WorldWideScience

Sample records for rapidly scale-up hiv

  1. Use of task-shifting to rapidly scale-up HIV treatment services: experiences from Lusaka, Zambia

    Directory of Open Access Journals (Sweden)

    Chi Harmony F

    2009-01-01

    Full Text Available Abstract The World Health Organization advocates task-shifting, the process of delegating clinical care functions from more specialized to less specialized health workers, as a strategy to achieve the United Nations Millennium Development Goals. However, there is a dearth of literature describing task shifting in sub-Saharan Africa, where services for antiretroviral therapy (ART have scaled up rapidly in the face of generalized human resource crises. As part of ART services expansion in Lusaka, Zambia, we implemented a comprehensive task-shifting program among existing health providers and community-based workers. Training begins with didactic sessions targeting specialized skill sets. This is followed by an intensive period of practical mentorship, where providers are paired with trainers before working independently. We provide on-going quality assessment using key indicators of clinical care quality at each site. Program performance is reviewed with clinic-based staff quarterly. When problems are identified, clinic staff members design and implement specific interventions to address targeted areas. From 2005 to 2007, we trained 516 health providers in adult HIV treatment; 270 in pediatric HIV treatment; 341 in adherence counseling; 91 in a specialty nurse "triage" course, and 93 in an intensive clinical mentorship program. On-going quality assessment demonstrated improvement across clinical care quality indicators, despite rapidly growing patient volumes. Our task-shifting strategy was designed to address current health care worker needs and to sustain ART scale-up activities. While this approach has been successful, long-term solutions to the human resource crisis are also urgently needed to expand the number of providers and to slow staff migration out of the region.

  2. Assessing stakeholder perceptions of the acceptability and feasibility of national scale-up for a dual HIV/syphilis rapid diagnostic test in Malawi.

    Science.gov (United States)

    Maddox, Brandy L Peterson; Wright, Shauntā S; Namadingo, Hazel; Bowen, Virginia B; Chipungu, Geoffrey A; Kamb, Mary L

    2017-12-01

    The WHO recommends pregnant women receive both HIV and syphilis testing at their first antenatal care visit, as untreated maternal infections can lead to severe, adverse pregnancy outcomes. One strategy for increasing testing for both HIV and syphilis is the use of point-of-care (rapid) diagnostic tests that are simple, proven effective and inexpensive. In Malawi, pregnant women routinely receive HIV testing, but only 10% are tested for syphilis at their first antenatal care visit. This evaluation explores stakeholder perceptions of a novel, dual HIV/syphilis rapid diagnostic test and potential barriers to national scale-up of the dual test in Malawi. During June and July 2015, we conducted 15 semistructured interviews with 25 healthcare workers, laboratorians, Ministry of Health leaders and partner agency representatives working in prevention of mother-to-child transmission in Malawi. We asked stakeholders about the importance of a dual rapid diagnostic test, concerns using and procuring the dual test and recommendations for national expansion. Stakeholders viewed the test favourably, citing the importance of a dual rapid test in preventing missed opportunities for syphilis diagnosis and treatment, improving infant outcomes and increasing syphilis testing coverage. Primary technical concerns were about the additional procedural steps needed to perform the test, the possibility that testers may not adhere to required waiting times before interpreting results and difficulty reading and interpreting test results. Stakeholders thought national scale-up would require demonstration of cost-savings, uniform coordination, revisions to testing guidelines and algorithms, training of testers and a reliable supply chain. Stakeholders largely support implementation of a dual HIV/syphilis rapid diagnostic test as a feasible alternative to current antenatal testing. Scale-up will require addressing perceived barriers; negotiating changes to existing algorithms and guidelines

  3. Scaling up Prevention of Mother to Child Transmission of HIV ...

    African Journals Online (AJOL)

    AJRH Managing Editor

    Nigeria is scaling up prevention of mother-to-child transmission (PMTCT) of HIV interventions to primary health care ... Of 10,289 women who had antenatal HIV test, 74 had positive results. ..... counselling and lack of reinforcement of contents.

  4. Improved HIV testing coverage after scale-up of ... - Lusaka

    African Journals Online (AJOL)

    Improved HIV testing coverage after scale-up of antiretroviral therapy programs in urban Zambia: Evidence from serial hospital surveillance. ... Background: We evaluated changing HIV testing coverage and prevalence rates before and after expanding city-wide antiretroviral therapy (ART) programs in Lusaka, Zambia.

  5. Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

    Directory of Open Access Journals (Sweden)

    Simbaya Joseph

    2010-09-01

    Full Text Available Abstract Background Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Methods Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural, to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Results Clinical staff (doctors, nurses and nurse-midwives, and clinical officers numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART and prevention of mother to child transmission (PMTCT per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. Conclusions This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of

  6. Task sharing in Zambia: HIV service scale-up compounds the human resource crisis

    LENUS (Irish Health Repository)

    Walsh, Aisling

    2010-09-17

    Abstract Background Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV\\/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Methods Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Results Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses\\/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. Conclusions This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV\\/AIDS service delivery has been on the back of sustained non-HIV

  7. Task sharing in Zambia: HIV service scale-up compounds the human resource crisis.

    Science.gov (United States)

    Walsh, Aisling; Ndubani, Phillimon; Simbaya, Joseph; Dicker, Patrick; Brugha, Ruairí

    2010-09-17

    Considerable attention has been given by policy makers and researchers to the human resources for health crisis in Africa. However, little attention has been paid to quantifying health facility-level trends in health worker numbers, distribution and workload, despite growing demands on health workers due to the availability of new funds for HIV/AIDS control scale-up. This study analyses and reports trends in HIV and non-HIV ambulatory service workloads on clinical staff in urban and rural district level facilities. Structured surveys of health facility managers, and health services covering 2005-07 were conducted in three districts of Zambia in 2008 (two urban and one rural), to fill this evidence gap. Intra-facility analyses were conducted, comparing trends in HIV and non-HIV service utilisation with staff trends. Clinical staff (doctors, nurses and nurse-midwives, and clinical officers) numbers and staff population densities fell slightly, with lower ratios of staff to population in the rural district. The ratios of antenatal care and family planning registrants to nurses/nurse-midwives were highest at baseline and increased further at the rural facilities over the three years, while daily outpatient department (OPD) workload in urban facilities fell below that in rural facilities. HIV workload, as measured by numbers of clients receiving antiretroviral treatment (ART) and prevention of mother to child transmission (PMTCT) per facility staff member, was highest in the capital city, but increased rapidly in all three districts. The analysis suggests evidence of task sharing, in that staff designated by managers as ART and PMTCT workers made up a higher proportion of frontline service providers by 2007. This analysis of workforce patterns across 30 facilities in three districts of Zambia illustrates that the remarkable achievements in scaling-up HIV/AIDS service delivery has been on the back of sustained non-HIV workload levels, increasing HIV workload and stagnant

  8. Protecting HIV information in countries scaling up HIV services: a baseline study.

    Science.gov (United States)

    Beck, Eduard J; Mandalia, Sundhiya; Harling, Guy; Santas, Xenophon M; Mosure, Debra; Delay, Paul R

    2011-02-06

    Individual-level data are needed to optimize clinical care and monitor and evaluate HIV services. Confidentiality and security of such data must be safeguarded to avoid stigmatization and discrimination of people living with HIV. We set out to assess the extent that countries scaling up HIV services have developed and implemented guidelines to protect the confidentiality and security of HIV information. Questionnaires were sent to UNAIDS field staff in 98 middle- and lower-income countries, some reportedly with guidelines (G-countries) and others intending to develop them (NG-countries). Responses were scored, aggregated and weighted to produce standard scores for six categories: information governance, country policies, data collection, data storage, data transfer and data access. Responses were analyzed using regression analyses for associations with national HIV prevalence, gross national income per capita, OECD income, receiving US PEPFAR funding, and being a G- or NG-country. Differences between G- and NG-countries were investigated using non-parametric methods. Higher information governance scores were observed for G-countries compared with NG-countries; no differences were observed between country policies or data collection categories. However, for data storage, data transfer and data access, G-countries had lower scores compared with NG-countries. No significant associations were observed between country score and HIV prevalence, per capita gross national income, OECD economic category, and whether countries had received PEPFAR funding. Few countries, including G-countries, had developed comprehensive guidelines on protecting the confidentiality and security of HIV information. Countries must develop their own guidelines, using established frameworks to guide their efforts, and may require assistance in adapting, adopting and implementing them.

  9. Progress on scaling up integrated services for sexual and reproductive health and HIV

    OpenAIRE

    Dickinson, Clare; Attawell, Kathy; Druce, Nel

    2009-01-01

    This paper considers new developments to strengthen sexual and reproductive health and HIV linkages and discusses factors that continue to impede progress. It is based on a previous review undertaken for the United Kingdom Department for International Development in 2006 that examined the constraints and opportunities to scaling up these linkages. We argue that, despite growing evidence that linking sexual and reproductive health and HIV is feasible and beneficial, few countries have achieved...

  10. Scaling up success to improve health: Towards a rapid assessment guide for decision makers

    Directory of Open Access Journals (Sweden)

    Jason Paltzer

    2015-01-01

    Full Text Available Introduction Evidence-based health interventions exist and are effectively implemented throughout resource-limited settings. The literature regarding scale-up strategies and frameworks is growing. The purpose of this paper is to identify and systematically document the variation in scale-up strategies to develop a rapid assessment tool for decision-makers looking to identify the most appropriate strategy for their organizational and environmental contexts. Methods A list of scale-up strategies and frameworks were identified through an in-depth literature review and conversations with scale-up and quality improvement leaders. The literature search included a broad range of terms that might be used interchangeably with scale-up of best practices. Terms included: implementation research, knowledge translation, translational research, quality improvement research, health systems improvement, scale-up, best practices, improvement collaborative, and community based research. Based on this research, 18 strategies and frameworks were identified, and nine met our inclusion criteria for scale-up of health-related strategies. We interviewed the key contact for four of the nine strategies to obtain additional information regarding the strategy’s scale-up components, targets, underlying theories, evaluation efforts, facilitating factors, and barriers. A comparative analysis of common elements and strategy characteristics was completed by two of the authors on the nine selected strategies. Key strategy characteristics and common factors that facilitate or hinder the strategy’s success in scaling up health-related interventions were identified. Results Common features of scale-up strategies include: 1 the development of context-specific evidence; 2 collaborative partnerships; 3 iterative processes; and 4 shared decision-making. Facilitating factors include strong leadership, community engagement, communication, government collaboration, and a focus on

  11. Scale-up, retention and HIV/STI prevalence trends among female sex workers attending VICITS clinics in Guatemala.

    Directory of Open Access Journals (Sweden)

    Sonia Morales-Miranda

    Full Text Available Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW attending VICITS clinics in Guatemala.Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention.During 2007-2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361% during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention.Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently

  12. Scale-up, retention and HIV/STI prevalence trends among female sex workers attending VICITS clinics in Guatemala.

    Science.gov (United States)

    Morales-Miranda, Sonia; Jacobson, Jerry O; Loya-Montiel, Itzel; Mendizabal-Burastero, Ricardo; Galindo-Arandi, César; Flores, Carlos; Chen, Sanny Y

    2014-01-01

    Since 2007, Guatemala integrated STI clinical service with an HIV prevention model into four existing public health clinics to prevent HIV infection, known as the VICITS strategy. We present the first assessment of VICITS scale-up, retention, HIV and STI prevalence trends, and risk factors associated with HIV infection among Female Sex Workers (FSW) attending VICITS clinics in Guatemala. Demographic, behavioral and clinical data were collected using a standardized form. Data was analyzed by year and health center. HIV and STI prevalence were estimated from routine visits. Retention was estimated as the percent of new users attending VICITS clinics who returned for at least one follow-up visit to any VICITS clinic within 12 months. Separate multivariate logistic regression models were conducted to investigate factors associated with HIV infection and program retention. During 2007-2011 5,682 FSW visited a VICITS clinic for the first-time. HIV prevalence varied from 0.4% to 5.8%, and chlamydia prevalence from 0% to 14.3%, across sites. Attending the Puerto Barrios clinic, having a current syphilis infection, working primarily on the street, and using the telephone or internet to contact clients were associated with HIV infection. The number of FSW accessing VICITS annually increased from 556 to 2,557 (361%) during the period. In 2011 retention varied across locations from 7.7% to 42.7%. Factors negatively impacting retention included current HIV diagnosis, having practiced sex work in another country, being born in Honduras, and attending Marco Antonio Foundation or Quetzaltenango clinic sites. Systematic time trends did not emerge, however 2008 and 2010 were characterized by reduced retention. Our data show local differences in HIV prevalence and clinic attendance that can be used to prioritize prevention activities targeting FSW in Guatemala. VICITS achieved rapid scale-up; however, a better understanding of the causes of low return rates is urgently needed.

  13. Progress on scaling up integrated services for sexual and reproductive health and HIV.

    Science.gov (United States)

    Dickinson, Clare; Attawell, Kathy; Druce, Nel

    2009-11-01

    This paper considers new developments to strengthen sexual and reproductive health and HIV linkages and discusses factors that continue to impede progress. It is based on a previous review undertaken for the United Kingdom Department for International Development in 2006 that examined the constraints and opportunities to scaling up these linkages. We argue that, despite growing evidence that linking sexual and reproductive health and HIV is feasible and beneficial, few countries have achieved significant scale-up of integrated service provision. A lack of common understanding of terminology and clear technical operational guidance, and separate policy, institutional and financing processes continue to represent significant constraints. We draw on experience with tuberculosis and HIV integration to highlight some lessons. The paper concludes that there is little evidence to determine whether funding for health systems is strengthening linkages and we make several recommendations to maximize opportunities represented by recent developments.

  14. Improving laboratory efficiencies to scale-up HIV viral load testing.

    Science.gov (United States)

    Alemnji, George; Onyebujoh, Philip; Nkengasong, John N

    2017-03-01

    Viral load measurement is a key indicator that determines patients' response to treatment and risk for disease progression. Efforts are ongoing in different countries to scale-up access to viral load testing to meet the Joint United Nations Programme on HIV and AIDS target of achieving 90% viral suppression among HIV-infected patients receiving antiretroviral therapy. However, the impact of these initiatives may be challenged by increased inefficiencies along the viral load testing spectrum. This will translate to increased costs and ineffectiveness of scale-up approaches. This review describes different parameters that could be addressed across the viral load testing spectrum aimed at improving efficiencies and utilizing test results for patient management. Though progress is being made in some countries to scale-up viral load, many others still face numerous challenges that may affect scale-up efficiencies: weak demand creation, ineffective supply chain management systems; poor specimen referral systems; inadequate data and quality management systems; and weak laboratory-clinical interface leading to diminished uptake of test results. In scaling up access to viral load testing, there should be a renewed focus to address efficiencies across the entire spectrum, including factors related to access, uptake, and impact of test results.

  15. HIV testing as prevention among MSM in China: the business of scaling-up.

    Science.gov (United States)

    Fan, Elsa L

    2014-01-01

    In this paper, I examine the emergence of goumai fuwu, or contracting with social organisations to provide social services, in the HIV/AIDS sector in China. In particular, I interrogate the outsourcing of HIV testing to community-based organisations (CBOs) serving men who have sex with men (MSM) as a means of scaling-up testing in this population, and how the commodification of testing enables new forms of surveillance and citizenship to emerge. In turn, I tie the scaling-up of testing and its commodification to the sustainability of CBOs as they struggle to survive. In recent years, the HIV/AIDS response in China has shifted to expanding testing among MSM in order to reduce new infections. This response has been catalysed by the transition to sexual contact as the primary transmission route for HIV and the rising rates of infection among MSM, leading government institutions and international donors to mobilise CBOs to expand testing. These efforts to scale-up are as much about testing as they are about making visible this hidden population. CBOs, in facilitating testing, come to rely on outsourcing as a long-term funding base and in doing so, unintentionally extend the reach of the state into the everyday lives of MSM.

  16. A qualitative assessment of participation in a rapid scale-up, diagonally-integrated MDG-related disease prevention campaign in Rural Kenya.

    Directory of Open Access Journals (Sweden)

    Timothy De Ver Dye

    Full Text Available BACKGROUND: Many countries face severe scale-up barriers toward achievement of MDGs. We ascertained motivational and experiential dimensions of participation in a novel, rapid, "diagonal" Integrated Prevention Campaign (IPC in rural Kenya that provided prevention goods and services to 47,000 people within one week, aimed at rapidly moving the region toward MDG achievement. Specifically, the IPC provided interventions and commodities targeting disease burden reduction in HIV/AIDS, malaria, and water-borne illness. METHODS: Qualitative in-depth interviews (IDI were conducted with 34 people (18 living with HIV/AIDS and 16 not HIV-infected randomly selected from IPC attendees consenting to participate. Interviews were examined for themes and patterns to elucidate participant experience and motivation with IPC. FINDINGS: Participants report being primarily motivated to attend IPC to learn of their HIV status (through voluntary counseling and testing, and with receipt of prevention commodities (bednets, water filters, and condoms providing further incentive. Participants reported that they were satisfied with the IPC experience and offered suggestions to improve future campaigns. INTERPRETATION: Learning their HIV status motivated participants along with the incentive of a wider set of commodities that were rapidly deployed through IPC in this challenging region. The critical role of wanting to know their HIV status combined with commodity incentives may offer a new model for rapid scaled-up of prevention strategies that are wider in scope in rural Africa.

  17. Improving health outcomes through concurrent HIV program scale-up and health system development in Rwanda: 20 years of experience.

    Science.gov (United States)

    Nsanzimana, Sabin; Prabhu, Krishna; McDermott, Haley; Karita, Etienne; Forrest, Jamie I; Drobac, Peter; Farmer, Paul; Mills, Edward J; Binagwaho, Agnes

    2015-09-09

    The 1994 genocide against the Tutsi destroyed the health system in Rwanda. It is impressive that a small country like Rwanda has advanced its health system to the point of now offering near universal health insurance coverage. Through a series of strategic structural changes to its health system, catalyzed through international assistance, Rwanda has demonstrated a commitment towards improving patient and population health indicators. In particular, the rapid scale up of antiretroviral therapy (ART) has become a great success story for Rwanda. The country achieved universal coverage of ART at a CD4 cell count of 200 cells/mm(3) in 2007 and increased the threshold for initiation of ART to ≤350 cells/mm(3) in 2008. Further, 2013 guidelines raised the threshold for initiation to ≤500 cells/mm(3) and suggest immediate therapy for key affected populations. In 2015, guidelines recommend offering immediate treatment to all patients. By reviewing the history of HIV and the scale-up of treatment delivery in Rwanda since the genocide, this paper highlights some of the key innovations of the Government of Rwanda and demonstrates the ways in which the national response to the HIV epidemic has catalyzed the implementation of interventions that have helped strengthen the overall health system.

  18. Scaling-up health information systems to improve HIV treatment: An assessment of initial patient monitoring systems in Mozambique.

    Science.gov (United States)

    Hochgesang, Mindy; Zamudio-Haas, Sophia; Moran, Lissa; Nhampossa, Leopoldo; Packel, Laura; Leslie, Hannah; Richards, Janise; Shade, Starley B

    2017-01-01

    The rapid scale-up of HIV care and treatment in resource-limited countries requires concurrent, rapid development of health information systems to support quality service delivery. Mozambique, a country with an 11.5% prevalence of HIV, has developed nation-wide patient monitoring systems (PMS) with standardized reporting tools, utilized by all HIV treatment providers in paper or electronic form. Evaluation of the initial implementation of PMS can inform and strengthen future development as the country moves towards a harmonized, sustainable health information system. This assessment was conducted in order to 1) characterize data collection and reporting processes and PMS resources available and 2) provide evidence-based recommendations for harmonization and sustainability of PMS. This baseline assessment of PMS was conducted with eight non-governmental organizations that supported the Ministry of Health to provide 90% of HIV care and treatment in Mozambique. The study team conducted structured and semi-structured surveys at 18 health facilities located in all 11 provinces. Seventy-nine staff were interviewed. Deductive a priori analytic categories guided analysis. Health facilities have implemented paper and electronic monitoring systems with varying success. Where in use, robust electronic PMS facilitate facility-level reporting of required indicators; improve ability to identify patients lost to follow-up; and support facility and patient management. Challenges to implementation of monitoring systems include a lack of national guidelines and norms for patient level HIS, variable system implementation and functionality, and limited human and infrastructure resources to maximize system functionality and information use. This initial assessment supports the need for national guidelines to harmonize, expand, and strengthen HIV-related health information systems. Recommendations may benefit other countries with similar epidemiologic and resource

  19. Why did the scale-up of HIV treatment work? A case example from Malawi.

    Science.gov (United States)

    Harries, Anthony D; Makombe, Simon D; Libamba, Edwin; Schouten, Erik J

    2011-08-01

    The national scale-up of antiretroviral therapy (ART) in Malawi is based on a public health approach, with principles and practices borrowed from the successful DOTS (directly observed treatment short course-the system used to successfully deliver antituberculosis treatment to people in some of the poorest countries of the world) tuberculosis control framework. During the first 6 years, the number of patients registered on treatment increased from 3000 to >350,000 in both the public and private sectors. The most important reasons for this success have been strong international and national leadership combined with adequate funds, a standardized approach to ART with practical guidelines, an approved national scale-up plan with clear, time-bound milestones; investment in an intensive program of training and accreditation of ART sites, quarterly supervision and monitoring of ART and operational research, rational drug forecasting and no stock-outs of drugs during the first few years, and involvement of the private sector. The looming challenges of human resources, guaranteed financial support, better but also more expensive ART regimens, use of electronic medical records to monitor response to therapy, and attention to HIV prevention need to be met head-on and solved if the momentum of the earlier years is to be maintained.

  20. Addressing challenges in scaling up TB and HIV treatment integration in rural primary healthcare clinics in South Africa (SUTHI): a cluster randomized controlled trial protocol.

    Science.gov (United States)

    Naidoo, Kogieleum; Gengiah, Santhanalakshmi; Yende-Zuma, Nonhlanhla; Padayatchi, Nesri; Barker, Pierre; Nunn, Andrew; Subrayen, Priashni; Abdool Karim, Salim S

    2017-11-13

    A large and compelling clinical evidence base has shown that integrated TB and HIV services leads to reduction in human immunodeficiency virus (HIV)- and tuberculosis (TB)-associated mortality and morbidity. Despite official policies and guidelines recommending TB and HIV care integration, its poor implementation has resulted in TB and HIV remaining the commonest causes of death in several countries in sub-Saharan Africa, including South Africa. This study aims to reduce mortality due to TB-HIV co-infection through a quality improvement strategy for scaling up of TB and HIV treatment integration in rural primary healthcare clinics in South Africa. The study is designed as an open-label cluster randomized controlled trial. Sixteen clinic supervisors who oversee 40 primary health care (PHC) clinics in two rural districts of KwaZulu-Natal, South Africa will be randomized to either the control group (provision of standard government guidance for TB-HIV integration) or the intervention group (provision of standard government guidance with active enhancement of TB-HIV care integration through a quality improvement approach). The primary outcome is all-cause mortality among TB-HIV patients. Secondary outcomes include time to antiretroviral therapy (ART) initiation among TB-HIV co-infected patients, as well as TB and HIV treatment outcomes at 12 months. In addition, factors that may affect the intervention, such as conditions in the clinic and staff availability, will be closely monitored and documented. This study has the potential to address the gap between the establishment of TB-HIV care integration policies and guidelines and their implementation in the provision of integrated care in PHC clinics. If successful, an evidence-based intervention comprising change ideas, tools, and approaches for quality improvement could inform the future rapid scale up, implementation, and sustainability of improved TB-HIV integration across sub-Sahara Africa and other resource

  1. Balancing the need to rapidly scale-up and improve clinical outcomes in antiretroviral programmes in developing countries: lessons from an Indian programmatic cohort study.

    Science.gov (United States)

    Bock, Peter; Beyers, Nulda; Fidler, Sarah

    2014-10-01

    Antiretroviral treatment (ART) is highly effective reducing mortality and AIDS-related morbidity in HIV-infected people and at preventing transmission of HIV between individuals. The article reviewed for this commentary reported on data from an Indian ART cohort that showed low median baseline CD4 counts and high rates of mortality and loss to follow-up. Programme implementers in developing regions need to balance the need for rapid scale-up and simultaneous improvement in clinical outcomes. Challenges outlined support HIV treatment strategies that combine improved HIV diagnosis, linkage to care and provision of ART with a strong community-based component. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  2. Scale-up of HIV treatment through PEPFAR: a historic public health achievement.

    Science.gov (United States)

    El-Sadr, Wafaa M; Holmes, Charles B; Mugyenyi, Peter; Thirumurthy, Harsha; Ellerbrock, Tedd; Ferris, Robert; Sanne, Ian; Asiimwe, Anita; Hirnschall, Gottfried; Nkambule, Rejoice N; Stabinski, Lara; Affrunti, Megan; Teasdale, Chloe; Zulu, Isaac; Whiteside, Alan

    2012-08-15

    Since its inception in 2003, the US President's Emergency Plan for AIDS Relief (PEPFAR) has been an important driving force behind the global scale-up of HIV care and treatment services, particularly in expansion of access to antiretroviral therapy. Despite initial concerns about cost and feasibility, PEPFAR overcame challenges by leveraging and coordinating with other funders, by working in partnership with the most affected countries, by supporting local ownership, by using a public health approach, by supporting task-shifting strategies, and by paying attention to health systems strengthening. As of September 2011, PEPFAR directly supported initiation of antiretroviral therapy for 3.9 million people and provided care and support for nearly 13 million people. Benefits in terms of prevention of morbidity and mortality have been reaped by those receiving the services, with evidence of societal benefits beyond the anticipated clinical benefits. However, much remains to be accomplished to achieve universal access, to enhance the quality of programs, to ensure retention of patients in care, and to continue to strengthen health systems.

  3. HIV-Related Medical Admissions to a South African District Hospital Remain Frequent Despite Effective Antiretroviral Therapy Scale-Up

    NARCIS (Netherlands)

    Meintjes, Graeme; Kerkhoff, Andrew D.; Burton, Rosie; Schutz, Charlotte; Boulle, Andrew; van Wyk, Gavin; Blumenthal, Liz; Nicol, Mark P.; Lawn, Stephen D.

    2015-01-01

    The public sector scale-up of antiretroviral therapy (ART) in South Africa commenced in 2004. We aimed to describe the hospital-level disease burden and factors contributing to morbidity and mortality among hospitalized HIV-positive patients in the era of widespread ART availability. Between June

  4. Scaling up HIV viral load - lessons from the large-scale implementation of HIV early infant diagnosis and CD4 testing.

    Science.gov (United States)

    Peter, Trevor; Zeh, Clement; Katz, Zachary; Elbireer, Ali; Alemayehu, Bereket; Vojnov, Lara; Costa, Alex; Doi, Naoko; Jani, Ilesh

    2017-11-01

    The scale-up of effective HIV viral load (VL) testing is an urgent public health priority. Implementation of testing is supported by the availability of accurate, nucleic acid based laboratory and point-of-care (POC) VL technologies and strong WHO guidance recommending routine testing to identify treatment failure. However, test implementation faces challenges related to the developing health systems in many low-resource countries. The purpose of this commentary is to review the challenges and solutions from the large-scale implementation of other diagnostic tests, namely nucleic-acid based early infant HIV diagnosis (EID) and CD4 testing, and identify key lessons to inform the scale-up of VL. Experience with EID and CD4 testing provides many key lessons to inform VL implementation and may enable more effective and rapid scale-up. The primary lessons from earlier implementation efforts are to strengthen linkage to clinical care after testing, and to improve the efficiency of testing. Opportunities to improve linkage include data systems to support the follow-up of patients through the cascade of care and test delivery, rapid sample referral networks, and POC tests. Opportunities to increase testing efficiency include improvements to procurement and supply chain practices, well connected tiered laboratory networks with rational deployment of test capacity across different levels of health services, routine resource mapping and mobilization to ensure adequate resources for testing programs, and improved operational and quality management of testing services. If applied to VL testing programs, these approaches could help improve the impact of VL on ART failure management and patient outcomes, reduce overall costs and help ensure the sustainable access to reduced pricing for test commodities, as well as improve supportive health systems such as efficient, and more rigorous quality assurance. These lessons draw from traditional laboratory practices as well as fields

  5. Up-scaling expectations among Pakistan's HIV bureaucrats: entrepreneurs of the self and job precariousness post-scale-up.

    Science.gov (United States)

    Qureshi, Ayaz

    2014-01-01

    Existing research has documented how the expansion of HIV programming has produced new subjectivities among the recipients of interventions. However, this paper contends that changes in politics, power and subjectivities may also be seen among the HIV bureaucracy in the decade of scale-up. One year's ethnographic fieldwork was conducted among AIDS control officials in Pakistan at a moment of rolling back a World Bank-financed Enhanced Programme. In 2003, the World Bank convinced the Musharraf regime to scale up the HIV response, offering a multimillion dollar soft loan package. I explore how the Enhanced Programme initiated government employees into a new transient work culture and turned the AIDS control programmes into a hybrid bureaucracy. However, the donor money did not last long and individuals' entrepreneurial abilities were tested in a time of crisis engendered by dependence on aid, leaving them precariously exposed to job insecurity, and undermining the continuity of AIDS prevention and treatment in the country. I do not offer a story of global 'best practices' thwarted by local 'lack of capacity', but an ethnographic critique of the transnational HIV apparatus and its neoliberal underpinning. I suggest that this Pakistan-derived analysis is more widely relevant in the post-scale-up decade.

  6. GeneXpert HIV-1 quant assay, a new tool for scale up of viral load monitoring in the success of ART programme in India.

    Science.gov (United States)

    Kulkarni, Smita; Jadhav, Sushama; Khopkar, Priyanka; Sane, Suvarna; Londhe, Rajkumar; Chimanpure, Vaishali; Dhilpe, Veronica; Ghate, Manisha; Yelagate, Rajendra; Panchal, Narayan; Rahane, Girish; Kadam, Dilip; Gaikwad, Nitin; Rewari, Bharat; Gangakhedkar, Raman

    2017-07-21

    Recent WHO guidelines identify virologic monitoring for diagnosing and confirming ART failure. In view of this, validation and scale up of point of care viral load technologies is essential in resource limited settings. A systematic validation of the GeneXpert® HIV-1 Quant assay (a point-of-care technology) in view of scaling up HIV-1 viral load in India to monitor the success of national ART programme was carried out. Two hundred nineteen plasma specimens falling in nine viral load ranges (5 L copies/ml) were tested by the Abbott m2000rt Real Time and GeneXpert HIV-1 Quant assays. Additionally, 20 seronegative; 16 stored specimens and 10 spiked controls were also tested. Statistical analysis was done using Stata/IC and sensitivity, specificity, PPV, NPV and %misclassification rates were calculated as per DHSs/AISs, WHO, NACO cut-offs for virological failure. The GeneXpert assay compared well with the Abbott assay with a higher sensitivity (97%), specificity (97-100%) and concordance (91.32%). The correlation between two assays (r = 0.886) was statistically significant (p performance and rapidity will aid in timely diagnosis of ART failures, integrated HIV-TB management and will facilitate the UNAIDS 90-90-90 target.

  7. How equitable is the scaling up of HIV service provision in South ...

    African Journals Online (AJOL)

    Objectives. To assess the extent of inequalities in availability and utilisation of HIV services across South Africa. Design. Cross-sectional descriptive study. Setting. Three districts reflecting different socio-economic conditions, but with similar levels of HIV infection, were purposively sampled. Outcome measures. Availability ...

  8. Young, Online and in the Dark: Scaling Up HIV Testing among MSM in ASEAN.

    Science.gov (United States)

    Guadamuz, Thomas E; Cheung, Doug H; Wei, Chongyi; Koe, Stuart; Lim, Sin How

    2015-01-01

    Poor HIV testing uptake by MSM may be attributable to unique challenges that are localized in Southeast Asia. To characterize MSM who never tested for HIV, to identify correlates of never testing, and to elucidate the perceived barriers to HIV testing. The present study used data from the Asian Internet MSM Sex Survey (AIMSS) and restricted the analysis to 4,310 MSM from the ten member countries of the Association of South East Asian Nations (ASEAN). Among MSM participants from ASEAN in our sample, 1290 (29.9%) reported having never been tested for HIV, 471 (10.9%) tested for HIV more than 2 years ago, and 2186 (50.7%) reported their last test date was between 6 months and two years ago, with only 363 (8.4%) of these men having been tested in the past 6 months. In multivariable logistic regression, younger MSM (age 15-22 years old [AOR: 4.60, 95% CI: 3.04-6.96]), MSM with lower education (secondary school or lower [AOR: 1.37, 95% CI: 1.03-1.83]), MSM who identify as bisexual or heterosexual (compared to gay-identified) (AOR: 1.94, 95% CI: 1.60-2.35), and MSM who had never used a condom with male partners (AOR: 1.61, 95% CI: 1.32-1.97) had higher odds of never been HIV tested. Main reason for not being tested was a low risk perception of HIV exposure (n = 390, 30.2%). Current HIV prevention response must not leave MSM "in the dark," but instead meet them where they are by utilizing the Internet creatively through social media and smart phones. As ASEAN Economic Community (AEC) is quickly becoming a reality, so must there be an equally fast and united response to slowing down the HIV epidemics among MSM in ASEAN.

  9. Young, Online and in the Dark: Scaling Up HIV Testing among MSM in ASEAN.

    Directory of Open Access Journals (Sweden)

    Thomas E Guadamuz

    Full Text Available Poor HIV testing uptake by MSM may be attributable to unique challenges that are localized in Southeast Asia.To characterize MSM who never tested for HIV, to identify correlates of never testing, and to elucidate the perceived barriers to HIV testing.The present study used data from the Asian Internet MSM Sex Survey (AIMSS and restricted the analysis to 4,310 MSM from the ten member countries of the Association of South East Asian Nations (ASEAN.Among MSM participants from ASEAN in our sample, 1290 (29.9% reported having never been tested for HIV, 471 (10.9% tested for HIV more than 2 years ago, and 2186 (50.7% reported their last test date was between 6 months and two years ago, with only 363 (8.4% of these men having been tested in the past 6 months. In multivariable logistic regression, younger MSM (age 15-22 years old [AOR: 4.60, 95% CI: 3.04-6.96], MSM with lower education (secondary school or lower [AOR: 1.37, 95% CI: 1.03-1.83], MSM who identify as bisexual or heterosexual (compared to gay-identified (AOR: 1.94, 95% CI: 1.60-2.35, and MSM who had never used a condom with male partners (AOR: 1.61, 95% CI: 1.32-1.97 had higher odds of never been HIV tested. Main reason for not being tested was a low risk perception of HIV exposure (n = 390, 30.2%.Current HIV prevention response must not leave MSM "in the dark," but instead meet them where they are by utilizing the Internet creatively through social media and smart phones. As ASEAN Economic Community (AEC is quickly becoming a reality, so must there be an equally fast and united response to slowing down the HIV epidemics among MSM in ASEAN.

  10. Scaling-up HIV responses with key populations in West Africa.

    Science.gov (United States)

    Wheeler, Tisha; Wolf, R Cameron; Kapesa, Laurent; Cheng Surdo, Alison; Dallabetta, Gina

    2015-03-01

    Despite decades of HIV responses in pockets of West and Central Africa (WCA), the HIV response with key populations remains an understudied area. Recently, there has been a proliferation of studies highlighting epidemiologic and behavioral data that challenge attitudes of complacency among donors and country governments uncomfortable in addressing key populations. The articles in this series highlight new studies that provide a better understanding of the epidemiologic and structural burden facing key populations in the WCA region and how to improve responses through more effective targeting. Key populations face pervasive structural barriers including institutional and sexual violence and an intersection of stigma, criminalization, and marginalization as sexual minorities. Despite decades of smaller interventions that have shown the importance of integrated services for key populations, there remains incongruent provision of outreach or testing or family planning pointing to sustained risk. There remains an incongruent resource provision for key populations where they shoulder the burden of HIV and their access to services alone could turn around HIV epidemics within the region. These proximal and distal determinants must be addressed in regional efforts, led by the community, and resourced for scale, targeting those most at risk for the acquisition and transmission of HIV. This special issue builds the knowledge base for the region focusing on interventions that remove barriers to service access including treatment uptake for those living with HIV. Better analysis and use of data for strategic planning are shown to lead to more effective targeting of prevention, care, and HIV treatment programs with key populations. These articles further demonstrate the immediate need for comprehensive action to address HIV among key populations throughout the WCA region.

  11. Antiretroviral Treatment Scale-Up and Tuberculosis Mortality in High TB/HIV Burden Countries: An Econometric Analysis.

    Science.gov (United States)

    Yan, Isabel; Bendavid, Eran; Korenromp, Eline L

    2016-01-01

    Antiretroviral therapy (ART) reduces mortality in patients with active tuberculosis (TB), but the population-level relationship between ART coverage and TB mortality is untested. We estimated the reduction in population-level TB mortality that can be attributed to increasing ART coverage across 41 high HIV-TB burden countries. We compiled TB mortality trends between 1996 and 2011 from two sources: (1) national program-reported TB death notifications, adjusted for annual TB case detection rates, and (2) WHO TB mortality estimates. National coverage with ART, as proportion of HIV-infected people in need, was obtained from UNAIDS. We applied panel linear regressions controlling for HIV prevalence (5-year lagged), coverage of TB interventions (estimated by WHO and UNAIDS), gross domestic product per capita, health spending from domestic sources, urbanization, and country fixed effects. Models suggest that that increasing ART coverage was followed by reduced TB mortality, across multiple specifications. For death notifications at 2 to 5 years following a given ART scale-up, a 1% increase in ART coverage predicted 0.95% faster mortality rate decline (p = 0.002); resulting in 27% fewer TB deaths in 2011 alone than would have occurred without ART. Based on WHO death estimates, a 1% increase in ART predicted a 1.0% reduced TB death rate (peconometric analysis supports a substantial impact of ART on population-level TB mortality realized already within the first decade of ART scale-up, that is apparent despite variable-quality mortality data.

  12. An appraisal of female sex work in Nigeria--implications for designing and scaling up HIV prevention programmes.

    Science.gov (United States)

    Ikpeazu, Akudo; Momah-Haruna, Amaka; Madu Mari, Baba; Thompson, Laura H; Ogungbemi, Kayode; Daniel, Uduak; Aboki, Hafsatu; Isac, Shajy; Gorgens, Marelize; Mziray, Elizabeth; Njie, Ndella; Akala, Francisca Ayodeji; Emmanuel, Faran; Odek, Willis Omondi; Blanchard, James F

    2014-01-01

    The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs)--a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes. It involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients ("hotspots"). In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected. Across the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%), hotels/lodges (29.6%), streets (16.6%), and brothels (14.6%). Furthermore, the population density of FSWs (per thousand adult men) across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory. FSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning process for scaling up focused HIV prevention programmes.

  13. An Appraisal of Female Sex Work in Nigeria - Implications for Designing and Scaling Up HIV Prevention Programmes

    Science.gov (United States)

    Ikpeazu, Akudo; Momah-Haruna, Amaka; Madu Mari, Baba; Thompson, Laura H.; Ogungbemi, Kayode; Daniel, Uduak; Aboki, Hafsatu; Isac, Shajy; Gorgens, Marelize; Mziray, Elizabeth; Njie, Ndella; Akala, Francisca Ayodeji; Emmanuel, Faran; Odek, Willis Omondi; Blanchard, James F.

    2014-01-01

    Background The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs) - a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes. Methodology It involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients (“hotspots”). In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected. Results Across the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%), hotels/lodges (29.6%), streets (16.6%), and brothels (14.6%). Furthermore, the population density of FSWs (per thousand adult men) across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory. Conclusion FSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning process for

  14. An appraisal of female sex work in Nigeria--implications for designing and scaling up HIV prevention programmes.

    Directory of Open Access Journals (Sweden)

    Akudo Ikpeazu

    Full Text Available BACKGROUND: The HIV epidemic in Nigeria is complex with diverse factors driving the epidemic. Accordingly, Nigeria's National Agency for the Control of AIDS is coordinating a large-scale initiative to conduct HIV epidemic appraisals across all states. These appraisals will help to better characterize the drivers of the epidemic and ensure that the HIV prevention programmes match the local epidemic context, with resources allocated to interventions that have the greatest impact locally. Currently, the mapping and size estimation of Female Sex Workers (FSWs--a major component of the appraisal has been completed in seven states. These states are using the data generated to plan, prioritize and scale-up sub-national HIV prevention programmes. METHODOLOGY: It involved a two-level process of identifying and validating locations where FSWs solicit and/or meet clients ("hotspots". In the first level, secondary key informants were interviewed to collect information about the geographic location and description of the hotspots. For the second level, FSWs were interviewed at each hotspot and information on population size estimates, typologies and operational dynamics of the FSWs were collected. RESULTS: Across the seven states, a total of 17,266 secondary key informants and 5,732 FSWs were interviewed. 10,233 hotspots were identified with an estimated 126,489 FSWs ranging from 5,920 in Anambra to 46,691 in Lagos. The most common hotspots were bars/nightclubs (30%, hotels/lodges (29.6%, streets (16.6%, and brothels (14.6%. Furthermore, the population density of FSWs (per thousand adult men across the states ranged from 2 in Anambra to 17 in the Federal Capital Territory. CONCLUSION: FSW populations in Nigeria are large and diverse, with substantial differences between and within states. Improved understanding of the location, population size, density, organizational typologies and clients of sex work has informed and is central to Nigeria's planning

  15. TB preventive therapy for people living with HIV: key considerations for scale-up in resource-limited settings.

    Science.gov (United States)

    Pathmanathan, I; Ahmedov, S; Pevzner, E; Anyalechi, G; Modi, S; Kirking, H; Cavanaugh, J S

    2018-06-01

    Tuberculosis (TB) is the leading cause of death for persons living with the human immunodeficiency virus (PLHIV). TB preventive therapy (TPT) works synergistically with, and independently of, antiretroviral therapy to reduce TB morbidity, mortality and incidence among PLHIV. However, although TPT is a crucial and cost-effective component of HIV care for adults and children and has been recommended as an international standard of care for over a decade, it remains highly underutilized. If we are to end the global TB epidemic, we must address the significant reservoir of tuberculous infection, especially in those, such as PLHIV, who are most likely to progress to TB disease. To do so, we must confront the pervasive perception that barriers to TPT scale-up are insurmountable in resource-limited settings. Here we review available evidence to address several commonly stated obstacles to TPT scale-up, including the need for the tuberculin skin test, limited diagnostic capacity to reliably exclude TB disease, concerns about creating drug resistance, suboptimal patient adherence to therapy, inability to monitor for and prevent adverse events, a 'one size fits all' option for TPT regimen and duration, and uncertainty about TPT use in children, adolescents, and pregnant women. We also discuss TPT delivery in the era of differentiated care for PLHIV, how best to tackle advanced planning for drug procurement and supply chain management, and how to create an enabling environment for TPT scale-up success.

  16. Nursing and midwifery regulation and HIV scale-up: establishing a baseline in East, Central and Southern Africa.

    Science.gov (United States)

    McCarthy, Carey F; Voss, Joachim; Verani, Andre R; Vidot, Peggy; Salmon, Marla E; Riley, Patricia L

    2013-03-25

    Shifting HIV treatment tasks from physicians to nurses and midwives is essential to scaling-up HIV services in sub-Saharan Africa. Updating nursing and midwifery regulations to include task shifting and pre-service education reform can help facilitate reaching new HIV targets. Donor-supported initiatives to update nursing and midwifery regulations are increasing. However, there are gaps in our knowledge of current practice and education regulations and a lack of information to target and implement regulation strengthening efforts. We conducted a survey of national nursing and midwifery councils to describe current nursing and midwifery regulations in 13 African countries. A 30-item survey was administered to a convenience sample of 13 national nursing and midwifery regulatory body leaders in attendance at the PEPFAR-supported African Health Profession Regulatory Collaborative meeting in Nairobi, Kenya on 28 February, 2011. The survey contained questions on task shifting and regulations such as registration, licensure, scope of practice, pre-service education accreditation, continuing professional development and use of international guidelines. Survey data were analyzed to present country-level, comparative and regional findings. Task shifting to nurses and midwives was reported in 11 of the 13 countries. Eight countries updated their scope of practice within the last five years; only one reported their regulations to reflect task shifting. Countries vary with regard to licensure, pre-service accreditation and continuing professional development regulations in place. There was no consistency in terms of what standards were used to design national practice and education regulations. Many opportunities exist to assist countries to modernise regulations to incorporate important advancements from task shifting and pre-service reform. Appropriate, revised regulations can help sustain successful health workforce strategies and contribute to further scale-up HIV services

  17. Implications of differentiated care for successful ART scale-up in a concentrated HIV epidemic in Yangon, Myanmar.

    Science.gov (United States)

    Mesic, Anita; Fontaine, Julie; Aye, Theingy; Greig, Jane; Thwe, Thin Thin; Moretó-Planas, Laura; Kliesckova, Jarmila; Khin, Khin; Zarkua, Nana; Gonzalez, Lucia; Guillergan, Erwin Lloyd; O'Brien, Daniel P

    2017-07-21

    National AIDS Programme in Myanmar has made significant progress in scaling up antiretroviral treatment (ART) services and recognizes the importance of differentiated care for people living with HIV. Indeed, long centred around the hospital and reliant on physicians, the country's HIV response is undergoing a process of successful decentralization with HIV care increasingly being integrated into other health services as part of a systematic effort to expand access to HIV treatment. This study describes implementation of differentiated care in Médecins Sans Frontières (MSF)-supported programmes and reports its outcomes. A descriptive cohort analysis of adult patients on antiretroviral treatment was performed. We assessed stability of patients as of 31 December 2014 and introduced an intervention of reduced frequency of physicians' consultations for stable patients, and fast tract ART refills. We measured a number of saved physician's visits as the result of this intervention. Main outcomes, remained under care, death, lost to follow up, treatment failure, were assessed on 31 December 2015 and reported as rates for different stable groups. On 31 December 2014, our programme counted 16, 272 adult patients enrolled in HIV care, of whom 80.34% were stable. The model allowed for an increase in the average number of patients one medical team could care for - from 745 patients in 2011 to 1, 627 in 2014 - and, thus, a reduction in the number of teams needed. An assessment of stable patients enrolled on ART one year after the implementation of the new model revealed excellent outcomes, aggregated for stable patients as 98.7% remaining in care, 0.4% dead, 0.8% lost to follow-up, 0.8% clinical treatment failure and 5.8% with immunological treatment failure. Implementation of a differentiated model reduced the number of visits between stable clients and physicians, reduced the medical resources required for treatment and enabled integrated treatment of the main co

  18. HIV scale-up in Mozambique: Exceptionalism, normalisation and global health

    Science.gov (United States)

    Høg, Erling

    2014-01-01

    The large-scale introduction of HIV and AIDS services in Mozambique from 2000 onwards occurred in the context of deep political commitment to sovereign nation-building and an important transition in the nation's health system. Simultaneously, the international community encountered a willing state partner that recognised the need to take action against the HIV epidemic. This article examines two critical policy shifts: sustained international funding and public health system integration (the move from parallel to integrated HIV services). The Mozambican government struggles to support its national health system against privatisation, NGO competition and internal brain drain. This is a sovereignty issue. However, the dominant discourse on self-determination shows a contradictory twist: it is part of the political rhetoric to keep the sovereignty discourse alive, while the real challenge is coordination, not partnerships. Nevertheless, we need more anthropological studies to understand the political implications of global health funding and governance. Other studies need to examine the consequences of public health system integration for the quality of access to health care. PMID:24499102

  19. Elusive accountabilities in the HIV scale-up: 'ownership' as a functional tautology.

    Science.gov (United States)

    Esser, Daniel E

    2014-01-01

    Mounting concerns over aid effectiveness have rendered 'ownership' a central concept in the vocabulary of development assistance for health (DAH). The article investigates the application of both 'national ownership' and 'country ownership' in the broader development discourse as well as more specifically in the context of internationally funded HIV/AIDS interventions. Based on comprehensive literature reviews, the research uncovers a multiplicity of definitions, most of which either divert from or plainly contradict the concept's original meaning and intent. During the last 10 years in particular, it appears that both public and private donors have advocated for greater 'ownership' by recipient governments and countries to hedge their own political risk rather than to work towards greater inclusion of the latter in agenda-setting and programming. Such politically driven semantic dynamics suggest that the concept's salience is not merely a discursive reflection of globally skewed power relations in DAH but a deliberate exercise in limiting donors' accountabilities. At the same time, the research also finds evidence that this conceptual contortion frames current global public health scholarship, thus adding further urgency to the need to critically re-evaluate the international political economy of global public health from a discursive perspective.

  20. Building laboratory infrastructure to support scale-up of HIV/AIDS treatment, care, and prevention: in-country experience.

    Science.gov (United States)

    Abimiku, Alash'le G

    2009-06-01

    An unprecedented influx of funds and support through large programs such as the Global Fund for AIDS, Malaria and Tuberculosis and the World Health Organization's and President's Emergency Plan for AIDS Relief (PEPFAR) has made it possible for more than 1 million persons in resource-limited settings to access AIDS treatment and several million more to be in care and prevention programs. Nevertheless, there remain major challenges that prevent AIDS drugs and care from reaching many more in need, especially in rural settings. The roll-out of a high-quality treatment, care, and prevention program depends on an effective and reliable laboratory infrastructure. This article presents a strategy used by the Institute of Human Virology (IHV)-University of Maryland and its affiliate IHV-Nigeria to establish a multifaceted, integrated tier laboratory program to support a PEPFAR-funded scale-up of its AIDS Care Treatment in Nigeria program, in collaboration with the Centers for Disease Control and Prevention and the Nigerian government, as a possible model for overcoming a key challenge that faces several resource-limited countries trying to roll out and scale-up their HIV/AIDS treatment, care, and prevention program.

  1. A novel Online-to-Offline (O2O) model for pre-exposure prophylaxis and HIV testing scale up.

    Science.gov (United States)

    Anand, Tarandeep; Nitpolprasert, Chattiya; Trachunthong, Deondara; Kerr, Stephen J; Janyam, Surang; Linjongrat, Danai; Hightow-Weidman, Lisa B; Phanuphak, Praphan; Ananworanich, Jintanat; Phanuphak, Nittaya

    2017-03-13

    (OR 3.79, 95%CI 2.06-6.95; p  < 0.001) were independently associated with PrEP uptake. Adam's Love O2O model is highly effective in linking online at-risk MSM and TG to PrEP and HIV testing services, and has high potential to be replicated and scaled up in other settings with high Internet penetration among key populations.

  2. Playing the Catch-Up Game: Accelerating the Scale-Up of Prevention of Mother-To-Child Transmission of HIV (PMTCT Services to Eliminate New Pediatric HIV Infection in Nigeria.

    Directory of Open Access Journals (Sweden)

    Edward Adekola Oladele

    Full Text Available As the world is making progress towards elimination of mother-to-child transmission of HIV, poor coverage of PMTCT services in Nigeria remains a major challenge. In order to address this, scale-up was planned with activities organized into 3 phases. This paper describes the process undertaken in eight high burden Nigerian states to rapidly close PMTCT coverage gaps at facility and population levels between February 2013 and March 2014.Activities were grouped into three phases-pre-assessment phase (engagement of a wide range of stakeholders, assessment (rapid health facility assessment, a cross sectional survey using mixed methods conducted in the various states between Feb and May 2013 and impact modelling, and post-assessment (drawing up costed state operational plans to achieve eMTCT by 2015, data-driven smart scale-up.Over a period of 10 months starting June 2013, 2044 facilities were supported to begin provision of PMTCT services. This increased facility coverage from 8% to 50%. A 246% increase was also recorded in the number of pregnant women and their families who have access to HIV testing and counselling in the context of PMTCT. Similarly, access to antiretrovirals for PMTCT has witnessed a 152% increase in these eight states between October 2013 and October 2014.A data-driven and participatory approach can be used to rapidly scale-up PMTCT services at community and facility levels in this region. These results present us with hope for real progress in Nigeria. We are confident that the efforts described here will contribute significantly to eliminating new pediatric HIV infection in Nigeria.

  3. Scaling up stigma? The effects of antiretroviral roll-out on stigma and HIV testing. Early evidence from rural Tanzania

    Science.gov (United States)

    Roura, M; Urassa, M; Busza, J; Mbata, D; Wringe, A; Zaba, B

    2009-01-01

    Objective: To investigate the interplay between antiretroviral therapy (ART) scale-up, different types of stigma and Voluntary Counselling and Testing (VCT) uptake 2 years after the introduction of free ART in a rural ward of Tanzania. Methods: Qualitative study using in-depth interviews and group activities with a purposive sample of 91 community leaders, 77 ART clients and 16 health providers. Data were analysed for recurrent themes using NVIVO-7 software. Results: The complex interplay between ART, stigma and VCT in this setting is characterised by two powerful but opposing dynamics. The availability of effective treatment has transformed HIV into a manageable condition which is contributing to a reduction in self-stigma and is stimulating VCT uptake. However, this is counterbalanced by the persistence of blaming attitudes and emergence of new sources of stigma associated with ART provision. The general perception among community leaders was that as ART users regained health, they increasingly engaged in sexual relations and “spread the disease.” Fears were exacerbated because they were perceived to be very mobile and difficult to identify physically. Some leaders suggested giving ART recipients drugs “for impotence,” marking them “with a sign” and putting them “in isolation camps.” In this context, traditional beliefs about disease aetiology provided a less stigmatised explanation for HIV symptoms contributing to a situation of collective denial. Conclusion: Where anticipated stigma prevails, provision of antiretroviral drugs alone is unlikely to have sufficient impact on VCT uptake. Achieving widespread public health benefits of ART roll-out requires community-level interventions to ensure local acceptability of antiretroviral drugs. PMID:19036776

  4. Scaling-up access to antiretroviral therapy for children: A cohort study evaluating care and treatment at mobile and hospital-affiliated HIV clinics in rural Zambia

    NARCIS (Netherlands)

    J.H. van Dijk (Janneke); W.J. Moss (William); F. Hamangaba (Francis); B. Munsanje (Bornface); C.G. Sutcliffe (Catherine)

    2014-01-01

    textabstractBackground: Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART), but few programs have been evaluated. We compared outcomes for children receiving

  5. Scale-up of networked HIV treatment in Nigeria: creation of an integrated electronic medical records system.

    Science.gov (United States)

    Chaplin, Beth; Meloni, Seema; Eisen, Geoffrey; Jolayemi, Toyin; Banigbe, Bolanle; Adeola, Juliette; Wen, Craig; Reyes Nieva, Harry; Chang, Charlotte; Okonkwo, Prosper; Kanki, Phyllis

    2015-01-01

    The implementation of PEPFAR programs in resource-limited settings was accompanied by the need to document patient care on a scale unprecedented in environments where paper-based records were the norm. We describe the development of an electronic medical records system (EMRS) put in place at the beginning of a large HIV/AIDS care and treatment program in Nigeria. Databases were created to record laboratory results, medications prescribed and dispensed, and clinical assessments, using a relational database program. A collection of stand-alone files recorded different elements of patient care, linked together by utilities that aggregated data on national standard indicators and assessed patient care for quality improvement, tracked patients requiring follow-up, generated counts of ART regimens dispensed, and provided 'snapshots' of a patient's response to treatment. A secure server was used to store patient files for backup and transfer. By February 2012, when the program transitioned to local in-country management by APIN, the EMRS was used in 33 hospitals across the country, with 4,947,433 adult, pediatric and PMTCT records that had been created and continued to be available for use in patient care. Ongoing trainings for data managers, along with an iterative process of implementing changes to the databases and forms based on user feedback, were needed. As the program scaled up and the volume of laboratory tests increased, results were produced in a digital format, wherever possible, that could be automatically transferred to the EMRS. Many larger clinics began to link some or all of the databases to local area networks, making them available to a larger group of staff members, or providing the ability to enter information simultaneously where needed. The EMRS improved patient care, enabled efficient reporting to the Government of Nigeria and to U.S. funding agencies, and allowed program managers and staff to conduct quality control audits. Copyright © 2014

  6. The HIV Treatment Gap: Estimates of the Financial Resources Needed versus Available for Scale-Up of Antiretroviral Therapy in 97 Countries from 2015 to 2020.

