Go to the content. | Move to the navigation | Go to the site search | Go to the menu | Contacts | Accessibility

| Create Account

Massavon, William Gabriel Kofi (2014) Community and Home-Based Care HIV Service Delivery Model in the Context of Paediatric HIV Management and Contributing to Health Systems Strengthening in a Resource-Limited Setting (Uganda): Operational Research. [Ph.D. thesis]

Full text disponibile come:

PDF Document (Thesis) - Submitted Version

Abstract (english)

This thesis is about the Tukula Fenna Project (TFP) that was set up at the Home Care Department of St. Raphael of St Francis Hospital (Nsambya Hospital) in Kampala, Uganda. In 2003, Associazione Casa Accoglienza alla vita “Padre Angelo” (ACAVPA) or “HOUSE FOR LIFE, Father Angelo” and other Italian partners; in particular, PENTA Foundation and University of Padova, Department of paediatrics collectively signed a memorandum of understanding (MoU) with Nsambya Hospital. The aim of the MoU was to collaborate with the hospital in the fight against HIV particularly in children and adolescents, orphans and vulnerable children (OVC) and their families in Kampala and three surrounding districts (Mukono, Wakiso and Mpigi). Thus, the MoU officially established the children’s HIV programme at Nsambya Hospital, Home Care Department in 2003. The programme was then called the “PCP Project” because the initial intervention was among other things, providing Cotrimoxazole prophylaxis against Pneumocystis Carinii pneumonia (PCP, also known as Jiroveci Pneumonia). As more resources including provision of antiretroviral drugs (ARVs) from external sources and expertise became available over the years, the project evolved into a full-blown HIV programme for infants, children and adolescents as well as their families and caretakers. Additionally, the name “PCP”, was replaced by “Tukula Fenna”, which means “growing up together” in the local language (Luganda).
The project was implemented at the Home Care Department within an existing community home-based care (CHBC) model that evolved in response to the HIV epidemic in Uganda, and other high-burden resource-limited settings. The TFP provides comprehensive HIV care, treatment and psychosocial support services (PSS) and apart from operating at the Home Care department of Nsambya Hospital, it also operates at Ggaba Parish Outreach Clinic and 3 other outreach clinics in and around Kampala.

This thesis describes the research outcomes of the project that was managed by Dr. Massavon from 2008 to 2013. It reviews the published literature from the key milestones of the HIV epidemic to the post-conflict health reforms in Uganda and their relevance to current health outcomes, the national AIDS response and health systems strengthening. The literature review also examines the human resources for health (HRH) crisis and task shifting in the scaling up of ART in high-burden resource-limited settings. In addition, the review looks at the evolution of complementary HIV service delivery models like community and home-based care as a spontaneous response to the HIV epidemic in many resource-limited settings including Uganda. Finally, the literature documents that, there are relatively few paediatric HIV services in the country, leading to poor geographical access and a low antiretroviral therapy (ART) coverage for children and that, HIV-infected children and in particular, AIDS orphans are an underserved and an understudied population.

At the time of this thesis, approximately 2,100 infants, children and adolescents had been enrolled into care in the TFP; about 1140 were active in care, and about 60% were on ART. Approximately, 47% of children and adolescents in the project are orphans.

This thesis therefore aims at contributing to improving paediatric HIV management through operational research in the context of a CHBC model in Kampala, Uganda. The findings cover key outcomes such as retention in care, attrition and loss to follow up (LTFU), treatment failure, mortality on antiretroviral therapy (ART) and operationalization of dried blood spots (DBS) for viral load testing among HIV-infected children. The thesis also included a specific study on HIV-Epstein-Barr Virus (EBV) co infections in children and adolescents, considered relevant to the project setting.

Except for study 5 (EBV study) which was a cross-sectional study, the studies were generally retrospective cohort studies conducted at the Home Care Department of Nsambya Hospital in Kampala, Uganda. The methodology of the operational research was based on an implementation schema derived from the ART guidelines of the WHO and Uganda (Figure 17). The selection of the outcomes for the operational research was based on the rationale that, they have direct bearings on implementation and potentially could improve the same.
The findings and implications from the six studies that constitute the chapters of the thesis are summarized as follows:
Study 1: This retrospective observational study compared HIV and TB outcomes from adults and children in the Nsambya CHBC with national averages from 2007-2011. The core findings show that Nsambya CHBC activities enhance and complement national HIV and TB management, and resulted in better outcomes when compared to the national averages.
This approach may hold the potential for chronic disease management in resource-limited settings. Scaling up CHBC could have wider positive impacts on the management of not only HIV and TB, but also other chronic diseases as well as the general health system. A long-standing “faith-based solidarity” among international donors and partners has been pivotal to the survival and evolution of the Nsambya CHBC.
Study 2: This is a retrospective cohort analysis of attrition and LTFU and their predictors among children and adolescents aged 0-20 years. Over the study period, 5.34% (62) of patients died, 37.61% (437) were LTFU, and thus overall attrition was 42.94% (499).
Generally, attrition and LTFU were relatively high among children and adolescents in the TFP. Not receiving ART was the single factor significantly associated with attrition in the cohort, while both baseline BMI z-scores and receipt of ART were protective against LTFU among HIV positive children and adolescents. Efforts should be made to initiate ART among all paediatric patients as soon as possible, and to provide aggressive follow-up for those not yet receiving ART. Orphans need more nutritional support to reduce the burden of malnutrition and improved access to early ART, which could also promote growth responses in this vulnerable and understudied group.
Study 3:
This retrospective cohort study reviewed records from HIV positive children age 0 to 18 years engaged in a CHBC and a Facility-based, family-centred approach (FBFCA) from 2003 to 2010 focussing on retention in care, loss to follow-up, mortality, use of ART, and clinical characteristics.
Irrespective of model of care, children receiving ART had better retention in care and therefore long-term survival. Encouragingly, if children were on ART, then their survival was as good, if not slightly better, in the CHBC compared to the FBFCA. Based on our observations, substantial improvement in child survival can be achieved in either a community-based or a family-care model as long as HIV- infected children are identified early and begun on ART. To ensure this occurs, early identification of HIV infected children requires strong linkages of pregnant HIV- infected women to prevention of mother to child transmission (PMTCT) services; active tracking to ensure all HIV exposed infants receive Polymerase Chain Reaction-based early infant diagnosis. Additionally, rapid early initiation of ART among HIV infected infants and children are essential.
Study 4:
This is an observational study that included HIV-infected children attending the Beira Central Hospital (Mozambique) and the Nsambya Hospital, Home Care Department (Uganda), and evaluated clinical and immunological failure according to the WHO 2006 guidelines.
Two hundred and eighteen of 740 children with at least 24 weeks follow-up experienced treatment failure ((29% 95%CI (26-33)), with crude incidence of 20.0 events per 100 person-years (95%CI 17.5-22.9). Having tuberculosis co-infection or WHO stage 4, or starting a non-triple cART significantly increased the risk of failure. Drug toxicity (18.3%), drug availability (17.3%) and anti-tuberculosis drug interactions (52, 25.7%) were the main reported reasons while only 9 (4%) patients switched cART for clinical or immunological failure.
Considerable delay in switching to second line cART may occur despite an observed high rate of treatment failure. Our findings reinforce the need for simplification of more effective clinical and immunological criteria for prompt recognition of cART treatment failure. Children presenting with advanced disease and TB co-infection should be targeted for closer and more sensitive monitoring of treatment response. This should be matched with a constant provision of appropriate antiretroviral drugs with optimization of first line drugs and treatment sequencing. Supply of new paediatric formulations for second line regimens and drug optimization should be considered as critical milestones to allow scaling up of early cART and reduction of treatment failure in children.

Study 5: In this cross-sectional study, dried blood spot (DBS) samples from 213 HIV-1 infected children were collected and EBV DNA was extracted and analysed for quantification of EBV types 1 and 2 and for quantification of 16S ribosomial DNA (16S rDNA), a marker of microbial translocation.
Ninety-two of 140(66%) children on ART and 57 of 73(78%) ART-naive children had detectable EBV levels. Co-infection with both EBV types was significantly less frequent in ART-treated than in ART-naïve children (OR=0.54, 95%CI 0.30;0.98, p=0.042). HIV-1 inducing microbial translocation and a state of persistent immune activation, may lead to EBV replication and expansion of EBV-infected B-cells, thus increasing the EBV-DNA load. Super-infection by both types of EBV in HIV-1 infected subjects may represent an additional risk for the onset of EBV-related malignancies. ART, by limiting HIV-1 replication, microbial translocation and related immune activation, may prevent super-infection by both EBV types and keep EBV viremia down, thus reducing the risk of EBV-associated lymphomas.

