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1.
Reprod Health ; 17(1): 75, 2020 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-32456657

RESUMO

BACKGROUND: The role of global initiatives in catalyzing change within national contexts is complex and less understood. Addressing adolescent sexual and reproductive health in Kenya requires concerted efforts of both state and non-state actors and more importantly, a supportive environment. This paper deconstructs the moral and social narratives of adolescents' and young people's sexual and reproductive health (AYSRH) in Kenya as driven by the powerful discourse and ideologies pre- and within the Millennium Development Goal (MDG) era. METHODS: Literature was systematically searched in PubMed and Medline with policy documents obtained from government agencies from the pre-MDG period (2000 and earlier) and within the MDG period (2001-2015). Literature with a substantial focus on SRH were eligible if they captured the different facets of ASRH in Kenya and sub-Saharan Africa (SSA). The results were reviewed and synthesized to disentangle the moral and social narratives of AYSRH in Kenya with an MDG lens. RESULTS: The evolution of AYSRH policies and programmes in Kenya was gradual and largely shaped by prevailing development threats and moral and social narratives. Pre-MDG period was dominated by issue-based policies of population growth and high fertility rates, with a focus on married population with strong cultural and religious barriers to AYSRH; early to mid-MDG was mainly influenced by the threat of HIV/AIDS, culminating in the first Adolescent Reproductive Health and Development Policy in 2003. However, the policies and subsequent programmes focused on abstinence only and medical narratives, with persistent religious and cultural opposition to AYSRH. Late-MDG saw more progressive policies (these are policies that refer to those that tends towards acceptance of liberal social reforms and which sometimes are contrary to entrenched social norms, beliefs and practices), high government commitment and a refocus on SRH issues due to sustained early childbearing, culminating in the revised Adolescent Sexual and Reproductive Health Policy of 2015. CONCLUSION: Debates in the translation of global goals and commitments to policy and practice at country level need to account for national level realities in AYSRH reforms. The findings contribute to critical evidence for strategic policy and programming approaches for AYSRH in Kenya and in SSA and for the realization of their rights within the context of sustainable development goals.

3.
Glob Health Action ; 12(1): 1662685, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31510887

RESUMO

Background: Ending AIDS as a public health threat by 2030 is a significant challenge, as new HIV infections among adolescents and young people have not decreased fast enough to curb the epidemic. The combination of slow HIV response and increasing youth populations 15-24 could affect progress towards 2030 goals. Objective: This analysis aimed to describe global and regional trends from 2010-2050 in the HIV epidemic among adolescents and young people by accounting for demographic projections and recent trends in HIV interventions. Methods: 148 national HIV estimates files were used to project the HIV epidemic to 2050. Numbers of people living with HIV and new HIV infections were projected by sex and five-year age group. Along with demographic data, projections were based on three key assumptions: future trends in HIV incidence, antiretroviral treatment coverage, and coverage of antiretrovirals for prevention of mother-to-child transmission. Results represent nine geographic regions. Results: While the number of adolescents and young people is projected to increase by 10% from 2010-2050, those living with HIV is projected to decrease by 61%. In Eastern and Southern Africa, which hosts the largest HIV epidemic, new HIV infections among adolescents and young people are projected to decline by 84% from 2010-2050. In West and Central Africa, which hosts the second-largest HIV epidemic, new infections are projected to decline by 35%. Conclusions: While adolescents and young people living with HIV are living longer and ageing into adulthood, if current trends continue, the number of new HIV infections is not projected to decline fast enough to end AIDS as a health threat in this age group. Regional variations suggest that while progress in Eastern and Southern Africa could reduce the size of the epidemic by 2050, other regions exhibit slower rates of decline among adolescents and young people.


Assuntos
Demografia/tendências , Infecções por HIV/epidemiologia , Adolescente , África Austral , Antirretrovirais/uso terapêutico , Bases de Dados Factuais , Feminino , Previsões , Humanos , Incidência , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Masculino , Adulto Jovem
6.
AIDS Behav ; 21(Suppl 1): 23-33, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28063074

