Suchergebnisse

The past decade has seen notable progress in confronting the HIV epidemic. By the end of 2013, almost 13 million persons living with HIV had access to antiretroviral therapy (ART) in low‐ and middle‐income countries (LMIC). In addition, progress has also been achieved in terms of HIV prevention with 26 LMIC achieving a 50% decrease in number of new infections including 15 countries in sub‐Saharan Africa. New research findings also offer new efficacious prevention interventions that offer new opportunities for further mitigation of new HIV infections. Such progress has inspired ambitious pronouncements such as achieving "The End of AIDS" or "An AIDS Free Generation." This progress has also motivated the development of new guidelines aimed to achieving these goals. Implementation of guideline recommendations, however, requires translation of these guidelines into actionable steps and then their successful delivery within established health services. The opportunities offered by new guidelines frequently meet the realities of the frailties of the health system. Achieving current ambitious global targets must confront the specific deficits in the health system that inhibit access and acceptability of programmes as well as hinder achievement of high quality or desired coverage.

The growing movement to make antiretroviral therapy (ART) widely available in South Africa has spurred discussion on different aspects of delivering HIV treatment services,1 2 deliberations that have taken on new importance in light of the national government's recent announcement of a plan to make ART widely available in the public sector. Yet one critical aspect of delivering ART effectively within HIV care services has received surprisingly little attention, namely the challenge of retaining patients in long-term programmes of primary care. Here we discuss the importance of distinguishing adherence to medications from retention in care, as well as the possible interventions that may be employed to improve long-term patient retention.

In his 2003 State of the Union Address, President George W. Bush asked Congress to commit $15 billion over the next 5 years for the President's Emergency Plan for AIDS Relief (PEPFAR) to combat the global epidemic of human immunodeficiency virus (HIV) infection. Thus was launched one of the largest international health-assistance programs in history. PEPFAR has since been both condemned as unilateral, paternalistic, narrowly focused, and distorted by a political agenda and lauded as groundbreaking, visionary, effective, and responsible for saving hundreds of thousands of lives. This year, Congress has had to consider the reauthorization of the program. On July 16, the Senate approved legislation that would increase the funding to $48 billion for the next 5 years, sending the measure into conference committee. Thus, this seems an appropriate time to examine PEPFAR's achievements, limitations, and lessons for the future.

The growing movement to make antiretroviral therapy (ART) widely available in South Africa has spurred discussion on different aspects of delivering HIV treatment services, deliberations that have taken on new importance in light of the national government's recent announcement of a plan to make ART widely available in the public sector. Yet one critical aspect of delivering ART effectively within HIV care services has received surprisingly little attention, namely the challenge of retaining patients in long-term programmes of primary care. Here we discuss the importance of distinguishing adherence to medications from retention in care, as well as the possible interventions that may be employed to improve long-term patient retention.

Tuberculosis (TB) and human immunodeficiency virus (HIV) disease have been closely entwined since the early years of the HIV/AIDS pandemic. The 2 conditions overlap in their epidemiologic characteristics and clinical manifestations and are both clothed in stigma. They individually carry the risk of creating social, economic, and political instability, which is markedly worsened when they affect a region in concert. The overwhelming burden of disease due to both TB and HIV is borne by resource-limited countries and the hardest hit among these are in sub-Saharan Africa. In sub-Saharan Africa, the HIV epidemic is accelerating what was already a massive TB epidemic, with the incidence rate of TB increasing from 146 per 100,000 in 1990 to 345 per 100,000 in 2003. Each disease contributes to the morbidity and mortality of the other. TB is now the leading cause of death among persons with HIV disease. HIV increases the risk of reactivation of latent TB infection (LTBI) and progression to active TB disease more than any other known risk factor. In some countries, the percentage of patients with active TB who are coinfected with HIV is now greater than 60%. Even with appropriate management of TB, patients with HIV co-infection have increased mortality as a consequence of HIV-related complications.

Abstract China has made substantial health commitments to Africa in the past several decades. However, while much has been written regarding China-Africa aid overall, relatively little attention has been given to China's health aid. To better understand these investments, we provide an overview of the current framework and characteristics of China's health aid to Africa. China's health assistance has been perceived by some as opportunistic, largely as a demonstration of China's engagement in "soft power" and an attempt to enhance its access to natural resources and political favors by African countries. Others have attributed altruistic intent, aiming to support the advancement of the health of populations in the African continent with a "no strings attached" approach. Our overview demonstrated that despite the magnitude of China's health assistance, many questions remain regarding the scope of this aid, its effectiveness and the governance mechanisms that guide the conceptualization and implementation of such efforts. We also identified the need for a systematic and rigorous evaluation of the various elements of China's health assistance to African countries in order to gain a deeper understanding of how priorities and allocations for health aid are determined, how such aid fits within the specific African country's health strategies and to assess the effectiveness of such aid. Insights garnered through such an assessment could help determine future priorities for investment as well as inform efforts to optimize the value of China's aid for the populations of the recipient countries.

Background Since the beginning of the Syrian conflict in 2011, Jordan, Lebanon and Turkey have hosted large refugee populations, with a high pre-conflict burden of non-communicable diseases (NCDs). Objectives We aimed to describe the ways in which these three host country health systems have provided NCD services to Syrian refugees over time, and to highlight the successes and challenges they encountered. Methods We conducted a descriptive review of the academic and grey literature, published between March 2011 and March 2017, using PubMed and Google searches complemented with documents provided by relevant stakeholders. Results Forty-one articles and reports met our search criteria. Despite the scarcity of systematic population-level data, these documents highlight the high burden of reported NCDs among Syrian refugees, especially amongst older adults. The three host countries utilized different approaches to the design, delivery and financing of NCD services for these refugees. In Jordan and Lebanon, Ministries of Health and the United Nations High Commissioner for Refugees (UNHCR) coordinate a diverse group of health care providers to deliver health services to Syrian refugees at a subsidized cost. In Turkey, however, services are provided solely by the Disaster and Emergency Management Presidency (AFAD), a Turkish governmental agency, with no cost to patients for primary or secondary care. Access to NCD services varied both within and between countries, with no data available from Turkey. The cost of NCD treatment is the primary barrier to accessing healthcare, with high out-of-pocket payments required for medications and secondary and tertiary care services, despite the availability of free or subsidized primary health services. Financial impediments led refugees to adopt coping strategies, including returning to Syria to seek treatment, with associated frequent treatment interruptions. These gaps were compounded by health system related barriers such as complex referral systems, lack of effective guidance on navigating the health system, limited health facility capacity and suboptimal NCD health education. Conclusion As funding shortages for refugee services continue, innovative service delivery models are needed to create responsive and sustainable solutions to the NCD burden among refugees in host countries.