Study 6:
This was a retrospective study to evaluate viral load (VL) using DBS and to explore the accuracy of clinical and immunological criteria for treatment failure (TF) in a cohort of HIV-1-infected children. In this cohort, immunological and clinical criteria as per WHO 2010 guidelines poorly predicted the presence of a viral load greater than either 1000 cp/ml or 5000 cp/ml (whole blood) from DBS. The low sensitivity and positive predictive values for immunological and/or clinical failure confirm those reported by the literature. This finding further supports the WHO recommendations that VL monitoring should be implemented and used to identify cases of treatment failure earlier.
Policy implications of key findings of thesis
Scaling up CHBC could have wider positive impacts on the management of not only HIV and TB, but also other chronic diseases as well as the general health system.
In this thesis, and in line with the literature, Early ART initiation was associated with improved survival and retention in both community-based and facility-based approaches.
ART is potentially protective against EBV-related lymphoproliferative disorders in HIV-EBV co infected children. This calls for early ART initiation and close monitoring in such children.
Operationalization of the use of DBS in viral load monitoring in HIV-infected children in low and middle-income countries is feasible and should be encouraged to improve the quality of paediatric HIV management in such settings.
The low ART coverage among children calls for urgent, greater and more effective decentralization of paediatric ART services within primary health care services at the district and sub-district levels in the general health system in Uganda.
Children presenting with advanced HIV disease and TB co-infection should be targeted for closer and more sensitive monitoring of treatment response.
Orphans need more nutritional support to reduce the burden of malnutrition and improved access to early ART, which in turn could promote growth responses in this vulnerable and understudied group

Abstract (italian)

Questa tesi descrive il Progetto Fenna Tukula (TFP) in corso presso il Home Care Department dell'Ospedale St. Raphael e St. Francis (Nsambya Hospital) a Kampala (Uganda).
Nel 2003, l'Associazione Casa Accoglienza alla Vita "Padre Angelo" (ACAVPA) insieme ad altri Partner (in particolare la Fondazione PENTA e l'Università di Padova), hanno firmato una lettera di intenti con il Nsambya Hospital. L'obiettivo di questo documento era di collaborare con l'ospedale nella lotta all'AIDS nei bambini ed adolescenti, orfani (OVC) e le loro famiglie a Kampala e nei distretti circostanti di Mukono, Wakiso e Mpigi.
Il progetto è stato chiamato inizialmente "PCP project" in quanto l'intervento consisteva essenzialmente nella profilassi con il Cotrimoxazole per la prevenzione della polmonite da Pneumocystis Carinii (conosciuta anche come Jiroveci Pneumonia). Dopo due anni dall’inizio del progetto grazie ad una aumentata disponibilita’ di risorse e’ stato possibile fornire ai bambini che ne avevano necessita’ la terapia con farmaci antiretrovirali (ARVs) da e quindi il progetto si e’ inidirizzato verso un programma 'tout-court' di lotta all'AIDS pediatrico con un approccio globale, che includeva anche le famiglie e non solamente i bambini. Di conseguenza, il nome "PCP" è stato rimpiazzato da "Tukula Fenna", che significa "crescere insieme" nella lingua locale (luganda).
Il progetto si e’ caratterizzato con l’implementazione di un modello di cure domiciliari (CHBC) adattato alla realta’ dell’ Uganda andando quindi oltre i confini dello NHC fino a comprendere delle strutture periferiche tra cui la Clinica della Parrocchia di Ggaba ed altre 3 cliniche nei dintorni di Kampala.

Questa tesi descrive i risultati dell’ attivita’ di ricerca svolta nell’ ambito del progetto che è stato coordinato dal Dr. Massavon tra il 2008 e il 2013. La tesi si articola in una prima parte di revisione della letteratura con particolare riferimento alla realta’ ugandese sia da un punto di vista dell’ epidemiologia dell’ HIV che dell’ organizzazione sanitaria nel paese con particolare riferimento all'evoluzione dei modelli sanitari finalizzati alla lotta all'AIDS, come modelli di cura comunitaria o domiciliari. L’ analisi della letteratura ha documentato che, in Uganda vi sono relativamente pochi servizi specialistici sull’ HIV pediatrico. Tale aspetto ha come conseguenza una disparita’ tra le varie regioni del paese e un limitato accesso alla terapia antiretrovirale per i bambini soprattutto coloro che sono senza genitori naturali.

A dicembre 2013 circa 2.100 bambini ed adolescenti sono stati arruolati nel TFP. 1.140 sono seguiti regolarmente e il 60% di loro sono in terapia con ART. Il 47% dei bambini è orfano.

La finalita’ ultima della tesi e’ quello di contribuire al miglioramento delle cure nei bambini HIV positivi in Uganda attraverso la valutazione di un modello di assistenza domiciliare. In quest’ ottica l’ attivita’ di ricerca si e’ articolata nella valutazione delle caratteristiche dei pazienti persi al follow-up, dell’ outcome della terapia antiretrovirale e, in un ambito piu’ prettamente clinico, nello studio dell’ impatto della infezione da EBV sulla progressione della malattia da HIV.
L’ attivita’ si e’ sviluppata attorno diverse linee di ricerca i cui risultati sono stati pubblicati (o in corso di pubblicazione) nei lavori i cui elementi fondamentali sono riassunti di seguito:
Studio 1: Studio osservazionale retrospettivo che analizza i risultati del follow-up dei pazienti con HIV e TB (adulti e bambini) seguiti presso lo Nsambya Hospital confrontandoli con i dati nazionali tra il 2007 e il 2011. I risultati mostrano che il modello seguito allo Nsambya ha prodotto migliori risultati in termini di morbilita’ e mortalita’ rispetto alle medie nazionali. Il modello descritto basato sull’ assistenza domiciliare potrebbe essere utilizzato anche in altri contesti nei paesi in via di sviluppo.

Studio 2: Analisi di coorte retrospettiva per la valutazione delle caratteristiche dei pazienti persi al follow up (LTFU) e dei fattori di rischio associati, nei bambini ed adolescenti tra 0 e 20 anni. Nel corso del periodo di follow up considerato, il 5,3% dei pazienti è deceduto, il 37,6% e’ stato perso al follow-up con un “attritio” globale del 42,9%.
In generale, LTFU sono stati relativamente alti tra i bambini e gli adolescenti nel TFP. La terapia con ARV e la crescita regolare sono stati fattori associati con la permanenza in follow up e con la sopravvivenza. Tali osservazioni suggeriscono come gli sforzi dovrebbero essere indirizzati ad iniziare la ART nei pazienti pediatrici il prima possibile, e a fornire un follow-up regolare a coloro che non sono ancora in terapia. Particolare attenzione va data agli orfani che necessitano di un supporto alimentare particolarmente attento e di un follow up regolare per definire il momento migliore quando iniziare la ART.

Studio 3: Studio di coorte retrospettivo che ha studiato i bambini HIV positivi tra 0 e 18 anni inseriti in un programma di assistenza domiciliare con un approccio centrato sulla famiglia (FBFCA) dal 2003 al 2010, focalizzandosi sulla perdita al follow-up, la mortalità, l'uso di ART e le caratteristiche cliniche.
A prescindere dal modello di cura, i bambini che ricevevano l'ART sono seguiti piu’ regolarmente e di conseguenza hanno una sopravvivenza a lungo termine maggiore. Basandosi sulle nostre osservazioni, un miglioramento sostanziale nella sopravvivenza dei bambini può essere raggiunto sia con un modello basato sulla assistenza domiciliare che sul coinvolgimento attivo della comunita’.

