Antiretroviral drug supply challenges in the era of scaling up ART in Malawi

The number of people receiving antiretroviral treatment (ART) has increased considerably in recent years and is expected to continue to grow in the coming years. A major challenge is to maintain uninterrupted supplies of antiretroviral (ARV) drugs and prevent stock outs. This article discusses issues around the management of ARVs and prevention of stock outs in Malawi, a low-income country with a high HIV/AIDS burden, and a weak procurement and supply chain management system. This system for ARVs, paid for by the Global Fund to Fight AIDS, Tuberculosis and Malaria, and bypassing the government Central Medical Stores, is in place, using the United Nations Children’s Fund’s (UNICEF’s) procurement services. The system, managed by a handful of people who spend limited time on supply management, is characterized by a centrally coordinated quantification based on verified data from all national ART clinics, parallel procurement through UNICEF, and direct distribution to ART clinics. The model worked well in the first years of the ART programme with a single first-line ARV regimen, but with more regimens becoming available (e.g., alternative first-line, second-line and paediatric regimens), it has become more difficult to administer. Managing supplies through a parallel system has the advantage that weaknesses in the national system have limited influence on the ARV procurement and supply chain management system. However, as the current system operates without a central warehouse and national buffer stock capacity, it diminishes the ability to prevent ARV stock outs. The process of ordering ARVs, from the time that estimates are made to the arrival of supplies in health facilities, takes approximately one year. Addressing the challenges involved in maintaining ARVs through an efficient procurement and supply chain management system that prevents ARV stock outs through the establishment of a dedicated procurement team, a central warehouse and/or national buffer stock is a priority

New deal for disabled people national extension: findings from the first wave of qualitative research with clients, job brokers and jobcentre plus staff

The New Deal for Disabled People (NDDP) was introduced in 1998 and 1999 as a series of pilots designed to evaluate services based on the use of personal advisers to help disabled people move into or stay in paid employment. The pilots were wound up in 2001 and superseded by what is known as the ‘national extension’ of NDDP, the aim of which is to ‘support and test innovative ways of helping people on Incapacity Benefits move from economic inactivity into sustained employment’ (DSS, ES, DfEE research specification, April, 2001). Services under the national extension are provided by a network of around 60 ‘Job Broker’ organisations including voluntary and other not-for-profit bodies, commercial companies, government agencies and other public sector organisations. This report presents findings from a first wave of qualitative research carried out in 2002 which forms part of a larger programme of work aimed at providing the Department for Work and Pensions with a comprehensive evaluation of the NDDP extension. The overall aim of the qualitative research is to explore the organisation, operation and impacts of the Job Broker service from the perspective of all key stakeholders, including users and providers of Job Broker services, and staff of Jobcentre Plus offices. Specifically, the research was designed to produce data on the following: • factors affecting participation in the Job Broker programme • clients’ understanding and experiences of NDDP • the role and operation of Job Brokers • the role and operation of the Jobcentre Plus staff who can provide people with information about Job Broker services. A research design was adopted that aimed to gather data using a range of qualitative research techniques from key actors associated with 18 Job Broker services operating in 15 specific geographical areas. The first wave of data collection was carried out in the Summer/Autumn of 2002; a second wave is planned for 2003. The report is organised into three main parts. Part I (Chapters 2 to 5) presents findings from the Job Broker and Jobcentre Plus staff research. In Part II (Chapters 6 to 9), the client perspective is presented. Part III (Chapter 10) provides an overall summary of the emerging issues

Strategic Administration for Online Courses in Communication and Writing Programs

The strategic administration of online courses in communication and writing programs depends on a balance of standardization and flexibility to meet the needs of diverse stakeholders. Based on experiences managing online courses in three large communication and writing programs, the authors of this study argue that exercising collaborative leadership and using iterative development principles to create pre-designed courses can support a sustainable approach to creating user-centered learning experiences for both students and instructors. In addition to providing a research-based rationale and sharing situated examples, this study provides specific recommendations to help programs promote collaborative leadership and integrate elements of the PARS framework—personal, accessible, responsive, and strategic—into the iterative development of pre-designed courses.This book chapter is published as Anders, A., Aune, J. Fulton, K., Kretsinger-Harries, A., Walton, A., and White, C. (2023). Strategic Administration for Online Courses in Large Communication and Writing Programs. In J. Borman & C. McArdle. (Eds), PARS for Writing Programs. Chapter 13;186-205.https://wac.colostate.edu/books/practice/pars3/ . Posted with permission. Copyright © 2023 Jessie Borgman, Casey McArdle, and the authors of individual parts of this book. This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 International License. 344 pages, with notes, illustrations, and bibliographies. This book will be available in print from University Press of Colorado as well as from any online or brick-and-mortar bookstore. Available in digital formats for no charge on this page at the WAC Clearinghouse. You may view this book. You may print personal copies of this book. You may link to this page. You may not reproduce this book on another website

