Download or read book Oral Pre exposure Prophylaxis Delivery Among HIV negative Pregnant and Postpartum Women in Antenatal Clinics of Cape Town South Africa written by Nehaa Khadka and published by . This book was released on 2023 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: HIV acquisition risks remain high for pregnant and breastfeeding populations in South Africa. Oral pre-exposure prophylaxis (PrEP) with tenofovir disoproxil fumarate/emtricitabine (TDF-FTC) can be used daily during periods of sexual activity to prevent HIV infections for cisgender women. In 2021, oral PrEP became the standard of care for HIV prevention during pregnancy and breastfeeding periods. The objective of this dissertation was to evaluate trends in oral PrEP initiation, continuation, and adherence among adolescent girls and young women, women experiencing intimate partner violence, and by sexual behaviors throughout gestational periods and postpartum. We used data from the PrEP in Pregnancy and Postpartum (PrEP-PP) study, a prospective cohort in Cape Town of 1200 participants without HIV. The PrEP-PP study provided HIV prevention counselling and offered PrEP to pregnant and breastfeeding women.The first study evaluated the oral PrEP cascade framework among adolescent girls and young women (AGYW) in the PrEP-PP study. Approximately 83% of AGYW initiated PrEP at their first antenatal care (ANC) visit, 34% continued PrEP at 6 months, and 11% stopped and restarted. AGYW with a higher HIV risk had an increased adjusted likelihood of continuing PrEP through 6 months (adjusted odds ratio[aOR]:1.91 [95% CI, 1.15-3.16]). About 7% of AGYW had high adherence to PrEP at 6 months. The second study examined the relationship between recent and past-year intimate partner violence (IPV) experienced by pregnant and postpartum women and oral PrEP continuation and adherence. Women who experienced past-year IPV were less likely to discontinue PrEP(adjusted hazards ratio: 0.80 (95% CI: 0.61, 1.06) and had higher adherence(quantifiable tenofovir-diphosphate[TFV-DP] in dried blood spots; aOR=1.82 (95% CI: 1.02, 3.25) at 6-month follow-up visits. The third study evaluated prevention-effective adherence by gestational trimesters of pregnancy and postpartum. Prevention-effective adherence(initiation/quantifiable TFV-DP or reported use during follow-up among those engaging in condomless sex) was 65% overall, with the highest adherence in trimester 1(81%) and lowest at early postpartum(49%). There was a positive association between engaging in condomless sex and PrEP use(quantifiable TFV-DP or self-reported use; adjusted risk ratio:1.88; 95% CI: 1.67, 2.12). In conclusion, AGYW during pregnancy and postpartum had high oral uptake, but retention in PrEP by 6 months was low. Those with higher HIV risks are more likely to continue PrEP. Pregnant/postpartum women who experienced past-year IPV were more likely to stay in the study and had greater adherence. The findings suggest that pregnant and postpartum women align their PrEP use with their potential HIV risks. Implementing violence screening and oral PrEP counselling (with conversations about changing HIV risks) at ANC may improve HIV prevention for women during pregnancy and postpartum in South Africa and beyond.