Studio 4: Studio osservazionale prospettico che ha incluso bambini HIV positivi assistiti presso il Beira Central Hospital, in Mozambico e lo Nsambya Hospital, che ha valutato il rischio di fallimento immunologico e clinico secondo le linee guida del WHO del 2006.
218 su 740 bambini con almeno 24 settimane di follow-up ha avuto un fallimento della terapia ((29% 95% CI (26-33)), con una incidenza di 20.0 eventi su 100 anni-persona (95%CI 17.5-22.9). La coinfezione con la TB, la presenza di AIDS (WHO stadio 4), o l’inizio della ART con uno o due farmaci aumenta significativamente il rischio di fallimento terapeutico.
Un ritardo considerevole nel passaggio alla seconda linea di cART si e’ osservato nonostante un alto tasso di fallimento terapeutico. Tali osservazioni sottolineano ancora una volta l’importanza di garantire un efficace monitoraggio clinico e immunolgico per poter modificare la terapia prima che insorgano ceppi virali resistenti. Insieme alla necessita’ di un corretto monitoraggio va sottolineata l’importanza di garantire una fornitura di farmaco regolare senza interruzioni e le formulazioni pediatriche per i bambini piu’ piccoli

Studio 5: Studio trasversale, effettuato su campioni raccolti in cartoncini assorbenti (DBS) prelevati da 243 bambini affetti da HIV-1 da cui e’ stato estratto il DNA del EBV per analisi e quantificazione dei tipi 1 e 2, e per la quantificazione di 16s DNA ribosomiale (16S rDNA), un marker di traslocazione microbica.
92 su 140 (66%) dei bambini in terapia con ART e 57 su 73 (78%) di bambini non trattati sono risultati positivi all’ EBV. La coinfezione con entrambi i tipi di EBV è stata significativamente meno frequente in coloro in terapia con ART (OR=0.54, 95%CI 0.30; 0.98, p=0.042). Tale osservazione e’ compatibile con il fatto che ' HIV-1, che induce una traslocazione microbica e uno stato di persistente attivazione immunitaria, può portare a una replicazione di EBV ed ad una espansione di cellule B infette, aumentando di conseguenza il DNA dell'EBV.
La co-infezione da EBV in soggetti affetti da HIV-1 può rappresentare un rischio addizionale per lo scatenarsi di tumori (linfomi) associati al EBV. Il trattamento con ART, riducendo la replicazione dell’ HIV-1, la traslocazione microbica e la relativa attivazione immunitaria, può prevenire la super infezione da EBV e mantenere la viremia EBV bassa, riducendo il rischio di linfomi ad esso associata.

Studio 6: Studio retrospettivo per valutare la carica virale dell’HIV (VL) su campioni raccolti in DBS e per esplorare l'accuratezza dei criteri clinici ed immunologici per la definizione del fallimento terapeutico. La bassa sensibilità e valore predittivo del fallimento clinico e/o immunologico, da noi osservate, confermano quanto riportato in letteratura. Questa osservazione supporta ulteriormente la raccomandazione del WHO che il monitoraggio della carica virale debba essere implementato ed utilizzato per identificare precocemente casi di fallimento del trattamento.

Implicazioni dei risultati della tesi e messaggi chiave
Il modello assistenziale centrato sull’ assistenza domiciliare e’ risultato molto efficace per ridurre il rischio di perdita al follow up. Tale modello potrebbe quindi essere considerato anche per l’assistenza dei malati di TB o con altre malattie croniche.
Le nostre osservazioni supportano quanto gia’ riportato in letteratura che l’inizio precoce dell’ ART e’ era associato non solo aduna migliore sopravvivenza ma anche ad un minor rischio di perdita al follow up.
Il trattamento ART è potenzialmente protettivo contro patologie linfoproliferative correlate al EBV nei bambini con coinfezione da HIV ed EBV.
L’uso del DBS per il monitoraggio della carica virale nei bambini HIV positivi si e’ rivelato fattibile sia da un punto di vista organizzativo che della qualita’ dei campioni da testare. Tale metodica dovrebbe quindi essere incoraggiata per migliorare la qualità della gestione pediatrica dell'HIV soprattutto nei paesi in via di sviluppo
La bassa copertura di ART tra i bambini richiede un urgente, maggiore e più efficace decentramento dei servizi pediatrici centrali e la loro integrazione con i servizi sanitari di base a livello distrettuale e sub-distrettuale in Uganda.
I bambini che presentino uno stadio avanzato di infezione HIV e coinfezione da TB dovrebbero essere sottoposti a monitoraggio più serrato per iniziare il trattamento ART appena cio’ si renda necessario.
Gli orfani necessitano un particolare attenzione sia per quanto riguarda il supporto nutrizionale che il monitoraggio clinico e immunologico necessario per iniziare correttamente la ART.

Statistiche Download - Aggiungi a RefWorks
EPrint type:Ph.D. thesis
Tutor:Giaquinto, Carlo
Data di deposito della tesi:30 January 2014
Anno di Pubblicazione:30 January 2014
Key Words:modello di cure comunitarie e domiciliari per l'HIV/ community and home-based care
Settori scientifico-disciplinari MIUR:Area 06 - Scienze mediche > MED/38 Pediatria generale e specialistica
Struttura di riferimento:Dipartimenti > Dipartimento di Salute della Donna e del Bambino
Codice ID:6714
Depositato il:19 May 2015 17:22
Simple Metadata
Full Metadata
EndNote Format


I riferimenti della bibliografia possono essere cercati con Cerca la citazione di AIRE, copiando il titolo dell'articolo (o del libro) e la rivista (se presente) nei campi appositi di "Cerca la Citazione di AIRE".
Le url contenute in alcuni riferimenti sono raggiungibili cliccando sul link alla fine della citazione (Vai!) e tramite Google (Ricerca con Google). Il risultato dipende dalla formattazione della citazione.

1. CDC: MMWR Morb Mortal Wkly Rep, June 5, 1981 / 30(21); 1-3. 1981. Cerca con Google

2. CDC: Pneumocystis Pneumonia — Los Angeles MMWR Morb Mortal Wkly Rep 1996, 45(34). Cerca con Google

3. Piot P, Quinn TC: Response to the AIDS pandemic--a global health model. N Engl J Med 2013, 368(23):2210-2218. Cerca con Google

4. CDC: Revision of the CDC Surveillance Case Definition for Acquired Immunodeficiency Syndrome. MMWR Morb Mortal Wkly Rep 1987, 36(1S). Cerca con Google

5. Doitsh G, Galloway NLK, Geng X, Yang Z, Monroe KM, Zepeda O, Hunt PW, Hatano H, Sowinski S, Muñoz-Arias I, Greene WC: Cell death by pyroptosis drives CD4 T-cell depletion in HIV-1 infection. Nature 2013, 000 (12940). Cerca con Google

6. Monroe KM, Yang Z, Johnson JR, Geng X, Doitsh G, Krogan NJ, WC. G: IFI16 DNA Sensor Is Required for Death of Lymphoid CD4 T Cells Abortively Infected with HIV. Science 2013, 1243640(10.1126). Cerca con Google

7. KA. S: AIDS — THE FIRST 20 YEARS. N Engl J Med, 2001, 344(23). Cerca con Google

8. CDC: Public Health Then and Now: Celebrating 50 Years of MMWR at CDC: MMWR Morb Mortal Wkly Rep 2011, 60. Cerca con Google

9. UNAIDS: 30 years into the AIDS epidemic 30 milestones, thoughts, images, words, artworks, breakthroughs, inspirations and ideas in response. 2011. Cerca con Google

10. International AIDS Society: Timeline of the IAS 1988. Cerca con Google

11. UNAIDS: UNAIDS Special Report: UPDATE. 2013. Cerca con Google

12. UNAIDS: Global AIDS Response progress reporting: monitoring the 2011 political declaration on HIV/AIDS: guidelines on construction of core indicators: 2012 reporting. 2011. Cerca con Google

13. De Cock KM, Jaffe HW, Curran JW: The evolving epidemiology of HIV/AIDS. AIDS 2012, 26(10):1205-1213. Cerca con Google

14. Piot P, Bartos M, Ghys PD, Walker N, Schwartländer B: The global impact of HIV/AIDS. NATURE 2001, 410. Cerca con Google

15. United Nations: Declaration of Commitment on HIV/AIDS. UNITED NATIONS GENERAL ASSEMBLY SPECIAL SESSION ON HIV/AIDS 25 - 27 JUNE 2001. Cerca con Google

16. Görgens-Albino M, Mohammad N, Blankhart D, Odutolu O: The Africa Multi-Country AIDS Program 2000–2006: Results of the World Bank’s Response to a Development Crisis. 2007. Cerca con Google

17. UNAIDS/UNICEF/WHO: GLOBAL AIDS RESPONSE PROGRESS REPORTING 2013: Construction of Core Indicators for monitoring the 2011 UN Political Declaration on HIV/AIDS. 2013. Cerca con Google

