International Public Health Laboratory Twinning: An Innovative Approach to Strengthen the National Health Laboratory System in Uganda, 2014-2017.

International initiatives to strengthen national health laboratory systems in resource-poor countries are often hampered by unfamiliarity with the country's health laboratory environment and turnover of international partners during the initiative. This study provides an overview of, and lessons learned from, the use of a laboratory long-term partnership approach (ie, "twinning") to strengthen the national public health laboratory system in an international setting. We focused on the partnering of the Uganda Ministry of Health Central Public Health Laboratory (CPHL) with the New Mexico State Public Health Laboratory to help the CPHL become Uganda's national public health reference laboratory (Uganda National Health Laboratory Services [UNHLS] Institute) and leader of its nascent Uganda National Health Laboratory Network (UNHLN). Via twinning, CPHL leadership received training on laboratory leadership and management, quality systems, facility management, and the One Health environmental strategy (ie, that the health of persons is connected to the health of animals and the environment), and drafted a National Health Laboratory Policy, UNHLS Institute business plan, and strategic and operating plans for the UNHLS Institute and UNHLN. The CPHL is now responsible for the UNHLS Institute and coordinates the UNHLN. Lessons learned include (1) twinning establishes stable long-term collaborations and (2) success requires commitment to a formal statement of activities and objectives, as well as clear and regular communication among partners.

12-Month Cost Outcomes of Community Engagement Versus Technical Assistance for Depression Quality Improvement: A Partnered, Cluster Randomized, Comparative-Effectiveness Trial.

Objective: To compare community engagement and planning (CEP) for coalition support to implement depression quality improvement (QI) to resources for services (RS) effects on service-use costs over a 12-month period. Design: Matched health and community programs (N=93) were cluster-randomized within communities to CEP or RS. Setting: Two Los Angeles communities. Participants: Adults (N=1,013) with depressive symptoms (Patient Health Questionnaire (PHQ-8) ≥10); 85% African American and Latino. Interventions: CEP and RS to support programs in depression QI. Main Outcome Measures: Intervention training and service-use costs over 12 months. Results: CEP planning and training costs were almost 3 times higher than RS, largely due to greater CEP provider training participation vs RS, with no significant differences in 12-month service-use costs. Conclusions: Compared with RS, CEP had higher planning and training costs with similar service-use costs.

Global health development assistance remained steady in 2013 but did not align with recipients' disease burden.

Tracking development assistance for health for low- and middle-income countries gives policy makers information about spending patterns and potential improvements in resource allocation. We tracked the flows of development assistance and explored the relationship between national income, disease burden, and assistance. We estimated that development assistance for health reached US$31.3 billion in 2013. Increased assistance from the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the GAVI Alliance; and bilateral agencies in the United Kingdom helped raise funding to the highest level to date. The largest portion of health assistance targeted HIV/AIDS (25 percent); 20 percent targeted maternal, newborn, and child health. Disease burden and economic development were significantly associated with development assistance for health, but many countries received considerably more or less aid than these indicators predicted. Five countries received more than five times their expected amount of health aid, and seven others received less than one-fifth their expected funding. The lack of alignment between disease burden, income, and funding reveals the potential for improvement in resource allocation.

State "technical assistance programs" for nursing home quality improvement: variations and potential implications.

To improve nursing home quality, many states have developed "technical assistance programs" that provide on-site consultation and training for nursing facility staff. We conducted a national survey on these state programs to collect data on program design, operations, financing, and perceived effectiveness. As of 2010, 17 states had developed such programs. Compared to existing state nursing home quality regulations, these programs represent a collaborative, rather than enforcement-oriented, approach to quality. However, existing programs vary substantially in key structural features such as staffing patterns, funding levels, and relationship with state survey and certification agencies. Perceived effectiveness by program officials on quality was high, although few states have performed formal evaluations. Perceived barriers to program effectiveness included lack of appropriate staff and funding, among others. In conclusion, state technical assistance programs for nursing homes vary in program design and perceived effectiveness. Future comparative evaluations are needed to inform evidence-based quality initiatives.

Defining and assessing evidence for the effectiveness of technical assistance in furthering global health.

In an era when health resources are increasingly constrained, international organisations are transitioning from directly managing health services to providing technical assistance (TA) to in-country owners of public health programmes. We define TA as: 'A dynamic, capacity-building process for designing or improving the quality, effectiveness, and efficiency of specific programmes, research, services, products, or systems'. TA can build sustainable capacities, strengthen health systems and support country ownership. However, our assessment of published evaluations found limited evidence for its effectiveness. We summarise socio-behavioural theories relevant to TA, review published evaluations and describe skills required for TA providers. We explore challenges to providing TA including cost effectiveness, knowledge management and sustaining TA systems. Lastly, we outline recommendations for structuring global TA systems. Considering its important role in global health, more rigorous evaluations of TA efforts should be given high priority.

Estimation of Japanese international financial assistance for HIV/AIDS control for 2003-2007: difficulties and limitations of data collection.