    Directory of Open Access Journals (Sweden)

    Arin Dutta

    2015-11-01

    Full Text Available The World Health Organization (WHO released revised guidelines in 2015 recommending that all people living with HIV, regardless of CD4 count, initiate antiretroviral therapy (ART upon diagnosis. However, few studies have projected the global resources needed for rapid scale-up of ART. Under the Health Policy Project, we conducted modeling analyses for 97 countries to estimate eligibility for and numbers on ART from 2015 to 2020, along with the facility-level financial resources required. We compared the estimated financial requirements to estimated funding available.Current coverage levels and future need for treatment were based on country-specific epidemiological and demographic data. Simulated annual numbers of individuals on treatment were derived from three scenarios: (1 continuation of countries' current policies of eligibility for ART, (2 universal adoption of aspects of the WHO 2013 eligibility guidelines, and (3 expanded eligibility as per the WHO 2015 guidelines and meeting the Joint United Nations Programme on HIV/AIDS "90-90-90" ART targets. We modeled uncertainty in the annual resource requirements for antiretroviral drugs, laboratory tests, and facility-level personnel and overhead. We estimate that 25.7 (95% CI 25.5, 26.0 million adults and 1.57 (95% CI 1.55, 1.60 million children could receive ART by 2020 if countries maintain current eligibility plans and increase coverage based on historical rates, which may be ambitious. If countries uniformly adopt aspects of the WHO 2013 guidelines, 26.5 (95% CI 26.0 27.0 million adults and 1.53 (95% CI 1.52, 1.55 million children could be on ART by 2020. Under the 90-90-90 scenario, 30.4 (95% CI 30.1, 30.7 million adults and 1.68 (95% CI 1.63, 1.73 million children could receive treatment by 2020. The facility-level financial resources needed for scaling up ART in these countries from 2015 to 2020 are estimated to be US$45.8 (95% CI 45.4, 46.2 billion under the current scenario, US$48.7 (95

  7. The impact of human immunodeficiency virus (HIV) service scale-up on mechanisms of accountability in Zambian primary health centres: a case-based health systems analysis.

    Science.gov (United States)

    Topp, Stephanie M; Black, Jim; Morrow, Martha; Chipukuma, Julien M; Van Damme, Wim

    2015-02-18

    Questions about the impact of large donor-funded HIV interventions on low- and middle-income countries' health systems have been the subject of a number of expert commentaries, but comparatively few empirical research studies. Aimed at addressing a particular evidence gap vis-à-vis the influence of HIV service scale-up on micro-level health systems, this article examines the impact of HIV scale-up on mechanisms of accountability in Zambian primary health facilities. Guided by the Mechanisms of Effect framework and Brinkerhoff's work on accountability, we conducted an in-depth multi-case study to examine how HIV services influenced mechanisms of administrative and social accountability in four Zambian primary health centres. Sites were selected for established (over 3 yrs) antiretroviral therapy (ART) services and urban, peri-urban and rural characteristics. Case data included provider interviews (60); patient interviews (180); direct observation of facility operations (2 wks/centre) and key informant interviews (14). Resource-intensive investment in HIV services contributed to some early gains in administrative answerability within the four ART departments, helping to establish the material capabilities necessary to deliver and monitor service delivery. Simultaneous investment in external supervision and professional development helped to promote transparency around individual and team performance and also strengthened positive work norms in the ART departments. In the wider health centres, however, mechanisms of administrative accountability remained weak, hindered by poor data collection and under capacitated leadership. Substantive gains in social accountability were also elusive as HIV scale-up did little to address deeply rooted information and power asymmetries in the wider facilities. Short terms gains in primary-level service accountability may arise from investment in health system hardware. However, sustained improvements in service quality and

  8. A scoping study to identify opportunities to advance the ethical implementation and scale-up of HIV treatment as prevention: priorities for empirical research.

    Science.gov (United States)

    Knight, Rod; Small, Will; Pakula, Basia; Thomson, Kimberly; Shoveller, Jean

    2014-07-03

    Despite the evidence showing the promise of HIV treatment as prevention (TasP) in reducing HIV incidence, a variety of ethical questions surrounding the implementation and "scaling up" of TasP have been articulated by a variety of stakeholders including scientists, community activists and government officials. Given the high profile and potential promise of TasP in combatting the global HIV epidemic, an explicit and transparent research priority-setting process is critical to inform ongoing ethical discussions pertaining to TasP. We drew on the Arksey and O'Malley framework for conducting scoping review studies as well as systematic approaches to identifying empirical and theoretical gaps within ethical discussions pertaining to population-level intervention implementation and scale up. We searched the health science database PubMed to identify relevant peer-reviewed articles on ethical and implementation issues pertaining to TasP. We included English language articles that were published after 2009 (i.e., after the emergence of causal evidence within this field) by using search terms related to TasP. Given the tendency for much of the criticism and support of TasP to occur outside the peer-reviewed literature, we also included grey literature in order to provide a more exhaustive representation of how the ethical discussions pertaining to TasP have and are currently taking place. To identify the grey literature, we systematically searched a set of search engines, databases, and related webpages for keywords pertaining to TasP. Three dominant themes emerged in our analysis with respect to the ethical questions pertaining to TasP implementation and scale-up: (a) balancing individual- and population-level interests; (b) power relations within clinical practice and competing resource demands within health care systems; (c) effectiveness considerations and socio-structural contexts of HIV treatment experiences within broader implementation contexts. Ongoing research

  9. Scaling up antiretroviral treatment services in Karnataka, India: impact on CD4 counts of HIV-infected people.

    Directory of Open Access Journals (Sweden)

    Suresh Shastri

    Full Text Available SETTING: Twelve antiretroviral treatment centres under National AIDS Control Programme (NACP, Karnataka State, India. OBJECTIVE: For the period 2004-2011, to describe the trends in the numbers of people living with HIV (PLHIV registered for care and their median baseline CD4 counts, disaggregated by age and sex. DESIGN: Descriptive study involving analysis of routinely captured data (year of registration, age, sex, baseline CD4 count under NACP. RESULTS: 34,882 (97% of total eligible PLHIV were included in analysis. The number registered for care has increased by over 12 times during 2004-11; with increasing numbers among females. The median baseline CD4 cell count rose from 125 in 2004 to 235 in 2011--the increase was greater among females as compared to males. However, about two-thirds still presented at CD4 cell counts less than 350. CONCLUSION: We found an increasing trend of median CD4 counts among PLHIV presenting to ART centres in Karnataka, an indicator of enhanced and early access to HIV care. Equal proportion of females and higher baseline CD4 counts among them allays any fear of differential access by gender. Despite this relative success, a substantial proportion still presented at low CD4 cell counts indicating possibly delayed HIV diagnosis and delayed linkage to HIV care. Universal HIV testing at health care facilities and strengthening early access to care are required to bridge the gap.

  10. A community empowerment approach to the HIV response among sex workers: effectiveness, challenges, and considerations for implementation and scale-up.

    Science.gov (United States)

    Kerrigan, Deanna; Kennedy, Caitlin E; Morgan-Thomas, Ruth; Reza-Paul, Sushena; Mwangi, Peninah; Win, Kay Thi; McFall, Allison; Fonner, Virginia A; Butler, Jennifer

    2015-01-10

    A community empowerment-based response to HIV is a process by which sex workers take collective ownership of programmes to achieve the most effective HIV outcomes and address social and structural barriers to their overall health and human rights. Community empowerment has increasingly gained recognition as a key approach for addressing HIV in sex workers, with its focus on addressing the broad context within which the heightened risk for infection takes places in these individuals. However, large-scale implementation of community empowerment-based approaches has been scarce. We undertook a comprehensive review of community empowerment approaches for addressing HIV in sex workers. Within this effort, we did a systematic review and meta-analysis of the effectiveness of community empowerment in sex workers in low-income and middle-income countries. We found that community empowerment-based approaches to addressing HIV among sex workers were significantly associated with reductions in HIV and other sexually transmitted infections, and with increases in consistent condom use with all clients. Despite the promise of a community-empowerment approach, we identified formidable structural barriers to implementation and scale-up at various levels. These barriers include regressive international discourses and funding constraints; national laws criminalising sex work; and intersecting social stigmas, discrimination, and violence. The evidence base for community empowerment in sex workers needs to be strengthened and diversified, including its role in aiding access to, and uptake of, combination interventions for HIV prevention. Furthermore, social and political change are needed regarding the recognition of sex work as work, both globally and locally, to encourage increased support for community empowerment responses to HIV. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. Scaling-up access to antiretroviral therapy for children: a cohort study evaluating care and treatment at mobile and hospital-affiliated HIV clinics in rural Zambia.

    Directory of Open Access Journals (Sweden)

    Janneke H van Dijk

    Full Text Available Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART, but few programs have been evaluated. We compared outcomes for children receiving care in mobile and hospital-affiliated HIV clinics in rural Zambia.Outcomes were measured within an ongoing cohort study of HIV-infected children seeking care at Macha Hospital, Zambia from 2007 to 2012. Children in the outreach clinic group received care from the Macha HIV clinic and transferred to one of three outreach clinics. Children in the hospital-affiliated clinic group received care at Macha HIV clinic and reported Macha Hospital as the nearest healthcare facility.Seventy-seven children transferred to the outreach clinics and were included in the analysis. Travel time to the outreach clinics was significantly shorter and fewer caretakers used public transportation, resulting in lower transportation costs and fewer obstacles accessing the clinic. Some caretakers and health care providers reported inferior quality of service provision at the outreach clinics. Sixty-eight children received ART at the outreach clinics and were compared to 41 children in the hospital-affiliated clinic group. At ART initiation, median age, weight-for-age z-scores (WAZ and CD4(+ T-cell percentages were similar for children in the hospital-affiliated and outreach clinic groups. Children in both groups experienced similar increases in WAZ and CD4(+ T-cell percentages.HIV care and treatment can be effectively delivered to HIV-infected children at rural health centers through mobile ART teams, removing potential barriers to uptake and retention. Outreach teams should be supported to increase access to HIV care and treatment in rural areas.

  12. A novel Online-to-Offline (O2O) model for pre-exposure prophylaxis and HIV testing scale up

    NARCIS (Netherlands)

    Anand, Tarandeep; Nitpolprasert, Chattiya; Trachunthong, Deondara; Kerr, Stephen J.; Janyam, Surang; Linjongrat, Danai; Hightow-Weidman, Lisa B.; Phanuphak, Praphan; Ananworanich, Jintanat; Phanuphak, Nittaya

    2017-01-01

    PrEP awareness and uptake among men who have sex with men (MSM) and transgender women (TG) in Thailand remains low. Finding ways to increase HIV testing and PrEP uptake among high-risk groups is a critical priority. This study evaluates the effect of a novel Adam's Love Online-to-Offline (O2O) model

  13. Scaling up integration: development and results of a participatory assessment of HIV/TB services, South Africa

    Directory of Open Access Journals (Sweden)

    Caldwell Judy

    2010-07-01

    Full Text Available Abstract Background In South Africa the need to integrate HIV, TB and STI programmes has been recognised at a policy and organisation level; the challenge is now one of translating policies into relevant actions and monitoring implementation to ensure that the anticipated benefits of integration are achieved. In this research, set in public primary care services in Cape Town, South Africa, we set out to determine how middle level managers could be empowered to monitor the implementation of an effective, integrated HIV/TB/STI service. Methods A team of managers and researchers designed an evaluation tool to measure implementation of key components of an integrated HIV/TB/STI package with a focus on integration. They used a comprehensive health systems framework based on conditions for programme effectiveness and then identified and collected tracer indicators. The tool was extensively piloted in two rounds involving 49 clinics in 2003 and 2004 to identify data necessary for effective facility-level management. A subsequent evaluation of 16 clinics (2 per health sub district, 12% of all public primary care facilities was done in February 2006. Results 16 clinics were reviewed and 635 records sampled. Client access to HIV/TB/STI programmes was limited in that 50% of facilities routinely deferred clients. Whilst the physical infrastructure and staff were available, there was problem with capacity in that there was insufficient staff training (for example, only 40% of clinical staff trained in HIV care. Weaknesses were identified in quality of care (for example, only 57% of HIV clients were staged in accordance with protocols and continuity of care (for example, only 24% of VCT clients diagnosed with HIV were followed up for medical assessment. Facility and programme managers felt that the evaluation tool generated information that was useful to manage the programmes at facility and district level. On the basis of the results facility managers drew

  14. Grassroots community organizations’ contribution to the scale-up of HIV testing and counselling services in Zimbabwe

    Science.gov (United States)

    Gregson, Simon; Nyamukapa, Constance A.; Sherr, Lorraine; Mugurungi, Owen; Campbell, Catherine

    2013-01-01

    Objective: To investigate whether community engagement (participation in grassroots organizations) contributed to increases in HIV testing in Zimbabwe. Methods: Prospective data on membership of local community organizations (e.g. women's groups and burial societies) and uptake of HIV testing and counselling (HTC) and prevention-of-mother-to-child transmission (PMTCT) services were collected from 5260 adults interviewed in two consecutive rounds of a general-population cohort survey in eastern Zimbabwe between 2003 and 2008. The effects of community engagement on uptake of services during the follow-up period were measured using logistic regression to adjust for observed confounding factors. Results: Sixteen percent of men and 47% of women were consistent members of community organizations; 58 and 35% of these people discussed HIV in their meetings and were members of externally sponsored organizations, respectively. Fewer men (10.1%) than women (32.4%) took up HTC during follow-up [adjusted odds ratio (aOR) = 4.08, 95% confidence interval (CI) 3.43–4.86, P organizations than for nonmembers: men, 15.0 versus 9.2% (1.67, 1.15–2.43, P = 0.007); women, 35.6 versus 29.6% (1.26, 1.06–1.49, P = 0.008). Membership of community organizations showed a nonsignificant association with PMTCT uptake amongst recently pregnant women (42.3 versus 34.2%; 1.30, 0.94–1.78, P = 0.1). The most consistent positive associations between community participation and HTC and PMTCT uptake were found in organizations that discussed HIV and when external sponsorship was absent. Conclusion: Grassroots organizations contributed to increased uptake of HTC services in eastern Zimbabwe in the mid-2000s. Partnerships with these organizations could harness community support for the further increases in HIV testing needed in sub-Saharan Africa. PMID:24047764

  15. Scaled-Up Mobile Phone Intervention for HIV Care and Treatment: Protocol for a Facility Randomized Controlled Trial.

    Science.gov (United States)

    L'Engle, Kelly L; Green, Kimberly; Succop, Stacey M; Laar, Amos; Wambugu, Samuel

    2015-01-23

    Adherence to prevention, care, and treatment recommendations among people living with HIV (PLHIV) is a critical challenge. Yet good clinical outcomes depend on consistent, high adherence to antiretroviral therapy (ART) regimens. Mobile phones offer a promising means to improve patient adherence and health outcomes. However, limited information exists on the impact that mobile phones for health (mHealth) programs have on ART adherence or the behavior change processes through which such interventions may improve patient health, particularly among ongoing clients enrolled in large public sector HIV service delivery programs and key populations such as men who have sex with men (MSM) and female sex workers (FSW). Our aim is to evaluate an mHealth intervention where text message reminders are used as supportive tools for health providers and as motivators and reminders for ART clients to adhere to treatment and remain linked to care in Ghana. Using an implementation science framework, we seek to: (1) evaluate mHealth intervention effects on patient adherence and health outcomes, (2) examine the delivery of the mHealth intervention for improving HIV care and treatment, and (3) assess the cost-effectiveness of the mHealth intervention. The 36-month study will use a facility cluster randomized controlled design (intervention vs standard of care) for evaluating the impact of mHealth on HIV care and treatment. Specifically, we will look at ART adherence, HIV viral load, retention in care, and condom use at 6 and 12-month follow-up. In addition, participant adoption and satisfaction with the program will be measured. This robust methodology will be complemented by qualitative interviews to obtain feedback on the motivational qualities of the program and benefits and challenges of delivery, especially for key populations. Cost-effectiveness will be assessed using incremental cost-effectiveness ratios, with health effects expressed in terms of viral load suppression and costs

  16. Strengthening government management capacity to scale up HIV prevention programs through the use of Technical Support Units: lessons from Karnataka state, India

    Science.gov (United States)

    Sgaier, Sema K; Anthony, John; Bhattacharjee, Parinita; Baer, James; Malve, Vidyacharan; Bhalla, Aparajita; Hugar, Vijaykumar S

    2014-01-01

    ABSTRACT Scaling up HIV prevention programming among key populations (female sex workers and men who have sex with men) has been a central strategy of the Government of India. However, state governments have lacked the technical and managerial capacity to oversee and scale up interventions or to absorb donor-funded programs. In response, the national government contracted Technical Support Units (TSUs), teams with expertise from the private and nongovernmental sectors, to collaborate with and assist state governments. In 2008, a TSU was established in Karnataka, one of 6 Indian states with the highest HIV prevalence in the country and where monitoring showed that its prevention programs were reaching only 5% of key populations. The TSU provided support to the state in 5 key areas: assisting in strategic planning, rolling out a comprehensive monitoring and evaluation system, providing supportive supervision to intervention units, facilitating training, and assisting with information, education, and communication activities. This collaborative management model helped to increase capacity of the state, enabling it to take over funding and oversight of HIV prevention programs previously funded through donors. With the combined efforts of the TSU and the state government, the number of intervention units statewide increased from 40 to 126 between 2009 and 2013. Monthly contacts with female sex workers increased from 5% in 2008 to 88% in 2012, and with men who have sex with men, from 36% in 2009 to 81% in 2012. There were also increases in the proportion of both populations who visited HIV testing and counseling centers (from 3% to 47% among female sex workers and from 6% to 33% among men who have sex with men) and sexually transmitted infection clinics (from 4% to 75% among female sex workers and from 7% to 67% among men who have sex with men). Changes in sexual behaviors among key populations were also documented. For example, between 2008 and 2010, the proportion of

  17. Prevention of mother-to-child transmission of HIV in rural Uganda: Modelling effectiveness and impact of scaling-up PMTCT services

    Directory of Open Access Journals (Sweden)

    Elin C. Larsson

    2015-02-01

    Full Text Available Background: The reported coverage of any antiretroviral (ARV prophylaxis for prevention of mother-to-child transmission (PMTCT has increased in sub-Saharan Africa in recent years, but was still only 60% in 2010. However, the coverage estimate is subject to overestimations since it only considers enrolment and not completion of the PMTCT programme. The PMTCT programme is complex as it builds on a cascade of sequential interventions that should take place to reduce mother-to-child transmission (MTCT of HIV: starting with antenatal care (ANC, HIV testing, and ARVs for the woman and the baby. Objective: The objective was to estimate the number of children infected with HIV in a district population, using empirical data on uptake of PMTCT components combined with data on MTCT rates. Design: This study is based on a population-based cohort of pregnant women recruited in the Iganga-Mayuge Health and Demographic Surveillance Site in rural Uganda 2008–2010. We later modelled different scenarios assuming increased uptake of specific PMTCT components to estimate the impact on MTCT for each scenario. Results: In this setting, HIV infections in children could be reduced by 28% by increasing HIV testing capacity at health facilities to ensure 100% testing among women seeking ANC. Providing ART to all women who received ARV prophylaxis would give an 18% MTCT reduction. Conclusions: Our results highlight the urgency in scaling-up universal access to HIV testing at all ANC facilities, and the potential gains of early enrolment of all pregnant women on antiretroviral treatment for PMTCT. Further, to determine the effectiveness of PMTCT programmes in different settings, it is crucial to analyse at what stages of the PMTCT cascade that dropouts occur to target interventions accordingly.

  18. Civil society, political mobilization, and the impact of HIV scale-up on health systems in Brazil.

    Science.gov (United States)

    Parker, Richard G

    2009-11-01

    This article examines the role of civil society in shaping HIV and AIDS policies and programs in Brazil. It focuses on the historical context of the redemocratization of Brazilian society during the 1980s, when the initial response to the epidemic took shape, and emphasizes the role of social movements linked to the progressive Catholic Church, the sanitary reform movement in public health, and the emerging gay rights movement in the early response to the epidemic in Brazil. It highlights the broad-based civil society coalition that took shape over the course of the 1990s and the political alliances that were built up shortly after the 1996 International AIDS Conference in Vancouver, Canada, to pass legislation guaranteeing the right to access to antiretroviral treatment. It emphasizes the continued importance of civil society organizations-in particular, AIDS-related nongovernmental organizations-and leading AIDS activists in exerting continued pressure to guarantee the sustainability of treatment access and the impact that action focused on HIV and AIDS has had on the Brazilian public health system more broadly, particularly through strengthening health infrastructures and providing a model for health-related social mobilization.

  19. Meaningful change or more of the same? The Global Fund's new funding model and the politics of HIV scale-up.

    Science.gov (United States)

    Kapilashrami, Anuj; Hanefeld, Johanna

    2014-01-01

    As we enter the fourth decade of HIV and AIDS, sustainability of treatment and prevention programmes is a growing concern in an environment of shrinking resources. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) will be critical to maintaining current trajectories of scale-up and ultimately, ensuring access to HIV treatment and prevention for people in low/middle-income countries. The authors' prior research in India, Zambia and South Africa contributed evidence on the politics and impact of new institutional and funding arrangements, revealing a 'rhetoric-reality gap' in their impact on health systems, civil society participation, and achievement of population health. With its new funding strategy and disbursement model, the Fund proposes dramatic changes to its approach, emphasising value for money, greater fund predictability and flexibility and more proactive engagement in recipient countries, while foregrounding a human rights approach. This paper reviews the Fund's new strategy and examines its potential to respond to key criticisms concerning health systems impact, particularly the elite nature of this funding mechanism that generates competition between public and private sectors and marginalises local voices. The authors analyse strategy documents against their own research and published literature and reflect on whether the changes are likely to address challenges faced in bringing HIV programmes to scale and their likely effect on AIDS politics.

  20. Scaling up the 2010 World Health Organization HIV Treatment Guidelines in resource-limited settings: a model-based analysis.

    Directory of Open Access Journals (Sweden)

    Rochelle P Walensky

    2010-12-01

    Full Text Available The new 2010 World Health Organization (WHO HIV treatment guidelines recommend earlier antiretroviral therapy (ART initiation (CD4<350 cells/µl instead of CD4<200 cells/µl, multiple sequential ART regimens, and replacement of first-line stavudine with tenofovir. This paper considers what to do first in resource-limited settings where immediate implementation of all of the WHO recommendations is not feasible.We use a mathematical model and local input data to project clinical and economic outcomes in a South African HIV-infected cohort (mean age = 32.8 y, mean CD4 = 375/µl. For the reference strategy, we assume that all patients initiate stavudine-based ART with WHO stage III/IV disease and receive one line of ART (stavudine/WHO/one-line. We rank-in survival, cost-effectiveness, and equity terms-all 12 possible combinations of the following: (1 stavudine replacement with tenofovir, (2 ART initiation (by WHO stage, CD4<200 cells/µl, or CD4<350 cells/µl, and (3 one or two regimens, or lines, of available ART. Projected life expectancy for the reference strategy is 99.0 mo. Considering each of the guideline components separately, 5-y survival is maximized with ART initiation at CD4<350 cells/µl (stavudine/<350/µl/one-line, 87% survival compared with stavudine/WHO/two-lines (66% and tenofovir/WHO/one-line (66%. The greatest life expectancies are achieved via the following stepwise programmatic additions: stavudine/<350/µl/one-line (124.3 mo, stavudine/<350/µl/two-lines (177.6 mo, and tenofovir/<350/µl/two-lines (193.6 mo. Three program combinations are economically efficient: stavudine/<350/µl/one-line (cost-effectiveness ratio, US$610/years of life saved [YLS], tenofovir/<350/µl/one-line (US$1,140/YLS, and tenofovir/<350/µl/two-lines (US$2,370/YLS.In settings where immediate implementation of all of the new WHO treatment guidelines is not feasible, ART initiation at CD4<350 cells/µl provides the greatest short- and long

  1. Influence of model assumptions about HIV disease progression after initiating or stopping treatment on estimates of infections and deaths averted by scaling up antiretroviral therapy

    Science.gov (United States)

    Sucharitakul, Kanes; Boily, Marie-Claude; Dimitrov, Dobromir

    2018-01-01

    Background Many mathematical models have investigated the population-level impact of expanding antiretroviral therapy (ART), using different assumptions about HIV disease progression on ART and among ART dropouts. We evaluated the influence of these assumptions on model projections of the number of infections and deaths prevented by expanded ART. Methods A new dynamic model of HIV transmission among men who have sex with men (MSM) was developed, which incorporated each of four alternative assumptions about disease progression used in previous models: (A) ART slows disease progression; (B) ART halts disease progression; (C) ART reverses disease progression by increasing CD4 count; (D) ART reverses disease progression, but disease progresses rapidly once treatment is stopped. The model was independently calibrated to HIV prevalence and ART coverage data from the United States under each progression assumption in turn. New HIV infections and HIV-related deaths averted over 10 years were compared for fixed ART coverage increases. Results Little absolute difference (ART coverage (varied between 33% and 90%) if ART dropouts reinitiated ART at the same rate as ART-naïve MSM. Larger differences in the predicted fraction of HIV-related deaths averted were observed (up to 15pp). However, if ART dropouts could only reinitiate ART at CD4ART interruption did not affect the fraction of HIV infections averted with expanded ART, unless ART dropouts only re-initiated ART at low CD4 counts. Different disease progression assumptions had a larger influence on the fraction of HIV-related deaths averted with expanded ART. PMID:29554136

  2. Ethiopia's experience on scaling up latent TB infection management for people living with HIV and under-five child household contacts of index TB patients

    Directory of Open Access Journals (Sweden)

    Blen Ayele Kebede

    2018-01-01

    Full Text Available Management of latent tuberculosis infection (LTBI is one of the globally recommended key strategies to end tuberculosis. However, there is limited experience with translation of global recommendations into action at country levels. We present Ethiopia's experience in implementing LTBI management. Our objective is to share promising practices, existing opportunities and to suggest specific steps required for further scale up of the services. Our report is based on synthesis of data from secondary sources including official routine reports of Ministry of Health, materials presented at review meetings, and findings from supervisory visits to districts and health facilities. Our results suggest that Ethiopia has made significant strides toward strengthening LTBI management in people living with HIV and among under-five-year-old household contacts of TB patients. The use of contact investigation as entry point for LTBI management could be taken as best practice. More effort is needed to further strengthen implementation of LTBI management, and it should be supported through context-specific implementation and operational research activities.

  3. Assessing network scale-up estimates for groups most at risk of HIV/AIDS: evidence from a multiple-method study of heavy drug users in Curitiba, Brazil.

    Science.gov (United States)

    Salganik, Matthew J; Fazito, Dimitri; Bertoni, Neilane; Abdo, Alexandre H; Mello, Maeve B; Bastos, Francisco I

    2011-11-15

    One of the many challenges hindering the global response to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic is the difficulty of collecting reliable information about the populations most at risk for the disease. Thus, the authors empirically assessed a promising new method for estimating the sizes of most at-risk populations: the network scale-up method. Using 4 different data sources, 2 of which were from other researchers, the authors produced 5 estimates of the number of heavy drug users in Curitiba, Brazil. The authors found that the network scale-up and generalized network scale-up estimators produced estimates 5-10 times higher than estimates made using standard methods (the multiplier method and the direct estimation method using data from 2004 and 2010). Given that equally plausible methods produced such a wide range of results, the authors recommend that additional studies be undertaken to compare estimates based on the scale-up method with those made using other methods. If scale-up-based methods routinely produce higher estimates, this would suggest that scale-up-based methods are inappropriate for populations most at risk of HIV/AIDS or that standard methods may tend to underestimate the sizes of these populations.

  4. Involving new actors to achieve ART scaling-up: difficulties in an HIV/AIDS counselling and testing centre in Cameroon.

    Science.gov (United States)

    Yakam, J C Y Tantchou; Gruénais, M-E

    2009-03-01

    The high HIV/AIDS-related mortality among young adults is devastating countries in sub-Saharan Africa. The implementing capacity of the health systems is the main limiting factor of antiretroviral treatment (ART) scaling-up;(1) this capacity depends mainly on the health workforce. Tackling the issue of human resources for health is thus of paramount importance to achieve universal access to ART and for the survival of health systems in time of AIDS. To support such a process, the World Health Organization stresses the importance of task shifting(2) from medical doctors to nurses and from nurses to community health workers. Such task shifting is not easy to achieve but undoubtedly needed. This paper raises issues about the involvement of new actors(3) without precise redefinitions of roles and task-shifting procedures. We take the example of a 'Centre de Prévention et de Dépistage Volontaire du VIH/sida'(4) in one major town of the Far-North province of Cameroon (Central Africa). The study was qualitative. Observations were carried out in the service and in-depth interviews conducted with health workers and actors of Cameroon's National AIDS Control Committee. These interviews were recorded and transcribed. The material was analysed using keywords. KEY RESULT: The involvement of new actors in a context of human resources for health shortage and health system crisis creates confusion and role conflicts, which lead to frustration. It favours the appearance of chinks within which these new actors slip and 'find their way' in the system; it finally raises problems related to their legitimacy and position within the existing hierarchy. KEY POLICY MESSAGE: It is necessary, when involving new staff members (particularly when they do not belong to internationally recognized health professionals such as nurses, doctors and pharmacists), to redefine roles and build precise task-shifting procedures so that everyone may still have a place in the whole system and feel useful.

  5. Costing of scaling up HIV/AIDS treatment in Mexico Costos del tratamiento de VIH/SIDA en México

    Directory of Open Access Journals (Sweden)

    Sergio Bautista-Arredondo

    2008-01-01

    Full Text Available OBJECTIVE: To determine the net effect of introducing highly active antiretroviral treatment (HAART in Mexico on total annual per-patient costs for HIV/AIDS care, taking into account potential savings from treatment of opportunistic infections and hospitalizations. MATERIAL AND METHODS: A multi-center, retrospective patient chart review and collection of unit cost data were performed to describe the utilization of services and estimate costs of care for 1003 adult HIV+ patients in the public sector. RESULTS: HAART is not cost-saving and the average annual cost per patient increases after initiation of HAART due to antiretrovirals, accounting for 90% of total costs. Hospitalizations do decrease post-HAART, but not enough to offset the increased cost. CONCLUSIONS: Scaling up access to HAART is feasible in middle income settings. Since antiretrovirals are so costly, optimizing efficiency in procurement and prescribing is paramount. The observed adherence was low, suggesting that a proportion of these high drug costs translated into limited health benefits.OBJETIVO: Determinar el efecto neto de la introducción de la terapia antirretroviral altamente activa (TARAA en México sobre los costos anuales totales por paciente en el tratamiento de VIH/SIDA, tomando en cuenta el posible ahorro en el tratamiento de infecciones oportunistas y hospitalización. MATERIAL Y MÉTODOS: Se hizo un estudio retrospectivo, multicéntrico, mediante la revisión de los expedientes de los pacientes y la recolección de datos de costos unitarios para describir la utilización de los servicios y calcular los costos de la atención de 1 003 pacientes adultos VIH positivos en el sector público. RESULTADOS: La TARAA no ahorra costos y el costo promedio anual por paciente aumenta después de su inicio debido a los antirretrovirales, que representan 90% del costo total. Las hospitalizaciones disminuyen después de iniciada la TARAA, pero no lo suficiente como para compensar el

  6. The perceptions on male circumcision as a preventive measure against HIV infection and considerations in scaling up of the services: a qualitative study among police officers in Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Tarimo Edith AM

    2012-07-01

    Full Text Available Abstract Background In recent randomized controlled trials, male circumcision has been proven to complement the available biomedical interventions in decreasing HIV transmission from infected women to uninfected men. Consequently, Tanzania is striving to scale-up safe medical male circumcision to reduce HIV transmission. However, there is a need to investigate the perceptions of male circumcision in Tanzania using specific populations. The purpose of the present study was to assess the perceptions of male circumcision in a cohort of police officers that also served as a source of volunteers for a phase I/II HIV vaccine (HIVIS-03 trial in Dar es Salaam, Tanzania. Methods In-depth interviews with 24 men and 10 women were conducted. Content analysis informed by the socio-ecological model was used to analyze the data. Results Informants perceived male circumcision as a health-promoting practice that may prevent HIV transmission and other sexually transmitted infections. They reported male circumcision promotes sexual pleasure, confidence and hygiene or sexual cleanliness. They added that it is a religious ritual and a cultural practice that enhances the recognition of manhood in the community. However, informants were concerned about the cost involved in male circumcision and cleanliness of instruments used in medical and traditional male circumcision. They also expressed confusion about the shame of undergoing circumcision at an advanced age and pain that could emanate after circumcision. The participants advocated for health policies that promote medical male circumcision at childhood, specifically along with the vaccination program. Conclusions The perceived benefit of male circumcision as a preventive strategy to HIV and other sexually transmitted infections is important. However, there is a need to ensure that male circumcision is conducted under hygienic conditions. Integrating male circumcision service in the routine childhood vaccination

  7. Performance, costs and cost-effectiveness analysis of the Tay Ho HIV integrative prevention and care & treatment outpatient clinic, Vietnam. : is the model worth scale up?

    OpenAIRE

    Guérard, Vincent

    2014-01-01

    Since the early 1990s, Vietnam has been experiencing an HIV/AIDS epidemic with a general prevalence rate of 0.42 % in 2008 and a projected prevalence rate in 2012 of 0.47%. Although the general HIV prevalence rate is considered low, the virus heavily affects some at-risk population groups in Vietnam, including commercial sex workers, injectable drug users and the men who have sex with men. According to studies, prevalence among these groups is considerable, up to 65%. Risky sexual behaviours ...

  8. SCALE-UP OF RAPID SMALL-SCALE ADSORPTION TESTS TO FIELD-SCALE ADSORBERS: THEORETICAL BASIS AND EXPERIMENTAL RESULTS FOR A CONSTANT DIFFUSIVITY

    Science.gov (United States)

    Granular activated carbon (GAC) is an effective treatment technique for the removal of some toxic organics from drinking water or wastewater, however, it can be a relatively expensive process, especially if it is designed improperly. A rapid method for the design of large-scale f...

  9. HIV rapid diagnostic testing by lay providers in a key population-led health service programme in Thailand.

    Science.gov (United States)

    Wongkanya, Rapeeporn; Pankam, Tippawan; Wolf, Shauna; Pattanachaiwit, Supanit; Jantarapakde, Jureeporn; Pengnongyang, Supabhorn; Thapwong, Prasopsuk; Udomjirasirichot, Apichat; Churattanakraisri, Yutthana; Prawepray, Nanthika; Paksornsit, Apiluk; Sitthipau, Thidadaow; Petchaithong, Sarayut; Jitsakulchaidejt, Raruay; Nookhai, Somboon; Lertpiriyasuwat, Cheewanan; Ongwandee, Sumet; Phanuphak, Praphan; Phanuphak, Nittaya

    2018-01-01

    Introduction:  Rapid diagnostic testing (RDT) for HIV has a quick turn-around time, which increases the proportion of people testing who receive their result. HIV RDT in Thailand has traditionally been performed only by medical technologists (MTs), which is a barrier to its being scaled up. We evaluated the performance of HIV RDT conducted by trained lay providers who were members of, or worked closely with, a group of men who have sex with men (MSM) and with transgender women (TG) communities, and compared it to tests conducted by MTs. Methods:  Lay providers received a 3-day intensive training course on how to perform a finger-prick blood collection and an HIV RDT as part of the Key Population-led Health Services (KPLHS) programme among MSM and TG. All the samples were tested by lay providers using Alere Determine HIV 1/2. HIV-reactive samples were confirmed by DoubleCheckGold Ultra HIV 1&2 and SD Bioline HIV 1/2. All HIV-positive and 10% of HIV-negative samples were re-tested by MTs using Serodia HIV 1/2. Results:  Of 1680 finger-prick blood samples collected and tested using HIV RDT by lay providers in six drop-in centres in Bangkok, Chiang Mai, Chonburi and Songkhla, 252 (15%) were HIV-positive. MTs re-tested these HIV-positive samples and 143 randomly selected HIV-negative samples with 100% concordant test results. Conclusion:  Lay providers in Thailand can be trained and empowered to perform HIV RDT as they were found to achieve comparable results in sample testing with MTs. Based on the task-shifting concept, this rapid HIV testing performed by lay providers as part of the KPLHS programme has great potential to enhance HIV prevention and treatment programmes among key at-risk populations.

  10. An assessment of the positive partnership project in Thailand: key considerations for scaling-up microcredit loans for HIV-positive and negative pairs in other settings.

    Science.gov (United States)

    Viravaidya, M; Wolf, R C; Guest, P

    2008-01-01

    Stigmatization and discrimination against people living with HIV/AIDS (PLHA), and their families, remains a barrier to participation in prevention and care programmes. This barrier takes on added significance as Thailand expands provision of free antiretroviral therapy (ART). This paper documents an innovative approach to improve quality of life for PLHA, while reducing levels of stigma and discrimination. The Population and Community Development Association (PDA) began implementing the Positive Partnership Project (PPP) in 2002. In this project, an HIV-negative person must team up with an HIV-positive person to become eligible for a loan for income-generating activities. The use of microcredit to explicitly reduce stigma and discrimination is a unique feature of the PPP. While the microcredit component of the project is an important dimension for improving the status of participating PLHA, the impacts of the project extend far beyond the PLHA who receive loans. Both directly and indirectly, it has contributed to improved quality of life and economic conditions for PLHA, while raising their visibility and acceptance in hundreds of communities throughout urban and rural Thailand. This paper identifies key features of the project and considerations for adapting its use in other settings.

  11. Cost-effectiveness analysis of rapid diagnostic test, microscopy and syndromic approach in the diagnosis of malaria in Nigeria: implications for scaling-up deployment of ACT

    Directory of Open Access Journals (Sweden)

    Onwujekwe Obinna E

    2009-11-01

    Full Text Available Abstract Background The diagnosis and treatment of malaria is often based on syndromic presentation (presumptive treatment and microscopic examination of blood films. Treatment based on syndromic approach has been found to be costly, and contributes to the development of drug resistance, while microscopic diagnosis of malaria is time-consuming and labour-intensive. Also, there is lack of trained microscopists and reliable equipment especially in rural areas of Nigeria. However, although rapid diagnostic tests (RDTs have improved the ease of appropriate diagnosis of malaria diagnosis, the cost-effectiveness of RDTs in case management of malaria has not been evaluated in Nigeria. The study hence compares the cost-effectiveness of RDT versus syndromic diagnosis and microscopy. Methods A total of 638 patients with fever, clinically diagnosed as malaria (presumptive malaria by health workers, were selected for examination with both RDT and microscopy. Patients positive on RDT received artemisinin-based combination therapy (ACT and febrile patients negative on RDT received an antibiotic treatment. Using a decision tree model for a hypothetical cohort of 100,000 patients, the diagnostic alternatives considered were presumptive treatment (base strategy, RDT and microscopy. Costs were based on a consumer and provider perspective while the outcome measure was deaths averted. Information on costs and malaria epidemiology were locally generated, and along with available data on effectiveness of diagnostic tests, adherence level to drugs for treatment, and drug efficacy levels, cost-effectiveness estimates were computed using TreeAge programme. Results were reported based on costs and effects per strategy, and incremental cost-effectiveness ratios. Results The cost-effectiveness analysis at 43.1% prevalence level showed an incremental cost effectiveness ratio (ICER of 221 per deaths averted between RDT and presumptive treatment, while microscopy is dominated

  12. The cost and impact of scaling up pre-exposure prophylaxis for HIV prevention: a systematic review of cost-effectiveness modelling studies.

    Directory of Open Access Journals (Sweden)

    Gabriela B Gomez

    Full Text Available Cost-effectiveness studies inform resource allocation, strategy, and policy development. However, due to their complexity, dependence on assumptions made, and inherent uncertainty, synthesising, and generalising the results can be difficult. We assess cost-effectiveness models evaluating expected health gains and costs of HIV pre-exposure prophylaxis (PrEP interventions.We conducted a systematic review comparing epidemiological and economic assumptions of cost-effectiveness studies using various modelling approaches. The following databases were searched (until January 2013: PubMed/Medline, ISI Web of Knowledge, Centre for Reviews and Dissemination databases, EconLIT, and region-specific databases. We included modelling studies reporting both cost and expected impact of a PrEP roll-out. We explored five issues: prioritisation strategies, adherence, behaviour change, toxicity, and resistance. Of 961 studies retrieved, 13 were included. Studies modelled populations (heterosexual couples, men who have sex with men, people who inject drugs in generalised and concentrated epidemics from Southern Africa (including South Africa, Ukraine, USA, and Peru. PrEP was found to have the potential to be a cost-effective addition to HIV prevention programmes in specific settings. The extent of the impact of PrEP depended upon assumptions made concerning cost, epidemic context, programme coverage, prioritisation strategies, and individual-level adherence. Delivery of PrEP to key populations at highest risk of HIV exposure appears the most cost-effective strategy. Limitations of this review include the partial geographical coverage, our inability to perform a meta-analysis, and the paucity of information available exploring trade-offs between early treatment and PrEP.Our review identifies the main considerations to address in assessing cost-effectiveness analyses of a PrEP intervention--cost, epidemic context, individual adherence level, PrEP programme coverage

  13. A national survey of the impact of rapid scale-up of antiretroviral therapy on health-care workers in Malawi: effects on human resources and survival.

    Science.gov (United States)

    Makombe, Simon D; Jahn, Andreas; Tweya, Hannock; Chuka, Stuart; Yu, Joseph Kwong-Leung; Hochgesang, Mindy; Aberle-Grasse, John; Pasulani, Olesi; Schouten, Erik J; Kamoto, Kelita; Harries, Anthony D

    2007-11-01

    To assess the human resources impact of Malawis rapidly growing antiretroviral therapy (ART) programme and balance this against the survival benefit of health-care workers who have accessed ART themselves. We conducted a national cross-sectional survey of the human resource allocation in all public-sector health facilities providing ART in mid-2006. We also undertook a survival analysis of health-care workers who had accessed ART in public and private facilities by 30 June 2006, using data from the national ART monitoring and evaluation system. By 30 June 2006, 59 581 patients had accessed ART from 95 public and 28 private facilities. The public sites provided ART services on 2.4 days per week on average, requiring 7% of the clinician workforce, 3% of the nursing workforce and 24% of the ward clerk workforce available at the facilities. We identified 1024 health-care workers in the national ART-patient cohort (2% of all ART patients). The probabilities for survival on ART at 6 months, 12 months and 18 months were 85%, 81% and 78%, respectively. An estimated 250 health-care workers lives were saved 12 months after ART initiation. Their combined work-time of more than 1000 staff-days per week was equivalent to the human resources required to provide ART at the national level. A large number of ART patients in Malawi are managed by a small proportion of the health-care workforce. Many health-care workers have accessed ART with good treatment outcomes. Currently, staffing required for ART balances against health-care workers lives saved through treatment, although this may change in the future.

  14. Prevalence of Chlamydia trachomatis infection in women, heterosexual men and MSM visiting HIV counselling institutions in North Rhine-Westphalia, Germany - should Chlamydia testing be scaled up?

    Directory of Open Access Journals (Sweden)

    Anne Lallemand

    2016-10-01

    Full Text Available Abstract Background Patients asking for a free anonymous HIV test may have contracted other sexually transmitted infections (STIs such as Chlamydia trachomatis, yet Chlamydia prevalence in that population is unknown. This study aimed to assess the prevalence and factors associated with Chlamydia infection in patients seeking HIV testing at local public health authorities (LPHA in order to evaluate whether Chlamydia testing should be routinely offered to them. Methods We conducted a cross-sectional study among patients (≥18 years attending 18 LPHA in North Rhine-Westphalia from November 2012 to September 2013. LPHA collected information on participants’ socio-demographic characteristics, sexual and HIV testing behaviours, previous STI history and clinical symptoms. Self-collected vaginal swabs and urine (men were analysed by Transcription-Mediated Amplification. We assessed overall and age-stratified Chlamydia prevalence and 95 % confidence intervals (95 % CI. Using univariate and multivariable binomial regression, we estimated adjusted prevalence ratios (aPR to identify factors associated with Chlamydia infection. Results The study population comprised 1144 (40.5 % women, 1134 (40.1 % heterosexual men and 549 (19.4 % men who have sex with men (MSM; median age was 30 years. Chlamydia prevalence was 5.3 % (95 % CI: 4.1–6.8 % among women, 3.2 % (95 % CI: 2.2–4.4 in heterosexual men and 3.5 % (95 % CI: 2.1–5.4 in MSM. Prevalence was highest among 18–24 year-old women (9 %; 95 % CI: 5.8–13 and heterosexual men (5.7 %; 95 % CI: 3.0–9.8 %, respectively. Among MSM, the prevalence was highest among 30–39 year-olds (4.4 %; 95 % CI: 1.9–8.5 %. Among those who tested positive, 76.7 % of women, 75.0 % of heterosexual men and 84.2 % of MSM were asymptomatic. Among women, factors associated with Chlamydia infection were young age (18–24 years versus ≥ 40 years, aPR: 3.0, 95 % CI: 1.2–7.8, having had more than 2

  15. Treatment initiation, program attrition and patient treatment outcomes associated with scale-up and decentralization of HIV care in rural Malawi.

    Science.gov (United States)

    McGuire, Megan; Pinoges, Loretxu; Kanapathipillai, Rupa; Munyenyembe, Tamika; Huckabee, Martha; Makombe, Simon; Szumilin, Elisabeth; Heinzelmann, Annette; Pujades-Rodríguez, Mar

    2012-01-01

    To describe patient antiretroviral therapy (cART) outcomes associated with intensive decentralization of services in a rural HIV program in Malawi. Longitudinal analysis of data from HIV-infected patients starting cART between August 2001 and December 2008 and of a cross-sectional immunovirological assessment conducted 12 (±2) months after therapy start. One-year mortality, lost to follow-up, and attrition (deaths and lost to follow-up) rates were estimated with exact Poisson 95% confidence intervals (CI) by type of care delivery and year of initiation. Association of virological suppression (centralized care and 11,090 decentralized care. At therapy start, patients treated in decentralized health facilities had higher median CD4 count levels (167 vs. 130 cell/µL, Pdecentralized than centralized facilities (9.9 per 100 person-years, 95% CI: 9.5-10.4 vs. 20.8 per 100 person-years, 95% CI: 19.7-22.0). One year after treatment start, differences in immunological success (adjusted OR=1.23, 95% CI: 0.83-1.83), and viral suppression (adjusted OR=0.80, 95% CI: 0.56-1.14) between patients followed at centralized and decentralized facilities were not statistically significant. In rural Malawi, 1- and 2-year program attrition was lower in decentralized than in centralized health facilities and no statistically significant differences in one-year immunovirological outcomes were observed between the two health care levels. Longer follow-up is needed to confirm these results.

  16. Treatment initiation, program attrition and patient treatment outcomes associated with scale-up and decentralization of HIV care in rural Malawi.

    Directory of Open Access Journals (Sweden)

    Megan McGuire

    Full Text Available OBJECTIVE: To describe patient antiretroviral therapy (cART outcomes associated with intensive decentralization of services in a rural HIV program in Malawi. METHODS: Longitudinal analysis of data from HIV-infected patients starting cART between August 2001 and December 2008 and of a cross-sectional immunovirological assessment conducted 12 (±2 months after therapy start. One-year mortality, lost to follow-up, and attrition (deaths and lost to follow-up rates were estimated with exact Poisson 95% confidence intervals (CI by type of care delivery and year of initiation. Association of virological suppression (<50 copies/mL and immunological success (CD4 gain ≥100 cells/µL, with type of care was investigated using multiple logistic regression. RESULTS: During the study period, 4322 cART patients received centralized care and 11,090 decentralized care. At therapy start, patients treated in decentralized health facilities had higher median CD4 count levels (167 vs. 130 cell/µL, P<0.0001 than other patients. Two years after cART start, program attrition was lower in decentralized than centralized facilities (9.9 per 100 person-years, 95% CI: 9.5-10.4 vs. 20.8 per 100 person-years, 95% CI: 19.7-22.0. One year after treatment start, differences in immunological success (adjusted OR=1.23, 95% CI: 0.83-1.83, and viral suppression (adjusted OR=0.80, 95% CI: 0.56-1.14 between patients followed at centralized and decentralized facilities were not statistically significant. CONCLUSIONS: In rural Malawi, 1- and 2-year program attrition was lower in decentralized than in centralized health facilities and no statistically significant differences in one-year immunovirological outcomes were observed between the two health care levels. Longer follow-up is needed to confirm these results.

  17. Scaling-up antiretroviral therapy in Malawi.

    Science.gov (United States)

    Jahn, Andreas; Harries, Anthony D; Schouten, Erik J; Libamba, Edwin; Ford, Nathan; Maher, Dermot; Chimbwandira, Frank

    2016-10-01

    In Malawi, health-system constraints meant that only a fraction of people infected with human immunodeficiency virus (HIV) and in immediate need of antiretroviral treatment (ART) received treatment. In 2004, the Malawian Ministry of Health launched plans to scale-up ART nationwide, adhering to the principle of equity to ensure fair geographical access to therapy. A public health approach was used with standardized training and treatment and regular supervision and monitoring of the programme. Before the scale-up, an estimated 930 000 people in Malawi were HIV-infected, with 170 000 in immediate need of ART. About 3000 patients were on ART in nine clinics. By December 2015, cumulatively 872 567 patients had been started on ART from 716 clinics, following national treatment protocols and using the standard monitoring system. Strong national leadership allowed the ministry of health to implement a uniform system for scaling-up ART and provided benchmarks for implementation on the ground. New systems of training staff and accrediting health facilities enabled task-sharing and decentralization to peripheral health centres and a standardized approach to starting and monitoring ART. A system of quarterly supervision and monitoring, into which operational research was embedded, ensured stocks of drug supplies at facilities and adherence to national treatment guidelines.

  18. ScaleUp America Communities

    Data.gov (United States)

    Small Business Administration — SBA’s new ScaleUp America Initiative is designed to help small firms with high potential “scale up” and grow their businesses so that they will provide more jobs and...

  19. Evolving trade policy and the Trans-Pacific Partnership Agreement: does it threaten Vietnam's access to medicine and its progress towards scaling up HIV prevention, treatment and care?

    Science.gov (United States)

    Linh, Nguyen Nhat; Huong, Nguyen Thanh; Thuy, Hua Thanh

    2015-01-01

    The Trans-Pacific Partnership Agreement (TPP) has undergone 18 rounds of secretive negotiation between the USA and 11 Asia-Pacific countries. Aiming at a free trade area, this multilateral trade proposal covers all aspects of commercial relations among the countries involved. Despite some anticipated positive impacts in trade, specific articles in this proposal's intellectual property and transparency chapters might negatively impact access to medicine, in general, and to antiretroviral (ARV) drugs, in particular, in Vietnam. Drawing on a desk review and qualitative in-depth interviews with 20 key informants from government, academia, hospitals and civil society, we analyse various provisions of the proposal being negotiated leaked after the 14th round of negotiations in September 2012. Findings suggest that the TPP could lead to increased monopoly protection and could limit technological advancements within the local pharmaceutical manufacturing industry, resulting in higher medicine prices in Vietnam. This outcome would have a significant impact on Vietnam's ability to achieve goals for HIV prevention, treatment and care, and create barriers to universal health-care coverage. This research provides unique evidence for Vietnam to advocate for more equitable pharmaceutical provisions in and to raise awareness of the implications of the TPP among the pharmaceutical stakeholder community in Vietnam.

  20. High Acceptability of HIV Self-Testing among Technical Vocational Education and Training College Students in Gauteng and North West Province: What Are the Implications for the Scale Up in South Africa?

    Science.gov (United States)

    Mokgatle, Mathildah Mpata; Madiba, Sphiwe

    2017-01-01

    Although HIV self-testing (HIVST) is globally accepted as an important complement to existing HIV testing approaches, South Africa has lagged behind in its adoption. As a result, data on the acceptability and uptake of HIVST testing is limited. The study investigated the acceptability of HIVST among students in Technical Vocational Education and Training (TVET) colleges in two provinces in South Africa. A cross-sectional survey using a self-administered structured questionnaire was used to collect data among 3,662 students recruited from 13 TVET colleges. The mean age of the students was 21.9 years. The majority (80.9%) were sexually active; while 66.1% reported that they had one sexual partner, and 33.9% had two or more sexual partners in the past year, and66.5% used condoms during the last sexual act. Three-quarters tested for HIV in the past year but less than half knew about HIVST prior to the survey. The acceptability of HIVST was high; about three-quarters showed a willingness to purchase a self-test kit and a majority would self-test with partners. Acceptability of HIVST was associated with being sexually active (OR = 1.73, p = 0.02, confidence interval (CI): 1.08-2.75), having ever been tested for HIV (OR = 1.74, p = 0.001, CI: 1.26-2.38), and having multiple sexual partners (OR = 0.61, p = 0.01, CI: 0.42-0.88). Three-quarters would confirm test results at a local health facility. In terms of counselling, telephone hotlines were acceptable to only 39.9%, and less than half felt that test-kit leaflets would provide sufficient information to self-test. The high acceptability of HIVST among the students calls for extensive planning and preparation for the scaling up of HIVST in South Africa. In addition, campaigns similar to those conducted to promote HIV counselling and testing (HCT) should be considered to educate communities about HIVST.

  1. High Acceptability of HIV Self-Testing among Technical Vocational Education and Training College Students in Gauteng and North West Province: What Are the Implications for the Scale Up in South Africa?

    Directory of Open Access Journals (Sweden)

    Mathildah Mpata Mokgatle

    Full Text Available Although HIV self-testing (HIVST is globally accepted as an important complement to existing HIV testing approaches, South Africa has lagged behind in its adoption. As a result, data on the acceptability and uptake of HIVST testing is limited. The study investigated the acceptability of HIVST among students in Technical Vocational Education and Training (TVET colleges in two provinces in South Africa.A cross-sectional survey using a self-administered structured questionnaire was used to collect data among 3,662 students recruited from 13 TVET colleges.The mean age of the students was 21.9 years. The majority (80.9% were sexually active; while 66.1% reported that they had one sexual partner, and 33.9% had two or more sexual partners in the past year, and66.5% used condoms during the last sexual act. Three-quarters tested for HIV in the past year but less than half knew about HIVST prior to the survey. The acceptability of HIVST was high; about three-quarters showed a willingness to purchase a self-test kit and a majority would self-test with partners. Acceptability of HIVST was associated with being sexually active (OR = 1.73, p = 0.02, confidence interval (CI: 1.08-2.75, having ever been tested for HIV (OR = 1.74, p = 0.001, CI: 1.26-2.38, and having multiple sexual partners (OR = 0.61, p = 0.01, CI: 0.42-0.88. Three-quarters would confirm test results at a local health facility. In terms of counselling, telephone hotlines were acceptable to only 39.9%, and less than half felt that test-kit leaflets would provide sufficient information to self-test.The high acceptability of HIVST among the students calls for extensive planning and preparation for the scaling up of HIVST in South Africa. In addition, campaigns similar to those conducted to promote HIV counselling and testing (HCT should be considered to educate communities about HIVST.

  2. Toward Automating HIV Identification: Machine Learning for Rapid Identification of HIV-Related Social Media Data.

    Science.gov (United States)

    Young, Sean D; Yu, Wenchao; Wang, Wei

    2017-02-01

    "Social big data" from technologies such as social media, wearable devices, and online searches continue to grow and can be used as tools for HIV research. Although researchers can uncover patterns and insights associated with HIV trends and transmission, the review process is time consuming and resource intensive. Machine learning methods derived from computer science might be used to assist HIV domain experts by learning how to rapidly and accurately identify patterns associated with HIV from a large set of social data. Using an existing social media data set that was associated with HIV and coded by an HIV domain expert, we tested whether 4 commonly used machine learning methods could learn the patterns associated with HIV risk behavior. We used the 10-fold cross-validation method to examine the speed and accuracy of these models in applying that knowledge to detect HIV content in social media data. Logistic regression and random forest resulted in the highest accuracy in detecting HIV-related social data (85.3%), whereas the Ridge Regression Classifier resulted in the lowest accuracy. Logistic regression yielded the fastest processing time (16.98 seconds). Machine learning can enable social big data to become a new and important tool in HIV research, helping to create a new field of "digital HIV epidemiology." If a domain expert can identify patterns in social data associated with HIV risk or HIV transmission, machine learning models could quickly and accurately learn those associations and identify potential HIV patterns in large social data sets.

