Investment in HIV/AIDS programs: Does it help strengthen health systems in developing countries?

<p>Abstract</p> <p>Background</p> <p>There is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries. This article examines and assesses the evidence and proposes ways forward.</p> <p>Discussion</p> <p>Considerably increased resources have been brought into countries for HIV/AIDS programs by major Global Health Initiatives. Among the positive impacts are the increased awareness of and priority given to public health by governments. In addition, services to people living with HIV/AIDS have rapidly expanded. In many countries infrastructure and laboratories have been strengthened, and in some, primary health care services have been improved. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and, to an extent, by task-shifting. However, there are reports of concerns, too – among them, a temporal association between increasing AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programs. Unfortunately, there is limited hard evidence of these health system impacts.</p> <p>Because service delivery for AIDS has not yet reached a level that could conceivably be considered "as close to Universal Access as possible," countries and development partners must maintain the momentum of investment in HIV/AIDS programs. At the same time, it should be recognized that global action for health is even more underfunded than is the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both.</p> <p>Summary</p> <p>The evidence is mixed – mostly positive but some negative – as to the impact on health systems of the scaled-up responses to HIV/AIDS driven primarily by global health partnerships. Current scaled-up responses to HIV/AIDS must be maintained and strengthened. Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to also broadly strengthen the primary health care systems.</p

Investment in HIV/AIDS programs: Does it help strengthen health systems in developing countries?

Background: There is increasing debate about whether the scaled-up investment in HIV/AIDS programs is strengthening or weakening the fragile health systems of many developing countries. This article examines and assesses the evidence and proposes ways forward. Discussion: Considerably increased resources have been brought into countries for HIV/AIDS programs by major Global Health Initiatives. Among the positive impacts are the increased awareness of and priority given to public health by governments. In addition, services to people living with HIV/AIDS have rapidly expanded. In many countries infrastructure and laboratories have been strengthened, and in some, primary health care services have been improved. The effect of AIDS on the health work force has been lessened by the provision of antiretroviral treatment to HIV-infected health care workers, by training, and, to an extent, by task-shifting. However, there are reports of concerns, too – among them, a temporal association between increasing AIDS funding and stagnant reproductive health funding, and accusations that scarce personnel are siphoned off from other health care services by offers of better-paying jobs in HIV/AIDS programs. Unfortunately, there is limited hard evidence of these health system impacts. Because service delivery for AIDS has not yet reached a level that could conceivably be considered &quot;as close to Universal Access as possible,&quot; countries and development partners must maintain the momentum of investment in HIV/AIDS programs. At the same time, it should be recognized that global action for health is even more underfunded than is the response to the HIV epidemic. The real issue is therefore not whether to fund AIDS or health systems, but how to increase funding for both. Summary: The evidence is mixed – mostly positive but some negative – as to the impact on health systems of the scaled-up responses to HIV/AIDS driven primarily by global health partnerships. Current scaled-up responses to HIV/AIDS must be maintained and strengthened. Instead of endless debate about the comparative advantages of vertical and horizontal approaches, partners should focus on the best ways for investments in response to HIV to also broadly strengthen the primary health care systems

Clinical Efficacy and Microbiome Changes Following Fecal Microbiota Transplantation in Children With Recurrent Clostridium Difficile Infection

Fecal microbiota transplantation (FMT) has been shown as an effective treatment for recurrent clostridium difficile infection (RCDI) in adults. In this study, we aim to evaluate the clinical efficacy of FMT in treating children with RCDI, and explore fecal microbiota changes during FMT treatment. A total of 11 RCDI subjects with a median age of 3.5 years were enrolled in this single-center prospective pilot study. All patients were cured (11/11, 100%) by FMT either through upper gastrointestinal tract route with a nasointestinal tube (13/16, 81.2%) or lower gastrointestinal tract route with a rectal tube (3/16, 18.8%). The cure rate of single FMT was 63.6% (7/11), and 4 (4/11, 36.4%) cases were performed with 2 or 3 times of FMT. Mild adverse events were reported in 4 children (4/11, 36.4%), including transient diarrhea, mild abdominal pain, transient fever and vomit. Gut microbiota composition analysis of 59 fecal samples collected from 34 participants (9 RCDI children, 9 donors and 16 health controls) showed that the alpha diversity was lower in pediatric RCDI patients before FMT than the healthy controls and donors, and fecal microbial community of pre-FMT samples (beta diversity) was apart from that of healthy controls and donors. No significant differences in alpha diversity, beta diversity or phylogenetic distance were detected between donors and healthy controls. Both the richness and diversity of gut microbiota were improved in the pediatric RCDI patients after FMT, and the bacteria community was shifted closer to the donor and healthy control group. Furthermore, FMT re-directed gut microbiome functions of pediatric RCDI toward a health state. Our results indicate that it is safe and tolerant to use FMT in treating pediatric RCDI. FMT shifted the gut microbiome composition and function in children with RCDI toward a healthy state