18. UNAIDS: AIDS at 30: Nations at the crossroads. 2011. Cerca con Google

19. WHO Regional Office for Africa: Crisis in Human Resources for Health in the African Region. African Health Monitor 2007, 7(1). Cerca con Google

20. WHO Regional Office for Africa: Health systems and reproductive health in the African Region. The African Health Monitor 2011, 14. Cerca con Google

21. United Nations: The Millennium Development Goals Report 2013. Cerca con Google

22. Maher D, Smeeth L, Sekajugo J: Health transition in Africa: practical policy proposals for primary care. Bull World Health Organ 2010, 88(12):943-948. Cerca con Google

23. WHO: The global burden of disease: 2004 update. Cerca con Google

24. Institute for Health Metrics and Evaluation: The Global Burden of Disease: Cerca con Google

Generating Evidence, Guiding Policy. Seattle, WA: IHME, 2013. Cerca con Google

25. Friedman E, Katz I, Kiley E, Williams E, and Lion A (2011). : Global Fund‘s Support for Health Systems Strengthening Interventions: A Reference Guide. Bethesda, MD: Physicians for Human Rights, Health Systems 20/20 project, Abt Associates Inc. 2011. Cerca con Google

26. Hawley T, Spear M, Guo J, Wu Y: Inhibition of HIV replication in vitro by clinical immunosuppressants and chemotherapeutic agents. Cell & bioscience 2013, 3(1):22. Cerca con Google

27. Taylor BS, Wilkin TJ, Shalev N, Hammer SM: CROI 2013: Advances in Antiretroviral Therapy. Conference Highlights-Antiretroviral Therapy 2013, 21(2). Cerca con Google

28. UNAIDS: Twelve recommendations following a discussion about the ‘Mississippi baby’. Implications for public health programmes to eliminate new HIV infections among children. 2013. Cerca con Google

29. Saez-Cirion A, Bacchus C, Hocqueloux L, Avettand-Fenoel V, Girault I, Lecuroux C, Potard V, Versmisse P, Melard A, Prazuck T et al: Post-treatment HIV-1 controllers with a long-term virological remission after the interruption of early initiated antiretroviral therapy ANRS VISCONTI Study. PLoS pathogens 2013, 9(3):e1003211. Cerca con Google


31. UNAIDS: Global report: UNAIDS report on the global AIDS epidemic 2013. Cerca con Google

32. United Nations Children's Fund: Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013, UNICEF, New York, 2013. Cerca con Google

33. UNAIDS: UNAIDS 2013: AIDS by the numbers. In.; 2013. Cerca con Google

34. Penazzato M, Prendergast A, Tierney J, Cotton M, Gibb D: Effectiveness of antiretroviral therapy in HIV-infected children under 2 years of age. Cochrane Database Syst Rev 2012, 7:CD004772. Cerca con Google

35. Ministry of Health Uganda: Annual Health Sector Performance Report 2013. Cerca con Google

36. Barnabas RV, Webb EL, Weiss HA, Wasserheit JN: The role of coinfections in HIV epidemic trajectory and positive prevention: a systematic review and meta-analysis. AIDS 2011, 25(13):1559-1573. Cerca con Google

37. Banura C, Franceschi S, Doorn LJ, Arslan A, Wabwire-Mangen F, Mbidde EK, Quint W, Weiderpass E: Infection with human papillomavirus and HIV among young women in Kampala, Uganda. J Infect Dis 2008, 197(4):555-562. Cerca con Google

38. Brown M, Miiro G, Nkurunziza P, Watera C, Quigley MA, Dunne DW, Whitworth JA, Elliott AM: Schistosoma mansoni, nematode infections, and progression to active tuberculosis among HIV-1-infected Ugandans. Am J Trop Med Hyg 2006, 74(5):819-825. Cerca con Google

39. Marais BJ, Graham SM, Cotton MF, Beyers N: Diagnostic and management challenges for childhood tuberculosis in the era of HIV. J Infect Dis 2007, 196 Suppl 1:S76-85. Cerca con Google

40. WHO: The Global Plan to Stop TB 2011-2015. 2011. Cerca con Google

41. WHO: Global tuberculosis control: WHO report 2011. 2011. Cerca con Google

42. WHO: TB/HIV Control Strategy For The African Region. 2004. Cerca con Google

43. WHO: Guidelines for intensified tuberculosis case finding and isoniazid preventive therapy for people living with HIV in resource constrained settings. 2011. Cerca con Google

44. WHO: TB/HIV FACTS 2011. 2011. Cerca con Google

45. Ssenyonga R, Seremba E: Family Medicine’s Role in Health Care Systems in Sub-Saharan Africa: Uganda as an Example. Family medicine 2007, 39(9):623-626. Cerca con Google

46. Marinucci F, Majigo M, Wattleworth M, Paterniti AD, Hossain MB, Redfield R: Factors affecting job satisfaction and retention of medical laboratory professionals in seven countries of sub-Saharan Africa. Human Resources for Health 2013, 11(1):38. Cerca con Google

47. Tashobya CK, Ssengooba F, Cruz VO: Health Systems Reforms in Uganda: processes and outputs: Health Systems Development Programme, London School of Hygiene & Tropical Medicine, London, UK (pp 117-118). Cerca con Google

London School of Hygiene & Tropical Medicine Press; 2006. Cerca con Google

48. Gaber S, Patel P: Tracing health system challenges in post-conflict Cote d'Ivoire from 1893 to 2013. Glob Public Health 2013, 8(6):698-712. Cerca con Google


50. WHO: Declaration of Alma-Ata. International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978. 1978. Cerca con Google

51. Cueto M: The ORIGINS of Primary Health Care and SELECTIVE Primary Health Care. American Journal of Public Health 2004, 94(11). Cerca con Google

52. Litsios S: The Christian Medical Commission and the Development of the World Health Organization’s Primary Health Care Approach. American Journal of Public Health 2004, 94(11). Cerca con Google

53. Pfeiffer J, Montoya P, Baptista AJ, Karagianis M, Pugas MDM, Micek M, Johnson W, Sherr K, Gimbel S, Baird S, Lambdin B, Gloyd S: Integration of HIV/AIDS services into African primary health care: lessons learned for health system strengthening in Mozambique - a case study. Journal of the International AIDS Society 2010, 13(3). Cerca con Google

54. UNAIDS: Delivering results toward ending AIDS, Tuberculosis and Malaria in Africa. African Union accountability report on Africa–G8 partnership commitments 2013. Cerca con Google

55. Ssengooba F, Yates R, Cruz VO, Tashobya CK (2006): Have systems reforms resulted in a more efficient and equitable allocation of resources in the Ugandan health sector? In: Health systems reform in Uganda: processes and outputs. Christine Kuringa Tashobya, Freddie Ssengooba and Valeria Oliveira Cruz (editors). Health Systems Development Programme, London School of Hygiene & Tropical Medicine, London, UK (pp109-118).). Cerca con Google

56. WHO/UNAIDS/UNICEF: Towards Universal Access: Scaling up priority HIV/AIDS interventions in the health sector. 2010 Progress Report. 2010. Cerca con Google

57. WHO: WHO Global Health Sector Strategy on HIV/AIDS 2011-2015. 2011. Cerca con Google

58. WHO Regional Office for Africa: The African Regional Health Report: The Health of the People. 2006. Cerca con Google

59. Gilson L, Mills A: Health sector reforms in sub-Saharan Africa: lessons of the last 10 years. Health Policy 1995, 32:215-243. Cerca con Google

60. Ministry of Health Uganda: Health Sector Strategic Plan 2000/01 – 2004/05. Cerca con Google

61. Ministry of Health Uganda: Health Sector Strategic Plan II 2005/06 – 2009/2010. Cerca con Google

62. Ministry of Health Uganda: HEALTH SECTOR STRATEGIC PLAN III 2010/11-2014/15. Cerca con Google

63. Cruz VO, Cooper R, McPake B, Yates R, Ssengooba F, Omaswa F, Tashobya CK, Murindwa G. (2006): Is the sector-wide approach (SWAp) improving health sector performance in Uganda? In: Health systems reform in Uganda: processes and outputs. Christine Kuringa Tashobya, Freddie Ssengooba and Valeria Oliveira Cruz (editors). Health Systems Development Programme, London School of Hygiene & Tropical Medicine, London, UK (pp 29-39). Cerca con Google

64. Jeppsson A: SWAp dynamics in a decentralized context: experiences from Uganda. Soc Sci Med 2002, 55(11):2053-2060. Cerca con Google

