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Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence

HEPATOLOGY 2013年第4期57卷 1333-1342页

作者： Hanafiah, Khayriyyah Mohd Groeger, Justina Flaxman, Abraham D. Wiersma, Steven T. Johns Hopkins Bloomberg Sch Publ Hlth Baltimore MD USA Ctr Dis Control & Prevent Div Viral Hepatitis Natl Ctr HIV AIDS Viral Hepatitis STD & TB Preven Atlanta GA USA Univ Washington Inst Hlth Metr & Evaluat Seattle WA 98195 USA WHO Global Hepatitis Programme CH-1211 Geneva Switzerland

In efforts to inform public health decision makers, the Global Burden of Diseases, Injuries, and Risk Factors 2010 (GBD2010) Study aims to estimate the burden of disease using available parameters. This study was conducted to collect and analyze available prevalence data to be used for estimating the hepatitis C virus (HCV) burden of disease. In this systematic review, antibody to HCV (anti-HCV) seroprevalence data from 232 articles were pooled to estimate age-specific seroprevalence curves in 1990 and 2005, and to produce age-standardized prevalence estimates for each of 21 GBD regions using a model-based meta-analysis. This review finds that globally the prevalence and number of people with anti-HCV has increased from 2.3% (95% uncertainty interval [UI]: 2.1%-2.5%) to 2.8% (95% UI: 2.6%-3.1%) and >122 million to >185 million between 1990 and 2005. Central and East Asia and North Africa/Middle East are estimated to have high prevalence (>3.5%);South and Southeast Asia, sub-Saharan Africa, Andean, Central, and Southern Latin America, Caribbean, Oceania, Australasia, and Central, Eastern, and Western Europe have moderate prevalence (1.5%-3.5%);whereas Asia Pacific, Tropical Latin America, and North America have low prevalence (<1.5%). Conclusion: The high prevalence of global HCV infection necessitates renewed efforts in primary prevention, including vaccine development, as well as new approaches to secondary and tertiary prevention to reduce the burden of chronic liver disease and to improve survival for those who already have evidence of liver disease. (HEPATOLOGY 2013)

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Improving neonatal health in South-East Asia

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PUBLIC HEALTH 2012年第3期126卷 223-226页

作者： Nair, H. Arya, G. Vidnapathirana, J. Tripathi, S. Talukder, S. H. Srivastava, V. Integral Univ Lucknow Uttar Pradesh India Univ Edinburgh Global Hlth Acad Ctr Populat Hlth Sci Edinburgh Midlothian Scotland Publ Hlth Fdn India New Delhi India United Nations Children Fund Lucknow Uttar Pradesh India Minist Hlth Natl STD AIDS Control Programme Colombo Sri Lanka Mahidol Univ Natl Inst Child & Family Dev Bangkok 10700 Thailand Eminence Associates Social Dev Dhaka Bangladesh

The countries in South-east Asia have wide disparities in socio-economic and health indicators. This region accounts for almost one-third of global mortality in neonates and children under 5 years of age, and many countries in the region are unlikely to attain Millennium Development Goal 4. Over the past decade, several countries have initiated innovative projects with the aim of improving child health. This paper examines the innovations in neonatal health in four countries - Bangladesh, India, Sri Lanka and Thailand - and analyses the extent to which these have been successful in meeting their goals. This case study will inform national governments and donor agencies wishing to scale up or modify existing neonatal health interventions. (C) 2011 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.

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Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries

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BMC PUBLIC HEALTH 2012年第1期12卷 1-15页

作者： Hardon, Anita Vernooij, Eva Bongololo-Mbera, Grace Cherutich, Peter Desclaux, Alice Kyaddondo, David Ky-Zerbo, Odette Neuman, Melissa Wanyenze, Rhoda Obermeyer, Carla Univ Amsterdam Amsterdam Inst Social Sci Res Amsterdam Netherlands Res Equ & Community Hlth Trust Lilongwe Malawi Minist Hlth Natl AIDS STD Control Programme Nairobi Kenya Univ Paul Cezanne Aix Marseille Inst Rech Dev Dakar Senegal Makerere Univ Dept Social Work Child Hlth & Dev Ctr Kampala Uganda Programme Appui Monde Associatif & Communautaire Ouagadougou Burkina Faso Harvard Univ Sch Publ Hlth Dept Soc Human Dev & Hlth Boston MA 02115 USA Makerere Univ Sch Publ Hlth Kampala Uganda Amer Univ Beirut Fac Hlth Sci Beirut Lebanon

Background: Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes. Methods: Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services;2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support;(3) in-depth interviews with key informants and PMTCT healthcare workers;and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests. Results: The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret;only 37% had disclosed to their husband. Conclusion: To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.

