scholarly journals Understanding and measuring uptake and coverage of oral pre-exposure prophylaxis delivery among adolescent girls and young women in sub-Saharan Africa

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 513 ◽  
Author(s):  
Megan S. Dunbar ◽  
Katharine Kripke ◽  
Jessica Haberer ◽  
Delivette Castor ◽  
Shona Dalal ◽  
...  
Keyword(s):  
Hiv Infection ◽  
Adolescent Girls ◽  
Young Women ◽  
Sub Saharan Africa ◽  
World Health ◽  
Substantial Risk ◽  
Sub Saharan ◽  
Health Organization ◽  
Exposure Prophylaxis ◽  
Oral Prep

In response to World Health Organization (WHO) guidance recommending oral pre-exposure prophylaxis (PrEP) for all individuals at substantial risk for HIV infection, significant investments are being made to expand access to oral PrEP globally, particularly in sub-Saharan Africa. Some have interpreted early monitoring reports from new programs delivering oral PrEP to adolescent girls and young women (AGYW) as suggestive of low uptake. However, a lack of common definitions complicates interpretation of oral PrEP uptake and coverage measures, because various indicators with different meanings and uses are used interchangeably. Furthermore, operationalising these measures in real-world settings is challenged by the difficulties in defining the denominator for measuring uptake and coverage among AGYW, due to the lack of data and experience required to identify the subset of AGYW at substantial risk of HIV infection. This paper proposes an intervention-centric cascade as a framework for developing a common lexicon of metrics for uptake and coverage of oral PrEP among AGYW. In codifying these indicators, approaches to clearly define metrics for uptake and coverage are outlined, and the discussion on ‘low’ uptake is reframed to focus on achieving the highest possible proportion of AGYW using oral PrEP when they need and want it Recommendations are also provided for making increased investments in implementation research to better quantify the sub-group of AGYW in potential need of oral PrEP.and for improving monitoring systems to more efficiently address bottlenecks in the service delivery of oral PrEP to AGYW so that implementation can be taken to scale.

scholarly journals Going global: the adoption of the World Health Organization’s enabling recommendation on oral pre-exposure prophylaxis for HIV

Sexual Health ◽  
2018 ◽  
Vol 15 (6) ◽  
pp. 489 ◽  
Author(s):  
Ioannis Hodges-Mameletzis ◽  
Shona Dalal ◽  
Busisiwe Msimanga-Radebe ◽  
Michelle Rodolph ◽  
Rachel Baggaley
Keyword(s):  
Sub Saharan Africa ◽  
Essential Medicines ◽  
World Health ◽  
Middle Income ◽  
Income Status ◽  
The World ◽  
Sub Saharan ◽  
Health Organization ◽  
Exposure Prophylaxis ◽  
Oral Prep

In September 2015, the World Health Organization (WHO) launched evidence-based guidelines by recommending that any person at substantial HIV risk should be offered oral pre-exposure prophylaxis (PrEP) containing tenofovir disoproxil fumarate (TDF) as an additional prevention choice. Since 2017, PrEP medicines have also been listed in the WHO’s Essential Medicines List, including TDF/emtricitabine (FTC) and TDF in combination with lamivudine (3TC). A descriptive policy review and analysis of countries adopting WHO’s 2015 recommendation on oral PrEP was conducted. As of June 2018, we identified 35 countries that had some type of policy on oral PrEP, and an additional five countries where a specific policy on PrEP is currently pending. A total of 19 high-income countries (HICs) and 21 low- and middle-income countries (LMICs) have adopted or have a pending policy. Most countries that have adopted or pending PrEP are in the European (42.9%) or African (30.0%) region. TDF/FTC is the most commonly recommended PrEP drug in the guidelines reviewed, although seven countries, namely in sub-Saharan Africa (6/7), are also recommending the use of TDF/3TC for PrEP. In sum, by the end of 2018, at least 40 countries (20.6%) are anticipated to have adopted WHO’s oral PrEP recommendation. Nonetheless, policy uptake does not reflect broader programmatic coverage of PrEP services, which remain limited across all settings, irrespective of income status. Enhancing global partnerships is needed to support and track ongoing policy adoption and to ensure that policy is translated into meaningful implementation of PrEP services.

scholarly journals PrEP as a Lifestyle and Investment for Adolescent Girls and Young Women in Sub-Saharan Africa

2019 ◽  
Vol 18 ◽  
pp. 232595821983101 ◽  
Author(s):  
Jessica E. Haberer ◽  
Nelly Mugo ◽  
Jared M. Baeten ◽  
Maria Pyra ◽  
Elizabeth Bukusi ◽  
...  
Keyword(s):  
Adolescent Girls ◽  
Young Women ◽  
Sub Saharan Africa ◽  
Lifestyle Choice ◽  
Hiv Epidemic ◽  
Sub Saharan ◽  
The Many ◽  
Hiv Acquisition ◽  
Risk Of Hiv Acquisition ◽  
Exposure Prophylaxis

Adolescent girls and young women (AGYW) are highly affected by the HIV epidemic, yet standard approaches to pre-exposure prophylaxis (PrEP) delivery will not meet their needs. This commentary highlights key characteristics of AGYW related to PrEP use and delivery, including typical neurocognitive development, lack of experience with sustained medication use, and the social and connected nature of AGYW’s lives. We then suggest ways for programs to embrace these characteristics, such as presenting PrEP as a lifestyle choice and not a biomedical tool, making access to PrEP simple and easy, and recognizing the many influences AGYW face in taking PrEP. We also suggest ways for programs to identify AGYW at the highest risk of HIV acquisition. Adolescent girls and young women have an important role to play in ending the HIV epidemic and they deserve considerable, tailored investment.

