Challenges Accessing PrEP for HIV Prevention in England

The successful integration of HIV prevention programs that increase testing and offer early treatment for infected individuals is contributing to reductions in new HIV infections. By 2016, the 5,164 HIV diagnoses in gay and bisexual men living in England represented an 18% decline compared to the 6,286 diagnosis in 2015.  Secure integration of pre-exposure prophylaxis (PrEP) will continue to reduce infections. HIV prevention programs need to address persistent barriers and doubts however, including limited access of PrEP in England. Continue reading “Challenges Accessing PrEP for HIV Prevention in England”

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Global Health Weekly News Round-Up

Politics and Policies:

  • The Obama administration has given conditional approval to health insurance market places being set up by six states led by Democratic governors.
  • New Jersey Assembly panel passes a bill allowing driver’s licenses to include diabetic condition.
  • The Environmental Protection Agency (E.P.A.) has set a standard in the middle of the range of 11- 13 micrograms per cubic meter for the soot particles in the air.
  • Michigan works to ban synthetic drug phenethylamine.

Programs:

  • The United Nations (UN) has asked for $8.5 billion to deliver urgent humanitarian aid to 51 million people in crisis-stricken countries around the world in 2013.
  • The U N has launched an initiative to help to eliminate cholera in Haiti and the Dominican Republic.
  • Emergency vaccinations campaign has been organized in Sudan by its Federal Ministry of Health against mosquito- borne yellow fever.
  • Third phase of measles and rubella (MR) vaccination campaign has been started in Nepal.
  • The UN has warned that nearly 55 million tons of radioactive waste from old Soviet-era uranium mines in unsecured sites in northern Tajikistan.
  • The state of Iowa is planning to spend $3.2 million on tobacco prevention and cessation.
  • MidMichigan Health receives grant to fight childhood obesity.

Research:

  • A Sudanese neurologist has succeeded in giving the first clinical and psychological description of spastic paraplegia.
  • Researchers at the University of California and the University of Oxford have found a link between type-2 diabetes and corn syrup consumption.
  • A study published in Lancet states that air pollution tops the list of major health risk among the developing countries.
  • A study finds years living with disease and injury increasing globally.
  • In a study done by the researchers in United Kingdom, they found a link between the foliate consumption and risk of developing breast cancer.
  • The Food and Drug Administration (FDA) has given approval for Chronic Myeloid Leukemia (CML) and Philadelphia Chromosome positive acute lymphoblastic leukemia (ALL).
  • According to a study about 10% of the 6- 8 year old children of Finland have sleep – disordered breathing.
  • Experts say “plethora” of diseases caused by low vitamin D.
  • A study links work place bullying to developing risk for anxiety/ depression/ psychological problems.
  • A study done by the U.S. researcher’s show that Blacks have higher risk of heart disease.  They have a double risk of dying of coronary disease.
  • A study links drinking coffee with reduction in risk of throat and mouth cancer. It states that drinking more than four cups of coffee can cause significant rate of risk reduction.
  • Researchers at University of Copenhagen have found a very important function of BRCA2 gene. This knowledge could be used for the treatment of breast cancer.
  • A 2010 study states that the television in bedrooms may boost heart disease and diabetes among the children.
  • A study links innate immunity and inflammation pathway with advanced prostate cancer risk.

 Diseases and Disasters:

  • Outbreak of diarrhea killed seven people from lower Shabelle region in Southern Somalia.
  • A report released by the Centers of Disease Control and Prevention (CDC) states that Alaska ranks number one in United States for Chlamydia.
  • Seventh death due to fungal meningitis has been  reported in Indiana (U.S.).
  • A report released by the Centers of Disease Control and Prevention (CDC) states that Louisiana leads the nation in rates of gonorrhea and syphilis cases.
  • Drug resistant infection cluster has been reported in South Dakota. People who are healthy are not at risk as compared to those on ventilators, urinary or intravenous catheters or long courses of certain antibiotics.

 

 

 

 

APHA Mid-Year Meeting, Day 2: Public Health Jobs, Prevention, and Wellness (and why the heck does APHA serve sodas at lunch?)

