagnosis and to assess treatment efficacy. We surveyed the availability and utilization of technologies for HIV treatment monitoring and early infant diagnosis (EID) in World Health Organization (WHO) Member States. Methods and Findings The survey questionnaire included 14 structured questions focusing on HIV testing, cluster of differentiation 4 (CD4) testing, HIV viral load (VL) testing, and EID and was administered annually from 2012 to 2014 through WHO country offices, with each survey covering the previous 12-mo period. Across 127 targeted countries, survey response rates were 60% in 2012, 67% in 2013, and 78% in 2014. There were encouraging trends towards increased procurement of CD4 and VL/EID instruments in reporting countries. Globally, the capacity of available CD4 instruments was sufficient to meet the demand of all people living with HIV/AIDS (PLWHA), irrespective of treatment status (4.62 theoretical tests per PLWHA in 2013 [median 7.33; interquartile range (IQR) 3.44-17.75; median absolute deviation (MAD) 4.35]). The capacity of VL instruments was inadequate to cover all PLWHA in many reporting countries (0.44 tests per PLWHA in 2013 [median 0.90; IQR 0.30-2.40; MAD 0.74]). Of concern, only 13.7% of existing CD4 capacity (median 4.3%; IQR 1.1%-12.1%; MAD 3.8%) and only 36.5% of existing VL capacity (median 9.4%; IQR 2.3%-28.9%; MAD 8.2%) was being utilized across reporting countries in 2013. By the end of 2013, 7.4% of all CD4 instruments (5.8% CD4 conventional instruments and 11.0% of CD4 point of care [POC]) and 10% of VL/EID instruments were reportedly not in use because of lack of reagents, the equipment not being installed or deployed, maintenance, and staff training requirements. Major limitations of this survey included under-reporting and/or incomplete reporting in some national programmes and noncoverage of the private sector. Conclusion This is the first attempt to comprehensively gather information on HIV testing technology coverage in WHO Member States. The survey results suggest that major operational changes will need to be implemented, particularly in low- and middle-income countries, if the 90-90-90 targets are to be met.

One of the most compelling reasons for development aid to health is that it saves lives, often for a few hundred dollars per year of life saved. Relatively uniquely in [...]

Abstract Background In Zanzibar, the Ministry of Health and partners accelerated malaria control from September 2003 onwards. The impact of the scale-up of insecticide-treated nets (ITN), indoor-residual spraying (IRS) and artemisinin-combination therapy (ACT) combined on malaria burden was assessed at six out of seven in-patient health facilities. Methods Numbers of outpatient and inpatient cases and deaths were compared between 2008 and the pre-intervention period 1999-2003. Reductions were estimated by segmented log-linear regression, adjusting the effect size for time trends during the pre-intervention period. Results In 2008, for all age groups combined, malaria deaths had fallen by an estimated 90% (95% confidence interval 55-98%)(p < 0.025), malaria in-patient cases by 78% (48-90%), and parasitologically-confirmed malaria out-patient cases by 99.5% (92-99.9%). Anaemia in-patient cases decreased by 87% (57-96%); anaemia deaths and out-patient cases declined without reaching statistical significance due to small numbers. Reductions were similar for children under-five and older ages. Among under-fives, the proportion of all-cause deaths due to malaria fell from 46% in 1999-2003 to 12% in 2008 (p < 0.01) and that for anaemia from 26% to 4% (p < 0.01). Cases and deaths due to other causes fluctuated or increased over 1999-2008, without consistent difference in the trend before and after 2003. Conclusions Scaling-up effective malaria interventions reduced malaria-related burden at health facilities by over 75% within 5 years. In high-malaria settings, intensified malaria control can substantially contribute to reaching the Millennium Development Goal 4 target of reducing under-five mortality by two-thirds between 1990 and 2015.

Abstract Background Since 2003, the Global Fund has supported the scale-up of HIV/AIDS, tuberculosis and malaria control in low- and middle-income countries. This paper presents and discusses a methodology for estimating the lives saved through selected service deliveries reported to the Global Fund. Methods Global Fund-supported programs reported, by end-2007, 1.4 million HIV-infected persons on antiretroviral treatment (ARV), 3.3 million new smear-positive tuberculosis cases detected in DOTS (directly observed TB treatment, short course) programs, and 46 million insecticide-treated mosquito nets (ITNs) delivered. We estimated the corresponding lives saved using adaptations of existing epidemiological estimation models. Results By end-2007, an estimated 681,000 lives (95% uncertainty range 619,000-774,000) were saved and 1,097,000 (993,000-1,249,000) life-years gained by ARV. DOTS treatment would have saved 1.63 million lives (1.09 - 2.17 million) when compared against no treatment, or 408,000 lives (265,000-551,000) when compared against non-DOTS treatment. ITN distributions in countries with stable endemic falciparum malaria were estimated to have achieved protection from malaria for 26 million of child-years at risk cumulatively, resulting in 130,000 (27,000-232,000) under-5 deaths prevented. Conclusions These results illustrate the scale of mortality effects that supported programs may have achieved in recent years, despite margins of uncertainty and covering only selected intervention components. Evidence-based evaluation of disease impact of the programs supported by the Global Fund with international and in-country partners must be strengthened using population-level data on intervention coverage and demographic outcomes, information on quality of services, and trends in disease burdens recorded in national health information systems.

Abstract Background An increasing number of malaria-endemic African countries are rapidly scaling up malaria prevention and treatment. To have an initial estimate of the impact of these efforts, time trends in health facility records were evaluated in selected districts in Ethiopia and Rwanda, where long-lasting insecticidal nets (LLIN) and artemisinin-based combination therapy (ACT) had been distributed nationwide by 2007. Methods In Ethiopia, a stratified convenience sample covered four major regions where (moderately) endemic malaria occurs. In Rwanda, two districts were sampled in all five provinces, with one rural health centre and one rural hospital selected in each district. The main impact indicator was percentage change in number of in-patient malaria cases and deaths in children < 5 years old prior to (2001–2005/6) and after (2007) nationwide implementation of LLIN and ACT. Results In-patient malaria cases and deaths in children < 5 years old in Rwanda fell by 55% and 67%, respectively, and in Ethiopia by 73% and 62%. Over this same time period, non-malaria cases and deaths generally remained stable or increased. Conclusion Initial evidence indicated that the combination of mass distribution of LLIN to all children < 5 years or all households and nationwide distribution of ACT in the public sector was associated with substantial declines of in-patient malaria cases and deaths in Rwanda and Ethiopia. Clinic-based data was a useful tool for local monitoring of the impact of malaria programmes.