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ABSTRACTBackgroundSince the declaration of the 10th Ebola Virus Disease (EVD) outbreak in DRC on 1st Aug 2018, several neighboring countries have been developing and implementing preparedness efforts to prevent EVD cross-border transmission to enable timely detection, investigation, and response in the event of a confirmed EVD outbreak in the country.

This commentary highlights the challenges for pharmacovigilance (PV) posed by the COVID-19 pandemic and how PV practitioners in Africa can use this opportunity to strengthen patient safety. The commentary discusses remedies that lack clinical evidence and are potentially dangerous and the hidden effects of irrational use of medicines and medical products. It also examines the increase in poor reporting of adverse effects as well as the weakening of PV systems. It concludes that drug safety practitioners need to be vigilant about these risks and strengthen reporting systems to document, characterize, communicate, and minimize the risks of such remedies.

Please download to read the USAID Safe, Affordable, and Effective Medicines for Ukrainians (SAFEMed) Activity in Ukraine News Digest, May 2020 edition. 

PV is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other possible medicine-related problems. Adverse effects of medicines, particularly those that are unexpected, can negatively affect patients’ health and quality of life and further strain and undermine trust in the health care delivery system.

To determine the yield of tuberculosis (TB) and the prevalence of human immuno-deficiency virus (HIV) among key populations in the selected hotspot towns of Ethiopia, we undertook cross-sectional implementation research during August 2017-January 2018. A total of 1878 vulnerable people were screened. There was a statistically significant association of active TB cases with previous history of TB (Adjusted Odds Ratio (AOR): 11 95% CI, 4.06–29.81), HIV infection (AOR: 7.7 95% CI, 2.24–26.40), and being a health care worker (HCW). The prevalence of TB in key populations was nine times higher than 164/100,000 national estimated prevalence rate. The prevalence of HIV was five times higher than 1.15% of the national survey. The highest yield of TB was among HCWs and a high HIV burden was detected among female sex workers and internal migratory workers. These suggest the need for community and health facility based integrated and enhanced case finding approaches for TB and HIV in hotspot settings.

National HIV testing policies aim to increase the proportion of people living with HIV who know their status. National HIV testing policies were reviewed for each country from 2013 to 2018, and compared with WHO guidance. Three rounds of health facility surveys were conducted to assess facility level policy implementation in Karonga (Malawi), uMkhanyakude (South Africa), and Ifakara (Tanzania). A policy "implementation" score was developed and applied to each facility by site for each round. Most HIV testing policies were explicit and aligned with WHO recommendations. Policies about service coverage, access, and quality of care were implemented in >80% of facilities per site and per round. However, linkage to care and the provision of outreach HIV testing for key populations were poorly implemented. The proportion of facilities reporting HIV test kit stock-outs in the past year reduced over the study period in all sites, but still occurred in ≥17% of facilities per site by 2017. The implementation score improved over time in Karonga and Ifakara and declined slightly in uMkhanyakude. Efforts are needed to address HIV test kit stock-outs and to improve linkage to care among people testing positive in order to reach the 90-90-90 targets.

To assess the use of Xpert for accurate diagnosis, timely initiation, and rational use of anti-TB treatment among childhood TB patients, we reviewed data trends over four consecutive years; two years before the arrival of the machine and two years following the implementation of Xpert. During the intervention period (2016–2017), 371 children with presumptive TB were evaluated using Xpert. A total of 199 (53.6%) childhood TB cases were notified, of which 88 (44.2%) were Xpert positive and 111 (55.8%) were treated as Xpert-negative probable TB cases. The tendency to initiate anti-TB treatment for unconfirmed TB cases was reduced by a third. Compared with smear AFB, Xpert improved accuracy of diagnosing pediatric TB cases two-fold. The average waiting time to start anti-TB treatment was 1.33 days. There was a significant reduction in the waiting time to start anti-TB treatment, with a mean time difference before and during intervention of 5.62 days. Xpert use was associated with a significant increase in the accuracy of identifying confirmed TB cases, reduced unnecessary anti-TB prescription, and shortened the time taken to start TB treatment.

Accurate immunization delivery costs are necessary for assessing the cost-efectiveness and strategic planning needs of immunization programs. From a database of empirical immunization costing studies, we extracted estimates of the delivery cost per dose for routine childhood immunization services, excluding vaccine costs. We estimated the prediction model using the results from 29 individual studies, covering 24 countries. The predicted economic cost per dose for routine delivery of childhood vaccines (2018 US dollars), not including the price of the vaccine, was $1.87 (95% uncertainty interval $0.64–4.38) across all LMICs. By individual cost category, the programmatic economic cost per dose for routine delivery of childhood vaccines was $0.74 ($0.26–1.70) for labor, $0.26 ($0.08–0.67) for supply chain, $0.22 ($0.06–0.57) for capital, and $0.65 ($0.20–1.66) for other service delivery costs. The cost estimates from this analysis provide a broad indication of immunization delivery costs that may be useful when accurate local data are unavailable.