I get frustrated sometimes with the academic nature of policy presentations. I have spent enough time in masters classes and government work to be used to lofty language and bureaucracy-speak, but I wonder at its utility at a conference that is focusing on how the public health rubber is meeting the road in this climate of health reform. The breakout session I attended this morning was on the public health workforce. I scratched my head while trying to understand the connection between the session topic and the Brian Smedley’s (from the Joint Center for Political and Economic Studies) presentation on the disparities between white-dominated and minority neighborhoods (the moderator had to make the connection for the audience). Cynthia Lamberth from the University of Kentucky raised some good points on planning for changes in the number of public health workers that will be driven by reform. She said that while many universities and states are in a “wait and see” mode, we cannot afford to wait – hospitals and clinical establishments and planning now, and the field of public health should be following suit. (She also pointed out the convoluted and outdated hiring practices that make it so difficult for public health graduates to get jobs in academia or with the government, which I definitely appreciated).

The presentation that got me up to the microphone, however, was one by John Lisco of the CDC on their various fellowship programs. Any students or recent graduates reading this blog are most likely familiar with at least a few of these programs – Public Health Prevention Service, Epidemic Intelligence Service, Presidential Management Fellows, etc. – and are also familiar with how incredibly competitive they are. The competitiveness of a program is not a bad thing in and of itself, but in an economic climate (and corresponding job market) like ours, finding work is extremely difficult no matter where the vacancy is. On top of that, many of these fellowship programs have highly specific rubrics and ranking criteria – while the essays have very vague prompts. You have to know someone on the inside to know what the selection panel is looking for in your essay, and how to make yourself stand out among thousands of qualified applicants.

On the other hand, it was great to hear about the experiences of communities implementing prevention and wellness program during the afternoon sessions. Major areas of focus included obesity, smoking cessation, and working to make health foods available in low socioeconomic neighborhoods. I was particularly impressed by the results of tobacco-cessation program in Indiana presented by Carla Sneegas, Executive Director of the Indiana Tobacco Prevention and Cessation Program. The program used a fax-referral system that targeted employers, allowing them to fax in a form to enroll in the program to help their employees quit smoking. The program utilized various approaches, including “quitting competitions” and monetary incentives, and some employers had cessation rates of 50% or more. Kudos to Ryan Kellog from Seattle and King County for calling out APHA on having soft drinks at lunch. He added a slide at the end of his presentation on the Communities Putting Prevention to Work program in King County with the picture of the spread with Coke, Sprite, and Diet Coke. “Why the heck were there sugar-sweetened beverages at lunch today?” Good question, indeed.

Global HIV Prevention—Check!

by Kate McQuestion E-mail
In 2006, an article in the New England Journal of Medicine cited the substantial success of the implementation of a routine checklist on reducing catheter-related infections in the Intensive Care Unit of a Michigan Hospital. This story was shortly followed by media uptake the WHO Patient Safety Checklist, which, when utilized, reduced surgery-related mortality by almost 50%. The clinical use of checklists has become a hot topic for clinical quality improvement advocates, and as such, they been generally embraced in some areas of clinical practice.

Could this kind of tool be effective in public health?

The concept of a checklist is, intentionally, simple. The checklist serves as a mechanism to combat human failures of attention or memory—particularly in high stress or repetitive environments. The overall goal of a checklist is not only to ensure that each item is checked-off as prescribed, but to ensure an environment that promotes teamwork and professional discipline. Due to the ability of checklists to make complex systems approachable, they have already been widely used in industries such as aviation and construction, and now are advancing in medicine as well.

HIV prevention efforts, too, involve complex systems consisting of dynamic target populations, multiple programmatic efforts, and a lack of measurable quality indicators—all in all, making sustainable quality improvement challenging.

Checklists might provide a standardized method to ensure basic quality improvement and program management practices in an environment where pressing need may often lead to deficits in consistent and quality programming. Furthermore, they can be used as a tool to increase quality by improving communication, both internally within an organization, but also with the members of the target population being served.

It is a common complaint that too little emphasis falls of clinical delivery sciences, but it is fair to say that even less falls of preventative services delivery. NGOs working in HIV prevention need to keep better track of both the outcomes and impact of their programs. With out measuring results, it is hard to identify best practices and improve quality standards. HIV Quality Improvement Checklist tools could serve as a constant reminder for NGOs to monitor and evaluate results, thus improving health of communities world-wide.

Sources:

  • Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Eng J Med 2006; 355: 2725–32.
  • Gawande A. The Checklist Manifesto: How to Get Things Right. Henry Holt and Co: New York, 2009.
  • Haynes AB, Weiser TG, Berry WR, et al; Safe Surgery Saves Lives Study Group. A surgical safety checklist to reduce morbidity and mortality in a global population [published online ahead of print January 14, 2009]. N Engl J Med. 2009; 360(5):491-499.

Kate McQueston is a Master of Public Health Student at The Dartmouth Institute for Health Policy and Clinical Practice and Intern at the WHO Regional Office for Europe Division for Communicable Diseases.