Improving the Quality of Primary Health Care in Five African Countries

September 22nd, 2014

The African Health Initiative (AHI), established in 2008 by the Doris Duke Charitable Foundation, seeks to catalyze significant advances in strengthening health systems by supporting partnerships that will design, implement and evaluate large-scale models of care that link implementation research and workforce training directly to the delivery of integrated primary healthcare in sub-Saharan Africa.

globalsymposium_logosDuring the upcoming Third Global Symposium on Health Systems Research in Cape Town (30 September-3 October, the five AHI country projects (Ghana, Mozambique, Rwanda, Tanzania and Zambia) will be sharing their experiences in panel presentations. We will be tweeting at each panel presentation, and you can follow at: #HSG2014 and “Health  Systems Global” and “Bill Brieger Malaria“.

DSCN7134The first AHI panel is entitled “The Design, Implementation, and Preliminary Results of African Health Initiative (AHI) Strategies for Improving the Quality of Primary Health Care in Five Countries.” Please see an overview below.

Ever since the historic Alma Ata Conference called for national and international action to develop and implement primary health care throughout the world, research has been focused on the challenge of improving the accessibility and quality of health services in Africa. Although many promising interventions have emerged from such efforts, their full potential to improve the health of African families has been hindered by inter-connected systemic manpower, logistics, management, resource, and leadership problems. As a result, basic primary health care remains inaccessible and unaffordable to most families living in this region.

The African Health Initiative (AHI) aims to develop and test feasible means of solving these problems by implementing comprehensive packages of health strengthening interventions in Ghana, Mozambique, Rwanda, Tanzania and Zambia. The country teams participating in the AHI have created important healthcare-related innovations and have research capabilities that can be used to rigorously evaluate each project’s impact. All five projects have developed means of improving the quality of health services and assessing the impact of respective systems improvement strategies on childhood survival.

DSCN6259The purpose of this panel is to explain and contrast the design and implementation of project strategies for improving quality of care and to review preliminary results of project success. The targeted audience for this panel is health systems practitioners, clinical educators, researchers involved in the implementation or evaluation of community health workers programs.

AHI projects demonstrate practical means of utilizing research to develop and implement service quality improvement. Although evaluation designs differ, all focus on assessing the impact of improving service quality on childhood survival. As a set of initiatives, projects provide guidance on ways to achieve adaptive development of system strengthening in resource constrained settings.

The session will start with an overview of the AHI rationale and its focus on quality of care improvement. A presenter from each country team will review respective strategies for quality of care development. The Rwanda and Zambia projects will lead the discussion, as their projects enhance facility-based quality of care.

DSCN7150Rwanda, which introduced a district-wide initiative known as “All Babies Count”, combines a mentoring intervention with a learning collaborative for improving worker and system performance. In Zambia, the Better Health Care Outcomes through Mentorship and Assessment (BHOMA) project improves rural outpatient care quality by restructuring structured clinical information, the use of electronic technologies for transmitting patient data, and feedback to service personnel, managers and communities.

The “Ghana Essential Health Intervention Programme’s will discuss its strategy for evidence-driven quality improvement for prioritizing in-service training and emergency referral operations. The Tanzanian Connect project will illustrate the use of training, supervision, and community governance to develop and sustain quality assurance.

The Mozambique Strengthening Integrated Primary Health Care project will conclude by presenting their strategies for improving the delivery of health care by giving key health managers the skills and tools to identify and address service quality and efficiency problems.

UN General Assembly Resolves to Fight Malaria

September 11th, 2014

unlogo_blue_sml_enGhanaWeb reported this morning that, “The United Nations General Assembly at its 68th Session, adopted Resolution A/68/L.60, “Consolidating Gains and Accelerating Efforts to Control and Eliminate Malaria in Developing Countries, Particularly in Africa, by 2015” by consensus.”

Likewise the UN itself issued a press release confirming that in a final act the Assembly adopted this resolution in order to call for increased support for the implementation of international commitments and goals pertaining to the fight to eliminate malaria. GhanaWeb reiterated the UN’s message that, “with just less than 500 days until the 2015 deadline of the MDGs, the adoption of this resolution by the General Assembly reiterates the commitment of UN Member States to keep malaria high on the international development agenda.”

