A critical assessment of the WHO responsiveness tool: lessons from voluntary HIV testing and counselling services in Kenya

<p>Abstract</p> <p>Background</p> <p>Health, fair financing and responsiveness to the user's needs and expectations are seen as the essential objectives of health systems. Efforts have been made to conceptualise and measure responsiveness as a basis for evaluating the non-health aspects of health systems performance. This study assesses the applicability of the responsiveness tool developed by WHO when applied in the context of voluntary HIV counselling and testing services (VCT) at a district level in Kenya.</p> <p>Methods</p> <p>A mixed method study was conducted employing a combination of quantitative and qualitative research methods concurrently. The questionnaire proposed by WHO was administered to 328 VCT users and 36 VCT counsellors (health providers). In addition to the questionnaire, qualitative interviews were carried out among a total of 300 participants. Observational field notes were also written.</p> <p>Results</p> <p>A majority of the health providers and users indicated that the responsiveness elements were very important, e.g. confidentiality and autonomy were regarded by most users and health providers as very important and were also reported as being highly observed in the VCT room. However, the qualitative findings revealed other important aspects related to confidentiality, autonomy and other responsiveness elements that were not captured by the WHO tool. Striking examples were inappropriate location of the VCT centre, limited information provided, language problems, and concern about the quality of counselling.</p> <p>Conclusion</p> <p>The results indicate that the WHO developed responsiveness elements are relevant and important in measuring the performance of voluntary HIV counselling and testing. However, the tool needs substantial revision in order to capture other important dimensions or perspectives. The findings also confirm the importance of careful assessment and recognition of locally specific aspects when conducting comparative studies on responsiveness of HIV testing services.</p

Antinoceptive and Anti-inflammatory Activities of the Ethanolic Extract, Fractions and Flavones Isolated from Mimosa tenuiflora (Willd.) Poir (Leguminosae).

The bark of Mimosa tenuiflora (Willd.) Poiret (Leguminosae family), popularly known as "jurema preta" in Brazil, is used by the population of Contendas of Sincorá (Bahia State, Brazil) for the treatment of coughs and wound healing. Thus, the aim of this study was to evaluate the antinociceptive and anti-inflammatory activities of the bark ethanol extract (EEMT) and solvent soluble fractions (hexane-H, DCM-D, EtOAc-E and BuOH-B) of the extract in vivo. Additionally, we synthesized 5,7-dihidroxy-4'-methoxyflavanone (isosakuranetin) and isolated the compound sakuranetin, and both compounds were also tested. The anti-inflammatory and antinociceptive assays performed were: writhing test; nociception induced by intraplantar formalin injection; leukocyte recruitment to the peritoneal cavity; evaluation of vascular permeability (Evans blue test); and evaluation of mechanical hypernociception (von Frey test). Production of TNF-α, IL-10, myeloperoxidase and the expression of ICAM-1 were also evaluated. Statistical analysis was performed by one-way ANOVA followed by the Bonferroni post-test (n = 8), with P < 0.05. The EEMT showed antinociceptive activities in writhing test (100-200 mg/kg), in the second phase of the formalin test (50-200 mg/kg), and in mechanical hypernociception (100 mg/kg). EEMT showed an anti-inflammatory effect by reducing neutrophil migration to the peritoneal cavity and in the plantar tissue detected by the reduction of myeloperoxidase activity (100 mg/kg), reduction of IL-10 levels and expression of ICAM-1 in the peritoneal exudate and the mesentery (100 mg/kg), respectively. The four soluble EEMT fractions showed good results in tests for antinociceptive (H, D, E, B) and anti-inflammation (H, D, E). Only sakuranetin showed reduction of the writhing and neutrophil migration (200 mg/kg). Thus, the EEMT and soluble fractions of M. tenuiflora bark demonstrated great antinociceptive and anti-inflammatory activities, as also sakuranetin. More studies should be conducted to elucidate the mechanism of action of this compound. To the best of our knowledge, this is the first report on the antinociceptive activity of the M. tenuiflora fractions and the bioactive isolated compound sakuranetin in vivo

Effect of ethanolic extract of <i>M</i>. <i>tenuiflora</i> bark on vascular permeability using the Evans blue test.

