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1.
Glob Health Sci Pract ; 11(3)2023 Jun 21.
Artículo en Inglés | MEDLINE | ID: mdl-37348934

RESUMEN

INTRODUCTION: Locally led and owned development is considered the best practice for international aid. As an implementing agency for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. Agency for International Development (USAID) supported the goal of transitioning 70% of its portfolio funding directly to local organizations by 2020, including partner country governments. However, limited evidence or evaluation exists on how such a transition can help achieve HIV-related health outcomes. METHODS: We evaluated monitoring, evaluation, and reporting performance; calculated indicators; and quality of service across the HIV/AIDS treatment cascade for local and international partners in the USAID/PEPFAR portfolio implementing similar programs during the U.S. Government fiscal years (FY) 2019 to 2020 (October 1, 2018-September 30, 2020). We compared results aggregated globally, by country, and across individual partners. RESULTS: Globally, local partners met a lower proportion of their treatment targets than international partners and did not meet targets for pre-exposure prophylaxis or voluntary medical male circumcision in FY2020. However, local partners exceeded targets in programs supporting orphans, vulnerable children, and key populations affected by HIV/AIDS. Local partners also had testing positivity, linkage rates, and viral load suppression that were equivalent to or higher than that of international partners. Based on available assessments, local partners displayed quality of service delivery comparable to international partners. CONCLUSION: Local partners faced challenges, including unfamiliarity with USAID funding, increasing targets across several indicators, and the syndemics of HIV/AIDS and COVID-19. A higher percentage of targets and funding led South African local partners to yield an outsized effect on global percent target achievement. While these findings should be interpreted cautiously due to limited sample size and short time horizon, they are a key first step in evaluating the local partner transition support of the long-term goal of sustained epidemic control of HIV/AIDS.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , COVID-19 , Infecciones por VIH , Niño , Estados Unidos , Humanos , Masculino , Infecciones por VIH/tratamiento farmacológico , United States Agency for International Development , Cooperación Internacional
2.
J Acquir Immune Defic Syndr ; 93(4): 261-271, 2023 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-36989134

RESUMEN

INTRODUCTION: The COVID-19 pandemic has disrupted access to critical health services, resulting in diminished gains in HIV epidemic control. This review assesses the magnitude of the impact that the COVID-19 pandemic has had on HIV services for adolescents. METHODS: PEPFAR Monitoring, Evaluation, and Reporting programmatic data were analyzed from across 16 USAID-supported adolescent care and treatment programs for fiscal year 2020 (FY20; October 2019-September 2020). Descriptive statistics were used to calculate absolute number and percent change between the pre-COVID-19 (Quarters 1-2; October 2019-March 2020) and COVID-19 periods (Quarters 3-4; April 2020-September 2020) for clinical cascade indicators. All analyses were conducted in Microsoft Excel. RESULTS: The number of HIV tests conducted during COVID-19 decreased by 21.4% compared with pre-COVID-19, with a subsequent 28% decrease in adolescents identified living with HIV. The rate of proxy linkage to antiretroviral therapy increased between periods, from 86.9% to 90.4%. There was a 25.9% decrease in treatment initiations among adolescents during COVID-19. During FY20, viral load coverage rates for adolescents dropped from 81.6% in FY20Q1 to 76.5% in FY20Q4, whereas the rates of viral load suppression for adolescents increased from 76.1% in FY20Q1 to 80.5% in FY20Q4. CONCLUSION: There was a substantial decrease in case-finding, treatment initiations, and viral load coverage rates for adolescents supported in USAID/PEPFAR programs during the COVID-19 pandemic. Additional health systems adaptations and strategies are required to ensure adolescents have continued access to HIV services during pandemic disruptions.


Asunto(s)
COVID-19 , Infecciones por VIH , Estados Unidos/epidemiología , Humanos , Adolescente , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/epidemiología , COVID-19/epidemiología , Pandemias , United States Agency for International Development , Servicios de Salud
3.
BMC Health Serv Res ; 22(1): 1307, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-36324131