  3. Scaling up of renewable chemicals.

    Science.gov (United States)

    Sanford, Karl; Chotani, Gopal; Danielson, Nathan; Zahn, James A

    2016-04-01

    The transition of promising technologies for production of renewable chemicals from a laboratory scale to commercial scale is often difficult and expensive. As a result the timeframe estimated for commercialization is typically underestimated resulting in much slower penetration of these promising new methods and products into the chemical industries. The theme of 'sugar is the next oil' connects biological, chemical, and thermochemical conversions of renewable feedstocks to products that are drop-in replacements for petroleum derived chemicals or are new to market chemicals/materials. The latter typically offer a functionality advantage and can command higher prices that result in less severe scale-up challenges. However, for drop-in replacements, price is of paramount importance and competitive capital and operating expenditures are a prerequisite for success. Hence, scale-up of relevant technologies must be interfaced with effective and efficient management of both cell and steel factories. Details involved in all aspects of manufacturing, such as utilities, sterility, product recovery and purification, regulatory requirements, and emissions must be managed successfully. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. The SCALE-UP Project

    Science.gov (United States)

    Beichner, Robert

    2015-03-01

    The Student Centered Active Learning Environment with Upside-down Pedagogies (SCALE-UP) project was developed nearly 20 years ago as an economical way to provide collaborative, interactive instruction even for large enrollment classes. Nearly all research-based pedagogies have been designed with fairly high faculty-student ratios. The economics of introductory courses at large universities often precludes that situation, so SCALE-UP was created as a way to facilitate highly collaborative active learning with large numbers of students served by only a few faculty and assistants. It enables those students to learn and succeed not only in acquiring content, but also to practice important 21st century skills like problem solving, communication, and teamsmanship. The approach was initially targeted at undergraduate science and engineering students taking introductory physics courses in large enrollment sections. It has since expanded to multiple content areas, including chemistry, math, engineering, biology, business, nursing, and even the humanities. Class sizes range from 24 to over 600. Data collected from multiple sites around the world indicates highly successful implementation at more than 250 institutions. NSF support was critical for initial development and dissemination efforts. Generously supported by NSF (9752313, 9981107) and FIPSE (P116B971905, P116B000659).

  5. Determination of HIV Status in African Adults With Discordant HIV Rapid Tests.

    Science.gov (United States)

    Fogel, Jessica M; Piwowar-Manning, Estelle; Donohue, Kelsey; Cummings, Vanessa; Marzinke, Mark A; Clarke, William; Breaud, Autumn; Fiamma, Agnès; Donnell, Deborah; Kulich, Michal; Mbwambo, Jessie K K; Richter, Linda; Gray, Glenda; Sweat, Michael; Coates, Thomas J; Eshleman, Susan H

    2015-08-01

    In resource-limited settings, HIV infection is often diagnosed using 2 rapid tests. If the results are discordant, a third tie-breaker test is often used to determine HIV status. This study characterized samples with discordant rapid tests and compared different testing strategies for determining HIV status in these cases. Samples were previously collected from 173 African adults in a population-based survey who had discordant rapid test results. Samples were classified as HIV positive or HIV negative using a rigorous testing algorithm that included two fourth-generation tests, a discriminatory test, and 2 HIV RNA tests. Tie-breaker tests were evaluated, including rapid tests (1 performed in-country), a third-generation enzyme immunoassay, and two fourth-generation tests. Selected samples were further characterized using additional assays. Twenty-nine samples (16.8%) were classified as HIV positive and 24 of those samples (82.8%) had undetectable HIV RNA. Antiretroviral drugs were detected in 1 sample. Sensitivity was 8.3%-43% for the rapid tests; 24.1% for the third-generation enzyme immunoassay; 95.8% and 96.6% for the fourth-generation tests. Specificity was lower for the fourth-generation tests than the other tests. Accuracy ranged from 79.5% to 91.3%. In this population-based survey, most HIV-infected adults with discordant rapid tests were virally suppressed without antiretroviral drugs. Use of individual assays as tie-breaker tests was not a reliable method for determining HIV status in these individuals. More extensive testing algorithms that use a fourth-generation screening test with a discriminatory test and HIV RNA test are preferable for determining HIV status in these cases.

  6. Evaluation of simple rapid HIV assays and development of national rapid HIV test algorithms in Dar es Salaam, Tanzania.

    Science.gov (United States)

    Lyamuya, Eligius F; Aboud, Said; Urassa, Willy K; Sufi, Jaffer; Mbwana, Judica; Ndugulile, Faustin; Massambu, Charles

    2009-02-18

    Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA) or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from HIV-infected patients, pregnant women, voluntary counseling and testing attendees and blood donors, and to formulate an alternative confirmatory strategy based on rapid HIV testing algorithms suitable for use in Tanzania. Five rapid HIV assays: Determine HIV-1/2 (Inverness Medical), SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), First Response HIV Card 1-2.0 (PMC Medical India Pvt Ltd), HIV1/2 Stat-Pak Dipstick (Chembio Diagnostic System, Inc) and Uni-Gold HIV-1/2 (Trinity Biotech) were evaluated between June and September 2006 using 1433 whole blood samples from hospital patients, pregnant women, voluntary counseling and testing attendees and blood donors. All samples that were reactive on all or any of the five rapid assays and 10% of non-reactive samples were tested on a confirmatory Inno-Lia HIV I/II immunoblot assay (Immunogenetics). Three hundred and ninety samples were confirmed HIV-1 antibody positive, while 1043 were HIV negative. The sensitivity at initial testing of Determine, SD Bioline and Uni-Gold was 100% (95% CI; 99.1-100) while First Response and Stat-Pak had sensitivity of 99.5% (95% CI; 98.2-99.9) and 97.7% (95% CI; 95.7-98.9), respectively, which increased to 100% (95% CI; 99.1-100) on repeat testing. The initial specificity of the Uni-Gold assay was 100% (95% CI; 99.6-100) while specificities were 99.6% (95% CI; 99-99.9), 99.4% (95% CI; 98.8-99.7), 99.6% (95% CI; 99-99.9) and 99.8% (95% CI; 99.3-99.9) for Determine, SD Bioline, First Response and Stat-Pak assays, respectively. There was no any sample which was concordantly false positive in Uni-Gold, Determine and SD Bioline assays. An

  7. Accuracy in HIV Rapid Testing among Laboratory and Non-laboratory Personnel in Zambia: Observations from the National HIV Proficiency Testing System.

    Directory of Open Access Journals (Sweden)

    Sheila Mwangala

    Full Text Available Despite rapid task-shifting and scale-up of HIV testing services in high HIV prevalence countries, studies evaluating accuracy remain limited. This study aimed to assess overall accuracy level and factors associated with accuracy in HIV rapid testing in Zambia.Accuracy was investigated among rural and urban HIV testing sites participating in two annual national HIV proficiency testing (PT exercises conducted in 2009 (n = 282 sites and 2010 (n = 488 sites. Testers included lay counselors, nurses, laboratory personnel and others. PT panels of five dry tube specimens (DTS were issued to testing sites by the national reference laboratory (NRL. Site accuracy level was assessed by comparison of reported results to the expected results. Non-parametric rank tests and multiple linear regression models were used to assess variation in accuracy between PT cycles and between tester groups, and to examine factors associated with accuracy respectively.Overall accuracy level was 93.1% (95% CI: 91.2-94.9 in 2009 and 96.9% (95% CI: 96.1-97.8 in 2010. Differences in accuracy were seen between the tester groups in 2009 with laboratory personnel being more accurate than non-laboratory personnel, while in 2010 no differences were seen. In both PT exercises, lay counselors and nurses had more difficulties interpreting results, with more occurrences of false-negative, false-positive and indeterminate results. Having received the standard HIV rapid testing training and adherence to the national HIV testing algorithm were positively associated with accuracy.The study showed an improvement in tester group and overall accuracy from the first PT exercise to the next. Average number of incorrect test results per 1000 tests performed was reduced from 69 to 31. Further improvement is needed, however, and the national HIV proficiency testing system seems to be an important tool in this regard, which should be continued and needs to be urgently strengthened.

  8. Lack of HIV infection among truck drivers in Iran using rapid HIV test

    Directory of Open Access Journals (Sweden)

    Hossain Jabbari

    2010-01-01

    Full Text Available Background: The aim of this study was to evaluate the prevalence of HIV infection in Iranian long distance truck drivers using rapid HIV test. Methods: The study included 400 consecutive participants in Bazargan city, north-west of Iran in the late 2008 and the early 2009. Results: No HIV infection was observed among these long distance truck drivers. Conclusions: Although results of this study is plausible compared to other similar studies, repeated surveys are necessary to know the trend of HIV infection in truckers in Iran.

  9. Potential for false positive HIV test results with the serial rapid HIV testing algorithm

    Directory of Open Access Journals (Sweden)

    Baveewo Steven

    2012-03-01

    Full Text Available Abstract Background Rapid HIV tests provide same-day results and are widely used in HIV testing programs in areas with limited personnel and laboratory infrastructure. The Uganda Ministry of Health currently recommends the serial rapid testing algorithm with Determine, STAT-PAK, and Uni-Gold for diagnosis of HIV infection. Using this algorithm, individuals who test positive on Determine, negative to STAT-PAK and positive to Uni-Gold are reported as HIV positive. We conducted further testing on this subgroup of samples using qualitative DNA PCR to assess the potential for false positive tests in this situation. Results Of the 3388 individuals who were tested, 984 were HIV positive on two consecutive tests, and 29 were considered positive by a tiebreaker (positive on Determine, negative on STAT-PAK, and positive on Uni-Gold. However, when the 29 samples were further tested using qualitative DNA PCR, 14 (48.2% were HIV negative. Conclusion Although this study was not primarily designed to assess the validity of rapid HIV tests and thus only a subset of the samples were retested, the findings show a potential for false positive HIV results in the subset of individuals who test positive when a tiebreaker test is used in serial testing. These findings highlight a need for confirmatory testing for this category of individuals.

  10. Potential for false positive HIV test results with the serial rapid HIV testing algorithm.

    Science.gov (United States)

    Baveewo, Steven; Kamya, Moses R; Mayanja-Kizza, Harriet; Fatch, Robin; Bangsberg, David R; Coates, Thomas; Hahn, Judith A; Wanyenze, Rhoda K

    2012-03-19

    Rapid HIV tests provide same-day results and are widely used in HIV testing programs in areas with limited personnel and laboratory infrastructure. The Uganda Ministry of Health currently recommends the serial rapid testing algorithm with Determine, STAT-PAK, and Uni-Gold for diagnosis of HIV infection. Using this algorithm, individuals who test positive on Determine, negative to STAT-PAK and positive to Uni-Gold are reported as HIV positive. We conducted further testing on this subgroup of samples using qualitative DNA PCR to assess the potential for false positive tests in this situation. Of the 3388 individuals who were tested, 984 were HIV positive on two consecutive tests, and 29 were considered positive by a tiebreaker (positive on Determine, negative on STAT-PAK, and positive on Uni-Gold). However, when the 29 samples were further tested using qualitative DNA PCR, 14 (48.2%) were HIV negative. Although this study was not primarily designed to assess the validity of rapid HIV tests and thus only a subset of the samples were retested, the findings show a potential for false positive HIV results in the subset of individuals who test positive when a tiebreaker test is used in serial testing. These findings highlight a need for confirmatory testing for this category of individuals.

  11. Evaluation of a rapid test for HIV antibodies in saliva and blood ...

    African Journals Online (AJOL)

    Objective. To test whole blood and saliva for HIV antibodies (anti-HIV) using a rapid test strip capillary flow . immunoassay, and to correlate the test strip results with blood specimen results obtained from routine diagnostic antiHIV assays. Design. A prospective pilot study of selected HIV-positive and HIV-negative individuals ...

  12. Evaluation of simple rapid HIV assays and development of national rapid HIV test algorithms in Dar es Salaam, Tanzania

    Directory of Open Access Journals (Sweden)

    Mbwana Judica

    2009-02-01

    Full Text Available Abstract Background Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from HIV-infected patients, pregnant women, voluntary counseling and testing attendees and blood donors, and to formulate an alternative confirmatory strategy based on rapid HIV testing algorithms suitable for use in Tanzania. Methods Five rapid HIV assays: Determine™ HIV-1/2 (Inverness Medical, SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc., First Response HIV Card 1–2.0 (PMC Medical India Pvt Ltd, HIV1/2 Stat-Pak Dipstick (Chembio Diagnostic System, Inc and Uni-Gold™ HIV-1/2 (Trinity Biotech were evaluated between June and September 2006 using 1433 whole blood samples from hospital patients, pregnant women, voluntary counseling and testing attendees and blood donors. All samples that were reactive on all or any of the five rapid assays and 10% of non-reactive samples were tested on a confirmatory Inno-Lia HIV I/II immunoblot assay (Immunogenetics. Results Three hundred and ninety samples were confirmed HIV-1 antibody positive, while 1043 were HIV negative. The sensitivity at initial testing of Determine, SD Bioline and Uni-Gold™ was 100% (95% CI; 99.1–100 while First Response and Stat-Pak had sensitivity of 99.5% (95% CI; 98.2–99.9 and 97.7% (95% CI; 95.7–98.9, respectively, which increased to 100% (95% CI; 99.1–100 on repeat testing. The initial specificity of the Uni-Gold™ assay was 100% (95% CI; 99.6–100 while specificities were 99.6% (95% CI; 99–99.9, 99.4% (95% CI; 98.8–99.7, 99.6% (95% CI; 99–99.9 and 99.8% (95% CI; 99.3–99.9 for Determine, SD Bioline, First Response and Stat-Pak assays, respectively. There was no any sample which was

  13. Scale-up of precipitation processes

    OpenAIRE

    Zauner, R.

    1999-01-01

    This thesis concerns the scale-up of precipitation processes aimed at predicting product particle characteristics. Although precipitation is widely used in the chemical and pharmaceutical industry, successful scale-up is difficult due to the absence of a validated methodology. It is found that none of the conventional scale-up criteria reported in the literature (equal power input per unit mass, equal tip speed, equal stirring rate) is capable of predicting the experimentally o...

  14. Defective proviruses rapidly accumulate during acute HIV-1 infection

    Science.gov (United States)

    Bruner, Katherine M.; Murray, Alexandra J.; Pollack, Ross A.; Soliman, Mary G.; Laskey, Sarah B.; Capoferri, Adam A.; Lai, Jun; Strain, Matthew C.; Lada, Steven M.; Hoh, Rebecca; Ho, Ya-Chi; Richman, Douglas D.; Deeks, Steven G.; Siliciano, Janet D.; Siliciano, Robert F.

    2016-01-01

    Although antiretroviral therapy (ART) suppresses viral replication to clinically undetectable levels, HIV-1 persists in CD4+ T cells in a latent form not targeted by the immune system or ART1–5. This latent reservoir is a major barrier to cure. Many individuals initiate ART during chronic infection, and in this setting, most proviruses are defective6. However, the dynamics of the accumulation and persistence of defective proviruses during acute HIV-1 infection are largely unknown. Here we show that defective proviruses accumulate rapidly within the first few weeks of infection to make up over 93% of all proviruses, regardless of how early ART is initiated. Using an unbiased method to amplify near full-length proviral genomes from HIV-1 infected adults treated at different stages of infection, we demonstrate that early ART initiation limits the size of the reservoir but does not profoundly impact the proviral landscape. This analysis allows us to revise our understanding of the composition of proviral populations and estimate the true reservoir size in individuals treated early vs. late in infection. Additionally, we demonstrate that common assays for measuring the reservoir do not correlate with reservoir size. These findings reveal hurdles that must be overcome to successfully analyze future HIV-1 cure strategies. PMID:27500724

  15. Evaluation of nine HIV rapid test kits to develop a national HIV testing algorithm in Nigeria

    Directory of Open Access Journals (Sweden)

    Orji Bassey

    2015-05-01

    Full Text Available Background: Non-cold chain-dependent HIV rapid testing has been adopted in many resource-constrained nations as a strategy for reaching out to populations. HIV rapid test kits (RTKs have the advantage of ease of use, low operational cost and short turnaround times. Before 2005, different RTKs had been used in Nigeria without formal evaluation. Between 2005 and 2007, a study was conducted to formally evaluate a number of RTKs and construct HIV testing algorithms. Objectives: The objectives of this study were to assess and select HIV RTKs and develop national testing algorithms. Method: Nine RTKs were evaluated using 528 well-characterised plasma samples. These comprised 198 HIV-positive specimens (37.5% and 330 HIV-negative specimens (62.5%, collected nationally. Sensitivity and specificity were calculated with 95% confidence intervals for all nine RTKs singly and for serial and parallel combinations of six RTKs; and relative costs were estimated. Results: Six of the nine RTKs met the selection criteria, including minimum sensitivity and specificity (both ≥ 99.0% requirements. There were no significant differences in sensitivities or specificities of RTKs in the serial and parallel algorithms, but the cost of RTKs in parallel algorithms was twice that in serial algorithms. Consequently, three serial algorithms, comprising four test kits (BundiTM, DetermineTM, Stat-Pak® and Uni-GoldTM with 100.0% sensitivity and 99.1% – 100.0% specificity, were recommended and adopted as national interim testing algorithms in 2007. Conclusion: This evaluation provides the first evidence for reliable combinations of RTKs for HIV testing in Nigeria. However, these RTKs need further evaluation in the field (Phase II to re-validate their performance.

  16. Scaling up Effects in the Organic Laboratory

    Science.gov (United States)

    Persson, Anna; Lindstrom, Ulf M.

    2004-01-01

    A simple and effective way of exposing chemistry students to some of the effects of scaling up an organic reaction is described. It gives the student an experience that may encounter in an industrial setting.

  17. Scaling-up and rooting-down: a case study of North-South partnerships for health from Tanzania

    Directory of Open Access Journals (Sweden)

    Gro Th. Lie

    2012-06-01

    Full Text Available Background: North-South Partnership (NSP is the mandated blueprint for much global health action. Northern partners contribute funding and expertise and Southern partners contribute capacity for local action. Potential Northern partners are attracted to Southern organizations that have a track record of participating in well-performing NSPs. This often leads to the rapid ‘scaling up’ of the Southern organization's activities, and more predictable and stable access to resources. Yet, scaling up may also present challenges and threats, as the literature on rapid organization growth shows. However, studies of the impact of scaling up within NSPs in particular are absent from the literature, and the positive and negative impact of scaling up on Southern partners’ functioning is a matter of speculation. Objective: The purpose of this study is to examine how scaling up affects a Southern partner's organizational functioning, in a Southern grassroots NGO with 20 years of scaling up experience. Design: A case study design was used to explore the process and impact of scaling up in KIWAKKUKI, a women's grassroots organization working on issues of HIV and AIDS in the Kilimanjaro region of Tanzania. Data included documents, observation notes and in-depth interviews with six participants. The data were analyzed by applying an established systems framework of partnership functioning, in addition to a scaling up typology. Results: KIWAKKUKI has experienced significant scale-up of activities over the past 20 years. Over time, successful partnerships and programs have created synergy and led to further growth. As KIWAKUKKI expanded so did both its partnerships and grassroots base. The need for capacity building for volunteers exceeded the financial resources provided by Northern partners. Some partners did not have such capacity building as part of their own central mission. This gap in training has produced negative cycles within the organization and its

  18. evaluation of a rapid test for hiv antibodies in saliva and blood

    African Journals Online (AJOL)

    To test whole blood and saliva for HIV antibodies. (anti-HIV) using a rapid test strip capillary flow . immunoassay ... Design. A prospective pilot study of selected HIV-positive and ... defined by the underlying illness or condition is illustrated in.

  19. Evaluation of four rapid tests for diagnosis and differentiation of HIV-1 and HIV-2 infections in Guinea-Conakry, West Africa.

    OpenAIRE

    Chaillet, Pascale; Tayler-Smith, Katie; Zachariah, Rony; Duclos, Nanfack; Moctar, Diallo; Beelaert, Greet; Fransen, Katrien

    2010-01-01

    With both HIV-1 and HV-2 prevalent in Guinea-Conakry, accurate diagnosis and differentiation is crucial for treatment purposes. Thus, four rapid HIV tests were evaluated for their HIV-1 and HIV-2 diagnostic and discriminative capacity for use in Guinea-Conakry. These included SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), Genie II HIV1/HIV2 (Bio-Rad), First Response HIV Card Test 1-2.0 (PMC Medical) and Immunoflow HIV1-HIV2 (Core Diagnostics). Results were compared with gold standard tes...

  20. Addressing unmet need for HIV testing in emergency care settings: a role for computer-facilitated rapid HIV testing?

    Science.gov (United States)

    Kurth, Ann E; Severynen, Anneleen; Spielberg, Freya

    2013-08-01

    HIV testing in emergency departments (EDs) remains underutilized. The authors evaluated a computer tool to facilitate rapid HIV testing in an urban ED. Randomly assigned nonacute adult ED patients were randomly assigned to a computer tool (CARE) and rapid HIV testing before a standard visit (n = 258) or to a standard visit (n = 259) with chart access. The authors assessed intervention acceptability and compared noted HIV risks. Participants were 56% nonWhite and 58% male; median age was 37 years. In the CARE arm, nearly all (251/258) of the patients completed the session and received HIV results; four declined to consent to the test. HIV risks were reported by 54% of users; one participant was confirmed HIV-positive, and two were confirmed false-positive (seroprevalence 0.4%, 95% CI [0.01, 2.2]). Half (55%) of the patients preferred computerized rather than face-to-face counseling for future HIV testing. In the standard arm, one HIV test and two referrals for testing occurred. Computer-facilitated HIV testing appears acceptable to ED patients. Future research should assess cost-effectiveness compared with staff-delivered approaches.

  1. Evaluation of four rapid tests for diagnosis and differentiation of HIV-1 and HIV-2 infections in Guinea-Conakry, West Africa.

    Science.gov (United States)

    Chaillet, Pascale; Tayler-Smith, Katie; Zachariah, Rony; Duclos, Nanfack; Moctar, Diallo; Beelaert, Greet; Fransen, Katrien

    2010-09-01

    With both HIV-1 and HV-2 prevalent in Guinea-Conakry, accurate diagnosis and differentiation is crucial for treatment purposes. Thus, four rapid HIV tests were evaluated for their HIV-1 and HIV-2 diagnostic and discriminative capacity for use in Guinea-Conakry. These included SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), Genie II HIV1/HIV2 (Bio-Rad), First Response HIV Card Test 1-2.0 (PMC Medical) and Immunoflow HIV1-HIV2 (Core Diagnostics). Results were compared with gold standard tests (INNO-LIA HIV-I/II Score) and NEW LAV BLOT II (Bio-Rad). Four hundred and forty three sequential stored HIV-positive serum samples, of known HIV-type, were evaluated. Genie II HIV1/HIV2, Immunoflow HIV1-HIV2 and SD Bioline HIV 1/2 3.0 had 100% sensitivity (95% CI, 98.9-100%) while for First Response HIV Card Test 1-2.0 this was 99.5% (95% CI, 98.2%-99.9%). In terms of discriminatory capacity, Genie II HIV1/HIV2 identified 382/ 384(99.5%) HIV-1 samples, 49/ 52(95%) HIV-2 and 7/7(100%) HIV-positive untypable samples. Immunoflow HIV1-HIV2 identified 99% HIV-1, 67% HIV-2 and all HIV-positive untypable samples. First Response HIV Card Test 1-2.0 identified 94% HIV-1, 64% HIV-2 and 57% HIV-positive untypable samples. SD-Bioline HIV 1/2 3.0 was the worst overall performer identifying 65% HIV-1, 69% HIV-2 and all HIV-positive untypable samples. The use of SD Bioline HIV 1/2 3.0 (the current standard in Guinea-Conakry) as a discriminatory HIV test is poor and may be best replaced by Immunoflow HIV1-HIV2. Copyright 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.

  2. Brief Report: Impact of Early Antiretroviral Therapy on the Performance of HIV Rapid Tests and HIV Incidence Assays.

    Science.gov (United States)

    Fogel, Jessica M; Piwowar-Manning, Estelle; Debevec, Barbara; Walsky, Tamara; Schlusser, Katherine; Laeyendecker, Oliver; Wilson, Ethan A; McCauley, Marybeth; Gamble, Theresa; Tegha, Gerald; Soko, Dean; Kumwenda, Johnstone; Hosseinipour, Mina C; Chen, Ying Q; Cohen, Myron S; Eshleman, Susan H

    2017-08-01

    Antiretroviral therapy (ART) can downregulate antibody responses to HIV infection. We evaluated the impact of early vs. delayed ART on the performance of HIV diagnostic and incidence assays. Samples were obtained from 207 participants in the HPTN 052 trial, who were stably suppressed on ART for ≥4 years [Malawi sites; pre-ART CD4 cell count 350-550 cells/mm (early ART arm, N = 180) or ART arm, N = 27)]. Samples were tested with 2 HIV rapid tests and 2 HIV incidence assays; selected samples were also tested with two fourth-generation immunoassays and a Western blot (WB) assay. A pre-ART sample was analyzed if the follow-up sample had a false-negative or weakly-reactive rapid test result, or had an incidence assay result indicative of recent infection (false-recent result). Ten (4.8%) samples had a nonreactive or weakly-reactive rapid test result (7/180 early ART arm, 3/27 delayed ART arm, P = 0.13); one sample had nonreactive fourth-generation assay results and 3 had indeterminate WBs. Forty (18.9%) samples had a false-recent incidence assay result; 16 (7.8%) had false-recent results with both incidence assays. Baseline samples had stronger rapid test and WB bands, higher fourth-generation assay signal-to-cutoff values, and fewer HIV incidence assay results indicative of recent infection. False-negative/weakly-reactive HIV rapid tests and false-recent HIV incidence assay results were observed in virally-suppressed individuals, regardless of pre-ART CD4 cell count. Downregulation of the antibody response to HIV infection in the setting of ART may impact population-level surveys of HIV prevalence and incidence.

  3. Scale up of proteoliposome derived Cochleate production.

    Science.gov (United States)

    Zayas, Caridad; Bracho, Gustavo; Lastre, Miriam; González, Domingo; Gil, Danay; Acevedo, Reinaldo; del Campo, Judith; Taboada, Carlos; Solís, Rosa L; Barberá, Ramón; Pérez, Oliver

    2006-04-12

    Cochleate are highly stable structures with promising immunological features. Cochleate structures are usually obtaining from commercial lipids. Proteoliposome derived Cochleate are derived from an outer membrane vesicles of Neisseria meningitidis B. Previously, we obtained Cochleates using dialysis procedures. In order to increase the production process, we used a crossflow system (CFS) that allows easy scale up to obtain large batches in an aseptic environment. The raw material and solutions used in the production process are already approved for human application. This work demonstrates that CFS is very efficient process to obtain Cochleate structures with a yield of more than 80% and the immunogenicity comparable to that obtained by dialysis membrane.

  4. Scale-up of heterogeneous catalytic reactions

    Energy Technology Data Exchange (ETDEWEB)

    Heggs, P; Sunderland, P

    1979-12-01

    This report on the Institution of Chemical Engineers ''Problems in Applied Catalysis'' Meeting (Bath, U.K. 1/4-5/78) covers papers on the nature of the catalyst surface, including the use of IR spectroscopy, electron energy loss spectroscopy, low-energy electron diffraction, electron spectroscopy, secondary ion mass spectroscopy, and modular-beam scattering for investigating solid surfaces and their relevance to catalysis; study of the reaction mechanisms by which catalysis takes place; use of mechanistic models to determine the true chemical kinetics illustrated for the oxidation of benzene to maleic anhydride over a vanadium pentoxide/molybdenum trioxide catalyst; the study with respect to the importance of transport effects in catalyst pellets on scale-up, falsification of true kinetics, and the design of laboratory reactors; full-scale reactor design of packed-bed reactors; and practical scale-up problems illustrated for methanol synthesis over a copper catalyst, ammonia oxidation over a cobalt oxide catalyst, and the steam reforming of naphtha.

  5. Scaling Up Cortical Control Inhibits Pain

    Directory of Open Access Journals (Sweden)

    Jahrane Dale

    2018-05-01

    Full Text Available Summary: Acute pain evokes protective neural and behavioral responses. Chronic pain, however, disrupts normal nociceptive processing. The prefrontal cortex (PFC is known to exert top-down regulation of sensory inputs; unfortunately, how individual PFC neurons respond to an acute pain signal is not well characterized. We found that neurons in the prelimbic region of the PFC increased firing rates of the neurons after noxious stimulations in free-moving rats. Chronic pain, however, suppressed both basal spontaneous and pain-evoked firing rates. Furthermore, we identified a linear correlation between basal and evoked firing rates of PFC neurons, whereby a decrease in basal firing leads to a nearly 2-fold reduction in pain-evoked response in chronic pain states. In contrast, enhancing basal PFC activity with low-frequency optogenetic stimulation scaled up prefrontal outputs to inhibit pain. These results demonstrate a cortical gain control system for nociceptive regulation and establish scaling up prefrontal outputs as an effective neuromodulation strategy to inhibit pain. : Dale et al. find that acute pain increases activity levels in the prefrontal cortex. Chronic pain reduces both basal spontaneous and pain-evoked activity in this region, whereas neurostimulation to restore basal activities can in turn enhance nociception-evoked prefrontal activities to inhibit pain. Keywords: chronic pain, neuromodulation, prefrontal cortex, PFC, cortical gain control

  6. The cost of implementing rapid HIV testing in sexually transmitted disease clinics in the United States.

    Science.gov (United States)

    Eggman, Ashley A; Feaster, Daniel J; Leff, Jared A; Golden, Matthew R; Castellon, Pedro C; Gooden, Lauren; Matheson, Tim; Colfax, Grant N; Metsch, Lisa R; Schackman, Bruce R

    2014-09-01

    Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV infected. We determined the cost to sexually transmitted disease (STD) clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared with current testing practices. Criteria for offering rapid HIV testing and methods for delivering nonrapid test results varied among clinics before the trial. Rapid HIV testing cost an average of US $22/patient without brief risk reduction counseling and US $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were US $1100 and US $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of US $19,500 to a cost of US $40,700 without counseling and a cost of US $98,000 to US $153,900 with counseling. Universal rapid HIV testing in STD clinics with same-day results can be implemented at relatively low cost to STD clinics, if brief risk reduction counseling is not offered.

  7. Scaling-Up the Functional Diagnostic Systems

    International Nuclear Information System (INIS)

    Mohamed, A.H.

    2008-01-01

    Functional diagnostic systems received a lot of attention in the last decade. They have proven their powerful for diagnosis the new faults of some complex systems. But, they still have some complexity in both the representation and reasoning about the large-scale systems. This paper introduces a new functional diagnostic system that can divide its small functions into main and auxiliary ones. This process enables the diagnostic system to scale -up the representation of the tested system and simplify the diagnostic mechanism tasks. Thus, it can improve both the representation and reasoning complexity. Also,it can decrease the required analysis, cost, and time. Proposed system can be applied for a wide area of the large-scale systems. It has been proven its acceptance to be applied practically for the Complex real-time systems

  8. A retrospective evaluation of proficiency testing, and rapid HIV test ...

    African Journals Online (AJOL)

    Background: Proficiency testing (PT) has been implemented as a form of External Quality Assurance (EQA) by the National HIV Reference Laboratory in Kenya since 2007 in order to monitor and improve on the quality of HIV testing and counselling HTC services. Objective: To compare concordance between National HIV ...

  9. Acceptability of rapid HIV diagnosis technology among primary healthcare practitioners in Spain.

    Science.gov (United States)

    Agustí, C; Fernàndez-López, L; Mascort, J; Carrillo, R; Aguado, C; Montoliu, A; Puigdengolas, X; De La Poza, M; Rifà, B; Casabona, J

    2013-01-01

    This study investigated the acceptability of rapid HIV testing among general practitioners (GP) and aimed to identify perceived barriers and needs in order to implement rapid testing in primary care settings. An anonymous questionnaire was distributed online to all members of the two largest Spanish scientific medical societies for family and community medicine. The study took place between 15 June 2012 and 31 October 2010. Completed questionnaires were returned by 1308 participants. The majority (90.8%) of respondents were GP. Among all respondents, 70.4% were aware of the existence of rapid tests for the diagnosis of HIV but they did not know how to use them. Nearly 80% of participants would be willing to offer rapid HIV testing in their practices and 74.7% would be confident of the result obtained by these tests. The barriers most commonly identified by respondents were a lack of time and a need for training, both in the use of rapid tests (44.3% and 56.4%, respectively) and required pre- and post-test counselling (59.2% and 34.5%, respectively). This study reveals a high level of acceptance and willingness on the part of GPs to offer rapid HIV testing in their practices. Nevertheless, the implementation of rapid HIV testing in primary care will not be possible without moving from comprehensive pre-test counselling towards brief pre-test information and improving training in the use of rapid tests.

  10. Computer-facilitated rapid HIV testing in emergency care settings: provider and patient usability and acceptability.

    Science.gov (United States)

    Spielberg, Freya; Kurth, Ann E; Severynen, Anneleen; Hsieh, Yu-Hsiang; Moring-Parris, Daniel; Mackenzie, Sara; Rothman, Richard

    2011-06-01

    Providers in emergency care settings (ECSs) often face barriers to expanded HIV testing. We undertook formative research to understand the potential utility of a computer tool, "CARE," to facilitate rapid HIV testing in ECSs. Computer tool usability and acceptability were assessed among 35 adult patients, and provider focus groups were held, in two ECSs in Washington State and Maryland. The computer tool was usable by patients of varying computer literacy. Patients appreciated the tool's privacy and lack of judgment and their ability to reflect on HIV risks and create risk reduction plans. Staff voiced concerns regarding ECS-based HIV testing generally, including resources for follow-up of newly diagnosed people. Computer-delivered HIV testing support was acceptable and usable among low-literacy populations in two ECSs. Such tools may help circumvent some practical barriers associated with routine HIV testing in busy settings though linkages to care will still be needed.

  11. Development of a definition for Rapid Progression (RP) of renal function in HIV-positive persons

    DEFF Research Database (Denmark)

    Kamara, David A; Nielsen, Lene Ryom; Ross, Michael

    2014-01-01

    No consensus exists on how to define abnormally rapid deterioration in renal function (Rapid Progression, RP). We developed an operational definition of RP in HIV-positive persons with baseline estimated glomerular filtration rate (eGFR) >90ml/min/1.73m2 (using Cockcroft Gault) in the Data...

  12. Knowledge of HIV and willingness to conduct oral rapid HIV testing among dentists in Xi'an China.

    Directory of Open Access Journals (Sweden)

    Lirong Wang

    Full Text Available China is considered a country of low HIV prevalence (780,000 people living with HIV, however, HIV infections among high-risk populations continue to grow at alarming rates. Voluntary Counseling and Testing services were first implemented in 2003, and oral rapid HIV testing (ORHT began in 2012. Dentists, as oral health experts, would be well placed to conduct ORHT. We assessed willingness of dentists to undertake ORHT in their clinical practice.A cross-sectional, paper-based survey of dentists from the Xi'an region of China was conducted from April to June 2013. Dentists were recruited from Shaanxi Stomatological Association using a stratified sampling methodology. A 40-item survey was used to measure knowledge of HIV, attitudes toward people living with HIV and willingness to conduct ORHT.477 dentists completed the survey with a mean HIV knowledge test score of 13.2/18 (SD 1.9. If made available in the dental setting, 276 (57.9% preferred to use blood to diagnose HIV, only 190 (39.8% preferred saliva or both. Four hundred and thirty-five (91.2% thought that ORHT was needed in dental clinics. Female dentists felt more accepting of ORHT than males (93.8% vs. 87.8%; χ2=5.145; p<0.05. 42.6% of the participants who responded thought that lack of education on ORHT for dentists was the most urgent problem to solve for ORHT, 144 (31.3% thought that lack of support for ORHT from patients was the most urgent problem. There was statistically significant difference among dental hospital, dentistry and department of dentistry (χ2=24.176; p<0.05.The majority of Chinese dentists thought that ORHT was needed in the dental setting. Providing opportunities for dentists and dental students to learn about HIV testing guidelines and practices is needed as well as feasibility and implementation science research.

  13. Cost-effectiveness of scaling up voluntary counselling and testing in West-Java, Indonesia.

    Science.gov (United States)

    Tromp, Noor; Siregar, Adiatma; Leuwol, Barnabas; Komarudin, Dindin; van der Ven, Andre; van Crevel, Reinout; Baltussen, Rob

    2013-01-01

    to evaluate the costs-effectiveness of scaling up community-based VCT in West-Java. the Asian epidemic model (AEM) and resource needs model (RNM) were used to calculate incremental costs per HIV infection averted and per disability-adjusted life years saved (DALYs). Locally monitored demographic, epidemiological behavior and cost data were used as model input. scaling up community-based VCT in West-Java will reduce the overall population prevalence by 36% in 2030 and costs US$248 per HIV infection averted and US$9.17 per DALY saved. Cost-effectiveness estimation were most sensitive to the impact of VCT on condom use and to the population size of clients of female sex workers (FSWs), but were overall robust. The total costs for scaling up community-based VCT range between US$1.3 and 3.8 million per year and require the number of VCT integrated clinics at public community health centers to increase from 73 in 2010 to 594 in 2030. scaling up community-based VCT seems both an effective and cost-effective intervention. However, in order to prioritize VCT in HIV/AIDS control in West-Java, issues of budget availability and organizational capacity should be addressed.

  14. Acute HIV infection with rapid progression to AIDS

    Directory of Open Access Journals (Sweden)

    Marcio de Oliveira Silva

    Full Text Available Acute HIV infection is rarely recognized as the signs and symptoms are normally unspecific and can persist for days or weeks. The normal HIV course is characterized by a progressive loss of CD4+ cells, which normally leads to severe immunodeficiency after a variable time interval. The mean time from initial infection to development of clinical AIDS is approximately 8-10 years, but it is variable among individuals and depends on a complex interaction between virus and host. Here we describe an extraordinary case of a man who developed Pneumocisits jiroveci pneumonia within one month after sexual exposure to HIV-1, and then presented with 3 consecutive CD4 counts bellow 200 cells/mm³ within 3 months, with no other opportunistic disease. Although antiretroviral therapy (AZT+3TC+ATZ/r was started, with full adherence of the patient, and genotyping indicating no primary antiretroviral resistance mutations, he required more than six months to have a CD4 restoration to levels above 200 cells/mm³ and 10 months to HIV-RNA to become undetectable.

  15. Rapid Antiretroviral Therapy Initiation for Women in an HIV-1 Prevention Clinical Trial Experiencing Primary HIV-1 Infection during Pregnancy or Breastfeeding.

    Science.gov (United States)

    Morrison, Susan; John-Stewart, Grace; Egessa, John J; Mubezi, Sezi; Kusemererwa, Sylvia; Bii, Dennis K; Bulya, Nulu; Mugume, Francis; Campbell, James D; Wangisi, Jonathan; Bukusi, Elizabeth A; Celum, Connie; Baeten, Jared M

    2015-01-01

    During an HIV-1 prevention clinical trial in East Africa, we observed 16 cases of primary HIV-1 infection in women coincident with pregnancy or breastfeeding. Nine of eleven pregnant women initiated rapid combination antiretroviral therapy (ART), despite having CD4 counts exceeding national criteria for ART initiation; breastfeeding women initiated ART or replacement feeding. Rapid ART initiation during primary HIV-1 infection during pregnancy and breastfeeding is feasible in this setting.

  16. Rapid Antiretroviral Therapy Initiation for Women in an HIV-1 Prevention Clinical Trial Experiencing Primary HIV-1 Infection during Pregnancy or Breastfeeding.

    Directory of Open Access Journals (Sweden)

    Susan Morrison

    Full Text Available During an HIV-1 prevention clinical trial in East Africa, we observed 16 cases of primary HIV-1 infection in women coincident with pregnancy or breastfeeding. Nine of eleven pregnant women initiated rapid combination antiretroviral therapy (ART, despite having CD4 counts exceeding national criteria for ART initiation; breastfeeding women initiated ART or replacement feeding. Rapid ART initiation during primary HIV-1 infection during pregnancy and breastfeeding is feasible in this setting.

  17. Diagnostic accuracy of the rapid urine lipoarabinomannan test for pulmonary tuberculosis among HIV-infected adults in Ghana-findings from the DETECT HIV-TB study

    DEFF Research Database (Denmark)

    Bjerrum, Stephanie; Kenu, Ernest; Lartey, Margaret

    2015-01-01

    BACKGROUND: Rapid diagnostic tests are urgently needed to mitigate HIV-associated tuberculosis (TB) mortality. We evaluated diagnostic accuracy of the rapid urine lipoarabinomannan (LAM) test for pulmonary TB and assessed the effect of a two-sample strategy. METHODS: HIV-infected adults eligible...

  18. Non-reactive HIV-1 Rapid Tests after Sustained Viral Suppression Following Antiretroviral Therapy Initiation During Primary Infection.

    Science.gov (United States)

    Stefic, Karl; Novelli, Sophie; Mahjoub, Nadia; Seng, Remonie; Molina, Jean-Michel; Cheneau, Christine; Barin, Francis; Chaix, Marie-Laure; Meyer, Laurence; Delaugerre, Constance

    2018-03-02

    We assessed the impact of early antiretroviral treatment (ART) on HIV antibody detection by rapid tests in 44 individuals after several years of successful ART. HIV self-tests and point-of-care tests were negative in respectively 30% and 7-9% of cases. These data reinforce the message that patients should never be retested after entering HIV care.

  19. Field evaluation of a dual rapid diagnostic test for HIV infection and syphilis in Lima, Peru.

    Science.gov (United States)

    Bristow, Claire C; Leon, Segundo R; Huang, Emily; Brown, Brandon J; Ramos, Lourdes B; Vargas, Silver K; Flores, Juan A; Caceres, Carlos F; Klausner, Jeffrey D

    2016-05-01

    Screening for HIV and syphilis in key populations is recommended by the WHO to reduce the morbidity, mortality and transmission associated with undiagnosed and untreated infections. Rapid point-of-care tests that can detect multiple infections with a single fingerprick whole blood specimen using a single device are gaining popularity. We evaluated the field performance of a rapid dual HIV and syphilis test in people at high risk of HIV and syphilis infections. Participants included men who have sex with men and transgender women recruited in Lima, Peru. Reference standard testing for detection of HIV and syphilis infections, conducted using blood samples from venipuncture, included Treponema pallidum particle agglutination and fourth-generation HIV enzyme immunoassay for which positive results had a confirmation HIV Western blot test. For the evaluation test, SD BIOLINE HIV/Syphilis Duo test (Standard Diagnostics, Korea), a fingerprick blood specimen was used. Sensitivity and specificity were calculated and the exact binomial method was used to determine 95% CIs. A total of 415 participants were recruited for the study. The dual test sensitivity for detection of T. pallidum infection was 89.2% (95% CI 83.5% to 93.5%) and specificity 98.8% (95% CI 96.5% to 99.8%). For detection of HIV infection, the sensitivity of the dual test was 99.1% (95% CI 94.8% to 100%) and specificity 99.4% (95% CI 97.7% to 99.9%). This high performing dual test should be considered for the use in clinical settings to increase uptake of simultaneous testing of HIV and syphilis and accelerate time to treatment for those who need it. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  20. Challenges in scaling up biofuels infrastructure.

    Science.gov (United States)

    Richard, Tom L

    2010-08-13

    Rapid growth in demand for lignocellulosic bioenergy will require major changes in supply chain infrastructure. Even with densification and preprocessing, transport volumes by mid-century are likely to exceed the combined capacity of current agricultural and energy supply chains, including grain, petroleum, and coal. Efficient supply chains can be achieved through decentralized conversion processes that facilitate local sourcing, satellite preprocessing and densification for long-distance transport, and business models that reward biomass growers both nearby and afar. Integrated systems that are cost-effective and energy-efficient will require new ways of thinking about agriculture, energy infrastructure, and rural economic development. Implementing these integrated systems will require innovation and investment in novel technologies, efficient value chains, and socioeconomic and policy frameworks; all are needed to support an expanded biofuels infrastructure that can meet the challenges of scale.

  1. 'Time is costly': modelling the macroeconomic impact of scaling-up antiretroviral treatment in sub-Saharan Africa.

    Science.gov (United States)

    Ventelou, Bruno; Moatti, Jean-Paul; Videau, Yann; Kazatchkine, Michel

    2008-01-02

    Macroeconomic policy requirements may limit the capacity of national and international policy-makers to allocate sufficient resources for scaling-up access to HIV care and treatment in developing countries. An endogenous growth model, which takes into account the evolution of society's human capital, was used to assess the macroeconomic impact of policies aimed at scaling-up access to HIV/AIDS treatment in six African countries (Angola, Benin, Cameroon, Central African Republic, Ivory Coast and Zimbabwe). The model results showed that scaling-up access to treatment in the affected population would limit gross domestic product losses due to AIDS although differently from country to country. In our simulated scenarios of access to antiretroviral therapy, only 10.3% of the AIDS shock is counterbalanced in Zimbabwe, against 85.2% in Angola and even 100.0% in Benin (a total recovery). For four out of the six countries (Angola, Benin, Cameroon, Ivory Coast), the macro-economic gains of scaling-up would become potentially superior to its associated costs in 2010. Despite the variability of HIV prevalence rates between countries, macro-economic estimates strongly suggest that a massive investment in scaling-up access to HIV treatment may efficiently counteract the detrimental long-term impact of the HIV pandemic on economic growth, to the extent that the AIDS shock has not already driven the economy beyond an irreversible 'no-development epidemiological trap'.

  2. Effective strategies for scaling up evidence-based practices in primary care: a systematic review.

    Science.gov (United States)

    Ben Charif, Ali; Zomahoun, Hervé Tchala Vignon; LeBlanc, Annie; Langlois, Léa; Wolfenden, Luke; Yoong, Sze Lin; Williams, Christopher M; Lépine, Roxanne; Légaré, France

    2017-11-22

    While an extensive array of existing evidence-based practices (EBPs) have the potential to improve patient outcomes, little is known about how to implement EBPs on a larger scale. Therefore, we sought to identify effective strategies for scaling up EBPs in primary care. We conducted a systematic review with the following inclusion criteria: (i) study design: randomized and non-randomized controlled trials, before-and-after (with/without control), and interrupted time series; (ii) participants: primary care-related units (e.g., clinical sites, patients); (iii) intervention: any strategy used to scale up an EBP; (iv) comparator: no restrictions; and (v) outcomes: no restrictions. We searched MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and the Cochrane Library from database inception to August 2016 and consulted clinical trial registries and gray literature. Two reviewers independently selected eligible studies, then extracted and analyzed data following the Cochrane methodology. We extracted components of scaling-up strategies and classified them into five categories: infrastructure, policy/regulation, financial, human resources-related, and patient involvement. We extracted scaling-up process outcomes, such as coverage, and provider/patient outcomes. We validated data extraction with study authors. We included 14 studies. They were published since 2003 and primarily conducted in low-/middle-income countries (n = 11). Most were funded by governmental organizations (n = 8). The clinical area most represented was infectious diseases (HIV, tuberculosis, and malaria, n = 8), followed by newborn/child care (n = 4), depression (n = 1), and preventing seniors' falls (n = 1). Study designs were mostly before-and-after (without control, n = 8). The most frequently targeted unit of scaling up was the clinical site (n = 11). The component of a scaling-up strategy most frequently mentioned was human resource-related (n = 12). All

  3. Effective strategies for scaling up evidence-based practices in primary care: a systematic review

    Directory of Open Access Journals (Sweden)

    Ali Ben Charif

    2017-11-01

    Full Text Available Abstract Background While an extensive array of existing evidence-based practices (EBPs have the potential to improve patient outcomes, little is known about how to implement EBPs on a larger scale. Therefore, we sought to identify effective strategies for scaling up EBPs in primary care. Methods We conducted a systematic review with the following inclusion criteria: (i study design: randomized and non-randomized controlled trials, before-and-after (with/without control, and interrupted time series; (ii participants: primary care-related units (e.g., clinical sites, patients; (iii intervention: any strategy used to scale up an EBP; (iv comparator: no restrictions; and (v outcomes: no restrictions. We searched MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and the Cochrane Library from database inception to August 2016 and consulted clinical trial registries and gray literature. Two reviewers independently selected eligible studies, then extracted and analyzed data following the Cochrane methodology. We extracted components of scaling-up strategies and classified them into five categories: infrastructure, policy/regulation, financial, human resources-related, and patient involvement. We extracted scaling-up process outcomes, such as coverage, and provider/patient outcomes. We validated data extraction with study authors. Results We included 14 studies. They were published since 2003 and primarily conducted in low-/middle-income countries (n = 11. Most were funded by governmental organizations (n = 8. The clinical area most represented was infectious diseases (HIV, tuberculosis, and malaria, n = 8, followed by newborn/child care (n = 4, depression (n = 1, and preventing seniors’ falls (n = 1. Study designs were mostly before-and-after (without control, n = 8. The most frequently targeted unit of scaling up was the clinical site (n = 11. The component of a scaling-up strategy most frequently mentioned was

  4. A cross-sectional survey of attitudes to HIV risk and rapid HIV testing among clients of sex workers in Switzerland.

    Science.gov (United States)

    Darling, Katharine E A; Diserens, Esther-Amélie; N'garambe, Chantal; Ansermet-Pagot, Anne; Masserey, Eric; Cavassini, Matthias; Bodenmann, Patrick

    2012-10-01

    To assess attitudes to HIV risk and acceptability of rapid HIV testing among clients of street-based female sex workers (FSW) in Lausanne, Switzerland, where HIV prevalence in the general population is 0.4%. The authors conducted a cross-sectional study in the red light district of Lausanne for five nights in September of 2008, 2009 and 2010. Clients of FSW were invited to complete a questionnaire in the street assessing demographic characteristics, attitudes to HIV risk and HIV testing history. All clients interviewed were then offered anonymous finger stick rapid HIV testing in a van parked on-site. The authors interviewed 112, 127 and 79 clients in 2008, 2009 and 2010, respectively. All were men, average age 32-37 years old; 40-60% were in a stable relationship. History of unprotected sex was higher with non-commercial partners (33-50%) than with FSW (6-11%); 29-46% of clients had never undergone an HIV test. Anonymous rapid HIV testing was accepted by 45-50% of clients. Out of 109 HIV tests conducted during the three study periods, none was reactive. On-site HIV counselling and testing is acceptable among clients of FSW in this urban setting. These individuals represent an unquantified population, a proportion of which has an incomplete understanding of HIV risk in the face of high-risk behaviour, with implications for potential onward transmission to non-commercial sexual partners.

  5. Who accepts a rapid HIV antibody test? The role of race/ethnicity and HIV risk behavior among community adolescents.

    Science.gov (United States)

    Swenson, Rebecca R; Hadley, Wendy S; Houck, Christopher D; Dance, S Kwame; Brown, Larry K

    2011-05-01

    Centers for Disease Control and Prevention guidelines recommend routine human immunodeficiency virus (HIV) screening in health care settings for all individuals aged 13-64 years; however, overall testing rates among adolescents still continue to remain low. This study examined factors related to the acceptance of HIV testing among an at-risk sample of ethnically/racially diverse community adolescents. Adolescents aged 15-21 (N = 81) years were recruited from community-based youth organizations to complete HIV risk assessment surveys. After the completion of the survey, participants were offered a free OraQuick rapid HIV antibody test. More than half (53.1%) of the participants accepted the test, with the black population being more likely to accept testing as compared to Latinos (75% vs. 39%). After controlling for race/ethnicity, significant predictors of test acceptance included history of sexual intercourse (OR = 5.43), having only one sexual partner in the past 3 months (OR = 4.88), not always using a condom with a serious partner (OR = 3.94), and not using a condom during last sexual encounter (OR = 4.75). Given that many adolescents are willing to know their HIV status, policies that support free or low-cost routine testing may lead to higher rates of case identification among youth. However, approaches must be developed to increase test acceptance among Latino adolescents and teenagers with multiple sexual partners. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  6. [The social marketing models and policy advices for HIV rapid testing initiated by non-govermental organization].

    Science.gov (United States)

    Liu, H; Cai, L P; Xue, H; Zhao, Y; Wu, D; Zhang, D P; Yin, W Y; Sun, J P

    2016-10-06

    Currently, a growing number of community-based organizations are providing rapid HIV testing service in various forms, some people with specific needs also purchase HIV rapid test papers through online sales channels, those imply that the demand of HIV self-test is in increasing year by year.In this paper, aims to understand the current situation of HIV rapid test led by CBOs and the approach, strategies and results of social marketing by means of expert interviews and site visits. Hope to illustrate the current situation, and make recommendations for future work.

  7. Scaling-up voluntary medical male circumcision - what have we learned?

    Science.gov (United States)

    Ledikwe, Jenny H; Nyanga, Robert O; Hagon, Jaclyn; Grignon, Jessica S; Mpofu, Mulamuli; Semo, Bazghina-Werq

    2014-01-01

    In 2007, the World Health Organization (WHO) and the joint United Nations agency program on HIV/AIDS (UNAIDS) recommended voluntary medical male circumcision (VMMC) as an add-on strategy for HIV prevention. Fourteen priority countries were tasked with scaling-up VMMC services to 80% of HIV-negative men aged 15-49 years by 2016, representing a combined target of 20 million circumcisions. By December 2012, approximately 3 million procedures had been conducted. Within the following year, there was marked improvement in the pace of the scale-up. During 2013, the total number of circumcisions performed nearly doubled, with approximately 6 million total circumcisions conducted by the end of the year, reaching 30% of the initial target. The purpose of this review article was to apply a systems thinking approach, using the WHO health systems building blocks as a framework to examine the factors influencing the scale-up of the VMMC programs from 2008-2013. Facilitators that accelerated the VMMC program scale-up included: country ownership; sustained political will; service delivery efficiencies, such as task shifting and task sharing; use of outreach and mobile services; disposable, prepackaged VMMC kits; external funding; and a standardized set of indicators for VMMC. A low demand for the procedure has been a major barrier to achieving circumcision targets, while weak supply chain management systems and the lack of adequate financial resources with a heavy reliance on donor support have also adversely affected scale-up. Health systems strengthening initiatives and innovations have progressively improved VMMC service delivery, but an understanding of the contextual barriers and the facilitators of demand for the procedure is critical in reaching targets. There is a need for countries implementing VMMC programs to share their experiences more frequently to identify and to enhance best practices by other programs.

  8. HIV rapid testing in a Veterans Affairs hospital ED setting: a 5-year sustainability evaluation.

    Science.gov (United States)

    Knapp, Herschel; Hagedorn, Hildi; Anaya, Henry D

    2014-08-01

    Routine HIV testing in primary care settings is now recommended in the United States. The US Department of Veterans Affairs (VA) has increased the number of patients tested for HIV, but overall HIV testing rates in VA remain low. A proven strategy for increasing such testing involves nurse-initiated HIV rapid testing (HIV RT). The purpose of this work was to use a mixed methodology approach to evaluate the 5-year sustainability of an intervention that implemented HIV RT in a VA emergency department setting in a large, urban VA medical center to reduce missed diagnostic and treatment opportunities in this vulnerable patient population. In-person semistructured interviews were conducted with providers and stakeholders. Interview notes were qualitatively coded for emerging themes. Quarterly testing rates were evaluated for a 5-year time span starting from the launch in July 2008. Findings indicate that HIV RT was sustained by the enthusiasm of 2 clinical champions who oversaw the registered nurses responsible for conducting the testing. The departure of the clinical champions was correlated with a substantial drop-off in testing. Findings also indicate potential strategies for improving sustainability including engaging senior leadership in the project, engaging line staff in the implementation planning from the start to increase ownership over the innovation, incorporating information into initial training explaining the importance of the innovation to quality patient care, providing ongoing training to maintain skills, and providing routine progress reports to staff to demonstrate the ongoing impact of their efforts. Published by Elsevier Inc.