RESUMO

Progress towards achievement of global targets for the prevention of mother-to-child transmission of HIV (PMTCT) and paediatric HIV care and treatment is an integral part of global and national HIV and AIDS responses. This paper documents the development of the global and national monitoring and reporting systems for PMTCT and paediatric HIV care and treatment programmes, achievements and remaining challenges. A review of the development of the monitoring and reporting process since 2002-2016 was conducted using existing published literature and taking into account changes in WHO HIV treatment guidelines, global HIV goals and targets, programmatic and methodological developments, and increased need for interagency partnerships, coordination and harmonization of global monitoring and reporting mechanisms. The number and type of indicators reported increased and evolved from monitoring of existence of national policies and guidelines, service delivery sites and trained health workers and coverage of PMTCT and paediatric HIV interventions to measuring outcomes and impact in reducing new HIV infections and AIDS related deaths, including efforts to validate elimination of mother-to-child transmission of HIV. These changes were required to mirror changes in WHO and national PMTCT and HIV treatment guidelines. The number of countries reporting PMTCT coverage increased from 53 in 2003 to over 130 in 2015. National monitoring processes have also expanded in scope and the capacity to report on disaggregated data by type of ARV regimen and for paediatric HIV care and treatment has increased. Monitoring of PMTCT and paediatric HIV programmes has contributed a rich body of evidence that helped monitor how quickly countries were adopting and implementing the latest WHO HIV treatment guidelines for pregnant and breastfeeding women and children. The reported data and experiences were instrumental in shaping global policies, national programmes, and investment choices.


Assuntos
Assistência à Saúde/normas , Infecções por HIV/prevenção & controle , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Síndrome de Imunodeficiência Adquirida/transmissão , Adulto , Aleitamento Materno , Criança , Assistência à Saúde/métodos , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/transmissão , Humanos , Mães , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/tratamento farmacológico , Cuidado Pré-Natal , Avaliação de Programas e Projetos de Saúde
7.
J Acquir Immune Defic Syndr ; 66 Suppl 2: S144-53, 2014 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-24918590

RESUMO

OBJECTIVES: To examine levels and patterns of HIV prevalence, knowledge, sexual behavior, and coverage of selected HIV services among adolescents aged 10-19 years and highlight data gaps and challenges. METHODS: Data were reviewed from Joint United Nations Programme on HIV/AIDS HIV estimates, nationally representative household surveys, behavioral surveillance surveys, and published literature. RESULTS: A number of gaps exist for adolescent-specific HIV-related data; however, important implications for programming can be drawn. Eighty-two percent of the estimated 2.1 million adolescents aged 10-19 years living with HIV in 2012 were in sub-Saharan Africa, and the majority of these (58%) were females. Comprehensive accurate knowledge about HIV, condom use, HIV testing, and antiretroviral treatment coverage remain low in most countries. Early sexual debut (sex before 15 years of age) is more common among adolescent girls than boys in low- and middle-income countries, consistent with early marriage and early childbirth in these countries. In low and concentrated epidemic countries, HIV prevalence is highest among key populations. CONCLUSIONS: Although the available HIV-related data on adolescents are limited, increased HIV vulnerability in the second decade of life is evident in the data. Improving data gathering, analysis, and reporting systems specific to adolescents is essential to monitoring progress and improving health outcomes for adolescents. More systematic and better quality disaggregated data are needed to understand differences by sex, age, geography, and socioeconomic factors and to address equity and human rights obligations, especially for key populations.


Assuntos
Infecções por HIV/epidemiologia , Adolescente , Envelhecimento , Criança , Epidemias , Feminino , Infecções por HIV/mortalidade , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Prevalência , Comportamento Sexual , Adulto Jovem
8.
J Acquir Immune Defic Syndr ; 66 Suppl 2: S170-5, 2014 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-24918592

RESUMO

BACKGROUND: In 2005, the resources needed to support orphans and vulnerable children in sub-Saharan Africa were estimated at US$ 1.1-4.1 billion. Approaches to support vulnerable children have changed considerably since then. This study updates previous estimates by including new types of support and information on support costs. METHODS: We considered 16 types of support categorized as economic strengthening, education support, social care and community outreach, and program support. The estimates combine the number of children in need of each intervention with unit costs derived from the literature and coverage goals based on current coverage and feasible future improvements. RESULTS: The number of children affected by AIDS in low- and middle-income countries varies from 58 million to 315 million depending on the definition of need. The resources required to provide support to children living in poor households will grow from US$ 4.2 billion in 2012 to US$ 5-8 billion by 2020. Almost two-thirds of these resources will be needed for Sub-Saharan Africa. The largest needs are for cash transfers, community care workers, early childhood development, block grants for education, M&E monitoring and evaluation, and direct material support. DISCUSSION: The results show that we can significantly improve the coverage of services for vulnerable children with only modest increases in resources. This results from stable or declining numbers of orphans and children living with HIV plus economic growth that is moving more households out of poverty. The results also reflect an important shift toward providing support to strengthen families and communities that care for children rather than direct material support. CONCLUSION: More resources are required to support children affected by AIDS, but new approaches to provide that support will be cost effective and have broad social and economic benefits.


