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Akselrod S, Collins TE, Berlina D, Collins A, Allen LN. The impact of UN high-level meetings on non-communicable disease funding and policy implementation. BMJ Glob Health 2023; 8:e012186. [PMID: 37907235 PMCID: PMC10619094 DOI: 10.1136/bmjgh-2023-012186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 06/16/2023] [Indexed: 11/02/2023] Open
Abstract
Since the original UN General Assembly 'special session' for HIV/AIDS, there has been a proliferation of health-related high-level meetings (HLMs), including three for non-communicable diseases (NCDs) and a 2019 HLM on universal health coverage that was closely aligned to the NCD framework. This paper attempts to assess the impact of these meetings in terms of funding allocations, domestic NCD policy implementation, as well as the level of international engagement with the HLMs by reviewing attendance data and records of statements ('interventions') made by country delegations. In contrast to HIV/AIDS, whilst NCDs have enjoyed a marked rise in international political exposure and high-level political commitments, these have not always translated into national policy implementation or greater funding allocations. This is true even for countries that have engaged most deeply with HLMs. These findings should give pause to NCD advocacy groups that expend substantial energy in calling for further high-level political commitments and highlight the need to focus support on the translation of commitments into sustainably funded action.
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Affiliation(s)
| | | | - Daria Berlina
- Global NCD Platform, World Health Organization, Geneve, Switzerland
| | - Amy Collins
- Healthcare Without Harm, Vancouver, British Columbia, Canada
| | - Luke N Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
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2
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Ramani-Chander A, Joshi R, van Olmen J, Wouters E, Delobelle P, Vedanthan R, Miranda JJ, Oldenburg B, Sherwood S, Rawal LB, Mash RJ, Irazola VE, Martens M, Lazo-Porras M, Liu H, Agarwal G, Waqa G, Marcolino MS, Esandi ME, Ribeiro ALP, Probandari A, González-Salazar F, Shrestha A, Sujarwoto S, Levitt N, Paredes M, Sugishita T, Batal M, Li Y, Haghparast-Bidgoli H, Naanyu V, He FJ, Zhang P, Mfinanga SG, De Neve JW, Daivadanam M, Siddiqi K, Geldsetzer P, Klipstein-Grobusch K, Huffman MD, Webster J, Ojji D, Beratarrechea A, Tian M, Postma M, Owolabi MO, Birungi J, Antonietti L, Ortiz Z, Patel A, Peiris D, Schouw D, Koot J, Nakamura K, Tampubolon G, Thrift AG. Applying systems thinking to identify enablers and challenges to scale-up interventions for hypertension and diabetes in low-income and middle-income countries: protocol for a longitudinal mixed-methods study. BMJ Open 2022; 12:e053122. [PMID: 35437244 PMCID: PMC9016402 DOI: 10.1136/bmjopen-2021-053122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 02/04/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There is an urgent need to reduce the burden of non-communicable diseases (NCDs), particularly in low-and middle-income countries, where the greatest burden lies. Yet, there is little research concerning the specific issues involved in scaling up NCD interventions targeting low-resource settings. We propose to examine this gap in up to 27 collaborative projects, which were funded by the Global Alliance for Chronic Diseases (GACD) 2019 Scale Up Call, reflecting a total funding investment of approximately US$50 million. These projects represent diverse countries, contexts and adopt varied approaches and study designs to scale-up complex, evidence-based interventions to improve hypertension and diabetes outcomes. A systematic inquiry of these projects will provide necessary scientific insights into the enablers and challenges in the scale up of complex NCD interventions. METHODS AND ANALYSIS We will apply systems thinking (a holistic approach to analyse the inter-relationship between constituent parts of scaleup interventions and the context in which the interventions are implemented) and adopt a longitudinal mixed-methods study design to explore the planning and early implementation phases of scale up projects. Data will be gathered at three time periods, namely, at planning (TP), initiation of implementation (T0) and 1-year postinitiation (T1). We will extract project-related data from secondary documents at TP and conduct multistakeholder qualitative interviews to gather data at T0 and T1. We will undertake descriptive statistical analysis of TP data and analyse T0 and T1 data using inductive thematic coding. The data extraction tool and interview guides were developed based on a literature review of scale-up frameworks. ETHICS AND DISSEMINATION The current protocol was approved by the Monash University Human Research Ethics Committee (HREC number 23482). Informed consent will be obtained from all participants. The study findings will be disseminated through peer-reviewed publications and more broadly through the GACD network.
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Affiliation(s)
- Anusha Ramani-Chander
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Rohina Joshi
- The George Institute for Global Health, New Delhi, India
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Josefien van Olmen
- Department of Family Health and Population Medicine, University of Antwerp, Antwerpen, Belgium
| | - Edwin Wouters
- Department of Sociology, Centre for Population, Family & Health, Faculty of Social Sciences, Univesrity of Antwerp, Antwerp, Belgium
| | - Peter Delobelle
- Chronic Diseases Initiative of Africa, University of Cape Town, Cape Town, South Africa
- Department of Public Health, Vrije Universiteit, Brussel, Belgium
| | - Rajesh Vedanthan
- Department of Population Health, NYU Grossman School of Medicine, New York City, New York, USA
| | - J Jaime Miranda
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Brian Oldenburg
- Department of Cardiovascular Research, Translation and Implementation, Baker Heart and Diabetes Institute and La Trobe University, Melbourne, Victoria, Australia
| | - Stephen Sherwood
- Fundación EkoRural and Knowledge, Technology and Innovation, Wageningen University, Wageningen, The Netherlands
| | - Lal B Rawal
- School of Health, Medical and Applied Sciences, College of Science and Sustainability, Central Queensland University, Sydney, New South Wales, Australia
| | - Robert James Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Vilma Edith Irazola
- Department of Chronic Diseases-CESCAS, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Monika Martens
- Department of Family Medicine and Population Health, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Maria Lazo-Porras
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hueiming Liu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Gade Waqa
- C-POND, Fiji National University, College of Medicine, Nursing and Health Sciences, Suva, Fiji
| | - Milena Soriano Marcolino
- Medical School and Telehealth Center, University Hospital, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Maria Eugenia Esandi
- Epidemiological Research Institute, National Academy of Medicine, Buenos Aires, Argentina
| | - Antonio Luiz Pinho Ribeiro
- Internal Medicine Department, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Head of Research and Innovation, Hospital das Clínicas, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - Ari Probandari
- Department of Public Health, Faculty of Medicine, Universitas Sebalas Maret, Saurakarta, Indonesia
| | - Francisco González-Salazar
- Departamento de Ciencias Básicas, Division de Ciencias de la Salud, Universidad de Monterrey, Monterrey, Mexico
| | - Abha Shrestha
- Department of Community Medicine, Kathmandu University School of Medical Sciences, Dhulikhel, Nepal
- Dhulikhel Hospital, Dhulikhel, Nepal
| | - Sujarwoto Sujarwoto
- Department of Public Administration, University of Brawijaya, Malang, Indonesia
| | - Naomi Levitt