  9. Electronic vending machines for dispensing rapid HIV self-testing kits: a case study.

    Science.gov (United States)

    Young, Sean D; Klausner, Jeffrey; Fynn, Risa; Bolan, Robert

    2014-02-01

    This short report evaluates the feasibility of using electronic vending machines for dispensing oral, fluid, rapid HIV self-testing kits in Los Angeles County. Feasibility criteria that needed to be addressed were defined as: (1) ability to find a manufacturer who would allow dispensing of HIV testing kits and could fit them to the dimensions of a vending machine, (2) ability to identify and address potential initial obstacles, trade-offs in choosing a machine location, and (3) ability to gain community approval for implementing this approach in a community setting. To address these issues, we contracted a vending machine company who could supply a customized, Internet-enabled machine that could dispense HIV kits and partnered with a local health center available to host the machine onsite and provide counseling to participants, if needed. Vending machines appear to be feasible technologies that can be used to distribute HIV testing kits.

  10. Population size estimation of men who have sex with men through the network scale-up method in Japan.

    Directory of Open Access Journals (Sweden)

    Satoshi Ezoe

    Full Text Available BACKGROUND: Men who have sex with men (MSM are one of the groups most at risk for HIV infection in Japan. However, size estimates of MSM populations have not been conducted with sufficient frequency and rigor because of the difficulty, high cost and stigma associated with reaching such populations. This study examined an innovative and simple method for estimating the size of the MSM population in Japan. We combined an internet survey with the network scale-up method, a social network method for estimating the size of hard-to-reach populations, for the first time in Japan. METHODS AND FINDINGS: An internet survey was conducted among 1,500 internet users who registered with a nationwide internet-research agency. The survey participants were asked how many members of particular groups with known population sizes (firepersons, police officers, and military personnel they knew as acquaintances. The participants were also asked to identify the number of their acquaintances whom they understood to be MSM. Using these survey results with the network scale-up method, the personal network size and MSM population size were estimated. The personal network size was estimated to be 363.5 regardless of the sex of the acquaintances and 174.0 for only male acquaintances. The estimated MSM prevalence among the total male population in Japan was 0.0402% without adjustment, and 2.87% after adjusting for the transmission error of MSM. CONCLUSIONS: The estimated personal network size and MSM prevalence seen in this study were comparable to those from previous survey results based on the direct-estimation method. Estimating population sizes through combining an internet survey with the network scale-up method appeared to be an effective method from the perspectives of rapidity, simplicity, and low cost as compared with more-conventional methods.

  11. Voluntary medical male circumcision: an introduction to the cost, impact, and challenges of accelerated scaling up.

    Directory of Open Access Journals (Sweden)

    Catherine Hankins

    2011-11-01

    Full Text Available Scaling up voluntary medical male circumcision (VMMC for HIV prevention is cost saving and creates fiscal space in the future that otherwise would have been encumbered by antiretroviral treatment costs. An investment of US$1,500,000,000 between 2011 and 2015 to achieve 80% coverage in 13 priority countries in southern and eastern Africa will result in net savings of US$16,500,000,000. Strong political leadership, country ownership, and stakeholder engagement, along with effective demand creation, community mobilisation, and human resource deployment, are essential. This collection of articles on determining the cost and impact of VMMC for HIV prevention signposts the way forward to scaling up VMMC service delivery safely and efficiently to reap individual- and population-level benefits.

  12. Rapid turnover of 2-LTR HIV-1 DNA during early stage of highly active antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Weijun Zhu

    Full Text Available BACKGROUND: Despite prolonged treatment with highly active antiretroviral therapy (HAART, the infectious HIV-1 continues to replicate and resides latently in the resting memory CD4+ T lymphocytes, which blocks the eradication of HIV-1. The viral persistence of HIV-1 is mainly caused by its proviral DNA being either linear nonintegrated, circular nonintegrated, or integrated. Previous reports have largely focused on the dynamics of HIV-1 DNA from the samples collected with relatively long time intervals during the process of disease and HAART treatment, which may have missed the intricate changes during the intervals in early treatment. METHODOLOGY/PRINCIPAL FINDINGS: In this study, we investigated the dynamics of HIV-1 DNA in patients during the early phase of HARRT treatment. Using optimized real time PCR, we observed significant changes in 2-LTR during the first 12-week of treatment, while total and integrated HIV-1 DNA remained stable. The doubling time and half-life of 2-LTR were not correlated with the baseline and the rate of changes in plasma viral load and various CD4+ T-cell populations. Longitudinal analyses on 2-LTR sequences and plasma lipopolysaccharide (LPS levels did not reveal any significant changes in the same treatment period. CONCLUSIONS/SIGNIFICANCE: Our study revealed the rapid changes in 2-LTR concentration in a relatively large number of patients during the early HAART treatment. The rapid changes indicate the rapid infusion and clearance of cells bearing 2-LTR in the peripheral blood. Those changes are not expected to be caused by the blocking of viral integration, as our study did not include the integrase inhibitor raltegravir. Our study helps better understand the dynamics of HIV-DNA and its potential role as a biomarker for the diseases and for the treatment efficacy of HAART.

  13. Strengthening scaling up through learning from implementation: comparing experiences from Afghanistan, Bangladesh and Uganda.

    Science.gov (United States)

    Bennett, Sara; Mahmood, Shehrin Shaila; Edward, Anbrasi; Tetui, Moses; Ekirapa-Kiracho, Elizabeth

    2017-12-28

    Many effective innovations and interventions are never effectively scaled up. Implementation research (IR) has the promise of supporting scale-up through enabling rapid learning about the intervention and its fit with the context in which it is implemented. We integrate conceptual frameworks addressing different dimensions of scaling up (specifically, the attributes of the service or innovation being scaled, the actors involved, the context, and the scale-up strategy) and questions commonly addressed by IR (concerning acceptability, appropriateness, adoption, feasibility, fidelity to original design, implementation costs, coverage and sustainability) to explore how IR can support scale-up. We draw upon three IR studies conducted by Future Health Systems (FHS) in Afghanistan, Bangladesh and Uganda. We reviewed project documents from the period 2011-2016 to identify information related to the dimensions of scaling up. Further, for each country, we developed rich descriptions of how the research teams approached scaling up, and how IR contributed to scale-up. The rich descriptions were checked by FHS research teams. We identified common patterns and differences across the three cases. The three cases planned quite different innovations/interventions and had very different types of scale-up strategies. In all three cases, the research teams had extensive prior experience within the study communities, and little explicit attention was paid to contextual factors. All three cases involved complex interactions between the research teams and other stakeholders, among stakeholders, and between stakeholders and the intervention. The IR planned by the research teams focussed primarily on feasibility and effectiveness, but in practice, the research teams also had critical insights into other factors such as sustainability, acceptability, cost-effectiveness and appropriateness. Stakeholder analyses and other project management tools further complemented IR. IR can provide

  14. Performance of rapid tests and algorithms for HIV screening in Abidjan, Ivory Coast.

    Science.gov (United States)

    Loukou, Y G; Cabran, M A; Yessé, Zinzendorf Nanga; Adouko, B M O; Lathro, S J; Agbessi-Kouassi, K B T

    2014-01-01

    Seven rapid diagnosis tests (RDTs) of HIV were evaluated by a panel group who collected serum samples from patients in Abidjan (HIV-1 = 203, HIV-2 = 25, HIV-dual = 25, HIV = 305). Kit performances were recorded after the reference techniques (enzyme-linked immunosorbent assay). The following RDTs showed a sensitivity of 100% and a specificity higher than 99%: Determine, Oraquick, SD Bioline, BCP, and Stat-Pak. These kits were used to establish infection screening strategies. The combination with 2 or 3 of these tests in series or parallel algorithms showed that series combinations with 2 tests (Oraquick and Bioline) and 3 tests (Determine, BCP, and Stat-Pak) gave the best performances (sensitivity, specificity, positive predictive value, and negative predictive value of 100%). However, the combination with 2 tests appeared to be more onerous than the combination with 3 tests. The combination with Determine, BCP, and Stat-Pak tests serving as a tiebreaker could be an alternative to the HIV/AIDS serological screening in Abidjan.

  15. HIV Rapid Testing in a VA Emergency Department Setting: Cost Analysis at 5 Years.

    Science.gov (United States)

    Knapp, Herschel; Chan, Kee

    2015-07-01

    To conduct a comprehensive cost-minimization analysis to comprehend the financial attributes of the first 5 years of an implementation wherein emergency department (ED) registered nurses administered HIV oral rapid tests to patients. A health science research implementation team coordinated with ED stakeholders and staff to provide training, implementation guidelines, and support to launch ED registered nurse-administered HIV oral rapid testing. Deidentified quantitative data were gathered from the electronic medical records detailing quarterly HIV rapid test rates in the ED setting spanning the first 5 years. Comprehensive cost analyses were conducted to evaluate the financial impact of this implementation. At 5 years, a total of 2,620 tests were conducted with a quarterly mean of 131 ± 81. Despite quarterly variability in testing rates, regression analysis revealed an average increase of 3.58 tests per quarter. Over the course of this implementation, Veterans Health Administration policy transitioned from written to verbal consent for HIV testing, serving to reduce the time and cost(s) associated with the testing process. Our data indicated salient health outcome benefits for patients with respect to the potential for earlier detection, and associated long-run cost savings. Copyright © 2015. Published by Elsevier Inc.

  16. Acceptability of using electronic vending machines to deliver oral rapid HIV self-testing kits: a qualitative study.

    Directory of Open Access Journals (Sweden)

    Sean D Young

    Full Text Available Rates of unrecognized HIV infection are significantly higher among Latino and Black men who have sex with men (MSM. Policy makers have proposed that HIV self-testing kits and new methods for delivering self-testing could improve testing uptake among minority MSM. This study sought to conduct qualitative assessments with MSM of color to determine the acceptability of using electronic vending machines to dispense HIV self-testing kits.African American and Latino MSM were recruited using a participant pool from an existing HIV prevention trial on Facebook. If participants expressed interest in using a vending machine to receive an HIV self-testing kit, they were emailed a 4-digit personal identification number (PIN code to retrieve the test from the machine. We followed up with those who had tested to assess their willingness to participate in an interview about their experience.Twelve kits were dispensed and 8 interviews were conducted. In general, participants expressed that the vending machine was an acceptable HIV test delivery method due to its novelty and convenience.Acceptability of this delivery model for HIV testing kits was closely associated with three main factors: credibility, confidentiality, and convenience. Future research is needed to address issues, such as user-induced errors and costs, before scaling up the dispensing method.

  17. Acceptability of using electronic vending machines to deliver oral rapid HIV self-testing kits: a qualitative study.

    Science.gov (United States)

    Young, Sean D; Daniels, Joseph; Chiu, ChingChe J; Bolan, Robert K; Flynn, Risa P; Kwok, Justin; Klausner, Jeffrey D

    2014-01-01

    Rates of unrecognized HIV infection are significantly higher among Latino and Black men who have sex with men (MSM). Policy makers have proposed that HIV self-testing kits and new methods for delivering self-testing could improve testing uptake among minority MSM. This study sought to conduct qualitative assessments with MSM of color to determine the acceptability of using electronic vending machines to dispense HIV self-testing kits. African American and Latino MSM were recruited using a participant pool from an existing HIV prevention trial on Facebook. If participants expressed interest in using a vending machine to receive an HIV self-testing kit, they were emailed a 4-digit personal identification number (PIN) code to retrieve the test from the machine. We followed up with those who had tested to assess their willingness to participate in an interview about their experience. Twelve kits were dispensed and 8 interviews were conducted. In general, participants expressed that the vending machine was an acceptable HIV test delivery method due to its novelty and convenience. Acceptability of this delivery model for HIV testing kits was closely associated with three main factors: credibility, confidentiality, and convenience. Future research is needed to address issues, such as user-induced errors and costs, before scaling up the dispensing method.

  18. Factors associated with willingness to accept oral fluid HIV rapid testing among most-at-risk populations in China.

    Directory of Open Access Journals (Sweden)

    Huanmiao Xun

    Full Text Available The availability of oral fluid HIV rapid testing provides an approach that may have the potential to expand HIV testing in China, especially among most-a-risk populations. There are few investigations about the acceptability of oral fluid HIV testing among most-at-risk populations in China.A cross-sectional study with men who have sex with men (MSM, female sex workers (FSW and voluntary counseling and testing (VCT clients was conducted in three cities of Shandong province, China from 2011 to 2012. Data were collected by face-to-face questionnaire.About 71% of participants were willing to accept the oral fluid HIV rapid testing, and home HIV testing was independently associated with acceptability of the new testing method among MSM, FSW and VCT clients (AOR of 4.46, 3.19 and 5.74, respectively. Independent predictors of oral fluid HIV rapid testing acceptability among MSM were having ever taken an oral fluid HIV rapid test (AOR= 15.25, having ever taken an HIV test (AOR= 2.07, and education level (AOR= 1.74. Engagement in HIV-related risk behaviors (AOR= 1.68 was an independent predictor of acceptability for FSW. Having taken an HIV test (AOR= 2.85 was an independent predictor of acceptability for VCT clients. The primary concern about the oral fluid HIV testing was accuracy. The median price they would pay for the testing ranged from 4.8 to 8.1 U.S. dollars.High acceptability of oral fluid HIV rapid testing was shown among most-at-risk populations. Findings provide support for oral rapid HIV testing as another HIV prevention tool, and provide a backdrop for the implementation of HIV home testing in the near future. Appropriate pricing and increased public education through awareness campaigns that address concerns about the accuracy and safety of the oral fluid HIV rapid testing may help increase acceptability and use among most-at-risk populations in China.

  19. [Introduction of rapid syphilis and HIV testing in prenatal care in Colombia: qualitative analysis].

    Science.gov (United States)

    Ochoa-Manjarrés, María Teresa; Gaitán-Duarte, Hernando Guillermo; Caicedo, Sidia; Gómez, Berta; Pérez, Freddy

    2016-12-01

    Interpret perceptions of Colombian health professionals concerning factors that obstruct and facilitate the introduction of rapid syphilis and HIV testing in prenatal care services. A qualitative study based on semi-structured interviews was carried out. A convenience sample was selected with 37 participants, who included health professionals involved in prenatal care services, programs for pregnant women, clinical laboratories, and directors of health care units or centers, as well as representatives from regional departments and the Ministry of Health. Colombia does not do widespread screening with rapid syphilis and HIV tests in prenatal care. The professionals interviewed stated they did not have prior experience in the use of rapid tests-except for laboratory staff-or in the course of action in response to a positive result. The insurance system hinders access to timely diagnosis and treatment. Health authorities perceive a need to review existing standards, strengthen the first level of care, and promote comprehensive prenatal care starting with contracts between insurers and health service institutional providers. Participants recommended staff training and integration between health-policymaking and academic entities for updating training programs. The market approach and the characteristics of the Colombian health system constitute the main barriers to implementation of rapid testing as a strategy for elimination of mother-to-child transmission of syphilis and HIV. Measures identified include making changes in contracts between insurers and health service institutional providers, adapting the timing and duration of prenatal care procedures, and training physicians and nurses involved in prenatal care.

  20. The evaluation of a rapid in situ HIV confirmation test in a programme with a high failure rate of the WHO HIV two-test diagnostic algorithm.

    Directory of Open Access Journals (Sweden)

    Derryck B Klarkowski

    Full Text Available BACKGROUND: Concerns about false-positive HIV results led to a review of testing procedures used in a Médecins Sans Frontières (MSF HIV programme in Bukavu, eastern Democratic Republic of Congo. In addition to the WHO HIV rapid diagnostic test algorithm (RDT (two positive RDTs alone for HIV diagnosis used in voluntary counselling and testing (VCT sites we evaluated in situ a practical field-based confirmation test against western blot WB. In addition, we aimed to determine the false-positive rate of the WHO two-test algorithm compared with our adapted protocol including confirmation testing, and whether weakly reactive compared with strongly reactive rapid test results were more likely to be false positives. METHODOLOGY/PRINCIPAL FINDINGS: 2864 clients presenting to MSF VCT centres in Bukavu during January to May 2006 were tested using Determine HIV-1/2 and UniGold HIV rapid tests in parallel by nurse counsellors. Plasma samples on 229 clients confirmed as double RDT positive by laboratory retesting were further tested using both WB and the Orgenics Immunocomb Combfirm HIV confirmation test (OIC-HIV. Of these, 24 samples were negative or indeterminate by WB representing a false-positive rate of the WHO two-test algorithm of 10.5% (95%CI 6.6-15.2. 17 of the 229 samples were weakly positive on rapid testing and all were negative or indeterminate by WB. The false-positive rate fell to 3.3% (95%CI 1.3-6.7 when only strong-positive rapid test results were considered. Agreement between OIC-HIV and WB was 99.1% (95%CI 96.9-99.9% with no false OIC-HIV positives if stringent criteria for positive OIC-HIV diagnoses were used. CONCLUSIONS: The WHO HIV two-test diagnostic algorithm produced an unacceptably high level of false-positive diagnoses in our setting, especially if results were weakly positive. The most probable causes of the false-positive results were serological cross-reactivity or non-specific immune reactivity. Our findings show that the OIC-HIV

  1. [Benefits of using rapid HIV testing at the PMU-FLON walk-in clinic in Lausanne].

    Science.gov (United States)

    Gilgien, W; Aubert, J; Bischoff, T; Herzig, L; Perdrix, J

    2012-05-16

    Lab tests are frequently used in primary care to guide patient care. This is particularly the case when a severe disorder, or one that will affect patients' initial care, needs to be excluded rapidly. At the PMU-FLON walk-in clinic the use of HIV testing as recommended by the Swiss Office of Public Health was hampered by the delay in obtaining test results. This led us to introduce rapid HIV testing which provides results within 30 minutes. Following the first 250 tests the authors discuss the results as well as the benefits of rapid HIV testing in an urban walk-in clinic.

  2. Rapid quantification of the latent reservoir for HIV-1 using a viral outgrowth assay.

    Directory of Open Access Journals (Sweden)

    Gregory M Laird

    Full Text Available HIV-1 persists in infected individuals in a stable pool of resting CD4(+ T cells as a latent but replication-competent provirus. This latent reservoir is the major barrier to the eradication of HIV-1. Clinical trials are currently underway investigating the effects of latency-disrupting compounds on the persistence of the latent reservoir in infected individuals. To accurately assess the effects of such compounds, accurate assays to measure the frequency of latently infected cells are essential. The development of a simpler assay for the latent reservoir has been identified as a major AIDS research priority. We report here the development and validation of a rapid viral outgrowth assay that quantifies the frequency of cells that can release replication-competent virus following cellular activation. This new assay utilizes bead and column-based purification of resting CD4(+ T cells from the peripheral blood of HIV-1 infected patients rather than cell sorting to obtain comparable resting CD4(+ T cell purity. This new assay also utilizes the MOLT-4/CCR5 cell line for viral expansion, producing statistically comparable measurements of the frequency of latent HIV-1 infection. Finally, this new assay employs a novel quantitative RT-PCR specific for polyadenylated HIV-1 RNA for virus detection, which we demonstrate is a more sensitive and cost-effective method to detect HIV-1 replication than expensive commercial ELISA detection methods. The reductions in both labor and cost make this assay suitable for quantifying the frequency of latently infected cells in clinical trials of HIV-1 eradication strategies.

  3. Act local, think global: how the Malawi experience of scaling up antiretroviral treatment has informed global policy

    Directory of Open Access Journals (Sweden)

    Anthony D. Harries

    2016-09-01

    Full Text Available Abstract The scale-up of antiretroviral therapy (ART in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework. From 2004 to 2015, the number of new patients started on ART increased from about 3000 to over 820,000. Despite being a small country, Malawi has made a significant contribution to the 15 million people globally on ART and has also contributed policy and service delivery innovations that have supported international guidelines and scale up in other countries. The first set of global guidelines for scaling up ART released by the World Health Organization (WHO in 2002 focused on providing clinical guidance. In Malawi, the ART guidelines adopted from the outset a more operational and programmatic approach with recommendations on health systems and services that were needed to deliver HIV treatment to affected populations. Seven years after the start of national scale-up, Malawi launched a new strategy offering all HIV-infected pregnant women lifelong ART regardless of the CD4-cell count, named Option B+. This strategy was subsequently incorporated into a WHO programmatic guide in 2012 and WHO ART guidelines in 2013, and has since then been adopted by the majority of countries worldwide. In conclusion, the Malawi experience of ART scale-up has become a blueprint for a public health response to HIV and has informed international efforts to end the AIDS epidemic by 2030.

  4. Act local, think global: how the Malawi experience of scaling up antiretroviral treatment has informed global policy.

    Science.gov (United States)

    Harries, Anthony D; Ford, Nathan; Jahn, Andreas; Schouten, Erik J; Libamba, Edwin; Chimbwandira, Frank; Maher, Dermot

    2016-09-06

    The scale-up of antiretroviral therapy (ART) in Malawi was based on a public health approach adapted to its resource-poor setting, with principles and practices borrowed from the successful tuberculosis control framework. From 2004 to 2015, the number of new patients started on ART increased from about 3000 to over 820,000. Despite being a small country, Malawi has made a significant contribution to the 15 million people globally on ART and has also contributed policy and service delivery innovations that have supported international guidelines and scale up in other countries. The first set of global guidelines for scaling up ART released by the World Health Organization (WHO) in 2002 focused on providing clinical guidance. In Malawi, the ART guidelines adopted from the outset a more operational and programmatic approach with recommendations on health systems and services that were needed to deliver HIV treatment to affected populations. Seven years after the start of national scale-up, Malawi launched a new strategy offering all HIV-infected pregnant women lifelong ART regardless of the CD4-cell count, named Option B+. This strategy was subsequently incorporated into a WHO programmatic guide in 2012 and WHO ART guidelines in 2013, and has since then been adopted by the majority of countries worldwide. In conclusion, the Malawi experience of ART scale-up has become a blueprint for a public health response to HIV and has informed international efforts to end the AIDS epidemic by 2030.

  5. Integrase inhibitors in late pregnancy and rapid HIV viral load reduction.

    Science.gov (United States)

    Rahangdale, Lisa; Cates, Jordan; Potter, JoNell; Badell, Martina L; Seidman, Dominika; Miller, Emilly S; Coleman, Jenell S; Lazenby, Gweneth B; Levison, Judy; Short, William R; Yawetz, Sigal; Ciaranello, Andrea; Livingston, Elizabeth; Duthely, Lunthita; Rimawi, Bassam H; Anderson, Jean R; Stringer, Elizabeth M

    2016-03-01

    Minimizing time to HIV viral suppression is critical in pregnancy. Integrase strand transfer inhibitors (INSTIs), like raltegravir, are known to rapidly suppress plasma HIV RNA in nonpregnant adults. There are limited data in pregnant women. We describe time to clinically relevant reduction in HIV RNA in pregnant women using INSTI-containing and non-INSTI-containing antiretroviral therapy (ART) options. We conducted a retrospective cohort study of pregnant HIV-infected women in the United States from 2009 through 2015. We included women who initiated ART, intensified their regimen, or switched to a new regimen due to detectable viremia (HIV RNA >40 copies/mL) at ≥20 weeks gestation. Among women with a baseline HIV RNA permitting 1-log reduction, we estimated time to 1-log RNA reduction using the Kaplan-Meier estimator comparing women starting/adding an INSTI in their regimen vs other ART. To compare groups with similar follow-up time, we also conducted a subgroup analysis limited to women with ≤14 days between baseline and follow-up RNA data. This study describes 101 HIV-infected pregnant women from 11 US clinics. In all, 75% (76/101) of women were not taking ART at baseline; 24 were taking non-INSTI containing ART, and 1 received zidovudine monotherapy. In all, 39% (39/101) of women started an INSTI-containing regimen or added an INSTI to their ART regimen. Among 90 women with a baseline HIV RNA permitting 1-log reduction, the median time to 1-log RNA reduction was 8 days (interquartile range [IQR], 7-14) in the INSTI group vs 35 days (IQR, 20-53) in the non-INSTI ART group (P pregnancy. Inclusion of an INSTI may play a role in optimal reduction of HIV RNA for HIV-infected pregnant women presenting late to care or failing initial therapy. Larger studies are urgently needed to assess the safety and effectiveness of this approach. Copyright © 2016 Elsevier Inc. All rights reserved.

  6. Scaling-up Sustainable Aquaculture Development in Sri Lanka ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    ... of Sri Lanka is increasingly emphasizing aquaculture development as a means to foster ... Pilot interventions tested the effectiveness of mobile short text messaging to ... Building on this project, researchers will test three ways of scaling-up ...

  7. Accuracy and user-acceptability of HIV self-testing using an oral fluid-based HIV rapid test.

    Directory of Open Access Journals (Sweden)

    Oon Tek Ng

    Full Text Available BACKGROUND: The United States FDA approved an over-the-counter HIV self-test, to facilitate increased HIV testing and earlier linkage to care. We assessed the accuracy of self-testing by untrained participants compared to healthcare worker (HCW testing, participants' ability to interpret sample results and user-acceptability of self-tests in Singapore. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study, involving 200 known HIV-positive patients and 794 unknown HIV status at-risk participants was conducted. Participants (all without prior self-test experience performed self-testing guided solely by visual instructions, followed by HCW testing, both using the OraQuick ADVANCE Rapid HIV 1/2 Antibody Test, with both results interpreted by the HCW. To assess ability to interpret results, participants were provided 3 sample results (positive, negative, and invalid to interpret. Of 192 participants who tested positive on HCW testing, self-testing was positive in 186 (96.9%, negative in 5 (2.6%, and invalid in 1 (0.5%. Of 794 participants who tested negative on HCW testing, self-testing was negative in 791 (99.6%, positive in 1 (0.1%, and invalid in 2 (0.3%. Excluding invalid tests, self-testing had sensitivity of 97.4% (95% CI 95.1% to 99.7% and specificity of 99.9% (95% CI: 99.6% to 100%. When interpreting results, 96%, 93.1% and 95.2% correctly read the positive, negative and invalid respectively. There were no significant demographic predictors for false negative self-testing or wrongly interpreting positive or invalid sample results as negative. Eighty-seven percent would purchase the kit over-the-counter; 89% preferred to take HIV tests in private. 72.5% and 74.9% felt the need for pre- and post-test counseling respectively. Only 28% would pay at least USD15 for the test. CONCLUSIONS/SIGNIFICANCE: Self-testing was associated with high specificity, and a small but significant number of false negatives. Incorrectly identifying model results as

  8. Toward a Common Ontology of Scaling Up in Development

    Directory of Open Access Journals (Sweden)

    April N. Frake

    2018-03-01

    Full Text Available Scaling up development measures to target global food insecurity has a distinctly spatial character and is often cited as a solution to the global hunger crisis. Development does not occur without scaling and consensus on the ontological meaning of scaling up is a vital component to developing sustainable solutions to the global hunger crisis across geographical scales. Yet ‘scaling up’, while frequently used throughout Research and Development (R&D and Natural Resource Management (NRM literature, lacks ontological agreement. We begin by considering the noun, ‘scale’ and existing literature on scaling up, then present a visual analysis of definitions provided for scaling up across development institutions. Our study finds that the organization of terms used across these definitions falls into three distinct categories: Interventions, Mechanisms, and Outcomes. Further, we contend that the continued uncertainty is linked to scale being applied in two fashions: as a noun (outcome and verb (process. Rather than calling for reformed definitions, we argue for precision of definitions. To that end, we present a conceptual framework of scaling up that gives greater emphasis on separating the noun scale, from the verb, to scale. Further, Monitoring and Evaluation (M&E in our model complements scaling efforts beginning with how scaling up is defined by program, through to final evaluation of success.

  9. Scale up risk of developing oil shale processing units

    International Nuclear Information System (INIS)

    Oepik, I.

    1991-01-01

    The experiences in oil shale processing in three large countries, China, the U.S.A. and the U.S.S.R. have demonstrated, that the relative scale up risk of developing oil shale processing units is related to the scale up factor. On the background of large programmes for developing the oil shale industry branch, i.e. the $30 billion investments in colorado and Utah or 50 million t/year oil shale processing in Estonia and Leningrad Region planned in the late seventies, the absolute scope of the scale up risk of developing single retorting plants, seems to be justified. But under the conditions of low crude oil prices, when the large-scale development of oil shale processing industry is stopped, the absolute scope of the scale up risk is to be divided between a small number of units. Therefore, it is reasonable to build the new commercial oil shale processing plants with a minimum scale up risk. For example, in Estonia a new oil shale processing plant with gas combustion retorts projected to start in the early nineties will be equipped with four units of 1500 t/day enriched oil shale throughput each, designed with scale up factor M=1.5 and with a minimum scale up risk, only r=2.5-4.5%. The oil shale retorting unit for the PAMA plant in Israel [1] is planned to develop in three steps, also with minimum scale up risk: feasibility studies in Colorado with Israel's shale at Paraho 250 t/day retort and other tests, demonstration retort of 700 t/day and M=2.8 in Israel, and commercial retorts in the early nineties with the capacity of about 1000 t/day with M=1.4. The scale up risk of the PAMA project r=2-4% is approximately the same as that in Estonia. the knowledge of the scope of the scale up risk of developing oil shale processing retorts assists on the calculation of production costs in erecting new units. (author). 9 refs., 2 tabs

  10. HIV rapid testing in the framework of an STI prevention project on a cohort of vulnerable Italians and immigrants.

    Science.gov (United States)

    Uccella, Ilaria; Petrelli, Alessio; Vescio, Maria Fenicia; De Carolis, Silvia; Fazioli, Cecilia; Pezzotti, Patrizio; Rezza, Gianni

    2017-08-01

    Uptake of HIV tests is a challenging issue in vulnerable populations including immigrants, normally using standard diagnostic tools. Objectives of this study were to evaluate the acceptability of HIV rapid test; estimate the percentage of newly HIV diagnoses and evaluate knowledge, attitudes and perception (KAP) about HIV/AIDS and other STIs in a specific set of immigrants and vulnerable population in Rome (Italy). All immigrant and Italian people, aged 16-70 years, attending the infectious disease outpatient clinic of the National Institute for Health, Migration and Poverty (INMP) in Rome (Italy), during the period December 2012 to December 2013 were enrolled. HIV rapid testing was provided for free and patients were asked to fill in a questionnaire evaluating KAP about HIV/STIs. All patients with risky sexual behaviours or with a recent diagnosis of STIs were invited to come back after 3-6 months and a post-counselling questionnaire was offered. Out of the total sample, 99.2% (n = 825) accepted the "rapid test" and 10 new HIV diagnoses were found (1.22%; 95% CI 0.58%-2.22%). Three hundred and eighty-five participants (47%) answered the entry questionnaire and 58 (15%) completed the follow-up. Overall, we found high knowledge about HIV/AIDS; however, lower educational level and immigrant status were associated with poor knowledge about HIV, other STIs and prevention methods. Immigrants have lower perception of sexual risk and higher prejudice than Italians. Our study showed high acceptance of rapid test in this specific vulnerable population and this allowed to identify new HIV diagnoses in unaware people. Socioeconomic inequalities observed in the KAP questionnaire suggest the need for actions to support the reduction of cultural differences in knowledge of HIV/AIDS and for policies aimed at improving access to health services and preventions programmes of marginalized populations.

  11. Surveillance of transmitted HIV drug resistance in antiretroviral-naive patients aged less than 25 years, in Bangkok, Thailand.

    Science.gov (United States)

    Sungkanuparph, Somnuek; Pasomsub, Ekawat; Chantratita, Wasun

    2014-01-01

    Emergence of transmitted HIV drug resistance (TDR) is a concern after global scale-up of antiretroviral therapy (ART). World Health Organization had developed threshold survey method for surveillance of TDR in resource-limited countries. ART in Thailand has been scaling up for >10 years. To evaluate the current TDR in Thailand, a cross-sectional study was conducted among antiretroviral-naive HIV-infected patients aged Thailand after a decade of rapid scale-up of ART. Interventions to prevent TDR at the population level are essentially needed in Thailand. Surveillance for TDR in Thailand has to be regularly performed.

  12. Oral rapid test: an alternative to traditional HIV screening in Chile

    Directory of Open Access Journals (Sweden)

    Lisette Paola Irarrazábal

    2013-06-01

    Full Text Available OBJECTIVE: To compare the sensitivity and specificity of an Oral Rapid Test (ORT to that of the Enzyme-Linked Immunosorbent Assay (ELISA for HIV testing in Santiago, Chile; to track the number of study participants returning for ELISA testing results; and to analyze the participants' perceptions of the ORT compared to the ELISA. METHODS: A total of 497 people were recruited in Santiago, Chile: 153 had previously tested positive for HIV, and 344 were of unknown status. Participants were tested for HIV using both the ELISA and the ORT to examine and compare specificity and sensitivity. Qualitative data were collected from 22 participants to compare perceptions of the testing experience with ORT versus ELISA. RESULTS: The ELISA reported 184 (37% of the 497 participants as being "positive" for HIV antibodies; the ORT showed 181 (36.4% as being "reactive" for HIV. The ORT showed a sensitivity of 98.4% (95.7%-99.9%, 95% Confidence Interval and specificity of 100%. The Kappa test produced K = 0.983 (P < 0.0001. Of the 344 participants whose HIV status was unknown at the start of the study, 55 failed to return for their ELISA results. Participants positively perceived ORT as having reduced both waiting time and anxiety over obtaining their test results. ORT oral swabbing appeared more practical and less invasive than drawing blood for the ELISA. CONCLUSIONS: The ORT and ELISA were statistically equal in specificity and sensitivity. ORT provides quicker results, potentially ensuring that more people receive them, and does not require handling of or exposure to potentially hazardous blood products. Trial number: ClinicalTrials.gov identifier: NCT01733927.

  13. DEPIVIH 2: Use of three HIV testing methods in French primary care settings - ELISA laboratory screening versus two rapid point-of-care HIV tests.

    Science.gov (United States)

    Papadima, D; Gauthier, R; Prévoteau du Clary, F; Bouée, S; Conort, G; Livrozet, J-M; Taulera, O; Wajsbrot, A; Majerholc, C; Peter, J-M; Aubert, J-P

    2018-03-01

    The primary endpoint was to evaluate the use of HIV testing methods by French primary care providers: Elisa laboratory screening, instant result HIV diagnostic test and rapid result HIV diagnostic test. The secondary endpoints were the population screening rate of unknown HIV status consulting during the study period, reasons for screening and for choosing the specific screening method, the investigators' satisfaction with the rapid diagnostic test (RDT) and problems encountered. National prospective interventional study with French family physicians (FP) from December 2013 to December 2014. FPs enrolled all consenting adults consulting for an HIV screening test during a 6-month period: the choice was an Elisa laboratory test or one of the two RDTs. During the study period, 43 FPs included 981 patients. HIV screening was performed for the first time for 31.6% of patients; 767 (78.2%) Elisa laboratory test prescriptions and 214 (21.8%) RDTs were performed, leading to a screening rate of 1.3%. For 120 (15.7%) of the Elisa laboratory tests, the result was not reported and six RDTs were not valid. Nine patients were diagnosed as HIV-infected (0.9%): five with Elisa laboratory test and four with RDT. Almost 90% of FPs were willing to keep on using RDTs in their daily practice. In general practice, RDTs may be an important additional tool to traditional HIV screening. They could account for one in five tests prescribed in this context. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  14. Performance of 3 Rapid Tests for Discrimination Between HIV-1 and HIV-2 in Guinea-Bissau, West Africa

    DEFF Research Database (Denmark)

    Hønge, Bo Langhoff; Bjarnason Obinah, Magnús Pétur; Jespersen, Sanne

    2014-01-01

    As HIV-2 is intrinsically resistant to nonnucleoside reverse transcriptase inhibitors, it is mandatory to discriminate between HIV types before initiating antiretroviral treatment. Guinea-Bissau has the world's highest prevalence of HIV-2 and HIV-1/HIV-2 dually infected individuals. We evaluated ...... (agreement 90.9%) and SD Bioline HIV-1/2 3.0 (agreement 84.5%). Our results underscore the need for evaluation of tests in relevant populations before implementation....

  15. Operational feasibility of using whole blood in the rapid HIV testing algorithm of a resource-limited settings like Bangladesh.

    Science.gov (United States)

    Munshi, Saif U; Oyewale, Tajudeen O; Begum, Shahnaz; Uddin, Ziya; Tabassum, Shahina

    2016-03-01

    Serum-based rapid HIV testing algorithm in Bangladesh constitutes operational challenge to scaleup HIV testing and counselling (HTC) in the country. This study explored the operational feasibility of using whole blood as alternative to serum for rapid HIV testing in Bangladesh. Whole blood specimens were collected from two study groups. The groups included HIV-positive patients (n = 200) and HIV-negative individuals (n = 200) presenting at the reference laboratory in Dhaka, Bangladesh. The specimens were subjected to rapid HIV tests using the national algorithm with A1 = Alere Determine (United States), A2 = Uni-Gold (Ireland), and A3 = First Response (India). The sensitivity and specificity of the test results, and the operational cost were compared with current serum-based testing. The sensitivities [95% of confidence interval (CI)] for A1, A2, and A3 tests using whole blood were 100% (CI: 99.1-100%), 100% (CI: 99.1-100%), and 97% (CI: 96.4-98.2%), respectively, and specificities of all test kits were 100% (CI: 99.1-100%). Significant (P < 0.05) reduction in the cost of establishing HTC centre and consumables by 94 and 61%, respectively, were observed. The cost of administration and external quality assurance reduced by 39 and 43%, respectively. Overall, there was a 36% cost reduction in total operational cost of rapid HIV testing with blood when compared with serum. Considering the similar sensitivity and specificity of the two specimens, and significant cost reduction, rapid HIV testing with whole blood is feasible. A review of the national HIV rapid testing algorithm with whole blood will contribute toward improving HTC coverage in Bangladesh.

  16. Laboratory evaluation of three dual rapid diagnostic tests for HIV and syphilis in China and Nigeria.

    Science.gov (United States)

    Yin, Yue-Ping; Ngige, Evelyn; Anyaike, Chukwuma; Ijaodola, Gbenga; Oyelade, Taiwo A; Vaz, Rui Gama; Newman, Lori M; Chen, Xiang-Sheng

    2015-06-01

    To determine the laboratory-based performance and operational characteristics of three dual rapid diagnostic tests (RDTs) for testing HIV and syphilis. Three dual RDTs (SD Bioline, Chembio, and MedMira) were evaluated using 1514 serum specimens archived at laboratories or collected from clinics in China and Nigeria to determine sensitivity and specificity, with 95% confidence intervals. Concordance of testing results read by two technicians, stability of testing results read at two time points, and test operation characteristics were also assessed. All three of the evaluated RDTs gave excellent performance with a combined sensitivity ranging from 99.0%-99.6% for HIV and 98.3%-99.0% for syphilis, and a combined specificity ranging from 97.9%-99.0% for HIV and 97.2%-99.6% for syphilis. Concordance of testing results between two technicians and stability of testing results read within and one hour past the recommended reading period showed excellent agreement, with Kappa greater than or equal to 0.98. All the tests were found to be very or fairly easy to use and easy to interpret the results. Further evaluations of these dual RDTs with whole blood in field settings, and more studies on the implication of introduction of these tests in HIV and syphilis control programs are needed. Copyright © 2015. Published by Elsevier Ireland Ltd.

  17. Acceptability of rapid oral fluid HIV testing among male injection drug users in Taiwan, 1997 and 2007.

    Science.gov (United States)

    Lyu, Shu-Yu; Morisky, Donald E; Yeh, Ching-Ying; Twu, Shiing-Jer; Peng, Eugene Yu-Chang; Malow, Robert M

    2011-04-01

    Rapid oral fluid HIV testing (rapid oral testing) is in the process of being adapted in Taiwan and elsewhere given its advantages over prior HIV testing methods. To guide this process, we examined the acceptability of rapid oral testing at two time points (i.e., 1997 and 2007) among one of the highest risk populations, male injection drug users (IDUs). For this purpose, an anonymous self-administered survey was completed by HIV-negative IDUs involved in the criminal justice system in 1997 (N (1)=137 parolees) and 2007 (N (2)=106 prisoners). A social marketing model helped guide the design of our questionnaire to assess the acceptability of rapid oral testing. This included assessing a new product, across four marketing dimensions: product, price, promotion, and place. Results revealed that in both 1997 and 2007, over 90% indicated that rapid oral testing would be highly acceptable, particularly if the cost was under US$6, and that a pharmacy would be the most appropriate and accessible venue for selling the rapid oral testing kits. The vast majority of survey respondents believed that the cost of rapid oral testing should be federally subsidized and that television and newspaper advertisements would be the most effective media to advertise for rapid oral testing. Both the 1997 and 2007 surveys suggested that rapid oral HIV testing would be particularly accepted in Taiwan by IDUs after release from the criminal justice system.

  18. A cross sectional survey of the barriers for implementing rapid HIV testing among French general practitioners.

    Science.gov (United States)

    Fraisse, Thibaut; Fourcade, Camille; Brazes-Sanz, Julie; Koumar, Yatrika; Lavigne, Jean Philippe; Sotto, Albert; Laureillard, Didier

    2016-10-01

    In France, almost 30,000 people are unaware of their HIV-positive status. Innovative screening strategies are essential to reach this population. The aim of this study was to describe the acceptability of rapid HIV testing (RHT) among French general practitioners (GPs) working in the south of France and barriers for implementing this strategy. We analysed an anonymous questionnaire sent by mail to GPs about demographic data, routine practice, knowledge of RHT and barriers to its use. Between 1 April and 30 September 2013, out of the 165 GPs contacted, 78 returned the questionnaires. The GPs' mean age was 52 years; 49 were men. Fifty-one GPs reported that their registered patients included at least one HIV-infected person and 70 GPs reported taking care of high-risk patients. Sixty-three percent of GPs reported being interested in using RHT in their daily practice. The main reasons reported by uninterested GPs were: greater confidence in standard HIV testing, difficulties including RHT during the routine consultation, difficulties to screen for other sexually transmitted infections simultaneously, and difficulties to deliver a positive result. French National Authorities for Health propose to screen the population at least once in their lifetime and high-risk people at least once a year. In order to achieve this aim, RHT should be included in the GPs' arsenal for HIV testing. We showed a high acceptability of RHT by GPs. If specific and adapted training is developed, and if solutions to barriers reported by GPs are found, RHT could be implemented in to their routine activity. © The Author(s) 2016.

  19. Evaluation of Blood-Based Antibody Rapid Testing for HIV Early Therapy: A Meta-Analysis of the Evidence

    Directory of Open Access Journals (Sweden)

    Xiaojie Huang

    2018-06-01

    Full Text Available BackgroundWestern blot (WB assay is considered the gold standard test for HIV infection confirmation. However, it requires technical expertise and is quite time-consuming. WHO recommends blood-based rapid diagnosis to achieve same-day test and treatment. However, this rapid testing strategy has not been promoted worldwide due to inadequate research evaluating the effectiveness of rapid tests (RTs as an alternative confirmatory HIV test for WB. This study aims to compare the diagnostic performance of rapid HIV tests compared with WB.MethodsPubMed and Web of Science were searched for publications on rapid HIV tests using blood specimen. A meta-analysis was performed to quantitatively evaluate the diagnostic performance of rapid HIV tests compared with the WB assay in terms of pooled sensitivity, specificity, area under summary receiver operating characteristic (SROC curve, and diagnostic odds ratio (DOR.ResultsTwenty articles involving 27,343 fresh specimens for rapid HIV tests were included in the meta-analysis. Regarding Capillus HIV-1/HIV-2, the pooled sensitivity, specificity, area under SROC curve, and DOR derived from six studies were 0.999 (95% CI, 0.956–1.000, 0.999 (95% CI, 0.991–1.00, 1.00 (95% CI, 0.99–1.00, and 1.0 × 106 (95% CI, 2.6 × 104–3.9 × 107 compared with the WB assay, respectively. With respect to Determine HIV-1/2, the pooled sensitivity, specificity area under SROC, and DOR derived from eight studies were 1.00 (95% CI, 0.789–1.000, 0.992 (95% CI, 0.985–0.996, 1.00 (95% CI, 0.99–1.00, and 1.8 × 106 (95% CI 406.049–7.8 × 109 compared with the WB assay, respectively. Regarding two-step serial RTs, the pooled sensitivity, specificity area under SROC, and DOR derived from eight studies were 0.998 (95% CI, 0.991–1.000, 0.998 (95% CI, 0.994–0.999, and 1.00 (95% CI 0.99–1.00 compared with the WB assay, respectively.ConclusionOur meta-analysis results may provide evidenced-based support

  20. HIV-TRACE (Transmission Cluster Engine): a tool for large scale molecular epidemiology of HIV-1 and other rapidly evolving pathogens.

    Science.gov (United States)

    Kosakovsky Pond, Sergei L; Weaver, Steven; Leigh Brown, Andrew J; Wertheim, Joel O

    2018-01-31

    In modern applications of molecular epidemiology, genetic sequence data are routinely used to identify clusters of transmission in rapidly evolving pathogens, most notably HIV-1. Traditional 'shoeleather' epidemiology infers transmission clusters by tracing chains of partners sharing epidemiological connections (e.g., sexual contact). Here, we present a computational tool for identifying a molecular transmission analog of such clusters: HIV-TRACE (TRAnsmission Cluster Engine). HIV-TRACE implements an approach inspired by traditional epidemiology, by identifying chains of partners whose viral genetic relatedness imply direct or indirect epidemiological connections. Molecular transmission clusters are constructed using codon-aware pairwise alignment to a reference sequence followed by pairwise genetic distance estimation among all sequences. This approach is computationally tractable and is capable of identifying HIV-1 transmission clusters in large surveillance databases comprising tens or hundreds of thousands of sequences in near real time, i.e., on the order of minutes to hours. HIV-TRACE is available at www.hivtrace.org and from github.com/veg/hivtrace, along with the accompanying result visualization module from github.com/veg/hivtrace-viz. Importantly, the approach underlying HIV-TRACE is not limited to the study of HIV-1 and can be applied to study outbreaks and epidemics of other rapidly evolving pathogens. © The Author 2018. Published by Oxford University Press on behalf of the Society for Molecular Biology and Evolution. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  1. Comparative effectiveness of single and dual rapid diagnostic tests for syphilis and HIV in antenatal care services in Colombia.

    Science.gov (United States)

    Gaitán-Duarte, Hernando Guillermo; Newman, Lori; Laverty, Maura; Habib, Ndema Abu; González-Gordon, Lina María; Ángel-Müller, Edith; Abella, Catleya; Barros, Esther Cristina; Rincón, Carlos; Caicedo, Sidia; Gómez, Bertha; Pérez, Freddy

    2016-12-01

    To assess the effectiveness of a dual rapid test compared to a single rapid test for syphilis and HIV screening. A cluster-randomized open-label clinical trial was performed in 12 public antenatal care (ANC) centers in the cities of Bogotá and Cali, Colombia. Pregnant women who were over 14 years of age at their first antenatal visit and who had not been previously tested for HIV and syphilis during the current pregnancy were included. Pregnant women were randomized to single HIV and single syphilis rapid diagnostic tests (Arm A) or to dual HIV and syphilis rapid diagnostic tests (Arm B). The four main outcomes measured were: (1) acceptability of the test, (2) uptake in testing, (3) treatment on the same day (that is, timely treatment), and (4) treatment at any time for positive rapid test cases. Bivariate and multivariate analyses were calculated to adjust for the clustering effect and the period. A total of 1 048 patients were analyzed in Arm A, and 1 166 in Arm B. Acceptability of the rapid tests was 99.8% in Arm A and 99.6% in Arm B. The prevalence of positive rapid tests was 2.21% for syphilis and 0.36% for HIV. Timely treatment was provided to 20 of 29 patients (69%) in Arm A and 16 of 20 patients (80%) in Arm B (relative risk (RR), 1.10; 95% confidence interval (CI): (1.00 -1.20). Treatment at any time was given to 24 of 29 patients (83%) in Arm A and to 20 of 20 (100%) in Arm B (RR, 1.11; 95% CI: 1.01-1.22). There were no differences in patient acceptability, testing and timely treatment between dual rapid tests and single rapid tests for HIV and syphilis screening in the ANC centers. Same-day treatment depends also on the interpretation of and confidence in the results by the health providers.

  2. Scale-up of a comprehensive harm reduction programme for people injecting opioids: lessons from north-eastern India.

    Science.gov (United States)

    Lalmuanpuii, Melody; Biangtung, Langkham; Mishra, Ritu Kumar; Reeve, Matthew J; Tzudier, Sentimoa; Singh, Angom L; Sinate, Rebecca; Sgaier, Sema K

    2013-04-01

    Harm reduction packages for people who inject illicit drugs, including those infected with human immunodeficiency virus (HIV), are cost-effective but have not been scaled up globally. In the north-eastern Indian states of Manipur and Nagaland, the epidemic of HIV infection is driven by the injection of illicit drugs, especially opioids. These states needed to scale up harm reduction programmes but faced difficulty doing so. In 2004, the Bill & Melinda Gates Foundation funded Project ORCHID to scale up a harm reduction programme in Manipur and Nagaland. In 2003, an estimated 10 000 and 16 000 people were injecting drugs in Manipur and Nagaland, respectively. The prevalence of HIV infection among people injecting drugs was 24.5% in Manipur and 8.4% in Nagaland. By 2012, the harm reduction programme had been scaled up to an average of 9011 monthly contacts outside clinics (80% of target); an average of 1709 monthly clinic visits (15% of target, well above the 5% monthly goal) and an average monthly distribution of needles and syringes of 16 each per programme participant. Opioid agonist maintenance treatment coverage was 13.7% and retention 6 months after enrolment was 63%. Antiretroviral treatment coverage for HIV-positive participants was 81%. A harm reduction model consisting of community-owned, locally relevant innovations and business approaches can result in good harm reduction programme scale-up and influence harm reduction policy. Project ORCHID has influenced national harm reduction policy in India and contributed to the development of harm reduction guidelines.

  3. Scale-up of a comprehensive harm reduction programme for people injecting opioids: lessons from north-eastern India

    Science.gov (United States)

    Lalmuanpuii, Melody; Biangtung, Langkham; Mishra, Ritu Kumar; Reeve, Matthew J; Tzudier, Sentimoa; Singh, Angom L; Sinate, Rebecca

    2013-01-01

    Abstract Problem Harm reduction packages for people who inject illicit drugs, including those infected with human immunodeficiency virus (HIV), are cost-effective but have not been scaled up globally. In the north-eastern Indian states of Manipur and Nagaland, the epidemic of HIV infection is driven by the injection of illicit drugs, especially opioids. These states needed to scale up harm reduction programmes but faced difficulty doing so. Approach In 2004, the Bill & Melinda Gates Foundation funded Project ORCHID to scale up a harm reduction programme in Manipur and Nagaland. Local setting In 2003, an estimated 10 000 and 16 000 people were injecting drugs in Manipur and Nagaland, respectively. The prevalence of HIV infection among people injecting drugs was 24.5% in Manipur and 8.4% in Nagaland. Relevant changes By 2012, the harm reduction programme had been scaled up to an average of 9011 monthly contacts outside clinics (80% of target); an average of 1709 monthly clinic visits (15% of target, well above the 5% monthly goal) and an average monthly distribution of needles and syringes of 16 each per programme participant. Opioid agonist maintenance treatment coverage was 13.7% and retention 6 months after enrolment was 63%. Antiretroviral treatment coverage for HIV-positive participants was 81%. Lessons learnt A harm reduction model consisting of community-owned, locally relevant innovations and business approaches can result in good harm reduction programme scale-up and influence harm reduction policy. Project ORCHID has influenced national harm reduction policy in India and contributed to the development of harm reduction guidelines. PMID:23599555

  4. Scaling up agroforestry farming systems: Lessons from the Malawi ...

    African Journals Online (AJOL)

    The study examined the factors affecting agroforestry technology upscaling and identified gaps in scaling up approaches of agroforestry technologies. One hundred and sixty-four farmers in Malawi Agroforestry Extension (MAFE) project districts of Mzimba, Ntcheu and Mangochi were interviewed. Logistic model was used in ...

  5. Scaling Up the Production of More Nutritious Yellow Potatoes in ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    English · Français ... Researchers will scale up improved yellow potato varieties that -yield 15% more than other varieties -are ... -have nearly 20% more iron and zinc than the most cultivated Colombian variety The project will deliver these ...

  6. Scaling up Education Reform: Addressing the Politics of Disparity

    Science.gov (United States)

    Bishop, Russell; O'Sullivan, Dominic; Berryman, Mere

    2010-01-01

    What is school reform? What makes it sustainable? Who needs to be involved? How is scaling up achieved? This book is about the need for educational reforms that have built into them, from the outset, those elements that will see them sustained in the original sites and spread to others. Using the Te Kotahitanga Project as a model the authors…

  7. Millions Learning: Scaling up Quality Education in Developing Countries

    Science.gov (United States)

    Robinson, Jenny Perlman; Winthrop, Rebecca

    2016-01-01

    "Millions Learning: Scaling up Quality Education in Developing Countries" tells the story of where and how quality education has scaled in low- and middle-income countries. The story emerges from wide-ranging research on scaling and learning, including 14 in-depth case studies from around the globe. Ultimately, "Millions…

  8. Scaling-Up Successfully: Pathways to Replication for Educational NGOs

    Science.gov (United States)

    Jowett, Alice; Dyer, Caroline

    2012-01-01

    Non-government organisations (NGOs) are big players in international development, critical to the achievement of the Millennium Development Goals (MDGs) and constantly under pressure to "achieve more". Scaling-up their initiatives successfully and sustainably can be an efficient and cost effective way for NGOs to increase their impact across a…

  9. Scaling up: Expanding the impact of food security and nutrition ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Corey Piccioni

    Together with partners, IDRC is scaling up proven food security and ... In rural Kenya and Uganda, a pre-mix for preparation of yogurt in community-based kitchens is key to ... Pre-cooked beans for improving food security, nutrition, and income.

  10. Scaling-up Support for Emergency Response Organizations

    NARCIS (Netherlands)

    Oomes, A.H.J.; Neef, R.M.

    2005-01-01

    We present the design of an information system that supports the process of scaling-up of emergency response organizations. This process is vital for effective emergency response but tends to go awry in practice. Our proposed system consists of multiple distributed agents that are capable of

  11. New tuberculosis technologies: challenges for retooling and scale-up.

    Science.gov (United States)

    Pai, M; Palamountain, K M

    2012-10-01

    The availability of new tools does not mean that they will be adopted, used correctly, scaled up or have public health impact. Experience to date with new diagnostics suggests that many national tuberculosis programmes (NTPs) in high-burden countries are reluctant to adopt and scale up new tools, even when these are backed by evidence and global policy recommendations. We suggest that there are several common barriers to effective national adoption and scale-up of new technologies: global policy recommendations that do not provide sufficient information for scale-up, complex decision-making processes and weak political commitment at the country level, limited engagement of and support to NTP managers, high cost of tools and poor fit with user needs, unregulated markets and inadequate business models, limited capacity for laboratory strengthening and implementation research, and insufficient advocacy and donor support. Overcoming these barriers will require enhanced country-level advocacy, resources, technical assistance and political commitment. Some of the BRICS (Brazil, Russia, India, China, South Africa) countries are emerging as early adopters of policies and technologies, and are increasing their investments in TB control. They may provide the first opportunities to fully assess the public health impact of new tools.

