Integrating interventions supported by development assistance for health into local health system: evidence from a China-World Bank-UK rural health system strengthening project (1998-2007).

INTRODUCTION: To empirically investigate sustainability of development assistance for health (DAH), we conducted a retrospective case study on the Basic Health Services Project (BHSP) for rural health system strengthening, supported by the World Bank and the UK in China between 1998 and 2007. Specifically, this study examines the integration of the BHSP interventions into China's health system. METHODS: From December 2021 to December 2022, we reviewed 64 published papers and project or policy documents, and conducted semistructured interviews with 22 key informants, ranging from managers of donor agencies and the government to township-level hospital directors. From February to March 2023, the data were analysed under an analytical framework for integration of targeted health interventions into health systems. RESULTS: Evidence of the BHSP shows that the integration outcomes can vary by the levels of integration (national or subnational), geographical coverage (project areas or both project and non-project areas) and approach to integration (policy or routinisation). The country's health system reform facilitated the integration of the interventions relevant to the reform policies, as the BHSP was one of the pilot schemes. However, interventions incompatible with this broad context were integrated to a limited extent. This integration occurred through embedding the project within the existing system, with a higher degree of embeddedness leading to smoother integration. Cross-sectoral leading groups and a technical support system heightened the project visibility and enabled contextualised local adaptation, contributing to the smooth integration of the project interventions. CONCLUSION: The DAH-supported interventions can achieve sustainability by being integrated into the local health system. This integration can take various forms to improve health outcomes, including being accepted and internalised, modified as well as innovated and expanded. The host country and development partners can promote DAH sustainability by contextually integrating these interventions within the project scope.

Growth of infants delivered by mothers with HIV in Guangxi, China: An 18-month longitudinal follow-up study, 2015-2021.

OBJECTIVES: The prevention of mother-to-child transmission of HIV has been a global success. But little is known about the growth parameters of infants delivered by mothers with HIV or the drug resistance of infants with HIV in China. The study aimed to assess growth parameters and drug resistance in Chinese infants exposed to HIV. METHODS: We conducted an 18-month longitudinal follow-up study of 3283 infants (3222 without HIV; 61 with HIV) born to mothers with HIV in the Guangxi Zhuang Autonomous Region between January 2015 and December 2021. The weight and length of all participants was recorded. In addition, genetic subtypes and drug resistance analysis were performed for infants with HIV. RESULTS: Compared with infants without HIV, those with HIV had significantly lower weight/length Z-scores, except at 18 months of age. The length/age Z-scores of infants with HIV was significantly reduced, except at 1 month of age. The weight/age Z-scores of infants with HIV were significantly lower at all follow-up time points. The weight/length Z-scores of male infants without HIV were significantly lower than for female infants without HIV at all follow-up time points. Male infants without HIV had lower length/age and weight/age Z-scores than female infants at the remaining follow-up points, except at 1 month of age. Of a total of 61 infants with HIV, subtype and drug-resistance data were obtained from 37 (60.66%) samples. Infants with HIV were dominated by the CRF01_AE genotype and showed a diversity of mutation sites dominated by non-nucleoside reverse transcriptase inhibitor resistance. CONCLUSION: Our study demonstrates the growth of infants exposed to HIV in southwest China and provides detailed information on subtype distribution and drug resistance of those with HIV. Nutritional support and drug-resistance surveillance for infants exposed to HIV need to be strengthened.

Development assistance, donor-recipient dynamic, and domestic policy: a case study of two health interventions supported by World Bank-UK and Global Fund in China.