The UN Press Release explained that, “The resolution urged malaria-endemic countries to work towards financial sustainability to increase national resources allocated to controlling that disease, while also working with the private sector to improve access to quality medical services.  Further, the resolution called upon Member States to establish or strengthen national policies, operational plans and research, with a view to achieving internationally agreed malaria targets for 2015.”

DSCN0730This effort is consistent with moves two years ago in the 66th General Assembly when it called for “accelerated efforts to eliminate malaria in developing countries, particularly Africa, by 2015, in consensus resolution” (document A/66/L.58) where the “Consolidating Gains …” document was first shared. The draft of the 2012  resolution, according to the UN Press release was sponsored by Liberia on behalf of the African Group, and called on Member States, particularly malaria-endemic countries, to strengthen national policies and operational plans, with a view to scaling up efforts to achieve internationally agreed malaria targets for 2015.

The sad irony of Liberia’s current predicament wherein the Ebola epidemic is rendering it nearly impossible to provide malaria services should give us pause. According to Reuters, “Treatable diseases such as malaria and diarrhea are left untended because frightened Liberians are shunning medical centers, and these deaths could outstrip those from the Ebola virus by three or four fold.”

The new resolution (A/68/L.60) in calling for increases national resources allocated to controlling that disease from public and private sources demonstrates the importance of national commitment to sustain and advance malaria control into the era of malaria elimination. It is now up to local malaria advocates to ensure that their governments, as well as private sector and local NGO partners, follow through to guarantee the needed quantity and quality of malaria services.

Press Release: Bangladesh joins APMEN as new Country Partner

September 3rd, 2014

Bangladesh joins the Asia Pacific Malaria Elimination Network (APMEN) as Country Partner

apmen_bannerThe Asia Pacific Malaria Elimination Network (APMEN) is pleased to announce Bangladesh as the 16th Country Partner to join the Network.

APMEN brings together countries in the Asia Pacific region that have adopted a national or sub-national goal for malaria elimination, and connects them with a broad range of regional and global malaria partners to develop best practices for eliminating the disease. By strengthening linkages in eliminating countries, APMEN addresses important regional challenges such as Plasmodium vivax, and provides a forum for the discussion of important issues such as the spread of anti-malarial drug resistance.

Malaria remains endemic in 13 of the 64 districts in Bangladesh, and more than 13 million1 people are still at risk of the disease. Malaria control and elimination activities fall under the National Malaria Control Program (NMCP) of the Ministry of Health and Family Welfare. The NMCP is currently aiming for malaria pre-elimination in four districts, with the goal of Bangladesh becoming malaria-free by 2020.

Director of Disease Control in Bangladesh and Public Health and Infectious Disease Specialist, Professor Be-Nazir Ahmed, expressed his gratitude towards APMEN at the formalization of this important partnership, saying that it is another step forward for Bangladesh and the region to eliminate the disease.

The spatial distribution of Plasmodium falciparum malaria endemicity map in 2010 in Bangladesh - http://www.map.ox.ac.uk/browse-resources/endemicity/Pf_mean/BGD/

The spatial distribution of Plasmodium falciparum malaria endemicity map in 2010 in Bangladesh – http://www.map.ox.ac.uk/browse-resources/endemicity/Pf_mean/BGD/

“Bangladesh is moving very quickly towards elimination after concerted national efforts to focus on malaria control,” Professor Be-Nazir said.

“By joining APMEN, Bangladesh now has many windows of opportunities to learn from other eliminating countries in our region as we face similar challenges.”

According to the World Health Organization, Bangladesh has reduced the number of confirmed malaria cases from nearly 440,000 in 2000 to less than 30,000 in 2012; a 93% overall decline2. The success is a result of intensive control interventions such as high coverage and increased use of insecticide-treated nets, increased use of rapid diagnostic tests and effective antimalarial treatment, as well as the deployment of a high number of community health workers in collaboration with NGOs and augmenting services at the health facilities. The combination of technical and human resource capacity serves as a strong example of how national and international efforts can lead to reduced malaria transmission3.

