PEPFAR Public Health Evaluation-Care and Support -Phase I Kenya

Phase 1, a survey of 120 care facilities in Kenya and Uganda, found that over 90% of facilities provided some level of clinical, psychological,and preventive care. Pain control was very limited with paracetamol often the only analgesic. In focus group discussions, patients appreciated free care and positive attitudes from staff, but said that services would be improved by more staff, shorter queues, and reliable drug supplies

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

Phase 1, a survey of 120 care facilities in Kenya and Uganda, found that over 90% of facilities provided some level of clinical, psychological,and preventive care. Pain control was very limited with paracetamol often the only analgesic. In focus group discussions, patients appreciated free care and positive attitudes from staff, but said that services would be improved by more staff, shorter queues, and reliable drug supplies

Modeling the Impact of Land Surface Degradation on the Climate of Tropical North Africa

Degradation of the land surface has been suggested as a cause of persistent drought in tropical north Africa. A general circulation model is used to assess the impact of degradation of five regions within tropical north Africa. Idealized degradation scenarios are used since existing observations are inadequate the determine the extent and severity of historical degradation. It is found that the impact of degradation varies between the regions. The greatest effects are found from degradation of the Sahel or West Africa, which result in substantial reduction of precipitation over the degraded area. Both surface evaporation and atmospheric moisture convergence are reduced. In the Sahelian case the precipitation reduction extends well to the south of the area of changed land surface. The occurrence of easterly wave disturbances is not altered by degradation, but the mean rainfall from each event is reduced. Degradation of an area in eastern north Africa results in smaller reductions of precipitation and moisture convergence. Finally, degradation of a southern area next to the Gulf of Guinea has little effect on precipitation because of a compensatory increase of moisture convergence. The simulated rainfall reduction following degradation of the Sahel is comparable to observed changes in recent decades, suggesting that degradation may have contributed to that change

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

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

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

Current HIV/AIDS end-of-life care in sub-Saharan Africa: a survey of models, services, challenges and priorities

BACKGROUND: In response to increased global public health funding initiatives to HIV/AIDS care in Africa, this study aimed to describe practice models, strategies and challenges to delivering end-of-life care in sub-Saharan Africa. METHODS: A survey end-of-life care programs was conducted, addressing the domains of service aims and configuration, barriers to pain control, governmental endorsement and strategies, funding, monitoring and evaluation, and research. Both closed and qualitative responses were sought. RESULTS: Despite great structural challenges, data from 48 programs in 14 countries with a mean annual funding of US $374,884 demonstrated integrated care delivery across diverse settings. Care was commonly integrated with all advanced disease care (67%) and disease stages (65% offering care from diagnosis). The majority (98%) provided home-based care for a mean of 301 patients. Ninety-four percent reported challenges in pain control (including availability, lack of trained providers, stigma and legal restrictions), and 77% addressed the effects of poverty on disease progression and management. Although 85% of programs reported Government endorsement, end-of-life and palliative care National strategies were largely absent. CONCLUSIONS: The interdependent tasks of expanding pain control, balancing quality and coverage of care, providing technical assistance in monitoring and evaluation, collaborating between donor agencies and governments, and educating policy makers and program directors of end-of-life care are all necessary if resources are to reach their goals

The future for global water assessment

The global water cycle is a fundamental component of our climate and Earth system. Many, if not the majority, of the impacts of climate change are water related. We have an imperfect description and understanding of components of the water cycle. This arises from an incomplete observation of some of the stores and fluxes in the water cycle (in particular: precipitation, evaporation, soil moisture and groundwater), problems with the simulation of precipitation by global climate models and the wide diversity of global hydrological models currently in use. This paper discusses these sources of errors and, in particular, explores the errors and advantages of bias correcting climate model outputs for hydrological models using a single large catchment as an example (the Rhine). One conclusion from this analysis is that bias correction is necessary and has an impact on the mean flows and their seasonal cycle. However choice of hydrological model has an equal, if not larger effect on the quality of the simulation. The paper highlights the importance of improving hydrological models, which run at a continental and global scale, and the importance of quantifying uncertainties in impact studies

How should we manage information needs, family anxiety, depression, and breathlessness for those affected by advanced disease: development of a Clinical Decision Support Tool using a Delphi design

Background: Clinicians request guidance to aid the routine use and interpretation of Patient Reported Outcome Measures (PROMs),but tools are lacking. We aimed to develop a Clinical Decision Support Tool (CDST) focused on information needs, family anxiety, depression, and breathlessness (measured using the Palliative care Outcome Scale (POS)) and related PROM implementation guidance. Methods: We drafted recommendations based on findings from systematic literature searches. In a modified online Delphi study, 38 experts from 12 countries with different professional backgrounds, including four patient/carer representatives, were invited to rate the appropriateness of these recommendations for problems of varying severity in the CDST. The quality of evidence was added for each recommendation, and the final draft CDST reappraised by the experts. The accompanying implementation guidance was built on data from literature scoping with expert revision (n = 11 invited experts). Results: The systematic literature searches identified over 560 potential references, of which 43 met the inclusion criteria. Two Delphi rounds (response rate 66 % and 62 %;n = 25 and 23) found that good patient care, psychosocial support and empathy, and open communication were central to supporting patients and families affected by all POS concerns as a core requirement. Assessment was recommended for increasing problems (i.e. scores),followed by non-pharmacological interventions and for breathlessness and depression, pharmacological interventions. Accompanying PROM implementation guidance was built based on the 8-step International Society for Quality of Life Research framework, as revised by nine (response rate 82 %) experts. Conclusions: This CDST provides a straightforward guide to help support clinical care and improve evidence-based outcomes for patients with progressive illness and their families, addressing four areas of clinical uncertainty. Recommendations should be used flexibly, alongside skilled individual clinical assessment and knowledge, taking into account patients' and families' individual preferences, circumstances, and resources. The CDST is provided with accompanying implementation guidance to facilitate PROM use and is ready for further development and evaluation

The conceptual models and mechanisms of action that underpin advance care planning for cancer patients: A systematic review of randomised controlled trials

Background: No systematic review has focused on conceptual models underpinning advance care planning for patients with advancedcancer, and the mechanisms of action in relation to the intended outcomes.Aim: To appraise conceptual models and develop a logic model of advance care planning for advanced cancer patients, examining thecomponents, processes, theoretical underpinning, mechanisms of action and linkage with intended outcomes.Design: A systematic review of randomised controlled trials was conducted, and was prospectively registered on PROSPERO. Narrativesynthesis was used for data analysis.Data sources: The data sources were MEDLINE, CINAHL, PsycINFO, EMBASE, CENTRAL, PROSPERO, CareSearch, and OpenGreywith reference chaining and hand-searching from inception to 31 March 2017, including all randomised controlled trials withadvance care planning for cancer patients in the last 12 months of life. Cochrane quality assessment tool was used for qualityappraisal.Results: Nine randomised controlled trials were included, with only four articulated conceptual models. Mechanisms through whichadvance care planning improved outcomes comprised (1) increasing patients’ knowledge of end-of-life care, (2) strengtheningpatients’ autonomous motivation, (3) building patients’ competence to undertake end-of-life discussions and (4) enhancing shareddecision-making in a trustful relationship. Samples were largely highly educated Caucasian.Conclusion: The use of conceptual models underpinning the development of advance care planning is uncommon. When used, theyidentify the individual behavioural change. Strengthening patients’ motivation and competence in participating advance care planningdiscussions are key mechanisms of change. Understanding cultural feasibility of the logic model for different educational levels andethnicities in non-Western countries should be a research priority