BACKGROUND: This study views sustainability after the exit of development assistance for health (DAH) as a shared responsibility between donors and recipients and sees transitioning DAH-supported interventions into domestic health policy as a pathway to this sustainability. It aims to uncover and understand the reemergent aspects of the donor-recipient dynamic in DAH and how they contribute to formulating domestic health policy and post-DAH sustainability. METHODS: We conducted a case study on two DAH-supported interventions: medical financial assistance in the Basic Health Services Project supported by the World Bank and UK (1998-2007) and civil society engagement in the HIV/AIDS Rolling Continuation Channel supported by the Global Fund (2010-2013) in China. From December 2021 to December 2022, we analyzed 129 documents and interviewed 46 key informants. Our data collection and coding were guided by a conceptual framework based on Walt and Gilson's health policy analysis model and the World Health Organization's health system building blocks. We used process tracing for analysis. RESULTS: According to the collected data, our case study identified three reemergent, interrelated aspects of donor-recipient dynamics: different preferences and compromise, partnership dialogues, and responsiveness to the changing context. In the case of medical financial assistance, the dynamic was characterized by long-term commitment to addressing local needs, on-site mutual learning and understanding, and local expertise cultivation and knowledge generation, enabling proactive responses to the changing context. In contrast, the dynamic in the case of HIV/AIDS civil society engagement marginalized genuine civil society engagement, lacked sufficient dialogue, and exhibited a passive response to the context. These differences led to varying outcomes in transnational policy diffusion and sustainability of DAH-supported interventions between the cases. CONCLUSIONS: Given the similarities in potential alternative factors observed in the two cases, we emphasize the significance of the donor-recipient dynamic in transnational policy diffusion through DAH. The study implies that achieving post-DAH sustainability requires a balance between donor priorities and recipient ownership to address local needs, partnership dialogues for mutual understanding and learning, and collaborative international-domestic expert partnerships to identify and respond to contextual enablers and barriers.

Adapting national data systems for donor transition: comparative analysis of experience from Georgia and China.

Health management information systems (HMISs) are essential in programme planning, budgeting, monitoring and evidence-informed decision-making. This paper focuses on donor transitions in two upper-middle-income countries, China and Georgia, and explores how national HMIS adaptations were made and what facilitated or limited successful and sustainable transitions. This comparative analytical case study uses a policy triangle framework and a mixed-methods approach to explore how and why adaptations in the HMIS occurred under the Gavi Alliance and the Global Fund-supported programmes in China and Georgia. A review of published and grey literature, key informant interviews and administrative data analysis informed the study findings. Contextual factors such as the global and country context, and health system and programme needs drove HMIS developments. Other factors included accountability on a national and international level; improvements in HMIS governance by establishing national regulations for clear mandates of data collection and reporting rules and creating institutional spaces for data use; investing in hardware, software and human resources to ensure regular and reliable data generation; and capacitating national players to use data in evidence-based decision-making for programme and transition planning, budgeting and outcome monitoring. Not all the HMIS initiatives supported by donors were sustained and transitioned. For the successful adaptation and sustainable transition, five interlinked and closely coordinated support areas need to be considered: (1) coupling programme design with a good understanding of the country context while considering domestic and external demands for information, (2) regulating appropriate governance and management arrangements enhancing country ownership, (3) avoiding silo HMIS solutions and taking integrative approach, (4) ensuring the transition of funding onto domestic budget and enforcing fulfilment of the government's financial commitments and finally (5) investing in technologies and skilled human resources for the HMIS throughout all levels of the health system. Neglecting any of these elements risks not delivering sustainable outcomes.

External technical assistance and its contribution to donor transition and long-term sustainability: experience from China and Georgia.

External technical assistance has played a vital role in facilitating the transitions of donor-supported health projects/programmes (or their key components) to domestic health systems in China and Georgia. Despite large differences in size and socio-political systems, these two upper-middle-income countries have both undergone similar trajectories of 'graduating' from external assistance for health and gradually established strong national ownership in programme financing and policymaking over the recent decades. Although there have been many documented challenges in achieving effective and sustainable technical assistance, the legacy of technical assistance practices in China and Georgia provides many important lessons for improving technical assistance outcomes and achieving more successful donor transitions with long-term sustainability. In this innovation and practice report, we have selected five projects/programmes in China and Georgia supported by the following external health partners: the World Bank and the UK Department for International Development, Gavi Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria. These five projects/programmes covered different health focus areas, ranging from rural health system strengthening to opioid substitution therapy. We discuss three innovative practices of technical assistance identified by the cross-country research teams: (1) talent cultivation for key decision-makers and other important stakeholders in the health system; (2) long-term partnerships between external and domestic experts; and (3) evidence-based policy advocacy nurtured by local experiences. However, the main challenge of implementation is insufficient domestic budgets for capacity building during and post-transition. We further identify two enablers for these practices to facilitate donor transition: (1) a project/programme governance structure integrated into the national health system and (2) a donor-recipient dynamic that enabled deep and far-reaching engagements with external and domestic stakeholders. Our findings shed light on the practices of technical assistance that strengthen long-term post-transition sustainability across multiple settings, particularly in middle-income countries.