Bangladesh, like many other APMEN Country Partners, face many challenges en route to its national elimination goal of 2020, namely  ensuring services  reach mobile populations in highly endemic districts such as the Jhum cultivators4, and sustaining commitment by the government, communities and development partners to malaria control and elimination.

Malaria was nearly eliminated from Bangladesh pre-1970, but never disappeared in the eastern border regions which are associated with tea gardens and forests. These districts have international boundaries with the eastern states of India and partly with Myanmar. In the 1990s, malaria re-emerged as a major public health concern.

A key Bangladesh public health organization, the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), joined APMEN as a Partner Institution in August 2013.

APMEN Joint Secretariat (UQ) Office, School of Population Health | Room 117 | Public Health Building, Herston Road | Herston Qld 4006| Australia,  Email: apmen@sph.uq.edu.au | Website: www.apmen.org |  Phone (within Australia): 07 3365 5446 | Phone (from outside Australia): 61 7 3365 5446

Hearing, Seeing, Changing: Bednet Behavior

September 2nd, 2014

An important new article in Malaria Journal by colleagues at the Johns Hopkins University Center for Communications Programs gives confidence to health educators and behavior change practitioners that their interventions do make a difference. Using the 2010 Malaria Indicator Survey (MIS) from Zambia, they were able to comparing women’s reports of exposure to behavior change communication (BCC) messages and their use of insecticide treated nets (ITNs) the previous night.

CAM03755 smExposure to ITN messages was focused on women who “reported hearing or seeing any malaria messages in the past six months and also cited at least one specific channel: television or radio, in the newspaper, on posters or billboards, or from peer educators and drama groups.” Using two different analytic approaches, the authors found that exposure to messages was responsible for between 12-29% of net use. They concluded that the results “illustrate that BCC programmes can contribute to national programmes seeking to increase the use of ITNs inside the home.”

The recent MIS in a variety of endemic countries have taken up the task of measuring not just use of ITNs but also knowledge of the role of ITNs in preventing malaria and exposure to BCC messaging about ITNs.  Similar analysis should be performed on these data sets.

NetMark billboard aThe 2010 Nigeria MIS, for example, reported that 27.9% of women reported exposure to malaria messages in 4 weeks prior to the study. Likewise 57.9% of women had knowledge that Sleeping under mosquito net prevents malaria in pregnancy (MIP).  The 2012 MIS from Malawi reported that 25.3 women claimed exposure to malaria messages in past 4 weeks, and of those, 87.3% had knowledge that Sleeping under mosquito net prevents MIP.

A 2011 survey in Ghana found that 57.3% of women claimed exposure to malaria messages in past 4 weeks, and of those 83.7% had knowledge that Sleeping under and ITN prevents MIP. A question remains though, what was the actual nature of those media efforts to which women claim exposure?

The surveys do note the broad sources of information, e.g. radio, health workers/clinic, community activities. A review of overall national malaria strategies  and specific malaria BCC documents will certainly indicate that national programs and their partners intend to engage in a variety of BCC activities. The issue is whether, where and how those activities took place.

To give more validity to BCC outcomes, we must also encourage national malaria programs and their partners to document better their BCC activities so we can more easily attribute ITN behavior change itself to specific, funded interventions.

Documenting SBCC’s Important Role in Malaria Case Management

August 27th, 2014

Community health worker Cheikh Tandian in southern Senegal during routine sweeps of villages with RDTs and ACTs. Photo by Ian Hennessee

Are there examples of effective social and behavior change communication (SBCC) for malaria case management that can be shared with other countries looking to improve their programming?

After examining research, policy documents and program evaluations from Ethiopia, Rwanda, Senegal and Zambia to determine whether effective SBCC activities have been used to improve malaria case management, I haven’t come across many strong examples. Program reports don’t tend to mention SBCC program evaluation. Reports that do mention it are difficult to find credible because the indicators used don’t address the real determinants of behavior.