- Chronic Disease Initiative for Africa, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Myriam Paredes
- Facultad Latinoamericana de Ciencias Sociales Sede Ecuador (FLACSO), Quito, Ecuador
| | - Tomohiko Sugishita
- Department of International Affairs and Tropical Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Malek Batal
- Nutrition Department, Faculty of Medicine, University of Montreal, Montreal, Québec, Canada
- Centre for Public Health Research (CReSP), Montreal, Québec, Canada
| | - Yuan Li
- Nutrition and Lifestyle Program, The George Institute for Global Health at Peking University Health Science Centre, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | | | | | - Feng J He
- Wolfson Institute of Population Health, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Sqaure, London, UK
| | - Puhong Zhang
- Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Heath at Peking University Health Science Center, Beijing, China
| | - Sayoki Godfrey Mfinanga
- Muhimbili Centre, National Institute for Medical Research, Dar es Salaam, Tanzania
- Liverpool School of Tropical Medicine, Liverpool, Liverpool, UK
| | - Jan-Walter De Neve
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Heidelberg, Germany
| | - Meena Daivadanam
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Global Public Health, Karolinska Instituet, Solna, Sweden
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, York, UK
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, USA
- Chan Zuckerberg Biohub, San Franciso, Caliornia, USA
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark D Huffman
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Cardiovascular Division and Global Health Center, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jacqui Webster
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Dike Ojji
- Department of Internal Medicine, Faculty of Clinical Sciences, University of Abuja and University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
| | - Andrea Beratarrechea
- Department of Research in Chronic Diseases, Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Maarten Postma
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | - Josephine Birungi
- Medical Research Council/Uganda Virus Research Institute & London School of Hygiene and Tropical Medicine (MRC/UVRI& LSHTM), Entebbe, Uganda
- The AIDS Support Organisation (TASO), Entebbe, Uganda
| | - Laura Antonietti
- Health Sciences Institute, Universidad Nacional Arturo Jauretche, Florencio Varela, Buenos Aires, Argentina
| | - Zulma Ortiz
- Epidemiological Research Institute, National Academy of Medicine, Buenos Aires, Argentina
| | - Anushka Patel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - David Peiris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Darcelle Schouw
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Jaap Koot
- Unit of Global Health, Department of Health Sciences, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health,Tokyo Medical and Dental University, Tokyo, Japan
| | - Gindo Tampubolon
- Global Development Institute, University of Manchester, Manchester, UK
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
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Galaviz KI, Colasanti JA, Kalokhe AS, Ali MK, Ofotokun I, Fernandez A. Factors associated with adherence to guideline-recommended cardiovascular disease prevention among HIV clinicians. Transl Behav Med 2021; 12:6371214. [PMID: 34529051 PMCID: PMC8764988 DOI: 10.1093/tbm/ibab125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Integrating cardiovascular disease (CVD) prevention in routine HIV care remains a challenge. This study aimed to identify factors associated with adherence to guideline-recommended CVD preventive practices among HIV clinicians. Clinicians from eight HIV clinics in Atlanta were invited to complete an online survey. The survey was informed by the Consolidated Framework for Implementation Research and assessed the following: clinician CVD risk screening and advice frequency (never to always), individual characteristics (clinician beliefs, self-efficacy, and motivation), inner setting factors (clinic culture, learning climate, leadership engagement, and resources available), and outer setting factors (peer pressure and patient needs). Bivariate correlations examined associations between these factors and guideline adherence. Thirty-eight clinicians completed the survey (82% women, mean age 42 years, 50% infectious disease physicians). For risk screening, clinicians always check patient blood pressure (median score 7.0/7), while they usually ask about smoking or check their blood glucose (median score 6.0/7). For advice provision, clinicians usually recommend quitting smoking, controlling cholesterol or controlling blood pressure (median score 6.0/7), while they often recommend controlling blood glucose, losing weight, or improving diet/physical activity (median score 5.5/7). Clinician beliefs, motivation and self-efficacy were positively correlated with screening and advice practices (r = .55−.84), while inner setting factors negatively correlated with lifestyle-related screening and advice practices (r = −.51 to −.76). Peer pressure was positively correlated with screening and advice practices (r = .57–.89). Clinician psychosocial characteristics and perceived peer pressure positively influence adherence to guideline-recommended CVD preventive practices. These correlates along with leadership engagement could be targeted with proven implementation strategies.
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Affiliation(s)
- Karla I Galaviz
- Department of Applied Health Science, Indiana University School of Public Health Bloomington, Bloomington, IN, USA
| | - Jonathan A Colasanti
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Infections Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Ameeta S Kalokhe
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Division of Infections Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Mohammed K Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Igho Ofotokun
- Division of Infections Disease, Emory University School of Medicine, Atlanta, GA, USA
| | - Alicia Fernandez
- School of Medicine, University of San Francisco California, San Francisco, CA, USA
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Spearman CW, Desalegn H, Ocama P, Awuku YA, Ojo O, Elsahhar M, Abdo AA, Ndububa DA, Fouad Y, Borodo MM, Ng'wanasayi M, Ally R, Elwakil R. The sub-Saharan Africa position statement on the redefinition of fatty liver disease: From NAFLD to MAFLD. J Hepatol 2021; 74:1256-1258. [PMID: 33484771 DOI: 10.1016/j.jhep.2021.01.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/07/2021] [Accepted: 01/10/2021] [Indexed: 02/08/2023]
Affiliation(s)
- C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town 7925, South Africa
| | - Hailemichael Desalegn
- Medical Department, St. Paul's Hospital, Millennium Medical College, Addis Ababa, Ethiopia
| | - Ponsiano Ocama
- School of Medicine, Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Yaw Asante Awuku
- Department of Medicine and Therapeutics, School of Medicine, University of Health and Allied Sciences, Ho, Ghana
| | - Olusegun Ojo
- Gastroenterology and Liver Pathology Unit, Department of Morbid Anatomy, Obafemi Awolowo University and Teaching Hospital Complex, Ile Ife, Nigeria
| | - Medhat Elsahhar
- Egyptian Association for the Study of Liver and Gastrointestinal Disease (EASLGD), Police Medical Academy, Cairo, Egypt
| | | | - Dennis Amajuoyi Ndububa
- Department of Medicine, Faculty of Clinical Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria
| | - Yasser Fouad
- Department of Gastroenterology, Hepatology and Endemic Medicine, Faculty of Medicine, Minia University, Minia, Egypt
| | | | | | - Reidwan Ally
- Departement of Gastroenterology, University of Witwatersr, Chris Hani Baraguanath Academic Hospital, Johansberg, South Africa
| | - Reda Elwakil
- Tropical Medicine Department, Faculty of Medicine, Ain Shams University, Egypt.
