Global HIV / AIDS initiatives and coordination, reporting and evaluation of HIV/AIDS programmes.

This policy brief describes the effectiveness of national and district level coordination structures and monitoring and evaluation systems in Zambia and the extent to which GHIs have engaged with these, and/or created new structures and systems for HIV/AIDS programmes. The overall study, whose fieldwork was conducted in 2007 and 2008, explored the effects of three GHIs on the Zambian health system: the Global Fund to fight AIDS, TB and Malaria (GFATM), the World Bank’s Multi-country AIDS Program (MAP) and the United States President’s Emergency Plan for AIDS Relief (PEPFAR)

Global Health Initiatives and Human Resources for HIV/AIDS Services in Malawi, Uganda and Zambia

In most sub-Saharan African countries, a region where just 3% of the world’s health workforce treat and care for 25% of the global disease burden, significant investment in Human Resources for HIV/ AIDS services (HR) is required. This briefing paper summarises the effect that scale-up of funds from three GHIs – the President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to fight AIDS, TB and Malaria, and the World Bank Multi-country AIDS Program (MAP) – has had on HR in 3 countries: Malawi, Uganda and Zambia. Drawing on primary data from country studies conducted by researchers from the Global HIV/AIDS Initiatives Network (GHIN), this briefing paper focuses on a set of interrelated HR components: numbers of health workers, workload, training, and incentives and motivation

Tracking global HIV / AIDS initiatives and their effects on the health system in Zambia.

This policy brief shows the impact of three global health initiatives - the World Bank Multi Country AIDS program (MAP), the Global Fund to fight AIDS, Tuberculosis, and Malaria (GFATM) and the President’s Emergency Plan For AIDS Relief (PEPFAR)- at national and sub-national levels in Zambia, including the effects on scale up of focal (HIV/AIDS) and non-focal health services, human resources for health, coordination and governance

Effects of the global fund HIV/AIDS programmes in Ukraine

Ukraine has one of the highest and most rapidly growing rates of HIV/AIDS in Europe with estimated numbers of people living with HIV/AIDS (PLWHA) reaching 400,000 in 2008. Since 2003 several Global Health Initiatives (GHIs) have committed to providing over US$ 300 million towards the control of HIV/AIDS in Ukraine. These funding mechanisms have had a significant impact on the availability of services for PLWHA and populations at risk of being infected. GHIs have also had an impact on the health system including on human resources, governance and management capacity, and on nongovernmental providers of HIV/AIDS services. This policy brief highlights the effects of the largest external funder of HIV/AIDS programmes in Ukraine, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and provides recommendations to improve the effectiveness of future funding and increase accessibility of HIV/AIDS services. It is based on research conducted in 2006-2008 in three regions: Kyiv, Odessa and L’viv

The HIV Modes of Transmission model: a systematic review of its findings and adherence to guidelines

Introduction: The HIV Modes of Transmission (MOT) model estimates the annual fraction of new HIV infections (FNI) acquired by different risk groups. It was designed to guide country-specific HIV prevention policies. To determine if the MOT produced context-specific recommendations, we analyzed MOT results by region and epidemic type, and explored the factors (e.g. data used to estimate parameter inputs, adherence to guidelines) influencing the differences. Methods: We systematically searched MEDLINE, EMBASE and UNAIDS reports, and contacted UNAIDS country directors for published MOT results from MOT inception (2003) to 25 September 2012. Results: We retrieved four journal articles and 20 UNAIDS reports covering 29 countries. In 13 countries, the largest FNI (range 26 to 63%) was acquired by the low-risk group and increased with low-risk population size. The FNI among female sex workers (FSWs) remained low (median 1.3%, range 0.04 to 14.4%), with little variability by region and epidemic type despite variability in sexual behaviour. In India and Thailand, where FSWs play an important role in transmission, the FNI among FSWs was 2 and 4%, respectively. In contrast, the FNI among men who have sex with men (MSM) varied across regions (range 0.1 to 89%) and increased with MSM population size. The FNI among people who inject drugs (PWID, range 0 to 82%) was largest in early-phase epidemics with low overall HIV prevalence. Most MOT studies were conducted and reported as per guidelines but data quality remains an issue. Conclusions: Although countries are generally performing the MOT as per guidelines, there is little variation in the FNI (except among MSM and PWID) by region and epidemic type. Homogeneity in MOT FNI for FSWs, clients and low-risk groups may limit the utility of MOT for guiding country-specific interventions in heterosexual HIV epidemics