RESUMEN

BACKGROUND: In collaboration with its partners, the Ethiopian government has been implementing standard Emergency Obstetric and Neonatal Care Services (CEmONC) since 2010. However, limited studies documented the lessons learned from such programs on the availability of CEmONC signal functions. This study investigated the availability of CEmONC signal functions and described lessons learned from Transform Health support in Developing Regional State in Ethiopia. METHOD: At baseline, we conducted a cross-sectional study covering 15 public hospitals in four developing regions of Ethiopia (Somali, Afar, Beneshangul Gumz, and Gambella). Then, clinical mentorship was introduced in ten selected hospitals. This was followed by reviewing the clinical mentorship program report implemented in all regions. We used the tool adapted from an Averting Maternal Death and Disability tools to collect data through face-to-face interviews. We also reviewed maternal and neonatal records. We then descriptively analyzed the data and presented the findings using text, tables, and graphs. RESULT: At baseline, six out of the 15 hospitals performed all the nine CEmONC signal functions, and one-third of the signal functions were performed in all hospitals. Cesarean Section service was available in eleven hospitals, while blood transfusion was available in ten hospitals. The least performed signal functions were blood transfusion, Cesarean Section, manual removal of placenta, removal of retained product of conceptus, and parenteral anticonvulsants. After implementing the clinical mentorship program, all CEmONC signal functions were available in all hospitals selected for the mentorship program except for Abala Hospital; the number of Cesarean Sections increased by 7.25% at the last quarter of 2021compared to the third quarter of 20,219; and the number of women referred for blood transfusions and further management of obstetric complications decreased by 96.67% at the last quarter of 2021 compared to the third quarter of 20,219. However, the number of women with post-cesarean Section surgical site infection, obstetric complications, facility maternal deaths, neonatal deaths, and stillbirths have not been changed. CONCLUSION: The availability of CEmONC signal functions in the supported hospitals did not change the occurrence of maternal death and stillbirth. This indicates the need for investigating underlying and proximal factors that contributed to maternal death and stillbirth in the Developing Regional State of Ethiopia. In addition, there is also the need to assess the quality of the CEmONC services in the supported hospitals, institutionalize reviews, surveillance, and response mechanism for maternal and perinatal or neonatal deaths and near misses.


Asunto(s)
Cesárea , Muerte Materna , Recién Nacido , Estados Unidos , Femenino , Embarazo , Humanos , Etiopía/epidemiología , Mortinato , Estudios Transversales , United States Agency for International Development
4.
Am J Trop Med Hyg ; 105(6): 1476-1482, 2021 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-34670193

RESUMEN

Countries across West Africa began reporting COVID-19 cases in February 2020. By March, the pandemic began disrupting activities to control and eliminate neglected tropical diseases (NTDs) as health ministries ramped up COVID-19-related policies and prevention measures. This was followed by interim guidance from the WHO in April 2020 to temporarily pause mass drug administration (MDA) and community-based surveys for NTDs. While the pandemic was quickly evolving worldwide, in most of West Africa, governments and health ministries took quick action to implement mitigation measures to slow the spread. The U.S. Agency for International Development's (USAID) Act to End NTDs | West program (Act | West) began liaising with national NTD programs in April 2020 to pave a path toward the eventual resumption of activities. This process consisted of first collecting and analyzing COVID-19 epidemiological data, policies, and standard operating procedures across the program's 11 countries. The program then developed an NTD activity restart matrix that compiled essential considerations to restart activities. By December 2020, all 11 countries in Act | West safely restarted MDA and certain surveys to monitor NTD prevalence or intervention impact. Preliminary results show satisfactory MDA program coverage, meaning that enough people are taking the medicine to keep countries on track toward achieving their NTD disease control and elimination goals, and community perceptions have remained positive. The purpose of this article is to share the lessons and best practices that have emerged from the adoption of strategies to limit the spread of the novel coronavirus during MDA and other program activities.


Asunto(s)
Antiinfecciosos/uso terapéutico , COVID-19/epidemiología , Administración Masiva de Medicamentos , Programas Nacionales de Salud/organización & administración , Enfermedades Desatendidas/terapia , SARS-CoV-2 , África Occidental , Antiinfecciosos/administración & dosificación , Humanos , Programas Nacionales de Salud/normas , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Factores de Tiempo , Clima Tropical , Estados Unidos , United States Agency for International Development
5.
PLoS One ; 16(4): e0249994, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33857244

