Showing papers by "Osondu Ogbuoji published in 2016"

A systematic review of interventions to improve postpartum retention of women in PMTCT and ART care

Abstract: Introduction : The World Health Organization recommends lifelong antiretroviral therapy (ART) for all pregnant and breastfeeding women living with HIV. Effective transitioning from maternal and child health to ART services, and long-term retention in ART care postpartum is crucial to the successful implementation of lifelong ART for pregnant women. This systematic review aims to determine which interventions improve (1) retention within prevention of mother-to-child HIV transmission (PMTCT) programmes after birth, (2) transitioning from PMTCT to general ART programmes in the postpartum period, and (3) retention of postpartum women in general ART programmes. Methods : We searched Medline, Embase, ISI Web of Knowledge, the regional World Health Organization databases and conference abstracts for data published between 2002 and 2015. The quality of all included studies was assessed using the GRADE criteria. Results and Discussion : After screening 8324 records, we identified ten studies for inclusion in this review, all of which were from sub-Saharan Africa except for one from the United Kingdom. Two randomized trials found that phone calls and/or text messages improved early (six to ten weeks) postpartum retention in PMTCT. One cluster-randomized trial and three cohort studies found an inconsistent impact of different levels of integration between antenatal care/PMTCT and ART care on postpartum retention. The inconsistent results of the four identified studies on care integration are likely due to low study quality, and heterogeneity in intervention design and outcome measures. Several randomized trials on postpartum retention in HIV care are currently under way. Conclusions : Overall, the evidence base for interventions to improve postpartum retention in HIV care is weak. Nevertheless, there is some evidence that phone-based interventions can improve retention in PMTCT in the first one to three months postpartum. Keywords: PMTCT; retention; Option B+; postpartum; HIV; antiretroviral therapy; loss to follow-up. (Published: 25 April 2016) Citation: Geldsetzer P et al. Journal of the International AIDS Socity 2016, 19 :20679 http://www.jiasociety.org/index.php/jias/article/view/20679 | http://dx.doi.org/10.7448/IAS.19.1.20679

Changing HIV treatment eligibility under health system constraints in sub-Saharan Africa: investment needs, population health gains, and cost-effectiveness.

Abstract: markdown__Objective:__ We estimated the investment needs, population health gains, and costeffectiveness of different policy options for scaling-up prevention and treatment of HIV in the 10 countries that currently comprise 80% of all people living with HIV in sub- Saharan Africa (Ethiopia, Kenya, Malawi, Mozambique, Nigeria, South Africa, Tanzania, Uganda, Zambia, and Zimbabwe). __Design:__ We adapted the established STDSIM model to capture the health system dynamics: Demand-side and supply-side constraints in the delivery of antiretroviral treatment (ART). __Methods:__ We compared different scenarios of supply-side (i.e. health system capacity) and demand-side (i.e. health seeking behavior) constraints, and determined the impact of changing guidelines to ART eligibility at any CD4+ cell count within these constraints. __Results:__ Continuing current scale-up would require US$178 billion by 2050. Changing guidelines to ART at any CD4+ cell count is cost-effective under all constraints tested in the model, especially in demand-side constrained health systems because earlier initiation prevents loss-to-follow-up of patients not yet eligible. Changing guidelines under current demand-side constraints would avert 1.8 million infections at US$208 per life-year saved. __Conclusion:__ Treatment eligibility at any CD4+ cell count would be cost-effective, even under health system constraints. Excessive loss-to-follow-up and mortality in patients not eligible for treatment can be avoided by changing guidelines in demand-side constrained systems. The financial obligation for sustaining the AIDS response in sub- Saharan Africa over the next 35 years is substantial and requires strong, long-term commitment of policy-makers and donors to continue to allocate substantial parts of their budgets.

Long-term financing needs for HIV control in sub-Saharan Africa in 2015-2050: a modelling study.