Strengthening surveillance of and response to HIV in the Western Pacific

editoria

How are countries in the Western Pacific Region tracking the HIV epidemic? Results from a 2011 survey of ministries of health

In 2011, as part of the World Health Organization global reporting tool to collect data on the progress of improving the health sector response to HIV/AIDS towards universal access, a questionnaire was sent to ministries of health of Western Pacific Region Member States on the scope and functioning of their HIV surveillance systems. Of the 17 countries that responded, 13 were low- to middle-income countries and four were high-income countries. Regular serosurveillance surveys are conducted with female sex workers in all lower- and middle-income countries that responded to the survey but less so with people who inject drugs and men who have sex with men. Furthermore, there are no surveillance activities of the key populations in most of the Pacific island countries. It is recommended that estimations of high-risk populations be conducted in priority Pacific island countries and tailored surveillance systems be designed. Efforts should also be made to gather and accumulate data from sufficient geographic coverage to allow the HIV epidemic to continue to be monitored

One-Shot Replay: Boosting Incremental Object Detection via Retrospecting One Object

Modern object detectors are ill-equipped to incrementally learn new emerging object classes over time due to the well-known phenomenon of catastrophic forgetting. Due to data privacy or limited storage, few or no images of the old data can be stored for replay. In this paper, we design a novel One-Shot Replay (OSR) method for incremental object detection, which is an augmentation-based method. Rather than storing original images, only one object-level sample for each old class is stored to reduce memory usage significantly, and we find that copy-paste is a harmonious way to replay for incremental object detection. In the incremental learning procedure, diverse augmented samples with co-occurrence of old and new objects to existing training data are generated. To introduce more variants for objects of old classes, we propose two augmentation modules. The object augmentation module aims to enhance the ability of the detector to perceive potential unknown objects. The feature augmentation module explores the relations between old and new classes and augments the feature space via analogy. Extensive experimental results on VOC2007 and COCO demonstrate that OSR can outperform the state-of-the-art incremental object detection methods without using extra wild data

Seasonal Variation and Driving Factors of Nitrate in Rivers of Miyun Reservoir Watershed, North China

In order to identify the seasonal variations and dominant driving factors of NO3-N in rivers, investigations of five consecutive years were conducted in seven rivers of the Miyun Reservoir Watershed. Significant seasonal variation of NO3-N in rivers was separately found in the dormant season (non-growing season) and the growing season. Furtherly, the V-shaped, W-shaped, and indistinct seasonal patterns of NO3-N accounted for 53.0%, 38.7%, and 8.3%, respectively. They were remarkably affected by stream flow, and their significant quadratic function was discovered. The annual maxima and minima of NO3-N corresponded to medium flow in the dormant season and low flow or flood in the growing season, respectively. On one hand, flood mainly played a role in the diluent for the Chao River with high NO3-N, and on the other hand, it acted as a nitrogen source for the Bai River with low NO3-N. The NO3-N was closely correlated with human activities, and this correlation had obvious seasonal change trend. In the dormant season, significant and mostly extremely significant high correlation coefficient (R) values were determined, while partly non-significant with low R values were found in July, August, September, and October. Increasing seasonal variation index of NO3-N from upstream to downstream was found that was gentle for large rivers and sharp for small tributaries. The seasonality of NO3-N was more affected by natural factors, especially flood, than human factors