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Impact of public-private partnerships addressing access to pharmaceuticals in low and middle income countries : A synthesis report from studies in Botswana, Sri Lanka, Uganda and Zambia

CAINES, Karen
LUSH, Louisiana
September 2004

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This report provides an overview, with general conclusions and recommendations, from a series of studies in Uganda (the pilot country) plus Botswana, Sri Lanka and Zambia, designed to assess the health and health systems impact of public-private partnerships for improving access to pharmaceuticals in relation to tropical diseases and/or HIV and AIDS, where pharmaceutical companies are involved as partners in supplying free or discounted drugs

Antiretroviral roll-out in South Africa : where do children feature?

SHUNG-KING, Maylene
ZAMPOLI, Marco
August 2004

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This is a discussion paper on South Africa's 2003 roll out plan for the 'Comprehensive Care and Treatment for HIV and AIDS' and its implementation. It considers how the plan addresses children's needs and assesses its weaknesses, particularly in relation to the topic of ART for HIV-infected children. The paper laments that children's specific needs are not adequately dealt with, stressing that a comprehensive, child-oriented approach must give consideration to the mother-infant relationship and acknowledge that the health of the mother is a necessary component of the well-being of children. The plan also fails to consider the issues of children in residential care facilities, counselling needs of children, the specific difficulties associated with testing and diagnosing babies and children, and aspects of drug availability and treatment adherence in children. The paper concludes with recommendations designed to help policy making, service delivery and advocacy strategies. In particular the document calls for child-specific attention in areas of monitoring, adherence and drug provision, recommends that greater emphasis is placed on children's needs in the upscaling of ART provision, particularly through primary health care services, and that watchdog bodies and children's rights organisations take a more active role

Processes and issues for improving access to medicines : willingness and ability to utilise TRIPS flexibilities in non-producing countries

BAKER, Brook K.
August 2004

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This paper addresses the varied ways by which a non-medicine producing country may lawfully utilise the agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS) flexibilities, primarily by importing. However, it also briefly discusses means for promoting local production through pharmaceutical capacity building and through both compulsory and voluntary licensing. To help decision-makers in understanding and evaluating the opportunities and constraints of each alternative, the paper briefly describes their respective advantages and disadvantages in terms of developing countries’ sustainable access to more affordable medicines, highlighting differing legal interpretations, political realities and pragmatic administrative and economic constraints

Report of PLACE assessments in Tashkent, Uzbekistan, Central Asia : 2002 and 2003

ABDULLAEV, Shukharat
et al
July 2004

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This is a report on two PLACE assessments conducted in Tashkent in 2002 and 2003. The aim was to investigate whether there was an overlap in drug use and sexual networks, and to identify the implications for HIV prevention. The findings suggest that there is a significant overlap among youth, drug users and sex workers, and that the rate of new partnership formation remains high, while condom availability has decreased. It suggests that interventions need to focus on the sites where youth and drug users socialise and where sex workers solicit clients

PLACE in Central Asia : a regional strategy to focus AIDS prevention in Almaty and Karaganda, Kazakhstan; Osh, Kyrgyzstan; Tashkent, Uzbekistan. 2002

MEASURE EVALUATION
July 2004

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The PLACE method is designed to expose sexual and injection drug use networks, identify sites where high-risk populations overlap and help focus interventions where they are most needed. This report presents both a baseline assessment of HIV/AIDS risks and an evaluation of condom promotion programmes in four cities in Central Asia. The report shows that sexual and drug use networks are extensive and diffuse. The rate of new partnership formation is also very high, and the use of condoms with new partners is "quite high". Injection drug use is common, and needles are often shared. The report calls for programmes and interventions to concentrate their efforts on sites at high risk, where there is an overlap of high-risk populations (people meeting new partners, youth, injection drug users, sex workers)

Antiretroviral therapy in primary health care : experience of the Chiradzulu programme in Malawi. Case study

MEDECINS SANS FRONTIERES (MSF) MALAWI
July 2004

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The Chiradzulu programme is one of MSF's largest. MSF currently provides HAART to more than 13,000 patients in 56 projects spread across 25 countries. These programmes provide a continuum of care, including prevention efforts (health education, prevention of mother-to-child transmission of HIV), voluntary counselling and testing, prevention and treatment of opportunistic infections, HAART and nutritional and psychosocial support. Although the Chiradzulu project is still evolving, and treatment systems and point of care continue to be modified, the project has already shown that when treatment is adapted to local conditions and is supported by human and financial resources, rural health systems can effectively provide comprehensive HIV/AIDS care