Behavioral researchers have spent decades trying to illustrate just how insufficient it is to measure only knowledge. Attitudinal factors like perceived risk, self-efficacy and cultural norms are important behavioral determinants conspicuously missing from reports on malaria case management program design and evaluation.

Here’s an example of an attitudinal indicator related to malaria case management: Proportion of health care service providers that believe new diagnosis and treatment guidelines (test before you treat) are effective. I found a carefully designed study (a cluster-randomized controlled trial) assessing community health workers ability to diagnose and treat children. After a brief training, health workers evaluated over a thousand children with fever and accurately treated them based on disease classification 94%-100% of the time. Of note in this study: facility-based health workers (nurses or doctors) in two districts of the Southern Province of Zambia were less likely to follow guidelines or honor the results of rapid diagnostic tests than community health workers.

MalariaCare recently conducted a series of interviews revealing the same pattern. A 2014 systematic review on malaria in pregnancy found health care provider reliance on clinical diagnosis and poor adherence to treatment policy is a consistent problem. Perhaps doctors feel their considerable experience enables them to diagnose patients accurately without policy-mandated tests? Do community health workers adhere to a policy more tightly because they have a limited number of tasks and take pride in fastidiously carrying them out? The point is that the most educated individuals in an entire country – or those most likely to have accurate, timely information – can be outperformed by individuals with little or no formal education when exposed to the exact same set of government guidelines.

The difference is attitude.

Are programs targeting the attitudinal barriers behind adherence to malaria test results? Are evaluators measuring changes in these key attitudes? You can’t measure impact if you didn’t actually change behavior and people don’t change the way they act unless their decision-making process – in all of its beautiful human complexity – is acknowledged and addressed.

The Roll Back Malaria Partnership (RBM) has an SBCC community of practice made up of public health professionals working to promote a more rigorous, evidence-based approach to malaria SBCC program design and evaluation. One of the group’s products, the Malaria Behavior Change Communication Indicator Reference Guide, was developed to help Ministries of Health, donor agencies and implementing partners design and measure levels of behavior change related to malaria prevention and case management. The guide contains a list of indicators that go beyond knowledge and awareness into important behavioral determinants like attitudes. The guide has been available since February 2014 and this month the group is happy to announce its publication in Portuguese (it is also available in French and English).

The answer to the question posed by this desk review is that there is a lot of great work being done in malaria case management but it is being in done in a way that makes it difficult for others to follow. This new tool was developed to ensure SBCC programming is designed in such a way that its impact can be measured and replicated.

Malarious Occupations

August 26th, 2014

Often the focus of malaria case management and malaria prevention is on children under five years of age and pregnant women. Adults generally can be at higher risk for getting malaria because of their occupations, as was seen in two recent publications.

The Asian Scientist reporting on Bangladesh explained that “Slash-and-burn farmers … are exposed to a higher risk of malaria infection.”  The report notes that not only are woodcutters and jhum (slash-and-burn) cultivators at increased risk of being infected by malaria and but they are also endangering their families.

The researchers at the Centre for Vaccine Sciences and the Centre for Population, Urbanisation and Climate Change of the icddr,b, in collaboration with the Johns Hopkins Malaria Research Institute, Baltimore, reported that “jhum cultivators and people living with them had 1.6 times higher odds of being infected with malaria than non-jhum cultivators.”

The study also appeared in the American Journal of tropical Medicine and Hygiene where the authors observed that “Possible mechanisms cited in the study for the observed higher malaria incidence among jhum cultivators include increased exposure to mosquitoes, sleeping away from home unprotected by bed nets and lack of access to health services.”

DSCN3692a

Wild cat Gold mining in Burkina Faso also exposes miners to malaria.

Gold mining is another ‘vulnerable occupation, according to a study in Venezuela. Daniel Pardo of BBC News posted photographs that show how mining creates water-filled pits as breeding sites and also the substandard living quarters of the miners where mosquitoes have easy access to victims.

