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Ten years ago, in 2004, testing positive for HIV in Ethiopia was a death sentence. It was the start of a painful decline, including illness and ostracism from society, ultimately leading to premature death.

The Ethiopia Network for HIV/AIDS Treatment, Care, & Support (ENHAT-CS) program, a USAID initiative funded by PEPFAR. was an MSH-led consortium of national and international partners.

Background In Ethiopia, over 60% of all people who are eligible for antiretroviral therapy (ART) receive it. However, coverage is only 12% among children under 15 years of age. Due to scarcity of data and limited awareness of possible HIV infection, especially in older children, the AIDS epidemic among Ethiopian children appears neglected in national programs. Methods

In Ethiopia, male-dominated gender dynamics and health care provider attitudes lead many women to avoid or not fully utilize antenatal care (ANC) and prevention of mother-to-child transmission (PMTCT) services, creating barriers to women’s access to care and to interrupting vertical transmission of HIV.

Following the World Health Organization’s 2013 guidelines endorsing antiretroviral therapy for all HIV-infected pregnant women, Ethiopia adopted Option B+ (initiation of triple regimen antiretroviral therapy (ART) for the duration of breastfeeding or for life regardless of a pregnant woman’s CD4 count) as the national standard for prevention of mother-to-child transmission (PMTCT

Ethiopia’s HIV prevalence rate is approximately 1.2 percent,2 equating to about 700,000 HIV-infected people. Since 2005, Ethiopia has been decentralizing free antiretroviral (ART) services from hospitals to health centers as a strategy to improve access to HIV care and treatment.

Mother-to-Child Transmission of HIV and Early Infant Diagnosis:The Global Situation

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.

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