Risk of HIV infection among adolescent girls and young women in age-disparate relationships in sub-Saharan Africa

AIDS ◽  
2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Francis Bajunirwe ◽  
Daniel Semakula ◽  
Jonathan Izudi
Keyword(s):  
Hiv Infection ◽  
Adolescent Girls ◽  
Young Women ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Wealth-related inequalities in demand for family planning satisfied among married and unmarried adolescent girls and young women in sub-Saharan Africa

2021 ◽  
Vol 18 (S1) ◽  
Author(s):  
Martin K. Mutua ◽  
Yohannes D. Wado ◽  
Monica Malata ◽  
Caroline W. Kabiru ◽  
Elsie Akwara ◽  
...  
Keyword(s):  
Family Planning ◽  
West Africa ◽  
Adolescent Girls ◽  
Young Women ◽  
Rate Of Change ◽  
Sub Saharan Africa ◽  
Demographic And Health Surveys ◽  
Sexually Active ◽  
Sub Saharan ◽  
Over Time

Abstract Background The use of modern contraception has increased in much of sub-Saharan Africa (SSA). However, the extent to which changes have occurred across the wealth spectrum among adolescents is not well known. We examine poor-rich gaps in demand for family planning satisfied by modern methods (DFPSm) among sexually active adolescent girls and young women (AGYW) using data from national household surveys. Methods We used recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys to describe levels of wealth-related inequalities in DFPSm among sexually active AGYW using an asset index as an indicator of wealth. Further, we used data from countries with more than one survey conducted from 2000 to assess DFPSm trends. We fitted linear models to estimate annual average rate of change (AARC) by country. We fitted random effects regression models to estimate regional AARC in DFPSm. All analysis were stratified by marital status. Results Overall, there was significant wealth-related disparities in DFPSm in West Africa only (17.8 percentage points (pp)) among married AGYW. The disparities were significant in 5 out of 10 countries in Eastern, 2 out of 6 in Central, and 7 out of 12 in West among married AGYW and in 2 out of 6 in Central and 2 out of 9 in West Africa among unmarried AGYW. Overall, DFPSm among married AGYW increased over time in both poorest (AARC = 1.6%, p < 0.001) and richest (AARC = 1.4%, p < 0.001) households and among unmarried AGYW from poorest households (AARC = 0.8%, p = 0.045). DPFSm increased over time among married and unmarried AGYW from poorest households in Eastern (AARC = 2.4%, p < 0.001) and Southern sub-regions (AARC = 2.1%, p = 0.030) respectively. Rwanda and Liberia had the largest increases in DPFSm among married AGYW from poorest (AARC = 5.2%, p < 0.001) and richest (AARC = 5.3%, p < 0.001) households respectively. There were decreasing DFPSm trends among both married (AARC = − 1.7%, p < 0.001) and unmarried (AARC = − 4.7%, p < 0.001) AGYW from poorest households in Mozambique. Conclusion Despite rapid improvements in DFPSm among married AGYW from the poorest households in many SSA countries there have been only modest reductions in wealth-related inequalities. Significant inequalities remain, especially among married AGYW. DFPSm stalled in most sub-regions among unmarried AGYW.

scholarly journals The Relationship Between the Global Burden of Influenza From 2017 to 2019 and COVID-19: Descriptive Epidemiological Assessment (Preprint)

2020 ◽  
Author(s):  
Stefan David Baral ◽  
Katherine Blair Rucinski ◽  
Jean Olivier Twahirwa Rwema ◽  
Amrita Rao ◽  
Neia Prata Menezes ◽  
...  
Keyword(s):  
Respiratory Infections ◽  
Temporal Trends ◽  
Sub Saharan Africa ◽  
World Health ◽  
Respiratory Pathogens ◽  
Modes Of Transmission ◽  
The World ◽  
Influenza Activity ◽  
Sub Saharan ◽  
Health Organization

