ABSTRACT
Gender-based violence (GBV) is a complex issue deeply rooted in social structures, making its eradication challenging. GBV increases the risk of HIV transmission and is a barrier to HIV testing, care, and treatment. Quality clinical services for GBV, which includes the provision of HIV postexposure prophylaxis (PEP), vary, and service delivery data are lacking. We describe GBV clinical service delivery in 15 countries supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention. Through a descriptive statistical analysis of PEPFAR Monitoring, Evaluation, and Reporting (MER) data, we found a 252% increase in individuals receiving GBV clinical services, from 158,691 in 2017 to 558,251 in 2021. PEP completion was lowest (15%) among 15-19-year-olds. Understanding GBV service delivery is important for policy makers, program managers, and providers to guide interventions to improve the quality of service delivery and contribute to HIV epidemic control.
Subject(s)
Gender-Based Violence , HIV Infections , Humans , HIV Infections/prevention & control , Delivery of Health Care , Health Facilities , Africa South of the Sahara/epidemiologyABSTRACT
The COVID-19 pandemic has highlighted the need for resilient health systems with the capacity to effectively detect and respond to disease outbreaks and ensure continuity of health service delivery. The pandemic has disproportionately affected resource-limited settings with inadequate health capacity, resulting in disruptions in health service delivery and worsened outcomes for key health indicators. As part of the US government's goal of ensuring health security, the US Centers for Disease Control and Prevention has used its scientific and technical expertise to build health capacity and address health threats globally. We describe how capacity developed through global health programs of the US Centers for Disease Control and Prevention in Cameroon was leveraged to respond to coronavirus disease and maintain health service delivery. The health system strengthening efforts in Cameroon can be applied in similar settings to ensure preparedness for future global public health threats and improve health outcomes.
Subject(s)
COVID-19 , Pandemics , United States/epidemiology , Humans , Pandemics/prevention & control , Global Health , COVID-19/prevention & control , Capacity Building , Centers for Disease Control and Prevention, U.S.ABSTRACT
OBJECTIVES: This descriptive and prospective study was designed to determine the incidence of smear-positive pulmonary tuberculosis (PTB+) by health area (HA) in Douala, use of Diagnosis and Treatment Centres (DTCs) and the factors influencing the choice of DTC. METHODS: Over a one-year period, the residence of all PTB+ patients and the DTC at which they were treated were located by means of a GPS system and represented on a geo-referenced health map. Incidence of PTB+ per HA was calculated. Focus group discussions with TB patients were then held in seven of the nineteen DTCs chosen by convenience. RESULTS: The incidence of PTB+ is not randomly distributed between HAs, as the incidence is fivefold higher than the mean in some HAs. More than one half of patients (65%) were not treated in the DTC to which they were designated by the health system. Attendance in a DTC mostly depends on chance decisions based on previous experiences with a health care unit, recommendations from family members, friends or strangers, or the (sometimes erroneous) reference by health care personnel. References rarely follow the logic of the system. CONCLUSION: The provision of health care for TB in the city of Douala and health care-seeking behaviour of patients frequently do not correspond. Information and communication on TB care delivery could make the management of tuberculosis more efficient and more effective.
