This document provides advice to clinicians on the use of the currently available antivirals for patients presenting with illness due to influenza virus infection as well the potential use of the medicines for chemoprophylaxis. While the focus is on management of patients with pandemic influenza (H1N1) 2009 virus infection, the document includes guidance on the use of the antivirals for other seasonal influenza virus strains, and for infections due to novel influenza. WHO recommends that country and local public health authorities issue local guidance for clinicians from time to time that places these recommendations in the context of epidemiological and antiviral susceptibility data on the locally circulating influenza strains. It emphasises that healthy people, namely those without chronic or acute diseases, do not need the antivirals.
Equitable health services
This paper, covering the period 2002–2008, describes how multisectoral teams at district level in Kenya have provided post-exposure prophylaxis, physical examination, sexually transmitted infection and pregnancy prevention services. These services were provided at casualty departments as well as through voluntary HIV counselling and testing sites. In 2003 there was a lack of policy, coordination and service delivery mechanisms for post-rape care services in Kenya. Post-exposure prophylaxis against HIV infection was not offered. The paper also found that, between early 2004 and the end of 2007, a total of 784 survivors were seen in the three centres at an average cost of US$27, with numbers increasing each year. Almost half (43%) of these were children younger than 15. The paper outlines how the lessons learned were translated into national policy and the scale-up of post-rape care services through the key involvement of the Division of Reproductive Health.
At least 6,000 people have been displaced by inter-clan fighting in Kenya's southwestern district of Kuria East, on the Tanzania border, according to humanitarian officials. The Red Cross has provided emergency relief aid for the displaced. The worst affected areas include Wagirabosi/Targai location in Ntimaru Division, inhabited by the Buirege clan; and Girigiri sub-location, and the villages of Nguruna, Getongoroma and Kebaroti in Kegonga Division. The Kenyan Red Cross said there were reports of gunshots along the Nyabasi-Buirege border on 22 June and that attacks and counter-attacks since late May had resulted in the displacement of at least 6,290 people and the burning of 765 homes. According to the Red Cross, health services have taken a knock, as there is no ambulance in Kuria East to support referrals and patients, while water and sanitation facilities remain critical, especially in camps for internally displaced people.
This study examines the effectiveness of the current methods for the diagnosis of malaria in Uganda. Diagnosis has mainly been through presumptive management, namely diagnosis on the basis of episodes of fever. However, this paper argues that presumptive management has significantly contributed to the misdiagnosis of malaria. Interviews were conducted with patients at 188 facilities and laboratory samples were taken to assess the accuracy of existing diagnoses. Overall prevalence of malaria was around 24.2%, with a rate of 13.9% in adults and 50.5% for children under five, with 96.2 percent of patients with a positive diagnosis receiving treatment, as well as 47.6% of patients with a negative result. The study authors therefore argue for changes in existing public health policy to include the use of laboratory methods such as microscopy and the introduction of malaria rapid diagnostic tests.
In an effort to tackle the challenges related to a severe shortage of human resources, and geographic and financial barriers, that prohibit patients from accessing care and treatment, a decision was taken to decentralise HIV and AIDS services in Lesotho to the primary health care level. This report outlines the community-based approach to the decentralisation of HIV and AIDS services. The Wellspring of Hope was the first programme in Lesotho to provide HIV and AIDS treatment and care through an entire health service area as a result of this initiative. The report discusses a range of topics: the delivery of HIV and AIDS services, specifically testing and counselling, prevention of mother-to-child transmission and antiretroviral therapy, a nurse-driven approach to the provision of antiretroviral therapy at the community level, and gives activities aimed at health systems strengthening challenges associated with the implementation of this model. This innovative approach has proven to be successful in delivering quality HIV and AIDS and TB services integrated into existing primary health care structures for a population living in remote, rural areas.