According to the BBC, “Venezuela used to be a world leader in managing malaria, but is now the only country in Latin America where incidence of the disease is increasing. Around 75,000 people were infected last year, and according to government figures, 60% of cases were in Sifontes, a tiny region of the country where gold mining – where workers drill for gold in mosquito-friendly standing water – is booming, and healthcare is scarce. “

These two experiences challenge our ideas of focusing control on only certain groups who are perceived as vulnerable. If we are to eliminate malaria, we need to identify all at risk populations, especially those in rural and hard to reach areas like miners and farmers.

This situation also tells us that much of the occupational risk of malaria is created by humans who overlook health costs in the economic calculations about their work. Clearly we cannot eliminate malaria without collaboration among the health and economic sectors in an effort to promote the overall welfare of populations.

Journal of Indigenous and Community Communication (JICC)

July 29th, 2014

Colleagues at the University of Ibadan have started on an important publishing endeavor as described below. Indigenous communication is an often neglected aspect of behavior change communication, and we hope this new Journal will bring more attention on how we can communicate about important health issues like malaria in ways that make sense to the community. Of course we also need to be willing to learn from the community first about their perceptions in order to have effective two-way communication:

Call for Papers for the Maiden Edition

JICCThe Editorial Board of the Journal of Indigenous and Community Communication (JICC) hereby invites original research articles, (empirical and discursive/expository), for the maiden edition of the journal that will be published in December 2014. JICC aims at offering space for scholars, researchers and development practitioners to contribute both qualitative and quantitative research findings in form of case studies, community-based situation analysis, reports of community-based interventions, evidence-based policy suggestions and intervention measures, and policy briefs. This volume will explore the theme of Community Communication and Poverty Reduction in Africa, with particular reference to the voices from community’s grassroots.

From recent researches,[1] the number of people living in absolute poverty in Africa is still high compared to most other low-income regions. Reasons given for the soaring numbers are diverse, ranging from leadership, irrelevant policies, failing institutions, human geography, among others. There are however many success stories from different African countries, stories that hardly get to find audience at the national and international levels, stories of people who through their daily struggle contribute to their betterment of their livelihoods.

This maiden edition is dedicated to how the community grassroots’ communication mechanisms contribute towards alleviating absolute poverty for those involved. Contributions to this edition should therefore centre on the efforts of knowledge and idea transfer at the very community’s basic level. Key questions around this focus include: In what ways do individuals get to exchange ideas about their own, and community’s development? Who takes initiative in the transfer of these ideas, and what informs this initiative? How (in)effective are these modes of communication? How can these grassroots, community-based communication initiatives become more widely accepted and engaged in dealing with poverty issues in African communities? What are the implications of these modes of indigenous/community-based communications with regards to reducing poverty in Africa?

Articles that explore these and other related questions, and especially field researches that are innovative and original are welcome.

Abstract submission

The first stage is to submit an abstract of a maximum of 300 words. In the abstract, indicate the gap that exists in literature and/or the key research question. It is important to link the key question to poverty and communication. Include the area (geographical) specificity of research in the case of empirical data and methodology, and how the findings will be useful in addressing/answering your research question. Include your name, institutional affiliation and email address. Once the editors have reviewed the abstracts, authors whose abstracts are accepted will be contacted to submit full papers. The deadline for abstract submission is August 10 2014. The abstracts should be submitted to: ayo.ojebode@mail.ui.edu.ng and mbusupa@yahoo.com

Article submission

Full articles should be written using the APA 6th style referencing. The words should be limited to 7,000 including footnotes and list of references (avoid providing bibliography). Briefings and policy briefs that provide review of specific country’s topical issues should be limited to a maximum of 3,000 words. Book reviews that are relevant to the theme of the edition should not exceed 1,000 words. Full articles for this volume are due November 15 2014.

JICC does not accept articles that are under consideration by other publishers. JICC does not compromise on matters of ethics and integrity. All academic articles will be peer-reviewed blind by three reviewers. An article is not recommended for revision unless it has at least two positive reviews. Two reviewers will review briefs and reports by organisations working in communities. JICC also strives to ensure that reviewers’ reports are turned in within six weeks. JICC conducts plagiarism checks on each article submitted to it. Any article that fails the test will be rejected and the author(s) will be barred from publishing in JICC in future.

