Search

Cardiovascular, respiratory, and related disorders (CVRDs) are the leading causes of adult death worldwide, and substantial inequalities in care of patients with CVRDs exist between countries of high income and countries of low and middle income. Based on current trends, the UN Sustainable Development Goal to reduce premature mortality due to CVRDs by a third by 2030 will be challenging for many countries of low and middle income. We did systematic literature reviews of effectiveness and cost-effectiveness to identify priority interventions. We summarise the key findings and present a costed essential package of interventions to reduce risk of and manage CVRDs. On a population level, we recommend tobacco taxation, bans on trans fats, and compulsory reduction of salt in manufactured food products. We suggest primary health services be strengthened through the establishment of locally endorsed guidelines and ensured availability of essential medications. The policy interventions and health service delivery package we suggest could serve as the cornerstone for the management of CVRDs, and afford substantial financial risk protection for vulnerable households. We estimate that full implementation of the essential package would cost an additional US$21 per person in the average low-income country and $24 in the average lower-middle-income country. The essential package we describe could be a starting place for low-income and middle-income countries developing universal health coverage packages. Interventions could be rolled out as disease burden demands and budgets allow. Our outlined interventions provide a pathway for countries attempting to convert the UN Sustainable Development Goal commitments into tangible action.

IntroductionScreening of modifiable cardiovascular disease (CVD) risk factors is recommended but not routinely provided for HIV-infected patients, especially in low-resource settings. Potential concerns include limited staff time and low patient acceptability, but little empirical data exists. As part of a pilot study of screening in a large urban HIV clinic in Swaziland, we conducted a time-motion study to assess the impact of screening on patient flow and HIV service delivery and exit interviews to assess patient acceptability.MethodsA convenience sample of patients ≥40 years of age attending routine HIV clinic visits was screened for hypertension, diabetes, hyperlipidemia and tobacco smoking. We observed HIV visits with and without screening and measured time spent on HIV and CVD risk factor screening activities. We compared screened and unscreened patients on total visit time and time spent receiving HIV services using Wilcoxon rank-sum tests. A separate convenience sample of screened patients participated in exit interviews to assess their satisfaction with screening.ResultsWe observed 172 patient visits (122 with CVD risk factor screening and 50 without). Screening increased total visit time from a median (range) of 4 minutes (2 to 11) to 15 minutes (9 to 30) (p

: Introduction: Tuberculosis (TB) causes one‐third of HIV‐related deaths worldwide, making TB preventive treatment (TPT) a critical element of HIV programmes. Approximately 16% of people living with HIV (PLHIV) on antiretrovirals in Zimbabwe are enrolled in the Fast Track (FT) differentiated service delivery model, which includes multi‐month dispensing of antiretrovirals and quarterly health facility (HF) visits. We assessed the feasibility and acceptability of utilizing FT to deliver 3HP (3 months of once‐weekly rifapentine and isoniazid) for TPT by aligning TPT and HIV visits, providing multi‐month dispensing of 3HP, and using phone‐based monitoring and adherence support. Methods: We recruited a purposive sample of 50 PLHIV enrolled in FT at a high‐volume HF in urban Zimbabwe. At enrolment, participants provided written informed consent, completed a baseline survey, and received counselling, education and a 3‐month supply of 3HP. A study nurse mentor called participants at weeks 2, 4 and 8 to monitor and support adherence and side effects. When participants returned for their routine 3‐month FT visit, they completed another survey, and study staff conducted a structured medical record review. In‐depth interviews were conducted with providers who participated in the pilot. Results: Participants were enrolled between April and June 2021 and followed through September 2021. Median age = 32 years (IQR 24,41), 50% female, median time in FT 1.8 years (IQR 0.8,2.7). Forty‐eight participants (96%) completed 3HP in 13 weeks; one completed in 16 weeks, and one stopped due to jaundice. Most participants (94%) reported “always” or “almost always” taking 3HP correctly. All reported they were very satisfied with the counselling, education, support and quality of care they received from providers and FT service efficiency. Almost all (98%) said they would recommend it to other PLHIV. Challenges reported included pill burden (12%) and tolerability (24%), but none had difficulty with phone‐based counselling or wished for additional HF‐based visits. Discussion: Using FT to deliver 3HP was feasible and acceptable. Some reported tolerability challenges but 98% completed 3HP, and all appreciated the efficiency of aligning TPT and HIV HF visits, multi‐month dispensing and phone‐based counselling. Conclusions: Scaling up this approach could expand TPT coverage in Zimbabwe., INTRODUCTION Tuberculosis (TB) is the second leading cause of death from an infectious disease, causing 1.6 million deaths in 2021 [1]. Despite the scale‐up of antiretroviral therapy (ART), people living [...]