Increasing access to essential medicines in the developing world : UK government policy and plans

DEPARTMENT FOR INTERNATIONAL DEVELOPMENT (DFID)
June 2004

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The lack of access to essential medicines in developing countries is one of the most pressing global health issues. Tackling this issue could save millions of lives every year. Yet major inequities remain, with a limited supply of affordable medicines and inadequate health systems to deliver them in many developing countries, and a continuing shortage of new products to meet developing country health needs. This paper sets out the UK Government's assessment of the key challenges that must be addressed if we are to increase access to medicines in the developing world. It aims to communicate clearly both this assessment, and its plans. Section 2 sets out the scale of the problem and the relationship between poverty and health; section 3 outlines the issues that developing countries and their partners need to address; section 4 looks at recent progress; and section 5 covers the UK government's key objectives and plans

HIV prevention in the era of expanded treatment access

GLOBAL PREVENTION WORKING GROUP
June 2004

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This report by the Global HIV Prevention Working Group emphasises the need for a simultaneous and integrated expansion of both antiretroviral therapy (ART) and prevention programmes. Unless effective prevention programmes reduce the incidence of HIV, treatment will not be available to all who need it. It includes recommendations on treatment, prevention both for HIV-positive and HIV-negative people and funding priorities

A rapid situation analysis of the access to care project in northern Thailand

PANPANICH, Ratana
et al
June 2004

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As antiretroviral (ARV) therapy becomes more widely available in Thailand, it is necessary to have a better understanding of operational issues related to expansion of existing programs. A Rapid Situation Analysis study was undertaken to understand the strengths and weaknesses of the Access to Care project in northern Thailand. The ultimate aim of the study is to make recommendations for action that will improve the quality of ARV services that clients receive and to enhance their adherence to highly active antiretroviral therapy

Prevalence, severity and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys

THE WHO WORLD MENTAL HEALTH SURVEY CONSORTIUM
June 2004

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This article provides estimates of the prevalence, severity, and treatment of mental disorders from the WHO World Mental Health Survey which included data from 14 countries (six less developed, eight developed) by conducting 60,463 face-to-face interviews with adult individuals representing the general population. The article concludes by recommending careful consideration of mild cases and a reallocation of treatment resources; however, it also acknowledges that structural barriers may exist to this reallocation
The Journal of the American Medical Association (JAMA), Vol 291, No 21

Health South Africa : efforts to ARV for kids are still in their infancy

NDURU, Moyiga
May 2004

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An interesting article noting the challenges of supplying the medicines to HIV positive children who have received little attention. Early in 2004 the South African national programme to provide anti-retrovirals (ARVs) became operational. There is now hope that this will bring opportunities for under 14 year olds including very young children to gain more access to the drugs. The government is seeking to treat over 50,000 people per year under the ARV programme. In private clinics it costs almost US$93 to put a child on ARV for one month although this has halved since two years ago. Doctors and health officials are debating about what age is right for a child to start ARV treatment although theoretically it can start as soon as it is born. Doctors Without Borders advises that treatment should start as soon as a child is discovered to be HIV positive so that the immune system is bolstered

Emerging challenges and opportunities in drug registration and regulation in developing countries

HILL, Suzanne
JOHNSON, Kent
May 2004

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This study describes current drug regulation and registration processes in selected countries, in order to understand how they affect the quality and availability of medicines in developing countries. It puts forward policy recommendations as to how systems can more efficiently allow appropriate quality drugs to be marketed and examines the emerging challenges and requirements posed by compulsory licensing, drugs for neglected diseases, anti-retroviral (ARV) and anti-tuberculosis (TB) drugs

The Senegalese antiretroviral drug access initiative : an economic, social, behavioural and biomedical analysis

DESCLAUX, Alice
et al
April 2004

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This very thorough analysis of the Senegalese Antiretroviral Drug Access Initiative (ISAARV) presents preliminary results from the initiative's first three years. The analysis explores four aspects of the programme: treatment access, adherence, therapeutic efficacy, and the impact of this treatment programme on the Senegalese health care system

HIV prevention and care with especially vulnerable young people : a framework for action