To investigate SARS-CoV-2 (the virus causing COVID-19) infection and exposure risks among grocery retail workers, and to investigate their mental health state during the pandemic, this cross-sectional study was conducted in May 2020 in a single grocery retail store in Massachusetts, USA. Among 104 workers tested, 21 (20%) had positive viral assays. Seventy-six percent of positive cases were asymptomatic. After multi-variate adjustments, employees with direct customer exposure had an odds of 4.7 (95% CI 1.2 to 32.0) being tested positive for SARS-CoV-2, while smokers had an odds of 0.1 (95% CI 0.01 to 0.8) having positive assay. As to mental health, the prevalence of anxiety and depression was 24% and 8%, respectively. Employees with direct costumer exposure were 5 times more likely to test positive for SARS-CoV-2.

Effective implementation of policies for expanding antiretroviral therapy (ART) requires a well-trained and adequately staffed workforce. Changes in national HIV workforce policies, health facility practices, and provider experiences were examined in rural Malawi and Tanzania between 2013 and 2017. In both countries, task-shifting and task-sharing policies were explicit by 2013. In facilities, the cadre mix of providers varied by site and changed over time, with a higher and growing proportion of lower cadre staff in the Malawi site. In Malawi, the introduction of lay counsellors was perceived to have eased the workload of other providers, but lay counsellors reported inadequate support. Both countries had guidance on the minimum numbers of personnel required to deliver HIV services. However, patient loads per provider increased in both settings for HIV tests and visits by ART patients and were not met with corresponding increases in provider capacity in either setting. Providers reported this as a challenge. Although increasing patient numbers bodes well for achieving universal antiretroviral therapy coverage, the quality of care may be undermined by increased workloads and insufficient provider training. Task-shifting strategies may help address workload concerns, but require careful monitoring, supervision and mentoring to ensure effective implementation.

Many people are not getting the HIV/AIDS services they need due to lack of health care providers. And paying the salaries of health personnel consumes a major proportion of national budgets for health services—up to 75 percent in some countries.

The international community has compelling humanitarian, political, security, and economic reasons to become involved in fragile states.

As a recent international conference initiated and hosted by Afghanistan showed, there is no substitute for collaborative action fuelled by a common vision – and when it comes to eradicating the six deadliest diseases in the world today (HIV/AIDS, malaria, cholera, polio, tuberculosis and avian influenza), political boundaries and territorial conflicts become irrelevant.

In many countries, preventing, detecting, and treating sexually transmitted diseases (STDs) are essential parts of reproductive health services. In light of the pandemic of the human immunodeficiency viruses (HIV) and acquired immunodeficiency disease (AIDS) and the roleof STDs in making men and women more vulnerable to HIV infection, STD services are receiving increased attention.

Since the 1994 International Conference on Population and Development (ICPD) in Cairo, family planning managers are rising to the challenge to offer a broader scope of reproductive health services to their clients.

Purpose: To standardize and improve data collection instruments and practices for monitoring and evaluation of HIV/AIDS prevention programs. Description:

Purpose: The purpose of this manual is to provide a set of flexible, adaptable tools, and guidelines to support supervisors in their role of improving the quality of care in the clinics. It is especially helpful for focusing managers on the key elements of integrated primary health care as they simultaneously integrate new interventions for HIV/AIDS, tuberculosis, and malaria.Description:

UNAIDS estimates that about 2.6 million children (aged 0-14) were living with HIV/AIDS in sub-Saharan Africa at the end of the year 2001, and most of these HIV infections were a result of mother-to-child transmission (MTCT) of HIV. In the same year, about 11 million children aged 0-14 were orphans as a result of their parent or parents' AIDSrelated death.

The essential medicines concept has become an established approach in international public health – a vital component for combating HIV/AIDS, tuberculosis, malaria, respiratory infections, other communicable diseases and the vast majority of non-communicable diseases. But the survival and global dissemination of the essential medicines concept were by no means assured at the outset.  

Background: HIV prevalence among pregnant women in Malawi is 12.6%, and mother-to-child transmission is a major route of transmission. As PMTCT services have expanded in Malawi in recent years, we sought to determine uptake of services, HIV-relevant infant feeding practices and mother-child health outcomes.

The Need for Change Management

Objective  To describe how district-wide access to HIV/AIDS care was achieved and maintained in Thyolo District, Malawi. Method  In mid-2003, the Ministry of Health and Médecins Sans Frontières developed a model of care for Thyolo district (population 587 455) based on decentralization of care to health centres and community sites and task shifting.

The debate on the interaction between disease-specific programmes and health system strengthening in the last few years has intensified as experts seek to tease out common ground and find solutions and synergies to bridge the divide. Unfortunately, the debate continues to be largely academic and devoid of specificity, resulting in the issues being irrelevant to health care workers on the ground.

In the CIPRA-SA trial (July 3, p. 33), Ian Sanne and colleagues compared the outcomes of nurse-monitored patients with those of doctor-monitored patients in an antiretroviral treatment (ART) program in South Africa and concluded that the outcomes of ART services provided by nurses were non-inferior to those provided by doctors.

Background:Increased availability and accessibility of antiretroviral therapy (ART) has improved the length and quality of life amongst people living with HIV/AIDS. This has changed the landscape for care from episodic to long-term care that requires more monitoring of adherence. This has led to increased demand on human resources, a major problem for most ART programs.