65. Orinda V, Kakande H, Kabarangira J, Nanda G, Mbonye AK: A sector-wide approach to emergency obstetric care in Uganda. Int J Gynaecol Obstet 2005, 91(3):285-291. Cerca con Google

66. Tashobya CK, McPake B, Nabyonga J, Yates R (2006): Health sector reforms and increasing access to health services by the poor: what role has the abolition of user fees played in Uganda? In: Health systems reform in Uganda: processes and outputs. Christine Kuringa Tashobya, Freddie Ssengooba and Valeria Oliveira Cruz (editors). Health Systems Development Programme, London School of Hygiene & Tropical Medicine, London, UK (pp 45-57). Cerca con Google

67. Nazerali H, Oteba MO, Mwoga J, Zaramba S. (2006): Medicines – driving demand for health services in Uganda? In: Health systems reform in Uganda: processes and outputs. Christine Kuringa Tashobya, Freddie Ssengooba and Valeria Oliveira Cruz (editors). Health Systems Development Programme, London School of Hygiene & Tropical Medicine, London, UK (pp61-79). Cerca con Google

68. Lochoro P, Bataringaya J, Tashobya CK, Kyabaggu JH.(2006) : Public-private partnership in health: working together to improve health sector performance in Uganda. In: Health systems reform in Uganda: processes and outputs. Christine Kuringa Tashobya, Freddie Ssengooba and Valeria Oliveira Cruz (editors). Health Systems Development Programme, London School of Hygiene & Tropical Medicine, London, UK (pp83-95). Cerca con Google

69. Murindwa G, Tashobya CK, Kyabagu HJ, Rutebemberwa E, Nabyonga J. (eds.): Meeting the challenges of decentralized health service delivery in Uganda as a component of broader health sector reforms. London (UK): Health Systems Development Programme, London School of Hygiene & Tropical Medicine, UK (pp97-107). Cerca con Google

70. Orem JN, Zikusooka CM: Health financing reform in Uganda: How equitable is the proposed National Health Insurance scheme? Int J Equity Health 2010, 9:23. Cerca con Google

71. Morestin F, Ridde V: The abolition of user fees for health services in Africa. Lessons from the literature. Université de Montréal, Canada 2009. Cerca con Google

72. Robert E, Ridde V: Global health actors no longer in favor of user fees: a documentary study. Globalization and Health 2013, 9(29). Cerca con Google

73. Yates R, Tashobya CK, Cruz VO, McPake B, Ssengooba F, Murindwa G, Lochoro P, Bataringaya J, Nazerali H, Omaswa F. (2006): The Ugandan health systems reforms: miracle or mirage? In: Health systems reform in Uganda: processes and outputs. Christine Kuringa Tashobya, Freddie Ssengooba and Valeria Oliveira Cruz (editors). Health Systems Development Programme, London School of Hygiene & Tropical Medicine, London, UK (pp 15-25). Cerca con Google

74. Ministry of Health, Health Systems 20/20, and Makerere University School of Public Health. April 2012. Uganda Health System Assessment 2011. Kampala, Uganda and Bethesda, MD: Health Systems 2020/2020 project, Abt Associates Inc. Cerca con Google

75. Ministry of Health Uganda: STOCK STATUS REPORT FOR PERIOD ENDING MARCH 2010. Cerca con Google

76. Ministry of Health Uganda: STOCK STATUS REPORT FOR PERIOD ENDING DECEMBER 2010. Cerca con Google

77. Ministry of Health Uganda: STOCK STATUS REPORT AS AT 1ST MAY 2013. Cerca con Google

78. Uganda AIDS Commission: Global AIDS response Progress report: Country Progress Report Uganda.2012. Cerca con Google

79. UNAIDS: Global AIDS Response progress reporting: monitoring the 2011 political declaration on HIV/AIDS: guidelines on construction of core indicators: 2012 reporting. Cerca con Google

80. UNAIDS: Abuja +12 Shaping the future of health in Africa. 2013. Cerca con Google

81. Richter LM, Sherr L, Adato M, Belsey M, Chandan U, Desmond C, Drimie S, Haour-Knipe M, Hosegood V, Kimou J et al: Strengthening families to support children affected by HIV and AIDS. AIDS Care 2009, 21 Suppl 1:3-12. Cerca con Google

82. Seeley J, Dercon S, Barnett T: The effects of HIV/AIDS on rural communities in East Africa: a 20-year perspective. Trop Med Int Health 2010, 15(3):329-335. Cerca con Google

83. Richter L, Foster G: Strengthening Systems to Support Children’s Healthy Development in Communities Affected by HIV/AIDS. Geneva: Department of Child and Adolescent Health and Development (CAH), World Health Organization. 2005. Cerca con Google

84. UNAIDS: The Benchmark: What the world thinks about the AIDS response. 2010. Cerca con Google

85. UNAIDS: World leaders embrace the African Union Roadmap on AIDS, TB and malaria: Establishing Shared Responsibility and Global Solidarity as a vision for global health in the Post-2015 development agenda. 2012. Cerca con Google

86. UNAIDS: Country ownership for a sustainable AIDS response: from principles to practice. Discussion Paper UNAIDS July 2012. Cerca con Google

87. Uganda Bureau of Statistics (UBOS) and ICF International Inc. 2012. Uganda Demographic and Health Survey 2011. Kampala, Uganda: UBOS and Calverton, Maryland: ICF International Inc. Cerca con Google

88. UNAIDS: Financing the Response to AIDS in Low- and Middle- Income Countries: International Assistance from Donor Governments in 2011. 2012. Cerca con Google

89. UNAIDS: AIDS DEPENDENCY CRISIS: Sourcing African Solutions. UNAIDS ISSUES BRIEF. 2012. Cerca con Google

90. WHO/UNAIDS: Progress on Global Access to HIV Antiretroviral Therapy: a Report on "3 by 5" and Beyond, M a r c h 2 0 0 6. Cerca con Google

91. Nabyonga Orem J, Mugisha F, Kirunga C, Macq J, Criel B: Abolition of user fees: the Uganda paradox. Health Policy Plan 2011, 26 Suppl 2: 41-51. Cerca con Google

92. Kiwanuka SN, Ekirapa EK, Peterson S, Okui O, Rahman MH, Peters D, Pariyo GW: Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Trans R Soc Trop Med Hyg 2008, 102(11):1067-1074. Cerca con Google

93. Nabyonga Orem J, Mugisha F, Okui AP, Musango L, Kirigia JM: Health care seeking patterns and determinants of out-of-pocket expenditure for malaria for the children under-five in Uganda. Malar J 2013, 12:175. Cerca con Google

94. WHO: The World Health Report 2008. Primary Health Care Now More Than Ever. 2008. Cerca con Google

95. Zikusooka CM, Kyomuhang R, Orem JN, Tumwine M: Is health care financing in Uganda equitable? Afr Health Sci 2009, 9 Suppl 2:S52-58. Cerca con Google

96. WHO: The world health report: health systems financing: the path to universal coverage. 2010. Cerca con Google

97. Dovlo D: Wastage in the health workforce: some perspectives from African countries. Hum Resour Health 2005, 3:6. Cerca con Google


99. UNAIDS: Case study 2012. Promising practices in community engagement for elimination of new HIV infections among children by 2015 and keeping their mothers alive. 2012. Cerca con Google

100. Janssens B, Van Damme W, Raleigh B, Gupta J, Khem S, Ty K, Vun C, Ford N, Zachariah R: Offering integrated care for HIV/AIDS, diabetes and hypertension within chronic disease clinics in Cambodia. Bull World Health Organ 2007, 85(11):880 - 885. Cerca con Google

101. van Olmen J, Schellevis F, Van Damme W, Kegels G, Rasschaert F: Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care. Journal of tropical medicine 2012, 2012:349312. Cerca con Google

102. Ncama BP: Models of Community/Home-Based Care for People Living With HIV/AIDS in Southern Africa. Journal of the Association of Nurses in AIDS care, 16(3):33-40. Cerca con Google

103. Mohammad N, Gikonyo J: Operational Challenges Community Home Based Care (CHBC) for PLWHA in Multi-Country Aids Programs (MAP) in Africa. Africa Region Working Paper Series 2005, No. 88. Cerca con Google

104. WHO: Scaling up antiretroviral therapy : experience in Uganda : case study. (Perspectives and practice in antiretroviral treatment). 2003. Cerca con Google