Download or read book Delivery of Antiretroviral Pre exposure Prophylaxis for HIV Prevention in Pregnant and Postpartum Women written by Jillian Pintye and published by . This book was released on 2017 with total page 94 pages. Available in PDF, EPUB and Kindle. Book excerpt: Women in sub-Saharan Africa have substantial risk of acquiring HIV acquisition during and soon after pregnancy. Additionally, acute HIV infection among pregnant and breastfeeding women poses a double burden in that acute maternal HIV accounts for nearly one-third of all mother-to-child transmissions of HIV (MTCT). To reach global targets for elimination of MTCT and HIV prevention for mothers, it is critical to integrate effective primary HIV prevention strategies into maternal and child health (MCH) services. Tenofovir disoproxil fumarate (TDF)-based pre-exposure prophylaxis (PrEP) prevents HIV infection in adherent women. The World Health Organization (WHO) recommends PrEP for all individuals, including pregnant and breastfeeding women, at substantial HIV risk (defined as HIV residence in regions where HIV incidence is >3%). Programmatic delivery of PrEP for pregnant women is currently being considered in high-prevalence regions, though implementation approaches that efficiently optimize the benefit of PrEP during pregnancy have not been defined. Additionally, although WHO guidelines support PrEP use in pregnancy, national committees have differed in their conclusions. For example, PrEP use during pregnancy is supported by Kenyan antiretroviral guidelines but the lack of complete safety data led PrEP to be contraindicated for pregnant women in the current South African PrEP guidelines. As countries expand programmatic delivery of PrEP to pregnant women, it is important to understand motivations and beliefs for using PrEP during pregnancy to address concerns unique to this population. The studies within this dissertation address the implementation science gaps described above for the delivery of PrEP for HIV prevention to pregnant and postpartum in sub-Saharan Africa. To inform efficient PrEP delivery models, we present an empiric risk score for identifying pregnant and postpartum Kenyan women at highest risk for HIV acquisition who would mostly benefit from PrEP while reducing unnecessary exposure among low-risk women. Using data that could be easily collected in standard MCH clinic settings without additional laboratory diagnostics, our risk score identified 56% of pregnant women who acquired HIV among just 16% of women. Using register data from 62 antenatal MCH facilities throughout Kenya, we further estimated the absolute number and proportion of HIV-uninfected pregnant women in Kenya who could be offered PrEP under different public health approaches, including offering PrEP universally or based on either regional HIV prevalence and/or individual-level HIV risk factors. We found that offering PrEP only to pregnant women in the region with highest HIV prevalence (Nyanza) would reduce PrEP use among low-risk women by 74%, but exclude 63% of women with high risk for HIV based on individual-level characteristics nationally. To complement service delivery data, we also assessed experiences of using PrEP during pregnancy among HIV-uninfected Kenyan women in HIV-serodiscordant couples who became pregnant while using PrEP. The personal experiences of women with direct exposure to PrEP during pregnancy offers valuable insights for informing development of effective PrEP messaging strategies and programs. Finally, we evaluate whether adverse perinatal outcomes were more frequent in a cohort of Kenyan and Ugandan HIV-infected women who used TDF-containing antiretroviral therapy (ART) during pregnancy compared to HIV-infected women who used ART during pregnancy that did not contain TDF. Our findings support the growing evidence that prolonged prenatal TDF use is not associated with adverse perinatal outcomes and contribute to the few prospective studies evaluating the safety of TDF use during pregnancy from African cohorts. The studies within this dissertation aim to address these implementation science gaps and inform optimal and effective delivery of PrEP for HIV prevention to pregnant and postpartum in sub-Saharan Africa.

Download or read book Evaluation of Oral Pre exposure Prophylaxis prep Implementation in Public HIV Care Clinics in Kenya written by Elizabeth M. Irungu and published by . This book was released on 2021 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: Daily, oral pre-exposure prophylaxis (PrEP) with emtricitabine/tenofovir disoproxil fumarate (FTC/TDF) is a highly potent HIV prevention intervention with potential to reduce HIV incidence among populations at risk of HIV in Africa if delivered with sufficient coverage. There are extensive data from high-income countries describing diverse settings in which PrEP services are offered. However, data describing PrEP scale-up models in low- and middle-income countries are limited. Public HIV care and treatment programs in Africa have been very successful at scaling up antiretroviral therapy (ART) over the last 15 years and are an attractive choice for integration of PrEP delivery. The main objective of the work described in this dissertation was to evaluate the effectiveness of PrEP implementation and integration in public HIV care clinics. The specific aims include to 1) conduct a step wedge cluster randomized trial of PrEP integration in public health HIV care clinics (the Partners Scale-Up Project) and evaluate impact; 2) conduct a process evaluation of PrEP integration in public HIV care clinics in Kenya, focusing on adaptation; 3) develop and evaluate the effectiveness of an on-site modular training approach to amplify the number of health care providers trained to deliver PrEP in public HIV care clinics in Kenya; and 4) summarize early PrEP rollout in African settings, challenges encountered and opportunities to expand implementation. We found evidence that integration of PrEP in public HIV clinics was feasible. By improving the capacity of health providers in those care clinics to offer PrEP services through training and technical support, PrEP uptake increased more than 20-fold and was sustained. With existing personnel and infrastructure, the high-volume HIV care clinics efficiently reached partners of HIV infected persons and other populations at HIV risk. PrEP users had reasonable continuation rates and objective evidence of high adherence. Using qualitative methods, we found that clinics made pragmatic, effective adaptations to non-core components of PrEP delivery services and to their routine practice to address challenges in PrEP delivery. We established that clinics that instituted some of the adaptations had above average monthly PrEP initiation and continuation rates. To amplify PrEP delivery in public health facilities, we developed and evaluated an innovative on-site modular training approach. We found that this approach was acceptable and it enabled many health providers to receive PrEP training conveniently and at a relatively low cost. Finally, our summary of early PrEP roll out in Africa revealed that there was high interest in PrEP among all populations at risk of acquiring HIV, but individuals did not continue use as expected. We suggested strategies to make PrEP delivery efficient, including delivery within community pharmacies, use of peers, services availed in low tier facilities and exploration of one-stop services to make PrEP delivery less burdensome. The collective results presented in this dissertation illustrate that integration of PrEP services in public HIV care clinics in Kenya is a successful and sustainable model for PrEP implementation. We posit that this model can be scaled up in African countries planning to set up PrEP programs.

