Association of vaccine stockout with immunisation coverage in low-income and middle-income countries: a retrospective cohort study.

OBJECTIVES: This study investigated the association between vaccine stockout and immunisation coverage, and infant/under 5 mortality rates. DESIGN: A retrospective cohort study. SETTING: Low-income and middle-income countries. PARTICIPANTS: A cohort of 131 low-income and middle-income countries from 2004 to 2019. PRIMARY OUTCOME MEASURES: Main outcomes included immunisation coverages of (1) diphtheria-tetanus-pertussis containing vaccine (DTP), (2) measles containing vaccine (MCV), (3) BCG and (4) oral polio vaccine (OPV). We also included infant and under 5 mortality rates as secondary outcomes. RESULTS: The countries that experienced national-level stockouts of DTP and MCV had 3.7 and 4 percentage points lower coverage rates of DTP3 and MCV1, respectively, compared with the countries without the stockout events (p<0.01). Moreover, the statistically significant differences in the immunisation coverage rates across the countries with and without the stockout events are 2.4 percentage points and 2.6 percentage points for BCG and OPV, respectively (p<0.01). CONCLUSION: Our findings show that the incidence of vaccine stockout events is associated with the decreased immunisation coverages for children in low-income and middle-income countries. However, we did not observe a statistically significant association between the increasing frequency of vaccine stockout and infant and under 5 mortality rates.

Evidence-based programming for adolescent HIV prevention and care: operational research to inform best practices.

BACKGROUND: Globally, a staggering number of adolescents, approximately 2.1 million, were estimated to be living with HIV in 2012. Unique developmental, psychosocial, and environmental considerations make them particularly vulnerable to HIV acquisition and argue for a comprehensive response to address this burgeoning problem. METHODS: This article explores the current state of the science of HIV prevention, treatment, and care for adolescents and identifies opportunities to address knowledge gaps and improve health outcomes for this age group. RESULTS: Over the past decade, several important milestones have been achieved in HIV prevention and care among adults, and despite evidence that adherence to care and medications among affected adolescents is significantly compromised, critical research among adolescents and young adults substantially lags behind. Operational research, in particular, is crucial to understanding how to use effective services and interventions for HIV prevention and care safely and effectively for adolescents who are in dire need. CONCLUSIONS: Operational research among adolescent populations affected by HIV is critically needed to close the knowledge and investment gaps, and scale-up efforts for HIV prevention, treatment, care, and support for this vulnerable age group.

Informing policy and programme decisions for scaling up the PMTCT and paediatric HIV response through joint technical missions.

In 2005, due to slow global progress in the scale-up of prevention of mother-to-child transmission (PMTCT) and paediatric HIV programmes, the Inter-agency Task Team (IATT) on the Prevention of HIV infection among Pregnant Women, Mothers, and their Children initiated joint technical missions (JTMs) to countries of high HIV disease burden. The JTMs were intended to galvanize country actions for a more comprehensive response to PMTCT and paediatric HIV by bringing national and global stakeholders together to review national policies and programmes and develop country-specific recommendations for accelerating scale-up. Between 2005 and 2010, the IATT conducted JTMs in 18 low- and middle-income countries. In 2007, to assess the role played by the missions, a review in the first eight countries (Burkina Faso, Cameroon, Côte d'Ivoire, India, Malawi, Rwanda, Tanzania and Zambia) that hosted JTMs was undertaken. Country progress was assessed through desk review and key informant interviews. For each country, documents reviewed included JTM reports, baseline data for PMTCT and paediatric HIV care and treatment, and 2004 to 2007 trend data on key PMTCT and paediatric HIV indicators. Drawing upon the findings, this paper posits that JTMs contributed to national scale-up of PMTCT and paediatric HIV programmes through strengthening governance and co-ordination mechanisms for the programmes, promoting enabling policy environments, and supporting the development of national scale-up plans, which have been critical for leveraging additional financial resources for scale-up. Although the impact of the JTMs could be enhanced through greater follow-up and continued targeted assistance in technical areas such as infant and young child feeding, community-based programming and supply chain management, findings indicate that the JTMs are a useful mechanism for informing policy and programme decisions necessary for scaling up PMTCT and paediatric HIV responses. Moreover, by bringing stakeholders together around unified action plans, the JTMs created a platform for common action-a key tenet of the 'Three Ones' principles for effective HIV/AIDS responses.

Towards an improved investment approach for an effective response to HIV/AIDS.

Substantial changes are needed to achieve a more targeted and strategic approach to investment in the response to the HIV/AIDS epidemic that will yield long-term dividends. Until now, advocacy for resources has been done on the basis of a commodity approach that encouraged scaling up of numerous strategies in parallel, irrespective of their relative effects. We propose a strategic investment framework that is intended to support better management of national and international HIV/AIDS responses than exists with the present system. Our framework incorporates major efficiency gains through community mobilisation, synergies between programme elements, and benefits of the extension of antiretroviral therapy for prevention of HIV transmission. It proposes three categories of investment, consisting of six basic programmatic activities, interventions that create an enabling environment to achieve maximum effectiveness, and programmatic efforts in other health and development sectors related to HIV/AIDS. The yearly cost of achievement of universal access to HIV prevention, treatment, care, and support by 2015 is estimated at no less than US$22 billion. Implementation of the new investment framework would avert 12·2 million new HIV infections and 7·4 million deaths from AIDS between 2011 and 2020 compared with continuation of present approaches, and result in 29·4 million life-years gained. The framework is cost effective at $1060 per life-year gained, and the additional investment proposed would be largely offset from savings in treatment costs alone.