Introduction: Despite the global scale-up of HIV testing, prevention and treatment, these services remain inaccessible to groups most vulnerable to HIV. Globally, most new HIV infections are concentrated among members of key populations (KP), including female sex workers, men who have sex with men, transgender people, people who inject drugs and their sexual partners. These populations lag in access to HIV prevention and antiretroviral therapy (ART) and have less favourable HIV outcomes compared to the general population. Intersecting behavioural and structural factors contribute to these gaps in service access for at-risk KP and those living with HIV; corresponding comprehensive approaches to improving service delivery for KP are urgently needed. Differentiated service delivery (DSD) models tailor HIV programmes to the needs and preferences of specific groups but are rarely implemented at scale for KP. We describe the FIKIA Project, which implemented innovative approaches to scaling up DSD models to reach and engage KP in Tanzania. Methods: The FIKIA Project worked with diverse KP communities in Tanzania to tailor HIV services to their needs and to pair healthcare workers with trained peer educators and expert client counsellors to expand uptake of community-based HIV testing and ART services. We analysed routine aggregate project data from 2016 to 2020 to describe project implementation, outcomes and best practices. Results and discussion: The FIKIA Project conducted 1,831,441 HIV tests in community settings; of the 98,349 (5.4%) individuals with new HIV diagnoses, 89,640 (91.1%) initiated ART. The project reached substantial numbers of KP: 203,233 received HIV tests, 28,830 (14.2%) received a new HIV diagnosis and 25,170 KP (87.3%) initiated ART at the point of diagnosis. Over time, HIV testing increased by 1.6 times overall (2.3 times among KP), HIV diagnoses increased by 8.7 times (10.9 times among KP) and ART initiation at the point of diagnosis increased from 80.0% to 95.9% overall (from 69.6% to 94.9% among KP). Conclusions: Over four years, the FIKIA Project scaled up HIV testing, diagnosis and treatment by using DSD principles to design services that meet the needs of KP and their communities. Keywords: key and vulnerable populations; differentiated care; HIV care continuum; community; testing; linkage to care, 1 | INTRODUCTION Despite the scale-up of effective, evidence-based interventions for HIV testing, prevention and treatment, key populations (KP), including female sex workers (FSW), men who have sex with men [...]

IntroductionOption B+, an approach that involves provision of antiretroviral therapy (ART) to all HIV-infected pregnant women for life, is the preferred strategy for prevention of mother to child transmission of HIV. Lifelong retention in care is essential to its success. We conducted a discrete choice experiment in Ethiopia and Mozambique to identify health system characteristics preferred by HIV-infected women to promote continuity of care.MethodsWomen living with HIV and receiving care at hospitals in Oromia Region, Ethiopia and Zambézia Province, Mozambique were shown nine choice cards and asked to select one of two hypothetical health facilities, each with six varying characteristics related to the delivery of HIV services for long term treatment. Mixed logit models were used to estimate the influence of six health service attributes on choice of clinics.Results2,033 women participated in the study (response rate 97.8% in Ethiopia and 94.7% in Mozambique). Among the various attributes of structure and content of lifelong ART services, the most important attributes identified in both countries were respectful provider attitude and ability to obtain non-HIV health services during HIV-related visits. Availability of counseling support services was also a driver of choice. Facility type, i.e., hospital versus health center, was substantially less important.ConclusionsEfforts to enhance retention in HIV care and treatment for pregnant women should focus on promoting respectful care by providers and integrating access to non-HIV health services in the same visit, as well as continuing to strengthen counseling.