Download or read book Disease Control Priorities Third Edition Volume 6 written by King K. Holmes and published by World Bank Publications. This book was released on 2017-11-06 with total page 1027 pages. Available in PDF, EPUB and Kindle. Book excerpt: Infectious diseases are the leading cause of death globally, particularly among children and young adults. The spread of new pathogens and the threat of antimicrobial resistance pose particular challenges in combating these diseases. Major Infectious Diseases identifies feasible, cost-effective packages of interventions and strategies across delivery platforms to prevent and treat HIV/AIDS, other sexually transmitted infections, tuberculosis, malaria, adult febrile illness, viral hepatitis, and neglected tropical diseases. The volume emphasizes the need to effectively address emerging antimicrobial resistance, strengthen health systems, and increase access to care. The attainable goals are to reduce incidence, develop innovative approaches, and optimize existing tools in resource-constrained settings.

Download or read book Scaling Up and Out written by Stephanie Roche and published by . This book was released on 2021 with total page 105 pages. Available in PDF, EPUB and Kindle. Book excerpt: In Kenya, daily oral pre-exposure prophylaxis (PrEP) for HIV prevention is a key component of the country’s national HIV/AIDS response. Since its approval by the Kenya national drug regulatory authority in 2015, PrEP has been rolled out predominantly in HIV clinics; however, the country’s 5-year plan for implementing PrEP at scale calls for integration of PrEP into other service delivery models and more efficient use of available resources. Currently, there is limited implementation science research to inform PrEP scale-up (i.e., expansion to additional HIV clinics) and scale-out (i.e., expansion to new service delivery models and populations) in Kenya. Our objective was to identify barriers and facilitators of PrEP integration and/or optimization in three healthcare settings: HIV clinics, family planning (FP) clinics, and retail pharmacies. In Aim 1, we analyzed data from a prospective cohort study delivering integrated PrEP-FP services to adolescent girls and young women (AGYW) at two FP clinics in Kisumu, Kenya. Using the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementing Change (ERIC) compilation, we identified supply-side implementation strategies for integrating PrEP into routine FP services and contextual factors influencing strategy choice and outcome, as captured in routine monitoring and evaluation documents (n=213) and key informant interviews (n=15). We found that, overall, implementing PrEP was more labor intensive at a public FP clinic compared to a private, youth-friendly clinic because it required a series of implementation strategies to make the physical and social environment conductive to offering AGYW-centered care. Nevertheless, provider adoption of PrEP delivery was low at both clinics, likely due to the widespread perception that PrEP was not within their scope of work. We recommend that PrEP implementers approach PrEP implementation, in part, as a behavioral intervention for FP providers and specifically assess the need for implementation strategies that support providers’ clinical decision-making, address workload constraints, and establish clear worker expectations. In Aim 2, we conducted a pilot study of a one-stop shop (OSS) model for PrEP delivery at four public clinics in Western Province, Kenya and evaluated whether this model could improve care efficiency and acceptability without negatively impacting PrEP uptake or continuation. Interviews with clients (n=15) and providers (n=14), technical assistance reports (n=69), and clinic flow maps indicate that the OSS achieved efficiency gains by redirecting PrEP clients away from bottlenecks, moving steps closer together (e.g., relocating supplies; cross-training and task-shifting), and differentiating clients based on the subset of services needed. Analysis of time-and-motion observations (n=47) revealed that, following OSS implementation, median client wait time dropped