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Gesesew HA, Mwanri L, Stephens JH, Woldemichael K, Ward P. COVID/HIV Co-Infection: A Syndemic Perspective on What to Ask and How to Answer. Front Public Health 2021; 9:623468. [PMID: 33791266 PMCID: PMC8006273 DOI: 10.3389/fpubh.2021.623468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
The present commentary explored the intersecting nature of the COVID-19 and HIV pandemics to identify a shared research agenda using a syndemic approach. The research agenda posits the following questions. Questions around HIV infection, transmission, and diagnosis include: (i) molecular, genetic, clinical, and environmental assessments of COVID-19 in people living with HIV, (ii) alternative options for facility-based HIV testing services such as self- and home-based HIV testing, and (iii) COVID-19 related sexual violence and mental health on HIV transmission and early diagnosis. These and related questions could be assessed using Biopsychosocial and socio-ecological models. Questions around HIV treatment include: (i) the effect of COVID-19 on HIV treatment services, (ii) alternative options for facility-based treatment provision such as community-based antiretroviral therapy groups, and (iii) equitable distribution of treatment and vaccines for COVID-19, if successful. Bickman's logic model and the social determinants of health framework could guide these issues. The impact of stigma, the role of leveraging lessons on sustained intra-behavioral change, the role of medical mistrust and conspiracy beliefs, and the role of digital health on integrated management of HIV care and spectrum of care of COVID-19 need assessment using several frameworks including Goffman's stigma framework, Luhmann's Trust theory, and Gidden's theory of structuration. In conclusion, the potential research agenda of this commentary encompasses a variety of research fields and disciplinary areas-clinicians, laboratory scientists, public health practitioners, health economists, and psychologists-, and suggests several theoretical frameworks to guide examination of complex issues comprehensively.
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Affiliation(s)
- Hailay Abrha Gesesew
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
- Epidemiology, School of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Lillian Mwanri
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | - Jacqueline H. Stephens
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
| | | | - Paul Ward
- Flinders Health and Medical Research Institute, Flinders University, Adelaide, SA, Australia
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Kibachio J, Mwenda V, Ombiro O, Kamano JH, Perez‐Guzman PN, Mutai KK, Guessous I, Beran D, Kasaie P, Weir B, Beecroft B, Kilonzo N, Kupfer L, Smit M. Recommendations for the use of mathematical modelling to support decision-making on integration of non-communicable diseases into HIV care. J Int AIDS Soc 2020; 23 Suppl 1:e25505. [PMID: 32562338 PMCID: PMC7305412 DOI: 10.1002/jia2.25505] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 03/03/2020] [Accepted: 03/31/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Integrating services for non-communicable diseases (NCDs) into existing primary care platforms such as HIV programmes has been recommended as a way of strengthening health systems, reducing redundancies and leveraging existing systems to rapidly scale-up underdeveloped programmes. Mathematical modelling provides a powerful tool to address questions around priorities, optimization and implementation of such programmes. In this study, we examine the case for NCD-HIV integration, use Kenya as a case-study to highlight how modelling has supported wider policy formulation and decision-making in healthcare and to collate stakeholders' recommendations on use of models for NCD-HIV integration decision-making. DISCUSSION Across Africa, NCDs are increasingly posing challenges for health systems, which historically focused on the care of acute and infectious conditions. Pilot programmes using integrated care services have generated advantages for both provider and user, been cost-effective, practical and achieve rapid coverage scale-up. The shared chronic nature of NCDs and HIV means that many operational approaches and infrastructure developed for HIV programmes apply to NCDs, suggesting this to be a cost-effective and sustainable policy option for countries with large HIV programmes and small, un-resourced NCD programmes. However, the vertical nature of current disease programmes, policy financing and operations operate as barriers to NCD-HIV integration. Modelling has successfully been used to inform health decision-making across a number of disease areas and in a number of ways. Examples from Kenya include (i) estimating current and future disease burden to set priorities for public health interventions, (ii) forecasting the requisite investments by government, (iii) comparing the impact of different integration approaches, (iv) performing cost-benefit analysis for integration and (v) evaluating health system capacity needs. CONCLUSIONS Modelling can and should play an integral part in the decision-making processes for health in general and NCD-HIV integration specifically. It is especially useful where little data is available. The successful use of modelling to inform decision-making will depend on several factors including policy makers' comfort with and understanding of models and their uncertainties, modellers understanding of national priorities, funding opportunities and building local modelling capacity to ensure sustainability.