Improvements in geospatial health data and tailored human immunodeficiency virus (HIV) testing, prevention and treatment have led to greater microtargeting of the HIV response, based on location, risk, clinical status and disease burden. These approaches show promise for achieving control of the HIV epidemic. At the same time, United Nations Member States have committed to achieving broader health and development goals by 2030, including universal health coverage (UHC). HIV epidemic control will facilitate UHC by averting the need to commit ever-increasing resources to HIV services. Yet an overly targeted HIV response could also distort health systems, impede integration and potentially threaten broader health goals. We discuss current approaches to achieving both UHC and HIV epidemic control, noting potential areas of friction between disease-specific microtargeting and integrated health systems, and highlighting opportunities for convergence that could enhance both initiatives. Examples of these programmatic elements that could be better aligned include: improved information systems with unique identifiers to track and monitor individuals across health services and the life course; strengthened subnational data use; more accountable supply chains that supply a broad range of services; and strengthened community-based services and workforces. We argue that the response both to HIV and to broader health threats should use these areas of convergence to increase health systems efficiency and mitigate the harm of any potential decrease in health funding. Further investments in implementation and monitoring of these programme elements will be needed to make progress towards both UHC and HIV epidemic control. Les ameliorations des donnees sanitaires geospatiales et la personnalisation du depistage, de la prevention et du traitement du virus de l'immunodeficience humaine (VIH) ont permis de developper le micro-ciblage de la reponse au VIH, en fonction du lieu, du risque, de la situation clinique et de la charge de morbidite. Ces approches sont prometteuses pour lutter contre l'epidemie de VIH. Dans le meme temps, les Etats membres des Nations Unies se sont engages a atteindre des objectifs plus larges de sante et de developpement d'ici 2030, notamment la couverture sanitaire universelle. Cette derniere sera facilitee par la lutte contre l'epidemie de VIH, qui reduira la necessite de consacrer toujours plus de ressources aux services lies au VIH. Cependant, une reponse au VIH trop ciblee pourrait egalement distordre les systemes de sante, empecher leur integration et potentiellement nuire aux objectifs de sante plus vastes. Nous abordons ici les approches actuelles en matiere de couverture sanitaire universelle et de lutte contre l'epidemie de VIH, en notant les points de friction potentiels entre un micro-ciblage specifique a certaines maladies et des systemes de sante integres, ainsi que les opportunites de convergence qui pourraient etre benefiques aux deux initiatives. Parmi les elements de programmes qui pourraient etre mieux coordonnes, nous pouvons citer: (amelioration des systemes d'information avec des identifiants uniques permettant de suivre les personnes dans leur parcours de soins et tout au long de leur vie; la plus grande utilisation des donnees infranationales; la responsabilisation des chaines d'approvisionnement qui fournissent un grand nombre de services; et le renforcement des services et des intervenants communautaires. Nous soutenons que la reponse au VIH et a d'autres menaces sanitaires devrait exploiter ces domaines de convergence pour accroitre l'efficacite des systemes de sante et attenuer le prejudice d'une eventuelle baisse des fonds alloues a la sante. Il sera necessaire d'investir davantage dans la mise en reuvre et le suivi de ces elements de programmes pour avancer, aussi bien vers la couverture sanitaire universelle que dans la lutte contre l'epidemie de VIH. Las mejoras en los datos geoespaciales de salud y las pruebas, la prevencion y el tratamiento adaptados al virus de la inmunodeficiencia humana (VIH) han conducido a una mayor focalizacion de la respuesta al VIH, basada en la ubicacion, el riesgo, el estado clinico y la carga de la enfermedad. Estos enfoques son prometedores para lograr el contro de la epidemia del VIH. Al mismo tiempo, los Estados Miembros de las Naciones Unidas se han comprometido a alcanzar objetivos de salud y desarrollo de mayor alcance para 2030, incluida la cobertura universa de salud (universal health coverage, UHC). El control de la epidemia del VIH facilitara la UHC porque evitara la necesidad de comprometer recursos cada vez mayores para los servicios del VIH. Sin embargo, una respuesta al VIH demasiado especifica tambien podria distorsionar los sistemas de salud, impedir la integracion y amenazar potencialmente los objetivos de salud de mayor alcance. Se discuten los enfoques actuales para lograr tanto la atencion primaria de salud como el control de la epidemia del VIH, se senalan las posibles areas de friccion entre la focalizacion especifica de la enfermedad y los sistemas integrados de salud, y se destacan las oportunidades de convergencia que podrian mejorar ambas iniciativas. Entre los ejemplos de estos elementos programaticos que podrian alinearse mejor se incluyen: sistemas de informacion mejorados con identificadores unicos para hacer un seguimiento y monitoreo de las personas a traves de los servicios de salud y el curso de la vida; el fortalecimiento del uso de datos a nivel subnacional; cadenas de suministro mas responsables que proveen una amplia gama de servicios; y el fortalecimiento de los servicios en la comunidad y las fuerzas de trabajo. Se argumenta que la respuesta tanto al VIH como a las amenazas para la salud en general debe utilizar estas areas de convergencia para aumentar la eficiencia de los sistemas de salud y mitigar el dano de cualquier posible disminucion en la financiacion de la salud. Se necesitaran mas inversiones en la ejecucion y el monitoreo de estos elementos del programa para avanzar tanto en el control de la epidemia de VIH como en la UHC, Introduction As the global human immunodeficiency virus (HIV) response matures, national programmes in low- and middle-income countries are providing lifesaving treatment for more than 20 million people and reaching millions [...]