  12. Scaling up complex interventions: insights from a realist synthesis.

    Science.gov (United States)

    Willis, Cameron D; Riley, Barbara L; Stockton, Lisa; Abramowicz, Aneta; Zummach, Dana; Wong, Geoff; Robinson, Kerry L; Best, Allan

    2016-12-19

    Preventing chronic diseases, such as cancer, cardiovascular disease and diabetes, requires complex interventions, involving multi-component and multi-level efforts that are tailored to the contexts in which they are delivered. Despite an increasing number of complex interventions in public health, many fail to be 'scaled up'. This study aimed to increase understanding of how and under what conditions complex public health interventions may be scaled up to benefit more people and populations.A realist synthesis was conducted and discussed at an in-person workshop involving practitioners responsible for scaling up activities. Realist approaches view causality through the linkages between changes in contexts (C) that activate mechanisms (M), leading to specific outcomes (O) (CMO configurations). To focus this review, three cases of complex interventions that had been successfully scaled up were included: Vibrant Communities, Youth Build USA and Pathways to Education. A search strategy of published and grey literature related to each case was developed, involving searches of relevant databases and nominations from experts. Data extracted from included documents were classified according to CMO configurations within strategic themes. Findings were compared and contrasted with guidance from diffusion theory, and interpreted with knowledge users to identify practical implications and potential directions for future research.Four core mechanisms were identified, namely awareness, commitment, confidence and trust. These mechanisms were activated within two broad scaling up strategies, those of renewing and regenerating, and documenting success. Within each strategy, specific actions to change contexts included building partnerships, conducting evaluations, engaging political support and adapting funding models. These modified contexts triggered the identified mechanisms, leading to a range of scaling up outcomes, such as commitment of new communities, changes in relevant

  13. Differences in antiretroviral scale up in three South African provinces: the role of implementation management

    Directory of Open Access Journals (Sweden)

    Van Rensburg Dingie

    2010-07-01

    Full Text Available Abstract Background South Africa’s antiretroviral programme is governed by defined national plans, establishing treatment targets and providing funding through ring-fenced conditional grants. However, in terms of the country’s quasi-federal constitution, provincial governments bear the main responsibility for provision of health care, and have a certain amount of autonomy and therefore choice in the way their HIV/AIDS programmes are implemented. Methods The paper is a comparative case study of the early management of ART scale up in three South African provincial governments – Western Cape, Gauteng and Free State – focusing on both operational and strategic dimensions. Drawing on surveys of models of ART care and analyses of the policy process conducted in the three provinces between 2005 and 2007, as well as a considerable body of grey and indexed literature on ART scale up in South Africa, it draws links between implementation processes and variations in provincial ART coverage (low, medium and high achieved in the three provinces. Results While they adopted similar chronic disease care approaches, the provinces differed with respect to political and managerial leadership of the programme, programme design, the balance between central standardisation and local flexibility, the effectiveness of monitoring and evaluation systems, and the nature and extent of external support and programme partnerships. Conclusions This case study points to the importance of sub-national programme processes and the influence of factors other than financing or human resource capacity, in understanding intervention scale up.

  14. Diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending an urban public health facility in Kampala, Uganda.

    Directory of Open Access Journals (Sweden)

    Joanita Nangendo

    Full Text Available The prevalence of HIV in Uganda is 7.3%, and yet nearly 40% of people living with HIV are unaware of their status. The current HIV testing policy which is strictly blood-based poses several challenges including: a need for high level laboratory skills, stringent waste disposal needs, and painful sample collection. It is envisaged that introduction of a rapid, painless HIV oral fluid test as a potential alternative is likely to increase the number of people testing. The aim of this study was to determine the diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending Kisenyi Health Centre IV in Kampala.We conducted a cross-sectional study among 440 adults recruited consecutively at Kisenyi Health Centre IV from January to March 2016. The diagnostic accuracy of the HIV oral test was assessed by comparing to the national HIV serial testing algorithm. We also assessed for acceptability among patients and health care workers (HCWs by triangulating responses from a structured questionnaire, three focus group discussions and seven key informant interviews. Acceptability was defined as willingness to take the test at the time of the study and intention for future use of the test if it was availed. The prevalence of HIV infection among study participants was 14.8%. The HIV oral fluid test was highly accurate with sensitivity of 100% (95% CI; 94.5-100.0, specificity of 100% (95% CI; 99.0-100.0, positive predictive value (PPV of 100% (95% CI; 94.5-100.0 and negative predictive value (NPV of 100% (95% CI; 99.0-100.0. Acceptability of HIV oral testing was also high at 87.0% (95% CI; 83.6-89.9. Participants preferred HIV oral testing because it was: pain free (91%, n = 399 and did not require blood draw (82%, n = 360.The HIV oral fluid test has high diagnostic accuracy and acceptability. HIV oral testing is a suitable addition to the national HIV testing strategies with the potential of increasing access to HIV testing services in

  15. Methadone Maintenance Therapy in Vietnam: An Overview and Scaling-Up Plan

    Directory of Open Access Journals (Sweden)

    Tam T. M. Nguyen

    2012-01-01

    Full Text Available Vietnam is among the countries with the highest rate of HIV transmission through injecting drug users. HIV prevalence among injecting drug users is 20% and up to 50% in many provinces. An estimated number of drug users in the country by the end of 2011 were 171,000 in which the most common is heroin (85%. Detoxification at home, community, and in rehabilitation centers have been the main modalities for managing heroin addiction until Methadone Maintenance Treatment (MMT was piloted in 2008. Recent reports have demonstrated positive treatment outcomes. Incidence of HIV was found remarkably low among patients on MMT. Treatment has significantly improved the quality of life as well as stability for society. The government has granted the Ministry of Health (MoH to expand Methadone treatment to at least 30 provinces to provide treatment for more than 80,000 drug users by 2015. The Vietnam Administration for HIV/AIDS Control (VAAC and MOH have outlined the role and responsibility of key departments at the central and local levels in implementing and maintaining MMT treatment. This paper will describe the achievements of the MMT pilot program and the scaling-up plan as well as strategies to ensure quality and sustainability and to overcome the challenges in the coming years.

  16. Scale-up of mixer-settler for uranium extraction

    International Nuclear Information System (INIS)

    Santana, A.O. de.

    1990-05-01

    The aim of this work was to obtain scale-up relations for a box type mixer-settler used in uranium extraction process for chloridric leaches. Three box type units with different sizes and with the same geometry were used for scale-up of the mixer. The correlation between extraction rate and specific power input, D/T ratio (stirrer diameter/mixer length) and residence time were experimentally obtained. The results showed that the extraction increases with power input for a constant value of D/T equal to 1/3, remaining however independent from mixer sizes for a specific value of power input. This behavior was observed for power input values ranging from 100 to 750 w/m 9 . (author). 23 refs, 22 figs, 23 tabs

  17. Growth kinetics and scale-up of Agrobacterium tumefaciens.

    Science.gov (United States)

    Leth, Ingrid K; McDonald, Karen A

    2017-06-01

    Production of recombinant proteins in plants through Agrobacterium-mediated transient expression is a promising method of producing human therapeutic proteins, vaccines, and commercial enzymes. This process has been shown to be viable at a large scale and involves growing large quantities of wild-type plants and infiltrating the leaf tissue with a suspension of Agrobacterium tumefaciens bearing the genes of interest. This study examined one of the steps in this process that had not yet been optimized: the scale-up of Agrobacterium production to sufficient volumes for large-scale plant infiltration. Production of Agrobacterium strain C58C1 pTFS40 was scaled up from shake flasks (50-100 mL) to benchtop (5 L) scale with three types of media: Lysogeny broth (LB), yeast extract peptone (YEP) media, and a sucrose-based defined media. The maximum specific growth rate (μ max ) of the strain in the three types of media was 0.46 ± 0.04 h -1 in LB media, 0.43 ± 0.03 h -1 in YEP media, and 0.27 ± 0.01 h -1 in defined media. The maximum biomass concentration reached at this scale was 2.0 ± 0.1, 2.8 ± 0.1, and 2.6 ± 0.1 g dry cell weight (DCW)/L for the three media types. Production was successfully scaled up to a 100-L working volume reactor with YEP media, using k L a as the scale-up parameter.

  18. Optimization of scaled-up chitosan microparticles for bone regeneration

    International Nuclear Information System (INIS)

    Jayasuriya, A Champa; Bhat, Archana

    2009-01-01

    The aim of this study was to scale-up and optimize the chitosan (CS) microparticles (MPs) from 1x batch (41-85 mg) to 4x batch (270-567 mg) to be used in bone regeneration. The MPs used in the present study were prepared by double emulsification technique using CS as a base material under physiologically friendly conditions throughout the process. Structural integrity of MPs was improved creating cross-links between amine groups in CS and phosphate groups in tripolyphosphate (TPP) which has been used as an ionic cross-linking agent. The cross-linking density was varied using different amounts of TPP to CS such as 0%, 8%, 32%, 64% and 110% (w/w). The CS MPs were approximately spherical in shape with a size of 30-50 μm according to scanning electron microscopy results. X-ray diffraction data revealed having TPP in the CS MPs. The evidence of ionic cross-links in the CS MPs was analyzed using Fourier Transform Infra Red. When we scaled-up the yield of MPs, we investigated that 64% TPP cross-linking density provided the best quality MPs. In addition, those MPs provided the yield from 75 mg to 310 mg when scaled up from 1x to 4x batch, respectively. The MPs developed have a great potential to be used as an injectable scaffold for bone regeneration including orthopedic and craniofacial applications using minimally invasive conditions compared with conventional three-dimensional scaffolds.

  19. Rapid High-Level Production of Functional HIV Broadly Neutralizing Monoclonal Antibodies in Transient Plant Expression Systems

    Science.gov (United States)

    Rosenberg, Yvonne; Sack, Markus; Montefiori, David; Forthal, Donald; Mao, Lingjun; -Abanto, Segundo Hernandez; Urban, Lori; Landucci, Gary; Fischer, Rainer; Jiang, Xiaoming

    2013-01-01

    Passive immunotherapy using anti-HIV broadly neutralizing monoclonal antibodies (mAbs) has shown promise as an HIV treatment, reducing mother-to-child-transmission (MTCT) of simian/human immunodeficiency virus (SHIV) in non-human primates and decreasing viral rebound in patients who ceased receiving anti-viral drugs. In addition, a cocktail of potent mAbs may be useful as mucosal microbicides and provide an effective therapy for post-exposure prophylaxis. However, even highly neutralizing HIV mAbs used today may lose their effectiveness if resistance occurs, requiring the rapid production of new or engineered mAbs on an ongoing basis in order to counteract the viral resistance or the spread of a certain HIV-1 clade in a particular region or patient. Plant-based expression systems are fast, inexpensive and scalable and are becoming increasingly popular for the production of proteins and monoclonal antibodies. In the present study, Agrobacterium-mediated transient transfection of plants, utilizing two species of Nicotiana, have been tested to rapidly produce high levels of an HIV 89.6PΔ140env and several well-studied anti-HIV neutralizing monoclonal antibodies (b12, 2G12, 2F5, 4E10, m43, VRC01) or a single chain antibody construct (m9), for evaluation in cell-based viral inhibition assays. The protein-A purified plant-derived antibodies were intact, efficiently bound HIV envelope, and were equivalent to, or in one case better than, their counterparts produced in mammalian CHO or HEK-293 cells in both neutralization and antibody dependent viral inhibition assays. These data indicate that transient plant-based transient expression systems are very adaptable and could rapidly generate high levels of newly identified functional recombinant HIV neutralizing antibodies when required. In addition, they warrant detailed cost-benefit analysis of prolonged incubation in plants to further increase mAb production. PMID:23533588

  20. Rapid high-level production of functional HIV broadly neutralizing monoclonal antibodies in transient plant expression systems.

    Directory of Open Access Journals (Sweden)

    Yvonne Rosenberg

    Full Text Available Passive immunotherapy using anti-HIV broadly neutralizing monoclonal antibodies (mAbs has shown promise as an HIV treatment, reducing mother-to-child-transmission (MTCT of simian/human immunodeficiency virus (SHIV in non-human primates and decreasing viral rebound in patients who ceased receiving anti-viral drugs. In addition, a cocktail of potent mAbs may be useful as mucosal microbicides and provide an effective therapy for post-exposure prophylaxis. However, even highly neutralizing HIV mAbs used today may lose their effectiveness if resistance occurs, requiring the rapid production of new or engineered mAbs on an ongoing basis in order to counteract the viral resistance or the spread of a certain HIV-1 clade in a particular region or patient. Plant-based expression systems are fast, inexpensive and scalable and are becoming increasingly popular for the production of proteins and monoclonal antibodies. In the present study, Agrobacterium-mediated transient transfection of plants, utilizing two species of Nicotiana, have been tested to rapidly produce high levels of an HIV 89.6PΔ140env and several well-studied anti-HIV neutralizing monoclonal antibodies (b12, 2G12, 2F5, 4E10, m43, VRC01 or a single chain antibody construct (m9, for evaluation in cell-based viral inhibition assays. The protein-A purified plant-derived antibodies were intact, efficiently bound HIV envelope, and were equivalent to, or in one case better than, their counterparts produced in mammalian CHO or HEK-293 cells in both neutralization and antibody dependent viral inhibition assays. These data indicate that transient plant-based transient expression systems are very adaptable and could rapidly generate high levels of newly identified functional recombinant HIV neutralizing antibodies when required. In addition, they warrant detailed cost-benefit analysis of prolonged incubation in plants to further increase mAb production.

  1. Building partnerships to address the HIV epidemic.

    Science.gov (United States)

    Chua, A C; Leo, Y S; Lee, C C

    2008-05-01

    Batam is one of the islands comprising the Riau Province in Indonesia, and is closest to Singapore. It is a popular destination of many Singaporeans. Surveillance reports among commercial sex workers conducted in Batam showed the prevalence rate of human immunodeficiency virus (HIV) is 16.2 percent. At the end of 2006, the total number of HIV-infected Singaporeans was 3,060, the majority being infected via heterosexual transmission. The aim of the Indonesian government is to rapidly scale up HIV treatment to those needing it. One of the factors critical to the rapid scale-up is healthcare worker training. An intersectoral collaboration addressing the issue of HIV care and treatment with a hospital in Batam was created. The first activity of the collaboration was a two-day HIV training course conducted in February 2007. The aim of the course was to provide a basic understanding of HIV, as well as knowledge on common opportunistic infections that may present to a general hospital or clinical setting. 34 doctors from 23 institutions in Batam and three doctors from two hospitals in the Riau Islands attended the two-day HIV training course. The participants found the training very useful and highly relevant. This first HIV training provided a foundation to build on further HIV education. It is our belief that through the HIV training programme, there will be more awareness of HIV among the various medical institutions in Batam. As the HIV epidemic knows no borders, working with neighbouring countries is one strategy that deserves attention.

  2. Clients of sex workers in Switzerland: it makes sense to counsel and propose rapid test for HIV on the street, a preliminary report.

    Science.gov (United States)

    Diserens, Esther-Amélie; Bodenmann, Patrick; N'Garambe, Chantal; Ansermet-Pagot, Anne; Vannotti, Marco; Masserey, Eric; Cavassini, Matthias

    2010-03-19

    Clients of street sex workers may be at higher risk for HIV infection than the general population. Furthermore, there is a lack of knowledge regarding HIV testing of clients of sex workers in developed countries. This pilot study assessed the feasibility and acceptance of rapid HIV testing by the clients of street-based sex workers in Lausanne, Switzerland. For 5 evenings, clients in cars were stopped by trained field staff for face-to-face interviews focusing on sex-related HIV risk behaviors and HIV testing history. The clients were then offered a free anonymous rapid HIV test in a bus parked nearby. Rapid HIV testing and counselling were performed by experienced nurse practitioners. Clients with reactive tests were offered confirmatory testing, medical evaluation, and care in our HIV clinic. We intercepted 144 men, 112 (77.8%) agreed to be interviewed. Among them, 50 (46.6%) had never been tested for HIV. A total of 31 (27.7%) rapid HIV tests were performed, 16 (51.6%) in clients who had not previously been tested. None were reactive. Initially, 19 (16.9%) additional clients agreed to HIV testing but later declined due to the 40-minute queue for testing. This pilot study showed that rapid HIV testing in the red light district of Lausanne was feasible, and that the clients of sex workers accepted testing at an unexpectedly high rate. This setting seems particularly appropriate for targeted HIV screening, since more than 40% of the clients had not previously been tested for HIV even though they engaged in sex-related HIV risk behaviour.

  3. Rapid selection of escape mutants by the first CD8 T cell responses in acute HIV-1 infection

    Energy Technology Data Exchange (ETDEWEB)

    Korber, Bette Tina Marie [Los Alamos National Laboratory

    2008-01-01

    The recent failure of a vaccine that primes T cell responses to control primary HIV-1 infection has raised doubts about the role of CD8+ T cells in early HIV-1 infection. We studied four patients who were identified shortly after HIV-1 infection and before seroconversion. In each patient there was very rapid selection of multiple HIV-1 escape mutants in the transmitted virus by CD8 T cells, including examples of complete fixation of non-synonymous substitutions within 2 weeks. Sequencing by single genome amplification suggested that the high rate of virus replication in acute infection gave a selective advantage to virus molecules that contained simultaneous and gained sequential T cell escape mutations. These observations show that whilst early HIV-1 specific CD8 T cells can act against virus, rapid escape means that these T cell responses are unlikely to benefit the patient and may in part explain why current HIV-1 T cell vaccines may not be protective.

  4. Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa

    OpenAIRE

    Jaya, Ziningi; Drain, Paul K.; Mashamba-Thompson, Tivani P.

    2017-01-01

    Introduction Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. Material and methods We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and couns...

  5. Scale-up on electrokinetic remediation: Engineering and technological parameters

    Energy Technology Data Exchange (ETDEWEB)

    López-Vizcaíno, Rubén [Department of Chemical Engineering, Institute of Chemical & Environmental Technologies, University of Castilla-La Mancha, Campus Universitario s/n, 13071 Ciudad Real (Spain); Navarro, Vicente; León, María J. [Geoenvironmental Group, Civil Engineering School, University of Castilla-La Mancha, Avda. Camilo José Cela s/n, 13071 Ciudad Real (Spain); Risco, Carolina [Department of Chemical Engineering, Institute of Chemical & Environmental Technologies, University of Castilla-La Mancha, Campus Universitario s/n, 13071 Ciudad Real (Spain); Rodrigo, Manuel A., E-mail: manuel.rodrigo@uclm.es [Department of Chemical Engineering, Faculty of Chemical Sciences & Technologies, University of Castilla-La Mancha, Campus Universitario s/n, 13071 Ciudad Real (Spain); Sáez, Cristina; Cañizares, Pablo [Department of Chemical Engineering, Faculty of Chemical Sciences & Technologies, University of Castilla-La Mancha, Campus Universitario s/n, 13071 Ciudad Real (Spain)

    2016-09-05

    Highlights: • Moisture and compaction of soil must be re-establish in Scale-up of EKR. • Degree of compaction of soil depends on moisture, type of soil and EKR reactor. • Scale of EKR process determines the energy consumption in the treatment. • Electroosmosis and electromigration processes are favoured in prototype scale. • In real scale EKR processes it is important determine evaporation and leaks effects. - Abstract: This study analyses the effect of the scale-up of electrokinetic remediation (EKR) processes in natural soils. A procedure is proposed to prepare soils based on a compacting process to obtaining soils with similar moisture content and density to those found in real soils in the field. The soil used here was from a region with a high agrarian activity (Mora, Spain). The scale-up study was performed in two installations at different scales: a mock-up pilot scale (0.175 m{sup 3}) and a prototype with a scale that was very similar to a real application (16 m{sup 3}). The electrode configuration selected consisted of rows of graphite electrodes facing each other located in electrolyte wells. The discharge of 20 mg of 2,4-dichlorophenoxyacetic acid [2,4-D] per kg of dry soil was treated by applying an electric potential gradient of 1 V cm{sup −1}. An increase in scale was observed to directly influence the amount of energy supplied to the soil being treated. As a result, electroosmotic and electromigration flows and electric heating are more intense than in smaller-scale tests (24%, 1% and 25%, respectively respect to the values in prototype). In addition, possible leaks were evaluated by conducting a watertightness test and quantifying evaporation losses.

  6. Scale-Up: Improving Large Enrollment Physics Courses

    Science.gov (United States)

    Beichner, Robert

    1999-11-01

    The Student-Centered Activities for Large Enrollment University Physics (SCALE-UP) project is working to establish a learning environment that will promote increased conceptual understanding, improved problem-solving performance, and greater student satisfaction, while still maintaining class sizes of approximately 100. We are also addressing the new ABET engineering accreditation requirements for inquiry-based learning along with communication and team-oriented skills development. Results of studies of our latest classroom design, plans for future classroom space, and the current iteration of instructional materials will be discussed.

  7. Feasibility of implementing rapid oral fluid HIV testing in an urban University Dental Clinic: a qualitative study

    Directory of Open Access Journals (Sweden)

    Hutchinson M

    2012-05-01

    Full Text Available Abstract Background More than 1 million individuals in the U.S. are infected with HIV; approximately 20% of whom do not know they are infected. Early diagnosis of HIV infection results in earlier access to treatment and reductions in HIV transmission. In 2006, the CDC recommended that health care providers offer routine HIV screening to all adolescent and adult patients, regardless of community seroprevalence or patient lifestyle. Dental providers are uniquely positioned to implement these recommendations using rapid oral fluid HIV screening technology. However, thus far, uptake into dental practice has been very limited. Methods The study utilized a qualitative descriptive approach with convenience samples of dental faculty and students. Six in-depth one-on-one interviews were conducted with dental faculty and three focus groups were conducted with fifteen dental students. Results Results were fairly consistent and indicated relatively high levels of acceptability. Barriers and facilitators of oral fluid HIV screening were identified in four primary areas: scope of practice/practice enhancement, skills/knowledge/training, patient service/patient reactions and logistical issues. Conclusions Oral fluid HIV screening was described as having benefits for patients, dental practitioners and the public good. Many of the barriers to implementation that were identified in the study could be addressed through training and interdisciplinary collaborations.

  8. Human anti-HIV IgM detection by the OraQuick ADVANCE® Rapid HIV 1/2 Antibody Test.

    Science.gov (United States)

    Guillon, Geraldine; Yearwood, Graham; Snipes, Casey; Boschi, Daniel; Reed, Michael R

    2018-01-01

    The Centers for Disease Control and Prevention (CDC) and many public health jurisdictions continue to advocate for the most sensitive rapid HIV test that is available. Currently, the recommendation is to utilize tests that can detect HIV infection biomarkers within 30 days of infection, when initial immune responses are mounted. The infected patient's IgM response is often used to detect acute infection within a 20-25 days window after infection. This requirement applies to lab-based testing with automated analyzers and rapid, point of care (POC) testing used for screening in a non-clinical setting. A recent study has demonstrated that POC tests using a Protein A-based detection system can detect samples with predominantly HIV-1 IgM reactivity (Moshgabadi et al., 2015). The OraQuick ADVANCE ® Rapid HIV-1/2 Antibody Test (OraQuick ADVANCE ®) also uses Protein A as the detection protein in the antibody-binding colloidal gold conjugate, so it is expected that the OraQuick ADVANCE ® Test will also detect samples with predominantly IgM reactivity. This report definitively demonstrates that the OraQuick ADVANCE ® Test can detect IgM antibodies during an acute infection window period of approximately 20-25 days after infection, and is therefore suitable for use in testing environments requiring adherence to current CDC recommendations.

  9. Evidence-based adaptation and scale-up of a mobile phone health information service.

    Science.gov (United States)

    L'Engle, Kelly; Plourde, Kate F; Zan, Trinity

    2017-01-01

    The research base recommending the use of mobile phone interventions for health improvement is growing at a rapid pace. The use of mobile phones to deliver health behavior change and maintenance interventions in particular is gaining a robust evidence base across geographies, populations, and health topics. However, research on best practices for successfully scaling mHealth interventions is not keeping pace, despite the availability of frameworks for adapting and scaling health programs. m4RH-Mobile for Reproductive Health-is an SMS, or text message-based, health information service that began in two countries and over a period of 7 years has been adapted and scaled to new population groups and new countries. Success can be attributed to following key principles for scaling up health programs, including continuous stakeholder engagement; ongoing monitoring, evaluation, and research including extensive content and usability testing with the target audience; strategic dissemination of results; and use of marketing and sustainability principles for social initiatives. This article investigates how these factors contributed to vertical, horizontal, and global scale-up of the m4RH program. Vertical scale of m4RH is demonstrated in Tanzania, where the early engagement of stakeholders including the Ministry of Health catalyzed expansion of m4RH content and national-level program reach. Ongoing data collection has provided real-time data for decision-making, information about the user base, and peer-reviewed publications, yielding government endorsement and partner hand-off for sustainability of the m4RH platform. Horizontal scale-up and adaptation of m4RH has occurred through expansion to new populations in Rwanda, Uganda, and Tanzania, where best practices for design and implementation of mHealth programs were followed to ensure the platform meets the needs of target populations. m4RH also has been modified and packaged for global scale-up through licensing and toolkit

  10. Do we have the right models for scaling up health services to achieve the Millennium Development Goals?

    Directory of Open Access Journals (Sweden)

    Subramanian Savitha

    2011-12-01

    Full Text Available Abstract Background There is widespread agreement on the need for scaling up in the health sector to achieve the Millennium Development Goals (MDGs. But many countries are not on track to reach the MDG targets. The dominant approach used by global health initiatives promotes uniform interventions and targets, assuming that specific technical interventions tested in one country can be replicated across countries to rapidly expand coverage. Yet countries scale up health services and progress against the MDGs at very different rates. Global health initiatives need to take advantage of what has been learned about scaling up. Methods A systematic literature review was conducted to identify conceptual models for scaling up health in developing countries, with the articles assessed according to the practical concerns of how to scale up, including the planning, monitoring and implementation approaches. Results We identified six conceptual models for scaling up in health based on experience with expanding pilot projects and diffusion of innovations. They place importance on paying attention to enhancing organizational, functional, and political capabilities through experimentation and adaptation of strategies in addition to increasing the coverage and range of health services. These scaling up approaches focus on fostering sustainable institutions and the constructive engagement between end users and the provider and financing organizations. Conclusions The current approaches to scaling up health services to reach the MDGs are overly simplistic and not working adequately. Rather than relying on blueprint planning and raising funds, an approach characteristic of current global health efforts, experience with alternative models suggests that more promising pathways involve "learning by doing" in ways that engage key stakeholders, uses data to address constraints, and incorporates results from pilot projects. Such approaches should be applied to current

  11. Do we have the right models for scaling up health services to achieve the Millennium Development Goals?

    Science.gov (United States)

    Subramanian, Savitha; Naimoli, Joseph; Matsubayashi, Toru; Peters, David H

    2011-12-14

    There is widespread agreement on the need for scaling up in the health sector to achieve the Millennium Development Goals (MDGs). But many countries are not on track to reach the MDG targets. The dominant approach used by global health initiatives promotes uniform interventions and targets, assuming that specific technical interventions tested in one country can be replicated across countries to rapidly expand coverage. Yet countries scale up health services and progress against the MDGs at very different rates. Global health initiatives need to take advantage of what has been learned about scaling up. A systematic literature review was conducted to identify conceptual models for scaling up health in developing countries, with the articles assessed according to the practical concerns of how to scale up, including the planning, monitoring and implementation approaches. We identified six conceptual models for scaling up in health based on experience with expanding pilot projects and diffusion of innovations. They place importance on paying attention to enhancing organizational, functional, and political capabilities through experimentation and adaptation of strategies in addition to increasing the coverage and range of health services. These scaling up approaches focus on fostering sustainable institutions and the constructive engagement between end users and the provider and financing organizations. The current approaches to scaling up health services to reach the MDGs are overly simplistic and not working adequately. Rather than relying on blueprint planning and raising funds, an approach characteristic of current global health efforts, experience with alternative models suggests that more promising pathways involve "learning by doing" in ways that engage key stakeholders, uses data to address constraints, and incorporates results from pilot projects. Such approaches should be applied to current strategies to achieve the MDGs.

  12. Scale-up of nature’s tissue weaving algorithms to engineer advanced functional materials

    Science.gov (United States)

    Ng, Joanna L.; Knothe, Lillian E.; Whan, Renee M.; Knothe, Ulf; Tate, Melissa L. Knothe

    2017-01-01

    We are literally the stuff from which our tissue fabrics and their fibers are woven and spun. The arrangement of collagen, elastin and other structural proteins in space and time embodies our tissues and organs with amazing resilience and multifunctional smart properties. For example, the periosteum, a soft tissue sleeve that envelops all nonarticular bony surfaces of the body, comprises an inherently “smart” material that gives hard bones added strength under high impact loads. Yet a paucity of scalable bottom-up approaches stymies the harnessing of smart tissues’ biological, mechanical and organizational detail to create advanced functional materials. Here, a novel approach is established to scale up the multidimensional fiber patterns of natural soft tissue weaves for rapid prototyping of advanced functional materials. First second harmonic generation and two-photon excitation microscopy is used to map the microscopic three-dimensional (3D) alignment, composition and distribution of the collagen and elastin fibers of periosteum, the soft tissue sheath bounding all nonarticular bone surfaces in our bodies. Then, using engineering rendering software to scale up this natural tissue fabric, as well as multidimensional weaving algorithms, macroscopic tissue prototypes are created using a computer-controlled jacquard loom. The capacity to prototype scaled up architectures of natural fabrics provides a new avenue to create advanced functional materials.

  13. Comparison of patient comprehension of rapid HIV pre-test fundamentals by information delivery format in an emergency department setting

    Directory of Open Access Journals (Sweden)

    Clark Melissa A

    2007-09-01

    Full Text Available Abstract Background Two trials were conducted to compare emergency department patient comprehension of rapid HIV pre-test information using different methods to deliver this information. Methods Patients were enrolled for these two trials at a US emergency department between February 2005 and January 2006. In Trial One, patients were randomized to a no pre-test information or an in-person discussion arm. In Trial Two, a separate group of patients were randomized to an in-person discussion arm or a Tablet PC-based video arm. The video, "Do you know about rapid HIV testing?", and the in-person discussion contained identical Centers for Disease Control and Prevention-suggested pre-test information components as well as information on rapid HIV testing with OraQuick®. Participants were compared by information arm on their comprehension of the pre-test information by their score on a 26-item questionnaire using the Wilcoxon rank-sum test. Results In Trial One, 38 patients completed the no-information arm and 31 completed the in-person discussion arm. Of these 69 patients, 63.8% had twelve years or fewer of formal education and 66.7% had previously been tested for HIV. The mean score on the questionnaire for the in-person discussion arm was higher than for the no information arm (18.7 vs. 13.3, p ≤ 0.0001. In Trial Two, 59 patients completed the in-person discussion and 55 completed the video arms. Of these 114 patients, 50.9% had twelve years or fewer of formal education and 68.4% had previously been tested for HIV. The mean score on the questionnaire for the video arm was similar to the in-person discussion arm (20.0 vs. 19.2; p ≤ 0.33. Conclusion The video "Do you know about rapid HIV testing?" appears to be an acceptable substitute for an in-person pre-test discussion on rapid HIV testing with OraQuick®. In terms of adequately informing ED patients about rapid HIV testing, either form of pre-test information is preferable than for patients

  14. Tissue strands as "bioink" for scale-up organ printing.

    Science.gov (United States)

    Yu, Yin; Ozbolat, Ibrahim T

    2014-01-01

    Organ printing, takes tissue spheroids as building blocks together with additive manufacturing technique to engineer tissue or organ replacement parts. Although a wide array of cell aggregation techniques has been investigated, and gained noticeable success, the application of tissue spheroids for scale-up tissue fabrication is still worth investigation. In this paper, we introduce a new micro-fabrication technique to create tissue strands at the scale of 500-700μm as a "bioink" for future robotic tissue printing. Printable alginate micro-conduits are used as semi-permeable capsules for tissue strand fabrication. Mouse insulinoma beta TC3 cell tissue strands were formed upon 4 days post fabrication with reasonable mechanical strength, high cell viability close to 90%, and tissue specific markers expression. Fusion was readily observed between strands when placing them together as early as 24h. Also, tissue strands were deposited with human umbilical vein smooth muscle cells (HUVSMCs) vascular conduits together to fabricated miniature pancreatic tissue analog. Our study provided a novel technique using tissue strands as "bioink" for scale-up bioprinting of tissues or organs.

  15. Cutting edge: Rapid recovery of NKT cells upon institution of highly active antiretroviral therapy for HIV-1 infection

    NARCIS (Netherlands)

    van der Vliet, Hans J. J.; van Vonderen, Marit G. A.; Molling, Johan W.; Bontkes, Hetty J.; Reijm, Martine; Reiss, Peter; van Agtmael, Michiel A.; Danner, Sven A.; van den Eertwegh, Alfons J. M.; von Blomberg, B. Mary E.; Scheper, Rik J.

    2006-01-01

    CD1d-restricted NKT cells play important regulatory roles in various immune responses and are rapidly and selectively depleted upon infection with HIV-1. The cause of this selective depletion is incompletely understood, although it is in part due to the high susceptibility of CD4+ NKT cells to

  16. Comparative effectiveness of single and dual rapid diagnostic tests for syphilis and HIV in antenatal care services in Colombia

    Directory of Open Access Journals (Sweden)

    Hernando Guillermo Gaitán-Duarte

    Full Text Available ABSTRACT Objective To assess the effectiveness of a dual rapid test compared to a single rapid test for syphilis and HIV screening. Methods A cluster-randomized open-label clinical trial was performed in 12 public antenatal care (ANC centers in the cities of Bogotá and Cali, Colombia. Pregnant women who were over 14 years of age at their first antenatal visit and who had not been previously tested for HIV and syphilis during the current pregnancy were included. Pregnant women were randomized to single HIV and single syphilis rapid diagnostic tests (Arm A or to dual HIV and syphilis rapid diagnostic tests (Arm B. The four main outcomes measured were: (1 acceptability of the test, (2 uptake in testing, (3 treatment on the same day (that is, timely treatment, and (4 treatment at any time for positive rapid test cases. Bivariate and multivariate analyses were calculated to adjust for the clustering effect and the period. Results A total of 1 048 patients were analyzed in Arm A, and 1 166 in Arm B. Acceptability of the rapid tests was 99.8% in Arm A and 99.6% in Arm B. The prevalence of positive rapid tests was 2.21% for syphilis and 0.36% for HIV. Timely treatment was provided to 20 of 29 patients (69% in Arm A and 16 of 20 patients (80% in Arm B (relative risk (RR, 1.10; 95% confidence interval (CI: (1.00 −1.20. Treatment at any time was given to 24 of 29 patients (83% in Arm A and to 20 of 20 (100% in Arm B (RR, 1.11; 95% CI: 1.01−1.22. Conclusions There were no differences in patient acceptability, testing and timely treatment between dual rapid tests and single rapid tests for HIV and syphilis screening in the ANC centers. Same-day treatment depends also on the interpretation of and confidence in the results by the health providers.

  17. Counting hard-to-count populations: the network scale-up method for public health

    Science.gov (United States)

    Bernard, H Russell; Hallett, Tim; Iovita, Alexandrina; Johnsen, Eugene C; Lyerla, Rob; McCarty, Christopher; Mahy, Mary; Salganik, Matthew J; Saliuk, Tetiana; Scutelniciuc, Otilia; Shelley, Gene A; Sirinirund, Petchsri; Weir, Sharon

    2010-01-01

    Estimating sizes of hidden or hard-to-reach populations is an important problem in public health. For example, estimates of the sizes of populations at highest risk for HIV and AIDS are needed for designing, evaluating and allocating funding for treatment and prevention programmes. A promising approach to size estimation, relatively new to public health, is the network scale-up method (NSUM), involving two steps: estimating the personal network size of the members of a random sample of a total population and, with this information, estimating the number of members of a hidden subpopulation of the total population. We describe the method, including two approaches to estimating personal network sizes (summation and known population). We discuss the strengths and weaknesses of each approach and provide examples of international applications of the NSUM in public health. We conclude with recommendations for future research and evaluation. PMID:21106509

  18. The Problem of Late ART initiation in Sub-Saharan Africa: A Transient Aspect of Scale-up or a Long-term Phenomenon?

    Science.gov (United States)

    Lahuerta, Maria; Ue, Frances; Hoffman, Susie; Elul, Batya; Kulkarni, Sarah Gorrell; Wu, Yingfeng; Nuwagaba-Biribonwoha, Harriet; Remien, Robert H.; Sadr, Wafaa El; Nash, Denis

    2013-01-01

    Efforts to scale-up HIV care and treatment have been successful at initiating large numbers of patients onto antiretroviral therapy (ART), although persistent challenges remain to optimizing scale-up effectiveness in both resource-rich and resource-limited settings. Among the most important are very high rates of ART initiation in the advanced stages of HIV disease, which in turn drive morbidity, mortality, and onward transmission of HIV. With a focus on sub-Saharan Africa, this review article presents a conceptual framework for a broader discussion of the persistent problem of late ART initiation, including a need for more focus on the upstream precursors (late HIV diagnosis and late enrollment into HIV care) and their determinants. Without additional research and identification of multilevel interventions that successfully promote earlier initiation of ART, the problem of late ART initiation will persist, significantly undermining the long-term impact of HIV care scale-up on reducing mortality and controlling the HIV epidemic. PMID:23377739

  19. HIV-1 drug resistance mutations among antiretroviral-naive HIV-1-infected patients in Asia: results from the TREAT Asia Studies to Evaluate Resistance-Monitoring Study.

    Science.gov (United States)

    Sungkanuparph, Somnuek; Oyomopito, Rebecca; Sirivichayakul, Sunee; Sirisanthana, Thira; Li, Patrick C K; Kantipong, Pacharee; Lee, Christopher K C; Kamarulzaman, Adeeba; Messerschmidt, Liesl; Law, Matthew G; Phanuphak, Praphan

    2011-04-15

    Of 682 antiretroviral-naïve patients initiating antiretroviral therapy in a prospective, multicenter human immunodeficiency virus type 1 (HIV-1) drug resistance monitoring study involving 8 sites in Hong Kong, Malaysia, and Thailand, the prevalence of patients with ≥1 drug resistance mutation was 13.8%. Primary HIV drug resistance is emerging after rapid scaling-up of antiretroviral therapy use in Asia.

  20. A Case Study with Green Dot Public Schools on Managing the Tension between Fidelity and Adaptation When Scaling-Up

    Science.gov (United States)

    Cevallos, Pedro F., Jr.

    2009-01-01

    This dissertation was a single case study with Green Dot Public Schools (GDPS) describing their rapid scale-up process. Specifically, it investigates the phenomenon of the inherent tension between maintaining the fidelity of the original model school's design, culture and values with local adaptation of the brand by stakeholders at the expansion…

  1. The reality of scaling up antiretroviral therapy in South Africa

    African Journals Online (AJOL)

    2015-07-02

    Jul 2, 2015 ... We situate a universal test and treat strategy within the governance, fiscal, ... test and treat strategy mean that this option is problematic in the short term. ... smart phone or mobile device to read online. Introduction. South Africa currently has the world's highest national incidence of HIV and AIDS, with 6.4.

  2. ORIGINAL ARTICLES Financial and economic costs of scaling up ...

    African Journals Online (AJOL)

    provision of free HAART to HIV-infected health professionals should be .... additional working hours is a fixed labour cost (of R55 799 per year). Estimates of staff .... tend to be unreliable as they are often partially completed, long after the actual ...

  3. Bioprinting scale-up tissue and organ constructs for transplantation.

    Science.gov (United States)

    Ozbolat, Ibrahim T

    2015-07-01

    Bioprinting is an emerging field that is having a revolutionary impact on the medical sciences. It offers great precision for the spatial placement of cells, proteins, genes, drugs, and biologically active particles to better guide tissue generation and formation. This emerging biotechnology appears to be promising for advancing tissue engineering toward functional tissue and organ fabrication for transplantation, drug testing, research investigations, and cancer or disease modeling, and has recently attracted growing interest worldwide among researchers and the general public. In this Opinion, I highlight possibilities for the bioprinting scale-up of functional tissue and organ constructs for transplantation and provide the reader with alternative approaches, their limitations, and promising directions for new research prospects. Copyright © 2015 Elsevier Ltd. All rights reserved.

  4. Microbial bioelectrosynthesis of hydrogen: Current challenges and scale-up.

    Science.gov (United States)

    Kitching, Michael; Butler, Robin; Marsili, Enrico

    2017-01-01

    Sustainable energy supplies are needed to supplement and eventually replace fossil fuels. Molecular hydrogen H 2 is a clean burning, high-energy fuel that is also used as reducing gas in industrial processes. H 2 is mainly synthesized by steam reforming of natural gas, a non-renewable fuel. There are biosynthetic strategies for H 2 production; however, they are associated with poor yield and have high cost. The application of an electrochemical driving force in a microbial electrolysis cell (MEC) improves the yield of biological reactions. The performance of the MEC is influenced by experimental parameters such as the electrode material, reactor design, microbial consortia and the substrate. In this review, factors that affect the performance of MECs are discussed and critically analysed. The potential for scale-up of H 2 bioelectrosynthesis is also discussed. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Scaling up biomass gasifier use: an application-specific approach

    International Nuclear Information System (INIS)

    Ghosh, Debyani; Sagar, Ambuj D.; Kishore, V.V.N.

    2006-01-01

    Biomass energy accounts for about 11% of the global primary energy supply, and it is estimated that about 2 billion people worldwide depend on biomass for their energy needs. Yet, most of the use of biomass is in a primitive and inefficient manner, primarily in developing countries, leading to a host of adverse implications on human health, environment, workplace conditions, and social well being. Therefore, the utilization of biomass in a clean and efficient manner to deliver modern energy services to the world's poor remains an imperative for the development community. One possible approach to do this is through the use of biomass gasifiers. Although significant efforts have been directed towards developing and deploying biomass gasifiers in many countries, scaling up their dissemination remains an elusive goal. Based on an examination of biomass gasifier development, demonstration, and deployment efforts in India-a country with more than two decades of experiences in biomass gasifier development and dissemination, this article identifies a number of barriers that have hindered widespread deployment of biomass gasifier-based energy systems. It also suggests a possible approach for moving forward, which involves a focus on specific application areas that satisfy a set of criteria that are critical to deployment of biomass gasifiers, and then tailoring the scaling up strategy to the characteristics of the user groups for that application. Our technical, financial, economic and institutional analysis suggests an initial focus on four categories of applications-small and medium enterprises, the informal sector, biomass-processing industries, and some rural areas-may be particularly feasible and fruitful

  6. Scaling up ART adherence clubs in the public sector health system in the Western Cape, South Africa: a study of the institutionalisation of a pilot innovation.

    Science.gov (United States)

    MacGregor, Hayley; McKenzie, Andrew; Jacobs, Tanya; Ullauri, Angelica

    2018-04-25

    In 2011, a decision was made to scale up a pilot innovation involving 'adherence clubs' as a form of differentiated care for HIV positive people in the public sector antiretroviral therapy programme in the Western Cape Province of South Africa. In 2016 we were involved in the qualitative aspect of an evaluation of the adherence club model, the overall objective of which was to assess the health outcomes for patients accessing clubs through epidemiological analysis, and to conduct a health systems analysis to evaluate how the model of care performed at scale. In this paper we adopt a complex adaptive systems lens to analyse planned organisational change through intervention in a state health system. We explore the challenges associated with taking to scale a pilot that began as a relatively simple innovation by a non-governmental organisation. Our analysis reveals how a programme initially representing a simple, unitary system in terms of management and clinical governance had evolved into a complex, differentiated care system. An innovation that was assessed as an excellent idea and received political backing, worked well whilst supported on a small scale. However, as scaling up progressed, challenges have emerged at the same time as support has waned. We identified a 'tipping point' at which the system was more likely to fail, as vulnerabilities magnified and the capacity for adaptation was exceeded. Yet the study also revealed the impressive capacity that a health system can have for catalysing novel approaches. We argue that innovation in largescale, complex programmes in health systems is a continuous process that requires ongoing support and attention to new innovation as challenges emerge. Rapid scaling up is also likely to require recourse to further resources, and a culture of iterative learning to address emerging challenges and mitigate complex system errors. These are necessary steps to the future success of adherence clubs as a cornerstone of

  7. 77 FR 25469 - Applications for New Awards; Investing in Innovation Fund, Scale-Up Grants

    Science.gov (United States)

    2012-04-30

    ... DEPARTMENT OF EDUCATION Applications for New Awards; Investing in Innovation Fund, Scale- Up Grants Catalog of Federal Domestic Assistance (CFDA) Number: 84.411A (Scale-up grants). AGENCY: Office of... fiscal year 2012 for the Investing in Innovation (i3) Scale-up grant competition (March 27 i3 Scale-up...

  8. Feasibility and acceptability of rapid HIV screening in a labour ward in Togo

    Science.gov (United States)

    Ekouevi, Didier K; Kariyiare, Benjamin G; Coffie, Patrick A; Jutand, Marthe-Aline; Akpadza, Koffi; Lawson-Evi, Annette; Tatagan, Albert; Dabis, François; Sibe, Mathieu; Pitche, Vincent P; Becquet, Renaud; David, Mireille

    2012-01-01

    Background HIV screening in a labour ward is the last opportunity to initiate an antiretroviral prophylaxis among pregnant women living with HIV to prevent mother-to-child HIV transmission. Little is known about the feasibility and acceptability of HIV screening during labour in West Africa. Findings A cross-sectional survey was conducted in the labour ward at the Tokoin Teaching Hospital in Lomé (Togo) between May and August 2010. Pregnant women admitted for labour were randomly selected to enter the study and were interviewed on the knowledge of their HIV status. Clinical and biological data were collected from the individual maternal health chart. HIV testing or re-testing was systematically proposed to all pregnant women. Among 1530 pregnant women admitted for labour, 508 (32.2%) were included in the study. Information on HIV screening was available in the charts of 359 women (71%). Overall, 467 women accepted HIV testing in the labour ward (92%). The HIV prevalence was 8.8% (95% confidence interval: 6.4 to 11.7%). Among the 41 women diagnosed as living with HIV during labour, 34% had not been tested for HIV during pregnancy and were missed opportunities. Antiretroviral prophylaxis had been initiated antenatally for 24 women living with HIV and 17 in the labour room. Conclusions This study is the first to show in West Africa that HIV testing in a labour room is feasible and well accepted by pregnant women. HIV screening in labour rooms needs to be routinely implemented to reduce missed opportunities for intervention aimed at HIV care and prevention, especially PMTCT. PMID:22905362

  9. Domestic biogas diffusion in Rwanda - Key learning for scale up

    International Nuclear Information System (INIS)

    2016-03-01

    The NGO Veterinaires Sans Frontieres Belgium (VSF-B) supports local populations to improve livestock keeping and other related aspects such as natural resources management and micro-loans. In 2013, ENEA conducted a study to assess the opportunity for VSF-B to include domestic biogas energy within its scope of activities in Rwanda. In 2014, VSF-B launched the EVE project to install 100 bio-digesters and provide capacity building to smallholder farmers in Southern Rwanda within 3 years. The project is strongly integrated to the local context, partnering with a local federation of farmers, IMBARAGA, to implement the project, and leveraging the Rwandan National Domestic Biogas Program (NDBP). In mid-2015, ENEA conducted a new study to provide VSF-B with an intermediate evaluation of the project, a preliminary assessment of its impacts as well as recommendations to scale-up. VSF-B / IMBARAGA's activity on biogas within the EVE project is successful thanks to an efficient approach combining sensitisation and financial and technical support. By September 2015, half of the target of the pilot phase had been reached - 50 biogas systems were installed or under construction - and the remaining half was likely to be reached by the end of the project. This is the result of an efficient approach for domestic biogas distribution set up by VSF-B / IMBARAGA. Intensive work of sensitisation of farmers combined with an adapted financial support scheme (additional subsidies and guarantee funds for credit) and with technical support and monitoring of farmers are the three pillars on which VSF-B / IMBARAGA's success is based. End-users are highly satisfied of biogas systems and use, thanks to the robustness of the technology and the various outcomes delivered. Although the initial levers for biogas adoption by farmers were fuel savings and convenience to cook, other outcomes appears to be as meaningful to them once they start using the system: increased convenience to boil water or milk

  10. Shifting Patterns of the HIV Epidemic in Southwest China: A Case Study Based on Sentinel Surveillance, 1995-2012.

    Science.gov (United States)

    Chow, Eric P F; Gao, Liangmin; Chen, Liang; Jing, Jun; Zhang, Lei

    2015-06-01

    The HIV epidemic is experiencing a rapid shift in transmission profile in China. This study aims to examine the changes in magnitude, transmission pattern, and trend of the HIV epidemic in a typical Southwest Chinese prefecture over the period of 1995-2012. HIV surveillance data from the web-based reporting system were analyzed during this period. We investigated the temporal trends in the changing characteristics of HIV transmission, the HIV disease burden in key affected populations, and assessed the impacts on HIV disease progression due to scale-up of antiretroviral treatment. A total of 3556 HIV/AIDS cases were reported in Yuxi prefecture, Yunnan, over the study period. The number of HIV tests conducted has dramatically increased from 1041 in 1995 to 247,859 in 2012, resulting in a substantial increase in HIV diagnoses from 11 cases to 327 cases over the same period. Since 2005, cumulatively 1250 eligible people living with HIV (PLHIV) have received combination antiretroviral therapy which reduced AIDS disease progression from 9.0% (95% CI: 6.7-11.4%) in 1995 to 0.1% (0-0.3%) in 2012 (ptrend=0.0002). The primary mode of HIV transmission has been shifted from injection sharing (71.9% diagnoses in 1995-2004) to unsafe sexual contacts (82.6% diagnoses in 2012). Yuxi prefecture is experiencing a concentrated but shifting HIV epidemic. Scale-up of HIV testing is essential to effective sentinel surveillance and enhancing early diagnosis and treatment in PLHIV.

  11. Post-marketing surveillance of OraQuick whole blood and oral fluid rapid HIV testing.

    Science.gov (United States)

    Wesolowski, Laura G; MacKellar, Duncan A; Facente, Shelley N; Dowling, Teri; Ethridge, Steven F; Zhu, Julia H; Sullivan, Patrick S

    2006-08-01

    Post-marketing surveillance was conducted to monitor the performance of the OraQuick Advance rapid HIV-1/2 antibody test (OraQuick) on whole blood and oral fluid. Surveillance of routinely collected data on clients tested with OraQuick in 368 testing sites affiliated with 17 state and city health departments between 11 August 2004 and 30 June 2005. For whole blood and oral fluid, we report the median (range) health department OraQuick specificity and positive predictive value (PPV), and the number of clients with discordant results (e.g. who had a reactive rapid test not confirmed positive by Western blot or indirect immunofluorescence). At one site with lower than expected oral-fluid specificity, we evaluated whether device expiration, manufacturing lot, operator practices, or device-storage or testing-area temperatures were associated with false-positive tests. During the surveillance period, 135 724 whole blood and 26 066 oral fluid rapid tests were conducted. The median health department whole blood OraQuick specificity was 99.98% (range: 99.73-100%) and PPV was 99.24% (range: 66.67-100%); the median oral fluid specificity was 99.89% (range: 99.44-100%) and PPV was 90.00% (range: 50.00-100%). A total of 124 discordant results were reported from 68 (0.05%) whole blood and 56 (0.22%) oral fluid rapid tests. The oral fluid specificity at the site with excess oral fluid false-positive tests was 98.7% (95% confidence interval: 98.18-99.11%). The increase in false-positive tests at that site was not associated with any specific device characteristic, operator procedure or temperature condition. The specificity of OraQuick performed on whole blood and oral fluid during post-marketing surveillance was compatible with the manufacturer's claim within the package insert. However, one site experienced lower than expected oral fluid specificity. Sites that observe that the specificity of OraQuick is lower than the range indicated in the package insert should notify the

  12. Scaling up: Assessing social impacts at the macro-scale

    International Nuclear Information System (INIS)

    Schirmer, Jacki

    2011-01-01

    Social impacts occur at various scales, from the micro-scale of the individual to the macro-scale of the community. Identifying the macro-scale social changes that results from an impacting event is a common goal of social impact assessment (SIA), but is challenging as multiple factors simultaneously influence social trends at any given time, and there are usually only a small number of cases available for examination. While some methods have been proposed for establishing the contribution of an impacting event to macro-scale social change, they remain relatively untested. This paper critically reviews methods recommended to assess macro-scale social impacts, and proposes and demonstrates a new approach. The 'scaling up' method involves developing a chain of logic linking change at the individual/site scale to the community scale. It enables a more problematised assessment of the likely contribution of an impacting event to macro-scale social change than previous approaches. The use of this approach in a recent study of change in dairy farming in south east Australia is described.

  13. Challenges and Opportunities in Scaling-Up Nutrition in Healthcare

    Directory of Open Access Journals (Sweden)

    Ian Darnton-Hill

    2015-01-01

    Full Text Available Healthcare continues to be in a state of flux; conventionally, this provides opportunities and challenges. The opportunities include technological breakthroughs, improved economies and increasing availability of healthcare. On the other hand, economic disparities are increasing and leading to differing accessibility to healthcare, including within affluent countries. Nutrition has received an increase in attention and resources in recent decades, a lot of it stimulated by the rise in obesity, type 2 diabetes mellitus and hypertension. An increase in ageing populations also has meant increased interest in nutrition-related chronic diseases. In many middle-income countries, there has been an increase in the double burden of malnutrition with undernourished children and overweight/obese parents and adolescents. In low-income countries, an increased evidence base has allowed scaling-up of interventions to address under-nutrition, both nutrition-specific and nutrition-sensitive interventions. Immediate barriers (institutional, structural and biological and longer-term barriers (staffing shortages where most needed and environmental impacts on health are discussed. Significant barriers remain for the near universal access to healthcare, especially for those who are socio-economically disadvantaged, geographically isolated, living in war zones or where environmental damage has taken place. However, these barriers are increasingly being recognized, and efforts are being made to address them. The paper aims to take a broad view that identifies and then comments on the many social, political and scientific factors affecting the achievement of improved nutrition through healthcare.

  14. Fungal biosynthesis of gold nanoparticles: mechanism and scale up.

    Science.gov (United States)

    Kitching, Michael; Ramani, Meghana; Marsili, Enrico

    2015-11-01

    Gold nanoparticles (AuNPs) are a widespread research tool because of their oxidation resistance, biocompatibility and stability. Chemical methods for AuNP synthesis often produce toxic residues that raise environmental concern. On the other hand, the biological synthesis of AuNPs in viable microorganisms and their cell-free extracts is an environmentally friendly and low-cost process. In general, fungi tolerate higher metal concentrations than bacteria and secrete abundant extracellular redox proteins to reduce soluble metal ions to their insoluble form and eventually to nanocrystals. Fungi harbour untapped biological diversity and may provide novel metal reductases for metal detoxification and bioreduction. A thorough understanding of the biosynthetic mechanism of AuNPs in fungi is needed to reduce the time of biosynthesis and to scale up the AuNP production process. In this review, we describe the known mechanisms for AuNP biosynthesis in viable fungi and fungal protein extracts and discuss the most suitable bioreactors for industrial AuNP biosynthesis. © 2014 The Authors. Microbial Biotechnology published by John Wiley & Sons Ltd and Society for Applied Microbiology.

  15. Progesterone lipid nanoparticles: Scaling up and in vivo human study.

    Science.gov (United States)

    Esposito, Elisabetta; Sguizzato, Maddalena; Drechsler, Markus; Mariani, Paolo; Carducci, Federica; Nastruzzi, Claudio; Cortesi, Rita

    2017-10-01

    This investigation describes a scaling up study aimed at producing progesterone containing nanoparticles in a pilot scale. Particularly hot homogenization techniques based on ultrasound homogenization or high pressure homogenization have been employed to produce lipid nanoparticles constituted of tristearin or tristearin in association with caprylic-capric triglyceride. It was found that the high pressure homogenization method enabled to obtain nanoparticles without agglomerates and smaller mean diameters with respect to ultrasound homogenization method. X-ray characterization suggested a lamellar structural organization of both type of nanoparticles. Progesterone encapsulation efficiency was almost 100% in the case of high pressure homogenization method. Shelf life study indicated a double fold stability of progesterone when encapsulated in nanoparticles produced by the high pressure homogenization method. Dialysis and Franz cell methods were performed to mimic subcutaneous and skin administration. Nanoparticles constituted of tristearin in mixture with caprylic/capric triglyceride display a slower release of progesterone with respect to nanoparticles constituted of pure tristearin. Franz cell evidenced a higher progesterone skin uptake in the case of pure tristearin nanoparticles. A human in vivo study, based on tape stripping, was conducted to investigate the performance of nanoparticles as progesterone skin delivery systems. Tape stripping results indicated a decrease of progesterone concentration in stratum corneum within six hours, suggesting an interaction between nanoparticle material and skin lipids. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. HWCVD of polymers: Commercialization and scale-up

    International Nuclear Information System (INIS)

    Pryce Lewis, Hilton G.; Bansal, Neeta P.; White, Aleksandr J.; Handy, Erik S.