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Affiliation(s)
- Joseph Kibachio
- Division of Non‐communicable DiseasesMinistry of HealthKenya
- Faculty of MedicineUniversity of GenevaSwitzerlandGeneva
| | - Valerian Mwenda
- Division of Non‐communicable DiseasesMinistry of HealthKenya
| | - Oren Ombiro
- Division of Non‐communicable DiseasesMinistry of HealthKenya
| | - Jamima H Kamano
- Department of MedicineMoi University School of MedicineKenyaEldoret
- AMPATHKenyaLondon
| | - Pablo N Perez‐Guzman
- MRC Centre for Global Infectious Disease AnalysisDepartment of Infectious Disease EpidemiologyImperial College LondonLondonUnited Kingdom
| | | | - Idris Guessous
- Division of Primary Care MedicineGeneva University Hospital and University of GenevaGenevaSwitzerland
| | - David Beran
- Division of Tropical and Humanitarian MedicineUniversity of Geneva and Geneva University HospitalsGenevaSwitzerland
| | - Paratsu Kasaie
- John Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Brian Weir
- John Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Blythe Beecroft
- Fogarty International CenterNational Institutes of HealthBethesdaMDUSA
| | | | - Linda Kupfer
- Fogarty International CenterNational Institutes of HealthBethesdaMDUSA
| | - Mikaela Smit
- MRC Centre for Global Infectious Disease AnalysisDepartment of Infectious Disease EpidemiologyImperial College LondonLondonUnited Kingdom
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Holst J. Global Health - emergence, hegemonic trends and biomedical reductionism. Global Health 2020; 16:42. [PMID: 32375801 PMCID: PMC7201392 DOI: 10.1186/s12992-020-00573-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 04/22/2020] [Indexed: 02/08/2023] Open
Abstract
Background Global Health has increasingly gained international visibility and prominence. First and foremost, the spread of cross-border infectious disease arouses a great deal of media and public interest, just as it drives research priorities of faculty and academic programmes. At the same time, Global Health has become a major area of philanthropic action. Despite the importance it has acquired over the last two decades, the complex collective term “Global Health” still lacks a uniform use today. Objectives The objective of this paper is to present the existing definitions of Global Health, and analyse their meaning and implications. The paper emphasises that the term “Global Health” goes beyond the territorial meaning of “global”, connects local and global, and refers to an explicitly political concept. Global Health regards health as a rights-based, universal good; it takes into account social inequalities, power asymmetries, the uneven distribution of resources and governance challenges. Thus, it represents the necessary continuance of Public Health in the face of diverse and ubiquitous global challenges. A growing number of international players, however, focus on public-private partnerships and privatisation and tend to promote biomedical reductionism through predominantly technological solutions. Moreover, the predominant Global Health concept reflects the inherited hegemony of the Global North. It takes insufficient account of the global burden of disease, which is mainly characterised by non-communicable conditions, and the underlying social determinants of health. Conclusions Beyond resilience and epidemiological preparedness for preventing cross-border disease threats, Global Health must focus on the social, economic and political determinants of health. Biomedical and technocratic reductionism might be justified in times of acute health crises but entails the risk of selective access to health care. Consistent health-in-all policies are required for ensuring Health for All and sustainably reducing health inequalities within and among countries. Global Health must first and foremost pursue the enforcement of the universal right to health and contribute to overcoming global hegemony.
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Affiliation(s)
- Jens Holst
- Department of Nursing and Health Sciences, Fulda University of Applied Sciences, Leipziger Strasse 123, D-36037, Fulda, Germany.
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8
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Chronic Diseases Multimorbidity among Adult People Living with HIV at Hawassa University Comprehensive Specialized Hospital, Southern Ethiopia. Int J Chronic Dis 2020; 2020:2190395. [PMID: 32099838 PMCID: PMC6998747 DOI: 10.1155/2020/2190395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 12/16/2022] Open
Abstract
Background Due to the wide implementation of antiretroviral therapy (ART), people living with HIV (PLWHIV) are now living longer. This increased the risk of developing noncommunicable chronic diseases (NCCDs) among them. Objective We aimed to describe prevalence of NCCDs multimorbidity among PLWHIV at Hawassa University Comprehensive Specialized Hospital (HUCSH). Method In April 2016, institution-based cross-sectional study was conducted among PLWHIV, aged ≥ 18 years at the ART unit of HUCSH. A nurse working in the ART unit interviewed patients and reviewed medical records. Data on the NCCDs and its risk factors were obtained. List of diseases considered in this study were arthritis, diabetes mellitus, hypertension, congestive heart failure (CHF), rheumatic heart diseases (RHD), chronic bronchitis, asthma, and cancer. Results More than half of the respondents (196) had at least one of the NCCDs and 34 (8.9%) had multimorbidity. The main system of the body affected were the musculoskeletal system, 146 (38.2%) and respiratory system, 46 (12.0%). There was no significant difference in the prevalence of individual NCCDs by gender. Patients aged above 44 years, patients with ART duration of at least 6 years, and patients with higher CD4 counts had increased odds of having any one of the NCCDs. Multimorbidity patients with a longer ART duration had an increased risk. Conclusion The prevalence of NCCD multimorbidity among PLWHIV was high. Monitoring the occurrence of NCCDs among PLWHIV and noncommunicable disease care is recommended.
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Haldane V, Singh SR, Srivastava A, Chuah FLH, Koh GCH, Chia KS, Perel P, Legido-Quigley H. Community involvement in the development and implementation of chronic condition programmes across the continuum of care in high- and upper-middle income countries: A systematic review. Health Policy 2019; 124:419-437. [PMID: 31837832 DOI: 10.1016/j.healthpol.2019.11.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 11/10/2019] [Accepted: 11/29/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Community involvement is an important component of health programme development and implementation, including those focused on chronic condition treatment and management. Yet, few studies explore the manifestations of community involvement in chronic care programmes. Our review aims to examine the evidence on how communities are involved in planning and implementing chronic condition programmes in high and upper-middle income countries. METHODS Eligible studies included those that involved the community in the planning, implementation, monitoring and evaluation of health services, policy or health interventions. We searched Medline, Embase, Global Health, Scopus, and LILACs from 2000 to 2016, independently screened articles for inclusion, conducted data extraction, and assessed studies for risk of bias. RESULTS 27,232 records were identified and after screening, 32 met inclusion criteria. We conducted a narrative synthesis to report on the forms and processes of community involvement used across mental health programmes and contrast this with the paucity of evidence on comparable programmes addressing other chronic conditions. Challenges reported included user factors, organisational factors, and social challenges such as stigma. CONCLUSION Our review adds to the evidence supporting community involvement in chronic condition management and the processes that contribute to successful and sustainable involvement. We report on a model, derived from inductive analysis, that considers social and cultural components, organisational factors and stakeholder relationships as underpinning the development of community interventions across the care continuum.
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Affiliation(s)
- Victoria Haldane
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Shweta R Singh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Aastha Srivastava
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Fiona L H Chuah
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Gerald C H Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK; World Heart Federation, Geneva, Switzerland
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Tahir Foundation Building, 117549, Singapore; London School of Hygiene and Tropical Medicine, WC1H 9SH, UK; Department of Nursing and Physiotherapy, University of Lleida, Spain.