JICC will be published availed online and in print.

Funding and Outlet

The Nigerian Community Radio Coalition supports JICC. However, we welcome support from other institutions and individuals in Africa and beyond.

JICC Editorial Board:

  1. Dr. Ayobami Ojebode – University of Ibadan, Nigeria
  2. Dr. Susan M. Kilonzo – Maseno University, Kenya
  3. Dr. Tunde Adegbola – African Languages Technology Initiative, ALT-I, Nigeria
  4. Prof. Holger Briel – Xi’an Jiaotong Liverpool University, Suzhou, China
  5. Prof. Kitche Magak – Maseno University, Kenya
  6. Prof. Christopher J. Odhiambo – Moi University, Kenya
  7. Dr. Birgitte Jallov – Empowerhouse, Denmark
  8. Ms. Jackline A. Owacgiu – Uganda/London School of Economics

[1]See for example Collier, P. Poverty reduction in Africa. Accessible at http://users.ox.ac.uk/~econpco/research/pdfs/PovertyReductionInAfrica.pdf. Collier’s book-The bottom billion: Why the poorest countries are failing and what can be done about it. New York, Oxford: Oxford University Press, explores this further.

Attending Antenatal Care Does Not Guarantee Antimalaria Services

July 28th, 2014

A new article by Clementine Rossier and colleagues compares access to maternal health services in Ouagadougou, Burkina Faso and Nairobi Kenya.  In both settings a very large proportion of pregnant women registered for antenatal care (ANC).  Twice the proportion of Nairobi women (47%) attended up to four times compared to those in Ouadougou (22%).  In both settings, the likelihood of attending four ANC visits increased with educational level of the women.

ANC Does Not Mean IPTp AccessAlthough the article does not discuss services received at ANC, we can consider the implications for malaria in pregnancy (MIP) control since ANC is a major platform for MIP service delivery. Here the demographic and health survey (DHS) and its malaria indicator survey (MIS) component are of help.  Both countries had a national survey in 2010 (their most recent).

Interestingly in 2010 Burkina Faso overall had better ANC registration (05%) than Kenya (86%). In neither country was intermittent preventive treatment in pregnancy (IPTp) coverage good. 25.7% of pregnant women in Kenya received one dose of sulfadoxine-pyrimethamine for IPTp, while 20.8% did so in Burkina Faso. IPTp2 coverage in Kenya was similar at 25.4%, but in Burkina Faso it dropped to 10.6%

DSCN7718The important lesson here is that even with good ANC registration, women have no guarantee of receiving life saving malaria prevention services.  If registration was lower we might suspect issues of local beliefs and other community barriers, but the situation in both countries points to health systems failures like inadequate drug supplies and health worker lapses.

The service delivery situation in both countries has changed dramatically since 2010. Kenya has refined its malaria map and is focusing IPTp on areas of stable and high transmission. Burkina Faso has received greater influx of financial support from the Global Fund and the US Agency for International Development. Hopefully the 2014 DHS/MIS studies currently in progress in both countries will paint a better picture. Of course, unless health systems issues are being addressed, funding alone will not solve the malaria service gaps.

Attaining and Sustaining – malaria targets

July 25th, 2014

Recent reports on the Global Burden of Disease with a focus on Millennium Development Goal #6 has stressed the improvement in malaria morbidity and mortality indicators since the Abuja Declaration of 2000. In particular, “Global malaria incidence peaked in 2003, with 232 million new cases, subsequently falling by about 29% to 165 million new cases in 2013.”

The improvements are attributed in part to the large increase in funding. The remaining challenge derives in part from the fact that four countries, India, Nigeria, Democratic Republic of the Congo and Mozambique account for nearly two-thirds of the global case load. Global progress in reducing disease has been achieved despite the fact that in these and many other countries, achievement of 2010 targets for malaria intervention coverage (80%) have lagged. In some cases national surveys have shown some declines in coverage (e.g. Nigeria).

