Faculty Opinions recommendation of Changes in rapid HIV treatment initiation after national "treat all" policy adoption in 6 sub-Saharan African countries: Regression discontinuity analysis.

Abstract Background Young adolescents with perinatally acquired human immunodeficiency virus (HIV) are at risk for poor care outcomes. We examined whether universal antiretroviral treatment (ART) eligibility policies (Treat All) improved rapid ART initiation after care enrollment among 10–14-year-olds in 7 sub-Saharan African countries. Methods Regression discontinuity analysis and data for 6912 patients aged 10–14-years were used to estimate changes in rapid ART initiation (within 30 days of care enrollment) after adoption of Treat All policies in 2 groups of countries: Uganda and Zambia (policy adopted in 2013) and Burundi, Democratic Republic of the Congo, Kenya, Malawi, and Rwanda (policy adopted in 2016). Results There were immediate increases in rapid ART initiation among young adolescents after national adoption of Treat All. Increases were greater in countries adopting the policy in 2016 than in those adopting it in 2013: 23.4 percentage points (pp) (95% confidence interval, 13.9–32.8) versus 11.2pp (2.5–19.9). However, the rate of increase in rapid ART initiation among 10–14-year-olds rose appreciably in countries with earlier treatment expansions, from 1.5pp per year before Treat All to 7.7pp per year afterward. Conclusions Universal ART eligibility has increased rapid treatment initiation among young adolescents enrolling in HIV care. Further research should assess their retention in care and viral suppression under Treat All.

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Population Policy Adoption in Sub-Saharan Africa: An Interplay of Global and Local Forces

Population Horizons ◽

10.1515/pophzn-2016-0001 ◽

2016 ◽

Vol 13 (1) ◽

pp. 9-18

Author(s):

Rachel Sullivan Robinson

Keyword(s):

Population Growth ◽

Socioeconomic Development ◽

Population Policy ◽

Sub Saharan Africa ◽

Policy Adoption ◽

African Countries ◽

Test Procedures ◽

Population Policies ◽

Sub Saharan ◽

Global And Local

AbstractSub-Saharan African countries have the highest population growth rates in the world, and are also the poorest. In response to a variety of global and local forces, during the 1980s and 1990s two thirds of sub- Saharan African countries adopted national population policies to reduce population growth. Drawing from existing research and using the texts of population policies to illustrate key points, this article summarises the factors that drove population policy adoption in the region. Globally, powerful donors with significant leverage promoted population policies as a solution to lagging socioeconomic development while international organizations spread norms about women’s rights and reproductive health. Locally, technocrats working within relevant ministries backed efforts to increase contraceptive prevalence, and population policies furthered political projects unrelated to population. The interplay of global and local forces led to governments adopting population policies. Ultimately, continued high desired fertility and limited implementation capacity have prevented population policies from significantly lowering fertility, but these policies have likely increased the availability of contraception, created important discursive space related to gender and sexuality, and provided countries with an opportunity to test procedures and approaches for policy-making on sensitive issues.

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Do differentiated service delivery models for HIV treatment in sub-Saharan Africa save money? Synthesis of evidence from field studies conducted in sub-Saharan Africa in 2017-2019

Gates Open Research ◽

10.12688/gatesopenres.13458.1 ◽

2021 ◽

Vol 5 ◽

pp. 177

Author(s):

Sydney Rosen ◽

Brooke Nichols ◽

Teresa Guthrie ◽

Mariet Benade ◽

Salome Kuchukhidze ◽

...

Keyword(s):

Observational Study ◽

Service Delivery ◽

Field Studies ◽

Conventional Care ◽

Hiv Treatment ◽

Sub Saharan Africa ◽

Differentiated Service ◽

African Countries ◽

Sub Saharan ◽

Cluster Randomized

Introduction: “Differentiated service delivery” (DSD) for antiretroviral therapy (ART) for HIV is rapidly being scaled up throughout sub-Saharan Africa, but only recently have data become available on the costs of DSD models to providers and patients. We synthesized recent studies of DSD model costs in five African countries. Methods: The studies included cluster randomized trials in Lesotho, Malawi, Zambia, and Zimbabwe and observational studies in Uganda and Zambia. For 3-5 models per country, studies collected patient-level data on clinical outcomes and provider costs for 12 months, and some studies surveyed patients about costs they incurred. We compared costs of differentiated models to those of conventional care and identified drivers of cost differences. We also report patient costs of seeking care. Results: The studies described 22 models, including facility-based conventional care. Of these, 13 were facility-based and 9 community-based models; 15 were individual and 7 group models. Average provider cost/patient/year ranged from $100 in Zambia to $187 in Zimbabwe, in both cases for facility-based conventional care. Conventional care was less expensive than any other model in the Zambia observational study, more expensive than any other model in Lesotho, Malawi, and Zimbabwe, and in the middle of the range in the Zambia trial and the observational study in Uganda. Models incorporating 6-month dispensing were consistently less expensive to the provider per patient treated. Savings to patients were substantial for most models, with patients’ costs roughly halved. Conclusion: In five field studies of the costs of DSD models for HIV treatment, most models within each country had relatively similar costs, except for 6-month dispensing models, which were slightly less expensive. Most models provided substantial savings to patients. Research is needed to understand the effect of DSD models on the costs of ART programmes as a whole.