Predicting fitness-to-drive following stroke using the Occupational Therapy – Driver Off Road Assessment Battery

Introduction: It is difficult to determine if, or when, individuals with stroke are ready to undergo on-road fitness-to-drive assessment. The Occupational Therapy - Driver Off Road Assessment Battery was developed to determine client suitability to resume driving. The predictive validity of the Battery needs to be verified for people with stroke. Aim: Examine the predictive validity of the Occupational Therapy - Driver Off Road Assessment Battery for on-road performance among people with stroke. Method: Off-road data were collected from 148 people post stroke on the Battery and the outcome of their on-road assessment was recorded as: fit-to-drive or not fit-to-drive. Results: The majority of participants (76%) were able to resume driving. A classification and regression tree (CART) analysis using four subtests (three cognitive and one physical) from the Battery demonstrated an area under the curve (AUC) of 0.8311. Using a threshold of 0.5, the model correctly predicted 98/112 fit-to-drive (87.5%) and 26/36 people not fit-to-drive (72.2%). Conclusion: The three cognitive subtests from the Occupational Therapy - Driver Off Road Assessment Battery and potentially one of the physical tests have good predictive validity for client fitness-to-drive. These tests can be used to screen client suitability for proceeding to an on-road test following stroke. Implications for Rehabilitation: Following stroke, drivers should be counseled (including consideration of local legislation) concerning return to driving. The Occupational Therapy - Driver Off Road Assessment Battery can be used in the clinic to screen people for suitability to undertake on road assessment. Scores on four of the Occupational Therapy - Driver Off Road Assessment Battery subtests are predictive of resumption of driving following stroke

Re-Treatment Tuberculosis Cases Categorised as “Other”: Are They Properly Managed?

BACKGROUND: Although the World Health Organization (WHO) provides information on the number of TB patients categorised as "other", there is limited information on treatment regimens or treatment outcomes for "other". Such information is important, as inappropriate treatment can lead to patients remaining infectious and becoming a potential source of drug resistance. Therefore, using a cohort of TB patients from a large registration centre in Lilongwe, Malawi, our study determined the proportion of all TB re-treatment patients who were registered as "other", and described their characteristics and treatment outcomes. METHODS: This retrospective observational study used routine program data to determine the proportion of all TB re-treatment patients who were registered as "other" and describe their characteristics and treatment outcomes between January 2006 and December 2008. RESULTS: 1,384 (12%) of 11,663 TB cases were registered as re-treatment cases. Of these, 898 (65%) were categorised as "other": 707 (79%) had sputum smear-negative pulmonary TB and 191 (21%) had extra pulmonary TB. Compared to the smear-positive relapse, re-treatment after default (RAD) and failure cases, smear-negative "other" cases were older than 34 years and less likely to have their HIV status ascertained. Among those with known HIV status, "other" TB cases were more likely to be HIV positive. Of TB patients categorised as "other", 462 (51%) were managed on the first-line regimen with a treatment success rate of 63%. CONCLUSION: A large proportion of re-treatment patients were categorised as "other". Many of these patients were HIV-infected and over half were treated with a first-line regimen, contrary to national guidelines. Treatment success was low. More attention to recording, diagnosis and management of these patients is warranted as incorrect treatment regimen and poor outcomes could lead to the development of drug resistant forms of TB

Using Touchscreen Electronic Medical Record Systems to Support and Monitor National Scale-Up of Antiretroviral Therapy in Malawi

Gerry Douglas and colleagues describe the rationale and their experience with scaling up electronic health records in six antiretroviral treatment sites in Malawi

Linking people and activities through community mobility : an international comparison of the mobility patterns of older drivers and non-drivers

Community mobility using private and public transportation is important for maintaining health, social participation and living well in later life. This international cross-sectional cohort study (N= 246) reported on the health and driving status of older adults from seven countries where the mobility patterns of drivers and non-drivers were compared in terms of city and rural areas, weather, as well as their respective differences in the number of out-of-home places accessed and quality of life. Older adults participated in a semi-structured interview and completed four standardised instruments: the EQ-5D-5L, modified PULSES health profile, modified Transportation Questionnaire, and the Transport – Participation in Activities and Places Outside the Home. Results suggested inclement weather and place of residence negatively impacted out-of-home activities but did not increase use of public transportation. Drivers accessed more out-of-home activities than non-drivers, suggesting higher community participation among this group, and quality of life was generally high among all participants, but slightly higher for drivers. Findings indicate that a complex myriad of factors can influence community mobility in older adults and further investigations are needed to understand patterns of transport in later life, particularly with regard to those factors that promote and maintain transport mobility, and relationships between transport mobility, community participation and quality of life