DSCN7147Ghana provides a good example of the challenges. National surveys in 2006, 2008 and 2011 have shown mixed results in the use of insecticide treated nets by children below the age of 5 years.  While the proportion rose from 20% to 39% between the first two surveys, it stayed steady in 2011. A new survey in underway, but as of 2012 there were still areas of the country that needed nets, and we know that nets wear out in between distributions  and need to be replaced through routine services as seen in the photo.

Ghana 2006,8,11 Child sleep under netThe three surveys so far in Ghana paint a mixed picture as seen in the attached graph.  In six of the ten regions, net coverage for young children declined and in four it increased over the period.  This on balance led to the lack of overall improvement.

Thinking back to the reduced burden of disease overall, one can surmise that even some level of malaria intervention can impact on incidence of the disease, but the goal was no mortality for 2015, just one year from now.  If the trend seen in Ghana (which is reflective of other countries) continues, we will pass 2015 without attaining the 2010 coverage targets and still experience an unacceptable malaria disease burden.  Malaria elimination looks farther away each day.

Malaria at AIDS2014

July 20th, 2014

Malaria and HIV/AIDS interact on several fronts from the biological, clinical, pharmacological to the service delivery levels.  The ongoing 20th International AIDS Conference in Melbourne, Australia (July 20-25, 2014) provides an opportunity to discuss some of these issues. Abstracts that are available as of 20th July are mentioned below and deal largely with integrated health service delivery issues. Details can be found at http://www.aids2014.org/. Also keep up to date on twitter at https://twitter.com/AIDS_conference, and on Facebook at https://www.facebook.com/InternationalAIDSConference.

8577_760104147337737_5024191_n1. Increasing HIV testing and counseling (HTC) uptake through integration of services at community and facility level (TUPE358 – Poster Exhibition). E. Aloyo Nyamugisa, B. Otucu, J.P. Otuba, L. Were, J. Komagum, F. Ocom, C. Musumali (USAID/NU-HITES Project, Plan International – Uganda, Gulu, Uganda).

HTC integration at community outreaches and facility service points increases service uptake by individuals, families and couples that come to access the different services that are offered concurrently such as immunization, family planning, cervical cancer screening, circumcision, Tuberculosis, malaria, nutrition screening services and other medical care.

2. Asymptomatic Malaria and HIV/AIDS co-morbidity in sickle cell disease (SCD) among children at Mulago Hospital, Kampala, Uganda (TUPE074 – Poster Exhibition). B.K. Kasule, G. Tumwine, (Hope for the Disabled Uganda, Kampala, Uganda, Watoto Child Care Ministries, Medical Department, Kampala, Uganda, Makerere University, College of Veterinary Medicine, Animal Resources & Bio-security, Kampala, Uganda).

The prevalence of HIV/AIDS and asymptomatic malaria in children attending SCD clinic were quite high with the former exceeding the national prevalence supporting the view than Ugandan children with SCD die before five years. Children were significantly stunted and underdeveloped which could have made them prone to increased clinic visits. National health programmes should focus on the health needs of children with SCD by integrating HIV/AIDS care, nutritional therapy, and malaria control programmes.

3. Technical support (TS) needs of countries for preparation of funding requests under the Global Fund’s new funding model (NFM) (THPE427 – Poster Exhibition). A. Nitzsche-Bell, B. Hersh (UNAIDS, Geneva, Switzerland).

The results of this survey suggest that there is very high demand GF funding in 2014 and a concomitant high demand for TS to assist in the preparation of funding requests. TS priority needs span across different technical, programmatic and management areas. Increased availability of funding for TS and enhanced partner coordination through the Country Dialogue process are needed to ensure that countries have access to timely, demand-driven, and high-quality TS to maximize mobilization of GF resources under the NFM.

4. Optimizing the efficiency of integrated service delivery systems within the existing scaled-up community health strategy in Kenya: pathfinder/USAID/APHIAplus Nairobi-Coast program experience (THPE351 – Poster Exhibition). V. Achieng Ouma, D.M. Mwakangalu, P. Eerens, J. Mwitari, E. Mokaya, J. Aungo Bwo’nderi, S. Naketo Konah (Pathfinder International, Nairobi, Kenya, Pathfinder International, Service Delivery, Mombasa, Kenya, Ministry of Health, Division of Community Health Strategy, Nairobi, Kenya, Pathfinder International, Research and Metrics/Strategic Information Hub, Nairobi, Kenya, University of Portsmouth, Geography, Portsmouth, United Kingdom).