105. Bakanda C, Birungi J, Mwesigwa R, Zhang W, Hagopian A, Ford N, Mills EJ: Density of healthcare providers and patient outcomes: evidence from a nationally representative multi-site HIV treatment program in Uganda. PLoS One 2011, 6(1):e16279. Cerca con Google

106. Sharpe U: Uganda. Assistance programme for AIDS orphans. Children worldwide 1993, 20(2-3):47-51. Cerca con Google

107. Shroufi A, Mafara E, Saint-Sauveur JF, Taziwa F, Vinoles MC: Mother to Mother (M2M) peer support for women in Prevention of Mother to Child Transmission (PMTCT) programmes: a qualitative study. PLoS One 2013, 8(6):e64717. Cerca con Google


109. Ministry of Health Uganda: Policy Guidelines for Implementing Home Based Care. 2008. Cerca con Google

110. WHO: Community home-based care in resource-limited settings: a framework for action. 2002. Cerca con Google

111. Massavon W, Mugenyi L, Nsubuga M, Lundin R, Penazzato M, Nannyonga M M, Namisi P C, Ingabire R, Kalibbala D, Kironde S et al: Nsambya Community Home-Based Care complements national HIV and TB management efforts and contributes to Health Systems Strengthening in Uganda: an observational study. "in press" 2014. Cerca con Google

112. No Authors Listed: Battling AIDS through home care in Uganda and Zambia. Caring : National Association for Home Care magazine 1992, 11(10):56-70. Cerca con Google

113. Kober K, Van Damme W: Expert patients and AIDS care: A literature review on expert patient programmes in high-income countries, and an exploration of their relevance for HIV/AIDS care in low-income countries with severe human resource shortages. 2006. Cerca con Google

114. Van Damme W, Kober K, Kegels G: Scaling-up antiretroviral treatment in Southern African countries with human resource shortage: How will health systems adapt? Social Science & Medicine 2008, 66(10):2108-2121. Cerca con Google

115. Walsh A, Ndubani P, Simbaya J, Dicker P, Brugha R: Task sharing in Zambia: HIV service scale-up compounds the human resource crisis. BMC Health Serv Res 2010, 10:272. Cerca con Google

116. Ford N, Calmy A, Mills EJ: The first decade of antiretroviral therapy in Africa. Global Health 2011, 7:33. Cerca con Google

117. Hanefeld J, Musheke M: What impact do Global Health Initiatives have on human resources for antiretroviral treatment roll-out? A qualitative policy analysis of implementation processes in Zambia. Human Resources for Health 2009, 7:8. Cerca con Google

118. Heidari S, Harries A, Zachariah R: Facing up to programmatic challenges created by the HIV/AIDS epidemic in sub-Saharan Africa. Journal of the International AIDS Society 2011, 14(Suppl 1):S1. Cerca con Google

119. Reynolds L: HIV as a chronic disease considerations for service planning in resource-poor settings. Global Health 2011, 7(1):35. Cerca con Google

120. WHO: Global Programme on AIDS: Report of the World Health Organization/Commonwealth Regional Secretariat Workshop on HIV/AIDS Community-Based Care and Control. Entebbe, Uganda, 6-11 October 1991. Cerca con Google

121. Bateganya M, Abdulwadud OA, Kiene SM: Home‐based HIV voluntary counselling and testing (VCT) for improving uptake of HIV testing. 2012. Cerca con Google

122. Shaibu S: Community home-based care in a rural village: challenges and strategies. J Transcult Nurs 2006, 17(1):89-94. Cerca con Google

123. MCDONNELL S, BRENNAN M, BURNHAM G, TARANTOLA D: Assessing and planning home-based care for persons with AIDS. Health Policy and Planning 1994, 9(4):429-437. Cerca con Google

124. Miti S, Mfungwe V, Reijer P, Maher D: Integration of tuberculosis treatment in a community-based home care programme for persons living with HIV/AIDS in Ndola, Zambia. Int J Tuberc Lung Dis 2003, 7(9 Suppl 1):S92-98. Cerca con Google

125. Baker MC, McFarland DA, Gonzales M, Diaz MJ, Molyneux DH: The impact of integrating the elimination programme for lymphatic filariasis into primary health care in the Dominican Republic. Int J Health Plann Manage 2007, 22(4):337-352. Cerca con Google

126. Unger JP, De Paepe P, Green A: A code of best practice for disease control programmes to avoid damaging health care services in developing countries. Int J Health Plann Manage 2003, 18 Suppl 1:S27-39. Cerca con Google

127. Maher D: Re-thinking global health sector efforts for HIV and tuberculosis epidemic control: promoting integration of programme activities within a strengthened health system. BMC Public Health 2010, 10:394. Cerca con Google

128. Walker M E, Aceng E, Tindyebwa D, Nabyonga J, Ogwang P, Kiiza P: AN ASSESSMENT OF HOME-BASED CARE PROGRAMS IN UGANDA: THEIR STRENGTHS AND WEAKNESSES. Working Paper Series 2003, 13(3). Cerca con Google

129. Pasha O, McClure EM, Wright LL, Saleem S, Goudar SS, Chomba E, Patel A, Esamai F, Garces A, Althabe et al: A combined community- and facility-based approach to improve pregnancy outcomes in low-resource settings: a Global Network cluster randomized trial. BMC Medicine 2013, 11(215). Cerca con Google

130. Decroo T, Rasschaert F, Telfer B, Remartinez D, Laga M, Ford N: Community-based antiretroviral therapy programs can overcome barriers to retention of patients and decongest health services in sub-Saharan Africa: a systematic review. International Health 2013, 5(3):169-179. Cerca con Google

131. Chalker JC, Wagner AK, Tomson G, Johnson K, Wahlstrom R, Ross-Degnan D: Appointment systems are essential for improving chronic disease care in resource-poor settings: learning from experiences with HIV patients in Africa. International Health 2013, 5(3):163-165. Cerca con Google

132. WHO: Global Tuberculosis Control: WHO Report 2010. Cerca con Google

133. Medecins Sans Frontieres (MSF): HELP WANTED. Confronting the health care worker crisis to expand access to HIV/AIDS treatment: MSF experience in southern Africa. 2007. Cerca con Google

134. Van Damme W, Kober K, Laga M: The real challenges for scaling up ART in sub-Saharan Africa. AIDS 2006, 20:653 - 656. Cerca con Google

135. Philips M, Zachariah R, S. V: Task shifting for antiretroviral treatment delivery in sub-Saharan Africa: not a panacea. Lancet 2008, 371:682–684 Cerca con Google

136. Kober K, van Damme W: Scaling-up access to antiretroviral treatment in Southern Africa: Who will do the job? The Lancet 2004(364):103-107. Cerca con Google

137. WHO/PEPFAR/UNAIDS: Task shifting: rational redistribution of tasks among health workforce teams : global recommendations and guidelines. 2008. Cerca con Google

138. Sadler K, Bahwere P, Guerrero S, Collins S: Community-based therapeutic care in HIV-affected populations. Trans R Soc Trop Med Hyg 2006, 100(1):6-9. Cerca con Google

139. Matovu JKB, Makumbi FE: Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001–2007. Tropical Medicine & International Health 2007, 12(11):1315-1322. Cerca con Google

140. USAID: Uganda Tuberculosis Profile. 2009. Cerca con Google

141. UNAIDS: Treatment 2015. 2013. Cerca con Google

142. Kipp W, Konde-Lule J, Rubaale T, Okech-Ojony J, Alibhai A, Saunders DL: Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda. BMC Int Health Hum Rights 2011, 11 Suppl 2:S12. Cerca con Google

143. WHO: Ensuring community involvement in TB care and prevention. 2008. Cerca con Google

144. WHO Regional Office for Africa: Atlas of Health Statistics of the African Region 2012. Health situation analysis of the African Region. 2012. Cerca con Google

145. WHO: World Health Report 2006: Working Together for Health. 2006. Cerca con Google

146. UNAIDS: Global report: UNAIDS report on the global AIDS epidemic 2010. Cerca con Google

147. Samb B, Celletti F, Holloway J, Van Damme W, De Cock K, Dybul M: Rapid expansion of the health workforce in response to the HIV epidemic. N Engl J Med 2007, 357:2510 - 2514. Cerca con Google