The Impact of Global Health Initiatives in Kyrgyzstan

This policy brief shows the effects of two global health initiatives - the Global Fund to fight AIDS, Tuberculosis, and Malaria (GFATM) and the World Bank’s Central Asia AIDS Project (CAAP) - at national and sub-national levels, including the effects on HIV/AIDS service scale-up, human resources, access to HIV/AIDS services and coordination

Funding and scale-up of HIV / AIDS services in Zambia

This policy brief describes the funding for HIV/AIDS in Zambia focusing on the President’s Emergency Plan for AIDS relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) and the World Bank Multi Country AIDS program (MAP). It highlights the impact of this funding on scale-up of HIV/AIDS services and on non-HIV/AIDS services in Zambia

Practical handbook for Sub-Saharan Africa

Home-based HIV testing and counselling (HBHTC) refers to HIV testing and counselling (HTC) services conducted by trained HTC service providers in someone's home. The main purpose of HBHTC is to bring HTC services to households, overcoming some of the barriers of access to testing services and providing testing to individuals who might not otherwise seek services. It has been_used successfully in rural and urban populations of sub-Saharan Africa with a high HIV prevalence and low coverage of HTC services. HBHTC provides services to individuals, couples, and family groups, and may be used to address specific populations (e.g. family members of known HIV-positive patients) and contribute to a family-based approach to HIV prevention and support. Using this approach can lead to decreased stigma in communities, help to diagnose individuals who are HIV-positive earlier, and potentially reach more couples than other HTC models. HBHTC has also led to increased follow-up for HIV-exposed infants.1. Background -- 1.1 Purpose of this practical handbook -- 1.2 Development of this handbook -- 1.3 Target audience -- 2. HBHTC delivery models -- 2.1 Door-to-door -- 2.2 Index-patient -- 2.3 Self-testing -- 3. Coordination at national level -- 3.1 Setting a national strategy for HBHTC -- 3.2 Coordination of partners conducting HBHTC -- 3.3 How organizations are authorized to conduct HBHTC -- 3.4 Human resources for HBHTC -- 3.5 Test kits to be used for HBHTC -- 4. Personnel -- 4.1 Programme structure and composition of a HBHTC team -- 4.2 Roles and responsibilities of different personnel in HBHTC -- 4.3 Recruitment and training of HBHTC service providers -- 4.4 Recruitment and training of community health workers/mobilizers -- 4.5 Staff retention -- 5. Programme planning -- 5.1 Choosing the location -- 5.2 Consulting stakeholders -- 5.3 Mapping of location -- 5.4 Determining availability of follow-up services -- 5.5 Planning return visits -- 5.6 Planning for data collection, protection, and storage -- 5.7 Supplies -- 5.8 Security and transport -- 5.9 Biosafety and waste disposal -- 6. Community and home entry -- 6.1 Community entry -- 6.2 Working with community health workers and/or mobilizers -- 6.3 Preparing the community -- 6.4 Home entry -- 7. Populations tested -- 7.1 Families -- 7.2 Couples and partners -- 7.3 Polygamous groups -- 7.4 Individuals -- 7.5 Child and adolescent testing -- 7.6 Disabled family members -- 7.7 Mental health disorders in the family -- 8. Protocol for HBHTC -- 8.1 Introducing the session -- 8.2 informed consent -- 8.3 Pre-test -- 8.4 Testing -- 8.5 Post-test and disclosure -- 9. Referral and linkages -- 9.1 Linkages to other services -- 9.2 Urgent referrals -- 9.3 Capacity at service-delivery points -- 9.4 Following up linkages and referrals -- 9.5 Understanding barriers to successful linkages -- 9.6 Strategies for improving successful linkages -- 10. Data, monitoring and evaluation -- 10.1 Types of data to collect -- 10.2 Programme indicators -- 10.3 Research data -- 10.4 Data collection methods -- 11. Quality assurance of HBHTC -- 11.1 Quality assurance for rapid HiV testing in HBHTC -- 11.2 Quality assurance for counselling -- 11.3 Involving the community in quality assurance -- 12. Special circumstances -- 12.1 Alcohol -- 12.2 Violence in the home -- 12.3 Sexual abuse -- 12.4 Key populations at higher risk of HIV exposure -- 13. Leaving an area -- 13.1 Determining when to move on -- 13.2 Returning results and following up linkages -- 13.3 Community feedback meetings -- 14. Useful resources.[Miriam Taegtmeyer].The work was funded by: the US Centers for Disease Control and Prevention through the PEPFAR technical working group on HIV testing and counselling.The main writer of this document was Dr Miriam Taegtmeyer of the Liverpool School of Tropical Medicine. The work was coordinated by Kristina Grabbe (CDC, Atlanta), Vincent Wong (USAID, Washington), and Rachel Baggaley, F. Amolo Okero, and Ying-ru Lo (HIV/ AIDS Department, WHO, Geneva).On cover: logos for World Health Organization, PEPFAR, Centers for Disease and Prevention, USAID, Liverpool School of Tropical Medicine.This handbook was first conceived of at a 2009 PEPFAR technical consultation on HBHTC [Home-based counseling and testing: program components and approaches. Technical consultation report. Washington, DC, AIDSTAR-One/USAID, 2010.]. Shortly thereafter, a survey, sent to PEPFAR HTC focal persons in 33 countries, identified 39 partners implementing HBHTC programmes in 10 sub-Saharan African countries in early 2011. Research revealed that the majority of countries surveyed lacked specific guidance for HBHTC. Although some country programmes had developed local operational manuals and guidance documents, there were no unified guidelines in place and no standard quality of implementation. As a result, HTC service providers were often left to develop their own solutions for challenging situations. this practical handbook was developed by WHO in collaboration with the PEPFAR HIV testing and counselling technical Working group (HTC TWG) in 2011, as a response to that problem. This handbook draws on existing guidelines, training and operational manuals, key informant interviews, observed practices, and site visits to HBHTC programmes. the authors specifically sought inputs and experiences of HTC service providers, supervisors, and programme managers using different community-based models, particularly focusing on offering testing in the home in different epidemic settings across Africa, for the development of these materials.Issued by: World Health Organization, Department of HIV/AIDS