Assuntos
Infecções por HIV/economia , Infecções por HIV/prevenção & controle , Custos de Cuidados de Saúde , Educação em Saúde/economia , Adolescente , Adulto , Infecções por HIV/mortalidade , Humanos , Modelos Econômicos , Adulto Jovem
9.
Health Policy Plan ; 28(4): 367-74, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-22826516

RESUMO

In 2005, due to slow global progress in the scale-up of prevention of mother-to-child transmission (PMTCT) and paediatric HIV programmes, the Inter-agency Task Team (IATT) on the Prevention of HIV infection among Pregnant Women, Mothers, and their Children initiated joint technical missions (JTMs) to countries of high HIV disease burden. The JTMs were intended to galvanize country actions for a more comprehensive response to PMTCT and paediatric HIV by bringing national and global stakeholders together to review national policies and programmes and develop country-specific recommendations for accelerating scale-up. Between 2005 and 2010, the IATT conducted JTMs in 18 low- and middle-income countries. In 2007, to assess the role played by the missions, a review in the first eight countries (Burkina Faso, Cameroon, Côte d'Ivoire, India, Malawi, Rwanda, Tanzania and Zambia) that hosted JTMs was undertaken. Country progress was assessed through desk review and key informant interviews. For each country, documents reviewed included JTM reports, baseline data for PMTCT and paediatric HIV care and treatment, and 2004 to 2007 trend data on key PMTCT and paediatric HIV indicators. Drawing upon the findings, this paper posits that JTMs contributed to national scale-up of PMTCT and paediatric HIV programmes through strengthening governance and co-ordination mechanisms for the programmes, promoting enabling policy environments, and supporting the development of national scale-up plans, which have been critical for leveraging additional financial resources for scale-up. Although the impact of the JTMs could be enhanced through greater follow-up and continued targeted assistance in technical areas such as infant and young child feeding, community-based programming and supply chain management, findings indicate that the JTMs are a useful mechanism for informing policy and programme decisions necessary for scaling up PMTCT and paediatric HIV responses. Moreover, by bringing stakeholders together around unified action plans, the JTMs created a platform for common action-a key tenet of the 'Three Ones' principles for effective HIV/AIDS responses.


Assuntos
Comportamento Cooperativo , Tomada de Decisões , Infecções por HIV/transmissão , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Formulação de Políticas , Complicações Infecciosas na Gravidez , Países em Desenvolvimento , Feminino , Infecções por HIV/diagnóstico , Acesso aos Serviços de Saúde , Humanos , Gravidez , Pesquisa Qualitativa
10.
J Acquir Immune Defic Syndr ; 60 Suppl 3: S120-6, 2012 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-22797733

RESUMO

Monitoring and evaluation (M&E) is fundamental to global HIV program implementation and has been a cornerstone of the President's Emergency Plan for AIDS Relief (PEPFAR). Rapid results were crucial to demonstrating feasibility and scalability of HIV care and treatment services early in PEPFAR. When national HIV M&E systems were nascent, the rapid influx of funds and the emergency expansion of HIV services contributed to the development of uncoordinated "parallel" information systems to serve donor demands for information. Close collaboration of PEPFAR with multilateral and national partners improved harmonization of indicators, standards, methods, tools, and reports. Concurrent PEPFAR investments in surveillance, surveys, program monitoring, health information systems, and human capacity development began to show signs of progress toward sustainable country-owned systems. Awareness of the need for and usefulness of data increased, far beyond discussions of indicators and reporting. Emphasis has turned toward ensuring the quality of data and using available data to improve the quality of care. Assessing progress toward an AIDS-free generation requires that the global community can measure the reduction of new HIV infections in children and adults and monitor the coverage, quality, and outcomes of highly efficacious interventions in combination. Building national M&E systems requires sustained efforts over long periods of time with effective leadership and coordination. PEPFAR, in close collaboration with its global and national partners, is well positioned to transform the successes and challenges associated with early rapid scale-up into future opportunities for sustainable, cost-effective, country-owned programs and systems.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Métodos Epidemiológicos , Saúde Global , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Vigilância da População/métodos , Parcerias Público-Privadas/organização & administração , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/tendências , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Pesquisa sobre Serviços de Saúde/métodos , Pesquisa sobre Serviços de Saúde/organização & administração , Pesquisa sobre Serviços de Saúde/tendências , Humanos , Incidência , Cooperação Internacional , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/tendências , Parcerias Público-Privadas/tendências , Estados Unidos
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