148. WHO: Accelerating progress towards the health-related Millennium Development Goals. 2010. Cerca con Google

149. United Nations: The Millennium Development Goals Report 2011. Cerca con Google

150. UNAIDS: Keeping the Promise: Summary of the Declaration of Commitment on HIV/AIDS. United Nations General Assembly Special Session on HIV/AIDS 25-27 June 2001, New York. 2001. Cerca con Google

151. Komatsu R, Korenromp E, Low-Beer D, Watt C, Dye C, Steketee R, Nahlen B, Lyerla R, Garcia-Calleja J, Cutler J et al: Lives saved by Global Fund-supported HIV/AIDS, tuberculosis and malaria programs: estimation approach and results between 2003 and end-2007. BMC Infectious Diseases 2010, 10(1):109. Cerca con Google

152. Avdeeva O, Lazarus J, Aziz MA, Atun R: The Global Fund's resource allocation decisions for HIV programmes: addressing those in need. Journal of the International AIDS Society 2011, 14(1):51. Cerca con Google

153. El-Sadr WM, Holmes CB, Mugyenyi P, Thirumurthy H, Ellerbrock T, Ferris R, Sanne I, Asiimwe A, Hirnschall G, Nkambule RN et al: Scale-up of HIV Treatment Through PEPFAR: A Historic Public Health Achievement. J Acquir Immune Defic Syndr 2012, 60(Suppl 3):S96–104. Cerca con Google

154. Van Damme W, Kegels G: Health System Strengthening and Scaling Up Antiretroviral Therapy: The Need for Context-Specific Delivery Models: Comment on Schneider et al. Reproductive Health Matters 2006, 14(27):24-26. Cerca con Google

155. Sachs JD, McArthur JW: The Millennium Project: a plan for meeting the Millennium Development Goals. The Lancet 2005, 365(9456):347-353. Cerca con Google

156. Hongoro C, McPake B: How to bridge the gap in human resources for health. The Lancet 2004, 364(9443):1451-1456. Cerca con Google

157. Hagopian A, Micek MA, Vio F, Gimbel-Sherr K, Montoya P: What if we decided to take care of everyone who needed treatment? Workforce planning in Mozambique using simulation of demand for HIV/AIDS care. Hum Resour Health 2008, 6:3. Cerca con Google

158. Miles K, Clutterbuck D, Seitio O, Sebogo M, Riley A: Antiretroviral treatment roll-out in a resource-constrained setting: capitalizing on nursing resources in Botswana. Bull World Health Organ 2007, 85:550 - 560. Cerca con Google

159. Spero JC, McQuide PA, Matte R: Tracking and monitoring the health workforce: a new human resources information system (HRIS) in Uganda. Hum Resour Health 2011, 9:6. Cerca con Google

160. Faye A, Fournier P, Diop I, Philibert A, Morestin F, Dumont A: Developing a tool to measure satisfaction among health professionals in sub-Saharan Africa. Human Resources for Health 2013, 11(30). Cerca con Google

161. WHO: Taking stock: health worker shortages and the response to AIDS. 2006. Cerca con Google

162. Clemens MA, Pettersson G: New data on African health professionals abroad. Hum Resour Health 2008, 6:1. Cerca con Google

163. Dieleman M, Biemba G, Mphuka S, Sichinga-Sichali K, Sissolak D, van der Kwaak A, van der Wilt GJ: 'We are also dying like any other people, we are also people': perceptions of the impact of HIV/AIDS on health workers in two districts in Zambia. Health Policy Plan 2007, 22(3):139-148. Cerca con Google

164. Ncayiyana DJ: Doctors and nurses with HIV and AIDS in sub-Saharan Africa :“We’re going to run out of people before we run out of money”. BMJ 2004, 329:584–585 Cerca con Google

165. WHO Europe: HIV/AIDS in Europe: Moving from death sentence to chronic disease management; 2006. Cerca con Google

166. Colvin CJ: HIV/AIDS, Chronic Diseases and Globalisation. Globalization and Health 2011, 7(1):31. Cerca con Google

167. Deeks SG, Lewin SR, Havlir DV: The end of AIDS: HIV infection as a chronic disease. The Lancet 2013, 382(9903):1525-1533. Cerca con Google

168. Arthura G, Bhattb SM, Muhindib D, Achiyad GA, Kariukic SM, Gilks CF: The changing impact of HIV/AIDS on Kenyatta National Hospital, Nairobi from 1988/89 through 1992 to 1997. AIDS 2000, 14:1625-1631 Cerca con Google

169. Buve A: AIDS and hospital bed occupancy: an overview. Tropical Medicine and International Health 1997, 2 (2):136–139 Cerca con Google

170. Tembo G, Friesan H, Asiimwe-Okiror G, Moser R, Naamara W, Bakyaita N, Musinguzi J: Bed occupancy due to HIV/AIDS in an urban hospital medical ward in Uganda. Aids 1994, 8(8):1169-1171. Cerca con Google

171. Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G et al: Human resources for health: overcoming the crisis. Lancet 2004, 364:1984–1990 Cerca con Google

172. Kurowski C, Wyss K, Abdulla S, Mills A: Scaling up priority health interventions in Tanzania: the human resources challenge. Health Policy Plan 2007, 22(3):113-127. Cerca con Google

173. Kurowski C, and, Mills A: Estimating human resource requirements for scaling up priority health interventions in Low-income countries of Sub-Saharan Africa: A methodology based on service quantity, tasks and productivity (THE QTP METHODOLOGY). 2006. Cerca con Google

174. WHO: The Global Health Workforce Alliance. Strategy 2013–2016. ADVANCING THE HEALTH WORKFORCE AGENDA WITHIN UNIVERSAL HEALTH COVERAGE. 2012. Cerca con Google


176. Health Workforce Australia: National Health Workforce Innovation and Reform Strategic Framework for Action 2011–2015. In.; 2011. Cerca con Google

177. Vian T, Richards SC, McCoy K, Connelly P, Feeley F: Public-private partnerships to build human capacity in low income countries: findings from the Pfizer program. Human Resources for Health 2007, 5(1):8. Cerca con Google

178. Buchan J, McCaffery J: Health Workforce Innovations: A Synthesis of Four Promising Practices. 2007. Cerca con Google

179. African Health Workforce Observatory : Human Resources for Health Country Profile Uganda. 2009. Cerca con Google

180. Assefa Y, Van Damme W, Hermann K: Human resource aspects of antiretroviral treatment delivery models: current practices and recommendations. Curr Opin HIV AIDS 2010, 5(1):78-82. Cerca con Google

181. WHO: Taking stock: Task shifting to tackle health worker shortages. 2007. Cerca con Google

182. Callaghan M, Ford N, Schneider H: A systematic review of task- shifting for HIV treatment and care in Africa. Hum Resour Health 2010, 8:8. Cerca con Google

183. Stringer J, Zulu I, Levy J: Rapid scale-up of antiretroviral therapy at primary care sites in Zambia: feasibility and early outcomes. JAMA 2006, 296(7):782 - 794. Cerca con Google

184. Morris MB, Chapula BT, Chi BH, Mwango A, Chi HF, Mwanza J, Manda H, Bolton C, Pankratz DS, Stringer JS et al: Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia. BMC Health Serv Res 2009, 9:5. Cerca con Google

185. Sherwood GD: Nurse practitioner descriptions for primary care centers: opportunities for ownership. Journal of the American Academy of Nurse Practitioners 1997, 9(10):463-469. Cerca con Google

186. Mullan F, Frehywot S: Non-physician clinicians in 47 sub-Saharan African countries. Lancet 2007, 370:2158–2163. Cerca con Google

187. Medecins Sans Frontieres (MSf): A dialogue on the delivery of antiretroviral treatment in resource-limited settings, held at Maropeng, Cradle of Humankind, Gauteng, South Africa, September 2006. Cerca con Google

188. Zachariah R, Teck R, Buhendwa L, Fitzerland M, Labana S, Chinji C, Humblet P, Harries AD: Community support is associated with better antiretroviral treatment outcomes in a resource-limited rural district in Malawi. Trans R Soc Trop Med Hyg 2007, 101(1):79-84. Cerca con Google

189. Farmer P, Leandre F, Mukherjee JS, Claude M, Nevil P, Smith-Fawzi MC, Koenig SP, Castro A, Becerra MC, Sachs J et al: Community-based approaches to HIV treatment in resource-poor settings. Lancet 2001, 358(9279):404-409. Cerca con Google

190. WHO/Global Health Workforce Alliance: Mid-level health workers for delivery of essential health services a global systematic review and country experiences. 2013. Cerca con Google