关键词： PMTCT Africa HIV testing Counseling Consent Disclosure

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The Safety Profile and Acceptability of a Disposable Male Circumcision Device in Kenyan Men Undergoing Voluntary Medical Male Circumcision

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JOURNAL OF UROLOGY 2011年第5期186卷 1923-1927页

作者： Musau, Pius Demirelli, Mustafa Muraguri, Nicholas Ndwiga, Francis Wainaina, Daniel Ali, Nabila Amin Moi Univ Sch Med Dept Surg & Anaesthesiol Eldoret Kenya Uasin Gishu Dist Hosp Minist Hlth Eldoret Kenya Natl AIDS STD Control Programme Nairobi Kenya Turkish Profess Circumcisers Assoc Ankara Turkey

Purpose: We established the safety and effectiveness as well as the acceptability of the Alisklamp(R) device for male circumcision among Kenyan men. Materials and Methods: To qualify for this hospital based, prospective, interventional cohort study one needed to be an uncircumcised adult male who was HIV negative with no comorbid factors or genitourinary anomalies precluding circumcision. A total of 58 men were recruited from a population of 90. Outcome measures were the safety profile of Alisklamp and its efficiency and acceptability by participants. Results: All 58 procedures were completed without device malfunction, hemorrhage or undesirable preputial excision. Mean +/- SD procedure time was 2.43 +/- 1.36 minutes and mean device removal time was 15.8 +/- 7.4 seconds. There were 2 adverse events, including mild edema and superficial wound infection related to poor hygiene in 1 case each. All men resumed routine activity immediately after circumcision. Of the 58 participants 25.9% experienced mild nocturnal erectile pains that required no medication. During 6-week followup all men were satisfied with the procedure, tolerated the device well and would recommend it to a friend. Conclusions: Alisklamp has an excellent safety profile and excellent acceptability among men who undergo circumcision using the device. This technique is easy to teach and it would prove to be a handy device to scale up the rate of male circumcision. Based on these findings the device merits a comparative clinical trial.

关键词： penis circumcision, male instrumentation HIV Kenya

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A qualitative exploration of the human resource policy implications of voluntary counselling and testing scale-up in Kenya: applying a model for policy analysis

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BMC PUBLIC HEALTH 2011年第1期11卷 1-10页

作者： Taegtmeyer, Miriam Martineau, Tim Namwebya, Jane H. Ikahu, Annrita Ngare, Carol W. Sakwa, James Lalloo, David G. Theobald, Sally Univ Liverpool Liverpool Sch Trop Med Clin Grp Liverpool L3 5QA Merseyside England Univ Liverpool Liverpool Sch Trop Med Int Hlth Grp Liverpool L3 5QA Merseyside England Liverpool VCT Treatment & Care Counselling Dept Nairobi Kenya Family Hlth Int Nairobi Kenya Natl AIDS & STD Control Programme Nairobi Kenya Assoc Kenya Med Lab Sci Officers Nairobi Kenya

Background: Kenya experienced rapid scale up of HIV testing and counselling services in government health services from 2001. We set out to examine the human resource policy implications of scaling up HIV testing and counselling in Kenya and to analyse the resultant policy against a recognised theoretical framework of health policy reform (policy analysis triangle). Methods: Qualitative methods were used to gain in-depth insights from policy makers who shaped scale up. This included 22 in-depth interviews with Voluntary Counselling and Testing (VCT) task force members, critical analysis of 53 sets of minutes and diary notes. We explore points of consensus and conflict amongst policymakers in Kenya and analyse this content to assess who favoured and resisted new policies, how scale up was achieved and the importance of the local context in which scale up occurred. Results: The scale up of VCT in Kenya had a number of human resource policy implications resulting from the introduction of lay counsellors and their authorisation to conduct rapid HIV testing using newly introduced rapid testing technologies. Our findings indicate that three key groups of actors were critical: laboratory professionals, counselling associations and the Ministry of Health. Strategic alliances between donors, NGOs and these three key groups underpinned the process. The process of reaching consensus required compromise and time commitment but was critical to a unified nationwide approach. Policies around quality assurance were integral in ensuring standardisation of content and approach. Conclusion: The introduction and scale up of new health service initiatives such as HIV voluntary counselling and testing necessitates changes to existing health systems and modification of entrenched interests around professional counselling and laboratory testing. Our methodological approach enabled exploration of complexities of scale up of HIV testing and counselling in Kenya. We argue that a better unders

