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Despite being a curable and preventable disease, tuberculosis (TB) remains as one of the major challenges for health systems, globally. Every year, TB affects more than 10 million people and kills m
...
ore than 1.4 million people. WHO’s Digital Health for the End TB Strategy – an Agenda for Action outlines a conceptual framework in which advantageously positioned digital health solutions are matched to the most urgent needs of TB programmes. Video-supported treatment is a component of one of the four core functions of this framework, the Patient Care domain, and primarily supports the first pillar of the End TB Strategy. This quick guide provides information on the solutions available for asynchronous modes of video communication and how these can be of use to TB programmes.
more
Background: Cardiovascular disease (CVD), mainly heart attack and stroke, is the
leading cause of premature mortality in low and middle income countries (LMICs).
Identifying
...
and managing individuals at high risk of CVD is an important strategy to prevent and control CVD, in addition to multisectoral population-based interventions to reduce CVD risk factors in the entire population.
Methods: We describe key public health considerations in identifying and managing individuals at high risk of CVD in LMICs.
Results: A main objective of any strategy to identify individuals at high CVD risk is to maximize the number of CVD events averted while minimizing the numbers of
individuals needing treatment. Scores estimating the total risk of CVD (e.g. ten-year risk of fatal and non-fatal CVD) are available for LMICs, and are based on the main CVD risk factors (history of CVD, age, sex, tobacco use, blood pressure, blood cholesterol and diabetes status). Opportunistic screening of CVD risk factors enables identification of persons with high CVD risk, but this strategy can be widely applied in low resource settings only if cost effective interventions are used (e.g. the WHO Package of Essential NCD interventions for primary health care in low resource settings package) and if treatment (generally for years) can be sustained, including continued availability ofaffordable medications and funding mechanisms that allow people to purchase medications without impoverishing them (e.g. universal access to health care). Thisalso emphasises the need to re-orient health systems in LMICs towards chronic diseases management.
Conclusion: The large burden of CVD in LMICs and the fact that persons with high
CVD can be identified and managed along cost-effective interventions mean that
health systems need to be structured in a way that encourages patient registration, opportunistic screening of CVD risk factors, efficient procedures for the management of chronic conditions (e.g. task sharing) and provision of affordable treatment for those with high CVD risk. The focus needs to be in primary care because that is where most of the population can access health care and because CVD programmes can be run effectively at this level.
more
Government of Nepal has an obligation to ensure availability of affordable and high quality basic health care services to its population
This publication provides recommendations for the management of critically ill adult patients with COVID-19 being treated in intensive care units (ICUs) in the Americas. These clinical practice guidelines provide evidence-informed recommendations fo
...
r identifying markers and mortality risk factors in critically ill patients, as well as infection control, sample collection, supportive care (respiratory and hemodynamic), pharmacological treatment, early rehabilitation, diagnostic imaging use, prevention of complications, and discharge requirements. The recommendations are for all health care staff caring for patients in emergency departments and ICUs. These guidelines are also intended for use by decisionmakers and government entities involved in the management of patients with COVID-19 in ICUs in the Region of the Americas.
more
The Radiation Injury Treatment Network® (RITN) provides comprehensive evaluation and treatment for victims of radiation exposure or other marrow t
...
oxic injuries.
The goals of RITN are:
1. to develop treatment guidelines for managing hematologic toxicity among victims of radiation exposure,
2. to educate health care professionals about pertinent aspects of radiation exposure management,
3. to help coordinate the medical response to radiation events, and
4. to provide comprehensive evaluation and treatment for victims at participating centers.
more
Overview
Learning objectives
• Understand the mental health treatment gap in low-, middle- and high-income countries.
• Understand the principles a
...
nd aims of the Mental Health Gap Action Programme.
• Acquire an introduction to mhGAP Intervention Guide (mhGAP-IG).
• Learn about mhGAP ToHP training methodology and what to expect from mhGAP ToHP
training.
• Prepare group training ground rules.
• Know the common presentations of mental, neurological and substance abuse (MNS)
conditions.
more
Operational considerations for case management of COVID-19 in health facility and community
recommended
This document is intended to guide the care of COVID-19 patients as the response capacity of health systems is challenged; to ensure that COVID-19 patients can access life-saving treatment, without
...
compromising public health objectives and safety of health workers.