    2009-01-01

    GVD Corporation specializes in process development and equipment design for the production of ultra-thin polymer coatings using hot wire chemical vapor deposition (HWCVD, also known as initiated chemical vapor deposition, iCVD). HWCVD allows many coating compositions to be produced, including fluorocarbon and silicone polymers, copolymers, and vinyl hydrocarbon polymers. It is especially valuable for creating ultra-thin layers of insoluble, infusible polymers which are hard to process by conventional means, such as polytetrafluoroethylene (PTFE, Teflon. HWCVD PTFE coatings are chemically robust, comprised of essentially 100% CF 2 , resistant to solvents, conformal to complex surface geometry, and have excellent adhesion to a wide range of substrates. Since the part to be coated remains at room temperature, fragile materials like plastics and fabrics can be coated with ease. GVD has focused on scale-up of the process equipment and has developed several standard coating systems, which will be discussed in this paper. These include laboratory-scale batch coating systems, a medium sized production batch coating system, a large scale custom batch coater, and a pilot scale roll-to-roll web coater. All of GVD's systems are complete with fully automated, computer based control systems and include options for effluent monitors and an exhaust scrubber.

  17. Polyethylene encapsulation of mixed wastes: Scale-up feasibility

    International Nuclear Information System (INIS)

    Kalb, P.D.; Heiser, J.H.; Colombo, P.

    1991-01-01

    A polyethylene process for the improved encapsulation of radioactive, hazardous, and mixed wastes have been developed at Brookhaven National Laboratory (BNL). Improvements in waste loading and waste form performance have been demonstrated through bench-scale development and testing. Maximum waste loadings of up to 70 dry wt % mixed waste nitrate salt were achieved, compared with 13--20 dry wt % using conventional cement processes. Stability under anticipated storage and disposal conditions and compliance with applicable hazardous waste regulations were demonstrated through a series of lab-scale waste form performance tests. Full-scale demonstration of this process using actual or surrogate waste is currently planned. A scale-up feasibility test was successfully conducted, demonstrating the ability to process nitrate salts at production rates (up to 450 kg/hr) and the close agreement between bench- and full-scale process parameters. Cored samples from the resulting pilot-scale (114 liter) waste form were used to verify homogeneity and to provide additional specimens for confirmatory performance testing

  18. Differing Experiences with Pre-Exposure Prophylaxis in Boston Among Lesbian, Gay, Bisexual, and Transgender Specialists and Generalists in Primary Care: Implications for Scale-Up.

    Science.gov (United States)

    Krakower, Douglas S; Ware, Norma C; Maloney, Kevin M; Wilson, Ira B; Wong, John B; Mayer, Kenneth H

    2017-07-01

    The Centers for Disease Control and Prevention estimates that one in four sexually active men who have sex with men (MSM) could decrease their HIV risk by using HIV pre-exposure prophylaxis (PrEP). Because many MSM access healthcare from primary care providers (PCPs), these clinicians could play an important role in providing access to PrEP. Semistructured qualitative interviews were conducted with 31 PCPs in Boston, MA, to explore how they approach decisions about prescribing PrEP to MSM and their experiences with PrEP provision. Purposive sampling included 12 PCPs from an urban community health center specializing in the care of lesbian, gay, bisexual, and transgender persons ("LGBT specialists") and 19 PCPs from a general academic medical center ("generalists"). Analyses utilized an inductive approach to identify emergent themes. Both groups of PCPs approached prescribing decisions about PrEP as a process of informed decision-making with patients. Providers would defer to patients' preferences if they were unsure about the appropriateness of PrEP. LGBT specialists and generalists were at vastly different stages of adopting PrEP into practice. For LGBT specialists, PrEP was a disruptive innovation that rapidly became normative in practice. Generalists had limited experience with PrEP; however, they desired succinct decision-support tools to help them achieve proficiency, because they considered preventive medicine to be central to their professional role. As generalists vastly outnumber LGBT specialists in the United States, interventions to support PrEP provision by generalists could accelerate the scale-up of PrEP for MSM nationally, which could in turn decrease HIV incidence for this priority population.

  19. Rapid testing may not improve uptake of HIV testing and same day results in a rural South African community: a cohort study of 12,000 women.

    Directory of Open Access Journals (Sweden)

    Ntombizodumo B Mkwanazi

    Full Text Available Rapid testing of pregnant women aims to increase uptake of HIV testing and results and thus optimize care. We report on the acceptability of HIV counselling and testing, and uptake of results, before and after the introduction of rapid testing in this area.HIV counsellors offered counselling and testing to women attending 8 antenatal clinics, prior to enrolment into a study examining infant feeding and postnatal HIV transmission. From August 2001 to April 2003, blood was sent for HIV ELISA testing in line with the Prevention of Mother-to-Child Transmission (PMTCT programme in the district. From May 2003 to September 2004 women were offered a rapid HIV test as part of the PMTCT programme, but also continued to have ELISA testing for study purposes. Of 12,323 women counselled, 5,879 attended clinic prior to May 2003, and 6,444 after May 2003 when rapid testing was introduced; of whom 4,324 (74.6% and 4,810 (74.6% agreed to have an HIV test respectively. Of the 4,810 women who had a rapid HIV test, only 166 (3.4% requested to receive their results on the same day as testing, the remainder opted to return for results at a later appointment. Women with secondary school education were less likely to agree to testing than those with no education (AOR 0.648, p35 years (AOR 0.756, p<0.01 compared to those <20 years.Contrary to other reports, few women who had rapid tests accepted their HIV results the same day. Finding strategies to increase the proportion of pregnant women knowing their HIV results is critical so that appropriate care can be given.

  20. Scale-up issues of CIGS thin film PV modules

    Energy Technology Data Exchange (ETDEWEB)

    Dhere, Neelkanth G. [Florida Solar Energy Center, 1679 Clearlake Road, Cocoa, FL 32922 (United States)

    2011-01-15

    Photovoltaics cost has been declining following a 70% learning curve. Now the challenge is to bring down the cost of solar electricity to make it competitive with conventional sources within the next decade. In the long run, the module efficiencies tend to reach 80% of the champion cell efficiencies. Using a semiempirical methodology, it has been shown earlier that while the triple junction a-Si:H thin film technology is competitive, CIGS and CdTe thin film module technologies are highly competitive and presently offer the best approach for significantly exceeding the cost/performance levels of standard and non-standard crystalline Si PV technologies. Since 2006, the production of thin film solar cell in the U.S. has surpassed that of c-Si. At present, the production of CIGS PV modules lags considerably behind that of CdTe PV modules. This is mainly because of its complexity. Scale-up issues related to various CIGS preparation technologies such as co-evaporation, metallic precursor deposition by magnetron sputtering and non-vacuum techniques such as ink-jet printing, electroplating or doctor-blade technology followed by their selenization/sulfurization are discussed so as to assist the CIGS technology to attain its full potential. Besides the welcome announcements of large volume production, it is essential to achieve the production cost below $1/Wp in the near term and attain production speeds comparable to CdTe production speeds. Comparable production speeds are expected to be achieved within the next decade. This will enable reduction of CIGS module production costs to {proportional_to}65 cents /Wp that would be comparable to the CdTe module projected production cost. Additionally CIGS will have a higher efficiency premium. (author)

  1. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review

    NARCIS (Netherlands)

    Heestermans, Tessa; Browne, Joyce L; Aitken, Susan C; Vervoort, Sigrid C; Klipstein-Grobusch, Kerstin

    2016-01-01

    Objective The rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of

  2. Viral hepatitis and rapid diagnostic test based screening for HBsAg in HIV-infected patients in rural Tanzania.

    Directory of Open Access Journals (Sweden)

    Fabian C Franzeck

    Full Text Available BACKGROUND: Co-infection with hepatitis B virus (HBV is highly prevalent in people living with HIV in Sub-Saharan Africa. Screening for HBV surface antigen (HBsAg before initiation of combination antiretroviral therapy (cART is recommended. However, it is not part of diagnostic routines in HIV programs in many resource-limited countries although patients could benefit from optimized antiretroviral therapy covering both infections. Screening could be facilitated by rapid diagnostic tests for HBsAg. Operating experience with these point of care devices in HIV-positive patients in Sub-Saharan Africa is largely lacking. We determined the prevalence of HBV and Hepatitis C virus (HCV infection as well as the diagnostic accuracy of the rapid test device Determine HBsAg in an HIV cohort in rural Tanzania. METHODS: Prospectively collected blood samples from adult, HIV-1 positive and antiretroviral treatment-naïve patients in the Kilombero and Ulanga antiretroviral cohort (KIULARCO in rural Tanzania were analyzed at the point of care with Determine HBsAg, a reference HBsAg EIA and an anti-HCV EIA. RESULTS: Samples of 272 patients were included. Median age was 38 years (interquartile range [IQR] 32-47, 169/272 (63% subjects were females and median CD4+ count was 250 cells/µL (IQR 97-439. HBsAg was detected in 25/272 (9.2%, 95% confidence interval [CI] 6.2-13.0% subjects. Of these, 7/25 (28% were positive for HBeAg. Sensitivity of Determine HBsAg was rated at 96% (95% CI 82.8-99.6% and specificity at 100% (95% CI, 98.9-100%. Antibodies to HCV (anti-HCV were found in 10/272 (3.7%, 95% CI 2.0-6.4% of patients. CONCLUSION: This study reports a high prevalence of HBV in HIV-positive patients in a rural Tanzanian setting. The rapid diagnostic test Determine HBsAg is an accurate assay for screening for HBsAg in HIV-1 infected patients at the point of care and may further help to guide cART in Sub-Saharan Africa.

  3. Scaling Down to Scale Up: A Health Economic Analysis of Integrating Point-of-Care Syphilis Testing into Antenatal Care in Zambia during Pilot and National Rollout Implementation.

    Directory of Open Access Journals (Sweden)

    Katharine D Shelley

    Full Text Available Maternal syphilis results in an estimated 500,000 stillbirths and neonatal deaths annually in Sub-Saharan Africa. Despite the existence of national guidelines for antenatal syphilis screening, syphilis testing is often limited by inadequate laboratory and staff services. Recent availability of inexpensive rapid point-of-care syphilis tests (RST can improve access to antenatal syphilis screening. A 2010 pilot in Zambia explored the feasibility of integrating RST within prevention of mother-to-child-transmission of HIV services. Following successful demonstration, the Zambian Ministry of Health adopted RSTs into national policy in 2011. Cost data from the pilot and 2012 preliminary national rollout were extracted from project records, antenatal registers, clinic staff interviews, and facility observations, with the aim of assessing the cost and quality implications of scaling up a successful pilot into a national rollout. Start-up, capital, and recurrent cost inputs were collected, including costs of extensive supervision and quality monitoring during the pilot. Costs were analysed from a provider's perspective, incremental to existing antenatal services. Total and unit costs were calculated and a multivariate sensitivity analysis was performed. Our accompanying qualitative study by Ansbro et al. (2015 elucidated quality assurance and supervisory system challenges experienced during rollout, which helped explain key cost drivers. The average unit cost per woman screened during rollout ($11.16 was more than triple the pilot unit cost ($3.19. While quality assurance costs were much lower during rollout, the increased unit costs can be attributed to several factors, including higher RST prices and lower RST coverage during rollout, which reduced economies of scale. Pilot and rollout cost drivers differed due to implementation decisions related to training, supervision, and quality assurance. This study explored the cost of integrating RST into

  4. Male Partner Risk Behaviors Are Associated With Reactive Rapid HIV Antibody Tests Among Pregnant Mexican Women: Implications for Prevention of Vertical and Sexual HIV Transmission in Concentrated HIV Epidemics.

    Science.gov (United States)

    Rivero, Estela; Kendall, Tamil

    2015-01-01

    Mexico's policies on antenatal HIV testing are contradictory, and little is known about social and behavioral characteristics that increase pregnant Mexican women's risks of acquiring HIV. We analyzed the association between risk behaviors reported by pregnant women for themselves and their male partners, and women's rapid HIV antibody test results from a large national sample. Three quarters of pregnant women with a reactive test did not report risk behaviors for themselves and one third did not report risk behaviors for themselves or their male partners. In the retrospective case-control analysis, other than reporting multiple sexual partners, reactive pregnant women reported risk behaviors did not differ from nonreactive women's behaviors. However, reactive pregnant women were significantly more likely to have reported risk behaviors for male partners. Our findings support universal offer of antenatal HIV testing and suggest that HIV prevention for women should focus on reducing risk of HIV acquisition within stable relationships. Copyright © 2015 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.

  5. Institutions and processes for scaling up renewables: Run-of-river hydropower in British Columbia

    International Nuclear Information System (INIS)

    Jaccard, Mark; Melton, Noel; Nyboer, John

    2011-01-01

    The dramatic scale-up of renewable energy over the coming decades is likely to pose significant challenges for coordinating land use allocation, environmental assessment, energy system planning and the design of greenhouse gas abatement policy. Of particular concern is the establishment of institutions and processes that enable consideration of multiple objectives and attributes, with adequate representation of affected interests, and without resulting in excessive delays in the development of renewable energy as part of a greenhouse gas abatement strategy. This paper uses the Canadian province of British Columbia as a case study for describing these challenges and the responses of policy makers seeking to rapidly scale-up renewables. Using evaluative criteria to assess this experience, we identify lessons that may be applicable to other jurisdictions seeking to quickly expand the production of renewable energy. These lessons include the design of institutions and processes that would likely be required in almost any jurisdiction with similar aims. - Research highlights: → Tension exists between mitigating climate change through substantial renewable energy development and the local environmental impacts associated with this development. → The deployment of renewable energy technologies required for climate change mitigation is likely to lead to intensifying conflicts over land-use. → For this deployment to be successful, institutions and processes must be able to integrate and consider trade-offs related to goals and interests at different scales of decision making.

  6. HIV-1 Drug Resistance Mutations Among Antiretroviral-Naïve HIV-1–Infected Patients in Asia: Results From the TREAT Asia Studies to Evaluate Resistance-Monitoring Study

    Science.gov (United States)

    Oyomopito, Rebecca; Sirivichayakul, Sunee; Sirisanthana, Thira; Kantipong, Pacharee; Lee, Christopher K. C.; Kamarulzaman, Adeeba; Messerschmidt, Liesl; Law, Matthew G.; Phanuphak, Praphan

    2011-01-01

    (See editorial commentary by Jordan on pages 1058–1060.) Of 682 antiretroviral-naïve patients initiating antiretroviral therapy in a prospective, multicenter human immunodeficiency virus type 1 (HIV-1) drug resistance monitoring study involving 8 sites in Hong Kong, Malaysia, and Thailand, the prevalence of patients with ≥1 drug resistance mutation was 13.8%. Primary HIV drug resistance is emerging after rapid scaling-up of antiretroviral therapy use in Asia. PMID:21460324

  7. Sex, drugs, and HIV: rapid assessment of HIV risk behaviors among street-based drug using sex workers in Durban, South Africa.

    Science.gov (United States)

    Needle, Richard; Kroeger, Karen; Belani, Hrishikesh; Achrekar, Angeli; Parry, Charles D; Dewing, Sarah

    2008-11-01

    South Africa is experiencing significant changes in patterns of illicit drug use, including increasing injection and non-injection drug use, and the use of drugs by persons engaged in sex work, both of which could further expand the HIV/AIDS epidemic. In 2005, a rapid ethnographic assessment was conducted in Durban, South Africa, to learn more about patterns of drug use and HIV risk behaviors among drug-using, street-based sex workers. Field teams recruited 52 current injection and non-injection drug users for key informant interviews and focus groups, and they conducted mapping and observation in identified high-risk neighborhoods. Key informants were offered free, voluntary counseling and HIV rapid testing. The results of the assessment indicate that in this population, drugs play an organizing role in patterns of daily activities, with sex work closely linked to the buying, selling, and using of drugs. Participants reported using multiple drugs including crack cocaine, heroin, Ecstasy and Mandrax, and their choices were based on their expectations about the functional role and behavioral and pharmacological properties of the drugs. The organization of sex work and patterns of drug use differ by gender, with males exercising more control over daily routines and drug and sexual transactions than females. Activities of female sex workers are subject to considerable control by individual pimps, many of whom also function as landlords and drug dealers. A strong hold over the overlapping economies of drugs and sex work by a few individuals extends to control of the physical and social settings in which sex is exchanged and drugs are sold and used as well as the terms under which sex work is carried out. The potential for accelerated HIV spread is considerable given the evidence of overlapping drug-using and sexual risk behaviors and the mixing patterns across drug and sexual risk networks.

  8. Fluorescent protein-tagged Vpr dissociates from HIV-1 core after viral fusion and rapidly enters the cell nucleus.

    Science.gov (United States)

    Desai, Tanay M; Marin, Mariana; Sood, Chetan; Shi, Jiong; Nawaz, Fatima; Aiken, Christopher; Melikyan, Gregory B

    2015-10-29

    HIV-1 Vpr is recruited into virions during assembly and appears to remain associated with the viral core after the reverse transcription and uncoating steps of entry. This feature has prompted the use of fluorescently labeled Vpr to visualize viral particles and to follow trafficking of post-fusion HIV-1 cores in the cytoplasm. Here, we tracked single pseudovirus entry and fusion and observed that fluorescently tagged Vpr gradually dissociates from post-fusion viral cores over the course of several minutes and accumulates in the nucleus. Kinetics measurements showed that fluorescent Vpr released from the cores very rapidly entered the cell nucleus. More than 10,000 Vpr molecules can be delivered into the cell nucleus within 45 min of infection by HIV-1 particles pseudotyped with the avian sarcoma and leukosis virus envelope glycoprotein. The fraction of Vpr from cell-bound viruses that accumulated in the nucleus was proportional to the extent of virus-cell fusion and was fully blocked by viral fusion inhibitors. Entry of virus-derived Vpr into the nucleus occurred independently of envelope glycoproteins or target cells. Fluorescence correlation spectroscopy revealed two forms of nuclear Vpr-monomers and very large complexes, likely involving host factors. The kinetics of viral Vpr entering the nucleus after fusion was not affected by point mutations in the capsid protein that alter the stability of the viral core. The independence of Vpr shedding of capsid stability and its relatively rapid dissociation from post-fusion cores suggest that this process may precede capsid uncoating, which appears to occur on a slower time scale. Our results thus demonstrate that a bulk of fluorescently labeled Vpr incorporated into HIV-1 particles is released shortly after fusion. Future studies will address the question whether the quick and efficient nuclear delivery of Vpr derived from incoming viruses can regulate subsequent steps of HIV-1 infection.

  9. HIV Rapid Testing in Substance Abuse Treatment: Implementation Following a Clinical Trial

    Science.gov (United States)

    Haynes, L. F.; Korte, J. E.; Holmes, B. E.; Gooden, L.; Matheson, T.; Feaster, D. J.; Leff, J. A.; Wilson, L.; Metsch, L. R.; Schackman, B. R.

    2011-01-01

    The Substance Abuse Mental Health Services Administration has promoted HIV testing and counseling as an evidence-based practice. Nevertheless, adoption of HIV testing in substance abuse treatment programs has been slow. This article describes the experience of a substance abuse treatment agency where, following participation in a clinical trial,…

  10. Drug resistance in HIV patients with virological failure or slow virological response to antiretroviral therapy in Ethiopia

    DEFF Research Database (Denmark)

    Abdissa, Alemseged; Yilma, Daniel; Fonager, Jannik

    2014-01-01

    BACKGROUND: The ongoing scale-up of antiretroviral therapy (ART) in sub-Saharan Africa has prompted the interest in surveillance of transmitted and acquired HIV drug resistance. Resistance data on virological failure and mutations in HIV infected populations initiating treatment in sub-Saharan Af...... mutations among failing patients justify increased vigilance by improving the availability and systematic use of VL testing to monitor ART response, and underlines the need for rapid, inexpensive tests to identify the most common drug resistance mutations....

  11. Scaling up debris-flow experiments on a centrifuge

    Science.gov (United States)

    Hung, C.; Capart, H.; Crone, T. J.; Grinspum, E.; Hsu, L.; Kaufman, D.; Li, L.; Ling, H.; Reitz, M. D.; Smith, B.; Stark, C. P.

    2013-12-01

    Boundary forces generated by debris flows can be powerful enough to erode bedrock and cause considerable damage to infrastructure during runout. Formulation of an erosion-rate law for debris flows is therefore a high priority, and it makes sense to build such a law around laboratory experiments. However, running experiments big enough to generate realistic boundary forces is a logistical challenge to say the least [1]. One alternative is to run table-top simulations with unnaturally weak but fast-eroding pseudo-bedrock, another is to extrapolate from micro-erosion of natural substrates driven by unnaturally weak impacts; hybrid-scale experiments have also been conducted [2]. Here we take a different approach in which we scale up granular impact forces by running our experiments under enhanced gravity in a geotechnical centrifuge [3]. Using a 40cm-diameter rotating drum [2] spun at up to 100g, we generate debris flows with an effective depth of over several meters. By varying effective gravity from 1g to 100g we explore the scaling of granular flow forces and the consequent bed and wall erosion rates. The velocity and density structure of these granular flows is monitored using laser sheets, high-speed video, and particle tracking [4], and the progressive erosion of the boundary surfaces is measured by laser scanning. The force structures and their fluctuations within the granular mass and at the boundaries are explored with contact dynamics numerical simulations that mimic the lab experimental conditions [5]. In this presentation we summarize these results and discuss how they can contribute to the formulation of debris-flow erosion law. [1] Major, J. J. (1997), Journal of Geology 105: 345-366, doi:10.1086/515930 [2] Hsu, L. (2010), Ph.D. thesis, University of California, Berkeley [3] Brucks, A., et al (2007), Physical Review E 75, 032301, doi:10.1103/PhysRevE.75.032301 [4] Spinewine, B., et al (2011), Experiments in Fluids 50: 1507-1525, doi: 10.1007/s00348

  12. Scale-up of microwave assisted flow synthesis by transient processing through monomode cavities in series

    NARCIS (Netherlands)

    Patil, N.G.; Benaskar, F.; Rebrov, E.; Meuldijk, J.; Hulshof, L.A.; Hessel, V.; Schouten, J.C.

    2014-01-01

    A new scale-up concept for microwave assisted flow processing is presented where modular scale-up is achieved by implementing microwave cavities in series. The scale-up concept is demonstrated for case studies of a packed-bed reactor and a wall-coated tubular reactor. With known kinetics and

  13. High risk exposure to HIV among sexually active individuals who tested negative on rapid HIV Tests in the Tshwane District of South Africa-The importance of behavioural prevention measures.

    Directory of Open Access Journals (Sweden)

    Simnikiwe H Mayaphi

    Full Text Available To assess the prevalence of HIV risk behaviour among sexually active HIV sero-negative individuals in the Tshwane district of South Africa (SA.Demographic and HIV risk behaviour data were collected on a questionnaire from participants of a cross-sectional study that screened for early HIV infection using pooled nucleic acid amplification testing (NAAT. The study enrolled individuals who tested negative on rapid HIV tests performed at five HIV counseling and testing (HCT clinics, which included four antenatal clinics and one general HCT clinic.The study enrolled 9547 predominantly black participants (96.6% with a median age of 27 years (interquartile range [IQR]: 23-31. There were 1661 non-pregnant and 7886 pregnant participants largely enrolled from the general and antenatal HCT clinics, respectively. NAAT detected HIV infection in 61 participants (0.6%; 95% confidence interval [CI]: 0.4-0.8 in the whole study. A high proportion of study participants, 62.8% and 63.0%, were unaware of their partner's HIV status; and also had high prevalence, 88.5% and 99.5%, of recent unprotected sex in the general and pregnant population, respectively. Consistent use of condoms was associated with protection against HIV infection in the general population. Trends of higher odds for HIV infection were observed with most demographic and HIV risk factors at univariate analysis, however, multivariate analysis did not show statistical significance for almost all these factors. A significantly lower risk of HIV infection was observed in circumcised men (p <0.001.These data show that a large segment of sexually active people in the Tshwane district of SA have high risk exposure to HIV. The detection of newly diagnosed HIV infections in all study clinics reflects a wide distribution of individuals who are capable of sustaining HIV transmission in the setting where HIV risk behaviour is highly prevalent. A questionnaire that captures HIV risk behaviour would be useful

  14. The long winding road of opioid substitution therapy implementation in South-East Asia: challenges to scale up

    Directory of Open Access Journals (Sweden)

    Gary Reid

    2014-03-01

    Full Text Available The South-East Asia Region contains an estimated 400,000-500,000 people who inject drugs (PWID. HIV prevalence among PWID is commonly 20% or higher in Indonesia, Thailand, Myanmar and some regions of India. Opioid substitution therapy (OST is an important HIV prevention intervention in this part of the world. However, key challenges and barriers to scale up of OST exist, including: pervasive stigma and discrimination towards PWID; criminalisation of drug use overshadowing a public health response; lack of political will and national commitment; low financial investment; focus towards traditional treatment models of detoxification and rehabilitation; inadequate dosing of OST; and poor monitoring and evaluation of programmes. Our review of local evidence highlights that OST can be successful within the Asian context. Such evidence should be utilised more widely to advocate for policy change and increased political commitment to ensure OST reaches substantially more drug users.

  15. Triggering HIV polyprotein processing by light using rapid photodegradation of a tight-binding protease inhibitor

    Czech Academy of Sciences Publication Activity Database

    Schimer, Jiří; Pávová, Marcela; Anders, M.; Pachl, Petr; Šácha, Pavel; Cígler, Petr; Weber, Jan; Majer, Pavel; Řezáčová, Pavlína; Kräusslich, H. G.; Müller, B.; Konvalinka, Jan

    2015-01-01

    Roč. 6, Mar (2015), 6461/1-6461/8 ISSN 2041-1723 R&D Projects: GA ČR GBP208/12/G016; GA MŠk LO1302 Grant - others:GA MŠk(CZ) ED1.1.00/02.0109 Program:ED Institutional support: RVO:61388963 Keywords : HIV maturation * HIV PR photodegradable inhibitor * HIV PR caging Subject RIV: CE - Biochemistry Impact factor: 11.329, year: 2015 http://www.nature.com/ncomms/2015/150309/ncomms7461/pdf/ncomms7461.pdf

  16. Situation of Linkage between Sexual and Reproductive Health and HIV-Related Policies in Islamic Republic of Iran – A Rapid Assessment in 2011–2

    Directory of Open Access Journals (Sweden)

    Ghobad Moradi

    2015-03-01

    Full Text Available The number of sexual transmission of HIV is increasing globally. Sexual and Reproductive Health (SRH issues and HIV/AIDS related problems are rooted in common grounds such as poverty, gender inequality, and social exclusion. As a result, international health organizations have suggested the integration of SRH services with HIV/AIDS services as a strategy to control HIV and to improve people’s access to SRH services. The aim of this study was to evaluate the relationship between reproductive health and HIV/AIDS services at policy-making level in Islamic Republic of Iran (IRI. This study was conducted in 2011–2 and was a rapid assessment based on guidelines provided by the World Health Organization (WHO, United Nations Programme on HIV/AIDS (UNAIDS, Family Health International Association, and some other international organizations. In this rapid assessment we used different methods such as a review of literature and documents, visiting and interviewing professionals and experts in family health and HIV/AIDS programs, and experts working in some NonGovernmental Organizations (NGOs. Overall, based on the results obtained in this study, in most cases there was not much linkage between HIV/AIDS policies and SRH policies in Iran. Since integration of HIV/AIDS services and SRH services is recommended as a model and an appropriate response to HIV epidemics worldwide, likewise to control the HIV/AIDS epidemic in Iran it is required to integrate HIV/AIDS and SRH services at all levels, particularly at the policy-making level.

  17. Evaluation du test rapide oral aware™ omt HIV 1/2 pour le ...

    African Journals Online (AJOL)

    Chaque participant a fourni un échantillon de fluide oral pour la réalisation du test Aware™ OMT HIV-1/2 et du sang testé suivant l'algorithme séquentiel de tests ELISAs Murex® HIV-1.2.0 (Laboratoires Abbott, Japon) et Test ELISA peptidique maison du CeDReS. Résultats : la sensibilité, la spécificité, la Valeur Prédictive ...

  18. Evaluation of HIV-1 rapid tests and identification of alternative testing algorithms for use in Uganda.

    Science.gov (United States)

    Kaleebu, Pontiano; Kitandwe, Paul Kato; Lutalo, Tom; Kigozi, Aminah; Watera, Christine; Nanteza, Mary Bridget; Hughes, Peter; Musinguzi, Joshua; Opio, Alex; Downing, Robert; Mbidde, Edward Katongole

    2018-02-27

    The World Health Organization recommends that countries conduct two phase evaluations of HIV rapid tests (RTs) in order to come up with the best algorithms. In this report, we present the first ever such evaluation in Uganda, involving both blood and oral based RTs. The role of weak positive (WP) bands on the accuracy of the individual RT and on the algorithms was also investigated. In total 11 blood based and 3 oral transudate kits were evaluated. All together 2746 participants from seven sites, covering the four different regions of Uganda participated. Two enzyme immunoassays (EIAs) run in parallel were used as the gold standard. The performance and cost of the different algorithms was calculated, with a pre-determined price cut-off of either cheaper or within 20% price of the current algorithm of Determine + Statpak + Unigold. In the second phase, the three best algorithms selected in phase I were used at the point of care for purposes of quality control using finger stick whole blood. We identified three algorithms; Determine + SD Bioline + Statpak; Determine + Statpak + SD Bioline, both with the same sensitivity and specificity of 99.2% and 99.1% respectively and Determine + Statpak + Insti, with sensitivity and specificity of 99.1% and 99% respectively as having performed better and met the cost requirements. There were 15 other algorithms that performed better than the current one but rated more than the 20% price. None of the 3 oral mucosal transudate kits were suitable for inclusion in an algorithm because of their low sensitivities. Band intensity affected the performance of individual RTs but not the final algorithms. We have come up with three algorithms we recommend for public or Government procurement based on accuracy and cost. In case one algorithm is preferred, we recommend to replace Unigold, the current tie breaker with SD Bioline. We further recommend that all the 18 algorithms that have shown better performance than the current one are made

  19. Development of a definition for Rapid Progression (RP) of renal function in HIV-positive persons : the D:A:D study

    NARCIS (Netherlands)

    Kamara, David A; Ryom, Lene; Ross, Michael; Kirk, Ole; Reiss, Peter; Morlat, Philippe; Moranne, Olivier; Fux, Christoph A; Mocroft, Amanda; Sabin, Caroline; Lundgren, Jens D; Smith, Colette J; Schölvinck, Elisabeth H.

    2014-01-01

    BACKGROUND: No consensus exists on how to define abnormally rapid deterioration in renal function (Rapid Progression, RP). We developed an operational definition of RP in HIV-positive persons with baseline estimated glomerular filtration rate (eGFR) >90 ml/min/1.73 m2 (using Cockcroft Gault) in the

  20. Development of a definition for Rapid Progression (RP) of renal function in HIV-positive persons: the D:A:D study

    NARCIS (Netherlands)

    Kamara, David A.; Ryom, Lene; Ross, Michael; Kirk, Ole; Reiss, Peter; Morlat, Philippe; Moranne, Olivier; Fux, Christoph A.; Mocroft, Amanda; Sabin, Caroline; Lundgren, Jens D.; Smith, Colette J.; Powderly, B.; Shortman, N.; Moecklinghoff, C.; Reilly, G.; Franquet, X.; Ryom, L.; Sabin, C. A.; Kamara, D.; Smith, C.; Phillips, A.; Mocroft, A.; Tverland, J.; Mansfeld, M.; Nielsen, J.; Raben, D.; Lundgren, J. D.; Brandt, R. Salbøl; Rickenbach, M.; Fanti, I.; Krum, E.; Hillebregt, M.; Geffard, S.; Sundström, A.; Prins, J. M.; Kuijpers, T. W.; Scherpbier, H. J.; van der Meer, J. T. M.; Wit, F. W. M. N.; Godfried, M. H.; Nellen, F. J. B.; Lange, J. M. A.; Geerlings, S. E.; van Vugt, M.; Pajkrt, D.; Grijsen, M. L.; Wiersinga, W. J.; Goorhuis, A.; Hovius, J. W. R.

    2014-01-01

    No consensus exists on how to define abnormally rapid deterioration in renal function (Rapid Progression, RP). We developed an operational definition of RP in HIV-positive persons with baseline estimated glomerular filtration rate (eGFR) >90 ml/min/1.73 m2 (using Cockcroft Gault) in the Data

  1. Development of a definition for Rapid Progression (RP) of renal function in HIV-positive persons: the D:A:D study

    NARCIS (Netherlands)

    Kamara, D.A.; Ryom, L.; Ross, M.; Kirk, O.; Reiss, P.; Morlat, P.; Moranne, O.; Fux, C.A.; Mocroft, A.; Sabin, C.; Lundgren, J.D.; Smith, C.J.; Koopmans †, P.P.; Keuter, M.; Ven, A.J.A.M. van der; Hofstede, H.J.M. ter; Dofferhoff, A.S.M.; Warris, A.; Crevel, R. van; et al.,

    2014-01-01

    BACKGROUND: No consensus exists on how to define abnormally rapid deterioration in renal function (Rapid Progression, RP). We developed an operational definition of RP in HIV-positive persons with baseline estimated glomerular filtration rate (eGFR) >90 ml/min/1.73 m2 (using Cockcroft Gault) in the

  2. Evaluation of rapid HIV test kits on whole blood and development of rapid testing algorithm for voluntary testing and counseling centers in Ethiopia.

    Science.gov (United States)

    Tegbaru, Belete; Messele, Tsehaynesh; Wolday, Dawit; Meles, PhD Hailu; Tesema, Desalegn; Birhanu, Hiwot; Tesfaye, Girma; Bond, Kyle B; Martin, Robert; Rayfield, Mark A; Wuhib, Tadesse; Fekadu, Makonnen

    2004-10-01

    Five simple and rapid HIV antibody detection assays viz. Determine, Capillus, Oraquick, Unigold and Hemastrip were evaluated to examine their performance and to develop an alternative rapid test based testing algorithm for voluntary counseling and testing (VCT) in Ethiopia. All the kits were tested on whole blood, plasma and serum. The evaluation had three phases: Primary lab review, piloting at point of service and implementation. This report includes the results of the first two phases. A total of 2,693 specimens (both whole blood and plasma) were included in the evaluation. Results were compared to double Enzyme Linked Immuno-Sorbent Assay (ELISA) system. Discordant EIA results were resolved using Western Blot. The assays had very good sensitivities and specificities, 99-100%, at the two different phases of the evaluation. A 98-100% result agreement was obtained from those tested at VCT centers and National Referral Laboratory for AIDS (NRLA), in the quality control phase of the evaluation. A testing strategy yielding 100% [95% CI; 98.9-100.0] sensitivity was achieved by the sequential use of the three rapid test kits. Direct cost comparison showed serial testing algorithm reduces the cost of testing by over 30% compared to parallel testing in the current situation. Determine, Capillus/Oraquick (presence/absence of frefrigeration) and Unigold were recommended as screening, confirmation and tiebreaker tests, respectively.

  3. Impact of SCALE-UP on science teaching self-efficacy of students in general education science courses

    Science.gov (United States)

    Cassani, Mary Kay Kuhr

    The objective of this study was to evaluate the effect of two pedagogical models used in general education science on non-majors' science teaching self-efficacy. Science teaching self-efficacy can be influenced by inquiry and cooperative learning, through cognitive mechanisms described by Bandura (1997). The Student Centered Activities for Large Enrollment Undergraduate Programs (SCALE-UP) model of inquiry and cooperative learning incorporates cooperative learning and inquiry-guided learning in large enrollment combined lecture-laboratory classes (Oliver-Hoyo & Beichner, 2004). SCALE-UP was adopted by a small but rapidly growing public university in the southeastern United States in three undergraduate, general education science courses for non-science majors in the Fall 2006 and Spring 2007 semesters. Students in these courses were compared with students in three other general education science courses for non-science majors taught with the standard teaching model at the host university. The standard model combines lecture and laboratory in the same course, with smaller enrollments and utilizes cooperative learning. Science teaching self-efficacy was measured using the Science Teaching Efficacy Belief Instrument - B (STEBI-B; Bleicher, 2004). A science teaching self-efficacy score was computed from the Personal Science Teaching Efficacy (PTSE) factor of the instrument. Using non-parametric statistics, no significant difference was found between teaching models, between genders, within models, among instructors, or among courses. The number of previous science courses was significantly correlated with PTSE score. Student responses to open-ended questions indicated that students felt the larger enrollment in the SCALE-UP room reduced individual teacher attention but that the large round SCALE-UP tables promoted group interaction. Students responded positively to cooperative and hands-on activities, and would encourage inclusion of more such activities in all of the

  4. Repeat confirmatory testing for persons with discordant whole blood and oral fluid rapid HIV test results: findings from post marketing surveillance.

    Science.gov (United States)

    Wesolowski, Laura G; Mackellar, Duncan A; Ethridge, Steven F; Zhu, Julia H; Owen, S Michele; Sullivan, Patrick S

    2008-02-06

    Reactive oral fluid and whole blood rapid HIV tests must be followed with a confirmatory test (Western blot (WB), immunofluorescent assay (IFA) or approved nucleic acid amplification test (NAAT)). When the confirmatory result is negative or indeterminate (i.e. discordant with rapid result), repeat confirmatory testing should be conducted using a follow-up specimen. Previous reports have not described whether repeat testing adequately resolves the HIV-infection status of persons with discordant results. Post-marketing surveillance was conducted in 368 testing sites affiliated with 14 state and 2 city health departments from August 11, 2004 to June 30, 2005 and one health department through December 31, 2005. For persons with discordant results, data were collected on demographics, risk behaviors, HIV test results and specimen types. Persons with repeat confirmatory results were classified as HIV-infected or uninfected. Regression models were created to assess risk factors for not having repeat testing. Of 167,371 rapid tests conducted, 2589 (1.6%) were reactive: of these, 2417 (93%) had positive WB/IFA, 172 (7%) had negative or indeterminate WB/IFA. Of 89/172 (52%) persons with a repeat confirmatory test: 17 (19%) were HIV-infected, including 3 with indeterminate WB and positive NAAT; 72 (81%) were uninfected, including 12 with repeat indeterminate WB. Factors associated with HIV-infection included having an initial indeterminate WB/IFA (vs. negative) (ptest [adjusted OR 2.6, 95% CI (1.3, 4.9)]. Though only half of persons with discordant results had repeat confirmatory testing, of those who did, nearly one in five were HIV-infected. These findings underscore the need for rapid HIV testing programs to increase repeat confirmatory testing for persons with discordant results. Because of the lower sensitivity of oral fluid WBs, confirmatory testing following a reactive rapid test should be conducted using serum or plasma, when possible.

  5. Estimating unbiased economies of scale of HIV prevention projects: a case study of Avahan.

    Science.gov (United States)

    Lépine, Aurélia; Vassall, Anna; Chandrashekar, Sudha; Blanc, Elodie; Le Nestour, Alexis

    2015-04-01

    Governments and donors are investing considerable resources on HIV prevention in order to scale up these services rapidly. Given the current economic climate, providers of HIV prevention services increasingly need to demonstrate that these investments offer good 'value for money'. One of the primary routes to achieve efficiency is to take advantage of economies of scale (a reduction in the average cost of a health service as provision scales-up), yet empirical evidence on economies of scale is scarce. Methodologically, the estimation of economies of scale is hampered by several statistical issues preventing causal inference and thus making the estimation of economies of scale complex. In order to estimate unbiased economies of scale when scaling up HIV prevention services, we apply our analysis to one of the few HIV prevention programmes globally delivered at a large scale: the Indian Avahan initiative. We costed the project by collecting data from the 138 Avahan NGOs and the supporting partners in the first four years of its scale-up, between 2004 and 2007. We develop a parsimonious empirical model and apply a system Generalized Method of Moments (GMM) and fixed-effects Instrumental Variable (IV) estimators to estimate unbiased economies of scale. At the programme level, we find that, after controlling for the endogeneity of scale, the scale-up of Avahan has generated high economies of scale. Our findings suggest that average cost reductions per person reached are achievable when scaling-up HIV prevention in low and middle income countries. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Rapid Immuno-Chromatographic Assay for the Detection of Antibodies to HIV Compare with Elisa among Voluntary and Replacement Blood Donor of Mymensingh Medical College Hospital.

    Science.gov (United States)

    Chakrabarty, P; Rudra, S; Hossain, M A; Begum, S A; Mirza, T T; Rudra, M

    2015-04-01

    Suitable algorithms based on a combination of two or more simple rapid HIV assays have been shown to have a diagnostic accuracy comparable to double enzyme-linked immunosorbent assay (ELISA) or double ELISA with Western Blot strategies. The aims of this study were to evaluate the performance of five simple rapid HIV assays using whole blood samples from voluntary and replacement blood donors & HIV-infected patients (positive samples from BSMMU, Dhaka). Five rapid HIV assays: Determine™ HIV-1/2 (Inverness Medical), SD Bioline HIV 1/2 3.0 (Standard Diagnostics Inc.), First Response HIV Card 1-2.0 (PMC Medical India Pvt Ltd.), HIV1/2 Stat-Pak Dipstick (Chembio Diagnostic System, Inc) and Uni-Gold™ HIV-1/2 (Biotech) were evaluated between 1st February to 30th June, 2013 using 400 whole blood samples from voluntary and replacement blood donors. All samples that were reactive on all or any of the five rapid assays and 10% of non-reactive samples were tested on a confirmatory Inno-Lia HIV I/II immunoblot assay (Immunogenetics). Only 01 sample including ten positive samples from BSMMU were confirmed HIV-1 antibody positive, while 399 were HIV negative. The sensitivity at initial testing of Determine, SD Bioline and Uni-Gold™ was 100% (95% CI; 99.1-100) while First Response and Stat-Pak had sensitivity of 99.5% (95% CI; 98.2-99.9) and 97.7% (95% CI; 95.7-98.9) respectively, which increased to 100% (95% CI; 99.1-100) on repeat testing. The initial specificity of the Uni-Gold™ assay was 100% (95% CI; 99.6-100) while specificities were 99.6% (95% CI; 99-99.9), 99.4% (95% CI; 98.8-99.7), 99.6% (95% CI; 99-99.9) and 99.8% (95% CI; 99.3-99.9) for Determine, SD Bioline, First Response and Stat-Pak assays, respectively. There was no any sample which was concordantly false positive in Uni-Gold™, Determine and SD Bioline assays. An alternative confirmatory HIV testing strategy based on initial testing on either SD Bioline or Determine assays followed by testing of reactive

  7. The diagnostic performance evaluation of the SD BIOLINE HIV/syphilis Duo rapid test in southern Ethiopia: a cross-sectional study.

    Science.gov (United States)

    Shimelis, Techalew; Tadesse, Endale

    2015-04-23

    To determine the diagnostic performance of the SD BIOLINE HIV/syphilis Duo rapid test. A hospital-based cross-sectional study. This evaluation was conducted at one of the largest hospitals in southern Ethiopia. Serum samples obtained from clients attending the antiretroviral therapy and voluntary counselling and testing centres were used. Sera were originally collected for the purpose of investigating syphilis epidemiology. The performance of the test to detect HIV was evaluated using 400 sera (200 HIV positives and 200 HIV negatives). Also, its performance to detect syphilis was evaluated using 85 syphilis positive and 100 syphilis negative serum samples. Individuals tiebreaker to determine the result. We also used ELISA to resolve discordant HIV results. Syphilis serostatus was determined using the Treponema pallidum haemagglutination assay (TPHA). The respective sensitivity, specificity, positive predictive value and negative predictive value of the SD BIOLINE HIV/syphilis Duo test were 100, 99.5, 99.5 and 100% for HIV and 97.6, 96, 95.4 and 98% for syphilis testing, respectively. In reference to TPHA, the test kit reported 4 false positives and 2 false negative results for syphilis. The κ values were 0.99 for HIV testing and 0.94 for syphilis testing. The excellent performance of the SD BIOLINE HIV/syphilis Duo test to detect HIV as well as syphilis facilitates the integration of syphilis testing and treatment to the already established HIV prevention programme, ultimately contributing to the dual HIV and syphilis elimination goal. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Global challenges with scale-up of the integrated management of childhood illness strategy: results of a multi-country survey

    Directory of Open Access Journals (Sweden)

    Muhe Lulu M

    2011-06-01

    .6%. Countries addressed these by piggy backing IMCI follow-up with routine supervisory visits. Conclusions Financial challenges to ICMT scale-up and follow-up after training are common. As IMCI is accepted globally as one of the key strategies to meet MDG4 several steps need to be taken to facilitate rapid acceleration of ICMT, including reviewing core competencies followed by competency-driven shortened training duration or 'on the job' training, 'distance learning' or training using mobile phones. Linkages with other 'better-funded' programmes e.g. HIV or malaria need to be improved. Routine Primary Health Care (PHC supervision needs to include follow-up after ICMT.

  9. ORIGINAL ARTICLES How equitable is the scaling up of HIV service ...

    African Journals Online (AJOL)

    included the provision of voluntary counselling and testing. (VCT), prevention of .... to travel up to 150 km to the nearest regional hospital, while in. Engcobo access to .... deteriorating relationship between staff and clients. Other studies15.

  10. Patients' Willingness to Participate in Rapid HIV Testing: A pilot study in three New York City dental hygiene clinics.

    Science.gov (United States)

    Davide, Susan H; Santella, Anthony J; Furnari, Winnie; Leuwaisee, Petal; Cortell, Marilyn; Krishnamachari, Bhuma

    2017-12-01

    Purpose: One in eight people living with an HIV infection in the United States is unaware of their status. Rapid HIV testing (RHT) is an easily used and accepted screening tool that has been introduced in a limited number of clinical settings. The purpose of this study was to investigate patient acceptability, certainty of their decision, and willingness to pay for screening if RHT was offered in university-based dental hygiene clinics. Methods: A cross-sectional survey was administered to 426 patients at three dental hygiene clinics in New York City over a period of four months. The survey questionnaire was based on the decisional conflict scale measuring personal perceptions; with zero indicating extremely high conflict to four indicating no conflict. Patients were assessed for their acceptance of RHT, provider preference for administration of the test and their willingness to pay for RHT. Results: Over half (72.2%) indicated acceptance of HIV testing in a dental hygiene clinic setting; with 85.3% choosing oral RHT, 4.9% fingerstick RHT, and 8.8% venipuncture. Respondents were amenable to testing when offered by dental hygienists (71.7%) and dentists (72.4%). Over 30% indicated their willingness to receive HIV testing in the dental setting when offered at no additional cost. The mean decisional conflict score was 3.42/4.0 indicating no decisional conflict. Conclusions: Patients are willing to undergo oral RHT when offered as a service and provided by dental hygienists in the dental setting. Patients appear to be aware of the benefits and risks associated with RHT. Further research is needed to evaluate the public health benefits and logistical challenges facing the delivery of RHT within in the dental setting. Copyright © 2017 The American Dental Hygienists’ Association.

  11. Large sharing networks and unusual injection practices explain the rapid rise in HIV among IDUs in Sargodha, Pakistan

    Directory of Open Access Journals (Sweden)

    Qureshi Salman U

    2009-06-01

    Full Text Available Abstract Background Of the nearly 100,000 street-based IDUs in Pakistan, 20% have HIV. We investigated the recent rise in HIV prevalence from 12 to 52% among IDUs in Sargodha despite > 70% coverage with syringe exchanges. Methods We interviewed approximately 150 IDUs and 30 outreach workers in focus group discussions. Results We found six rural and 28 urban injecting locations. Urban locations have about 20–30 people at any time and about 100 daily; rural locations have twice as many (national average: 4–15. About half of the IDUs started injecting within the past 2 years and are not proficient at injecting themselves. They use street injectors, who have 15–16 clients daily. Heroin is almost exclusively the drug used. Most inject 5–7 times daily. Nearly all injectors claim to use fresh syringes. However, they load, inject and share using a locally developed method called scale. Most Pakistani IDUs prefer to double pump drug the syringe, which allows mixing of blood with drug in the syringe. The injector injects 3 ml and keeps 2 ml (the scale as injection fee. The injector usually pools all the leftover scale (now with some blood mixed with drug either for his own use or to sell it. Most IDUs backload the scale they buy into their own fresh syringes. Discussion Use of an unprecedented method of injecting drugs that largely bypasses fresh syringes, larger size of sharing networks, higher injection frequency and near universal use of street injectors likely explain for the rapid rise in HIV prevalence among IDUs in Sargodha despite high level provision of fresh syringes. This had been missed by us and the national surveillance, which is quantitative. We have addressed this by hiring injectors as peer outreach workers and increasing syringe supply. Our findings highlight both the importance of qualitative research and operations research to enrich the quality of HIV prevention programs.

  12. A model-based framework for incremental scale-up of wastewater treatment processes

    DEFF Research Database (Denmark)

    Mauricio Iglesias, Miguel; Sin, Gürkan

    Scale-up is traditionally done following specific ratios or rules of thumb which do not lead to optimal results. We present a generic framework to assist in scale-up of wastewater treatment processes based on multiscale modelling, multiobjective optimisation and a validation of the model at the new...... large scale. The framework is illustrated by the scale-up of a complete autotropic nitrogen removal process. The model based multiobjective scaleup offers a promising improvement compared to the rule of thumbs based emprical scale up rules...

  13. The quality of rapid HIV testing in South Africa: an assessment of ...

    African Journals Online (AJOL)

    100%, which was higher than laboratory technicians who scored 99.3%.10 In this study, human error in recording results was considered to be a potential reason for the discrepancy.10 The proficiency of personnel administer- ing HIV testing has an impact on the sensitivity (ability of the kit to correctly detect specimens ...

  14. Structural defects and variations in the HIV-1 nef gene from rapid, slow and non-progressor children.

    Science.gov (United States)

    Casartelli, Nicoletta; Di Matteo, Gigliola; Argentini, Claudio; Cancrini, Caterina; Bernardi, Stefania; Castelli, Guido; Scarlatti, Gabriella; Plebani, Anna; Rossi, Paolo; Doria, Margherita

    2003-06-13

    Evaluation of sequence evolution as well as structural defects and mutations of the human immunodeficiency virus-type 1 (HIV-1) nef gene in relation to disease progression in infected children. We examined a large number of nef alleles sequentially derived from perinatally HIV-1-infected children with different rates of disease progression: six non-progressors (NPs), four rapid progressors (RPs), and three slow progressors (SPs). Nef alleles (182 total) were isolated from patients' peripheral blood mononuclear cells (PBMCs), sequenced and analysed for their evolutionary pattern, frequency of mutations and occurrence of amino acid variations associated with different stages of disease. The evolution rate of the nef gene apparently correlated with CD4+ decline in all progression groups. Evidence for rapid viral turnover and positive selection for changes were found only in two SPs and two RPs respectively. In NPs, a higher proportion of disrupted sequences and mutations at various functional motifs were observed. Furthermore, NP-derived Nef proteins were often changed at residues localized in the folded core domain at cytotoxic T lymphocytes (CTL) epitopes (E(105), K(106), E(110), Y(132), K(164), and R(200)), while other residues outside the core domain are more often changed in RPs (A(43)) and SPs (N(173) and Y(214)). Our results suggest a link between nef gene functions and the progression rate in HIV-1-infected children. Moreover, non-progressor-associated variations in the core domain of Nef, together with the genetic analysis, suggest that nef gene evolution is shaped by an effective immune system in these patients.

  15. High-sensitive and rapid detection of Mycobacterium tuberculosis infection by IFN-γ release assay among HIV-infected individuals in BCG-vaccinated area

    Directory of Open Access Journals (Sweden)

    Jiang Weimin

    2009-05-01

    Full Text Available Abstract Background An accurate test for Mycobacterium tuberculosis infection is urgently needed in immunosuppressed populations. The aim of this study was to investigate the diagnostic power of enzyme-linked immunospot (ELISPOT-based IFN-γ release assay in detecting active and latent tuberculosis in HIV-infected population in bacillus Calmette-Guerin (BCG-vaccinated area. A total of 100 HIV-infected individuals including 32 active tuberculosis patients were recruited. An ELISPOT-based IFN-γ release assay, T-SPOT.TB, was used to evaluate the M. tuberculosis ESAT-6 and CFP-10 specific IFN-γ response. Tuberculin skin test (TST was performed for all recruited subjects. Results The subjects were divided into group HIV+ATB (HIV-infected individuals with active tuberculosis, n = 32, group HIV+LTB (HIV-infected individuals with positive results of T-SPOT.TB assay, n = 46 and group HIV only (HIV-infected individuals with negative results of T-SPOT.TB assay and without evidence of tuberculosis infection, n = 22. In group HIV+ATB and HIV+LTB, T-SPOT.TB positive rate in subjects with TST P 85% in patients with TB treatment for less than 1 month and CD4+ T cells ≥200/μl, while for patients treated for more than 3 months and CD4+ T cells Conclusion ELISPOT-based IFN-γ release assay is more sensitive and rapid for the diagnosis of TB infection in Chinese HIV-infected individuals with history of BCG vaccination, and could be an effective tool for guiding preventive treatment with isoniazid in latently infected people and for TB control in China.

  16. Scaling-up exclusive breastfeeding support programmes: the example of KwaZulu-Natal.

    Directory of Open Access Journals (Sweden)

    Chris Desmond

    2008-06-01

    Full Text Available Exclusive breastfeeding (EBF for six months is the mainstay of global child health and the preferred feeding option for HIV-infected mothers for whom replacement feeding is inappropriate. Promotion of community-level EBF requires effective personnel and management to ensure quality counselling and support for women. We present a costing and cost effectiveness analysis of a successful intervention to promote EBF in high HIV prevalence area in South Africa, and implications for scale-up in the province of KwaZulu-Natal.The costing of the intervention as implemented was calculated, in addition to the modelling of the costs and outcomes associated with running the intervention at provincial level under three different scenarios: full intervention (per protocol, simplified version (half the number of visits compared to the full intervention; more clinic compared to home visits and basic version (one third the number of visits compared to the full intervention; all clinic and no home visits. Implementation of the full scenario costs R95 million ($14 million per annum; the simplified version R47 million ($7 million and the basic version R4 million ($2 million. Although the cost of the basic scenario is less than one tenth of the cost of the simplified scenario, modelled effectiveness of the full and simplified versions suggest they would be 10 times more effective compared to the basic intervention. A further analysis modelled the costs per increased month of EBF due to each intervention: R337 ($48, R206 ($29, and R616 ($88 for the full, simplified and basic scenarios respectively. In addition to the average cost effectiveness the incremental cost effectiveness ratios associated with moving from the less effective scenarios to the more effective scenarios were calculated and reported: Nothing-Basic R616 ($88, Basic-Simplified R162 ($23 and Simplified-Full R879 ($126.The simplified scenario, with a combination of clinic and home visits, is the most

  17. Electronic Government in the City of Fez, Morocco : Scaling up to the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    Electronic Government in the City of Fez, Morocco : Scaling up to the National Level. In the pilot phase of the project (101980), electronic service delivery was introduced and successfully deployed in the Fez-Agdal local government office. This phase will scale up the project to include the remaining local government offices ...

  18. School Processes That Can Drive Scaling-Up of an Innovation or Contribute to Its Abandonment

    Science.gov (United States)

    Newman, Denis; Zacamy, Jenna; Lazarev, Valeriy; Lin, Li

    2017-01-01

    This five-year study focused on school processes that promoted the scaling-up of a high school academic literacy framework, Reading Apprenticeship, developed by WestEd's Strategic Literacy Initiative (SLI). Implementing an innovative strategy for scaling-up involving school-based cross-disciplinary teacher teams, SLI brought the framework to 274…

  19. 'Scaling-up is a craft not a science': Catalysing scale-up of health innovations in Ethiopia, India and Nigeria.