RESUMEN

In 2017-2018, a group of international development funding agencies launched the Crops to End Hunger initiative to modernize public plant breeding in lower-income countries. To inform that initiative, USAID asked the International Food Policy Research Institute and the United States Department of Agriculture's Economic Research Service to estimate the impacts of faster productivity growth for 20 food crops on income and other indicators in 106 countries in developing regions in 2030. We first estimated the value of production in 2015 for each crop using data from FAO. We then used the IMPACT and GLOBE economic models to estimate changes in the value of production and changes in economy-wide income under scenarios of faster crop productivity growth, assuming that increased investment will raise annual rates of yield growth by 25% above baseline growth rates over the period 2015-2030. We found that faster productivity growth in rice, wheat and maize increased economy-wide income in the selected countries in 2030 by 59 billion USD, 27 billion USD and 21 billion USD respectively, followed by banana and yams with increases of 9 billion USD each. While these amounts represent small shares of total GDP, they are 2-15 times current public R&D spending on food crops in developing countries. Income increased most in South Asia and Sub-Saharan Africa. Faster productivity growth in rice and wheat reduced the population at risk of hunger by 11 million people and 6 million people respectively, followed by plantain and cassava with reductions of about 2 million people each. Changes in adequacy ratios were relatively large for carbohydrates (already in surplus) and relatively small for micronutrients. In general, we found that impacts of faster productivity growth vary widely across crops, regions and outcome indicators, highlighting the importance of identifying the potentially diverse objectives of different decision makers and recognizing possible tradeoffs between objectives.


Asunto(s)
Productos Agrícolas , Modelos Económicos , Producción de Cultivos , Países en Desarrollo , Abastecimiento de Alimentos , Humanos , Oryza/crecimiento & desarrollo , Triticum/crecimiento & desarrollo , Estados Unidos , United States Agency for International Development
7.
Mil Med ; 185(1-2): 162-169, 2020 02 12.
Artículo en Inglés | MEDLINE | ID: mdl-31503280

RESUMEN

INTRODUCTION: Obstetric fistulae are a leading scourge for women in developing countries resulting, in severe individual suffering and devastating socio-economic repercussions for her family and community. The underlying causes of obstetric fistula stem from multiple factors to include poor nutrition, early marriage, insufficient education and inferior social status of women as well as substandard medical care. The US Agency for International Development (USAID) has invested more than $100 million globally since 2004 to address these factors as well as support women suffering with fistulae. The ultimate goal is to eradicate obstetric fistula in Bangladesh in the next 20 years. Despite these efforts, nearly 20,000 women in Bangladesh, still suffer with this malady. METHODS: To close this gap, USAID and the Department of Defense (DOD) developed a novel Interagency Agreement (IAA) leveraging the surgical skills of military health professionals to scale-up the ongoing fistula care program. The agreement outlined three lines of effort: (1) treat existing fistulae by bolstering surgical capacity of the existing USAID fistula care program; (2) promote fistula mitigation with lectures and hands-on teaching of obstetric care as well as safe gynecologic surgery; and (3) assist with advocacy at higher levels of the Bangladesh government. A Bangladesh Fistula Mission Partnership working group was formed to design and implement this IAA. Critical partners from the US Embassy in Dhaka included USAID (Health, Legal, Contracting), the DOD (Office of Defense Cooperation), and Department of State (Regional Security Officer). Partners from the US Army included United States Army-Pacific Command (Surgeon, Legal, Finance, Security Cooperation, Contracting), Regional Health Command-Pacific (Operations, Legal, Public Affairs), and Tripler Army Medical Center (Department of OBGYN, Operations, Public Affairs). Institutional Review Board approval was not required as the treatments offered were standard of care. RESULTS: The Tripler Army Medical Center (TAMC) health professionals executed the IAA with one pre-deployment site survey and two surgical missions in 2016-2017. The military team supported the surgical repair of 40 pelvic fistulae and perineal tears and provided operative management for an additional 25 patients with pelvic organ prolapse. Furthermore, the team conducted 19 professional lectures and multiple educational forums at hospitals in Kumudini, Khulna and the premier medical university in Dhaka for over 800 attendees including physicians, nurses and students to help prevent obstetric and surgical fistulae. Importantly, the team assisted USAID as subject matter experts in its advocacy to the Bangladesh Ministry of Health for improved maternity care and regulatory oversight. During the missions, the team enhanced their readiness by exercising individual and collective tasks while exposing personnel to the cultural context of the region. CONCLUSION: This IAA was the first USAID funded and DoD-executed health mission in the US Indo-Pacific Command Area of Responsibility. Direct participation in the IAA enabled TAMC to support the US Indo-Pacific Command Theater Campaign Plan, the Department of Defense Instruction 2000.30 on Global Health Engagements, the USAID Country Development Cooperation Strategy, and the US Ambassadors Integrated Country Strategy Objectives in Bangladesh. This effort can serve as a model for future cooperation between USAID and the DoD.