关键词： Health Care Worker Quality Assurance System PITC Diary Note Comprehensive Quality Assurance

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Perceptions of door-to-door HIV counselling and testing in Botswana

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SAHARA J-JOURNAL OF SOCIAL ASPECTS OF HIV-aids 2011年第4期8卷 171-178页

作者： Kroeger, Karen Taylor, Allan Marlow, Heather Fleming, Douglas T. Beyleveld, Vanessa Alwano, Mary Grace Kejelepula, Mabel Tebogo Chilume, Kentsenao Busang Smith, Dawn K. Roels, Thierry H. Kilmarx, Peter H. US Ctr Dis Control & Prevent CDC Div STD Prevent Natl Ctr HIV Viral Hepatitis STD & TB Prevent NCH Atlanta GA USA CDC Global Programme AIDS Epidem Intelligence Serv Atlanta GA 30333 USA Univ N Carolina Dept Maternal & Child Hlth Chapel Hill NC USA S Africa HIV Antenatal Posttest Support Study Durban South Africa Bristol Myers Squibb Co Res & Dev Global Clin Res Metab Dis Princeton NJ USA Premiere Personnel Gaborone Botswana CDC Hlth Reform & Epidemiol Branch Div HIV AIDS Prevent Atlanta GA 30333 USA

Prevalence of HIV infection in Botswana is among the highest in the world, at 23.9% of 15 - 49-year-olds. Most HIV testing is conducted in voluntary counselling and testing centres or medical settings. Improved access to testing is urgently needed. This qualitative study assessed and documented community perceptions about the concept of door-to-door HIV counselling and rapid testing in two of the highest-prevalence districts of Botswana. Community members associated many positive benefits with home-based, door-to-door HIV testing, including convenience, confidentiality, capacity to increase the number of people tested, and opportunities to increase knowledge of HIV transmission, prevention and care through provision of correct information to households. Community members also saw the intervention as increasing opportunities to engage and influence family members and to role model positive behaviours. Participants also perceived social risks and dangers associated with home-based testing including the potential for conflict, coercion, stigma, and psychological distress within households. Community members emphasised the need for individual and community preparation, including procedures to protect confidentiality, provisions for psychological and social support, and links to appropriate services for HIV-positive persons.

关键词： HIV/aids counselling and testing home-based HIV testing Botswana qualitative research

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Developing WHO guidelines with pragmatic, structured, evidence-based processes: A case study

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GLOBAL PUBLIC HEALTH 2010年第4期5卷 395-412页

作者： Chang, L. W. Kennedy, C. E. Kennedy, G. E. Lindegren, M. L. Marston, B. J. Kaplan, J. E. Sweat, M. D. Bunnell, R. E. O'Reilly, K. Rutherford, G. W. Mermin, J. H. Univ Calif San Francisco Cochrane HIV AIDS Grp San Francisco CA 94143 USA Johns Hopkins Med Inst Div Infect Dis Baltimore MD 21205 USA Johns Hopkins Bloomberg Sch Publ Hlth Baltimore MD USA Ctr Dis Control & Prevent CDC HIV Care & Treatment Branch Global AIDS Programme GAP Natl Ctr HIV Viral Hepatitis STD & TB Prevent Atlanta GA USA Med Univ S Carolina Dept Psychiat & Behav Sci Charleston SC 29425 USA CDC Kenya GAP Nairobi Kenya WHO Dept HIV AIDS CH-1211 Geneva Switzerland CDC Kenya Coordinating Off Global Hlth Nairobi Kenya

Many guidelines, including those produced by the World Health Organisation (WHO), have failed to adhere to rigorous methodological standards. Operational examples of guideline development processes may provide important lessons learned to improve the rigour and quality of future guidelines. To this end, this paper describes the process of developing WHO guidelines on prevention and care interventions for adults and adolescents living with HIV. Using a pragmatic, structured, evidence-based approach, we created an organising committee, identified topics, conducted systematic reviews, identified experts and distributed evidence summaries. Subsequently, 55 global HIV experts drafted and anonymously submitted guideline statements at the beginning of a conference. During the conference, participants voted on statements using scales evaluating appropriateness of the statements, strength of recommendation and level of evidence. After review of voting results, open discussion, re-voting and refinement of statements, a draft version of the guidelines was completed. A post-conference writing team refined the guidelines based on pre-determined guideline writing principles and incorporated external comments into a final document. Successes and challenges of the guideline development process were identified and are used to highlight current issues and debates in developing guidelines with a focus on implications for future guideline development at WHO.