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Del Rio C. From Trained Infectious Diseases Clinician to Global Health Leader, Reflections on the Last 30 Years. J Infect Dis 2019; 216:S622-S623. [PMID: 28938037 DOI: 10.1093/infdis/jix258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Carlos Del Rio
- Hubert Department of Global Health, Rollins School of Public Health and Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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11
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Donkor A, Luckett T, Aranda S, Phillips J. Barriers and facilitators to implementation of cancer treatment and palliative care strategies in low- and middle-income countries: systematic review. Int J Public Health 2018; 63:1047-1057. [PMID: 29974131 DOI: 10.1007/s00038-018-1142-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/21/2018] [Accepted: 06/26/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To appraise improvement strategies adopted by low- and middle-income countries to increase access to cancer treatments and palliative care; and identify the facilitators and barriers to implementation. METHODS A systematic review was conducted and reported in accordance with PRISMA statement. MEDLINE, CINAHL, and the Cochrane Library databases were searched. Bias was assessed using the Standards for Quality Improvement Reporting Excellence, and evidence graded using the Australian National Health and Medical Research Council system. RESULTS Of 3069 articles identified, 18 studied were included. These studies involved less than a tenth (n = 12, 8.6%) of all low- and middle-income countries. Most were case reports (58%), and the majority focused on palliative care (n = 11, 61%). Facilitators included: stakeholder engagement, financial support, supportive learning environment, and community networks. Barriers included: lack of human resources, financial constraints, and limited infrastructure. CONCLUSIONS There is limited evidence on sustainable strategies for increasing access to cancer treatments and palliative care in low- and middle-income countries. Future strategies should be externally evaluated and be tailored to address service delivery; workforce; information; medical products, vaccines, and technologies; financing; and leadership and governance.
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Affiliation(s)
- Andrew Donkor
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, 2007, Australia. .,National Centre for Radiotherapy, Korle-Bu Teaching Hospital, Accra, Ghana.
| | - Tim Luckett
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Sanchia Aranda
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, 2007, Australia.,Cancer Council Australia, Sydney, NSW, Australia
| | - Jane Phillips
- Faculty of Health, IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, 2007, Australia
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12
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Palma AM, Rabkin M, Nuwagaba-Biribonwoha H, Bongomin P, Lukhele N, Dlamini X, Kidane A, El-Sadr WM. Can the Success of HIV Scale-Up Advance the Global Chronic NCD Agenda? Glob Heart 2016; 11:403-408. [PMID: 27938826 PMCID: PMC5157698 DOI: 10.1016/j.gheart.2016.10.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 10/04/2016] [Indexed: 11/30/2022] Open
Abstract
Noncommunicable diseases (NCD) are the leading causes of death and disability worldwide but have received suboptimal attention and funding from the global health community. Although the first United Nations General Assembly Special Session (UNGASS) for NCD in 2011 aimed to stimulate donor funding and political action, only 1.3% of official development assistance for health was allocated to NCD in 2015, even less than in 2011. In stark contrast, the UNGASS on human immunodeficiency virus and acquired immune deficiency syndrome (HIV/AIDS) in 2001 sparked billions of dollars in funding for HIV and enabled millions of HIV-infected individuals to access antiretroviral treatment. Using an existing analytic framework, we compare the global responses to the HIV and NCD epidemics and distill lessons from the HIV response that might be utilized to enhance the global NCD response. These include: 1) further educating and empowering communities and patients to increase demand for NCD services and to hold national governments accountable for establishing and achieving NCD targets; and 2) evidence to support the feasibility and effectiveness of large-scale NCD screening and treatment programs in low-resource settings. We conclude with a case study from Swaziland, a country that is making progress in confronting both HIV and NCD.
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Affiliation(s)
- Anton M Palma
- Department of Epidemiology, Columbia University, New York, NY, USA; ICAP at Columbia University, New York, NY, USA.
| | - Miriam Rabkin
- Department of Epidemiology, Columbia University, New York, NY, USA; ICAP at Columbia University, New York, NY, USA; Department of Medicine, Columbia University, New York, NY, USA
| | - Harriet Nuwagaba-Biribonwoha
- Department of Epidemiology, Columbia University, New York, NY, USA; ICAP at Columbia University, New York, NY, USA
| | - Pido Bongomin
- Department of Epidemiology, Columbia University, New York, NY, USA; ICAP at Columbia University, New York, NY, USA
| | | | | | | | - Wafaa M El-Sadr
- Department of Epidemiology, Columbia University, New York, NY, USA; ICAP at Columbia University, New York, NY, USA; Department of Medicine, Columbia University, New York, NY, USA
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13
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Afable A, Karingula NS. Evidence based review of type 2 diabetes prevention and management in low and middle income countries. World J Diabetes 2016; 7:209-229. [PMID: 27226816 PMCID: PMC4873312 DOI: 10.4239/wjd.v7.i10.209] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/28/2016] [Accepted: 03/09/2016] [Indexed: 02/05/2023] Open
Abstract
AIM: To identify the newest approaches to type 2 diabetes (T2DM) prevention and control in the developing world context.
METHODS: We conducted a systematic review of published studies of diabetes prevention and control programs in low and middle-income countries, as defined by the World Bank. We searched PubMed using Medical Subject Headings terms. Studies needed to satisfy four criteria: (1) Must be experimental; (2) Must include patients with T2DM or focusing on prevention of T2DM; (3) Must have a lifestyle intervention component; (4) Must be written in English; and (5) Must have measurable outcomes related to diabetes.
RESULTS: A total of 66 studies from 20 developing countries were gathered with publication dates through September 2014. India contributed the largest number of trials (11/66). Of the total 66 studies reviewed, all but 3 studies reported evidence of favorable outcomes in the prevention and control of type 2 diabetes. The overwhelming majority of studies reported on diabetes management (56/66), and among these more than half were structured lifestyle education programs. The evidence suggests that lifestyle education led by allied health professionals (nurses, pharmacists) were as effective as those led by physicians or a team of clinicians. The remaining diabetes management interventions focused on diet or exercise, but the evidence to recommend one approach over another was weak.
CONCLUSION: Large experimental diabetes prevention/control studies of dietary and exercise interventions are lacking particularly those that consider quality rather than quantity of carbohydrates and alternative exercise.
