Introduction HIV drug resistance (HIVDR) testing is not routinely available in many resource-limited settings (RLS), therefore ART program and site factors known to be associated with HIVDR should be monitored to optimize the quality of patient care and minimize the emergence of preventable HIVDR. Methods In 2009, Namibia selected five World Health Organization Early Warning Indicators (EWIs) and piloted abstraction at nine antiretroviral therapy (ART) sites: ART prescribing practices, Patients lost to follow-up (LTFU) at 12 months, Patient retention on first-line ART at 12 months, On-time antiretroviral (ARV) drug pick-up, and ARV drug-supply continuity. Results Records supported monitoring of three of five selected EWIs. 9/9 (100%) sites met the target of 100% initiated on appropriate first-line regimens. 8/9 (89%) sites met the target of ≤20% LTFU, although 20.8% of ART starters (range 4.6%-44.6%) had a period of absence without documented ART coverage of 2.3 months (range 1.5-3.9 months). 6/9 (67%) sites met the target of 0% switched to a second-line regimen. Conclusions EWI monitoring directly resulted in public health action which will optimize the quality of care, specifically the strengthening of ART record systems permitting monitoring of five EWIs in future years and protocols for improved ART patient defaulter tracing.
As countries embrace the ambitious universal health coverage (UHC) agenda whose major tenents include reaching everyone with the needed good quality services, strengthening the planning process to work towards a common objective is paramount. Drawing from country experiences-Swaziland and Zanzibar, we reviewed strategic planning processes to assess the extent to which they impact on realising alignment towards a collective health sector objective. Employing qualitative approaches, we reviewed strategic plans under implementation in the health sector and using an interview guide consisting of open-ended questions, interviewed key informants at the national and district level. Results showed that strategic plans are too many with majority of program strategies not well aligned to the health sector strategic plan, are not costed, and there overlaps in objectives among the several strategies addressing the same program. Weaknesses in the development process, perceived poor quality of the strategies, limited capacity, high staff turnover, and inadequate funding were the identified challenges that abate the utility of the strategic plans. Moving towards UHC starts with a robust planning process that rallies all actors and all available resources around a common objective. The planning process should be strengthened through ensuring participatory processes, evidence informed prioritisation, MoH institutional capacity to lead the process, and consideration for implementation feasibility. Flexibility to take into consideration emerging evidence and new developments in global health needs consideration.
Background Lymphatic filariasis (LF) is a debilitating neglected tropical disease which is targeted for elimination through co-administration of a single dose of ivermectin and albendazole in the affected population. Following implementation of such a treatment campaign over a period of years, control programmes are urged to conduct a transmission assessment survey to monitor the impact of the treatment and to ascertain whether the transmission is interrupted to a level that can no longer sustain transmission and hence mass drug administration (MDA) can be halted. Objective:This study was carried out to determine the prevalence of LF infection in Zanzibar communities, 13 years after stopping MDA, so as to inform and guide the control program. MethodologyA Finger prick blood sample was collected from each participant after obtaining informed consent. The sample was assessed for the presence of Wucheria bancrofti circulating antigen using rapid immunochromatographic test. ResultsA total of 2555 subjects were enrolled (1231 in Pemba and 1324 in Unguja) in the study with a mean age of 23.0yrs ± SD 18.9 (95% CI = 22.3-23.8). There were more female (53.9%) than male (46.1%); and their mean age significantly differed (t-test = 7.5, p = 0.00001). Only 2478 individuals gave blood sample . Of these, 88 (3.55%) were found to be infected with W. bancrofti. Overall, the prevalence of infection was higher in Pemba (5.1%) than in Unguja (2.1%). The prevalence of infection was similar between different older age groups , children aged 1-5yrs in Pemba had the highest prevalence indicating that transmission is ongoing. Observation of development of clinical manifestation, lymphoedema and hydrocele was also assessed. Overall, only 1.1% of the individuals had lymphoedema/elephantiasis; with male presented with more of those signs (1.6%) than female (0.7%). There was no male subject found to have hydrocele , although 8.3% of male had filariasis.The assessment of treatment history revealed that majority (64.7%) of the respondents had received at least one treatment round during their lifetime. Historical treatments with ivermectin did not correlate with current individual levels of infection but individuals who reported to have received 2 and 4 rounds of treatment were not found to be infected with filariasis.Conclusion and RecommendationIn view of our findings it clearly shows that the prevalence of LF in Zanzibar is still high to exceed the set threshold for discontinuation of MDA campaign. Children as young as 5yrs were found infected. It is therefore important to consider continuation of MDA so as to prevent potential disease sequel which might develop.
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