Introduction: Suboptimal male engagement in HIV programmes is a persistent challenge, leading to lower coverage of HIV testing, prevention and treatment services, and to worse outcomes for men. Differentiated service delivery models, such as peer-led community antiretroviral refill groups (CARGs), offer the opportunity to enhance patient satisfaction, retention and treatment outcomes. We conducted an exploratory qualitative study to identify facilitators and barriers to CARG participation by HIV-positive men, with inputs from recipients of HIV care, community members, healthcare workers (HCWs), donors and policymakers. Methods: Between July and October 2017, we conducted 20 focus group discussions (FGDs) with 147 adults living with HIV, including men and women enrolled in CARGs and men not enrolled in CARGs, and 46 key informant interviews (KIIs) with policymakers, donors, HCWs and community members. FGDs and KIIs were recorded, transcribed and translated. A constant comparison approach was used to triangulate findings and identify themes related to male engagement in CARGs in rural Zimbabwe. Results: CARG participants, policymakers, donors, HCWs, and community members noted many advantages to CARG participation, including convenience, efficiency, solidarity and mutual psychosocial support. Although those familiar with CARGs reported that these groups decreased HIV-related stigma, concerns about stigma and privacy were perceived to be the primary reason for men's non-participation. Other important barriers to male enrolment included lack of awareness of CARGs, misunderstanding of how CARGs operate, few perceived benefits and lack of flexibility in CARG implementation. Conclusions: More effective educational and awareness campaigns, community-based anti-stigma campaigns, more flexible CARG designs, and provision of financial and/or in-kind support to CARG members could mitigate many of the barriers to male enrolment in CARGs. Men may also prefer alternative differentiated service delivery models that are facility-based and/or do not require group participation. Keywords: HIV; male engagement; differentiated service delivery; community antiretroviral groups; Zimbabwe; qualitative, 1 | INTRODUCTION Engaging men in HIV testing, prevention and treatment is a persistent challenge [1-4]. In sub-Saharan Africa (SSA), population-based HIV surveys show that men consistently lag behind women [...]