It promotes two key messages:
1. Key public health interventions regardless of transmission scenario; and
2. Key action steps to be taken by transmission scenario to enable timely surge of clinical operations.
more
Prompt, effective antimalarial treatment, and supportive care can substantially reduce the rate of mortality from severe malaria. However, many chi
...
ldren in malaria-endemic countries do not have access to health facilities or a qualified health care provider and do not receive the necessary care in a timely fashion. Without rapid detection of danger signs and access to effective treatment, including pre-referral treatment that can be administered in the community level, many of these children with severe malaria die.
In situations where there is no immediate access to a health care facility, WHO recommends the administration of a standard dose of an effective antimalarial medicine as pre-referral treatment before referral to a facility at which complete treatment can be administered.
Rectal artesunate is the WHO-recommended pre-referral intervention in situations where artesunate injection are not feasible for children under the age of 6 years with suspected severe malaria. The intervention reduces the risk of death or permanent disability by up to 50% provided the child is referred to a health facility at which complete treatment can be administered.
This field guide is aimed at supporting the effective deployment of RAS as pre-referral treatment of suspected severe malaria in line with the WHO malaria guidelines.
more
There is no cure for rabies, but it is 100 percent preventable through prompt, appropriate medical care. Every year hundreds of South Carolinians must undergo preventive treatment for rabies due to
...
exposure to a rabid or suspected rabid animal. Although the cost varies, post-exposure treatment typically exceeds $8,000 per person.
more
Guidelines for essential trauma care
recommended
The Guidelines for essential trauma care seek to set achievable standards for trauma treatment services which could realistically be made available to almost every injured person in the world. They
...
then seek to define the resources that would be necessary to assure such care. These include human resources (staffing and training) and physical resources (infrastructure, equipment and supplies).
more
NSP Review
Engaging with South Africa’s National Strategic Plan for HIV, STIs and TB Edition 7 July – August 2013
A publication of the Treatment Action Campaign
...
and SECTION27
GeneXpert: An imperfect rollout
TB in South African prisons: Where to now?
Decentralising DR-TB care: How far along are we?
more
The present Consolidated guidelines include a comprehensive set of WHO recommendations for the treatment and care of DR-TB, derived from these WHO
...
guidelines documents. The consolidated guidelines include policy recommendations on treatment regimens for isoniazid-resistant TB (Hr-TB) and MDR/RR-TB, including longer and shorter regimens, culture monitoring of patients on treatment, the timing of antiretroviral therapy (ART) in MDR/RR-TB patients infected with the human immunodeficiency virus (HIV), use of surgery for patients receiving MDR-TB treatment, and optimal models of patient support and care.
more
The primary audience of these recommendations includes healthcare providers who are responsible for developing national and local health protocols (particularly those related to hypertensive disorders of pregnancy),
...
and those directly providing care to pregnant women and their newborns, including midwives, nurses, general medical practitioners, obstetricians, obstetric physicians, managers of maternal and child health programmes, and relevant staff in ministries of health, in all settings.
more
AWaRe – a new WHO tool to help countries improve antibiotic treatment, increase access and reduce resistance. We can reduce or even reverse antibiotic resistance by using antibiotics more responsi
...
bly. But how do we do that and still ensure that patients are treated effectively?WHO has developed a tool to help global, regional and national decision-making on which antibiotics to use when. The tool indexes the most effective antibiotics into three groups – ACCESS, WATCH, RESERVE (AWaRe for short). Evidence shows that to optimize use of antibiotics and reduce resistance, countries should increase the proportion of ACCESS antibiotics to correspond to at least 60% of total national consumption.
more
Access to NCD medicines: emergent issues during the COVID-19 pandemic and key structural factors
recommended
The coronavirus disease (COVID-19) pandemic exacerbated pre-existing inequalities in the treatment and care of noncommunicable diseases (NCDs). Thi
...
s report examines the effect of the COVID-19 pandemic on access to NCD medicines, and the policies and strategies implemented by countries and health systems to anticipate and mitigate stresses across NCD medicine supply chains. The full range of upstream and downstream impacts are investigated, including: manufacturing; procurement, importation and last mile delivery; patient-level effects through affordability and availability; and the effects on NCD medicine availability by category of disease. The report culminates in recommended actions and interventions for key stakeholders in the NCD pharmaceutical supply chain, including governments, regulatory authorities, manufacturers and the private sector; as well as directions for future research for improving access and supply chain access resilience.