Asunto(s)
Fístula , Servicios de Salud Materna , Bangladesh , Atención a la Salud , Países en Desarrollo , Femenino , Humanos , Embarazo , Estados Unidos , United States Agency for International Development
8.
Subst Abus ; 39(2): 139-144, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29595375

RESUMEN

The US Department of Veterans Affairs (VA), the largest health care system in the US, has been confronted with the health care consequences of opioid disorder (OUD). Increasing access to quality OUD treatment, including pharmacotherapy, is a priority for the VA. We examine the history of medications (e.g., methadone, buprenorphine, injectable naltrexone) used in the treatment of OUD within VA, document early and ongoing efforts to increase access and build capacity, primarily through the use of buprenorphine, and summarize research examining barriers and facilitators to prescribing and medication receipt. We find that there has been a slow but steady increase in the use of medications for OUD and, despite system-wide mandates and directives, uneven uptake across VA facilities and within patient sub-populations, including some of those most vulnerable. We conclude with recommendations intended to support the greater use of medication for OUD in the future, both within VA as well as other large health care systems.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Tratamiento de Sustitución de Opiáceos/métodos , Trastornos Relacionados con Opioides/tratamiento farmacológico , United States Department of Veterans Affairs/historia , United States Department of Veterans Affairs/tendencias , Creación de Capacidad , Predicción , Guías como Asunto , Política de Salud , Accesibilidad a los Servicios de Salud , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Tratamiento de Sustitución de Opiáceos/historia , Trastornos Relacionados con Opioides/historia , Estados Unidos
10.
Int J Health Plann Manage ; 29(1): 90-107, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-23165371

RESUMEN

The present article proposes an analysis of the USA-Bolivia relationships in the health sector between 1971 and 2010 based on a grey and scientific literature review and on interviews. We examined United States Agency for International Development (USAID) interventions, objectives, consistency with Bolivian needs, and impact on health system integration. USAID operational objectives--decentralization, fertility and disease control, and maternal and child health--may have worked against each other while competing for limited Ministry of Health resources. They largely contributed to the segmentation and fragmentation of the Bolivian health system. US cooperation in health did not significantly improve health status while the USAID failed to properly tackle anti-drugs, political, and economic US interests in Bolivia.


Asunto(s)
Cooperación Internacional , United States Agency for International Development , Bolivia , Atención a la Salud/organización & administración , Estado de Salud , Indicadores de Salud , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Cooperación Internacional/historia , Política , Factores Socioeconómicos , Estados Unidos
11.
PLoS One ; 8(5): e63134, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23717402

RESUMEN

INTRODUCTION: Modelling, supported by the USAID Health Policy Initiative and UNAIDS, performed in 2011, indicated that Uganda would need to perform 4.2 million medical male circumcisions (MMCs) to reach 80% prevalence. Since 2010 Uganda has completed 380,000 circumcisions, and has set a national target of 1 million for 2013. OBJECTIVE: To evaluate the relative reach and cost-effectiveness of PrePex compared to the current surgical SMC method and to determine the effect that this might have in helping to achieve the Uganda national SMC targets. METHODS: A cross-sectional descriptive cost-analysis study conducted at International Hospital Kampala over ten weeks from August to October 2012. Data collected during the performance of 625 circumcisions using PrePex was compared to data previously collected from 10,000 circumcisions using a surgical circumcision method at the same site. Ethical approval was obtained. RESULTS: The moderate adverse events (AE) ratio when using the PrePex device was 2% and no severe adverse events were encountered, which is comparable to the surgical method, thus the AE rate has no effect on the reach or cost-effectiveness of PrePex. The unit cost to perform one circumcision using PrePex is $30.55, 35% ($7.90) higher than the current surgical method, but the PrePex method improves operator efficiency by 60%, meaning that a team can perform 24 completed circumcisions compared to 15 by the surgical method. The cost-effectiveness of PrePex, comparing the cost of performing circumcisions to the future cost savings of potentially averted HIV infections, is just 2% less than the current surgical method, at a device cost price of $20. CONCLUSION: PrePex is a viable SMC tool for scale-up with unrivalled potential for superior reach, however national targets can only be met with effective demand creation and availability of trained human resource.