AGGLETON, Peter
CHASE, Elaine
RIVERS, Kim
April 2004

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This document sets out five core principles underpinning effective HIV/AIDS prevention programming with young people: putting the young person first; promoting meaningful participation; a commitment to rights; promoting gender equity; and tackling risk and vulnerability. It also offers a straightforward guide to priority setting, with a focus on action to reduce risk, action to reduce vulnerability and action to mitigate impact. Examples of successful implementation of this framework are presented in 'HIV prevention with especially vulnerable young people: case studies of success and innovation' (2006). This is a useful resource for policy-makers, practitioners and researchers working to promote young people's sexual health in resource-constrained settings

Equitable access to essential medicines : a framework for collective action

WORLD HEALTH ORGANIZATION (WHO)
March 2004

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Equitable and universal access to essential medicines is a vital aspect of any health strategy in resource-limited settings. This document provides a framework of action for policy makers, highlighting the key objectives of successful essential drugs programmes: rational selection and use of essential medicines; affordable prices; sustainable financing; reliable supply systems

Health systems strengthening and HIV/AIDS : an annotated bibliography and resources

KOLYADA, Lena
March 2004

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This annotated bibliography has been prepared in an effort to provide policy makers, technical personnel and other stakeholders with comprehensive information on the costs of interventions and impact of HIV on health systems. The documents included in the bibliograpy focus on those aspects of the pandemic most related to economic impact, financing and resource allocation, costing, health system strengthening, scaling up antiretroviral therapy, surveillance systems, and programme monitoring and evaluation. The bibliography describes 101 publications describing work done from 1995 onwards as well as a directory of web resources. The bibliography is not a comprehensive reveiw, but is rather intended to highlight current information in the field of HIV and health systems strengthening

Principles, issues and options for strengthening health systems for treatment access and equitable responses to HIV and AIDS in southern Africa

SOUTHERN AFRICAN REGIONAL NETWORK ON EQUITY IN HEALTH (EQUINET)
March 2004

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This summary document presents: the principles for ensuring universal treatment access through sustainable public health systems; the major findings and issues from the work carried out in southern Africa on equity in health sector responses to HIV and AIDS, particularly in terms of access to antiretroviral treatment; and the key challenges for follow up work identified at the southern African regional meeting on Strengthening health systems for treatment access and equitable responses to HIV/AIDS in Harare, Zimbabwe, February 2004 [Publisher's abstract]

Providing antiretroviral treatment in southern Africa : a literature review

HEALTH SYSTEMS TRUST
February 2004

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This report outlines experience with ART in a number of sub-Saharan countries. ART is provided through a number of different avenues, which include the public sector, the non-profit sector, the corporate sector and the private sector. ART programmes may involve collaboration between two or more sectors with such partnerships being encouraged in recognition that the magnitude of the task may exceed the capacity of any one sector. Particular attention is paid to Botswana, the first sub-Saharan country to provide ART on a wide-scale through the public sector. The report consists of four chapters, focusing on provision of ART in the different sectors, challenges to scaling up ART programmes (including community preparedness and involvement of people living with HIV/AIDS, and issues for further research

Breaking the cycle : ensuring equitable access to HIV treatment for women and girls

FLEISCHMAN, Janet
February 2004

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Outlines the situation of women and girls with regard to vulnerability to HIV and access to treatment. Makes recommendations for US policy reflecting the links between abuses against women and girls, and HIV/AIDS. Describes treatment programmes in Botswana and South Africa, and work around community mobilization and the involvement of civil society in ensuring access to ARV treatment

TB/HIV : a clinical manual

HARRIS, Anthony D
MAHER, Dermot
2004

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Developments since 1996, particularly in the TB/HIV field, have prompted a second edition of this popular manual which provides a pocket-sized guide to the clinical management of TB, particularly in patients suffering from co-infection with HIV. Designed for use by busy clinicians, the manual aims to promote the best possible diagnosis and treatment in low-income countries where the prevalence of TB and HIV infection is high, case loads are heavy, and laboratory support may be limited. With these needs in mind, the manual combines the latest scientific knowledge about TB and HIV with authoritative advice based on extensive field experience in several of the hardest hit countries. Throughout the manual, tables, flow charts, lists of do's and don'ts, questions and answers, and numerous practical tips are used to facilitate quick reference and correct decisions. Information ranges from advice on how to distinguish TB from other HIV-related pulmonary diseases to the simple reminder that in sub-Saharan Africa, anyone with TB is in a high risk group for HIV. Though primarily addressed to clinicians working at district hospitals in sub-Saharan Africa, the manual is also suitable for use in areas of Asia and South America where the problem of TB and HIV co-infection poses a growing clinical challenge

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