    Science.gov (United States)

    Spicer, Neil; Bhattacharya, Dipankar; Dimka, Ritgak; Fanta, Feleke; Mangham-Jefferies, Lindsay; Schellenberg, Joanna; Tamire-Woldemariam, Addis; Walt, Gill; Wickremasinghe, Deepthi

    2014-11-01

    Donors and other development partners commonly introduce innovative practices and technologies to improve health in low and middle income countries. Yet many innovations that are effective in improving health and survival are slow to be translated into policy and implemented at scale. Understanding the factors influencing scale-up is important. We conducted a qualitative study involving 150 semi-structured interviews with government, development partners, civil society organisations and externally funded implementers, professional associations and academic institutions in 2012/13 to explore scale-up of innovative interventions targeting mothers and newborns in Ethiopia, the Indian state of Uttar Pradesh and the six states of northeast Nigeria, which are settings with high burdens of maternal and neonatal mortality. Interviews were analysed using a common analytic framework developed for cross-country comparison and themes were coded using Nvivo. We found that programme implementers across the three settings require multiple steps to catalyse scale-up. Advocating for government to adopt and finance health innovations requires: designing scalable innovations; embedding scale-up in programme design and allocating time and resources; building implementer capacity to catalyse scale-up; adopting effective approaches to advocacy; presenting strong evidence to support government decision making; involving government in programme design; invoking policy champions and networks; strengthening harmonisation among external programmes; aligning innovations with health systems and priorities. Other steps include: supporting government to develop policies and programmes and strengthening health systems and staff; promoting community uptake by involving media, community leaders, mobilisation teams and role models. We conclude that scale-up has no magic bullet solution - implementers must embrace multiple activities, and require substantial support from donors and governments in

  20. Scaling Up

    Science.gov (United States)

    Johnson, Michele; Dodson, Tiare

    2016-01-01

    Carbon is at the heart of many of today's environmental challenges. It is the central element responsible for the structure and function of living systems--taken up by plants through photosynthesis and moving from plants to other organisms, soil, and the ocean and into the atmosphere. The imbalance of these connected biogeochemical…

  1. Scale-up of a Luminescent Solar Concentrator-Based Photomicroreactor via Numbering-up.

    Science.gov (United States)

    Zhao, Fang; Cambié, Dario; Janse, Jeroen; Wieland, Eric W; Kuijpers, Koen P L; Hessel, Volker; Debije, Michael G; Noël, Timothy

    2018-01-02

    The use of solar energy to power chemical reactions is a long-standing dream of the chemical community. Recently, visible-light-mediated photoredox catalysis has been recognized as the ideal catalytic transformation to convert solar energy into chemical bonds. However, scaling photochemical transformations has been extremely challenging due to Bouguer-Lambert-Beer law. Recently, we have pioneered the development of luminescent solar concentrator photomicroreactors (LSC-PMs), which display an excellent energy efficiency. These devices harvest solar energy, convert the broad solar energy spectrum to a narrow-wavelength region, and subsequently waveguide the re-emitted photons to the reaction channels. Herein, we report on the scalability of such LSC-PMs via a numbering-up strategy. Paramount in our work was the use of molds that were fabricated via 3D printing. This allowed us to rapidly produce many different prototypes and to optimize experimentally key design aspects in a time-efficient fashion. Reactors up to 32 parallel channels have been fabricated that display an excellent flow distribution using a bifurcated flow distributor (standard deviations below 10%). This excellent flow distribution was crucial to scale up a model reaction efficiently, displaying yields comparable to those obtained in a single-channel device. We also found that interchannel spacing is an important and unique design parameter for numbered-up LSC-PMs, which influences greatly the photon flux experienced within the reaction channels.

  2. Correlates of male circumcision in Eastern and Southern African countries: establishing a baseline prior to VMMC Scale-up.

    Directory of Open Access Journals (Sweden)

    Khai Hoan Tram

    Full Text Available BACKGROUND: Despite the importance of male circumcision (MC prevalence to HIV prevention efforts in Eastern and Southern Africa, there has been no systematic analysis on the correlates of male circumcision. This analysis identifies correlates of MC in 12 countries in the region with available data. METHODS: Data from the male questionnaire of DHS surveys collected between 2006-2011 in Ethiopia, Kenya, Lesotho, Malawi, Mozambique, Namibia, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe were analyzed. The dependent variable was self-reported male circumcision status. Independent variables included age, education, wealth quintile, place of residence, ethnicity, religion and region. Bivariate and multivariate analyses were conducted separately for each country. RESULTS: MC prevalence ranged from 8.2 percent in Swaziland to 92.2 percent in Ethiopia. Bivariate analyses showed a consistent positive association between age (being older and male circumcision. Education, wealth quintile, and place of residence were either not significantly related or differed in the direction of the relationship by country. Multivariate logistic regression showed three variables consistently associated with MC status: age (being older, religion (being Muslim and ethnicity. DISCUSSION: These data were collected prior to the scale-up of voluntary medical male circumcision (VMMC programs in 11 of the 12 countries. As the VMMC scale-up intensifies in countries across Eastern and Southern Africa, the correlates of VMMC are likely to change, with (younger age and education emerging as key correlates of VMMC performed in medical settings. The centuries-long tradition among Muslims to circumcise should continue to favor MC among this group. Non-circumcising ethnicities may become more open to MC if promoted as a health practice for decreasing HIV risk.

  3. Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

    Directory of Open Access Journals (Sweden)

    Ziningi Jaya

    Full Text Available Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC clinics in rural KwaZulu-Natal (KZN, South Africa.We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor. A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05.Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2% of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged

  4. Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

    Science.gov (United States)

    Jaya, Ziningi; Drain, Paul K; Mashamba-Thompson, Tivani P

    2017-01-01

    Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged between 64.4% (CI

  5. Scaling up community mobilisation through women's groups for maternal and neonatal health: experiences from rural Bangladesh

    Directory of Open Access Journals (Sweden)

    Nahar Tasmin

    2012-01-01

    Full Text Available Abstract Background Program coverage is likely to be an important determinant of the effectiveness of community interventions to reduce neonatal mortality. Rigorous examination and documentation of methods to scale-up interventions and measure coverage are scarce, however. To address this knowledge gap, this paper describes the process and measurement of scaling-up coverage of a community mobilisation intervention for maternal, child and neonatal health in rural Bangladesh and critiques this real-life experience in relation to available literature on scaling-up. Methods Scale-up activities took place in nine unions in rural Bangladesh. Recruitment and training of those who deliver the intervention, communication and engagement with the community and other stakeholders and active dissemination of intervention activities are described. Process evaluation and population survey data are presented and used to measure coverage and the success of scale-up. Results The intervention was scaled-up from 162 women's groups to 810, representing a five-fold increase in population coverage. The proportion of women of reproductive age and pregnant women who were engaged in the intervention increased from 9% and 3%, respectively, to 23% and 29%. Conclusions Examination and documentation of how scaling-up was successfully initiated, led, managed and monitored in rural Bangladesh provide a deeper knowledge base and valuable lessons. Strong operational capabilities and institutional knowledge of the implementing organisation were critical to the success of scale-up. It was possible to increase community engagement with the intervention without financial incentives and without an increase in managerial staff. Monitoring and feedback systems that allow for periodic programme corrections and continued innovation are central to successful scale-up and require programmatic and operational flexibility.

  6. A rapid assessment of post-disclosure experiences of urban HIV-positive and HIV-negative school-aged children in Kenya

    Directory of Open Access Journals (Sweden)

    Grace Gachanja

    2015-06-01

    Full Text Available There has been limited involvement of HIV-negative children in HIV disclosure studies; most studies conducted on the effects of disclosure on children have been with HIV-positive children and HIV-positive mother-child dyads. Seven HIV-positive and five HIV-negative children participated in a larger study conducted to understand the lived experiences of HIV-positive parents and their children during the disclosure process in Kenya. In this study, the experiences of these 12 children after receiving disclosure of their own and their parents’ illnesses respectively are presented. Each child underwent an in-depth qualitative semi-structured digitally recorded interview. The recorded interviews were transcribed and loaded into NVivo8 for phenomenological data analysis. Five themes emerged from the data, indicating that HIV-positive and negative children appear to have differing post-disclosure experiences revolving around acceptance of illness, stigma and discrimination, medication consumption, sexual awareness, and use of coping mechanisms. Following disclosure, HIV-negative children accepted their parents’ illnesses within a few hours to a few weeks; HIV-positive children took weeks to months to accept their own illnesses. HIV-negative children knew of high levels of stigma and discrimination within the community; HIV-positive children reported experiencing indirect incidences of stigma and discrimination. HIV-negative children wanted their parents to take their medications, stay healthy, and pay their school fees so they could have a better life in the future; HIV-positive children viewed medication consumption as an ordeal necessary to keep them healthy. HIV-negative children wanted their parents to speak to them about sexual-related matters; HIV-positive children had lingering questions about relationships, use of condoms, marriage, and childbearing options. All but one preadolescent HIV-positive child had self-identified a person to speak

  7. Hepatitis B virus surface antigen and anti-hepatitis C virus rapid tests underestimate hepatitis prevalence among HIV-infected patients.

    Science.gov (United States)

    Hønge, Bl; Jespersen, S; Medina, C; Té, Ds; da Silva, Zj; Ostergaard, L; Laursen, Al; Wejse, C; Krarup, H; Erikstrup, C

    2014-10-01

    In the case of coinfection with HIV and hepatitis B virus (HBV) and/or hepatitis C virus (HCV), hepatic disease progression is often accelerated, with higher rates of liver cirrhosis and liver-related mortality. We aimed to evaluate the performance of the rapid tests used routinely to detect HBV surface antigen (HBsAg) and anti-HCV among HIV-infected patients in Guinea-Bissau. Blood samples from HIV-infected patients in Guinea-Bissau were stored after testing for HBsAg and anti-HCV with rapid tests. Samples were subsequently re-tested for HBsAg and anti-HCV in Denmark. Two rapid tests were used in Guinea-Bissau: HBsAg Strip Ref 2034 (VEDA.LAB, Alençon, France; sensitivity 62.3%; specificity 99.2%) and HEPA-SCAN (Bhat Bio-Tech, Bangalore, India; sensitivity 57.1%; specificity 99.7%). In the two tests the ability to obtain the correct outcome depended on the antigen and antibody concentrations, respectively. Sex, age, CD4 cell count and antiretroviral therapy status did not differ between false negative and true positive samples in either of the tests. The study is limited by a low number of anti-HCV positive samples. New diagnostic rapid tests should always be evaluated in the setting in which they will be used before implementation. © 2014 British HIV Association.

  8. SCAlING UP THE USE OF ANTIRETROVIRAlS IN THE PUBLIC ...

    African Journals Online (AJOL)

    2003-08-01

    Aug 1, 2003 ... access also has to grapple with the challenge of ensuring that people take drugs ... scaling up procurement: provision of affordable drugs, and ... outside government. ... South Africa provide useful models for the design of an.

  9. Repeat confirmatory testing for persons with discordant whole blood and oral fluid rapid HIV test results: findings from post marketing surveillance.

    Directory of Open Access Journals (Sweden)

    Laura G Wesolowski

    Full Text Available BACKGROUND: Reactive oral fluid and whole blood rapid HIV tests must be followed with a confirmatory test (Western blot (WB, immunofluorescent assay (IFA or approved nucleic acid amplification test (NAAT. When the confirmatory result is negative or indeterminate (i.e. discordant with rapid result, repeat confirmatory testing should be conducted using a follow-up specimen. Previous reports have not described whether repeat testing adequately resolves the HIV-infection status of persons with discordant results. METHODOLOGY: Post-marketing surveillance was conducted in 368 testing sites affiliated with 14 state and 2 city health departments from August 11, 2004 to June 30, 2005 and one health department through December 31, 2005. For persons with discordant results, data were collected on demographics, risk behaviors, HIV test results and specimen types. Persons with repeat confirmatory results were classified as HIV-infected or uninfected. Regression models were created to assess risk factors for not having repeat testing. PRINCIPAL FINDINGS: Of 167,371 rapid tests conducted, 2589 (1.6% were reactive: of these, 2417 (93% had positive WB/IFA, 172 (7% had negative or indeterminate WB/IFA. Of 89/172 (52% persons with a repeat confirmatory test: 17 (19% were HIV-infected, including 3 with indeterminate WB and positive NAAT; 72 (81% were uninfected, including 12 with repeat indeterminate WB. Factors associated with HIV-infection included having an initial indeterminate WB/IFA (vs. negative (p<0.001 and having an initial oral fluid WB (vs. serum (p<0.001. Persons who had male-female sex (vs. male-male sex were at increased risk for not having a repeat test [adjusted OR 2.6, 95% CI (1.3, 4.9]. CONCLUSIONS: Though only half of persons with discordant results had repeat confirmatory testing, of those who did, nearly one in five were HIV-infected. These findings underscore the need for rapid HIV testing programs to increase repeat confirmatory testing for

  10. HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs.

    Directory of Open Access Journals (Sweden)

    David Wilson

    2015-06-01

    Full Text Available There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection "Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers" highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

  11. Perinatally acquired HIV infection in adolescents from sub-Saharan Africa: a review of emerging challenges.

    Science.gov (United States)

    Lowenthal, Elizabeth D; Bakeera-Kitaka, Sabrina; Marukutira, Tafireyi; Chapman, Jennifer; Goldrath, Kathryn; Ferrand, Rashida A

    2014-07-01

    Worldwide, more than three million children are infected with HIV, 90% of whom live in sub-Saharan Africa. As the HIV epidemic matures and antiretroviral treatment is scaled up, children with HIV are reaching adolescence in large numbers. The growing population of adolescents with perinatally acquired HIV infection living within this region presents not only unprecedented challenges but also opportunities to learn about the pathogenesis of HIV infection. In this Review, we discuss the changing epidemiology of paediatric HIV and the particular features of HIV infection in adolescents in sub-Saharan Africa. Longstanding HIV infection acquired when the immune system is not developed results in distinctive chronic clinical complications that cause severe morbidity. As well as dealing with chronic illness, HIV-infected adolescents have to confront psychosocial issues, maintain adherence to drugs, and learn to negotiate sexual relationships, while undergoing rapid physical and psychological development. Context-specific strategies for early identification of HIV infection in children and prompt linkage to care need to be developed. Clinical HIV care should integrate age-appropriate sexual and reproductive health and psychological, educational, and social services. Health-care workers will need to be trained to recognise and manage the needs of these young people so that the increasing numbers of children surviving to adolescence can access quality care beyond specialist services at low-level health-care facilities. Copyright © 2014 Elsevier Ltd. All rights reserved.

  12. HIV Programs for Sex Workers: Lessons and Challenges for Developing and Delivering Programs.

    Science.gov (United States)

    Wilson, David

    2015-06-01

    There is evidence that HIV prevention programs for sex workers, especially female sex workers, are cost-effective in several contexts, including many western countries, Thailand, India, the Democratic Republic of Congo, Kenya, and Zimbabwe. The evidence that sex worker HIV prevention programs work must not inspire complacency but rather a renewed effort to expand, intensify, and maximize their impact. The PLOS Collection "Focus on Delivery and Scale: Achieving HIV Impact with Sex Workers" highlights major challenges to scaling-up sex worker HIV prevention programs, noting the following: sex worker HIV prevention programs are insufficiently guided by understanding of epidemic transmission dynamics, situation analyses, and programmatic mapping; sex worker HIV and sexually transmitted infection services receive limited domestic financing in many countries; many sex worker HIV prevention programs are inadequately codified to ensure consistency and quality; and many sex worker HIV prevention programs have not evolved adequately to address informal sex workers, male and transgender sex workers, and mobile- and internet-based sex workers. Based on the wider collection of papers, this article presents three major clusters of recommendations: (i) HIV programs focused on sex workers should be prioritized, developed, and implemented based on robust evidence; (ii) national political will and increased funding are needed to increase coverage of effective sex worker HIV prevention programs in low and middle income countries; and (iii) comprehensive, integrated, and rapidly evolving HIV programs are needed to ensure equitable access to health services for individuals involved in all forms of sex work.

  13. Scaling up depot medroxyprogesterone acetate (DMPA): a systematic literature review illustrating the AIDED model.

    Science.gov (United States)

    Curry, Leslie; Taylor, Lauren; Pallas, Sarah Wood; Cherlin, Emily; Pérez-Escamilla, Rafael; Bradley, Elizabeth H

    2013-08-02

    Use of depot medroxyprogesterone acetate (DMPA), often known by the brand name Depo-Provera, has increased globally, particularly in multiple low- and middle-income countries (LMICs). As a reproductive health technology that has scaled up in diverse contexts, DMPA is an exemplar product innovation with which to illustrate the utility of the AIDED model for scaling up family health innovations. We conducted a systematic review of the enabling factors and barriers to scaling up DMPA use in LMICs. We searched 11 electronic databases for academic literature published through January 2013 (n = 284 articles), and grey literature from major health organizations. We applied exclusion criteria to identify relevant articles from peer-reviewed (n = 10) and grey literature (n = 9), extracting data on scale up of DMPA in 13 countries. We then mapped the resulting factors to the five AIDED model components: ASSESS, INNOVATE, DEVELOP, ENGAGE, and DEVOLVE. The final sample of sources included studies representing variation in geographies and methodologies. We identified 15 enabling factors and 10 barriers to dissemination, diffusion, scale up, and/or sustainability of DMPA use. The greatest number of factors were mapped to the ASSESS, DEVELOP, and ENGAGE components. Findings offer early empirical support for the AIDED model, and provide insights into scale up of DMPA that may be relevant for other family planning product innovations.

  14. Quality Assessment of Physical and Organoleptic Instant Corn Rice on Scale-Up Process

    Science.gov (United States)

    Kumalasari, R.; Ekafitri, R.; Indrianti, N.

    2017-12-01

    Development of instant corn rice product has been successfully conducted on a laboratory scale. Corn has high carbohydrate content but low in fiber. The addition of fiber in instant corn rice, intended to improve the functioning of the product, and replace fiber loss during the process. Scale up process of Instant corn rice required to increase the production capacity. Scale up was the process to get identic output on a larger scale based on predetermined production scale. This study aimed to assess the changes and differences in the quality of instant corn rice during scale up. Instant corn rice scale up was done on production capacity 3 kg, 4 kg and 5 kg. Results showed that scale up of instant corn rice producing products with rehydration ratio ranges between 514% - 570%, the absorption rate ranged between 414% - 470%, swelling rate ranging between 119% - 134%, bulk density ranged from 0.3661 to 0.4745 (g/ml) and porosity ranging between 30-37%. The physical quality of instant corn rice on scale up were stable from the ones at laboratory scale on swelling rate, rehydration ratio, and absorption rate but not stable on bulk density and porosity. Organoleptic qualities were stable at increased scale compared on a laboratory scale. Bulk density was higher than those at laboratory scale, and the porosity was lower than those at laboratory scale.

  15. Scale-up of mixer-settler for uranium extraction; Determinacao das relacoes de `scale-up` em misturador-decantador tipo caixa utilizado na extracao de uranio

    Energy Technology Data Exchange (ETDEWEB)

    Santana, A.O. de

    1990-05-01

    The aim of this work was to obtain scale-up relations for a box type mixer-settler used in uranium extraction process for chloridric leaches. Three box type units with different sizes and with the same geometry were used for scale-up of the mixer. The correlation between extraction rate and specific power input, D/T ratio (stirrer diameter/mixer length) and residence time were experimentally obtained. The results showed that the extraction increases with power input for a constant value of D/T equal to 1/3, remaining however independent from mixer sizes for a specific value of power input. This behavior was observed for power input values ranging from 100 to 750 w/m{sup 9}. (author). 23 refs, 22 figs, 23 tabs.

  16. What Is Needed to Eradicate Lymphatic Filariasis? A Model-Based Assessment on the Impact of Scaling Up Mass Drug Administration Programs.

    Directory of Open Access Journals (Sweden)

    Randee J Kastner

    Full Text Available Lymphatic filariasis (LF is a neglected tropical disease for which more than a billion people in 73 countries are thought to be at-risk. At a global level, the efforts against LF are designed as an elimination program. However, current efforts appear to aim for elimination in some but not all endemic areas. With the 2020 goal of elimination looming, we set out to develop plausible scale-up scenarios to reach global elimination and eradication. We predict the duration of mass drug administration (MDA necessary to reach local elimination for a variety of transmission archetypes using an existing model of LF transmission, estimate the number of treatments required for each scenario, and consider implications of rapid scale-up.We have defined four scenarios that differ in their geographic coverage and rate of scale-up. For each scenario, country-specific simulations and calculations were performed that took into account the pre-intervention transmission intensity, the different vector genera, drug regimen, achieved level of population coverage, previous progress toward elimination, and potential programmatic delays due to mapping, operations, and administration.Our results indicate that eliminating LF by 2020 is unlikely. If MDA programs are drastically scaled up and expanded, the final round of MDA for LF eradication could be delivered in 2028 after 4,159 million treatments. However, if the current rate of scale-up is maintained, the final round of MDA to eradicate LF may not occur until 2050.Rapid scale-up of MDA will decrease the amount of time and treatments required to reach LF eradication. It may also propel the program towards success, as the risk of failure is likely to increase with extended program duration.

  17. Can trained lay providers perform HIV testing services? A review of national HIV testing policies.

    Science.gov (United States)

    Flynn, David E; Johnson, Cheryl; Sands, Anita; Wong, Vincent; Figueroa, Carmen; Baggaley, Rachel

    2017-01-04

    Only an estimated 54% of people living with HIV are aware of their status. Despite progress scaling up HIV testing services (HTS), a testing gap remains. Delivery of HTS by lay providers may help close this testing gap, while also increasing uptake and acceptability of HIV testing among key populations and other priority groups. 50 National HIV testing policies were collated from WHO country intelligence databases, contacts and testing program websites. Data regarding lay provider use for HTS was extracted and collated. Our search had no geographical or language restrictions. This data was then compared with reported data from the Global AIDS Response Progress Reporting (GARPR) from July 2015. Forty-two percent of countries permit lay providers to perform HIV testing and 56% permit lay providers to administer pre-and post-test counseling. Comparative analysis with GARPR found that less than half (46%) of reported data from countries were consistent with their corresponding national HIV testing policy. Given the low uptake of lay provider use globally and their proven use in increasing HIV testing, countries should consider revising policies to support lay provider testing using rapid diagnostic tests.

  18. Technology transfer and scale-up of the Flublok recombinant hemagglutinin (HA) influenza vaccine manufacturing process.

    Science.gov (United States)

    Buckland, Barry; Boulanger, Robert; Fino, Mireli; Srivastava, Indresh; Holtz, Kathy; Khramtsov, Nikolai; McPherson, Clifton; Meghrous, Jamal; Kubera, Paul; Cox, Manon M J

    2014-09-22

    Multiple different hemagglutinin (HA) protein antigens have been reproducibly manufactured at the 650L scale by Protein Sciences Corporation (PSC) based on an insect cell culture with baculovirus infection. Significantly, these HA protein antigens were produced by the same Universal Manufacturing process as described in the biological license application (BLA) for the first recombinant influenza vaccine approved by the FDA (Flublok). The technology is uniquely designed so that a change in vaccine composition can be readily accommodated from one HA protein antigen to another one. Here we present a vaccine candidate to combat the recently emerged H7N9 virus as an example starting with the genetic sequence for the required HA, creation of the baculovirus and ending with purified protein antigen (or vaccine component) at the 10L scale accomplished within 38 days under GMP conditions. The same process performance is being achieved at the 2L, 10L, 100L, 650L and 2500L scale. An illustration is given of how the technology was transferred from the benchmark 650L scale facility to a retrofitted microbial facility at the 2500L scale within 100 days which includes the time for facility engineering changes. The successful development, technology transfer and scale-up of the Flublok process has major implications for being ready to make vaccine rapidly on a worldwide scale as a defense against pandemic influenza. The technology described does not have the same vulnerability to mutations in the egg adapted strain, and resulting loss in vaccine efficacy, faced by egg based manufacture. Copyright © 2014 Elsevier Ltd. All rights reserved.

  19. Preparation and scale up of extended-release tablets of bromopride

    Directory of Open Access Journals (Sweden)

    Guilherme Neves Ferreira

    2014-04-01

    Full Text Available Reproducibility of the tablet manufacturing process and control of its pharmaceutics properties depends on the optimization of formulation aspects and process parameters. Computer simulation such as Design of Experiments (DOE can be used to scale up the production of this formulation, in particular for obtaining sustained-release tablets. Bromopride formulations are marketed in the form of extended-release pellets, which makes the product more expensive and difficult to manufacture. The aim of this study was to formulate new bromopride sustained release formulations as tablets, and to develop mathematical models to standardize the scale up of this formulation, controlling weight and hardness of the tablets during manufacture according to the USP 34th edition. DOE studies were conducted using Minitab(tm software. Different excipient combinations were evaluated in order to produce bromopride sustained-release matrix tablets. In the scale-up study, data were collected and variations in tableting machine parameters were measured. Data were processed by Minitab(tm software, generating mathematical equations used for prediction of powder compaction behavior, according to the settings of the tableting machine suitable for scale-up purposes. Bromopride matrix tablets with appropriate characteristics for sustained release were developed. The scale-up of the formulation with the most suitable sustained release profile was established by using mathematical models, indicating that the formulation can be a substitute for the pellets currently marketed.

  20. Provider-related barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs) and hospitals.

    Science.gov (United States)

    Bogart, Laura M; Howerton, Devery; Lange, James; Setodji, Claude Messan; Becker, Kirsten; Klein, David J; Asch, Steven M

    2010-06-01

    We examined provider-reported barriers to rapid HIV testing in U.S. urban non-profit community clinics, community-based organizations (CBOs), and hospitals. 12 primary metropolitan statistical areas (PMSAs; three per region) were sampled randomly, with sampling weights proportional to AIDS case reports. Across PMSAs, all 671 hospitals and a random sample of 738 clinics/CBOs were telephoned for a survey on rapid HIV test availability. Of the 671 hospitals, 172 hospitals were randomly selected for barriers questions, for which 158 laboratory and 136 department staff were eligible and interviewed in 2005. Of the 738 clinics/CBOs, 276 were randomly selected for barriers questions, 206 were reached, and 118 were eligible and interviewed in 2005-2006. In multivariate models, barriers regarding translation of administrative/quality assurance policies into practice were significantly associated with rapid HIV testing availability. For greater rapid testing diffusion, policies are needed to reduce administrative barriers and provide quality assurance training to non-laboratory staff.

  1. Evaluation of Performance of Two Rapid Tests for Detection of HIV-1 and -2 in High- and Low-Prevalence Populations in Nigeria.

    Science.gov (United States)

    Manak, Mark M; Njoku, Ogbonnaya S; Shutt, Ashley; Malia, Jennifer; Jagodzinski, Linda L; Milazzo, Mark; Suleiman, Aminu; Ogundeji, Amos A; Nelson, Robert; Ayemoba, Ojor R; O'Connell, Robert J; Singer, Darrell E; Michael, Nelson L; Peel, Sheila A

    2015-11-01

    The availability of reliable human immunodeficiency virus types 1 and 2 (HIV-1/2) rapid tests in resource-limited settings represents an important advancement in the accurate diagnosis of HIV infection and presents opportunities for implementation of effective prevention and treatment interventions among vulnerable populations. A study of the potential target populations for future HIV vaccine studies examined the prevalence of HIV infections at six selected sites in Nigeria and evaluated the use of two rapid diagnostic tests (RDTs) for HIV. The populations included market workers at sites adjacent to military installations and workers at highway settlements (truck stops) who may have a heightened risk of HIV exposure. Samples from 3,187 individuals who provided informed consent were tested in parallel using the Determine (DT) and Stat-Pak (SP) RDTs; discordant results were subjected to the Uni-Gold (UG) RDT as a tiebreaker. The results were compared to those of a third-generation enzyme immunoassay screen with confirmation of repeat reactive samples by HIV-1 Western blotting. One participant was HIV-2 infected, yielding positive results on both RDTs. Using the laboratory algorithm as a gold standard, we calculated sensitivities of 98.5% (confidence interval [CI], 97.1 to 99.8%) for DT and 98.1% (CI, 96.7 to 99.6%) for SP and specificities of 98.7% (CI, 98.3 -99.1%) for DT and 99.8% (CI, 99.6 to 100%) for SP. Similar results were obtained when the sites were stratified into those of higher HIV prevalence (9.4% to 22.8%) versus those of lower prevalence (3.2% to 7.3%). A parallel two-test algorithm requiring both DT and SP to be positive resulted in the highest sensitivity (98.1%; CI, 96.7 to 99.6%) and specificity (99.97%; CI, 99.9 to 100%) relative to those for the reference laboratory algorithm. Copyright © 2015, Manak et al.

  2. Coming home to die? The association between migration and mortality in rural Tanzania before and after ART scale-up.

    Science.gov (United States)

    Levira, Francis; Todd, Jim; Masanja, Honorati

    2014-01-01

    Prior to the scale-up of antiretroviral therapy (ART), demographic surveillance cohort studies showed higher mortality among migrants than residents in many rural areas. This study quantifies the overall and AIDS-specific mortality between migrants and residents prior to ART, during ART scale-up, and after widespread availability of ART in Rufiji district in Tanzania. In Health and Demographic Surveillance System (HDSS), the follow-up of individuals aged 15-59 years was categorized into three periods: before ART (1998-2003), during ART scale-up (2004-2007), and after widespread availability of ART (2008-2011). Residents were those who never migrated within and beyond HDSS, internal migrants were those who moved within the HDSS, and external migrants were those who moved into the HDSS from outside. Mortality rates were estimated from deaths and person-years of observations calculated in each time period. Hazard ratios were estimated to compare mortality between migrants and residents. AIDS deaths were identified from verbal autopsy, and the odds ratio of dying from AIDS between migrants and residents was estimated using the multivariate logistic regression model. Internal and external migrants experienced higher overall mortality than residents before the introduction of ART. After widespread availability of ART overall mortality were similar for internal and external migrants. These overall mortality experiences observed were similar for males and females. In the multivariate logistic regression model, adjusting for age, sex, education, and social economic status, internal migrants had similar likelihood of dying from AIDS as residents (adjusted odds ratio [AOR]=1.14, 95% confidence interval [CI]: 0.70-1.87) while external migrants were 70% more likely to die from AIDS compared to residents prior to the introduction of ART (AOR=1.70, 95% CI: 1.06-2.73). After widespread availability of ART with the same adjustment factors, the odds of dying from AIDS were similar

  3. Performance and diagnostic usefulness of commercially available enzyme linked immunosorbent assay and rapid kits for detection of HIV, HBV and HCV in India.

    Science.gov (United States)

    Maity, Susmita; Nandi, Srijita; Biswas, Subrata; Sadhukhan, Salil Kumar; Saha, Malay Kumar

    2012-11-26

    HIV, HBV and HCV pose a major public health problem throughout the world. Detection of infection markers for these agents is a major challenge for testing laboratories in a resource poor setting. As blood transfusion is an important activity saving millions of live every year, it also carries a risk of transfusion transmissible infections caused by these fatal blood borne pathogens if the quality of testing is compromised. Conventional ELISA is regarded as the mostly used screening technique but due to limitations like high cost, unavailability in many blood banks and testing sites, involvement of costly instruments, time taking nature and requirement of highly skilled personnel for interpretation, rapid tests are gaining more importance and warrants comparison of performance. A comparative study between these two techniques has been performed using commercially available diagnostic kits to assess their efficacy for detection of HIV, HBV and HCV infections. Rapid kits were more efficient in specificity with synthetic antigens along with high PPV than ELISA in most cases. Comparison between different ELISA kits revealed that Microlisa HIV and Hepalisa (J. Mitra & Co. Pvt. Ltd.); ERBA LISA HIV1 + 2, ERBA LISA Hepatitis B and ERBA LISA HCV (Transasia Bio-medicals Ltd.) gives uniform result with good performance in terms of sensitivity, specificity, PPV, NPV and efficiency, whereas, Microlisa HCV (J. Mitra & Co. Pvt. Ltd.), Microscreen HBsAg ELISA and INNOVA HCV (Span Diagnostics Ltd.) did not perform well. Rapid kits were also having high degree of sensitivity and specificity (100%) except in HIV Comb and HCV Comb (J. Mitra & Co. Pvt. Ltd.). The kit efficiency didn't vary significantly among different companies and lots in all the cases except for HCV ELISA showing statistically significant variation (p bank. For availability of quality commercial diagnostic assays, evaluation of kit may be helpful.

  4. Enabling and challenging factors in institutional reform: The case of SCALE-UP

    Science.gov (United States)

    Foote, Kathleen; Knaub, Alexis; Henderson, Charles; Dancy, Melissa; Beichner, Robert J.

    2016-06-01

    While many innovative teaching strategies exist, integration into undergraduate science teaching has been frustratingly slow. This study aims to understand the low uptake of research-based instructional innovations by studying 21 successful implementations of the Student Centered Active Learning with Upside-down Pedagogies (SCALE-UP) instructional reform. SCALE-UP significantly restructures the classroom environment and pedagogy to promote highly active and interactive instruction. Although originally designed for university introductory physics courses, SCALE-UP has spread to many other disciplines at hundreds of departments around the world. This study reports findings from in-depth, open-ended interviews with 21 key contact people involved with successful secondary implementations of SCALE-UP throughout the United States. We defined successful implementations as those who restructured their pedagogy and classroom and sustained and/or spread the change. Interviews were coded to identify the most common enabling and challenging factors during reform implementation and compared to the theoretical framework of Kotter's 8-step Change Model. The most common enabling influences that emerged are documenting and leveraging evidence of local success, administrative support, interaction with outside SCALE-UP user(s), and funding. Many challenges are linked to the lack of these enabling factors including difficulty finding funding, space, and administrative and/or faculty support for reform. Our focus on successful secondary implementations meant that most interviewees were able to overcome challenges. Presentation of results is illuminated with case studies, quotes, and examples that can help secondary implementers with SCALE-UP reform efforts specifically. We also discuss the implications for policy makers, researchers, and the higher education community concerned with initiating structural change.

  5. Rapid point-of-care CD4 testing at mobile HIV testing sites to increase linkage to care: an evaluation of a pilot program in South Africa.

    Science.gov (United States)

    Larson, Bruce A; Schnippel, Kathryn; Ndibongo, Buyiswa; Xulu, Thembisile; Brennan, Alana; Long, Lawrence; Fox, Matthew P; Rosen, Sydney

    2012-10-01

    A mobile HIV counseling and testing (HCT) program around Johannesburg piloted the integration of point-of-care (POC) CD4 testing, using the Pima analyzer, to improve linkages to HIV care. We report results from this pilot program for patients testing positive (n = 508) from May to October 2010. We analyzed 3 primary outcomes: assignment to testing group (offered POC CD4 or not), successful follow-up (by telephone), and completed the referral visit for HIV care within 8 weeks after HIV testing if successfully followed up. Proportions for each outcome were calculated, and relative risks were estimated using a modified Poisson approach. Three hundred eleven patients were offered the POC CD4 test, and 197 patients were not offered the test. No differences in patient characteristics were observed between the 2 groups. Approximately 62.7% of patients were successfully followed up 8 weeks after HIV testing, with no differences observed between testing groups. Among those followed up, 54.4% reported completing their referral visit. Patients offered the POC CD4 test were more likely to complete the referral visit for further HIV care (relative risk 1.25, 95% confidence interval: 1.00 to 1.57). In this mobile HCT setting, patients offered POC CD4 testing as part of the HCT services were more likely to visit a referral clinic after testing, suggesting that rapid CD4 testing technology may improve linkage to HIV care. Future research can evaluate options for adjusting HCT services if POC CD4 testing was included permanently and the cost-effectiveness of the POC CD4 testing compared with other approaches for improving linkage of care.

  6. Will gay and bisexually active men at high risk of infection use over-the-counter rapid HIV tests to screen sexual partners?

    Science.gov (United States)

    Carballo-Diéguez, Alex; Frasca, Timothy; Dolezal, Curtis; Balan, Ivan

    2012-01-01

    The Food and Drug Administration may license OraQuick™, a rapid HIV test, for over-the-counter (OTC) sale. This study investigated whether HIV-uninfected, non-monogamous, gay and bisexual men who never or rarely use condoms would use the test with partners as a harm-reduction approach. Sixty participants responded to two computer-assisted self-interviews, underwent an in-depth interview, and chose whether to test themselves with OraQuick. Over 80% of the men said they would use the kit to test sexual partners or themselves if it became available OTC. Most participants understood that antibody tests have a window period in which the virus is undetectable, yet saw advantages to using the test to screen partners; 74% tested themselves in our offices. Participants offered several possible strategies to introduce the home-test idea to partners, frequently endorsed mutual testing, and highlighted that home testing could stimulate greater honesty in serostatus disclosure. Participants drew distinctions between testing regular versus occasional partners. Non-monogamous men who have sex with men, who never or rarely use condoms, may nevertheless seek to avoid HIV. Technologies that do not interfere with sexual pleasure are likely to be used when available. Studies are needed to evaluate the advantages and disadvantages of using OTC rapid HIV tests as one additional harm-reduction tool.

  7. Progress in AMSC scale-up of second generation HTS wire

    International Nuclear Information System (INIS)

    Zhang, W.; Rupich, M.W.; Schoop, U.; Verebelyi, D.T.; Thieme, C.L.H.; Li, X.; Kodenkandath, T.; Huang, Y.; Siegal, E.; Buczek, D.; Carter, W.; Nguyen, N.; Schreiber, J.; Prasova, M.; Lynch, J.; Tucker, D.; Fleshler, S.

    2007-01-01

    American Superconductor has successfully scaled up its low-cost, high volume second generation (2G) HTS wire process into pre-pilot scale production, with performance approaching first generation (1G) HTS wire. AMSC's manufacturing approach is based on RABiTS TM /MOD wide strip technology, with metal organic deposition (MOD) process for the YBCO layer and the Rolling Assisted Biaxially Textured Substrate (RABiTS) process for the template. In this paper, we review the status of the 2G manufacturing scale up at AMSC and describe the properties and architecture of the 2G wire being manufactured and developed for various applications

  8. Progress in AMSC scale-up of second generation HTS wire

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, W. [American Superconductor Corporation, 2 Technology Drive, Westborough, MA 01545 (United States)], E-mail: wzhang@amsuper.com; Rupich, M.W.; Schoop, U.; Verebelyi, D.T.; Thieme, C.L.H.; Li, X.; Kodenkandath, T.; Huang, Y.; Siegal, E.; Buczek, D.; Carter, W.; Nguyen, N.; Schreiber, J.; Prasova, M.; Lynch, J.; Tucker, D.; Fleshler, S. [American Superconductor Corporation, 2 Technology Drive, Westborough, MA 01545 (United States)

    2007-10-01

    American Superconductor has successfully scaled up its low-cost, high volume second generation (2G) HTS wire process into pre-pilot scale production, with performance approaching first generation (1G) HTS wire. AMSC's manufacturing approach is based on RABiTS{sup TM}/MOD wide strip technology, with metal organic deposition (MOD) process for the YBCO layer and the Rolling Assisted Biaxially Textured Substrate (RABiTS) process for the template. In this paper, we review the status of the 2G manufacturing scale up at AMSC and describe the properties and architecture of the 2G wire being manufactured and developed for various applications.

  9. Modeling heat efficiency, flow and scale-up in the corotating disc scraped surface heat exchanger

    DEFF Research Database (Denmark)

    Friis, Alan; Szabo, Peter; Karlson, Torben

    2002-01-01

    A comparison of two different scale corotating disc scraped surface heat exchangers (CDHE) was performed experimentally. The findings were compared to predictions from a finite element model. We find that the model predicts well the flow pattern of the two CDHE's investigated. The heat transfer...... performance predicted by the model agrees well with experimental observations for the laboratory scale CDHE whereas the overall heat transfer in the scaled-up version was not in equally good agreement. The lack of the model to predict the heat transfer performance in scale-up leads us to identify the key...

  10. Scale-up operations of CuSOB4B-NaB2BSOB4B electrolytic ...

    African Journals Online (AJOL)

    Scale-up techniques were established for an Inclined Cathode Electrochemical Cell (ICEC) for the removal of copper ions from a CuSOB4B-NaB2BSOB4B solution at reduced operation power consumption. The scale-up relationshi-ps were derived and applied in conjunction with scale-up factors. With a scale-up factor of 2, ...

  11. Intra-facility linkage of HIV-positive mothers and HIV-exposed babies into HIV chronic care: rural and urban experience in a resource limited setting.

    Directory of Open Access Journals (Sweden)

    Christine Mugasha

    Full Text Available INTRODUCTION: Linkage of HIV-infected pregnant women to HIV care remains critical for improvement of maternal and child outcomes through prevention of maternal-to-child transmission of HIV (PMTCT and subsequent chronic HIV care. This study determined proportions and factors associated with intra-facility linkage to HIV care and Early Infant Diagnosis care (EID to inform strategic scale up of PMTCT programs. METHODS: A cross-sectional review of records was done at 2 urban and 3 rural public health care facilities supported by the Infectious Diseases Institute (IDI. HIV-infected pregnant mothers, identified through routine antenatal care (ANC and HIV-exposed babies were evaluated for enrollment in HIV clinics by 6 weeks post-delivery. RESULTS: Overall, 1,025 HIV-infected pregnant mothers were identified during ANC between January and June, 2012; 267/1,025 (26% in rural and 743/1,025 (74% in urban facilities. Of these 375/1,025 (37% were linked to HIV clinics [67/267(25% rural and 308/758(41% urban]. Of 636 HIV-exposed babies, 193 (30% were linked to EID. Linkage of mother-baby pairs to HIV chronic care and EID was 16% (101/636; 8/179 (4.5%] in rural and 93/457(20.3% in urban health facilities. Within rural facilities, ANC registration <28 weeks-of-gestation was associated with mothers' linkage to HIV chronic care [AoR, 2.0 95% CI, 1.1-3.7, p = 0.019] and mothers' multi-parity was associated with baby's linkage to EID; AoR 4.4 (1.3-15.1, p = 0.023. Stigma, long distance to health facilities and vertical PMTCT services affected linkage in rural facilities, while peer mothers, infant feeding services, long patient queues and limited privacy hindered linkage to HIV care in urban settings. CONCLUSION: Post-natal linkage of HIV-infected mothers to chronic HIV care and HIV-exposed babies to EID programs was low. Barriers to linkage to HIV care vary in urban and rural settings. We recommend targeted interventions to rapidly improve linkage to

  12. Elevated Basal Pre-infection CXCL10 in Plasma and in the Small Intestine after Infection Are Associated with More Rapid HIV/SIV Disease Onset.

    Directory of Open Access Journals (Sweden)

    Mickaël J Ploquin

    2016-08-01

    Full Text Available Elevated blood CXCL10/IP-10 levels during primary HIV-1 infection (PHI were described as an independent marker of rapid disease onset, more robust than peak viremia or CD4 cell nadir. IP-10 enhances the recruitment of CXCR3+ cells, which include major HIV-target cells, raising the question if it promotes the establishment of viral reservoirs. We analyzed data from four cohorts of HIV+ patients, allowing us to study IP-10 levels before infection (Amsterdam cohort, as well as during controlled and uncontrolled viremia (ANRS cohorts. We also addressed IP-10 expression levels with regards to lymphoid tissues (LT and blood viral reservoirs in patients and non-human primates. Pre-existing elevated IP-10 levels but not sCD63 associated with rapid CD4 T-cell loss upon HIV-1 infection. During PHI, IP-10 levels and to a lesser level IL-18 correlated with cell-associated HIV DNA, while 26 other inflammatory soluble markers did not. IP-10 levels tended to differ between HIV controllers with detectable and undetectable viremia. IP-10 was increased in SIV-exposed aviremic macaques with detectable SIV DNA in tissues. IP-10 mRNA was produced at higher levels in the small intestine than in colon or rectum. Jejunal IP-10+ cells corresponded to numerous small and round CD68neg cells as well as to macrophages. Blood IP-10 response negatively correlated with RORC (Th17 marker gene expression in the small intestine. CXCR3 expression was higher on memory CD4+ T cells than any other immune cells. CD4 T cells from chronically infected animals expressed extremely high levels of intra-cellular CXCR3 suggesting internalization after ligand recognition. Elevated systemic IP-10 levels before infection associated with rapid disease progression. Systemic IP-10 during PHI correlated with HIV DNA. IP-10 production was regionalized in the intestine during early SIV infection and CD68+ and CD68neg haematopoietic cells in the small intestine appeared to be the major source of IP-10.

  13. Scaling up Evidence-Based Practices: Strategies from Investing in Innovation (i3)

    Science.gov (United States)

    DeWire, Tom; McKithen, Clarissa; Carey, Rebecca

    2017-01-01

    What can the Investing in Innovation (i3) grantees tell us about scaling innovative educational practices? The newly released white paper "Scaling Up Evidence-Based Practices: Strategies from Investing in Innovation (i3)" captures the experiences of nine grantees whose projects collectively have reached over 1.2 million students across…

  14. Tank 18-F And 19-F Tank Fill Grout Scale Up Test Summary

    International Nuclear Information System (INIS)

    Stefanko, D.; Langton, C.

    2012-01-01

    High-level waste (HLW) tanks 18-F and 19-F have been isolated from FTF facilities. To complete operational closure the tanks will be filled with grout for the purpose of: (1) physically stabilizing the tanks, (2) limiting/eliminating vertical pathways to residual waste, (3) entombing waste removal equipment, (4) discouraging future intrusion, and (5) providing an alkaline, chemical reducing environment within the closure boundary to control speciation and solubility of select radionuclides. This report documents the results of a four cubic yard bulk fill scale up test on the grout formulation recommended for filling Tanks 18-F and 19-F. Details of the scale up test are provided in a Test Plan. The work was authorized under a Technical Task Request (TTR), HLE-TTR-2011-008, and was performed according to Task Technical and Quality Assurance Plan (TTQAP), SRNL-RP-2011-00587. The bulk fill scale up test described in this report was intended to demonstrate proportioning, mixing, and transportation, of material produced in a full scale ready mix concrete batch plant. In addition, the material produced for the scale up test was characterized with respect to fresh properties, thermal properties, and compressive strength as a function of curing time.

  15. 3,4,5-Tri-dodecyloxybenzoic acid: optimisation and scale-up of the synthesis

    NARCIS (Netherlands)

    Hersmis, M.C.; Spiering, A.J.H.; Waterval, R.J.M.; Meuldijk, J.; Vekemans, J.A.J.M.; Hulshof, L.A.

    2001-01-01

    The synthesis of tris-O-dodecyl-gallic acid [3,4,5-tris(dodecyloxy)benzoic acid] - a versatile building block for org. liq. cryst. materials - has been selected for fine chem. scale-up. A large-scale procedure of the alkylation of Me gallate with dodecyl bromide was optimized with exptl. design

  16. Including Performance Assessments in Accountability Systems: A Review of Scale-Up Efforts

    Science.gov (United States)

    Tung, Rosann

    2010-01-01

    The purpose of this literature and field review is to understand previous efforts at scaling up performance assessments for use across districts and states. Performance assessments benefit students and teachers by providing more opportunities for students to demonstrate their knowledge and complex skills, by providing teachers with better…

  17. Integrated Graduate and Continuing Education in Protein Chromatography for Bioprocess Development and Scale-Up

    Science.gov (United States)

    Carta, Jungbauer

    2011-01-01

    We describe an intensive course that integrates graduate and continuing education focused on the development and scale-up of chromatography processes used for the recovery and purification of proteins with special emphasis on biotherapeutics. The course includes lectures, laboratories, teamwork, and a design exercise and offers a complete view of…

  18. Investing in the foundation of sustainable development: pathways to scale up for early childhood development.

    Science.gov (United States)

    Richter, Linda M; Daelmans, Bernadette; Lombardi, Joan; Heymann, Jody; Boo, Florencia Lopez; Behrman, Jere R; Lu, Chunling; Lucas, Jane E; Perez-Escamilla, Rafael; Dua, Tarun; Bhutta, Zulfiqar A; Stenberg, Karin; Gertler, Paul; Darmstadt, Gary L

    2017-01-07

    Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals. Copyright © 2017 Elsevier Ltd. All rights reserved.

  19. Scaling-up of CO2 fluxes to assess carbon sequestration in rangelands of Central Asia

    Science.gov (United States)

    Bruce K. Wylie; Tagir G. Gilmanov; Douglas A. Johnson; Nicanor Z. Saliendra; Larry L. Tieszen; Ruth Anne F. Doyle; Emilio A. Laca

    2006-01-01

    Flux towers provide temporal quantification of local carbon dynamics at specific sites. The number and distribution of flux towers, however, are generally inadequate to quantify carbon fluxes across a landscape or ecoregion. Thus, scaling up of flux tower measurements through use of algorithms developed from remote sensing and GIS data is needed for spatial...

  20. An efficient permeability scaling-up technique applied to the discretized flow equations

    Energy Technology Data Exchange (ETDEWEB)

    Urgelli, D.; Ding, Yu [Institut Francais du Petrole, Rueil Malmaison (France)

    1997-08-01

    Grid-block permeability scaling-up for numerical reservoir simulations has been discussed for a long time in the literature. It is now recognized that a full permeability tensor is needed to get an accurate reservoir description at large scale. However, two major difficulties are encountered: (1) grid-block permeability cannot be properly defined because it depends on boundary conditions; (2) discretization of flow equations with a full permeability tensor is not straightforward and little work has been done on this subject. In this paper, we propose a new method, which allows us to get around both difficulties. As the two major problems are closely related, a global approach will preserve the accuracy. So, in the proposed method, the permeability up-scaling technique is integrated in the discretized numerical scheme for flow simulation. The permeability is scaled-up via the transmissibility term, in accordance with the fluid flow calculation in the numerical scheme. A finite-volume scheme is particularly studied, and the transmissibility scaling-up technique for this scheme is presented. Some numerical examples are tested for flow simulation. This new method is compared with some published numerical schemes for full permeability tensor discretization where the full permeability tensor is scaled-up through various techniques. Comparing the results with fine grid simulations shows that the new method is more accurate and more efficient.

  1. Scaling up adsorption media reactors for copper removal with the aid of dimensionless numbers.

    Science.gov (United States)

    Chang, Ni-Bin; Houmann, Cameron; Wanielista, Martin

    2016-02-01

    Adsorption media may be used to sorb copper in an aquatic environment for pollution control. Effective design of adsorption media reactors is highly dependent on selection of the hydraulic residence time when scaling up a pilot-scale reactor to a field-scale reactor. This paper seeks to improve scaling-up technique of the reactor design process through the use of the Damköhler and Péclet numbers via a dimensional analysis. A new scaling-up theory is developed in this study through a joint consideration of the Damköhler and Péclet numbers for a constant media particle size such that a balance between transport control and reaction control can be harmonized. A series of column breakthrough tests at varying hydraulic residence times revealed a clear peak adsorption capacity at a Damköhler number of 2.74. The Péclet numbers for the column breakthrough tests indicated that mechanical dispersion is an important effect that requires further consideration in the scaling-up process. However, perfect similitude of the Damköhler number cannot be maintained for a constant media particle size, and relaxation of hydrodynamic similitude through variation of the Péclet number must occur. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. A scaled-up Seinhorst elutriater for extraction of cyst nematodes from soil

    NARCIS (Netherlands)

    Been, T.H.; Bekkum, van P.J.; Beers, van T.G.; Beniers, J.E.

    2007-01-01

    In order to process large soil samples containing potato cyst nematodes, the Seinhorst (1964) cyst elutriator was scaled up to process both sandy and marine-clay soils in batches of up to 2.5 kg. Several modifications were implemented. To maintain the required upward current of 3.01 min¿1, an inflow

  3. 77 FR 25152 - Applications for New Awards; Investing in Innovation Fund, Scale-Up Grants

    Science.gov (United States)

    2012-04-27

    ... DEPARTMENT OF EDUCATION Applications for New Awards; Investing in Innovation Fund, Scale- Up Grants Correction In notice document 2012-7362 appearing on pages 18216-18229 in the issue of Tuesday, March 27, 2012 make the following corrections: 1. On page 18225, in the second column, in the second...

  4. The Pennsylvania Positive Behavior Support Network: Describing Our Scale-Up

    Science.gov (United States)

    Runge, Timothy J.; Longwill, Douglas A.; Staszkiewicz, Mark J.; Palmiero, James; Lawson, Tina M.

    2016-01-01

    Pennsylvania began scaling up high-fidelity implementation of SchoolWide Positive Behavioral Interventions and Supports (SWPBIS) in 2006-2007 due to converging regulatory, legal, ethical, and practical influences. The Pennsylvania Community of Practice on School-Based Behavioral Health adopted Algozzine et al.'s (2010) blueprint to describe and…

  5. TANK 18-F AND 19-F TANK FILL GROUT SCALE UP TEST SUMMARY

    Energy Technology Data Exchange (ETDEWEB)

    Stefanko, D.; Langton, C.

    2012-01-03

    High-level waste (HLW) tanks 18-F and 19-F have been isolated from FTF facilities. To complete operational closure the tanks will be filled with grout for the purpose of: (1) physically stabilizing the tanks, (2) limiting/eliminating vertical pathways to residual waste, (3) entombing waste removal equipment, (4) discouraging future intrusion, and (5) providing an alkaline, chemical reducing environment within the closure boundary to control speciation and solubility of select radionuclides. This report documents the results of a four cubic yard bulk fill scale up test on the grout formulation recommended for filling Tanks 18-F and 19-F. Details of the scale up test are provided in a Test Plan. The work was authorized under a Technical Task Request (TTR), HLE-TTR-2011-008, and was performed according to Task Technical and Quality Assurance Plan (TTQAP), SRNL-RP-2011-00587. The bulk fill scale up test described in this report was intended to demonstrate proportioning, mixing, and transportation, of material produced in a full scale ready mix concrete batch plant. In addition, the material produced for the scale up test was characterized with respect to fresh properties, thermal properties, and compressive strength as a function of curing time.

  6. Scaling up and out as a Pathway for Food System Transitions

    Directory of Open Access Journals (Sweden)

    Hannah Pitt

    2016-10-01

    Full Text Available This paper contributes to the understanding of sustainability transitions by analysing processes of scaling up and out as change pathway. It defines scaling up and out as a distinct form of policy transfer focused on programme implementation, with continuity of actors across jurisdictions. We detail how scaling up and out occurs, introducing a new mechanism to policy transfer frameworks. This is explicated through the case study of Food for Life (FFL, a civil society innovation programme promoting sustainable healthy food in public settings. We highlight why FFL was scaled up and out, how this was achieved, by whom, and the results and success factors. The case study demonstrates the importance of interrogating motivations for transferring policies, and how these influence whether successful outcomes are achieved. This requires a revised framework for analysing policy transfer, with greater attention to the links between motives and outcomes, and a less binary understanding of agents’ roles. Where scaling is the mode of policy transfer, we suggest that continuous involvement of at least one transfer agent across the process is significant to success. We conclude by highlighting implications for future research into policy transfer and food system transitions.

  7. Scaling-up vaccine production: implementation aspects of a biomass growth observer and controller

    NARCIS (Netherlands)

    Soons, Z.I.T.A.; IJssel, van den J.; Pol, van der L.A.; Straten, van G.; Boxtel, van A.J.B.

    2009-01-01

    Abstract This study considers two aspects of the implementation of a biomass growth observer and specific growth rate controller in scale-up from small- to pilot-scale bioreactors towards a feasible bulk production process for whole-cell vaccine against whooping cough. The first is the calculation

  8. Investing in the foundation of sustainable development: pathways to scale up for early childhood development

    Science.gov (United States)

    Richter, Linda M; Daelmans, Bernadette; Lombardi, Joan; Heymann, Jody; Boo, Florencia Lopez; Behrman, Jere R; Lu, Chunling; Lucas, Jane E; Perez-Escamilla, Rafael; Dua, Tarun; Bhutta, Zulfiqar A; Stenberg, Karin; Gertler, Paul; Darmstadt, Gary L

    2018-01-01

    Building on long-term benefits of early intervention (Paper 2 of this Series) and increasing commitment to early childhood development (Paper 1 of this Series), scaled up support for the youngest children is essential to improving health, human capital, and wellbeing across the life course. In this third paper, new analyses show that the burden of poor development is higher than estimated, taking into account additional risk factors. National programmes are needed. Greater political prioritisation is core to scale-up, as are policies that afford families time and financial resources to provide nurturing care for young children. Effective and feasible programmes to support early child development are now available. All sectors, particularly education, and social and child protection, must play a role to meet the holistic needs of young children. However, health provides a critical starting point for scaling up, given its reach to pregnant women, families, and young children. Starting at conception, interventions to promote nurturing care can feasibly build on existing health and nutrition services at limited additional cost. Failure to scale up has severe personal and social consequences. Children at elevated risk for compromised development due to stunting and poverty are likely to forgo about a quarter of average adult income per year, and the cost of inaction to gross domestic product can be double what some countries currently spend on health. Services and interventions to support early childhood development are essential to realising the vision of the Sustainable Development Goals. PMID:27717610

  9. Early College for All: Efforts to Scale up Early Colleges in Multiple Settings

    Science.gov (United States)

    Edmunds, Julie A.

