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The Rwandan Ministry of Health partnered with the Integrated Health Systems Strengthening Project (IHSSP) to strengthen and coordinate its health information system. In 2009, when IHSSP was launched, the ministry had multiple systems to gather data from the country’s health services, but the systems used to aggregate and analyze the information were weak and were not interoperable.

Despite progress reducing maternal mortality, HIV-related maternal deaths remain high, accounting, for example, for up to 24 percent of all pregnancy-related deaths in sub-Saharan Africa. Antiretroviral therapy (ART) is effective in improving outcomes among HIV-infected pregnant and postpartum women, yet rates of initiation, adherence, and retention remain low. This systematic literature review synthesized evidence about individual and contextual factors affecting ART use among HIV-infected pregnant and postpartum women. Thirty-four studies were included in the review. Individual-level factors included both those within and outside a woman’s awareness and control (e.g., commitment to child’s health or age). Individual-level barriers included poor understanding of HIV, ART, and prevention of mother-to-child transmission; and difficulty managing practical demands of ART. At an interpersonal level, disclosure to a spouse and spousal involvement in treatment were associated with improved initiation, adherence, and retention. Fear of negative consequences was a barrier to disclosure. At a community level, stigma was a major barrier. Key structural barriers and enablers were related to health system use and engagement, including access to services and health worker attitudes. To be successful, programs seeking to expand access to and continued use of ART by integrating maternal health and HIV services must identify and address the relevant barriers and enablers in their own context that are described in this review. Further research on this population, including those who drop out of or never access health services, is needed to inform effective implementation.

Despite global progress in the fight to reduce maternal mortality, HIV-related maternal deaths remain persistently high, particularly in much of Africa. Lifelong antiretroviral therapy (ART) appears to be the most effective way to prevent these deaths, but the rates of three key outcomes—ART initiation, retention in care, and long-term ART adherence—remain low. This systematic review synthesized evidence on health systems factors affecting these outcomes in pregnant and postpartum women living with HIV. Low prioritization of maternal ART and persistent dropout along the maternal ART cascade were key findings. Service delivery barriers included poor communication and coordination among health system actors, poor clinical practices, and gaps in provider training. The few studies that assessed maternal ART interventions demonstrated the importance of multi-pronged, multi-leveled interventions. There has been a lack of emphasis on the experiences, needs, and vulnerabilities particular to HIV-infected pregnant and postpartum women. Supporting these women to successfully traverse the maternal ART cascade requires carefully designed and targeted interventions throughout the steps. Careful design of integrated service delivery models is of critical importance in this effort. Key knowledge gaps and research priorities were also identified, including definitions and indicators of adherence rates, and the importance of cumulative measures of dropout along the maternal ART cascade.

Best Practices for HIV Voluntary Testing and Counselling in Tanzania

The West African Abidjan to Lagos transport corridor crosses five countries through a densely populated and growing urban setting.

On the Road from Abidjan to Lagos, Urbanization Offers Risk and Opportunity, Hardship and Hope   A Corridor of Contrasts from Management Sciences for Health

Southern Africa has a long history of cross-border migration (movement of people across international borders) and internal migration (movement of people within a country). People migrate for political, social, and economic reasons.

BLC is responding to USAID Forward Agenda's Implementation and Procurement Reforms by providing capacity building support to local organizations, like North Star Alliance (NSA). The reforms emphasize long-term impact and sustainability as well as innovation and new partnerships.

Community Health Workers (CHWs) may include traditional birth attendants, caregivers, community mobilizers, and peer counselors/educators.

In Botswana, the USAID-funded Building Local Capacity for Delivery of HIV Services in Southern Africa Project (BLC) provides targeted technical assistance to the Ministry of Health and 11 health facilities to overcome the challenges to improve their service delivery and advance towards becoming internationally accredited.

More than one-third of children living in the small mountainous country of Lesotho are orphans, and nearly half of all households are caring for at least one orphan. In many cases, this is due to the country's HIV prevalence — 23 percent for people ages 15-49. Statistics like this are frequently publicized. However, do we stop to think about the impact on a single child?

In 2012, more than 15.1 million children in sub-Saharan Africa had lost one or both parents to HIV. The effect of parental loss on a child can be severe, especially as it frequently exacerbates poverty.

When building leadership, management, and governance capacity, the BLC Project often assists organizations in conducting research — collecting strategic information to inform organizational programming. For national and regional organizations with coordination mandates, relevant information often relates to the size and needs of their constituencies.

Swaziland has the highest adult HIV prevalence in the world, at 31 percent among adults ages 18-49. The country's extended national strategic framework for HIV and AIDS adopts a combination prevention approach, integrating biomedical, behavioral, social, and structural interventions for maximum impact in stopping new infections. One of the core programs is voluntary medical male circumcision.

The field of HIV is complex; no one government or organization is able to address all of the related issues. Instead, the HIV response requires a multitude of stakeholders with a variety of strengths to collaborate in order to be effective.

The field of HIV is complex; no one government or organization is able to address all of the related issues. Instead, the HIV response requires a multitude of stakeholders with a variety of strengths to collaborate in order to be effective. Together, they are the building-blocks of strong health systems and contribute to improved health of the people in southern Africa.

The Building Local Capacity for Delivery of HIV Services in Southern Africa Project (BLC), implemented by MSH and funded by USAID, was conceived to address many of the challenges of HIV and AIDS.

The HIV epidemic has contributed to a large number of orphans and vulnerable children (OVC) in southern Africa, particularly in Lesotho and Namibia, as a result of high HIV prevalence rates. One in every three children in Lesotho is an OVC, and nearly half of all households are caring for at least one orphan. In Namibia, one out of every five children is an OVC.

MSH has been assisting Malawi since 2003 to strengthen health care systems, increase disease prevention education, reduce maternal and childhood mortality rates, and expand access to quality HIV/AIDS services.

This systematic review (Jan. 2003-Dec. 2014) synthesized evidence on interventions that have directly reduced mortality in high-HIV-prevalence populations. Antiretroviral therapy (ART)was the only intervention identified that decreased death in HIV-infected pregnant and postpartum women. Multivitamin use was shown to reduce disease progression while other micronutrients and antibiotics had no beneficial effect on maternal mortality. The findings support global trends in encouraging initiation of lifelong ART for all HIV-infected pregnant and breastfeeding women (Option B+), regardless of their CD4+ count, as an important step in ensuring appropriate care and treatment.

These standards harmonize prevention, treatment and care provided throughout the region’s transport corridors, starting from the existing Cross Border Initiative roadside wellness centers.

HIV prevalence is disproportionately high among sex workers and long distance truck drivers compared to the general population, both globally and in the Southern African region.

While measurement and attribution of maternal mortality is challenging, available evidence indicates that HIV-infected pregnant and postpartum women have an increased risk of death compared to their uninfected peers.

Regional bodies have become active contributors to the development of Africa's health sector in the last 10 to 15 years.

This publication shares stories from the Strengthening TB and HIV & AIDS Responses in Eastern Uganda (STAR-E) project. STAR-E is a key partner with the government of Uganda in scaling up HIV and TB services. When the project began in 2009, STAR-E supported just 16 health facilities, with only one that provided antiretroviral therapy (ART).

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