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14
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Abstract
Diabetes is among the biggest of the 21st-century global health challenges. In the U.S. and other high-income countries, thanks to investments in science, dedication to implementing these findings, and measurement of quality of care, there have been improvements in diabetes management and declines in rate of diabetes complications and mortality. This good news, however, is overshadowed by the ever-increasing absolute numbers of people with diabetes and its complications and the unprecedented growth of diabetes in low- and middle-income countries of the world. To comprehensively win the war against diabetes requires 1) concerted attention to prevention and 2) expansion of global research to better inform population-level policies to curb diabetes but also to better understand individual- and population-level variations in pathophysiology and phenotypes globally so that prevention and treatment can be tailored. For example, preliminary data show that thin people in low- and middle-income countries such as India commonly experience type 2 diabetes. Global studies comparing these thin Asian Indians with other high-risk groups such as Pima Indians, a population with a high mean BMI, suggest that type 2 diabetes may not be a single pathophysiological entity. Pima Indians may represent the well-studied phenotype of poor insulin action (type 2A), whereas Asian Indians represent the grossly understudied phenotype of poor insulin secretion (type 2B). This has major implications for diagnosis, prevention, and treatment and highlights the mismatch between where diabetes burdens occur (i.e., low- and middle-income countries) and where research happens (i.e., high-income countries). Correcting this imbalance will advance our knowledge and arsenal to win the global war against diabetes.
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Affiliation(s)
- K M Venkat Narayan
- Emory Global Diabetes Research Center, Hubert Department of Global Health, Rollins School of Public Health, and Department of Medicine, School of Medicine, Emory University, Atlanta, GA
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15
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Gupta N, Bukhman G. Leveraging the lessons learned from HIV/AIDS for coordinated chronic care delivery in resource-poor settings. HEALTHCARE-THE JOURNAL OF DELIVERY SCIENCE AND INNOVATION 2015; 3:215-20. [PMID: 26699346 DOI: 10.1016/j.hjdsi.2015.09.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/22/2015] [Accepted: 09/29/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Neil Gupta
- Division of Global Health Equity, Brigham & Women's Hospital, Boston, USA; Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda.
| | - Gene Bukhman
- Division of Global Health Equity, Brigham & Women's Hospital, Boston, USA; Partners in Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Program in Global Non-Communicable Diseases and Social Change, Harvard Medical School, Boston, USA
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16
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Im H, Castro CM, Shao H, Liong M, Song J, Pathania D, Fexon L, Min C, Avila-Wallace M, Zurkiya O, Rho J, Magaoay B, Tambouret RH, Pivovarov M, Weissleder R, Lee H. Digital diffraction analysis enables low-cost molecular diagnostics on a smartphone. Proc Natl Acad Sci U S A 2015; 112:5613-8. [PMID: 25870273 PMCID: PMC4426451 DOI: 10.1073/pnas.1501815112] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The widespread distribution of smartphones, with their integrated sensors and communication capabilities, makes them an ideal platform for point-of-care (POC) diagnosis, especially in resource-limited settings. Molecular diagnostics, however, have been difficult to implement in smartphones. We herein report a diffraction-based approach that enables molecular and cellular diagnostics. The D3 (digital diffraction diagnosis) system uses microbeads to generate unique diffraction patterns which can be acquired by smartphones and processed by a remote server. We applied the D3 platform to screen for precancerous or cancerous cells in cervical specimens and to detect human papillomavirus (HPV) DNA. The D3 assay generated readouts within 45 min and showed excellent agreement with gold-standard pathology or HPV testing, respectively. This approach could have favorable global health applications where medical access is limited or when pathology bottlenecks challenge prompt diagnostic readouts.
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Affiliation(s)
- Hyungsoon Im
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114; Department of Radiology, Massachusetts General Hospital, Boston, MA 02114
| | - Cesar M Castro
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114; Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA 02114
| | - Huilin Shao
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | - Monty Liong
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | - Jun Song
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114; School of Engineering and Applied Sciences, Harvard University, Cambridge, MA 02138
| | - Divya Pathania
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114; Department of Radiology, Massachusetts General Hospital, Boston, MA 02114
| | - Lioubov Fexon
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | - Changwook Min
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | - Maria Avila-Wallace
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114
| | - Omar Zurkiya
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114; Department of Radiology, Massachusetts General Hospital, Boston, MA 02114
| | - Junsung Rho
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | - Brady Magaoay
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114
| | | | - Misha Pivovarov
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114; Department of Radiology, Massachusetts General Hospital, Boston, MA 02114
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114; Department of Radiology, Massachusetts General Hospital, Boston, MA 02114; Department of Systems Biology, Harvard Medical School, Boston, MA 02115
| | - Hakho Lee
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114; Department of Radiology, Massachusetts General Hospital, Boston, MA 02114;
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Pietrabissa G, Ceccarini M, Borrello M, Manzoni GM, Titon A, Nibbio F, Montano M, Bertone G, Gondoni L, Castelnuovo G. Enhancing behavioral change with motivational interviewing: a case study in a Cardiac Rehabilitation Unit. Front Psychol 2015; 6:298. [PMID: 25852614 PMCID: PMC4364083 DOI: 10.3389/fpsyg.2015.00298] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 03/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Psychological interventions in cardiac rehabilitation programs appear relevant in as much they significantly contribute to achieve the goals of rehabilitation, to reduce the risk of relapses and to improve patients' adherence to therapy. To this aim, motivational interviewing (MI) has shown promising results in improving motivation to change and individuals' confidence in their ability to do so. OBJECTIVE The purpose of this article is to integrate theory with practice by describing a three-session case scenario. It illustrates how MI's skills and strategies can be used to enhance heart-healthy habits. MI may be synergistic with other treatment approaches and it is used here in conjunction with brief strategic therapy. CONCLUSION By the use of MI principles and techniques, the patient reported an increase in his motivation and ability to change, developing a post discharge plan that incorporates self-care behaviors. CLINICAL IMPLICATIONS MI may be effective in motivating and facilitating health behavior change among obese patients suffering from heart failure.