Guidance on prevention of viral hepatitis B and C among people who inject drugs

This Guidance on prevention of viral hepatitis B and C among people who inject drugs is the first step in the provision of comprehensive guidance on viral hepatitis surveillance, prevention and treatment by the World Health Organization. These recommendations are based on systematic reviews of scientific evidence, community values and preferences and implementation issues. Although the focus of this guidance is on low- and middle-income countries, this guidance applies equally to high-income settings. The WHO, UNODC, UNAIDS technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users presents a comprehensive package of interventions for HIV prevention, treatment and care for people who inject drugs. This document has helped to achieve global consensus with high-level political bodies, the United Nations, donor agencies and civil society organizations on adopting a public health response that best addresses HIV in countries facing epidemics of injecting drug use. The nine interventions of this package are also relevant to the prevention of viral hepatitis, in particular the first two, needle and syringe programmes and opioid substitution therapy.Abbreviations and Acronyms -- Executive Summary -- 1. Introduction -- 2. Scope and Objectives -- 3. Background -- 3.1 Viral hepatitis B and C and injecting drug use -- 4. Methodology -- 4.1 WHO guideline development process -- 4.2 Viral hepatitis guideline development process -- 5. Guiding Principles -- 5.1 Human rights -- 5.2 Access to health care -- 5.3 Access to justice -- 5.4 Acceptability of services -- 5.5 Health literacy -- 5.6 Integrated service provision -- 6. Recommendations -- 6.1 Hepatitis B Vaccinaton -- 6.2 Type of syringes -- 6.3 Psychosocial and peer interventions -- 7. Existing Recommendations -- 8. Adapting These Guidelines -- 9. Operational and Implementation Issues -- 9.1 Health systems -- 9.2 Prevention services -- 9.3 Community involvement -- 10.Next Steps -- References -- Annexes (all annexes can be found on the internet at http://www.who.int/hiv/pub/guidelines/hepatitis_annex/en/) -- Annex 1: PICO questions -- Annex 2: Outcome frameworks -- Annex 3: GRADE notation and language -- Annex 4: GRADE evidence profiles -- Annex 5: Risk benefit/decision tables Annex 6: Evidence summaries -- Annex 7: Search strategies -- Annex 8: Report of Values and Preferences Survey -- Annex 9: Summary of declarations of interest.At head of title: HIV/AIDS Programme.July 2012.The development of these guidelines received financial support from the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC).Mode of access: Internet as an Acrobat .pdf file (1.68 MB, 52 p.).Includes bibliographical references (p. 38-46)