significantly from 31 minutes to 6 minutes (p=0.02) while median time spent with a provider remained around 23 minutes (p=0.4). Clients and providers expressed a strong preference for the OSS model and additionally identified increased privacy, reduced stigma, and higher quality client-provider interactions as benefits of the OSS model. Controlled interrupted time series analysis of PrEP initiations (n=1227) and follow-up visits (n=2696) revealed no significant difference between intervention and control clinics in terms of trends in PrEP initiation and on-time returns (all p>0.05). We conclude that the OSS model is a promising option for reducing variability in service time and increasing client and provider satisfaction without adding additional human resources. In Aim 3, we conducted a formative research study to understand the acceptability and feasibility of retail pharmacy-based PrEP delivery. Using the CFIR, we conducted and analyzed in-depth interviews with 40 pharmacy clients, 16 pharmacy providers, 16 PrEP clients, and 10 PrEP providers from Kisumu and Kiambu Counties, Kenya. Most participants expressed strong support for expanding PrEP to retail pharmacies, though conditioned their acceptance on assurances that care would be private, respectful, safe, and affordable. Participant-reported determinants of feasibility centered primarily on ensuring that the intervention is compatible with retail pharmacy operations (e.g., adequate staffing; use of documentation systems that meet PrEP reporting requirements). Our findings may inform the development of a tailored package of implementation strategies for integrating PrEP into routine pharmacy practice.

Download or read book Improving Pre exposure Prophylaxis Delivery for Young Women in Kenya written by Valentine Adhiambo Wanga and published by . This book was released on 2020 with total page 82 pages. Available in PDF, EPUB and Kindle. Book excerpt: The rollout of pre-exposure prophylaxis (PrEP) for HIV prevention to priority populations, including young women, is expanding in sub-Saharan Africa. However, existing barriers to PrEP rollout at the individual, community and policy levels could slow progress and impede the success of PrEP implementation programs. In order to achieve success in HIV prevention, it is crucial to address these barriers, particularly among young women, a population especially vulnerable to HIV. In this dissertation, we evaluated the links among risk perception, sexual behavior and PrEP adherence in serodiscordant couples, evaluated the impact of incorporating HIVST in PrEP delivery for young women and assessed the cost of delivering PrEP to young women. In Aim 1, we used data from HIV-negative adults enrolled in a study of PrEP and antiretroviral therapy for HIV-serodiscordant couples in Kenya and Uganda to examine associations between: 1) condom use and risk perception and 2) risk perception and PrEP adherence. In Aim 2, we offered HIV self-testing (HIVST) to young women enrolled in a PrEP implementation study in two family planning clinics and assessed satisfaction with HIV testing and clinic experience, and the impact of HIVST on PrEP delivery procedures. In Aim 3, using the same population as that in Aim 2, we used micro-costing methods to estimate the incremental cost of delivering PrEP to young women. We found that sexual behavior aligned with perceived HIV risk, which can facilitate an HIV-negative individual's decisions about PrEP use. Additionally, we found HIVST to be feasible and acceptable for young women using PrEP, highlighting the need to evaluate its utility to streamline PrEP delivery and provide more testing options for young women on PrEP. Lastly, using practical data from PrEP implementation, we estimated the cost of delivering PrEP to young women, providing valuable data to inform budget impact and cost-effectiveness analyses as well as local resource allocation for scale-up of PrEP delivery to young women. Collectively, these studies addressed some of the barriers to PrEP delivery, proposed solutions to these barriers and drew attention to priority research needs for PrEP delivery to young women.