Asunto(s)
Circuncisión Masculina/economía , Circuncisión Masculina/instrumentación , Análisis Costo-Beneficio/economía , Equipos y Suministros/economía , Circuncisión Masculina/efectos adversos , Ahorro de Costo/economía , Estudios Transversales , Equipos y Suministros/efectos adversos , Infecciones por VIH/economía , Política de Salud/economía , Humanos , Masculino , Uganda , Estados Unidos , United States Agency for International Development
13.
Int J Food Sci Nutr ; 60 Suppl 7: 219-28, 2009.
Artículo en Inglés | MEDLINE | ID: mdl-19449279

RESUMEN

Corn soy blend, wheat soy blend, and corn soy milk are fortified food-aid commodities distributed by the US Government, and often used in complementary feeding programs. The viscosity and energy density of these products was compared in cooked porridges, at concentrations between 8% and 20% (w/w), using a Bostwick consistometer. All three products required nearly 20% addition of dry meal in water to achieve the energy density of 0.8 kcal/g, recommended for complementary foods. At this concentration, all three were excessively viscous. Cooking times beyond 1 min showed no significant increase in viscosity. Corn soy milk was less viscous than the other products at lower concentrations. Replacement of corn meal and soy with vegetable oil produces less viscous porridges but reformulation would be needed to maintain protein and micronutrient levels. Significant process and formulation changes are needed in these products to increase their suitability for use as complementary foods.


Asunto(s)
Fenómenos Químicos , Culinaria/métodos , Productos Agrícolas/química , Grano Comestible/química , Alimentos Fortificados/análisis , Alimentos Infantiles/análisis , Animales , Ingestión de Energía , Humanos , Lactante , Leche/química , Valor Nutritivo , Aceites de Plantas/análisis , Sistemas de Socorro , Alimentos de Soja/análisis , Factores de Tiempo , Triticum/química , Estados Unidos , United States Agency for International Development , United States Department of Agriculture , Viscosidad , Zea mays/química
17.
Artículo | PAHO-IRIS | ID: phr-40297

RESUMEN

En este evento se reunieron participantes de los ocho paises de RAVREDA, de la Organización Panamericana de la Salud, de la Organización Mundial de la Salud (OMS), de la Agencia Internacional para el Desarrollo de los Estados Unidos (USAID) y de los Centros para el Control y la Prevención de Enfermedades CDC)


Reunión Técnica de Coordinación de la Red Amazónica de Vigilancia de la Resistencia de los Antimaláricos RAVREDA y de la Iniciativa de Malaria en la Amazonía AMI, 1. Organización Panamericana de la Salud; 19-20 mar. 2002


Asunto(s)
Antimaláricos , Malaria , Bolivia , Colombia , Ecuador , Guyana , Perú , Suriname , Venezuela , Brasil
18.
J Mod Afr Stud ; 37(3): 457-88, 1999.
Artículo en Inglés | MEDLINE | ID: mdl-21991624
19.
Soc Sci Med ; 42(12): 1703-19, 1996 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-8783432

RESUMEN

The Children's Vaccine Initiative (CVI) was created as an attempt to revolutionize the way vaccines are developed for the developing world. It was formed, in part, out of optimism that the scientific advances of the biotechnology revolution could be harnessed to create new and improved vaccines, and in part out of fear that the health needs, of the developing world would be ignored by the increasingly profit-oriented vaccine industry that gave low priority to countries lacking a hard currency market. The CVI was founded in 1990 1991 but its intellectual roots came out of ten years of discussion and agitation about the opportunities and dangers that faced the international health community. The article looks at the indispensable role played by pivotal individuals (William Foege of the Task Force for Child Survival. Kenneth Warren and Scott Halstead of the Rockefeller Foundation. James Grant and James Sherry of UNICEF and D.A. Henderson of Johns Hopkins University) without whom the CVI would not have come into existence. While these individuals worked within the confines created by the large social economic political changes that shaped the 1980s, their personal goals, often targeted at fairly limited objectives, were crucial in determining the final, rather unlikely, outcome. The role of both individual choice and serendipity in determining major policy decisions are often under-estimated in the social science literature.


Asunto(s)
Programas de Inmunización/historia , Vacunas/historia , Niño , Protección a la Infancia/historia , Política de Salud/historia , Historia del Siglo XX , Humanos , National Institutes of Health (U.S.)/historia , Vacuna Antipolio de Virus Inactivados/historia , Investigación/historia , Naciones Unidas/historia , Estados Unidos , United States Food and Drug Administration/historia
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