关键词： guidelines health policy HIV World Health Organisation group processes

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A peer-led HIV counselling and testing programme for the deaf in Kenya

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DISABILITY AND REHABILITATION 2009年第6期31卷 508-514页

作者： Taegtmeyer, M. Hightower, A. Opiyo, W. Mwachiro, L. Henderson, K. Angala, P. Ngare, C. Marum, E. Univ Liverpool Liverpool Sch Trop Med Liverpool L3 5QA Merseyside England Liverpool VCT Care & Treatment Nairobi Kenya Ctr Dis Control & Prevent Nairobi Kenya Natl AIDS & STD Control Programme Nairobi Kenya Ctr Dis Control & Prevent Atlanta GA USA

Purpose. To describe and evaluate the establishment of the first VCT services for the Deaf in Africa. Method. Operational research methods were used to document programme establishment. The demographics of deaf VCT clients were compared with hearing clients at the same sites as well as where clients had learned of the service, HIV risks, and HIV test results. Univariate and multivariate analyses were used. Results. During the two year period (January 2004 to December 2005) 1709 Deaf and 1649 hearing clients were seen at three Deaf VCT sites. The majority of Deaf clients in this sample learned of the services through the peer education programme. Data indicate that Deaf VCT clients are as much at risk of HIV from sexual transmission as their hearing counterparts and that Deaf persons seeking VCT services have an HIV prevalence of 7%, similar to the national rate of 6.7%. Conclusions. The Deaf in Kenya are at risk of HIV and there is an urgent need for Deaf-friendly HIV services, supplemented by peer education programmes. This is the first published report describing HIV services run by the Deaf for the Deaf in the developing world.

关键词： HIV counselling and testing deaf Kenya

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Implementation of a comprehensive program including psycho-social and treatment literacy activities to improve adherence to HIV care and treatment for a pediatric population in Kenya

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BMC PEDIATRICS 2008年第1期8卷 1-13页

作者： Van Winghem, Joelle Telfer, Barbara Reid, Tony Ouko, Judith Mutunga, Angela Jama, Zaina Vakil, Shobha Med Sans Frontieres Nairobi Kenya Med Sans Frontieres Ctr Operat Res Brussels Belgium Natl AIDS & STD Control Programme NASCOP Minist Hlth Govt Kenya ART Program Nairobi Kenya

Background: To achieve good clinical outcomes with HAART, patient adherence to treatment and care is a key factor. Since the literature on how to care for pediatric HIV patients is limited, we describe here adherence interventions implemented in our comprehensive care program in a resource-limited setting in Kenya. Methods: We based our program on factors reported to influence adherence to HIV care and treatment. We describe, in detail, our program with respect to how we adapted our clinical settings, implemented psycho-social support activities for children and their caregivers and developed treatment literacy for children and teenagers living with HIV/aids. Results: This paper focused on the details of the program, with the treatment outcomes as secondary. However, our program appeared to have been effective;for 648 children under 15 years of age who were started on HAART, the Kaplan-Meier mortality survival estimate was 95.27% (95% CI 93.16-96.74) at 12 months after the time of initiation of HAART. Conclusion: Our model of pediatric HIV/aids care, focused on a child-centered approach with inclusion of caregivers and extended family, addressed the main factors influencing treatment adherence. It appeared to produce good results and is replicable in resource-limited settings.

关键词： Human Immunodeficiency Virus Human Immunodeficiency Virus Testing Treatment Literacy Human Immunodeficiency Virus Status Human Immunodeficiency Virus Care

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Universal HIV testing and counselling in Africa

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LANCET 2008年第9631期371卷 2148-2150页

作者： Bunnell, Rebecca Cherutich, Peter Ctr Dis Control & Prevent Kenya Global Programme AIDS Nairobi Kenya Minist Hlth Natl AIDS STD Control Programme Nairobi Kenya

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