191. Dovlo D: Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Hum Resour Health 2004, 2(1):7. Cerca con Google

192. Keni BH: Training competent and effective Primary Health Care Workers to fill a void in the outer islands health service delivery of the Marshall Islands of Micronesia. Hum Resour Health 2006, 4:27. Cerca con Google

193. Hermann K, Van Damme W, Pariyo G, Schouten E, Assefa Y, Cirera A, Massavon W: Community health workers for ART in sub-Saharan Africa: learning from experience – capitalizing on new opportunities. Human Resources for Health 2009, 7(1):31. Cerca con Google

194. Van Balen H: Disease control in primary health care: a historical perspective. Tropical Medicine and International Health 2004, 9(6):A22-A26. Cerca con Google

195. WHO/PEPFAR/UNAIDS: International Conference on Task Shifting: Addis Ababa Declaration 10 January 2008. . Cerca con Google

196. Republic of Uganda: THE STATE OF UGANDA POPULATION REPORT 2013. Cerca con Google

197. UNFPA: The State of World Population 2013. Cerca con Google

198. Van Damme W, Pirard M, Assefa Y, Van Olmen J: Which Health Systems for Disease Control? How can Disease Control Programmes Contribute to Health Systems Strengthening in Sub-Saharan Africa? Institue of Tropical Medicine, Antwerp (Belgium) Studies in Health Services Organisation & Policy 2010, Working Paper Series(Working paper # 1). Cerca con Google

199. Tewodros B, Freya R, Yibeltal A, Atakilti B, Van Damme W: Disease Control Programs contribution to Health System Strengthening: Good practices and new approaches for scale up. A study by the Federal Ministry of Health, Ethiopia and the Institute of Tropical Medicine, Antwerp. Working Paper Series of the Studies in Health Services Organisation and Policy 2011(Nr. 4,). Cerca con Google


201. Seeley J, Kajura E, Bachengana C, Okongo M, Wagner U, Mulder D: The extended family and support for people with AIDS in a rural population in south west Uganda: a safety net with holes? AIDS Care 1993, 5(1):117-122. Cerca con Google

202. Bachmann M, Booysen F: Health and economic impact of HIV/AIDS on South African households: a cohort study. BMC Public Health 2003, 3(1):14. Cerca con Google

203. Nabyonga-Orem J, Bazeyo W, Okema A, Karamagi H, Walker O: Effects of HIV/AIDS on Household Welfare in Uganda Rural Communities: a Review. East Afr Med J 2008, 85(4):187-196. Cerca con Google

204. Marazzi MC, De Luca S, Palombi L, Scarcella P, Ciccacci F, Ceffa S, Nielsen-Saines K, De Luca A, Mancinelli S, Gennaro E et al: Predictors of Adverse Outcomes in HIV-1 Infected Children Receiving Combination Antiretroviral Treatment: Results from a DREAM Cohort in Sub-Saharan Africa. Pediatr Infect Dis J 2013. Cerca con Google

205. HEPS-Uganda: Campaign to End Paediatric HIV/AIDS. Uganda National Advocacy Action Plan 2010. Cerca con Google

206. WHO: ANTIRETROVIRAL ThERApy fOR hIV INfEcTION IN INfANTs ANd chILdREN: TOwARds uNIVERsAL AccEss. Recommendations for a public health approach: 2010 revision. 2010. Cerca con Google

207. Luyirika E, Towle MS, Achan J, Muhangi J, Senyimba C, Lule F, Muhe L: Scaling Up Paediatric HIV Care with an Integrated, Family-Centred Approach: An Observational Case Study from Uganda. PLoS One 2013, 8(8):e69548. Cerca con Google

208. Betancourt TS, Abrams EJ, McBain R, Fawzi MC: Family-centred approaches to the prevention of mother to child transmission of HIV. J Int AIDS Soc 2010, 13 Suppl 2:S2. Cerca con Google

209. Hielkema M, de Winter AF, de Meer G, Reijneveld SA: Effectiveness of a family-centered method for the early identification of social-emotional and behavioral problems in children: a quasi experimental study. BMC Public Health 2011, 11(1):636. Cerca con Google

210. Leeper S, Montague B, Friedman J, Flanigan T: Lessons learned from family-centred models of treatment for children living with HIV: current approaches and future directions. Journal of the International AIDS Society 2010, 13(Suppl 2):S3. Cerca con Google

211. Lewis Kulzer J, Penner JA, Marima R, Oyaro P, Oyanga AO, Shade SB, Blat CC, Nyabiage L, Mwachari CW, Muttai HC et al: Family model of HIV care and treatment: a retrospective study in Kenya. J Int AIDS Soc 2012, 15(1):8. Cerca con Google

212. Richter L: An introduction to family-centred services for children affected by HIV and AIDS. J Int AIDS Soc 2010, 13 Suppl 2:S1. Cerca con Google

213. Boulle A: Antiretroviral therapy and early mortality in South Africa. Bulletin of the World Health Organization 2008, 86(9):678-687. Cerca con Google

214. Massavon W, Lundin R, Costenaro P, Penazzato M, Namisi PC, Ingabire R, Nannyonga MM, Bilardi D, Mazza A, Giaquinto C: Attrition and loss to follow-up among children and adolescents in a community home-based care HIV programme in Uganda. "in press" 2013. Cerca con Google

215. Naidoo R, Rennert W, Lung A, Naidoo K, McKerrow N: The Influence of Nutritional Status on the Response to HAART in HIV-Infected Children in South Africa. The Pediatric Infectious Disease Journal 2010, 29(6):511-513 510.1097/INF.1090b1013e3181d1091e1989. Cerca con Google

216. Mubiana-Mbewe M, Bolton-Moore C, Banda Y, Chintu N, Nalubamba-Phiri M, Giganti M, Guffey MB, Sambo P, Stringer EM, Stringer JS et al: Causes of morbidity among HIV-infected children on antiretroviral therapy in primary care facilities in Lusaka, Zambia. Trop Med Int Health 2009, 14(10):1190-1198. Cerca con Google

217. Health Information For All by 2015: A Global Campaign and Knowledge Network: Annual Review 2010. Cerca con Google

218. Bertagnolio S, Parkin NT, Jordan M, Brooks J, García-Lerma JG: Dried blood spots for HIV-1 drug resistance and viral load testing: A review of current knowledge and WHO efforts for global HIV drug resistance surveillance. AIDS Rev 2010, 12(4):195-208. Cerca con Google

219. Parkin N, de Mendoza C, Schuurman R, Jennings C, Bremer J, Jordan MR, Bertagnolio S, Group WDGW: Evaluation of in-house genotyping assay performance using dried blood spot specimens in the Global World Health Organization laboratory network. Clin Infect Dis 2012, 54 Suppl 4:S273-S279. Cerca con Google

220. Johannessen A, Troseid M, Calmy A: Dried blood spots can expand access to virological monitoring of HIV treatment in resource-limited settings. J Antimicrob Chemother 2009, 64(6):1126-1129. Cerca con Google

221. Ziemniak C, Mengistu Y, Ruff A, Chen YH, Khaki L, Bedri A, Simen BB, Palumbo P, Eshleman SH, Persaud D: Use of dried-blood-spot samples and in-house assays to identify antiretroviral drug resistance in HIV-infected children in resource-constrained settings. J Clin Microbiol 2011, 49(12):4077-4082. Cerca con Google

222. Siedner MJ, Lankowski A, Tsai AC, Muzoora C, Martin JN, Hunt PW, Haberer JE, Bangsberg DR: GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda. Aids 2013, 27(9):1503-1508. Cerca con Google

223. Ministry of Health, Uganda: Status of Antiretroviral Therapy Services in Uganda: Quarterly ART Report for October – December 2011. STD/AIDS Control Programme, Ministry of Health, March 2012 Kampala, Uganda. 2012. Cerca con Google

224. Westley BP, DeLong AK, Tray CS, Sophearin D, Dufort EM, Nerrienet E, Schreier L, Harwell JI, Kantor R: Prediction of treatment failure using 2010 World Health Organization Guidelines is associated with high misclassification rates and drug resistance among HIV-infected Cambodian children. Clin Infect Dis 2012, 55(3):432-440. Cerca con Google

225. WHO: Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Geneva, Switzerland; 2013. Cerca con Google

Cerca con Google

Download statistics

Solo per lo Staff dell Archivio: Modifica questo record