National and subnational HIV/AIDS coordination: are global health initiatives closing the gap between intent and practice?

BACKGROUND: A coordinated response to HIV/AIDS remains one of the 'grand challenges' facing policymakers today. Global health initiatives (GHIs) have the potential both to facilitate and exacerbate coordination at the national and subnational level. Evidence of the effects of GHIs on coordination is beginning to emerge but has hitherto been limited to single-country studies and broad-brush reviews. To date, no study has provided a focused synthesis of the effects of GHIs on national and subnational health systems across multiple countries. To address this deficit, we review primary data from seven country studies on the effects of three GHIs on coordination of HIV/AIDS programmes: the Global Fund to Fight AIDS, Tuberculosis and Malaria, the President's Emergency Plan for AIDS Relief (PEPFAR), and the World Bank's HIV/AIDS programmes including the Multi-country AIDS Programme (MAP). METHODS: In-depth interviews were conducted at national and subnational levels (179 and 218 respectively) in seven countries in Europe, Asia, Africa and South America, between 2006 and 2008. Studies explored the development and functioning of national and subnational HIV coordination structures, and the extent to which coordination efforts around HIV/AIDS are aligned with and strengthen country health systems. RESULTS: Positive effects of GHIs included the creation of opportunities for multisectoral participation, greater political commitment and increased transparency among most partners. However, the quality of participation was often limited, and some GHIs bypassed coordination mechanisms, especially at the subnational level, weakening their effectiveness. CONCLUSIONS: The paper identifies residual national and subnational obstacles to effective coordination and optimal use of funds by focal GHIs, which these GHIs, other donors and country partners need to collectively address

Urotensin-2 Receptor Antagonist - Palosuran Decreases Blood Pressure And Plasma Renin Concentration In Laboratory Rats With Renovascular Hypertension

We were aimed to study effects of the Urotensin-2 receptor antagonist - Palosuran on blood pressure and plasma rennin concentration in laboratory rats with renovascular hypertension (2 kidneys + 1 clip).  Blood pressure was measured using noninvasive “tail cuff“ method.Studies have shown that in experimental rats palosuran (10 mg/kg/daily, during 4 weeks) reveal hypotensive effect. Blood pressure was decreased even after administration NO-synthase inhibitor - L-NAME (10 mg/kg, single dose), supposedly due to its urotensin-2 receptor antagonistic properties.In hypertensive rats plasma renin concentration was increased progressively compared to the data of healthy rats. In palosuran-treated hypertensive rats  renin concentration was significantly lower than in untreated hypertensive rats. Decreased renin concentration was maintained after administration of L-NAME, except during the late-onset of treatment.It could be concluded that in experimental rats with renovascular hypertension the vasodilatatory effect of palosuran outweighs the inhibitory effect of L-NAME on NO production and urotensin-induced endothelium-independent vasoconstrictive effect, especially at the early stages and early onset of treatment of hypertension. Palosuran might represent a new therapeutic option in individuals with hypertension disease

Circus monkeys or change agents? Civil society advocacy for HIV/AIDS in adverse policy environments.

This paper explores the factors enabling and undermining civil society efforts to advocate for policy reforms relating to HIV/AIDS and illicit drugs in three countries in Eastern Europe and Central Asia: Georgia, Kyrgyzstan and Ukraine. It examines how political contexts and civil society actors' strengths and weaknesses inhibit or enable advocacy for policy change - issues that are not well understood in relation to specific policy areas such as HIV/AIDS, or particular regions of the world where national policies are believed to be major drivers of the HIV/AIDS epidemic. The study is based on in-depth interviews with representatives of civil society organizations (CSOs) (n = 49) and national level informants including government and development partners (n = 22). Our policy analysis identified a culture of fear derived from concerns for personal safety but also risk of losing donor largesse. Relations between CSOs and government were often acrimonious rather than synergistic, and while we found some evidence of CSO collective action, competition for external funding - in particular for HIV/AIDS grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria was often divisive. Development partners and government tend to construct CSOs as service providers rather than advocates. While some advocacy was tolerated by governments, CSO participation in the policy process was, ultimately, perceived to be tokenistic. This was because there are financial interests in maintaining prohibitionist legislation: efforts to change punitive laws directed at the behaviors of minority groups such as injecting drug users have had limited impact

Risk factors associated with the occurrence of anthrax outbreaks in livestock in the country of Georgia: A case-control investigation 2013-2015.

IntroductionAnthrax is considered endemic in livestock in Georgia. In 2007, the annual vaccination became the responsibility of livestock owners, while contracting of private veterinarians was not officially required. Six years later, due to increase in human outbreaks associated with livestock handling, there is a need to find out the risk factors of livestock anthrax in Georgia.ObjectiveTo identify exposures and risk factors associated with livestock anthrax.MethodsA matched case-control study design was used to recruit the owners of individual livestock anthrax cases that occurred between June 2013 and May 2015, and owners of unaffected livestock from within ("village control") and outside the village ("area control"). We collected data about the case and control livestock animals' exposure and risk factors within the one-month prior to the disease onset of the case livestock (or matched case for the controls). We used logistic regression analysis (univariate and multivariable) to calculate the odds ratios of exposures and risk factors.ResultsDuring the study period, 36 anthrax cases met the case definition and were enrolled in the study; 67 matched village control livestock and 71 matched area control livestock were also enrolled. The findings from multivariable logistic regression analysis demonstrate that vaccination within the last two years significantly reduced the odds of anthrax in cattle (OR = 0.014; 95% Confidence interval = ConclusionsThe information obtained from this study has involved and been presented to decision makers, used to build technical capacity of veterinary staff, and to foster a One Health approach to the control of zoonotic diseases which will optimize prevention and control strategies. Georgia has embedded the knowledge and specific evidence that vaccination is a highly protective measure to prevent anthrax deaths among livestock, to which primary emphasis of the anthrax control program will be given. Education of livestock keepers in Georgia is an overriding priority

Knowledge, attitudes, and practices related to anthrax and animal care: A case-control study in Georgia.

INTRODUCTION:Anthrax is endemic in Georgia and recent outbreaks prompted a livestock-handler case-control study with a component to evaluate anthrax knowledge, attitudes, and practices (KAP) among livestock handlers or owners. METHODS:Cases were handlers of livestock with confirmed animal anthrax from June 2013-May 2015. Handlers of four matched unaffected animals were selected as controls, two from the same village as the case animal ("village control") and two from 3-10 km away ("area control"). Descriptive statistics were reported and conditional logistic regression was performed to estimate the magnitude of the association of cases with specific study KAP factors. RESULTS:Cases were more likely male, had lower level college education, less animal care experience, and provided more animal care to their cattle. Cases had lower odds of burying a suddenly dead animal compared to all controls (Odds Ratio [OR]: 0.32, 95% Confidence interval [CI]:0.12, 0.88) and area controls (OR: 0.32, 95% CI: 0.11, 0.91). On an 8-point knowledge scale, cases having an animal with anthrax had a 1.31 times greater knowledge score compared to all controls (95% CI: 1.03, 1.67). Cases had higher odds of ever having human anthrax or knowing another person who had anthrax compared to all controls (OR: 4.56, 95% CI: 1.45, 14.30) and area controls (OR: 7.16, 95% CI: 1.52, 33.80). DISCUSSION:Cases were more knowledgeable of anthrax and had better anthrax prevention practices, but these are likely a result of the case investigation and ring vaccination following the death of their animal. CONCLUSIONS:The findings reveal a low level of knowledge and practices related to anthrax control and prevention, and will guide educational material development to fill these gaps