Download or read book Modeling to Inform the Delivery of HIV Pre exposure Prophylaxis in Sub Saharan Africa written by David Allen Roberts and published by . This book was released on 2022 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Daily oral tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) as HIV pre-exposure prophylaxis (PrEP) is a safe and effective method for HIV prevention and offers potential to substantially reduce HIV incidence in sub-Saharan Africa. Mathematical models are commonly used to project the cost-effectiveness of investments in PrEP in comparison to alternative resource allocation strategies. Predictive modeling can also identify individuals at elevated risk who may benefit most from PrEP. The studies contained in this dissertation address fundamental issues in estimating the cost and potential impact of PrEP implementation in sub-Saharan Africa. First, we estimated the cost of routine PrEP delivery through maternal and child health (MCH) and family planning (FP) clinics in western Kenya (Chapter 1). PrEP delivery through MCH and FP leverages existing service delivery platforms that reach a large fraction of women at elevated HIV risk. Using data from over 20,000 PrEP encounters through 16 clinics, we estimated that the cost per client-month of PrEP dispensed to be $26.52 (2017 USD), with personnel (43%), drugs (25%), and laboratory testing (14%) accounting for the majority of costs. Postponing creatinine testing from PrEP initiation to the first follow-up visit could save 8% of total program costs. Under Ministry of Health implementation, we projected costs would decrease by 38%, but estimates were sensitive to changes in PrEP uptake and retention. Second, we used an individual-based transmission model calibrated to Eswatini to evaluate the sensitivity of model projections of PrEP impact and efficiency to specification HIV exposure heterogeneity (Chapter 2). A common method for introducing HIV exposure heterogeneity into a model is to stratify the population into “risk group” categories with different average sexual behavior parameters, allowing PrEP coverage to vary by risk group without having to explicitly represent individual partnerships. We found that this specification leads to a sharp tradeoff between total impact and efficiency depending on PrEP coverage levels in each risk group. In comparison, PrEP use among the general population is projected to be two times more efficient if PrEP use is prioritized during partnerships and over six times more efficient if use is further prioritized among individuals with HIV-positive partners. In addition, large incidence reductions can be achieved at low levels of PrEP coverage if PrEP use in the general population is concentrated when HIV exposure is more likely, but high levels of PrEP coverage are needed if time-varying individual risk is ignored. Third, we developed and validated HIV risk prediction models incorporating individual-level and geospatial covariates using data from nearly 20,000 individuals in a population-based cohort in rural KwaZulu-Natal, South Africa (Chapter 3). Individual-level predictors included demographic, socioeconomic, and sexual behavior measures, while geospatial covariates included local estimates of community HIV prevalence and viral load. We compared full models to simpler models restricted to only individual-level covariates or only age and geospatial covariates. Models using only age group and geospatial covariates had similar performance (women: area under the receiver operating characteristic curve (AUROC) = 0.65, men: AUROC = 0.71) to the full models (women: AUROC = 0.68, men: AUROC = 0.72). In addition, geospatial models more accurately identified high incidence regions than individual-level models; the 20% of the study area with the highest predicted risk accounted for 60% of the high incidence areas when using geospatial models but only 13% using models with only individual-level covariates. These findings have implications for PrEP policies. Our primary costing study identified service delivery bottlenecks and cost drivers that can inform efforts to streamline PrEP delivery. By ignoring the alignment of PrEP use with time-varying individual HIV exposure, models using a risk group specification may overestimate the cost and underestimate the impact of widespread PrEP availability. Finally, local estimates of HIV prevalence can help identify individuals and areas to prioritize for PrEP services to maximize impact.