Background Integration of HIV services with other health services has been proposed as an important strategy to boost the sustainability of the global HIV response. We conducted a systematic and comprehensive synthesis of the existing scientific evidence on the impact of service integration on the HIV care cascade, health outcomes, and cost-effectiveness. Methods and findings We reviewed the global quantitative empirical evidence on integration published between 1 January 2010 and 10 September 2021. We included experimental and observational studies that featured both an integration intervention and a comparator in our review. Of the 7,118 unique peer-reviewed English-language studies that our search algorithm identified, 114 met all of our selection criteria for data extraction. Most of the studies (90) were conducted in sub-Saharan Africa, primarily in East Africa (55) and Southern Africa (24). The most common forms of integration were (i) HIV testing and counselling added to non-HIV services and (ii) non-HIV services added to antiretroviral therapy (ART). The most commonly integrated non-HIV services were maternal and child healthcare, tuberculosis testing and treatment, primary healthcare, family planning, and sexual and reproductive health services. Values for HIV care cascade outcomes tended to be better in integrated services: uptake of HIV testing and counselling (pooled risk ratio [RR] across 37 studies: 1.67 [95% CI 1.41-1.99], p < 0.001), ART initiation coverage (pooled RR across 19 studies: 1.42 [95% CI 1.16-1.75], p = 0.002), time until ART initiation (pooled RR across 5 studies: 0.45 [95% CI 0.20-1.00], p = 0.050), retention in HIV care (pooled RR across 19 studies: 1.68 [95% CI 1.05-2.69], p = 0.031), and viral suppression (pooled RR across 9 studies: 1.19 [95% CI 1.03-1.37], p = 0.025). Also, treatment success for non-HIV-related diseases and conditions and the uptake of non-HIV services were commonly higher in integrated services. We did not find any significant differences for the following outcomes in our meta-analyses: HIV testing yield, ART adherence, HIV-free survival among infants, and HIV and non-HIV mortality. We could not conduct meta-analyses for several outcomes (HIV infections averted, costs, and cost-effectiveness), because our systematic review did not identify sufficient poolable studies. Study limitations included possible publication bias of studies with significant or favourable findings and comparatively weak evidence from some world regions and on integration of services for key populations in the HIV response. Conclusions Integration of HIV services and other health services tends to improve health and health systems outcomes. Despite some scientific limitations, the global evidence shows that service integration can be a valuable strategy to boost the sustainability of the HIV response and contribute to the goal of 'ending AIDS by 2030', while simultaneously supporting progress towards universal health coverage., Author(s): Caroline A. Bulstra 1,2,*, Jan A. C. Hontelez 1,2, Moritz Otto 1, Anna Stepanova 1, Erik Lamontagne 3,4, Anna Yakusik 3, Wafaa M. El-Sadr 5, Tsitsi Apollo 6, Miriam [...]

Introduction: Despite increasing focus on test and treat strategies for people living with HIV (PLHIV), many continue to enrol late in care and initiate antiretroviral therapy (ART) when they have advanced HIV disease. Methods: We analyzed PLHIV [greater than or equal to]15 years of age starting ART in Ethiopia, Kenya, Mozambique and Tanzania from 2005 to 2015 based on CD4+ groups at ART initiation ([greater than or equal to]200, 100 to 199, 50 to 99 and 6 months; deaths were ascertained from medical records. Results and discussion: A total of 305,443 PLHIV were included in the analysis: 118,580 (38.8%) CD4+ [greater than or equal to]200, 91,788 (30.1%) CD4+ 100 to 199, 44,029 (14.4%) CD4+ 50 to 99 and 51,046 (16.7%) CD4+ Conclusions: Greater efforts, including the identification of effective differentiated service delivery models, are needed to ensure that all PLHIV starting treatment can garner the benefits from ART and achieve favourable outcomes. Keywords: CD4 cell count; late ART initiation; loss to follow-up; mortality; attrition; differentiated service delivery models, 1 | INTRODUCTION In 2015, World Health Organization (WHO) guidelines recommended treatment for all persons living with HIV (PLHIV) [1] in order to maximize the benefits of treatment for individuals [...]

Introduction: The World Health Organization's (WHO) recommendation of 'Treat All' has accelerated the call for differentiated antiretroviral therapy (ART) delivery, a method of care that efficiently uses limited resources to increase access to HIV treatment. WHO has further recommended that stable individuals on ART receive refills every 3 to 6 months and attend clinical visits every 3 to 6 months. However, there is not yet consensus on how to ensure that the quality of services is maintained as countries strive to meet these standards. This commentary responds to this gap by defining a pragmatic approach to the monitoring and evaluation (M&E) of the scale up of differentiated ART delivery for global and national stakeholders. Discussion: Programme managers need to demonstrate that the scale up of differentiated ART delivery is achieving the desired effectiveness and efficiency outcomes to justify continued support by national and global stakeholders. To achieve this goal, the two existing global WHO HIV treatment indicators of ART retention and viral suppression should be augmented with two broad aggregate measures. The addition of indicators measuring the frequency of (1) clinical and (2) refill visits by PLHIV per year will allow evaluation of the pace of scale up while monitoring its overall effect on the quality and efficiency of services. The combination of these four routinely collected aggregate indicators will also facilitate the comparison of outcomes among facilities, regions or countries implementing different models of ART delivery. Enhanced monitoring or additional assessments will be required to answer other critical questions on the process of implementation, acceptability, effectiveness and efficiency. Conclusions: These proposed outcomes are useful markers for the effectiveness and efficiency of the health system's attempts to deliver quality treatment to those who need it--and still reserve as much of the available resource pool as possible for other key elements of the HIV response. Keywords: HIV; differentiated care; differentiated service delivery; monitoring and evaluation; efficiency; productivity; health care worker experience; patient experience, 1 | INTRODUCTION: THE POTENTIAL OF DIFFERENTIATED SERVICE DELIVERY AND THE NEED TO MEASURE ITS IMPACT The World Health Organization's (WHO) recommendation that all people living with HIV (PLHIV) should [...]