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Affiliation(s)
- Giada Pietrabissa
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Martina Ceccarini
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Maria Borrello
- Faculty of Psychology, University of Bergamo, BergamoItaly
| | - Gian Mauro Manzoni
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
| | - Annamaria Titon
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Ferruccio Nibbio
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Mariella Montano
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianandrea Bertone
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Luca Gondoni
- Cardiac Rehabilitation Unit, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Saint Joseph Hospital, VerbaniaItaly
- Department of Psychology, Catholic University of Milan, MilanItaly
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18
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Affiliation(s)
- Craig Van Dyke
- a Department of Psychiatry and Global Health Sciences, University of California, San Francisco
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19
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Practicalities and challenges in re-orienting the health system in Zambia for treating chronic conditions. BMC Health Serv Res 2014; 14:295. [PMID: 25005125 PMCID: PMC4094789 DOI: 10.1186/1472-6963-14-295] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/02/2014] [Indexed: 11/26/2022] Open
Abstract
Background The rapid evolution in disease burdens in low- and middle income countries is forcing policy makers to re-orient their health system towards a system which has the capability to simultaneously address infectious and non-communicable diseases. This paper draws on two different but overlapping studies which examined how actors in the Zambian health system are re-directing their policies, strategies and service structures to include the provision of health care for people with chronic conditions. Methods Study methods in both studies included semi-structured interviews with government health officials at national level, and governmental and non-governmental health practitioners operating from community-, primary health care to hospital facility level. Focus group discussions were conducted with staff, stakeholders and caregivers of programmes providing care and support at community- and household levels. Study settings included urban and rural sites. Results A series of adaptations transformed the HIV programme from an emergency response into the first large chronic care programme in the country. There are clear indications that the Zambian government is intending to expand this reach to patients with non-communicable diseases. Challenges to do this effectively include a lack of proper NCD prevalence data for planning, a concentration of technology and skills to detect and treat NCDs at secondary and tertiary levels in the health system and limited interest by donor agencies to support this transition. Conclusion The reorientation of Zambia’s health system is in full swing and uses the foundation of a decentralised health system and presence of local models for HIV chronic care which actively involve community partners, patients and their families. There are early warning signs which could cause this transition to stall, one of which is the financial capability to resource this process.
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Haregu TN, Setswe G, Elliott J, Oldenburg B. National Responses to HIV/AIDS and Non-Communicable Diseases in Developing Countries: Analysis of Strategic Parallels and Differences. J Public Health Res 2014; 3:99. [PMID: 25170505 PMCID: PMC4140380 DOI: 10.4081/jphr.2014.99] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/28/2014] [Indexed: 11/27/2022] Open
Abstract
HIV/AIDS and non-communicable diseases (NCDs) epidemics may have many important similarities in their aetiology, pathogenesis and management. Evidence about the similarities and differences between the national responses HIV/AIDS and NCDs is essential for an integrated response. The objective of this study was to examine the parallels and differences between national responses to HIV/AIDS and NCDs in selected developing countries. This study applied a strategic level comparative case study approach as its study design. The main construct was national response to HIV/AIDS and NCDs. The 4 overarching themes were policy response, institutional mechanism, programmatic response and strategic information. Four countries were purposively selected as cases. Data were collected and triangulated from a multiple sources. The focus of analysis included identifying items for comparison, characteristics to be compared, degrees of similarity, and strategic importance of similarities. Analysis of data was qualitative content analysis with within-case, between-case, and across-case comparisons. While the nature of the disease and the contents of national HIV/AIDS and NCD policies are different, the policy processes involved are largely similar. Functional characteristics of programmatic response to HIV/AIDS and NCDs are similar. But the internal constituents are different. Though both HIV and NCDs require both a multi-sectorial response and a national coordination mechanism, the model and the complexity of the coordination are different. Strategic information frameworks for HIV/AIDS and NCDs use similar models. However, the indicators, targets and priorities are different. In conclusion, the national responses between HIV/AIDS and NCDs are largely similar in approaches and functions but different in content. Significance for public health This study explores the parallels and differences between national responses to HIV/AIDS and non-communicable diseases (NCDs). The identified parallels can be the basis for integrated response to HIV/AIDS and NCDs. In contrast, the important differences are essential for maintaining the integrity of the responses to HIV/AIDS and NCDs in the process of integration.
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Affiliation(s)
- Tilahun Nigatu Haregu
- Department of Epidemiology and Preventive Medicine, Monash University , Melbourne, Australia
| | - Geoffrey Setswe
- School of Health Sciences, Monash University , Ruimsig, South Africa
| | - Julian Elliott
- Infectious Disease Unit, Alfred Hospital , Melbourne, Australia
| | - Brian Oldenburg
- Department of Epidemiology and Preventive Medicine, Monash University , Melbourne, Australia
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Abstract
Cancer and non-communicable diseases (ncds) sharing common causal risk factors are not under control [...]
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Atun R, Jaffar S, Nishtar S, Knaul FM, Barreto ML, Nyirenda M, Banatvala N, Piot P. Improving responsiveness of health systems to non-communicable diseases. Lancet 2013; 381:690-7. [PMID: 23410609 DOI: 10.1016/s0140-6736(13)60063-x] [Citation(s) in RCA: 183] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ogweno AW, Grice GR. Global management of chronic disease in sub-Saharan Africa: A call to action for pharmacists. J Am Pharm Assoc (2003) 2012; 52:e292-5. [DOI: 10.1331/japha.2012.12072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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In the shadow of HIV/AIDS: forgotten diseases in sub-Saharan Africa: global health issues and funding agency responsibilities. J Public Health Policy 2012; 33:430-8. [PMID: 22895470 DOI: 10.1057/jphp.2012.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The HIV/AIDS pandemic has generated international solidarity, particularly with sub-Saharan Africa. The mainly vertical approach to this challenge has, however, mobilized so much attention and so many resources that other crucial public health problems, such as chronic viral hepatitis and non-communicable diseases (NCDs), have been left in the shadows. One year after the first official World Hepatitis Day launched by WHO and the first UN meeting on NCDs, the world needs a vigorous debate on a more comprehensive approach to public health challenges in developing countries.
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HIV, aging and continuity care: strengthening health systems to support services for noncommunicable diseases in low-income countries. AIDS 2012; 26 Suppl 1:S77-83. [PMID: 22781180 DOI: 10.1097/qad.0b013e3283558430] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Although health systems in most low-income countries largely provide episodic care for acute symptomatic conditions, many HIV programs have developed effective, locally owned and contextually appropriate policies, systems and tools to support chronic care services for persons living with HIV (PLWH). The continuity of care provided by such programs may be especially critical for older PLWH, who are at risk for more rapid progression of disease and are more likely to have complications of HIV and its treatment than their younger counterparts. Older PLWH are also more likely to have other chronic noncommunicable diseases (NCDs), including hypertension, diabetes, cancers and chronic lung disease. As the number of older PLWH rises, enhanced chronic care systems will be required to optimize their health and wellbeing. These systems, lessons and resources can also be leveraged to support the burgeoning numbers of HIV-negative individuals with chronic NCD in need of ongoing care.