Abstract: Objectives To estimate the present value of current and future funding needed for HIV treatment and prevention in 9 sub-Saharan African (SSA) countries that account for 70% of HIV burden in Africa under different scenarios of intervention scale-up. To analyse the gaps between current expenditures and funding obligation, and discuss the policy implications of future financing needs. Design We used the Goals module from Spectrum, and applied the most up-to-date cost and coverage data to provide a range of estimates for future financing obligations. The four different scale-up scenarios vary by treatment initiation threshold and service coverage level. We compared the model projections to current domestic and international financial sources available in selected SSA countries. Results In the 9 SSA countries, the estimated resources required for HIV prevention and treatment in 2015–2050 range from US$98 billion to maintain current coverage levels for treatment and prevention with eligibility for treatment initiation at CD4 count of <500/mm3 to US$261 billion if treatment were to be extended to all HIV-positive individuals and prevention scaled up. With the addition of new funding obligations for HIV—which arise implicitly through commitment to achieve higher than current treatment coverage levels—overall financial obligations (sum of debt levels and the present value of the stock of future HIV funding obligations) would rise substantially. Conclusions Investing upfront in scale-up of HIV services to achieve high coverage levels will reduce HIV incidence, prevention and future treatment expenditures by realising long-term preventive effects of ART to reduce HIV transmission. Future obligations are too substantial for most SSA countries to be met from domestic sources alone. New sources of funding, in addition to domestic sources, include innovative financing. Debt sustainability for sustained HIV response is an urgent imperative for affected countries and donors.

Trends in the completeness of birth registration in Nigeria: 2002-2010

Abstract: 1. IntroductionBirth registration is a fundamental right that affords children the opportunity to be documented and establish their nationality. Unfortunately, this right is denied to many children, especially in less developed countries (Pais 2009; UNICEF 1989). Indeed, an estimated 230 million children worldwide have never had their births registered, thereby exposing them to various rights abuses (Bambas 2005; Bequele 2005; Cappa et al. 2014; Corbacho, Brito, and Rivas 2012; Dow 1998; UNICEF 2013). Like other global health challenges, Africa lags behind in the registration of births and is only better than Asia (Bequele 2005; Mikkelsen et al. 2015; UNICEF 2013, 2014a). Less than 10% of Africa's population live in countries with complete (above 90% coverage) birth registration (Mahapatra et al. 2007). There is evidence that the rate of birth registration stagnated between 1995 and 2004 (Mahapatra et al. 2007; Setel et al. 2007).The birth of a child is one of the important events routinely recorded in a Civil Registration System (CRS) (United Nations 2001; World Health Organization 2008). According to the United Nations, civil registration is defined as the "universal, continuous, permanent and compulsory recording of vital events provided through decree or regulation in accordance with the legal requirements in a country" (World Health Organization and World Bank 2014). However, compliance with birth registration is still below 50% in sub-Saharan Africa and South Asia, 25 years after the Convention on the Rights of the Child (CRC) (Cappa et al. 2014; UNICEF 2014a). The CRC is an international treaty comprising 54 articles developed in 1989 to recognize the rights of children. It is regarded as "the most widely and rapidly ratified human rights treaty in history" (UNICEF 2014a). The right of children to have their births registered is the seventh article of the CRC.The importance of CRS data in monitoring health outcomes cannot be understated and requires national and international action to ensure its availability and reliability in monitoring performance of interventions. The post-2015 global health agenda (the Sustainable Development Goals [SDGs]) has made strengthening birth registration one of its major targets (AbouZahr et al. 2015; United Nations 2015; World Health Organization and World Bank 2014). In particular, SDG goal 16.9 states as its aim that it will "by 2030, provide legal identity for all, including birth registration" (United Nations 2015). This gives added impetus to measure the performance of the CRS and focus attention on where it is found suboptimal to ensure progress toward meeting the universal birth registration target by the deadline. To this end, the World Health Organization, World Bank, and other partners have developed a ten-year plan, "The Global Civil Registration and Vital Statistics Scaling up Plan (2015-2024)," in the hope of providing the needed guidance to support governments toward the achievement of this goal (World Health Organization and World Bank 2014). Other charities and recognized individuals have also made financial commitments to supporting the improvement of the CRS in developing countries (Lopez and Setel 2015; United Nations Economic and Social Commission for Asia and the Pacific 2014).Birth statistics are a significant data source in the measurement of health in populations, providing the denominator data for calculating development indicators such as infant mortality and child mortality rates. These are also indicators that are used to measure the quality of health care in a country and the level of access to health care in the population (Alarcon and Robles 2007). Poor data on these parameters can be misleading and drive suboptimal investments in the health system. Additionally, birth statistics are important for monitoring policies and programs on fertility in a country. They can be a significant yardstick for assessing the impact of interventions aimed at controlling population growth and determining the need for an increased intensity of intervention. …