Download or read book Nutrition and HIV written by Saurabh Mehta and published by CRC Press. This book was released on 2018-05-15 with total page 326 pages. Available in PDF, EPUB and Kindle. Book excerpt: The world continues to lose more than a million lives each year to the HIV epidemic, and nearly two million individuals were infected with HIV in 2017 alone. The new Sustainable Development Goals, adopted by countries of the United Nations in September 2015, include a commitment to end the AIDS epidemic by 2030. Considerable emphasis on prevention of new infections and treatment of those living with HIV will be needed to make this goal achievable. With nearly 37 million people now living with HIV, it is a communicable disease that behaves like a noncommunicable disease. Nutritional management is integral to comprehensive HIV care and treatment. Improved nutritional status and weight gain can increase recovery and strength of individuals living with HIV/AIDS, improve dietary diversity and caloric intake, and improve quality of life. This book highlights evidence-based research linking nutrition and HIV and identifies research gaps to inform the development of guidelines and policies for the United Nations’ Sustainable Development Goals. A comprehensive approach that includes nutritional interventions is likely to maximize the benefit of antiretroviral therapy in preventing HIV disease progression and other adverse outcomes in HIV-infected men and women. Modification of nutritional status has been shown to enhance the quality of life of those suffering HIV/AIDS, both physically in terms of improved body mass index and immunological markers, and psychologically, by improving symptoms of depression. While the primary focus for those infected should remain on antiretroviral treatment and increasing its availability and coverage, improvement of nutritional status plays a complementary role in the management of HIV infection.

Download or read book Infections in Pregnancy written by Adel Elkady and published by Cambridge University Press. This book was released on 2019-10-24 with total page 215 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides effective diagnosis and management of infectious diseases in pregnant women in a single comprehensive available resource for busy clinicians.

Download or read book WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience written by World Health Organization and published by . This book was released on 2016 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Within the continuum of reproductive health care, antenatal care provides a platform for important health-care functions, including health promotion, screening and diagnosis, and disease prevention. It has been established that, by implementing timely and appropriate evidence-based practices, antenatal care can save lives. Endorsed by the United Nations Secretary-General, this is a comprehensive WHO guideline on routine antenatal care for pregnant women and adolescent girls. It aims to complement existing WHO guidelines on the management of specific pregnancy-related complications. The guidance captures the complex nature of the antenatal care issues surrounding healthcare practices and delivery, and prioritizes person-centered health and well-being --- not only the prevention of death and morbidity --- in accordance with a human rights-based approach.

Download or read book Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection written by World Health Organization and published by . This book was released on 2016 with total page 429 pages. Available in PDF, EPUB and Kindle. Book excerpt: These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care. This edition updates the 2013 consolidated guidelines on the use of antiretroviral drugs following an extensive review of evidence and consultations in mid-2015, shared at the end of 2015, and now published in full in 2016. It is being published in a changing global context for HIV and for health more broadly.

Download or read book Safe Abortion written by World Health Organization and published by World Health Organization. This book was released on 2003-05-13 with total page 107 pages. Available in PDF, EPUB and Kindle. Book excerpt: At a UN General Assembly Special Session in 1999, governments recognised unsafe abortion as a major public health concern, and pledged their commitment to reduce the need for abortion through expanded and improved family planning services, as well as ensure abortion services should be safe and accessible. This technical and policy guidance provides a comprehensive overview of the many actions that can be taken in health systems to ensure that women have access to good quality abortion services as allowed by law.

Download or read book HIV AIDS written by Nancy Dumais and published by BoD – Books on Demand. This book was released on 2017-02-22 with total page 176 pages. Available in PDF, EPUB and Kindle. Book excerpt: With increasing efficacy of antiretroviral therapy, HIV/AIDS has shifted from a disease with high mortality to a chronic illness with substantial longevity. However, researchers, physicians and social workers still face many challenges, and it is important to raise awareness on several aspects that people living with HIV/AIDS have to deal in their daily lives. This book has assembled an array of chapters on the medical, social and economic aspects of HIV/AIDS. The chapters were written by experts from around the globe reflecting the importance of the topic. This book will be of great interest not only to graduate students but also to active academics and practitioners.

