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Background: Cardiovascular disease (CVD), mainly heart attack and stroke, is the
leading cause of premature mortality in low and middle income countries (LMICs).
Identifying
...
and managing individuals at high risk of CVD is an important strategy to prevent and control CVD, in addition to multisectoral population-based interventions to reduce CVD risk factors in the entire population.
Methods: We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs.
Results: A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of
individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability ofaffordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). Thisalso emphasises the need to re-orient health systems in LMICs towards chronic diseases management.
Conclusion: The large burden of CVD in LMICs and the fact that persons with high
CVD can be identified and managed along cost-effective interventions mean that
health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
more
Universal Access to HIV/AIDS, Tuberculosis and Malaria Services by A United Africa by 2010
African Union;
(2006)
C2
Special summit of African Union on HIV and Aids, Tuberculosis and Malaria (atm) Abuja, Nigeria 2–4 may, 2006Sp/Assembly/ATM/2 (I), Rev.3
Abuja c
...
all for accelerated action towards universal access to HIV and Aids, Tuberculosis and Malaria services in Africa
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The World Health Organization (WHO) has recommended a universal antiretroviral therapy (ART) for all HIVinfected children before the age of two since 2010, but this implies an early identification of these infants. We described the Prevention of Mot
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her-to-Child HIV Transmission (PMTCT) cascade, the staffing and the quality of infrastructures in pediatric HIV care facilities, in Ouagadougou, Burkina Faso.
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The Zambia Population Based HIV impact assessment of 2016, reported the prevalence of viral hepatitis in Zambia as ranging between 5.6% among adults aged 15 to 59% in the general population,
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and 7.1% among HIV infected individuals. It is estimated that the majority of persons with chronic hepatitis B and/ or hepatitis C are unware of their infection and do not benefit from promotive, preventive and curative services designed to reduce onward transmission. Zambia introduced hepatitis B virus vaccine to the routine Under 5 vaccination schedule in 2005. Preliminary results from the ZAMPHIA indicate that hundreds of infections have been abated in children since then. However, its also clear that we continue to miss key opportunities to prevent transmission, diagnose and treat infections, prevent serious disease, and in many cases cure people. In addition, high risk groups inter alia health care workers still have limited access to the vaccine.
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Over 6 million people worldwide are infected with Trypanosoma cruzi, the protozoan that causes Chagas disease
(CD). T. cruzi is transmitted by triatomine insects, congenitally, through uncontrolled blood donations and organ transplants,
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and via consumption of food or drink contaminated by triatomines.
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Community health worker teams are potential game-changers in ensuring access to care in vulnerable communities. Who are they? What do they actually
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do? Can they help South Africa realize universal health coverage? As the proactive arm of the health services, community health workers teams provide household and community education, early screening, tracing and referrals for a range of health and social services. There is little local or global evidence on the household services provided by such teams, beyond specific disease-oriented activities such as for HIV and TB. This paper seeks to address this gap.
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AIDS Free Framework to accelerate paediatric and adolescent HIV treatment
World Health Organization; Elizabeth Glaser Foundation; Unicef; et al.
(2018)
C_WHO
Community health workers (CHWs) enable marginalised communities, often experiencing structural poverty, to access healthcare. Trust, important in all patient–provider relationships, is difficult
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to build in such
communities, particularly when stigma associated with HIV/AIDS, tuberculosis and now COVID-19, is widespread.
CHWs, responsible for bringing people back into care, must repair trust. In South Africa, where a national CHW programme is being rolled out, marginalised communities have high levels of unemployment, domestic violence and injury. In this complex social environment, we explored CHW workplace trust, interpersonal trust between the patient and CHW, and the institutional trust patients place in the health system
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Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We condu
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cted a randomised controlled trial of an enhanced asthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
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Outcomes of Universal Access to Antiretroviral Therapy (ART) in Georgia
T. Tsertsvadze; N. Chkhartishvili; L. Sharvadze; et al.
Hindawi Publishing Corporation AIDS Research and Treatment
(2011)
C2
Research Article
Hindawi Publishing Corporation
AIDS Research and Treatment
Volume 2011, Article ID 621078, 7 pages doi:10.1155/2011/621078
Barriers to Access: Medication-Assisted Treatment and Injection-Driven HIV Epidemics
Open Society Institute - Public Health Program; International Harm Reduction Development Program (IHRD)
(2019)
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Public Health Factsheet
Accessed: 29.09.2019
Integrating HIV, hepatitis B and syphilis screening and treatment through the Reproductive, Maternal, Newborn and Child Health platform to reach global elimination targets
J. Woodring; H.d Sobel; Y. Takashima; et al.
World Health Organization (Western Pacific Region)
(2017)
C_WHO
WPSAR Vol 8, No 4, 2017 | doi: 10.5365/wpsar.2017.8.3.005
DOI: http://dx.doi.org/10.5365/wpsar.v8i4.564
Despite the considerable improvement in global health, millions of people still lack access to quality health services, including access
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to effective antimicrobial medicines, or are impoverished as a result of health spending. At the same time, antimicrobial resistance – a consequence of overuse and misuse of antimicrobials – is increasingly a barrier to accessing effective care. The declining effectiveness of antibiotics is driven by multiple factors, many of which can be addressed through well functioning primary health care. However, primary health care has not always had much attention in national health sector responses to
antimicrobial resistance, which often focus on tertiary care, laboratory detection and surveillance. The three pillars of primary health care (community engagement, front-line health services including primary care and essential public health, and multisectoral action on wider health determinants) are central not just to Universal Health Coverage and the Sustainable Development Goals, but also to an effective response to antimicrobial resistance.
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HIV/AIDS prevention, care and treatment in the Region of the Americas: achievements, challenges and perspectives
F. Pérez; G. Ravasi; J. Peter Figueroa; et al.
PAHO (Pan American Health Organization; World Health Organization); Iris (Institutional Repository); Rev Panam Salud Publica; Pan American Journal of Public Health
(2016)
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Overview
Rev Panam Salud Publica 40(6), 2016
Policy Brief, Updated in March 2017
Downloaded free from http://www.j-hhr.org on Monday, March 06, 20
Journal of HIV and Human Reproduction: Year : 2015, volume : 3, Issue : 2, Page : 47-55
Task Shifting for Scale-up of HIV Care: Evaluation of Nurse-Centered Antiretroviral Treatment at Rural Health Centers in Rwanda
Shumbusho, F., van Griensven, J., Lowrance, D., Turate, I., Weaver, M.A., et al.
PLoS Medicine
(2009)
CC
The shortage of human resources for health, and in particular physicians, is one of the major barriers to achieve universal
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access to HIV care and treatment. In September 2005, a pilot program of nurse-centered antiretroviral treatment (ART) prescription was launched in three rural primary health centers in Rwanda. We retrospectively evaluated the feasibility and effectiveness of this task-shifting model using descriptive data.
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