Opportunities and challenges of trilateral South‒South cooperation for transforming development assistance for health: evidence from a DRC-UNICEF-China maternal, newborn, and child health project.

BACKGROUND: Trilateral South‒South cooperation is envisioned as an equal and empowering partnership model but still faces certain challenges. This study addresses whether and how trilateral South‒South cooperation can transform traditional development assistance for health (DAH) and explores the opportunities and challenges of trilateral South‒South cooperation for transforming future DAH, in the theme of "the emerging development partner's DAH transformation facilitated by a multilateral organization". METHODS: We evaluate a maternal, newborn, and child health (MNCH) project involving the Democratic Republic of Congo (DRC), the United Nations Children's Fund (UNICEF), and China (hereinafter referred to as the "DRC-UNICEF-China project"). We analyze data from project documents and seventeen semi-structured interviews using a pragmatic analytical framework based on the DAH program logic model and the OECD's trilateral cooperation framework. RESULTS: Evidence from the DRC-UNICEF-China MNCH project suggests that trilateral South‒South cooperation facilitated by a multilateral organization can provide transformative opportunities for emerging development partners' DAH to generate and deliver context-based, demand-oriented solutions, harmonize rules and procedures, institutionalize mutual learning and knowledge sharing, and increase the visibility of emerging development partners as sources for South‒South development experience transfer. However, the project revealed some challenges, including the neglect of key stakeholders in the complex governance structure, the high transaction costs needed to ensure transparency, and the harm local absence of the emerging development partner poses to long-term DAH engagement. CONCLUSIONS: This study echoes some of the findings in trilateral SSC literature that claim power structures and philanthropic, normative justification for health equity are often juxtaposed in trilateral SSC partnerships. The opportunities offered by the DRC-UNICEF-China project align with China's cognitive learning process for strengthening international engagement and global image building. However, challenges may arise as a result of complex governance structures and the entrustment of facilitating partners, which can threaten the effectiveness of trilateral cooperation. We call for strengthening the beneficiary partner's ownership at all levels, engaging the emerging development partner to better understand the beneficiary partner's local context(s) and needs, and ensuring available resources to support programmatic activities and long-term partnerships for the health and well-being of the beneficiaries.

HSF1 is involved in immunotherapeutic response through regulating APOJ/STAT3-mediated PD-L1 expression in hepatocellular carcinoma.

Hepatocellular cancer (HCC) is a serious illness with high prevalence and mortality throughout the whole world. For advanced HCC, immunotherapy is somewhat impactful and encouraging. Nevertheless, a substantial proportion of patients with advanced HCC are still unable to achieve a durable response, owing to heterogeneity from clonal variability and differential expression of the PD-1/PD-L1 axis. Recently, heat shock factor 1 (HSF1) is recognized as an important component of tumor immunotherapeutic response as well as related to PD-L1 expression in cancer. However, the mechanism of HSF1 regulating PD-L1 in cancer, especially in HCC, is still not fully clear. In this study, we observed the significantly positive correlation between HSF1 expression and PD-L1 expression in HCC samples; meanwhile combination expressions of HSF1 and PD-L1 served as the signature for predicting prognosis of patients with HCC. Mechanistically, HSF1 upregulated PD-L1 expression by inducing APOJ expression and activating STAT3 signaling pathway in HCC. In addition, we explored further the potential values of targeting the HSF1-APOJ-STAT3 axis against CD8+ T cells-mediated cancer cells cytotoxicity. These findings unveiled the important involvement of HSF1 in regulating PD-L1 expression in HCC as well as provided a novel invention component for improving the clinical response rate and efficacy of PD-1/PD-L1 blockade.

Assessing health governance across countries: a scoping review protocol on indices and assessment tools applied globally.