Objective To develop a novel measure to characterize human immunodeficiency virus (HIV) programme quality at health facilities in Kenya and explore its associations with patient--and facility-level characteristics. Methods We developed a composite indlcatorto measure quality of HIV care, comprising: assessment of eligibility for antiretroviral therapy (ART); initiation of ART; and retention on ART or in care, if ineligible for ART, for 12 months. We applied the comprehensive retention indicator to routinely collected clinical data from 13 331 patients enrolled In HIV care and treatment at 63 health facilities in the Eastern and Nyanza regions of Kenya from 1 January 2014 to 31 March 2016. We explored the association between facility--and patient-level characteristics and the primary outcome: appropriate staging and management of HIV, and retention in care over 12 months. Findings Of the enrolled patients, 8404 (63%) achieved comprehensive retention 12 months after enrolment in care. In univariate analyses, patients at facilities where nurses delivered HIV treatment services (including eligibility assessment, initiation and follow up of ART) had significantly higher comprehensive retention rates at 12 months. In multivariate analyses, after adjusting for both facility--and patient-level characteristics, patients at facilities where nurses initiated ART had significantly higher comprehensive retention in care at 12 months (relative risk, RR: 1.22; 95% confidence interval, CI: 1.00-1.48). Conclusion Nurse-led HIV services were significantly associated with quality of care, confirming the central role of nurses in the achievement of global health goals, and the need for further investment in nursing education, training and mentoring. Objectif Concevoir une nouvelle mesure pour caracteriser la qualite du programme VIH (virus de Hmmunodeficience humalne) dans des centres de sante au Kenya et analyser ses correlations avec les caracteristiques des patients et les caracteristiques des centres de sante. Methodes Pour mesurer la qualite des soins anti-VIH, nous avons concu un indicateur composite, qui englobe: Evaluation de l'eligibilite a une therapie antiretrovirale (TAR), le lancement de la TAR et le continuum de la TAR ou--pour les patients non eligibles a une TAR--le continuum de soins. Nous avons applique cet indicateur de continuum complet aux donnees cliniques habituellement consignees par les centres de sante; des donnees qui ont porte sur 13 331 patients pris en charge et traites pour une infection a VIH dans 63 centres de sante de la province orientaleet de la province de Nyanza au Kenya entre le 1er janvier 2014 et le 31 mars 2016. Nous avons analyse les correlations entre les caracteristigues des centres et des patients et le principal critere observe: le correct enchainement des etapes / la prise en charge appropriee de l'infection a VIH et le continuum de soins sur 12 mois. Resultats Le critere de continuum complet 12 mois apres la prise en charge a ete satisfait pour 8404 patients (63%). Dans nos analyses univariees, les taux de continuum complet a 12 mois ont ete sensiblement superieurs chez les patients pris en charge dans des centres ou les services de traitement contre le VIH ont ete menes par des infirmiers (charges notamment de Evaluation de l'eligibilite a une TAR ainsi que du lancement et du suivi des TAR). Dans nos analyses multivariees, apres ajustement en fonction des caracteristiques des centres et des patients, des taux sensiblement superieurs de continuum complet a 12 mois ont ete observes chez les patients pris en charge dans des centres ou les TAR ont ete lancees par des infirmiers (risque relatif: 1,22; intervalle de confiance de 95%: 1,00-1,48). Conclusion Les services anti-VIH menes par des infirmiers ont largement ete assocles a une bonne qualite des soins, ce qui confirme le role central des infirmiers dans l'atteinte des objectifs de sante mondiaux et la necessite d'investir davantage dans l'apprentissage, la formation et le tutorat des Infirmiers. Objetivo Desarrollar una medida novedosa para caracterizar la calidad del programa contra el virus de la inmunodeficiencia humana (VIH) en centros sanitarios de Kenya y explorar sus asociaciones con las caracteristicas a nivel de paciente y centro. Metodos Se desarrollo un indicador compuesto para medir la calidad de la atencion contra el VIH formado por: una evaluacion de la elegibilidad para el tratamiento antirretrovirico (TAR), la iniciacion del TAR y la retencion en el TAR o en la atencion, si no es posible recibir el TAR, durante 12 meses. Se aplico el Indicador de retencion completo a datos clinicos recopilados de forma rutinaria de 13 331 pacientes inscritos en la atencion y el tratamiento contra el VIH en 63 centros sanitarios en las provincias del Este y Nyanza, en Kenia, del 1 de enero de 2014 al 31 de marzo de 2016. Se analizo la asociacion entre las caracteristicas a nivel de pacientes y de centros y el resultado principal: una estadlficacion y gestion adecuadas del VIH, asi como una retencion de la atencion durante 12 meses. Resultados De los pacientes inscritos, 8 404 (63%) lograron una retencion completa al cabo de 12 meses de inscribirse en la atencion. En analisis univariables, los pacientes de los centros donde las enfermeras ofrecieron los servicios del tratamiento contra el VIH (incluida una evaluacion de la elegibilidad, la iniciacion y el seguimiento del TAR) registraron unas tasas de retencion completa mucho mas altas en 12 meses. En analisis multivariables, tras ajustar las caracteristicas a nivel de pacientes y de centros, los pacientes de los centros donde las enfermeras iniciaron el TAR registraron unas tasas de retencion completa mucho mas altas en 12 meses (riesgo relativo (RR): 1,22; intervalo de confianza (IC) del 95%: 1,00-1,48). Conclusion Los servicios contra el VIH dirigidos por enfermeras estaban significativamente asociados con la calidad de la atencion, lo que confirma el importante papel de las enfermeras a la hora de lograr objetivos de salud globales, asi como la necesidad de invertir mas en la educacion, formacion y orientacion de las enfermeras., Introduction The global response to the human immunodeficiency virus (HIV) epidemic has been remarkably successful. In low--and middle-income countries, the number of people living with HIV who have access to [...]