BACKGROUND SARS-CoV-2 and influenza are lipid-enveloped viruses with differential morbidity and mortality but shared modes of transmission. OBJECTIVE With a descriptive epidemiological framing, we assessed whether recent historical patterns of regional influenza burden are reflected in the observed heterogeneity in COVID-19 cases across regions of the world. METHODS Weekly surveillance data reported by the World Health Organization from January 2017 to December 2019 for influenza and from January 1, 2020 through October 31, 2020, for COVID-19 were used to assess seasonal and temporal trends for influenza and COVID-19 cases across the seven World Bank regions. RESULTS In regions with more pronounced influenza seasonality, COVID-19 epidemics have largely followed trends similar to those seen for influenza from 2017 to 2019. COVID-19 epidemics in countries across Europe, Central Asia, and North America have been marked by a first peak during the spring, followed by significant reductions in COVID-19 cases in the summer months and a second wave in the fall. In Latin America and the Caribbean, COVID-19 epidemics in several countries peaked in the summer, corresponding to months with the highest influenza activity in the region. Countries from regions with less pronounced influenza activity, including South Asia and sub-Saharan Africa, showed more heterogeneity in COVID-19 epidemics seen to date. However, similarities in COVID-19 and influenza trends were evident within select countries irrespective of region. CONCLUSIONS Ecological consistency in COVID-19 trends seen to date with influenza trends suggests the potential for shared individual, structural, and environmental determinants of transmission. Using a descriptive epidemiological framework to assess shared regional trends for rapidly emerging respiratory pathogens with better studied respiratory infections may provide further insights into the differential impacts of nonpharmacologic interventions and intersections with environmental conditions. Ultimately, forecasting trends and informing interventions for novel respiratory pathogens like COVID-19 should leverage epidemiologic patterns in the relative burden of past respiratory pathogens as prior information.

Pregnancy intention and gestational age at first antenatal care visit in Lesotho

2021 ◽  
Vol 15 (1) ◽  
pp. 1-11
Author(s):  
Paul Mkandawire ◽  
Joseph Kangmennaang ◽  
Chad Walker ◽  
Roger Antabe ◽  
Kilian Atuoye ◽  
...  
Keyword(s):  
Antenatal Care ◽  
Gestational Age ◽  
Secondary Data ◽  
Universal Coverage ◽  
Sub Saharan Africa ◽  
World Health ◽  
Antenatal Visit ◽  
Life Saving ◽  
Sub Saharan ◽  
Health Organization

Background/aims With coverage of antenatal care in sub-Saharan Africa approaching a universal level, attention is now turning to maximising the life-saving potential of antenatal care. This study assessed the gestational age at which pregnant mothers make their first antenatal visit in the context of high antenatal coverage in Lesotho. Methods For the purposes of this study, secondary data from the Demographic and Health Survey of 2014 was analysed. These data were collected in 2014, via an interviewer administered questionnaire. Survival analysis was applied to the data, using Stata SE 15 to compute time ratios that estimate time to first antenatal visit in Lesotho. Results Despite near universal coverage, only 24% of mothers start antenatal care before 12 weeks of gestation, as recommended by the World Health Organization. In addition, mothers with unwanted pregnancies are most likely to delay antenatal care until later in gestation, followed by mothers with mistimed pregnancies. Education, but not wealth, correlates with the start of antenatal care. Conclusions Having achieved near universal coverage, emphasising a prompt start and adherence to recommended visits could optimise the life-saving potential of antenatal care in Lesotho.

scholarly journals A Systematic Review of the Incremental Costs of Implementing a New Vaccine in the Expanded Program of Immunization in Sub-Saharan Africa

2019 ◽  
Vol 4 (2) ◽  
pp. 238146831989454
Author(s):  
Joe Brew ◽  
Christophe Sauboin
Keyword(s):  
Systematic Review ◽  
Data Collection ◽  
Interquartile Range ◽  
Sub Saharan Africa ◽  
World Health ◽  
African Countries ◽  
Vaccine Type ◽  
Sub Saharan ◽  
Health Organization ◽  
The Cost

Background. The World Health Organization is planning a pilot introduction of a new malaria vaccine in three sub-Saharan African countries. To inform considerations about including a new vaccine in the vaccination program of those and other countries, estimates from the scientific literature of the incremental costs of doing so are important. Methods. A systematic review of scientific studies reporting the costs of recent vaccine programs in sub-Saharan countries was performed. The focus was to obtain from each study an estimate of the cost per dose of vaccine administered excluding the acquisition cost of the vaccine and wastage. Studies published between 2000 and 2018 and indexed on PubMed could be included and results were standardized to 2015 US dollars (US$). Results. After successive screening of 2119 titles, and 941 abstracts, 58 studies with 80 data points (combinations of country, vaccine type, and vaccination approach–routine v. campaign) were retained. Most studies used the so-called ingredients approach as costing method combining field data collection with documented unit prices per cost item. The categorization of cost items and the extent of detailed reporting varied widely. Across the studies, the mean and median cost per dose administered was US$1.68 and US$0.88 with an interquartile range of US$0.54 to US$2.31. Routine vaccination was more costly than campaigns, with mean cost per dose of US$1.99 and US$0.88, respectively. Conclusion. Across the studies, there was huge variation in the cost per dose delivered, between and within countries, even in studies using consistent data collection tools and analysis methods, and including many health facilities. For planning purposes, the interquartile range of US$0.54 to US$2.31 may be a sufficiently precise estimate.

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