INTRODUCTION: Most global health indices or assessment tools focus on health outcomes rather than governance, and they have been developed primarily from the perspective of high-income countries. To benchmark global health governance for equity and solidarity, it becomes necessary to reflect on the current state of indices or assessment tools evaluating health governance across countries. This scoping review aims to review the existing multicountry indices and assessment tools applied globally with measurable indicators assessing health governance; summarise their differences and commonalities; identify the lessons learnt through analysis of their advantages and gaps; and evaluate the feasibility and necessity to establish a new index or consensus framework for assessing global health governance. METHODS AND ANALYSIS: This scoping review protocol follows Arksey and O'Malley's methodological framework, the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-analyses methodology for scoping reviews. Key information sources will be bibliographic databases (PubMed, Embase and Web of Science Core Collection), grey literature and citation tracking. The time frame will be from 1 January 2000 to 31 December 2021. Only indices or assessment tools that are globally applicable and provide measurable indicators of health governance will be eligible. A qualitative content analysis will follow the proposed data extraction form to explicate and compare each eligible index or assessment tool. An analysis based on a proposed preliminary evaluation framework will identify the advantages and gaps and summarise the lessons learnt. This scoping review will also discuss the feasibility and necessity of developing a new global health governance index or consensus framework to inform future research and practices. ETHICS AND DISSEMINATION: This scoping review does not require ethics approval. Dissemination will include a peer-review article, policy briefs and conference presentations. This protocol has been registered in the Open Science Framework (osf.io/y93mj).

Rate of the HIV Transmission and Associated Factors Among HIV-Exposed Infants in Guangxi, China: 2014-2019.

This study aims to evaluate the epidemiological characteristics of mother-to-child transmission (MTCT) of HIV and identify the possible factors leading to infant HIV infection using a retrospective cohort study of early infant diagnosis (EID). Information on a total of 3,145 exposed infant-mother pairs was collected from the EID platform from July 2014 to December 2019. The MTCT rate was 2.1%. Spatial-temporal maps showed that rates varied by year and by region, with four districts (Baise, Guigang, Guilin, and Hechi) maintaining rates of >2.0% in 2019. The rate of antiretroviral therapy (ART) use was 94.4%, with a gradual increase in prescriptions of highly active ART (HAART) from 83.0% in 2014 to 92.4% in 2019. A majority of 99.5% of infants were receiving artificial feeding. Factors associated with MTCT were ART use (odds ratio [OR] = 0.065, confidence interval [95% CI] = 0.035-0.121) and artificial feeding (OR = 0.091, 95% CI = 0.018-0.452). HAART was more helpful in decreasing the risk of MTCT compared with monotherapy (OR = 0.115, 95% CI = 0.014-0.933). ART during the postpartum period correlated with an increased risk (OR = 11.579, 95% CI = 1.402-95.960) compared with use of ART during pregnancy. This study indicates that MTCT rate of HIV is decreasing meaningfully in Guangxi. Some areas still face challenges in elimination of MTCT and need further resources and interventions. Future program planning should take into consideration the fact that ART use-in particular the use of HAART or ART during pregnancy-and replacement feeding may contribute to the prevention of MTCT.

Analysis of Glycosylation Profiles of Serum Glycoprotein from Iron Overload Thalassemia.

BACKGROUND: The aim of this study was to use a lectin microarray to detect differential glycan profiling of serous glycoprotein in iron overload thalassemia patients. METHODS: This study enrolled iron overload α/ß-thalassemia patients and no iron overload α/ß-thalassemia patients. Lectin microarray was used to detect the alteration of protein glycosylation. The reliability of the lectin microarray results was verified by the lectin blotting technique. Expression level of hepcidin, erythropoietin, ferritin, and transferrin were measured by western blotting. Data were analyzed using the SPSS 16.0 software. RESULTS: In this study, 19 differentiating lectins were screened from the iron overload α-thalassemia group, and 15 were screened from the iron overload ß-thalassemia group. The agglutinin blotting technique demonstrated that the results of the Aleuria aurantia lectin (AAL), Lens culinaris agglutinin (LCA), and Wheat germ agglutinin (WGA) agglutinin affinity for serum glycoproteins were consistent with the results of the lectin microarray. In iron overload thalassemia groups, expression levels of erythropoietin and ferritin were increased, but hepcidin and transferrin were significantly reduced. CONCLUSIONS: The differentially expressed glycoprotein database of iron overload thalassemia was successfully created, and the specific glycan patterns of serous glycoprotein might be efficient biomarkers for diagnosis or progression of iron overload thalassemia.

Serum Proteomic Analysis by Tandem Mass Tags (TMT) Based Quantitative Proteomics in Gastric Cancer Patients.