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Heymann EP, Goldsmith D. Best approaches in the battle against Globesity? Learning lessons from our experience tackling HIV-AIDS and tobacco smoking. JRSM SHORT REPORTS 2012; 3:45. [PMID: 22908026 PMCID: PMC3422850 DOI: 10.1258/shorts.2012.011159] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
In 2008, two-thirds of the annual global death toll was attributable to non-communicable diseases (NCDs). Defined as chronic conditions often caused or exacerbated by non-obligated lifestyle behaviours, the NCD epidemic has been fuelled by a combination of risk factors, including tobacco use, an unhealthy diet combined with lack of physical activity and overweight-obesity, and harmful alcohol use. The health consequences are mainly seen as cardiovascular diseases, diabetes, cancers and chronic respiratory problems. Generally associated with the West, they are now recognized as a global threat to public health. They are also an unsupportable global health economic burden. NCDs incidence can be significantly reduced through the adoption of proven and affordable interventional measures which are complementary to global health efforts already underway. To head off the certain future surge in morbidity and mortality, at record costs to health budgets worldwide, there is a pressing need to change global population's behaviours and choices in relation to these risk factors. The most pressing challenge in NCD prevention is combating the rise in overweight-obesity, which threatens individuals, communities and countries as never before. If not overcome, this may undo much of the progress seen in reducing the incidence of myocardial infarctions, strokes and some cancers evident from the 1960s onwards.
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Affiliation(s)
- Eric P Heymann
- King's Health Partners AHSC, Renal Department, Guy's Hospital , Great Maze Pond, London SE1 9RT , UK
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Bergman M, Buysschaert M, Schwarz PEH, Albright A, Narayan KMV, Yach D. Diabetes prevention: global health policy and perspectives from the ground. ACTA ACUST UNITED AC 2012; 2:309-321. [DOI: 10.2217/dmt.12.34] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Hendriks ME, Wit FWNM, Roos MTL, Brewster LM, Akande TM, de Beer IH, Mfinanga SG, Kahwa AM, Gatongi P, Van Rooy G, Janssens W, Lammers J, Kramer B, Bonfrer I, Gaeb E, van der Gaag J, Rinke de Wit TF, Lange JMA, Schultsz C. Hypertension in sub-Saharan Africa: cross-sectional surveys in four rural and urban communities. PLoS One 2012; 7:e32638. [PMID: 22427857 PMCID: PMC3299675 DOI: 10.1371/journal.pone.0032638] [Citation(s) in RCA: 240] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 01/28/2012] [Indexed: 12/18/2022] Open
Abstract
Background Cardiovascular disease (CVD) is the leading cause of adult mortality in low-income countries but data on the prevalence of cardiovascular risk factors such as hypertension are scarce, especially in sub-Saharan Africa (SSA). This study aims to assess the prevalence of hypertension and determinants of blood pressure in four SSA populations in rural Nigeria and Kenya, and urban Namibia and Tanzania. Methods and Findings We performed four cross-sectional household surveys in Kwara State, Nigeria; Nandi district, Kenya; Dar es Salaam, Tanzania and Greater Windhoek, Namibia, between 2009–2011. Representative population-based samples were drawn in Nigeria and Namibia. The Kenya and Tanzania study populations consisted of specific target groups. Within a final sample size of 5,500 households, 9,857 non-pregnant adults were eligible for analysis on hypertension. Of those, 7,568 respondents ≥18 years were included. The primary outcome measure was the prevalence of hypertension in each of the populations under study. The age-standardized prevalence of hypertension was 19.3% (95%CI:17.3–21.3) in rural Nigeria, 21.4% (19.8–23.0) in rural Kenya, 23.7% (21.3–26.2) in urban Tanzania, and 38.0% (35.9–40.1) in urban Namibia. In individuals with hypertension, the proportion of grade 2 (≥160/100 mmHg) or grade 3 hypertension (≥180/110 mmHg) ranged from 29.2% (Namibia) to 43.3% (Nigeria). Control of hypertension ranged from 2.6% in Kenya to 17.8% in Namibia. Obesity prevalence (BMI ≥30) ranged from 6.1% (Nigeria) to 17.4% (Tanzania) and together with age and gender, BMI independently predicted blood pressure level in all study populations. Diabetes prevalence ranged from 2.1% (Namibia) to 3.7% (Tanzania). Conclusion Hypertension was the most frequently observed risk factor for CVD in both urban and rural communities in SSA and will contribute to the growing burden of CVD in SSA. Low levels of control of hypertension are alarming. Strengthening of health care systems in SSA to contain the emerging epidemic of CVD is urgently needed.
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Affiliation(s)
- Marleen E Hendriks
- Department of Global Health, Academic Medical Center, University of Amsterdam, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands.
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Miranda JJ, Bernabe-Ortiz A, Smeeth L, Gilman RH, Checkley W. Addressing geographical variation in the progression of non-communicable diseases in Peru: the CRONICAS cohort study protocol. BMJ Open 2012; 2:e000610. [PMID: 22240652 PMCID: PMC3278488 DOI: 10.1136/bmjopen-2011-000610] [Citation(s) in RCA: 84] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background The rise in non-communicable diseases in developing countries has gained increased attention. Given that around 80% of deaths related to non-communicable diseases occur in low- and middle-income countries, there is a need for local knowledge to address such problems. Longitudinal studies can provide valuable information about disease burden of non-communicable diseases in Latin America to inform both public health and clinical settings. Methods The CRONICAS cohort is a longitudinal study performed in three Peruvian settings that differ by degree of urbanisation, level of outdoor and indoor pollution and altitude. The author sought to enrol an age- and sex-stratified random sample of 1000 participants at each site. Study procedures include questionnaires on socio-demographics and well-known risk factors for cardiopulmonary disease, blood draw, anthropometry and body composition, blood pressure and spirometry before and after bronchodilators. All participants will be visited at baseline, at 20 and 40 months. A random sample of 100 households at each site will be assessed for 24 h particulate matter concentration. Primary outcomes include prevalence of risk factors for cardiopulmonary diseases, changes in blood pressure and blood glucose over time and decline in lung function. Discussion There is an urgent need to characterise the prevalence and burden of non-communicable diseases in low- and middle-income countries. Peru is a middle-income country currently undergoing a rapid epidemiological transition. This longitudinal study will provide valuable information on cardiopulmonary outcomes in three different settings and will provide a platform to address potential interventions that are locally relevant or applicable to other similar settings in Latin America.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Epidemiology Unit, School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Liam Smeeth
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Robert H Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
- Área de Investigación y Desarrollo, Asociación Benéfica PRISMA, Lima, Peru
| | - William Checkley
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, USA
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
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