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Sherr L.,University College London | Cluver L.D.,University of Oxford | Cluver L.D.,University of Cape Town | Betancourt T.S.,Harvard University | And 4 more authors.
AIDS | Year: 2014

There is a growing evidence base on the immediate and short-term effects of adult HIV on children. We provide an overview of this literature, highlighting the multiple risks and resultant negative consequences stemming from adult HIV infection on the children they care for on an individual and family basis. We trace these consequences from their origin in the health and wellbeing of adults on whom children depend, through multiple pathways to negative impacts for children. As effective treatment reduces vertical transmission, the needs of affected children will predominate. Pathways include exposure to HIV in utero, poor caregiver mental or physical health, the impact of illness, stigma and increased poverty. We summarize the evidence of negative consequences, including those affecting health, cognitive development, education, child mental health, exposure to abuse and adolescent risk behaviour, including sexual risk behaviour, which has obvious implications for HIV-prevention efforts. We also highlight the evidence of positive outcomes, despite adversity, considering the importance of recognizing and supporting the development of resilience. This study is the first in a series of three commissioned by President's Emergency Plan for AIDS Relief (PEPFAR)/United States Agency for International Development (USAID), the summary provided here was used to inform a second study which seeks to identify insights from the broader child development field which will help us predict what long-term negative consequences children affected by HIV and AIDS are likely to experience. The third study discusses the design of a model to estimate these consequences. Although comprehensive, the review is often hampered by poor-quality research, inadequate design, small sample sizes and single studies in some areas. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.

Wagner A.K.,Harvard University | Quick J.D.,Management science for Health | Ross-Degnan D.,Harvard University
BMC Health Services Research | Year: 2014

Background: Medicines are a major driver of quality, safety, equity, and cost of care in low and middle-income country health systems. Universal health coverage implementers must explicitly address appropriate use of medicines to realize the health benefits of medicines, avoid wasting scarce resources, and sustain the financial viability of universal health coverage schemes. Discussion. Medicines are major contributors to the health and well-being of individuals and populations when used appropriately, and they waste resources and endanger health when used unnecessarily or incorrectly. Stakeholders need to balance inherently competing objectives in the pharmaceutical sector. Emerging and expanding UHC schemes provide potential levers to balance competing system objectives.To use these levers, sustainable universal coverage programs will require a) information systems that can track medicines utilization, expenditures, and quality of medicines use; b) routine monitoring of indicators of medicines availability, access, affordability, and use; c) policies and programs that facilitate appropriate medicines use by prescribers, dispensers, and patients; d) transparency in setting priorities for medicines coverage under resource constraints; and e) a system perspective to engage diverse actors.As they operationalize paths toward universal health coverage and include targeted medicines coverage policies and programs, systems can build on, and innovate, pharmaceutical policy frameworks and management tools from different countries' settings. Summary. Ensuring that medicines which achieve important health outcomes are available, accessible to all, used appropriately, and sustainably affordable is essential for realizing universal health coverage. Stakeholder cooperation and use of information and financing system levers provide opportunities to work toward this goal. © 2014 Wagner et al.; licensee BioMed Central Ltd.

Miller C.M.,Boston University | Tsoka M.,University of York | Reichert K.,Management science for Health
Development Policy Review | Year: 2010

Governments target transfers so that limited resources reach impoverished households; targeting errors therefore indicate inefficiency in resource use and inability to reach the poorest households. This article examines the Malawi Social Cash Transfer Scheme (SCTS), using mixed methods and multiple data sources, including examination of underlying assumptions, the operationalisation of key concepts, questions of implementation, and errors of inclusion and exclusion. Despite serious challenges, the scheme's error rates are within the range of global averages. Its impressive impacts provide strong motivation for improving the targeting process before it is scaled up to the national level. © 2010 No claim to original US governments works. Journal compilation © 2010 Overseas Development Institute.

'T Hoen E.F.M.,Independent Consultant | Hogerzeil H.V.,University of Groningen | Quick J.D.,Management science for Health | Sillo H.B.,Tanzania Food and Drugs Authority TFDA
Journal of Public Health Policy | Year: 2014

Problems with the quality of medicines abound in countries where regulatory and legal oversight are weak, where medicines are unaffordable to most, and where the official supply often fails to reach patients. Quality is important to ensure effective treatment, to maintain patient and health-care worker confidence in treatment, and to prevent the development of resistance. In 2001, the WHO established the Prequalification of Medicines Programme in response to the need to select good-quality medicines for UN procurement. Member States of the WHO had requested its assistance in assessing the quality of low-cost generic medicines that were becoming increasingly available especially in treatments for HIV/AIDS. From a public health perspective, WHO PQP's greatest achievement is improved quality of life-saving medicines used today by millions of people in developing countries. Prequalification has made it possible to believe that everyone in the world will have access to safe, effective, and affordable medicines. Yet despite its track record and recognized importance to health, funding for the programme remains uncertain. © 2014 Macmillan Publishers Ltd.

Lemay N.V.,Management science for Health | Sullivan T.,Center for Communication Programs | Jumbe B.,Management science for Health Malawi | Perry C.P.,Public Health Consultant
Journal of Health Communication | Year: 2012

mHealth has great potential to change the landscape of health service delivery in less developed countriesexpanding the reach of health information to frontline health workers in remote areas. Formative, process, and summative evaluation each play an important role in mHealth interventions. K4Health conducted a Health Information Needs Assessment in Malawi from July to September 2009 (formative evaluation) that found widespread use of cell phones among health workers offering new opportunities for knowledge exchange, especially in areas where access to health information is limited. K4Health subsequently designed an 18-month demonstration project (January 2010 to June 2011) to improve the exchange and use of family planning/reproductive health and HIV/AIDS knowledge among health workers, which included the introduction of a short message service (SMS) network. K4Health conducted a pretest of the mHealth intervention from June to October 2010. A baseline assessment was carried out in November 2010 before expanding the SMS network and included use of qualitative and quantitative measures and comparison groups (summative evaluation). Routinely collected statistics also guide the program (process evaluation). This article describes the approach and main findings of the SMS baseline study and contributes to a growing body of evidence measuring the effectiveness and efficiency of mHealth programs using a strong evaluation design. Copyright © Taylor & Francis Group, LLC.

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