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The coronavirus disease (COVID-19) pandemic exacerbated pre-existing inequalities in the treatment and care of noncommunicable diseases (NCDs). Thi
...
s report examines the effect of the COVID-19 pandemic on access to NCD medicines, and the policies and strategies implemented by countries and health systems to anticipate and mitigate stresses across NCD medicine supply chains. The full range of upstream and downstream impacts are investigated, including: manufacturing; procurement, importation and last mile delivery; patient-level effects through affordability and availability; and the effects on NCD medicine availability by category of disease. The report culminates in recommended actions and interventions for key stakeholders in the NCD pharmaceutical supply chain, including governments, regulatory authorities, manufacturers and the private sector; as well as directions for future research for improving access and supply chain access resilience.
more
Palliative care is an approach that improves the quality of life of patients (adults and children) and their families who are facing problems assoc
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iated with life-threatening illness. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual.
Addressing suffering involves taking care of issues beyond physical symptoms. Palliative care uses a team approach to support patients and their caregivers. This includes addressing practical needs and providing bereavement counselling. It offers a support system to help patients live as actively as possible until death.
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Background
Access to medicines is important for long‐term care of cardiovascular diseases and hypertension. This study provides a cross‐country assessment of availability, prices,
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and affordability of cardiovascular disease and hypertension medicines to identify areas for improvement in access to medication treatment.
Methods and Results
We used the World Health Organization online repository of national essential medicines lists (EMLs) for 53 countries to transcribe the information on the inclusion of 12 cardiovascular disease/hypertension medications within each country's essential medicines list. Data on availability, price, and affordability were obtained from 84 surveys in 59 countries that used the World Health Organization's Health Action International survey methodology. We summarized and compared the indicators across lowest‐price generic and originator brand medicines in the public and private sectors and by country income groups. The average availability of the select medications was 54% in low‐ and lower‐middle‐income countries and 60% in high‐ and upper‐middle‐income countries, and was higher for generic (61%) than brand medicines (41%). The average patient median price ratio was 80.3 for brand and 16.7 for generic medicines and was higher for patients in low‐ and lower‐middle‐income countries compared with high‐ and upper‐middle‐income countries across all medicine categories. The costs of 1 month's antihypertensive medications were, on average, 6.0 days’ wage for brand medicine and 1.8 days’ wage for generics. Affordability was lower in low‐ and lower‐middle‐income countries than high‐ and upper‐middle‐income countries for both brand and generic medications.
Conclusions
The availability and accessibility of pharmaceuticals is an ongoing challenge for health systems. Low availability and high costs are major barriers to the use of and adherence to essential cardiovascular disease and antihypertensive medications worldwide, particularly in low‐ and lower‐middle‐income countries.
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Guidelines on hepatitis B and C testing
recommended
Testing and diagnosis of hepatitis B (HBV) and C (HCV) infection is the gateway for access to both prevention and
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treatment services, and is a crucial component of an effective response to the hepatitis epidemic. Early identification of persons with chronic HBV or HCV infection enables them to receive the necessary care and treatment to prevent or delay progression of liver disease. Testing also provides an opportunity to link people to interventions to reduce transmission, through counselling on risk behaviours and provision of prevention commodities (such as sterile needles and syringes) and hepatitis B vaccination.
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Clinical management standard operating procedures.
Ebola virus disease (EVD) is a life-threatening multisystem illness associated with fever and gastrointestinal (GI) symptoms that frequently leads to hypovolaemia, metabolic acidosis, hypoglycaemia
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, and multi-organ failure. The prolonged 2013–2016 EVD outbreak in West Africa allowed for an evolution of care such that by outbreak end many patients received individualized and optimized supportive care (oSoC), including volume resuscitation, symptom control, laboratory and bedside monitoring of glucose, electrolyte levels and organ dysfunction, as well as rapid detection and treatment of co-infections, potentially contributing to the downward trend in the case fatality rate (CFR).
This guidance should serve as a foundation for oSoC that should be followed to ensure both the best possible chance for survival and allow for reliable comparison of investigational therapeutic interventions as part of a randomized controlled trial. This guideline provides recommendations for the management of adults and children.
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