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Crowdsourcing Covid-19 signals in sub-Saharan Africa: Leveraging digital contributor networks for participatory surveillance of Covid-19 symptoms and deaths (Preprint)

10.2196/preprints.26347 ◽

2020 ◽

Author(s):

Ngozi A Erondu ◽

Sagal A Ali ◽

Mohamed Ali ◽

Schadrac C Agbla

Keyword(s):

Public Health ◽

Sub Saharan Africa ◽

Specific Information ◽

Surveillance Systems ◽

Health Seeking ◽

African Countries ◽

Cross Sectional Survey ◽

Local Networks ◽

The World ◽

Sub Saharan

BACKGROUND In sub-Saharan Africa, underreporting of cases and deaths has been attributed to various factors including, weak disease surveillance, low health-seeking behaviour of flu like symptoms, and stigma of Covid-19. There is evidence that SARS-CoV-2 spread mimics transmission patterns of other countries across the world. Since the Covid-19 pandemic has changed the way research can be conducted and in light of restrictions on travel and risks to in-person data collection, innovative approaches to collecting data must be considered. Nearly 50% of Africa’s population is a unique mobile subscriber and it is one of the fastest growing smart-phone marketplaces in the world; hence, mobile phone platforms should be considered to monitor Covid-19 trends in the community. OBJECTIVE We demonstrate the use of digital contributor platforms to survey individuals about cases of flu-like symptoms and instances of unexplained deaths in Ethiopia, Kenya, Nigeria, Somalia, and Zimbabwe. METHODS Rapid cross-sectional survey of individuals with severe flu and pneumonia symptoms and unexplained deaths in Ethiopia, Kenya, Nigeria, Somalia and Zimbabwe RESULTS Using a non-health specific information platform, we found COVID-19 signals in five African countries, specifically: •Across countries, nearly half of the respondents (n=739) knew someone who had severe flu or pneumonia symptoms in recent months. •One in three respondents from Somalia and one in five from Zimbabwe respondents said they knew more than five people recently displaying flu and/or pneumonia symptoms. •In Somalia there were signals that a large number of people might be dying outside of health facilities, specifically in their homes or in IDP or refugee camps. CONCLUSIONS Existing digital contributor platforms with local networks are a non-traditional data source that can provide information from the community to supplement traditional government surveillance systems and academic surveys. We demonstrate that using these distributor networks to for community surveys can provide periodic information on rumours but could also be used to capture local sentiment to inform public health decision-making; for example, these insights could be useful to inform strategies to increase confidence in Covid19 vaccine. As Covid-19 continues to spread somewhat silently across sub-Saharan Africa, regional and national public health entities should consider expanding event-based surveillance sources to include these systems.

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Managing African Urbanization in the Context of Environmental Change

INTERdisciplina ◽

10.22201/ceiich.24485705e.2014.2.46528 ◽

2014 ◽

Vol 2 (2) ◽

Cited By ~ 13

Author(s):

Shuaib Lwasa

Keyword(s):

Climate Change ◽

Economic Growth ◽

Social Services ◽

Urban Areas ◽

Urban Governance ◽

Sub Saharan Africa ◽

African Countries ◽

Sub Saharan ◽

Urbanization Rate ◽

Development And Management

Africa’s urbanization rate has increased steadily over the past three decades and is reported to be faster than in any other region in the world . It is estimated that by 2030, over half of the African population will be living in urban areas . But the nature of Africa’s urbanization and subsequent form of cities is yet to be critically analyzed in the context of city authorities’ readiness to address the challenges . Evidence is also suggesting that urbanization in African countries is increasingly associated with the high economic growth that has been observed in the last two decades . Both underlying and proximate drivers are responsible for the urbanization, and these include population dynamics, economic growth, legislative designation, increasing densities in rural centers, as well as the growth of mega cities such as Lagos, Cairo and Kinshasa, that are extending to form urban corridors . With the opportunities of urbanization in Sub–Saharan Africa, there are also challenges in the development and management of these cities . Those challenges include provision of social services, sustainable economic development, housing development, urban governance, spatial development guidance and environmental management, climate change adaptation, mitigation and disaster risk reduction . The challenge involves dealing with the development and infrastructure deficit, in addition to required adaption to and mitigation of climate change . This paper examines the current state of urban management in Africa .

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