APHIAplus (a USAID sponsored health program in Kenya) supports the implementation of integrated government strategies that center around HIV, AIDS, and tuberculosis prevention, treatment, and care; integrated reproductive health and family planning services; and integrated malaria prevention and maternal and newborn health services. Lessons learned include the finding that integrated outreach holds potential to meet clients’ needs in an efficient, effective manner. For example, during a single contact with a service provider, a mother obtains immunization services and growth monitoring for her infant, counseling and testing for HIV, counseling on family planning, cervical cancer screening, and treatment of minor ailments. Results indicate better integration of HIV prevention, care, and treatment within complementary efforts that address key drivers of mortality and morbidity. Success in integration was fostered by a stronger focus on outcomes throughout the APHIAplus implementation cycle.

5. Long term outcomes of HIV-infected Malawian infants started on antiretroviral therapy while hospitalized (THPE070 – Poster Exhibition). A. Bhalakia, M. Bvumbwe, G.A. Preidis, P.N. Kazembe, N. Esteban-Cruciani, M.C. Hosseinipour, E.D. Mccollum (Albert Einstein College of Medicine and Children’s Hospital at Montefiore, Pediatrics, Bronx, United States, Baylor College of Medicine Abbott-Fund Children’s Clinical Centre of Excellence, Lilongwe, Malawi, Baylor College of Medicine, Pediatrics, Houston, United States, University of North Carolina Project, Lilongwe, Malawi, Johns Hopkins School of Medicine, Pediatrics, Division of Pulmonology, Baltimore, United States).

AIDS2014 bannerOne-year retention rates of HIV-infected infants diagnosed and started on ART in the hospital setting are comparable to outpatient ART initiations in other Sub-Saharan countries. Further studies are needed to determine if inpatient diagnosis and ART initiation can provide additional benefit to this population, a subset of patients with otherwise extremely high mortality rates.  Of the 16 children who died, median time from ART initiation to death was 2.7 months. Causes of death include pneumonia, diarrhea, fever, anemia, malnutrition, malaria and tuberculosis.

6. Killing three birds with one stone: integrated community based approach for increasing access to AIDS, TB and Malaria services in Oyo and Osun States of Nigeria (MOPE435 – Poster Exhibition). O. Oladapo, E. Olashore, K. Onawola, M. Ijidale. (PLAN Health Advocacy and Development Foundation, Programs, Ibadan, Nigeria, Civil Society for the Eradication of Tuberculosis in Nigeria, Programs, Ibadan, Nigeria, Community and Child Health Initiative (CCHI), Programs, Ibadan, Nigeria, Community Health Focus (CHeF), Programs, Ibadan, Nigeria).

Community Systems Strengthening (CSS) is a tested and successful strategy for providing integrated AIDS, TB and Malaria (ATM) services in resource-limited settings. 20 selected community based organizations (CBOs) working on at least one of AIDS, TB or Malaria were trained by PLAN Foundation on basics of ATM-related project management including monitoring and evaluation; demand generation through active referrals; and community outreaches. Empowering CBOs is an effective and low-cost strategy for increasing demand for ATM services in resource-limited settings. Integrating referral for ATM services increases effectiveness of and public confidence in primary healthcare services at the grassroots.

7. (Upcoming on 21st July) The health impact of a program to integrate household water treatment, hand washing promotion, insecticide-treated bed nets, and pediatric play activities into pediatric HIV care in Mombasa, Kenya (MOAE0104 – Oral Abstract Session). N. Sugar, K. Schilling, S. Sivapalasingam, A. Ahmed, D. Ngui, R. Quick. (Project Sunshine, New York, United States, U.S. Centers for Disease Control and Prevention, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging and Zoonotic Infections, CDC, Atlanta, United States, New York University, New York, United States, Bomu Hospital, Mombasa, Kenya).