Objectives To assess the prevalence of high blood pressure amongst postpartum women in rural Tanzania, and to explore factors associated with hypertension prevalence, awareness, treatment, and control. Methods 1849 women in Tanzania's Pwani Region who delivered a child in the prior year participated in the study. We measured blood pressure, administered a structured questionnaire and assessed factors associated with the prevalence, awareness, treatment, and control of hypertension (HTN) using bivariable and multivariable logistic regressions. Findings 26.7% of women had high blood pressure and/or were taking antihypertensive medication. Women were on average 27.5 years old (range 15-54). Nearly all women (99.5%) reported contact with the health system during their pregnancy and delivery, with an average of 5.2 visits for their own care in the past year. Only 23.5% of those with HTN were aware of their diagnosis, 17.4% were taking medication, and only 10.5% had controlled blood pressure. In multivariable analysis, facility delivery, health insurance, and increased distance from a hospital were associated with increased likelihood of HTN awareness; facility delivery and hospital distance were associated with current hypertensive treatment; younger age and increased hospital distance were associated with control of HTN. Conclusion The prevalence of high blood pressure in this postpartum population was high, and despite frequent recent contacts with the health system, awareness, treatment and control of HTN were low. These findings highlight an important missed opportunity to improve women's health during antenatal and postnatal care., Author(s): Elysia Larson [sup.1] , Miriam Rabkin [sup.2] , Godfrey M. Mbaruku [sup.3] , Redempta Mbatia [sup.4] , Margaret E. Kruk [sup.1] Author Affiliations: (1) 000000041936754Xgrid.38142.3cDepartment of Global Health and [...]

Keywords: HIV; viral load; sub-Saharan Africa1 INTRODUCTIONThe global HIV response has been remarkably successful. More than 19 million persons living with HIV (PLHIV) have accessed life-saving antiretroviral therapy (ART) [1] [...]

Author(s): Wafaa M. El-Sadr *, Katherine Harripersaud, Miriam Rabkin Much accomplished, but much more needed A decade ago, today's progress towards confronting the global HIV epidemic would have been unimaginable. [...]

Author(s): Margaret L. McNairy 1,2,*, Elaine J. Abrams 1,3, Miriam Rabkin 1,3, Wafaa M. El-Sadr 1,3 Summary points Current interest in differentiated models for HIV care has largely focused on [...]