Potential applications of conditional cash transfers for prevention of sexually transmitted infections and HIV in Sub-Saharan Africa

A growing number of developing countries have introduced conditional cash transfer programs that provide money to poor families with certain contingencies attached - such as requiring school attendance or regular immunization and health check-ups. As the popularity of conditional cash transfer programs has grown, experimentation with potential applications in other areas of health, such as sexual and reproductive health, and HIV prevention, in particular, has also increased. Evaluations of conditional cash transfer programs have focused almost exclusively on uptake of health and educational services, which make relatively low demands of participants compared with more complex interventions, which require the cessation of risky behaviors, such as smoking, obesity, and substance abuse. The literature on contingency management - based on the principle that behavioral change occurs when appropriate behaviors are reinforced and rewarded - provides a richer picture of the complexity of the use of conditionality to encourage healthy behavioral change. This paper examines developing countries'experiences with conditional cash transfer programs and the results of trials in clinical settings on the efficacy of contingency management, and addresses their relevance for designing conditional cash transfer programs to address risky sexual behavior and promote the prevention of sexually transmitted infections and HIV in Sub-Saharan Africa.Health Monitoring&Evaluation,Population Policies,Adolescent Health,Disease Control&Prevention,HIV AIDS

The Union and Médecins Sans Frontières approach to operational research.

Operational research (OR) has become a hot topic at national meetings, international conferences and donor fora. The International Union Against Tuberculosis and Lung Disease (The Union) and Médecins Sans Frontières (MSF) Operational Centre Brussels strongly promote and implement OR with colleagues in low- and middle-income countries. Here we describe how the two organisations define OR, and explain the guiding principles and methodology that underpin the strategy for developing and expanding OR in those countries. We articulate The Union's and MSF's approach to supporting OR, highlighting the main synergies and differences. Then, using the Malawi National Tuberculosis Control Programme as an example, we show how OR can be embedded within tuberculosis control activities, leading to changes in policy and practice at the national level. We discuss the difficult, yet vitally important, issue of capacity building, and share our vision of a new paradigm of product-related training and performance-based OR fellowships as two ways of developing the necessary skills at country level to ensure research is actually performed. Finally, we highlight the need to consider and incorporate into practice the ethical components of OR. This is a key moment to be involved in OR. We are confident that in partnership with interested stakeholders, including the World Health Organization, we can stimulate the implementation of quality, relevant OR as an integral part of health service delivery that in turn will lead to better health for people, particularly for those living in the poorer parts of the world

Bringing HIV Prevention to Scale: An Urgent Global Priority

Illustrates the need for a scaled-up HIV prevention response in order to stem the epidemic, describes impediments to HIV prevention efforts and examples of successful initiatives, and includes recommendations for governments, health agencies, and donors

PEPFAR Public Health Evaluation - Care and Support - Phase 2 Uganda

Phase 2 consisted of a longitudinal cohort study to measure patient-reported outcomes of care and support, a costing survey, and qualitative interviews to understand patient and carer experiences

Acceptability of isoniazid preventive therapy among Healthcare providers in selected HIV clinics in Nairobi County, Kenya

A research report submitted to the Faculty of Health Sciences in Partial fulfillment of the requirements for the degree of Master of Science in Epidemiology in the field of Implementation Science School of Public Health.The University of The Witwatersrand, 25 January 2018.Background: HIV/TB co-infection causes high morbidity and mortality among people living with HIV and places immense burden to health systems in developing settings. Isoniazid Preventive Therapy (IPT) is recognised as one of the most effective means of reducing TB burden in PLHIV yet its implementation still remains suboptimal, especially in sub-Saharan Africa. IPT implementation in Kenya (a high HIV/TB burden country) remains sub-optimal and little is known about the factors that influence its implementation. Data is also limited on the acceptability of IPT among health care providers in this context. This study assessed the factors influencing the acceptability of IPT among health care providers in selected HIV clinics in Nairobi County, Kenya. Methods: The study employed a cross-sectional design with an exploratory sequential mixed methods approach whereby a qualitative study was conducted followed by a quantitative survey. It was conducted in the HIV clinics of three purposively selected public health facilities. Qualitative data were collected through in-depth interviews with 18 purposively selected health care providers while quantitative data was collected from all health care providers in the clinics (74). Qualitative data on factors influencing IPT acceptability were analysed thematically and guided the development of the quantitative tool. An acceptability score was developed from nine items guided by four constructs of the Theoretical Framework for Acceptability. Explanatory variables were generated by grouping questionnaire items that assessed factors affecting acceptability. Multivariable linear regression analysis was performed to assess the relationship between the hypothesised factors and the acceptability scores. Results The qualitative inquiry found that policy and guideline-related, provider-related, patient-related, intervention-related, structural and operational factors influenced the acceptability of IPT among health care providers. The overall mean acceptability score in the study population was 70.33% (SD: 12.79) which was categorized as moderate. The health care providers did not find the intervention fully comfortable, agreeable or satisfactory to use. Among the determinants of acceptability of IPT, patient-related: model coefficient 5.12 (95% CI -0.39 – 10.63; P=0.050) and intervention-related: model coefficient 6.72 (95% CI 3.42– 10.01; P=0.000) factors were significantly associated with the acceptability scores in the quantitative analysis. An increase in the average composite score of these factors increased the acceptability score on average. Patient-related factors included patients’ adherence to IPT, pill burden, information on IPT, development of severe side-effects, refusal of IPT medication, clinical state and drug regimen. Intervention-related factors included INH resistance, side-effects and deaths, effectiveness of IPT, procedure of IPT related activities. Conclusion IPT was generally not fully acceptable among health care providers and was influenced by a number of different contextual factors. Among these, patient-related and intervention-related factors were important factors that affected the acceptability of IPT in the context of the three clinics. The promotion of evidence-based awareness and enforcement of implementation guidelines by policy makers and program managers are required to improve the acceptability of IPT among health care providers in the HIV clinics.LG201

European Philanthropic Support to Address HIV/AIDS in 2010

Analyzes data from a survey of thirty-one European foundations' HIV/AIDS-related funding in 2010 compared with past years, projected funding for 2011, and trends by country of origin, recipient country, types of projects supported, and population served