BACKGROUND: To use the tandem mass tags (TMT) based quantitative proteomics technique and bioinformatics method to identify potential serum diagnostic biomarkers for gastric cancer (GC). METHODS: This study enrolled GC patients and healthy control subjects. Mixed serum samples were pooled with 10 individual samples. The high-abundance proteins depleted serum proteins were collected by removing abundance albumin and immunoglobulin G (IgG). After desalting and ultrafiltration, the trypsin digested proteins were analyzed using TMT based quantitative proteomics system. The differential proteins were screened using the cutoff value of 1.2-fold change for up-regulation or down-regulation. The gene ontology (GO) was further analyzed using the UniProtKB/Swiss-Prot database. Then the differentially expressed protein ITIH4, S100A8, CD59, and COF1 were conducted using western blot. RESULTS: A total of 594 distinct serum proteins were identified between the GC group and the healthy controls. Forty-eight proteins were up-regulated and 57 were down-regulated using the cutoff value of 1.2-fold change. Using bioinformatics analysis, we found that the differentially expressed proteins were mainly concentrated in the extracellular exosome, extracellular region, extracellular space, and plasma membrane; their biological process activities included antigen binding, calcium ion binding, and protein homodimerization. In addition, the western blotting results showed that four differentially expressed proteins were completely coincident with the TMT quantification trend. CONCLUSIONS: The results showed that we were able to successfully create the differentially expressed protein database of GC using TMT technology. These proteins are potential molecular markers that could help us understand the potential molecular mechanism of GC.

Value of Red Cell Distribution Width in Assessing the Severity of Hepatitis B Virus-Related Decompensated Cirrhosis.

BACKGROUND: Hepatitis B virus infection is the main reason for liver cirrhosis in China. Thus, evaluating the disease severity of hepatitis B-related decompensated cirrhosis (HBV-DeCi) is very important. The red cell distribution width (RDW) is thought to be correlated with the severity of various diseases. The purpose of this investigation is to verify whether RDW can estimate the disease severity of HBV-DeCi. METHODS: This retrospective study included 172 subjects who had been diagnosed with HBV-DeCi. They were categorized into three groups on the basis of their RDW values. Receiver operating curve (ROC) was used to estimate the severity predictive performances and binary logistic regression was used to assess the independent variable predicting the severity of liver disease. RESULTS: The RDW values were evidently increased in the HBV-DeCi patients in comparison with the healthy controls (18.00% ± 0.04 vs. 13.19% ± 0.74, p < 0.001). There was also a significant difference in the model for endstage liver disease score of the three different RDW groups of A, B and C (13.2 ± 4.6, 16.0 ± 9.0, and 18.8 ± 6.5, p = 0.002). The RDW was an independent risk factor of the severity of HBV-DeCi. The cutoff level for RDW was > 14.0%, where the sensitivity and specificity were 90.7%, 100.0%, respectively, and the area under the curve (AUC) of ROC was 0.969. For a combination of RDW and MELD score, the AUC was 0.997, and the sensitivity and specificity were 98.3% and 99.1%, respectively. CONCLUSIONS: The RDW is a simple biomarker that may play an important role in predicting the severity of HBVDeCi.

Increased Red Blood Cell Volume Distribution Width: Important Clinical Implications in Predicting Gastric Diseases.

BACKGROUND: The red blood cell distribution width (RDW) is a blood analyzer marker showing the peripheral blood erythrocyte volume heterogeneity parameters. It is a normal diagnosis index of many diseases. This study was performed to evaluate the relationship between the RDW and gastric diseases. METHODS: A total of 189 patients with GC, 68 patients with gastric ulcers, 92 patients with chronic gastritis, and 157 healthy controls were enrolled in this study. Each patient's RDW and other biomarkers were recorded. All of the statistical analyses and comparisons between each group were determined using SPSS16.0 software. The statistical significance level was set to a p-value < 0.05. RESULTS: The RDW was significantly higher in those patients with gastric diseases when compared to the control group (p < 0.05). In addition, the RDW was independently correlated with the presence of GC and gastric ulcers. Significantly positive correlations between the RDW, platelets, and platelet distribution width (PDW) were observed in those patients with GC and gastric ulcers, although there were negative correlations with the red blood cells (RBCs), hemoglobin, and mean corpuscular volume (MCV) (p < 0.05). In the chronic gastritis group, elevated RDW values were closely associated with the hemoglobin, platelet, and MCV values (p < 0.05). The specificities of the gastric diseases groups were greater than 90%. CONCLUSIONS: In cases of gastric diseases, the RDW values were increased and were associated with several laboratory parameters. These finding may have important clinical implications in predicting gastric diseases.