BackgroundTo track the HIV epidemic and responses to it, the World Health Organization recommends 10 global indicators to collect information along the HIV care cascade. Patient diagnosis and medical record data, harnessed through case-based surveillance (CBS), can be used to measure 8 of these. While many high burden countries have well-established systems for monitoring patients on HIV treatment, few have formally adopted CBS.ObjectiveIn response to the need for improved strategic HIV information and to facilitate the development of CBS in resource-limited countries, we aimed to conduct situational assessments of existing data collection systems in Tanzania, South Africa, and Kenya.MethodsWe developed a standardized protocol and a modularized data collection tool to be adapted for the particular focus of the assessments within each country. The three countries were selected based on their stage of readiness for CBS. The assessment included three parts: a desk review of relevant materials on HIV surveillance and program monitoring, stakeholder meetings, and site visits.ResultsIn all three countries, routine HIV program monitoring is conducted, and information on new HIV diagnoses and persons accessing HIV care and treatment services is collected. Key findings from the assessments included substantial stakeholder support for the development of CBS, significant challenges in linking data within and between systems, data quality, the ability to obtain data from multiple sources, and information technology infrastructure. Viral load testing capacity varied by country, and vital registry data were not routinely linked to health systems to update medical records.ConclusionsOur findings support the development of CBS systems to systematically capture routinely collected health data to measure and monitor HIV epidemics and guide responses. Although there were wide variations in the systems examined, some of the current program and patient monitoring systems can be adapted to function effectively for CBS, especially if supported by an improved patient registration system with shared unique health identifiers.

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SummaryIn a cross-sectional study in 1998 we assessed human immunodeficiency virus (HIV)

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TATM 2003;5(1):277-284 • Safe blood • Scarce resources • Quality systems • Hemovigilance • HIV/AIDS In many parts of the world, people continue to die due to shortage of blood and blood products. The safety of blood transfusion therapy remains a continuing concern, particularly where resources are scarce.The different stages of economic and social development are reflected in the existing status of the countries health care systems and that of their national blood transfusion services. The lack of quality systems, standardization and traceability of collected blood along the blood transfusion chain are the major contributing factors to the undesired outcomes of transfusion and increased risk of transfusion-transmissible infections, namely HIV/AIDS and hepatitis. Hemovigilance as a concept and developed operational system, supports the continuous improvement of quality and safety of transfusion practices. Once the minimum safety requirements are in place, implementation of quality systems in the blood transfusion service throughout the entire blood transfusion chain has to be considered the first mandatory step for establishing hemovigilance systems. The challenge awaiting countries with scarce resources is the implementation of their own hemovigilance system in a sustainable way. The integrated approach for a safer blood supply developed by WHO is aimed at building capacities at a national level, through advocacy, infrastructure development, technical support, training and documentation, and it creates the necessary grounds for establishment of hemovigilance systems. By further increasing its commitment in this area, WHO fulfils its leadership role in preventing risk factors for major disease burden and in organizing equitable health services, in line with its strategic directions. Based on existing data and locally gained experience, joint programs and related expertise can be developed, strengthening inter-country, regional and global collaboration for a safer, adequate blood supply. ( Pa ge 27 7 ) Hemovigilance in Countries with Scarce Resources-A WHO Perspective NEELAM DHINGRA et al.

Background: Blood transfusion has always been an important route for Chagas Disease (CD) transmission. The high prevalence of CD in Latin America and its lifelong asymptomatic clinical picture pose a threat for the safety of the blood supply. The outcome of measures designed to improve transfusion safety can be assessed by evaluating the prevalence of CD among multitransfused patients

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Abstract Background: Traditional antenatal care (ANC) models often do not meet women’s needs for information, counseling, and support, resulting in gaps in quality and coverage. Group ANC (GANC) provides an alternative, person-centered approach where pregnant women of similar gestational age meet with the same health provider for facilitated discussion. There are few studies that show associations between GANC and various outcomes. Methods: We used mixed methods to evaluate a contextualized GANC model (Lea Mimba Pregnancy Clubs) and to understand implementation experiences at six health facilities in Kakamega County, Kenya. Between April 2018 and January 2019, we tracked 1,652 women who were assigned to 162 GANC cohorts to assess ANC retention. Using an intention-to-treat approach, we conducted baseline (N = 112) and endline surveys (N = 360) with women attending immunization visits to assess outcomes and used time diaries to assess wait times. At endline, we conducted 29 in-depth interviews (IDIs) and three focus group discussions with women who were currently and previously participating in GANC, and 15 IDIs with stakeholders.Results: GANC was associated with enhanced social support, with some evidence for improved knowledge, adoption of healthy behaviors, enhanced self-efficacy, and improved experience of care. Quantitatively, we found strong associations with knowledge of danger signs, women who shared their feelings with other women, knowledge and competence of health workers, respect shown by ANC providers, overall quality of care, and birth preparations. No changes were seen in knowledge of positive behaviors, empowerment, several aspects of the experience of care, ANC retention, early ANC, and other healthy behaviors. Qualitatively, women and stakeholders noted improvements in interactions between health providers and women, improved counseling, increased feelings of empowerment to ask questions and speak freely, and strengthened social networks and enhanced social cohesion among women. Both wait times and counseling times increased in GANC compared to traditional ANC.Conclusions: This is one of the few mixed-methods studies evaluating GANC and offers new measures for experience of care, empowerment, and adoption of healthy behaviors. While more research is required, GANC holds promise for enhancing women’s experiences during pregnancy. Modifications are needed for sustainability and scalability.