<p>VH is the vehicle group (negative control). The ethanol extract of <i>M</i>. <i>tenuiflora</i> bark was tested at the 100 mg/kg (s.c.) dose. The results are presented as the mean ± S.D. (n = 8). Statistical significance was calculated by ANOVA followed by Bonferroni's test. *<i>P</i> < 0.05 compared to the vehicle-negative control treated group.</p

Effect of the ethanolic extract of <i>M</i>. <i>tenuiflora</i> bark on ICAM-1 expression in the mesentery of mice.

<p>VH is the vehicle group (negative control). The ethanolic extract of <i>M</i>. <i>tenuiflora</i> bark was tested at the dose of 100 mg/kg (s.c.). The results are presented as the mean ± S.D. (n = 8). The optical density of the bands for ICAM-1 was normalized to α-tubulin expression. Statistical significance was calculated by ANOVA followed by Bonferroni's test. *<i>P</i> < 0.05 compared to the vehicle-negative control treated group.</p

Effect of the hexane (H), DCM (D), EtOAc (E) and BuOH (B) <i>M</i>. <i>tenuiflora</i> bark extract fractions on the nociception induced by intraplantar formalin injection in mice.

<p>Neurogenic phase (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0150839#pone.0150839.g012" target="_blank">Fig 12A</a>) and inflammatory phase (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0150839#pone.0150839.g012" target="_blank">Fig 12B</a>). Morphine (M, 5 mg/kg, s.c.) and indomethacin (I, 10 mg/kg, i.p.) were the positive control groups. The fractions were tested at 100 mg/kg. VH is the vehicle group (negative control). The results are presented as the mean ± S.D. (n = 8). Statistical significance was calculated by ANOVA followed by Bonferroni's test. *<i>P</i> < 0.05 compared to the vehicle-negative control treated group. # <i>P</i> > 0.05 compared to the morphine-treated group. • <i>P</i> > 0.05 compared to the indomethacin-treated group.</p

Effect of pretreatment of the mice with the hexane (H), DCM (D), ETOAc (E) and BuOH (B) (100 mg/kg) soluble fractions of the <i>M</i>. <i>tenuiflora</i> extract on acetic acid (0.6%)-induced writhing.

<p>VH is the vehicle group (negative control). The results are presented as the mean ± S.D. (n = 8). Statistical significance was calculated by ANOVA followed by Bonferroni's test. *<i>P</i> < 0.05 compared to the vehicle-negative control treated group.</p

Effect of the ethanolic extract of <i>M</i>. <i>tenuiflora</i> bark on Cg-induced TNF-α (A) and IL-10 (B) production in the peritoneal exudate.

<p>VH is the vehicle group (negative control). The ethanol extract of <i>M</i>. <i>tenuiflora</i> bark was tested at a dose of 100 mg/kg (s.c.). The results are presented as the mean ± S.D. (n = 8). Statistical significance was calculated by ANOVA followed by Bonferroni's test. *<i>P</i> < 0.05 compared to the vehicle-negative control treated group.</p

Effect of pretreatment of the mice with 50, 100 or 200 mg/kg of the ethanolic extract of <i>M</i>. <i>tenuiflora</i> bark on writhing induced by acetic acid (0.6%).

<p>VH is the vehicle group (negative control) and I is the positive control employing indomethacin (10 mg/kg, i.p.). The extract ethanol of <i>M</i>. <i>tenuiflora</i> bark was tested at doses of 50, 100 or 200 mg/kg (s.c.). The results are presented as the means ± S.D. of writhing in mice (n = 8). Statistical significance was calculated by ANOVA followed by Bonferroni's test. *<i>P</i> < 0.05 compared to the vehicle-negative control treated group. # <i>P</i> > 0.05 compared to the indomethacin—positive control group.</p

Flavonoids from <i>Mimosa tenuiflora</i>.

<p>Flavonoids from <i>Mimosa tenuiflora</i>.</p

Effect of the hexane (H) (200 mg/kg) and EtOAc (E) (50 mg/kg) <i>M</i>. <i>tenuiflora</i> bark extract fractions on neutrophil migration to the peritoneal cavity of mice after Cg administration.

<p>VH is the vehicle group (negative control). The results are presented as the mean ± S.D. (n = 8). Statistical significance was calculated by ANOVA followed by Bonferroni's test. *<i>P</i> < 0.05 compared to the vehicle-negative control treated group.</p