Download or read book The State of the World s Children 2009 written by UNICEF. and published by UNICEF. This book was released on 2008 with total page 168 pages. Available in PDF, EPUB and Kindle. Book excerpt: Having a child remains one of the biggest health risks for women worldwide. Fifteen hundred women die every day while giving birth. That's a half a million mothers every year. UNICEF's flagship publication, The State of the World's Children 2009, addresses maternal mortality, one of the most intractable problems for development work.The difference in pregnancy risk between women in developing countries and their peers in the industrialised world is often termed the greatest health divide in the world. A woman in Niger has a one in seven chance of dying during the course of her lifetime from complications during pregnancy or delivery. That's in stark contrast to the risk for mothers in America, where it's one in 4,800 or in Ireland, where it's just one in 48,000. Addressing that gap is a multidisciplinary challenge, requiring an emphasis on education, human resources, community involvement and social equality. At a minimum, women must be guaranteed antenatal care, skilled birth attendants and emergency obstetrics, and postpartum care. These essential interventions will only be guaranteed within the context of improved education and the abolition of discrimination.

Download or read book Consolidated Guideline on Sexual and Reproductive Health and Rights of Women Living with HIV written by World Health Organization and published by World Health Organization. This book was released on 2017-02-20 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt: he starting point for this guideline is the point at which a woman has learnt that she is living with HIV and it therefore covers key issues for providing comprehensive sexual and reproductive health and rights-related services and support for women living with HIV. As women living with HIV face unique challenges and human rights violations related to their sexuality and reproduction within their families and communities as well as from the health-care institutions where they seek care particular emphasis is placed on the creation of an enabling environment to support more effective health interventions and better health outcomes. This guideline is meant to help countries to more effectively and efficiently plan develop and monitor programmes and services that promote gender equality and human rights and hence are more acceptable and appropriate for women living with HIV taking into account the national and local epidemiological context. It discusses implementation issues that health interventions and service delivery must address to achieve gender equality and support human rights.

Download or read book Guidelines on the Management of Latent Tuberculosis Infection written by WHO and published by World Health Organization. This book was released on 2015-01-15 with total page 38 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Latent tuberculosis infection (LTBI), defined as a state of persistent immune response to prior-acquired Mycobacterium tuberculosis antigens without evidence of clinically manifested active TB, affects about one-third of the world's population. Approximately 10% of people with LTBI will develop active TB disease in their lifetime, with the majority developing it within the first five years after initial infection. Currently available treatments have an efficacy ranging from 60% to 90%. Systematic testing and treatment of LTBI in at-risk populations is a critical component of WHO's eight-point framework adapted from the End TB Strategy to target pre-elimination and, ultimately, elimination in low incidence countries. OVERVIEW: Recognizing the importance of expanding the response to LTBI, in 2014 WHO developed Guidelines on the Management of Latent Tuberculosis Infection. The guidelines are primarily targeted at high-income or upper middle-income countries with an estimated TB incidence rate of less than 100 per 100 000 population, because they are most likely to benefit from it due to their current TB epidemiology and resource availability. The overall objective of the guidelines is to provide public health approach guidance on evidence-based practices for testing, treating and managing LTBI in individuals with the highest risk of progression to active disease. Specific objectives include identifying and prioritizing at-risk population groups for targeted intervention of LTBI testing and treatment, including defining an algorithm, and recommending specific treatment options. The guidelines are expected to provide the basis and rationale for the development of national guidelines for LTBI management based on available resources, epidemiology of TB including intensity of transmission, the health-care delivery system of the country, and other national and local determinants.

Download or read book Equity Social Determinants and Public Health Programmes written by World Health Organization and published by World Health Organization. This book was released on 2010 with total page 302 pages. Available in PDF, EPUB and Kindle. Book excerpt: 1. Introduction and methods of work.-- 2. Alcohol: equity and social determinants.-- 3. Cardiovascular disease: equity and social determinants.-- 4. Health and nutrition of children: equity and social determinants.-- 5. Diabetes: equity and social determinants.-- 6. Food safety: equity and social determinants.-- 7. Mental disorders: equity and social determinants.-- 8. Neglected tropical diseases: equity and social determinants.-- 9. Oral health: equity and social determinants.-- 10. Unintended pregnancy and pregnancy outcome: equity and social determinants.-- 11. Tobacco use: equity and social determinants.-- 12. Tuberculosis: the role of risk factors and social determinants.-- 13. Violence and unintentional injury: equity and social determinants.-- 14. Synergy for equity.