The purpose of this paper is to: (1) collect relevant data and estimate Japanese international financial assistance for HIV/AIDS control; (2) discuss the difficulties in collecting relevant data and the limitations of the collected data; and (3) conduct a comparative analysis on the estimated data with OECD and Kaiser Family Foundation aggregate data. The point is that we have comprehensively collected and estimated the data on Japanese international expenditures for HIV/AIDS control while there is no reliable data that is totally managed and published. In addition, we discuss the difficulties and limitations of data collection: unpublished data; insufficient data; inseparable data; problems of exchange rates; gaps between disbursement and commitment; and difference in year period among calendar, fiscal and organization-specific years. Furthermore, we show the risk of underestimating the Japanese international contribution to HIV/AIDS control on the basis of OECD and Kaiser data. In this respect, it is significant to comprehensively collect and estimate the data on Japanese international assistance for HIV/AIDS control. Finally, we derive the implication that it is crucial for a relevant international organization and/or individual countries to comprehensively collect and administer data for international cooperation in the development of health policies for HIV/AIDS.

Improving the use of data for HIV prevention decision making: lessons learned.

HIV prevention community planning was developed to promote identification of local prevention priorities through a process that was evidence-based and provided community input. There are a variety of barriers to effective use of data in community planning which include characteristics of data (availability, timeliness, relevance to planning tasks), characteristics of planning group members and providers of data (e.g., skills in understanding and applying data), and social-organizational aspects of community-planning groups (CPGs). Lessons learned from this project illustrate how to create locally relevant sources of data, build data use skills of CPG members and data providers, and address social-organizational aspects of planning, while also better integrating community planning with implementation of prevention plans. Adaptation of tools and methods is discussed along with future considerations for research and planning practice.

Collaborative AIDS prevention research in the developing world: the CAPS experience.

BACKGROUND: Prevention through behavior change is the only way to control the spread of HIV infection in the developing world. Success in prevention requires consistent and persistent intervention over time, a clear understanding of the realities of target populations and involvement of members of these populations in prevention efforts. Applied local research is urgently needed, especially in the developing world, to design interventions that meet these criteria and to test their effectiveness. CENTER FOR AIDS PREVENTION STUDIES (CAPS) MODEL OF INTERNATIONAL COLLABORATIVE RESEARCH: Each year, eight to 10 scientists from developing countries visit CAPS in San Francisco for 10 weeks of intensive learning and collaboration. The main emphasis is on designing a protocol for a research project related to AIDS prevention in the visiting scientist's home country. CAPS provides pilot study funding and technical assistance to implement the project. RESULTS: The quality of the resulting collaborative research is represented by the articles published in this volume and by the many alumni of the program who have undertaken additional research projects and/or assumed leadership positions in AIDS control efforts in their countries.

PIP: Prevention through behavior change is the only way to control the spread of HIV infection in the developing world. Success in prevention requires consistent and persistent intervention over time, a clear understanding of the realities of target populations, and involvement of members of these populations in prevention efforts. Applied local research is urgently needed, especially in the developing world, to design interventions that meet these criteria and to test their effectiveness. The Center for AIDS Prevention Studies (CAPS) model of international collaborative research has been used at the University of California, San Francisco, for the past eight years. The model involves an intensive period for protocol development and another one for data analysis. Each year, 8-10 scientists from developing countries visit CAPS in San Francisco for 10 weeks of intensive learning and collaboration. They are immersed in HIV epidemiology, research design, computer skills, data management, and psychosocial aspect of the AIDS epidemic. The main emphasis is on designing a protocol for a research project related to AIDS prevention in the visiting scientist's home country. The greatest impediment to intervention trials in developing countries is lack of funding. CAPS provides pilot study funding and technical assistance to implement the project in the home country. In the summer of 1995 eight alumni worked intensively with the CAPS faculty on data analysis and manuscript preparation. The quality of the resulting collaborative research is represented by the articles published and by the many alumni of the program who have undertaken additional research projects and/or assumed leadership positions in AIDS control efforts in their countries. These studies cover a wide range of risk groups, including sexually transmitted disease patients in Zambia; adolescents in the Philippines and Russia; wives of HIV-infected men in Uganda; female sex workers in Brazil, India, and Thailand; and HIV-infected women of childbearing age in Rwanda.

Developing cancer control capacity in state and local public health agencies.

In 1986, the National Cancer Institute began a major grant program to enhance the technical capabilities of public health departments in cancer prevention and control. This effort, commonly referred to as "capacity building" for cancer control, provided funding to support eight State and one local health department. The program focused on developing the knowledge and skills of health department personnel to implement intervention programs in such areas as smoking cessation, diet modification, and breast and cervical cancer screening. The grants ranged from 2 to 5 years in length, with funding of $125,000 to $1.6 million per grant. The total for the program was $7.4 million. While the priorities set for these grants were nominally similar, their capacity building activities in cancer prevention and control evolved into unique interventions reflecting the individual needs and priorities of each State or locality. Their experiences illustrate that technical development for planning, implementing, and evaluating cancer prevention and control programs is a complex process that must occur at multiple levels, regardless of overall approach. Factors found to contribute to successful implementation of technical development programs include* commitment of the organization's leadership to provide adequate support for staff and activities and to keep cancer prevention and control on the organizational agenda,* the existence of appropriate data to monitor and evaluate programs,* appropriately trained staff,* building linkages with State and community agencies and coalitions to guide community action,* an established plan or process for achieving cancer control objectives,* access to the advice of and participation of individual cancer and health experts,* an informed State legislature,* diffusion of cancer prevention and control efforts,and* the ability to obtain funds needed for future activities.