Stronger health systems for more effective HIV/AIDS prevention and care

University of the Witwatersrand, Johannesburg, Gauteng, South Africa
International Journal of Health Planning and Management (Impact Factor: 0.97). 10/2003; 18(S1). DOI: 10.1002/hpm.725
Source: OAI


Of the 42 million living with HIV/AIDS world-wide some 90% live in developing countries. The international community acknowledges the devastating impact of HIV/AIDS on development and over the past few years resources to control HIV/AIDS have increased considerably. We argue that strengthening of health systems is a necessary prerequisite for improving the prevention of HIV infection and the care of HIV-infected persons. Sexual behaviour change requires a multidisciplinary approach, but health services play a crucial role in detection and treatment of other sexually transmitted infections; HIV counselling and testing; prevention of mother-to-child transmission of HIV; and care of HIV-infected patients. Increasing access to antiretroviral treatment especially poses formidable challenges to health authorities in developing countries. Additional resources for the prevention of HIV-infection and the care of HIV-infected persons may not have the desired impact if health systems in developing countries are not strengthened. Further, any activity in the area of HIV/AIDS prevention and care, carried out within health services, can have a positive ripple effect on other health care activities and vice versa. This interactive effect needs to be acknowledged and built on.

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Available from: James Mcintyre
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    • "In the wake of the human immunodeficiency virus (HIV) epidemic in Sub-Saharan Africa (SSA), alternative service delivery models like the Community Home-Based Care (CHBC) [1] [2] [3] [4] [5] [6] have evolved to fill the gap left by overstretched and underresourced health systems. CHBC includes any form of care (physical, psychosocial, palliative, and spiritual) given to the sick and the affected in their own homes and care extended from the hospital or health facility to their homes through family participation and community involvement [7] [8]. "
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    ABSTRACT: Community Home-Based Care (CHBC) has evolved in resource-limited settings to fill the unmet needs of people living with HIV/AIDS (PLHA). We compare HIV and tuberculosis (TB) outcomes from the Nsambya CHBC with national averages in Kampala,Uganda.This retrospective observational study compared HIV and TB outcomes from adults and children in the Nsambya CHBC to national averages from 2007 to 2011. Outcomes included numbers of HIV and TB patients enrolled into care, retention, loss to follow-up (LTFU), and mortality among patients on antiretroviral therapy (ART) at 12 months from initiation; new smear positive TB cure and defaulter rates; and proportion of TB patients tested for HIV. Chi-square test and trends analyses were used to compare outcomes from Nsambya CHBC with national averages. By 2011, approximately 14,000 PLHA had been enrolled in the Nsambya CHBC, and about 4,000 new cases of TB were detected and managed over the study period. Overall, retention and LTFU of ART patients 12 months after initiation, proportion of TB patients tested for HIV, and cure rates for new smear-positive TB scored higher in the Nsambya CHBC compared to national averages. The findings show that Nsambya CHBC complements national HIV and TB management and results in more positive outcomes.
    Full-text · Article · Mar 2014
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    • "Although these mass immunization campaigns may have a direct impact on polio immunization coverage, they are also known for their destructive effect on routine activities [8]. Finally, the weak health systems in developing countries have been also described as the major obstacle to the achievement of diseases control programs goals [9] "
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    ABSTRACT: Objective: The objective of this study was to analyze the current strategies used for eradicating wild polio viruses (WPV) and to propose some innovative strategies that may help to accelerate the progress towards polio eradication. Methods: We assessed the current strategies proposed by the World Health Organization, and the effectiveness of the current trivalent oral polio vaccine types 1, 2 and 3 (tOPV) schedule. Results: With the current schedule, tOPV is given four times to the child during his first year of life. After the four doses, 27%, 10% and 30% of children vaccinated are not immunized against WPV types 1, 2 and 3 respectively. In addition, low access to health care, insufficient funding of the routine immunization activities, and weak health systems hamper the tOPV coverage and the early detection of WPV cases for a rapid outbreak response. All these issues could explain the recurrence of WPV outbreaks, even in countries free of polio for many years. Therefore, we propose for countries of non-polio free regions, a new routine po-lio vaccination schedule composed of four doses of tOPV, followed by three doses of monovalent OPV type 1, and lastly by three doses of bivalent OPV types 1 and 3. With this schedule, of children fully vaccinated, 100%, 90% and 99% will be immunized against WPV types 1, 2 and 3 respectively. In addition, adequate funding for routine immuni-zation activities and health system strengthening are proposed to accelerate the achievement of the polio eradication goal in a near future. Conclusions: The polio eradication goal is achievable. However, innovative strategies are urgen-tly needed to improve the effectiveness and the efficiency of the routine polio immunization program.
    Full-text · Article · Jan 2012 · World Journal of Vaccines
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    • "In recent years, a number of global health leaders and experts have highlighted how HIV/AIDS-focused programs interact with other health services that are not included in the more targeted HIV/AIDS programs [9,10][11]. Some argue that concentrating efforts on HIV/AIDS should be able to strengthen health systems in general [12] by ensuring that qualified health care workers are at clinics, enabling resources allocated for HIV/AIDS to spill over to other health services, and drawing attention to deficiencies in the health system [13][14]. Others argue that a negative association between HIV/AIDS programs and other services exists; that the additional requirements of the HIV/AIDS programs disrupt basic health service delivery and overburden a fragile health system [15]. "
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    ABSTRACT: HIV/AIDS is a major public health concern in Uganda. There is widespread consensus that weak health systems hamper the effective provision of HIV/AIDS services. In recent years, the ways in which HIV/AIDS-focused programs interact with the delivery of other health services is often discussed, but the evidence as to whether HIV/AIDS programs strengthen or distort overall health services is limited. The aim of this study was to examine the effect of a PEPFAR-funded HIV/AIDS program on six government-run general clinics in Kampala. Longitudinal information on the delivery of health services was collected at each clinic. Monthly changes in the volume of HIV and non-HIV services were analyzed by using multilevel models to examine the effect of an HIV/AIDS program on health service delivery. We also conducted a cross-sectional survey utilizing patient exit interviews to compare perceptions of the experiences of patients receiving HIV care and those receiving non-HIV care. All HIV service indicators showed a positive change after the HIV program began. In particular, the number of HIV lab tests (10.58, 95% Confidence Interval (C.I.): 5.92, 15.23) and the number of pregnant women diagnosed with HIV tests (0.52, 95%C.I.: 0.15, 0.90) increased significantly after the introduction of the project. For non-HIV/AIDS health services, TB lab tests (1.19, 95%C.I.: 0.25, 2.14) and diagnoses (0.34, 95%C.I.: 0.05, 0.64) increased significantly. Noticeable increases in trends were identified in pediatric care, including immunization (52.43, 95%C.I.: 32.42, 74.43), malaria lab tests (1.21, 95%C.I.: 0.67, 1.75), malaria diagnoses (7.10, 95%C.I.: 0.73, 13.46), and skin disease diagnoses (4.92, 95%C.I.: 2.19, 7.65). Patients' overall impressions were positive in both the HIV and non-HIV groups, with more than 90% responding favorably about their experiences. This study shows that when a collaboration is established to strengthen existing health systems, in addition to providing HIV/AIDS services in a setting in which other primary health care is being delivered, there are positive effects not only on HIV/AIDS services, but also on many other essential services. There was no evidence that the HIV program had any deleterious effects on health services offered at the clinics studied.
    Full-text · Article · Mar 2011 · BMC International Health and Human Rights
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