This article reviews the progress made on a three-year tuberculosis (TB)/HIV plan implemented in Malawi between 2003 and 2005. The objectives of the plan were to scale up HIV testing among TB patients and, for HIV-positive TB patients, to provide cotrimoxazole preventive therapy (which provides protection against bacterial infections including pneumonia) and facilitate access to antiretroviral (ARV) treatment. The paper finds that the proportion of TB patients tested for HIV increased from 15 per cent in 2003 to 47 per cent in 2005. During this time, most HIV-positive TB patients started cotrimoxazole preventative therapy.
Equitable health services
Joint tuberculosis/HIV services in Malawi: progress, challenges and the way forward
Chimzizia R, Harries A: Bulletin of the World Health Organization 85 (5), May 2007
Protective effect of measles vaccine is short-lived in HIV-infected Zambian children
Moss WJ, Scott S, Mugala N, Ndhlovu Z, Beeler JA, Audet SA, Ngala M, Mwangala S, Nkonga-Mwangilwa C, Ryon JJ, Monze M, Kasolo F, Quinn TC, Cousens S, Griffin DE, Cutts FT: The Journal of Infectious Diseases, 196:347–355, 2007
The level and longevity of protective antibodies elicited by a measles vaccine is significantly shortened by HIV infection in Zambian children. Measles still remains a significant cause of childhood mortality in sub-Saharan Africa despite the availability of a vaccine. Barriers to successful measles control by vaccination include poor logistics and insufficient resources, lack of political will, and HIV/AIDS. Successful measles control in southern Africa with a high HIV prevalence suggests that the HIV epidemic is not a bottleneck to control. The determinants of this success must be identified so that it is replicated in other regions. Specifically, how can a high population immunity be achieved in regions with high HIV prevalence so that measles can be eliminated?
Tuberculosis in sub-Saharan Africa: opportunities, challenges, and change in the era of antiretroviral treatment
Corbett EL, Marston B, Churchyard GJ: The Lancet, 2007
This article reviews how commitments to antiretroviral (ARV) treatment affect tuberculosis (TB) control and sets out the changes needed to address HIV and TB in a coordinated manner. The article examines the burden of HIV and TB in Africa and how the HIV epidemic has challenged the Directly Observed Treatment Strategy (DOTS) as a way of controlling tuberculosis. The authors argue that collaboration between TB and HIV/AIDS treatment programmes is needed, along with a unified public-health vision towards the prevention and treatment of these interacting diseases.
Understanding and improving access to prompt and effective malaria treatment and care in rural Tanzania: the ACCESS Programme
Hetzel MW, Iteba N, Makemba A, Mshana C, Lengeler C, Obrist B, Schulze A, Nathan R, Dillip D, Alba S, Mayumana I, Khatib RA, Njau JD, Mshinda H: Malaria Journal 6:83, 29 June 2007
Prompt access to effective treatment is central in the fight against malaria. However, a variety of interlinked factors at household and health system level influence access to timely and appropriate treatment and care. Furthermore, access may be influenced by global and national health policies. As a consequence, many malaria episodes in highly endemic countries are not treated appropriately. The ACCESS Programme is a combination of multiple complementary interventions with a strong evaluation component. With this approach, ACCESS aims to contribute to the development of a more comprehensive access framework and to inform and support public health professionals and policy-makers in the delivery of improved health services.
Deficient supplies of drugs for life threatening diseases in an African community
Lufesi NN, Andrew M, Aursnes I: BMC Health Services Research 7:86, 15 June 2007
In Malawi essential drugs are provided free of charge to patients at all public health facilities in order to ensure equitable access to health care. The country thereby spends about 30% of the national health budget on drugs. In order to investigate the level of drug shortages and eventually find the reasons for the drugs shortages in Malawi, we studied the management of the drug supplies for common and life threatening diseases such as pneumonia and malaria in a random selection of health centres.
Donor leverage: Towards more equitable access to essential medicines?
Chan CK, de Wildt C: In Press
In early 2007, the Indonesian government decided to withhold its bird flu virus samples from WHO’s collaborating centers pending a new global mechanism for virus sharing that had better terms for developing countries. The 60th World Health Assembly subsequently resolved to establish an international stockpile of avian flu vaccines, and mandated WHO to formulate mechanisms and guidelines for equitable access to these vaccines. Are there analogous opportunities for study volunteers or donors of biological materials in clinical trials or other research settings to exercise corresponding leverage to advance health equity? This paper will appear in Development in Practice 18(1), February 2008 and also shortly as a UN-DESA working paper.
Establishing a malaria diagnostics centre of excellence in Kisumu, Kenya
Ohrt , Obare P, Nanakorn A, Adhiambo C, Awuondo K, Prudhomme O'Meara W, Remich S, Martin K, Cook E, Chretien J-P, Lucas C, Osoga J, McEvoy P, Owaga ML, Sande Odera J, Ogutu B: Malaria Journal 6:79, 12 June 2007
Malaria microscopy, while the gold standard for malaria diagnosis, has limitations. Efficacy estimates in drug and vaccine malaria trials are very sensitive to small errors in microscopy endpoints. This fact led to the establishment of a Malaria Diagnostics Centre of Excellence in Kisumu, Kenya. The primary objective was to ensure valid clinical trial and diagnostic test evaluations. Key secondary objectives were technology transfer to host countries, establishment of partnerships, and training of clinical microscopists.
Exploratory study of factors that affect the performance and use of rapid diagnostic tests for malaria in the Limpopo Province, South Africa
Moonasar D, Ebrahim Goga A, Frean J, Kruger P, Chandramohan D: Malaria Journal 6:74, 2 June 2007
Malaria rapid diagnostic tests (RDTs) are relatively simple to perform and provide results quickly for making treatment decisions. However, the accuracy and application of RDT results depends on several factors such as quality of the RDT, storage, transport and end user performance. A cross sectional survey to explore factors that affect the performance and use of RDTs was conducted in the primary care facilities in South Africa.
Pain relieving drugs in 12 African countries: Mapping providers, identifying challenges and enabling expansion of pain control provision in HIV and AIDS management
Harding R, Powell RA, Kiyange F: African Palliative Care Association, 2007
This report from the African Palliative Care Association (APCA) identifies a number of problems with the delivery of pain-relief drugs to people with HIV and AIDS. The survey found that the key problems were inadequate and unreliable supplies of drugs, restrictive legislation, poor levels of education and training about prescribing such drugs among clinical staff, and practical problems such as high costs and inadequate storage facilities. The key challenges to overcoming these problems were identified as a lack of political will, the need for education and cultural change among medical practitioners and a lack of resources.
State of the Nation, South Africa 2007: The Promise and the Practice of Transformation: the state of South Africas health system
Fonn S, Schneider H, Barron P: Human Sciences Research Council, 2007
This chapter provides an overview of developments in South Africas health system over the past 12 years, using the WHOs assessment framework. While this framework has good health is an obvious goal, broader social objectives such as responsiveness to the needs of citizens and promotion of equity are also measured. Despite the largely successful efforts to shrug off the legacy of a racially divided health system and to generate numerous transformation initiatives, the reality is that the current system is as problematic as it was 12 years ago.