Researchers are launching a clinical trial with 1,500 people infected with onchocerciasis (river blindness) in Liberia, Ghana and the Democratic Republic of Congo to test a remedy that could help stop transmission. Onchocerciasis is one of the leading causes of blindness in Africa, according to World Health Organization (WHO), and more than 100 million people, mostly in Africa, are at risk of infection, according to WHO, which estimates that there are about half a million people, mostly in Africa, who are blind due to onchocerciasis. The primary prevention method is black fly control, while treatment has been through annual doses of ivermectin, which might successfully treat individuals, but it does not stop the infection from spreading. If adult worms are not killed they continue to lay eggs in the skin and the disease can be passed on. The drug moxidectin is being studied for its potential to kill adult worms carrying the disease and to wipe out the disease in any high-risk area within six years. The upcoming clinical trials are expected to last two and a half years and will cost about US$6 million.
Poor ventilation, overcrowding and HIV co-infection make prison an ideal breeding-ground for tuberculosis (TB), but a new study will be among the first in South Africa to quantify TB among inmates and personnel. ‘Herisa Rifuba’, or ‘Stop TB’ in Setswana, will include about 3,500 prisoners and staff at the Johannesburg Central Prison, with around 12,000 existing inmates and about 500 new prisoners arriving daily. So far this year, the prison has recorded more than 100 cases of TB (an infection rate of about 10%). In 2006, Johannesburg Central became one of the first prisons accredited to offer antiretroviral (ARV) treatment on site. About 530 of were receiving treatment from the prison clinic, said Joyce Lethoba, a project manager at The Aurum Institute, which helped the prison obtain accreditation. If a prison does not have its own clinic, inmates on ARVs have to be transported to nearby state hospitals to fetch their medication, which carries a greater risk of escapes.
The World Health Organization (WHO) has launched an eight-point plan to respond to extensively drug-resistant tuberculosis (XDR-TB): strengthen the quality of basic TB and HIV/AIDS control; scale up programmatic management of multi-drug-resistant TB (MDR-TB) and XDR-TB; strengthen laboratory services; expand MDR-TB and XDR-TB surveillance; develop and implement infection control measures; strengthen advocacy, communication and social mobilization; pursue resource mobilisation at all levels; and promote research and development of new tools. Additional considerations included: conducting adherence research; building the evidence-base for infection control practices; supporting communities affected by TB; enhancing public health response, while addressing the social determinants of health; embracing palliative care; and advocacy for research.
The researchers in this paper identify a gap between what most international health organisations say they are doing to strengthen health systems, and the reality on the ground. Although global health actors claim to be strengthening health systems, the authors argue that they engage almost exclusively with activities that match their own specific aims; tend to concentrate on single diseases, and focus on strengthening elements of health systems essential to their own programmes. Part of the problem, say the researchers, is that the term 'health system strengthening' is being used for any capacity building. They call for a definition that is both shared and consistently applied.
Scale-up of vertical HIV transmission prevention has been too slow in sub-Saharan Africa. We describe approaches, challenges, and results obtained in Kinshasa. Staff members of 21 clinics managed by public servants or non-governmental organizations were trained in improved basic antenatal care (ANC) including nevirapine (NVP)-based HIV transmission prevention. Program initiation was supported on-site logistically and technically. Aggregate implementation data were collected and used for program monitoring. Contextual information was obtained through a survey. Among 45,262 women seeking ANC from June 2003 through July 2005, 90% accepted testing; 792 (1.9%) had HIV of whom 599 (76%) returned for their result. Among 414 HIV+ women who delivered in participating maternities, NVP coverage was 79%; 92% of newborns received NVP. Differences were noted by clinic management in program implementation and HIV prevalence (1.2 to 3.0%). Initiating vertical HIV transmission prevention embedded in improved antenatal services in a fragile, fragmented, severely resource-deprived health care system was possible and improved over time. Scope and quality of service coverage should further increase; strategies to decrease loss to follow-up of HIV+ women should be identified to improve program effectiveness. The observed differences in HIV prevalence highlight the importance of selecting representative sentinel surveillance centers.