    2016-01-01

    Given the positive impacts of the small, stand-alone early college model and the desire to provide those benefits to more students, organizations have begun efforts to scale up the early college model in a variety of settings. These efforts have been supported by the federal government, particularly by the Investing in Innovation (i3) program.…

  10. Electronic Government in the City of Fez, Morocco : Scaling up to the ...

    International Development Research Centre (IDRC) Digital Library (Canada)

    In the pilot phase of the project (101980), electronic service delivery was introduced and successfully deployed in the Fez-Agdal local government office. This phase will scale up the project to include the remaining local government offices in the city of Fez. It will also upgrade, enhance and complete the automation of the ...

  11. Self-Reported HIV-Positive Status But Subsequent HIV-Negative Test Result Using Rapid Diagnostic Testing Algorithms Among Seven Sub-Saharan African Military Populations

    Science.gov (United States)

    2017-07-07

    analysis, data interpretation, or writing of the report. Leidos provided support in the form of salaries for JH, BRT, AGT, MBJ and JM but did not have any...have data on a QA process. The survey used for all seven partner mili- taries was based on a standardized modular survey, which assessed HIV risk... Technical considerations Technical limitations have been shown to increase false-positive HIV test results in voluntary counseling and testing centers

  12. Performance and diagnostic usefulness of commercially available enzyme linked immunosorbent assay and rapid kits for detection of HIV, HBV and HCV in India

    Directory of Open Access Journals (Sweden)

    Maity Susmita

    2012-11-01

    Full Text Available Abstract Background HIV, HBV and HCV pose a major public health problem throughout the world. Detection of infection markers for these agents is a major challenge for testing laboratories in a resource poor setting. As blood transfusion is an important activity saving millions of live every year, it also carries a risk of transfusion transmissible infections caused by these fatal blood borne pathogens if the quality of testing is compromised. Conventional ELISA is regarded as the mostly used screening technique but due to limitations like high cost, unavailability in many blood banks and testing sites, involvement of costly instruments, time taking nature and requirement of highly skilled personnel for interpretation, rapid tests are gaining more importance and warrants comparison of performance. Results A comparative study between these two techniques has been performed using commercially available diagnostic kits to assess their efficacy for detection of HIV, HBV and HCV infections. Rapid kits were more efficient in specificity with synthetic antigens along with high PPV than ELISA in most cases. Comparison between different ELISA kits revealed that Microlisa HIV and Hepalisa (J. Mitra & Co. Pvt. Ltd.; ERBA LISA HIV1 + 2, ERBA LISA Hepatitis B and ERBA LISA HCV (Transasia Bio-medicals Ltd. gives uniform result with good performance in terms of sensitivity, specificity, PPV, NPV and efficiency, whereas, Microlisa HCV (J. Mitra & Co. Pvt. Ltd., Microscreen HBsAg ELISA and INNOVA HCV (Span Diagnostics Ltd. did not perform well. Rapid kits were also having high degree of sensitivity and specificity (100% except in HIV Comb and HCV Comb (J. Mitra & Co. Pvt. Ltd.. The kit efficiency didn’t vary significantly among different companies and lots in all the cases except for HCV ELISA showing statistically significant variation (p  Conclusions ELISA is a good screening assay for markers of HIV, HBV and HCV infections. Rapid tests are useful for

  13. A comparative analysis of costs of single and dual rapid HIV and syphilis diagnostics: results from a randomised controlled trial in Colombia.

    Science.gov (United States)

    Obure, Carol Dayo; Gaitan-Duarte, Hernando; Losada Saenz, Ricardo; Gonzalez, Lina; Angel-Muller, Edith; Laverty, Maura; Perez, Freddy

    2017-11-01

    HIV and congenital syphilis are major public health burdens contributing to substantial perinatal morbidity and mortality globally. Although studies have reported on the costs and cost-effectiveness of rapid diagnostic tests (RDTs) for syphilis screening within antenatal care in a number of resource-constrained settings, empirical evidence on country-specific cost and estimates of single RDTs compared with dual RDTs for HIV and syphilis are limited. A cluster randomised controlled study design was used to compare the incremental costs of two testing algorithms: (1) single RDTs for HIV and syphilis and (2) dual RDTs for HIV and syphilis, in 12 health facilities in Bogota and Cali, Colombia. The costs of single HIV and syphilis RDTs and dual HIV and syphilis RDTs were collected from each of the health facilities. The economic costs per woman tested for HIV and syphilis and costs per woman treated for syphilis defined as the total costs required to test and treat one woman for syphilis were estimated. A total of 2214 women were tested in the study facilities. Cost per pregnant woman tested and cost per woman treated for syphilis were US$10.26 and US$607.99, respectively in the single RDT arm. For the dual RDTs, the cost per pregnant woman tested for HIV and syphilis and cost per woman treated for syphilis were US$15.89 and US$1859.26, respectively. Overall costs per woman tested for HIV and syphilis and cost per woman treated for syphilis were lower in Cali compared with Bogota across both intervention arms. Staff costs accounted for the largest proportion of costs while treatment costs comprised <1% of the preventive programme. Findings show lower average costs for single RDTs compared with dual RDTs with costs sensitive to personnel costs and the scale of output at the health facilities. NCT02454816; results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  14. Age-associated changes in monocyte and innate immune activation markers occur more rapidly in HIV infected women.

    Directory of Open Access Journals (Sweden)

    Genevieve E Martin

    Full Text Available Aging is associated with immune dysfunction and the related development of conditions with an inflammatory pathogenesis. Some of these immune changes are also observed in HIV infection, but the interaction between immune changes with aging and HIV infection are unknown. Whilst sex differences in innate immunity are recognized, little research into innate immune aging has been performed on women.This cross-sectional study of HIV positive and negative women used whole blood flow cytometric analysis to characterize monocyte and CD8(+ T cell subsets. Plasma markers of innate immune activation were measured using standard ELISA-based assays.HIV positive women exhibited elevated plasma levels of the innate immune activation markers CXCL10 (p<0.001, soluble CD163 (sCD163, p = 0.001, sCD14 (p = 0.022, neopterin (p = 0.029 and an increased proportion of CD16(+ monocytes (p = 0.009 compared to uninfected controls. Levels of the innate immune aging biomarkers sCD163 and the proportion of CD16(+ monocytes were equivalent to those observed in HIV negative women aged 14.5 and 10.6 years older, respectively. CXCL10 increased with age at an accelerated rate in HIV positive women (p = 0.002 suggesting a synergistic effect between HIV and aging on innate immune activation. Multivariable modeling indicated that age-related increases in innate immune biomarkers CXCL10 and sCD163 are independent of senescent changes in CD8(+ T lymphocytes.Quantifying the impact of HIV on immune aging reveals that HIV infection in women confers the equivalent of a 10-14 year increase in the levels of innate immune aging markers. These changes may contribute to the increased risk of inflammatory age-related diseases in HIV positive women.

  15. Age-associated changes in monocyte and innate immune activation markers occur more rapidly in HIV infected women.

    Science.gov (United States)

    Martin, Genevieve E; Gouillou, Maelenn; Hearps, Anna C; Angelovich, Thomas A; Cheng, Allen C; Lynch, Fiona; Cheng, Wan-Jung; Paukovics, Geza; Palmer, Clovis S; Novak, Richard M; Jaworowski, Anthony; Landay, Alan L; Crowe, Suzanne M

    2013-01-01

    Aging is associated with immune dysfunction and the related development of conditions with an inflammatory pathogenesis. Some of these immune changes are also observed in HIV infection, but the interaction between immune changes with aging and HIV infection are unknown. Whilst sex differences in innate immunity are recognized, little research into innate immune aging has been performed on women. This cross-sectional study of HIV positive and negative women used whole blood flow cytometric analysis to characterize monocyte and CD8(+) T cell subsets. Plasma markers of innate immune activation were measured using standard ELISA-based assays. HIV positive women exhibited elevated plasma levels of the innate immune activation markers CXCL10 (p<0.001), soluble CD163 (sCD163, p = 0.001), sCD14 (p = 0.022), neopterin (p = 0.029) and an increased proportion of CD16(+) monocytes (p = 0.009) compared to uninfected controls. Levels of the innate immune aging biomarkers sCD163 and the proportion of CD16(+) monocytes were equivalent to those observed in HIV negative women aged 14.5 and 10.6 years older, respectively. CXCL10 increased with age at an accelerated rate in HIV positive women (p = 0.002) suggesting a synergistic effect between HIV and aging on innate immune activation. Multivariable modeling indicated that age-related increases in innate immune biomarkers CXCL10 and sCD163 are independent of senescent changes in CD8(+) T lymphocytes. Quantifying the impact of HIV on immune aging reveals that HIV infection in women confers the equivalent of a 10-14 year increase in the levels of innate immune aging markers. These changes may contribute to the increased risk of inflammatory age-related diseases in HIV positive women.

  16. Cost and impact of scaling up interventions to save lives of mothers and children: taking South Africa closer to MDGs 4 and 5

    Directory of Open Access Journals (Sweden)

    Lumbwe Chola

    2015-04-01

    Full Text Available Background: South Africa has made substantial progress on child and maternal mortality, yet many avoidable deaths of mothers and children still occur. This analysis identifies priority interventions to be scaled up nationally and projects the potential maternal and child lives saved. Design: We modelled the impact of maternal, newborn and child interventions using the Lives Saved Tools Projections to 2015 and used realistic coverage increases based on expert opinion considering recent policy change, financial and resource inputs, and observed coverage change. A scenario analysis was undertaken to test the impact of increasing intervention coverage to 95%. Results: By 2015, with realistic coverage, the maternal mortality ratio (MMR can reduce to 153 deaths per 100,000 and child mortality to 34 deaths per 1,000 live births. Fifteen interventions, including labour and delivery management, early HIV treatment in pregnancy, prevention of mother-to-child transmission and handwashing with soap, will save an additional 9,000 newborns and children and 1,000 mothers annually. An additional US$370 million (US$7 per capita will be required annually to scale up these interventions. When intervention coverage is increased to 95%, breastfeeding promotion becomes the top intervention, the MMR reduces to 116 and the child mortality ratio to 23. Conclusions: The 15 interventions identified were adopted by the National Department of Health, and the Health Minister launched a campaign to encourage Provincial Health Departments to scale up coverage. It is hoped that by focusing on implementing these 15 interventions at high quality, South Africa will reach Millennium Development Goal (MDG 4 soon after 2015 and MDG 5 several years later. Focus on HIV and TB during early antenatal care is essential. Strategic gains could be realised by targeting vulnerable populations and districts with the worst health outcomes. The analysis demonstrates the usefulness of priority

  17. Scaling-up treatment of depression and anxiety: a global return on investment analysis.

    Science.gov (United States)

    Chisholm, Dan; Sweeny, Kim; Sheehan, Peter; Rasmussen, Bruce; Smit, Filip; Cuijpers, Pim; Saxena, Shekhar

    2016-05-01

    Depression and anxiety disorders are highly prevalent and disabling disorders, which result not only in an enormous amount of human misery and lost health, but also lost economic output. Here we propose a global investment case for a scaled-up response to the public health and economic burden of depression and anxiety disorders. In this global return on investment analysis, we used the mental health module of the OneHealth tool to calculate treatment costs and health outcomes in 36 countries between 2016 and 2030. We assumed a linear increase in treatment coverage. We factored in a modest improvement of 5% in both the ability to work and productivity at work as a result of treatment, subsequently mapped to the prevailing rates of labour participation and gross domestic product (GDP) per worker in each country. The net present value of investment needed over the period 2016-30 to substantially scale up effective treatment coverage for depression and anxiety disorders is estimated to be US$147 billion. The expected returns to this investment are also substantial. In terms of health impact, scaled-up treatment leads to 43 million extra years of healthy life over the scale-up period. Placing an economic value on these healthy life-years produces a net present value of $310 billion. As well as these intrinsic benefits associated with improved health, scaled-up treatment of common mental disorders also leads to large economic productivity gains (a net present value of $230 billion for scaled-up depression treatment and $169 billion for anxiety disorders). Across country income groups, resulting benefit to cost ratios amount to 2·3-3·0 to 1 when economic benefits only are considered, and 3·3-5·7 to 1 when the value of health returns is also included. Return on investment analysis of the kind reported here can contribute strongly to a balanced investment case for enhanced action to address the large and growing burden of common mental disorders worldwide. Grand

  18. The development of an evidence-based teledermatology scale-up framework and roadmap

    CSIR Research Space (South Africa)

    Walters, Laticha EM

    2017-12-01

    Full Text Available these benefits. Because HIV/AIDS remains a major cause of morbidity and mortality in South Africa, and because skin pathology is often the first sign of an HIV/AIDS infection, swift, organised, and efficacious dermatology referral is essential. While...

  19. Scaling up implementation of ART: Organizational culture and early mortality of patients initiated on ART in Nairobi, Kenya.

    Science.gov (United States)

    Ayah, Richard

    2018-01-01

    Scaling up the antiretroviral (ART) program in Kenya has involved a strategy of using clinical guidelines coupled with decentralization of treatment sites. However decentralization pushes clinical responsibility downwards to health facilities run by lower cadre staff. Whether the organizational culture in health facilities affects the outcomes despite the use of clinical guidelines has not been explored. This study aimed to demonstrate the relationship between organizational culture and early mortality and those lost to follow up (LTFU) among patients enrolled for HIV care. A stratified sample of 31 health facilities in Nairobi County offering ART services were surveyed. Data of patients enrolled on ART and LTFU for the 12 months ending 30th June 2013 were abstracted. Mortality and LTFU were determined and used to rank health facilities. In the facilities with the lowest and highest mortality and LTFU key informant interviews were conducted using a tool adapted from team climate assessment measurement questionnaire and competing value framework tool to assess organizational culture. The strength of association between early mortality, LTFU and organizational culture was tested. Half (51.8%) of the 5,808 patients enrolled into care in 31 health facilities over the 12-month study period were started on ART. Of these 48 (1.6% 95% CI 0.8%-2.4%) died within three months of starting treatment, while a further 125 (4.2% 95% CI 2.1%-6.6%) were LTFU giving an attrition rate of 5.7% (95% CI 3.3%-8.6%). Tuberculosis was the most common comorbidity associated with high early mortality and high LTFU. Organizational culture, specifically an adhocratic type was found to be associated with low early mortality and low LTFU of patients enrolled for HIV care (P = 0.034). The use of ART clinical guidelines in a decentralized health systems are not sufficient to achieve required service delivery outcomes. The attrition rate above would mean 85,000 Kenyans missing care based on current

  20. Nb3Sn accelerator magnet technology scale up based on cos-theta coils

    International Nuclear Information System (INIS)

    Nobrega, F.; Ambrosio, G.; Andreev, N.; Barzi, E.; Bossert, R.; Carcagno, R.; Feher, S.; Kashikhin, V.S.; Kashikhin, V.V.; Lamm, M.J.; Novitski, I.; Pischalnikov, Yu.; Sylvester, C.; Tartaglia, M.; Turrioni, D.; Yamada, R.; Zlobin, A.V.; Fermilab

    2006-01-01

    After successful testing of a 1 m long dipole mirror magnet and three dipole models based on two-layer Nb 3 Sn coils, Fermilab has started a Nb 3 Sn technology scale-up program using the dipole mirror design and the developed Nb 3 Sn coil fabrication technology based on the wind-and-react method. The scale-up will be performed in several steps starting from a 2 m long coil made of Powder-in-Tube (PIT) strand. This will be followed by 4 m long Nb 3 Sn coils made of PIT and RRP strands that will be fabricated into dipole mirror magnets and tested. This paper presents a summary of Fermilab's wind-and-react short model program. It includes details on the 2 m and 4 m long, 2 layer Nb 3 Sn dipole mirror magnet design, mechanical structure, and fabrication infrastructure

  1. Nb3Sn accelerator magnet technology scale up based on cos-theta coils

    Energy Technology Data Exchange (ETDEWEB)

    Nobrega, F.; Ambrosio, G.; Andreev, N.; Barzi, E.; Bossert, R.; Carcagno, R.; Feher, S.; Kashikhin, V.S.; Kashikhin, V.V.; Lamm, M.J.; Novitski, I.; Pischalnikov, Yu.; Sylvester, C.; Tartaglia, M.; Turrioni, D.; Yamada, R.; Zlobin, A.V.; /Fermilab

    2006-08-01

    After successful testing of a 1 m long dipole mirror magnet and three dipole models based on two-layer Nb{sub 3}Sn coils, Fermilab has started a Nb{sub 3}Sn technology scale-up program using the dipole mirror design and the developed Nb{sub 3}Sn coil fabrication technology based on the wind-and-react method. The scale-up will be performed in several steps starting from a 2 m long coil made of Powder-in-Tube (PIT) strand. This will be followed by 4 m long Nb{sub 3}Sn coils made of PIT and RRP strands that will be fabricated into dipole mirror magnets and tested. This paper presents a summary of Fermilab's wind-and-react short model program. It includes details on the 2 m and 4 m long, 2 layer Nb{sub 3}Sn dipole mirror magnet design, mechanical structure, and fabrication infrastructure.

  2. From Project to Program: Tupange's Experience with Scaling Up Family Planning Interventions in Urban Kenya.

    Science.gov (United States)

    Keyonzo, Nelson; Nyachae, Paul; Kagwe, Peter; Kilonzo, Margaret; Mumba, Feddis; Owino, Kenneth; Kichamu, George; Kigen, Bartilol; Fajans, Peter; Ghiron, Laura; Simmons, Ruth

    2015-05-01

    This paper describes how the Urban Reproductive Health Initiative in Kenya, the Tupange Project (2010-2015), successfully applied the ExpandNet approach to sustainably scale up family planning interventions, first in Machakos and Kakamega, and subsequently also in its three core cities, Nairobi, Kisumu and Mombasa. This new focus meant shifting from a "project" to a "program" approach, which required paying attention to government leadership and ownership, limiting external inputs, institutionalizing interventions in existing structures and emphasizing sustainability. The paper also highlights the project's efforts to prepare for the future scale up of Tupange's interventions in other counties to support continuing and improved access to family planning services in the new context of devolution (decentralization) in Kenya. Copyright © 2015. Published by Elsevier Ltd.

  3. Allometric scaling of microbial fuel cells and stacks: The lifeform case for scale-up

    Science.gov (United States)

    Greenman, John; Ieropoulos, Ioannis A.

    2017-07-01

    This case study reports for the first time on the comparison between allometric scaling of lifeforms and scale-up of microbial fuel cell entities; enlarging individual units in volume, footprint and electrode surface area but also multiplying a static size/footprint and electrode surface area to scale-up by stacking. A study published in 2010 by DeLong et al. showed for the first time that Kleiber's law does not apply uniformly to all lifeforms, and that in fact growth rate for prokaryotes is superlinear, for protists is linear and for metazoa is sublinear. The current study, which is utilising data from previous experiments, is showing for the first time that for individual MFC units, which are enlarged, growth rate/power is sublinear, whereas for stacks this is superlinear.

  4. Pore-Water Extraction Scale-Up Study for the SX Tank Farm

    Energy Technology Data Exchange (ETDEWEB)

    Truex, Michael J.; Oostrom, Martinus; Wietsma, Thomas W.; Last, George V.; Lanigan, David C.

    2013-01-15

    The phenomena related to pore-water extraction from unsaturated sediments have been previously examined with limited laboratory experiments and numerical modeling. However, key scale-up issues have not yet been addressed. Laboratory experiments and numerical modeling were conducted to specifically examine pore-water extraction for sediment conditions relevant to the vadose zone beneath the SX Tank Farm at Hanford Site in southeastern Washington State. Available SX Tank Farm data were evaluated to generate a conceptual model of the subsurface for a targeted pore-water extraction application in areas with elevated moisture and Tc-99 concentration. The hydraulic properties of the types of porous media representative of the SX Tank Farm target application were determined using sediment mixtures prepared in the laboratory based on available borehole sediment particle size data. Numerical modeling was used as an evaluation tool for scale-up of pore-water extraction for targeted field applications.

  5. Development, modelling, optimisation and scale-up of chromatographic purification of a therapeutic protein

    DEFF Research Database (Denmark)

    Mollerup, Jørgen; Hansen, Thomas Budde; Kidal, Steffen

    2007-01-01

    Development of a chromatographic purification step proceeds through a number of stages. High-throughput screening techniques are used to identify suitable resins. This technique is also suitable for the design of a capture step and some intermediate chromatographic steps, but development and true...... by industry. The theory of residence time based scale-up is developed and applied. (c) 2007 Elsevier B.V. All rights reserved....

  6. Reallocating risks and returns to scale up adoption of distributed electricity resources

    International Nuclear Information System (INIS)

    Kulatilaka, Nalin; Santiago, Leonardo; Vakili, Pirooz

    2014-01-01

    Deployment of distributed electricity resources requires bringing together assets that belong to diverse and geographically diffuse owners. Using the example of distributed solar PV, we analyze the schemes used to encourage/induce owners of distributed assets to make them available for electricity generation. The dominant model in the U.S. is long term power purchase agreements (PPA) offered to owners/consumers by solar developers. We show that these agreements (mis)allocate the electricity price risk to owners/consumers and impose limitations on the scale up of distributed solar. By proper use of financial markets it is possible to shift the electricity price risk from owners/consumers to parties that are better positioned to manage it. The proposed contracts simplify the adoption decision for owners/consumers and can lead to a wider adoption. Removing barriers to scale up requires (i) eliminating the tight coupling between consumers and owners and (ii) rewarding the owners unambiguously for the assets they provide. These necessitate the transformation of the current intermediary firms into full-fledged distributed generators. We discuss the implications of such a transformation and argue that the broad outline of our analysis can be used to assess scale up schemes in other domains of distributed electricity resources as well. - Highlights: • We analyze schemes used to induce owners of distributed assets to make them available for electricity generation. • We show that power purchase agreements used in solar PV “misallocate” electricity price risk to owners/consumers. • We propose new contracts forms that shift price risk from consumers to parties that are better able to manage it. • Full-fledged distributed generators are created by unambiguously rewarding owners and de-coupling consumption/ownership. • We argue that our analysis can be used to assess scale up schemes in other domains of distributed electricity resources

  7. Chapter 6. Scaling Up Solutions to State, National and Global Levels

    OpenAIRE

    Kammen, Daniel; Rotman, Doug; Delmas, Magali; Feldman, David; Mielke, Mike; Ramesh, Ramamoorthy; Sperling, Daniel

    2016-01-01

    Scaling-up solutions require learning and adapting lessons between locations and at different scales. To accomplish this, common metrics are vital to building a shared language. For California, this has meant careful financial, cradle-to-grave life-cycle assessment methods leading to carbon accounting in many avenues of government (via the Low Carbon Fuel Standard or the Cap and Trade program). These methods themselves interact, such as the use of carbon accounting for the resources needed to...

  8. Scaling-up vaccine production: implementation aspects of a biomass growth observer and controller

    OpenAIRE

    Soons, Z.I.T.A.; IJssel, van den, J.; Pol, van der, L.A.; Straten, van, G.; Boxtel, van, A.J.B.

    2009-01-01

    Abstract This study considers two aspects of the implementation of a biomass growth observer and specific growth rate controller in scale-up from small- to pilot-scale bioreactors towards a feasible bulk production process for whole-cell vaccine against whooping cough. The first is the calculation of the oxygen uptake rate, the starting point for online monitoring and control of biomass growth, taking into account the dynamics in the gas-phase. Mixing effects and delays are caused by amongst ...

  9. Transforming Global Health by Improving the Science of Scale-Up

    OpenAIRE

    Kruk, Margaret E.; Yamey, Gavin; Angell, Sonia Y.; Beith, Alix; Cotlear, Daniel; Guanais, Frederico; Jacobs, Lisa; Saxenian, Helen; Victora, Cesar; Goosby, Eric

    2016-01-01

    In its report Global Health 2035, the Commission on Investing in Health proposed that health investments can reduce mortality in nearly all low- and middle-income countries to very low levels, thereby averting 10 million deaths per year from 2035 onward. Many of these gains could be achieved through scale-up of existing technologies and health services. A key instrument to close this gap is policy and implementation research (PIR) that aims to produce generalizable evidence on what works to i...

  10. Housing and Child Welfare: Emerging Evidence and Implications for Scaling up Services.

    Science.gov (United States)

    Fowler, Patrick J; Farrell, Anne F; Marcal, Katherine E; Chung, Saras; Hovmand, Peter S

    2017-09-01

    Inadequate housing threatens family stability in communities across the United States. This study reviews emerging evidence on housing interventions in the context of scale-up for the child welfare system. In child welfare, scale-up refers to the extent to which fully implemented interventions sustainably alleviate family separations associated with housing instability. It incorporates multiple aspects beyond traditional measures of effectiveness including costs, potential reach, local capacities for implementation, and fit within broader social services. The framework further encompasses everyday circumstances faced by service providers, program administrators, and policymakers who allocate resources under conditions of scarcity and uncertainty. The review of current housing interventions reveals a number of systemic constraints for scale-up in child welfare. Reliance on rental assistance programs limits capacity to address demand, while current practices that target the most vulnerable families may inadvertently diminish effectiveness of the intervention and increase overall demand. Alternative approaches that focus on homelessness prevention and early intervention must be tested in conjunction with community initiatives to increase accessibility of affordable housing. By examining system performance over time, the scalability framework provides an opportunity for more efficient coordination of housing services within and outside of the child welfare system. © Society for Community Research and Action 2017.

  11. Scale-up of a mixer-settler extractor using a unit operations approach

    International Nuclear Information System (INIS)

    Lindholm, D.C.; Bautista, R.G.

    1976-01-01

    The results of scale-up studies on a continuous, multistage horizontal mixer-settler extractor are presented. The chemical and mechanical system involves the separation of lanthanum from a mixture of rare earth chlorides using di(2-ethylhexyl) phosphoric acid as the solvent and dilute HCl as a scrub solution in a bench scale extractor. Each stage has a hold-up of 2.6 l. A single stage unit is utilized for scale-up studies. Results are obtained on four sizes of geometrically similar units, the largest being six times the volume of the original bench size. A unit operations technique is chosen so that mixing and settling can be examined independently. Variables examined include type of continuous phase, flow rate of inlet streams, and power input to the mixer. Inlet flow-rate ratios are kept constant for all tests. Two potential methods of unbaffled pump-mixer scale-up are explored; the maintenance of constant impeller tip speed and constant power input. For the settler, the previously successful method of basing design on constant flow-rate per unit cross-sectional area is used

  12. Discrete element method based scale-up model for material synthesis using ball milling

    Science.gov (United States)

    Santhanam, Priya Radhi

    Mechanical milling is a widely used technique for powder processing in various areas. In this work, a scale-up model for describing this ball milling process is developed. The thesis is a combination of experimental and modeling efforts. Initially, Discrete Element Model (DEM) is used to describe energy transfer from milling tools to the milled powder for shaker, planetary, and attritor mills. The rolling and static friction coefficients are determined experimentally. Computations predict a quasisteady rate of energy dissipation, E d, for each experimental configuration. It is proposed that the milling dose defined as a product of Ed and milling time, t, divided by the mass of milled powder, mp characterizes the milling progress independently of the milling device or milling conditions used. Once the milling dose is determined for one experimental configuration, it can be used to predict the milling time required to prepare the same material in any milling configuration, for which Ed is calculated. The concept is validated experimentally for DEM describing planetary and shaker mills. For attritor, the predicted Ed includes substantial contribution from milling tool interaction events with abnormally high forces (>103 N). The energy in such events is likely dissipated to heat or plastically deform milling tools rather than refine material. Indeed, DEM predictions for the attritor correlate with experiments when such events are ignored in the analysis. With an objective of obtaining real-time indicators of milling progress, power, torque, and rotation speed of the impeller of an attritor mill are measured during preparation of metal matrix composite powders in the subsequent portion of this thesis. Two material systems are selected and comparisons made between in-situ parameters and experimental milling progress indicators. It is established that real-time measurements can certainly be used to describe milling progress. However, they need to be interpreted carefully

  13. Solar thermal production of zinc - Final steps toward scale-up - Final report

    Energy Technology Data Exchange (ETDEWEB)

    Meier, A.

    2008-05-15

    A 10 kW receiver-reactor prototype (called ZIRRUS) was further improved and tested for the solar thermal de-composition of ZnO, which is the 1{sup st} step of the two-step water-splitting thermochemical ZnO/Zn cycle. The rotating cylindrical cavity was made of either sintered ZnO or sintered Al{sub 2}O{sub 3} tiles placed on top of a multi-layer Al{sub 2}O{sub 3}-SiO{sub 2}-Y{sub 2}O{sub 3}-based ceramics for thermal shock resistance, mechanical stability, gas diffusion barrier, and thermal insulation. Pre-heated Ar gas was injected for aerodynamic window protection and for minimizing recombination of product gases in the cavity. Experimentation was carried out at PSI's High-Flux Solar Simulator with the direct heating 10 kW reactor prototype subjected to peak radiative fluxes exceeding 5,800 suns. The reactor operated without incident for a total of more than 40 h at maximum temperatures - measured behind the ZnO and Al{sub 2}O{sub 3} tiles - ranging from 1807-1907 K. Thermal dissociation of ZnO(s) near 2000 K was demonstrated for experimental runs over 4 h in transient ablation mode with up to nine semi-continuous feed cycles of ZnO particles. A working Zn/O{sub 2} separation device based on the rapid quenching of the Zn/O{sub 2} mixture is ready to be incorporated at the exit of the solar reactor. Zinc yields of up to 94% were obtained when using total Ar/Zn(g) dilution of 530 and a cooling rate of about 10{sup 5} K/s. The fully integrated solar reactor will be scaled up to the pilot scale of 100 kW. A newly developed reactor model that couples radiation, conduction, and convection heat transfer to the reaction kinetics will allow determining optimal operational conditions for matching the feeding rate to the reaction rate and for maximizing solar-to-chemical energy conversion efficiency. The 2{sup nd} step of the ZnO/Zn cycle has been experimentally demonstrated at ETH using an aerosol-flow reactor for in-situ formation and hydrolysis of Zn nanoparticles

  14. Scaling up family planning in Sierra Leone: A prospective cost-benefit analysis.

    Science.gov (United States)

    Keen, Sarah; Begum, Hashina; Friedman, Howard S; James, Chris D

    2017-12-01

    Family planning is commonly regarded as a highly cost-effective health intervention with wider social and economic benefits. Yet use of family planning services in Sierra Leone is currently low and 25.0% of married women have an unmet need for contraception. This study aims to estimate the costs and benefits of scaling up family planning in Sierra Leone. Using the OneHealth Tool, two scenarios of scaling up family planning coverage to currently married women in Sierra Leone over 2013-2035 were assessed and compared to a 'no-change' counterfactual. Our costing included direct costs of drugs, supplies and personnel time, programme costs and a share of health facility overhead costs. To monetise the benefits, we projected the cost savings of the government providing five essential social services - primary education, child immunisation, malaria prevention, maternal health services and improved drinking water - in the scale-up scenarios compared to the counterfactual. The total population, estimated at 6.1 million in 2013, is projected to reach 8.3 million by 2035 in the high scenario compared to a counterfactual of 9.6 million. We estimate that by 2035, there will be 1400 fewer maternal deaths and 700 fewer infant deaths in the high scenario compared to the counterfactual. Our modelling suggests that total costs of the family planning programme in Sierra Leone will increase from US$4.2 million in 2013 to US$10.6 million a year by 2035 in the high scenario. For every dollar spent on family planning, Sierra Leone is estimated to save US$2.10 in expenditure on the five selected social sector services over the period. There is a strong investment case for scaling up family planning services in Sierra Leone. The ambitious scale-up scenarios have historical precedent in other sub-Saharan African countries, but the extent to which they will be achieved depends on a commitment from both the government and donors to strengthening Sierra Leone's health system post-Ebola.

  15. Teste rápido para detecção da infecção pelo HIV-1 em gestantes Rapid test to detect HIV-1 infection among pregnant women

    Directory of Open Access Journals (Sweden)

    Geraldo Duarte

    2001-03-01

    Full Text Available Objetivos: avaliar os resultados do teste de diagnóstico rápido da infecção pelo HIV-1 disponibilizado pelo Ministério da Saúde, para identificação de gestantes contaminadas por este vírus. Métodos: avaliação prospectiva de 443 gestantes sem teste sorológico para HIV no pré-natal, atendidas no Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirão Preto-Universidade de São Paulo (HCFMRP-USP, entre fevereiro e junho de 2000. As amostras destas pacientes foram submetidas ao teste rápido imunocromatográfico, sendo comparadas com ELISA e confirmadas pela aglutinação. Resultados: dentre as 443 gestantes submetidas ao teste rápido (20,1% dos partos no período, 16 apresentaram resultados positivos (3,6%. Nenhuma amostra negativa pelo teste rápido foi positiva pelo ELISA. Entretanto, das 16 amostras positivas pelo teste rápido, duas foram negativas pelos testes confirmatórios. Logo, a sensibilidade do teste rápido foi de 100,0%, especificidade 99,5%, valor preditivo positivo 87,5% e valor preditivo negativo 100,0%. Conclusões: os resultados obtidos na avaliação do teste para o diagnóstico rápido da infecção pelo HIV-1 em gestantes revelaram sensibilidade, especificidade e valores preditivos que o credenciam como recurso extremamente importante na indicação de medidas que reduzem a transmissão perinatal desse vírus.Purpose: to evaluate the results of a rapid diagnostic test for HIV-1 infection made available by the Health Ministry for the identification of pregnant women contaminated by this virus. Methods: we evaluated prospectively 443 pregnant women with no prenatal serologic anti-HIV test seen at the Department of Gynecology and Obstetrics of the Faculty of Medicine of Ribeirão Preto, University of São Paulo, from February to June, 2000. Samples from these patients were submitted to the rapid immunochromatographic test, which was compared with ELISA and submitted to a confirmatory

  16. Case Report: HIV test misdiagnosis

    African Journals Online (AJOL)

    Case Study: HIV test misdiagnosis 124. Case Report: HIV ... A positive rapid HIV test does not require ... 3 College of Medicine - Johns Hopkins Research Project, Blantyre,. Malawi ... test results: a pilot study of three community testing sites.

  17. Dilution testing using rapid diagnostic tests in a HIV diagnostic algorithm: a novel alternative for confirmation testing in resource limited settings.

    Science.gov (United States)

    Shanks, Leslie; Siddiqui, M Ruby; Abebe, Almaz; Piriou, Erwan; Pearce, Neil; Ariti, Cono; Masiga, Johnson; Muluneh, Libsework; Wazome, Joseph; Ritmeijer, Koert; Klarkowski, Derryck

    2015-05-14

    Current WHO testing guidelines for resource limited settings diagnose HIV on the basis of screening tests without a confirmation test due to cost constraints. This leads to a potential risk of false positive HIV diagnosis. In this paper, we evaluate the dilution test, a novel method for confirmation testing, which is simple, rapid, and low cost. The principle of the dilution test is to alter the sensitivity of a rapid diagnostic test (RDT) by dilution of the sample, in order to screen out the cross reacting antibodies responsible for falsely positive RDT results. Participants were recruited from two testing centres in Ethiopia where a tiebreaker algorithm using 3 different RDTs in series is used to diagnose HIV. All samples positive on the initial screening RDT and every 10th negative sample underwent testing with the gold standard and dilution test. Dilution testing was performed using Determine™ rapid diagnostic test at 6 different dilutions. Results were compared to the gold standard of Western Blot; where Western Blot was indeterminate, PCR testing determined the final result. 2895 samples were recruited to the study. 247 were positive for a prevalence of 8.5 % (247/2895). A total of 495 samples underwent dilution testing. The RDT diagnostic algorithm misclassified 18 samples as positive. Dilution at the level of 1/160 was able to correctly identify all these 18 false positives, but at a cost of a single false negative result (sensitivity 99.6 %, 95 % CI 97.8-100; specificity 100 %, 95 % CI: 98.5-100). Concordance between the gold standard and the 1/160 dilution strength was 99.8 %. This study provides proof of concept for a new, low cost method of confirming HIV diagnosis in resource-limited settings. It has potential for use as a supplementary test in a confirmatory algorithm, whereby double positive RDT results undergo dilution testing, with positive results confirming HIV infection. Negative results require nucleic acid testing to rule out false

  18. Dual rapid lateral flow immunoassay fingerstick wholeblood testing for syphilis and HIV infections is acceptable and accurate, Port-au-Prince, Haiti.

    Science.gov (United States)

    Bristow, Claire C; Severe, Linda; Pape, Jean William; Javanbakht, Marjan; Lee, Sung-Jae; Comulada, Warren Scott; Klausner, Jeffrey D

    2016-06-18

    Dual rapid tests for HIV and syphilis infections allow for detection of HIV infection and syphilis at the point-of-care. Those tests have been evaluated in laboratory settings and show excellent performance but have not been evaluated in the field. We evaluated the field performance of the SD BIOLINE HIV/Syphilis Duo test in Port-au-Prince, Haiti using whole blood fingerprick specimens. GHESKIO (Haitian Study Group for Kaposi's Sarcoma and Opportunistic Infections) clinic attendees 18 years of age or older were invited to participate. Venipuncture blood specimens were used for reference testing with standard commercially available tests for HIV and syphilis in Haiti. The sensitivity and specificity of the Duo test compared to the reference standard were calculated. The exact binomial method was used to determine 95 % confidence intervals (CI). Of 298 study participants, 237 (79.5 %) were female, of which 49 (20.7 %) were pregnant. For the HIV test component, the sensitivity and specificity were 99.2 % (95 % CI: 95.8 %, 100 %) and 97.0 % (95 % CI: 93.2 %, 99.0 %), respectively; and for the syphilis component were 96.5 % (95 % CI: 91.2 %, 99.0 %) and 90.8 % (95 % CI: 85.7 %, 94.6 %), respectively. In pregnant women, the sensitivity and specificity of the HIV test component were 93.3 % (95 % CI: 68.0 %, 99.8 %) and 94.1 % (95 % CI: 80.3 %, 99.3 %), respectively; and for the syphilis component were 100 % (95 % CI:81.5 %, 100 %) and 96.8 % (95 % CI:83.3 %, 99.9 %), respectively. The Standard Diagnostics BIOLINE HIV/Syphilis Duo dual test performed well in a field setting in Haiti and should be considered for wider use.

  19. Screening of HIV-1 Protease Using a Combination of an Ultra-High-Throughput Fluorescent-Based Assay and RapidFire Mass Spectrometry.

    Science.gov (United States)

    Meng, Juncai; Lai, Ming-Tain; Munshi, Vandna; Grobler, Jay; McCauley, John; Zuck, Paul; Johnson, Eric N; Uebele, Victor N; Hermes, Jeffrey D; Adam, Gregory C

    2015-06-01

    HIV-1 protease (PR) represents one of the primary targets for developing antiviral agents for the treatment of HIV-infected patients. To identify novel PR inhibitors, a label-free, high-throughput mass spectrometry (HTMS) assay was developed using the RapidFire platform and applied as an orthogonal assay to confirm hits identified in a fluorescence resonance energy transfer (FRET)-based primary screen of > 1 million compounds. For substrate selection, a panel of peptide substrates derived from natural processing sites for PR was evaluated on the RapidFire platform. As a result, KVSLNFPIL, a new substrate measured to have a ~ 20- and 60-fold improvement in k cat/K m over the frequently used sequences SQNYPIVQ and SQNYPIV, respectively, was identified for the HTMS screen. About 17% of hits from the FRET-based primary screen were confirmed in the HTMS confirmatory assay including all 304 known PR inhibitors in the set, demonstrating that the HTMS assay is effective at triaging false-positives while capturing true hits. Hence, with a sampling rate of ~7 s per well, the RapidFire HTMS assay enables the high-throughput evaluation of peptide substrates and functions as an efficient tool for hits triage in the discovery of novel PR inhibitors. © 2015 Society for Laboratory Automation and Screening.

  20. Business models and financing options for a rapid scale-up of rooftop solar power systems in Thailand

    International Nuclear Information System (INIS)

    Tongsopit, Sopitsuda; Moungchareon, Sunee; Aksornkij, Apinya; Potisat, Tanai

    2016-01-01

    Diverse solar PV business models and financing options exist in the international landscape, helping expand and accelerate the adoption of rooftop solar PV systems. The conditions for their emergence are context specific, depending on the policies, regulations, incentives, and market conditions of each country. After a review of the international landscape, this paper compiles and analyzes business models and financing options for rooftop solar PV investment in Thailand that have emerged during the period between 2013 and 2015. Despite policy discontinuity for the support of rooftop solar systems, diverse business models and financing options are driving market expansion and expanding solar access to more Thai consumers. Drawing on our policy and regulatory analyses and in-depth interviews with business representatives, we identify four types of business models and one financing option. The business models include Roof Rental, Solar PPA, Solar Leasing, and Community Solar, and the financing option is the solar loan. We analyze the drivers for their emergence, barriers to their success, and the risks from the business owners' and consumers' viewpoints. Our policy recommendation is focused on crafting a net-metering regulation with evidence-based studies on the potential costs and benefits to different stakeholders. - Highlights: •Advances understanding on PV business models in urban developing countries' context. •Reviews emerging rooftop solar business models in Thailand. •Thailand has a dynamic solar market despite policy uncertainties.

  1. Scale up and application of biosurfactant from Bacillus subtilis in Enhanced Oil recovery.

    Science.gov (United States)

    Amani, Hossein; Mehrnia, Mohammad Reza; Sarrafzadeh, Mohammad Hossein; Haghighi, Manouchehr; Soudi, Mohammad Reza

    2010-09-01

    There is a lack of fundamental knowledge about the scale up of biosurfactant production. In order to develop suitable technology of commercialization, carrying out tests in shake flasks and bioreactors was essential. A reactor with integrated foam collector was designed for biosurfactant production using Bacillus subtilis isolated from agricultural soil. The yield of biosurfactant on biomass (Y(p/x)), biosurfactant on sucrose (Y(p/s)), and the volumetric production rate (Y) for shake flask were obtained about 0.45 g g(-1), 0.18 g g(-1), and 0.03 g l(-1) h(-1), respectively. The best condition for bioreactor was 300 rpm and 1.5 vvm, giving Y(x/s), Y(p/x), Y(p/s), and Y of 0.42 g g(-1), 0.595 g g(-1), 0.25 g g(-1), and 0.057 g l(-1) h(-1), respectively. The biosurfactant maximum production, 2.5 g l(-1), was reached in 44 h of growth, which was 28% better than the shake flask. The obtained volumetric oxygen transfer coefficient (K(L)a) values at optimum conditions in the shake flask and the bioreactor were found to be around 0.01 and 0.0117 s(-1), respectively. Comparison of K(L)a values at optimum conditions shows that biosurfactant production scaling up from shake flask to bioreactor can be done with K(L) a as scale up criterion very accurately. Nearly 8% of original oil in place was recovered using this biosurfactant after water flooding in the sand pack.

  2. Scale-up considerations relevant to experimental studies of nuclear waste-package behavior

    International Nuclear Information System (INIS)

    Coles, D.G.; Peters, R.D.

    1986-04-01

    Results from a study that investigated whether testing large-scale nuclear waste-package assemblages was technically warranted are reported. It was recognized that the majority of the investigations for predicting waste-package performance to date have relied primarily on laboratory-scale experimentation. However, methods for the successful extrapolation of the results from such experiments, both geometrically and over time, to actual repository conditions have not been well defined. Because a well-developed scaling technology exists in the chemical-engineering discipline, it was presupposed that much of this technology could be applicable to the prediction of waste-package performance. A review of existing literature documented numerous examples where a consideration of scaling technology was important. It was concluded that much of the existing scale-up technology is applicable to the prediction of waste-package performance for both size and time extrapolations and that conducting scale-up studies may be technically merited. However, the applicability for investigating the complex chemical interactions needs further development. It was recognized that the complexity of the system, and the long time periods involved, renders a completely theoretical approach to performance prediction almost hopeless. However, a theoretical and experimental study was defined for investigating heat and fluid flow. It was concluded that conducting scale-up modeling and experimentation for waste-package performance predictions is possible using existing technology. A sequential series of scaling studies, both theoretical and experimental, will be required to formulate size and time extrapolations of waste-package performance

  3. On the hydrodynamics and the scale-up of flotation processes

    International Nuclear Information System (INIS)

    Schubert, H.

    1986-01-01

    In flotation machines, turbulence is process-determining. Macroturbulence is necessary for suspension, microturbulence controls the air dispersion, the rate of the particle-bubble collisions and the stresses on agglomerates. Consequently, the hydrodynamic optimization of flotation processes plays an important role for the flotation efficiency. In the paper the following aspects are considered: the turbulent microprocesses of flotation processes; the integral hydrodynamic characterization of flotation processes; correlations between particle size and optimum hydrodynamics; correlations between flocculation of fine particles and optimum-hydrodynamics; and hydrodynamic scale-up of flotation processes

  4. An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up

    Directory of Open Access Journals (Sweden)

    Colombini Manuela

    2012-07-01

    Full Text Available Abstract Background Malaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up. Methods In-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7. Results The implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling. Conclusions The national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place – in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the

  5. Advanced modeling to accelerate the scale up of carbon capture technologies

    Energy Technology Data Exchange (ETDEWEB)

    Miller, David C.; Sun, XIN; Storlie, Curtis B.; Bhattacharyya, Debangsu

    2015-06-01

    In order to help meet the goals of the DOE carbon capture program, the Carbon Capture Simulation Initiative (CCSI) was launched in early 2011 to develop, demonstrate, and deploy advanced computational tools and validated multi-scale models to reduce the time required to develop and scale-up new carbon capture technologies. This article focuses on essential elements related to the development and validation of multi-scale models in order to help minimize risk and maximize learning as new technologies progress from pilot to demonstration scale.

  6. Complementary factors contributing to the rapid spread of HIV-I in sub-Saharan Africa: a review.

    Science.gov (United States)

    Nyindo, M

    2005-01-01

    To examine and establish complementary factors that contribute to the alarmingly high prevalence of HIV-1 in sub-Saharan Africa (SSA) in order to create awareness and suggest possible measures to avert the spread of the pandemic. Review of literature via Medline, the Internet, articles in refereed journals, and un-refereed features from the East Africa media houses and personal communications. Most published data from 1981 to September 2004 found to have revealed an impact on the spread of HIV-1 in SSA were included in the review. Therefore, all selected articles were read and critically evaluated. Where possible the number of citations articles which had been received were sought to established the degree of impact. Abstracts of all articles identified were accessed, read and analysed to determined possible relevance to the spread of HIV-1. When relevance was established from the abstract the entire paper was read and important points were included in the review. A matrix was drawn to include all subtitles (e.g. polygamy, circumcision, poverty, etc). Below each subtitle all published works were included and prioritised. Published works that were found to have impact were included in the review. Finally a percent composite picture of all factors was drawn in an attempt to prioritise the factors, not withstanding the fact that most factors are interrelated and complementary. There are many reasons why the spread of HIV-1 in SSA has not been declining over the years. Main risk factors for HIV-1 infection and AIDS disease in SSA were found to include poverty, famine, low status of women in society, corruption, naive risk taking perception, resistance to sexual behaviour change, high prevalence of sexually transmitted infections (STI), internal conflicts and refugee status, antiquated beliefs, lack of recreational facilities, ignorance of individual's HIV status, child and adult prostitution, uncertainty of safety of blood intended for transfusion, widow inheritance

  7. 78 FR 32381 - Applications for New Awards, Investing in Innovation Fund, Scale-up and Validation Grants...

    Science.gov (United States)

    2013-05-30

    ... journals) or informal (e.g., newsletters) mechanisms, the results of any evaluations it conducts of its...., newsletters) mechanisms, the results of any evaluations it conducts of its funded activities. For Scale-up and... DEPARTMENT OF EDUCATION Applications for New Awards, Investing in Innovation Fund, Scale- up and...

  8. Scale-up of hydrophobin-assisted recombinant protein production in tobacco BY-2 suspension cells.

    Science.gov (United States)

    Reuter, Lauri J; Bailey, Michael J; Joensuu, Jussi J; Ritala, Anneli

    2014-05-01

    Plant suspension cell cultures are emerging as an alternative to mammalian cells for production of complex recombinant proteins. Plant cell cultures provide low production cost, intrinsic safety and adherence to current regulations, but low yields and costly purification technology hinder their commercialization. Fungal hydrophobins have been utilized as fusion tags to improve yields and facilitate efficient low-cost purification by surfactant-based aqueous two-phase separation (ATPS) in plant, fungal and insect cells. In this work, we report the utilization of hydrophobin fusion technology in tobacco bright yellow 2 (BY-2) suspension cell platform and the establishment of pilot-scale propagation and downstream processing including first-step purification by ATPS. Green fluorescent protein-hydrophobin fusion (GFP-HFBI) induced the formation of protein bodies in tobacco suspension cells, thus encapsulating the fusion protein into discrete compartments. Cultivation of the BY-2 suspension cells was scaled up in standard stirred tank bioreactors up to 600 L production volume, with no apparent change in growth kinetics. Subsequently, ATPS was applied to selectively capture the GFP-HFBI product from crude cell lysate, resulting in threefold concentration, good purity and up to 60% recovery. The ATPS was scaled up to 20 L volume, without loss off efficiency. This study provides the first proof of concept for large-scale hydrophobin-assisted production of recombinant proteins in tobacco BY-2 cell suspensions. © 2013 Society for Experimental Biology, Association of Applied Biologists and John Wiley & Sons Ltd.

  9. Biological hydrogen production by dark fermentation: challenges and prospects towards scaled-up production.

    Science.gov (United States)

    RenNanqi; GuoWanqian; LiuBingfeng; CaoGuangli; DingJie

    2011-06-01

    Among different technologies of hydrogen production, bio-hydrogen production exhibits perhaps the greatest potential to replace fossil fuels. Based on recent research on dark fermentative hydrogen production, this article reviews the following aspects towards scaled-up application of this technology: bioreactor development and parameter optimization, process modeling and simulation, exploitation of cheaper raw materials and combining dark-fermentation with photo-fermentation. Bioreactors are necessary for dark-fermentation hydrogen production, so the design of reactor type and optimization of parameters are essential. Process modeling and simulation can help engineers design and optimize large-scale systems and operations. Use of cheaper raw materials will surely accelerate the pace of scaled-up production of biological hydrogen. And finally, combining dark-fermentation with photo-fermentation holds considerable promise, and has successfully achieved maximum overall hydrogen yield from a single substrate. Future development of bio-hydrogen production will also be discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.

  10. Scaling-Up Quantum Heat Engines Efficiently via Shortcuts to Adiabaticity

    Directory of Open Access Journals (Sweden)

    Mathieu Beau

    2016-04-01

    Full Text Available The finite-time operation of a quantum heat engine that uses a single particle as a working medium generally increases the output power at the expense of inducing friction that lowers the cycle efficiency. We propose to scale up a quantum heat engine utilizing a many-particle working medium in combination with the use of shortcuts to adiabaticity to boost the nonadiabatic performance by eliminating quantum friction and reducing the cycle time. To this end, we first analyze the finite-time thermodynamics of a quantum Otto cycle implemented with a quantum fluid confined in a time-dependent harmonic trap. We show that nonadiabatic effects can be controlled and tailored to match the adiabatic performance using a variety of shortcuts to adiabaticity. As a result, the nonadiabatic dynamics of the scaled-up many-particle quantum heat engine exhibits no friction, and the cycle can be run at maximum efficiency with a tunable output power. We demonstrate our results with a working medium consisting of particles with inverse-square pairwise interactions that includes non-interacting and hard-core bosons as limiting cases.

  11. Fed batch fermentation scale up in the production of recombinant streptokinase

    Directory of Open Access Journals (Sweden)

    Salvador Losada-Nerey

    2017-01-01

    Full Text Available Due to the high international demand of the recombinant streptokinase (Skr produced at the National Center for Bioproducts (BioCen, it was necessary to increase the production capacity of the drug, since the current production volume does not cover the demand. A scale up of the process of fermentation of the recombinant streptokinase was made using a fed batch culture, from the bank scale towards a 300L fermenter. The scaling criteria used were: the intensive variables of the process, the relationships of volumes of the fermentation medium and inoculum, the volumetric coefficient of oxygen transfer and air volume to liquid flow relationship which were kept constant. With this scale up procedure it was possible to reproduce the results obtained at the bank scale of and to double the biomass production volume with the same equipment, fulfilling all the quality requirements of the product and to cover the current demand of the market. Techno-economic indicators demonstrated the feasibility of this option.

  12. Increasing power generation for scaling up single-chamber air cathode microbial fuel cells

    KAUST Repository

    Cheng, Shaoan; Logan, Bruce E.

    2011-01-01

    Scaling up microbial fuel cells (MFCs) requires a better understanding the importance of the different factors such as electrode surface area and reactor geometry relative to solution conditions such as conductivity and substrate concentration. It is shown here that the substrate concentration has significant effect on anode but not cathode performance, while the solution conductivity has a significant effect on the cathode but not the anode. The cathode surface area is always important for increasing power. Doubling the cathode size can increase power by 62% with domestic wastewater, but doubling the anode size increases power by 12%. Volumetric power density was shown to be a linear function of cathode specific surface area (ratio of cathode surface area to reactor volume), but the impact of cathode size on power generation depended on the substrate strength (COD) and conductivity. These results demonstrate the cathode specific surface area is the most critical factor for scaling-up MFCs to obtain high power densities. © 2010 Elsevier Ltd.

  13. Safer operating conditions and optimal scaling-up process for cyclohexanone peroxide reaction

    International Nuclear Information System (INIS)

    Zang, Na; Qian, Xin-Ming; Liu, Zhen-Yi; Shu, Chi-Min

    2015-01-01

    Highlights: • Thermal hazard of cyclohexanone peroxide reaction was measured by experimental techniques. • Levenberg–Marquardt algorithm was adopted to evaluate kinetic parameters. • Safer operating conditions at laboratory scale were acquired by BDs and TDs. • The verified safer operating conditions were used to obtain the optimal scale-up parameters applied in industrial plants. - Abstract: The cyclohexanone peroxide reaction process, one of the eighteen hazardous chemical processes identified in China, is performed in indirectly cooled semibatch reactors. The peroxide reaction is added to a mixture of hydrogen peroxide and nitric acid, which form heterogeneous liquid–liquid systems. A simple and general procedure for building boundary and temperature diagrams of peroxide process is given here to account for the overall kinetic expressions. Such a procedure has been validated by comparison with experimental data. Thermally safer operating parameters were obtained at laboratory scale, and the scaled-up procedure was performed to give the minimum dosing time in an industrial plant, which is in favor of maximizing industrial reactor productivity. The results are of great significance for governing the peroxide reaction process apart from the thermal runaway region. It also greatly aids in determining optimization on operating parameters in industrial plants.

  14. The design and scale-up of spray dried particle delivery systems.

    Science.gov (United States)

    Al-Khattawi, Ali; Bayly, Andrew; Phillips, Andrew; Wilson, David

    2018-01-01

    The rising demand for pharmaceutical particles with tailored physicochemical properties has opened new markets for spray drying especially for solubility enhancement, improving inhalation medicines and stabilization of biopharmaceuticals. Despite this, the spray drying literature is scattered and often does not address the principles underpinning robust development of pharmaceuticals. It is therefore necessary to present clearer picture of the field and highlight the factors influencing particle design and scale-up. Areas covered: The review presents a systematic analysis of the trends in development of particle delivery systems using spray drying. This is followed by exploring the mechanisms governing particle formation in the process stages. Particle design factors including those of equipment configurations and feed/process attributes were highlighted. Finally, the review summarises the current industrial approaches for upscaling pharmaceutical spray drying. Expert opinion: Spray drying provides the ability to design particles of the desired functionality. This greatly benefits the pharmaceutical sector especially as product specifications are becoming more encompassing and exacting. One of the biggest barriers to product translation remains one of scale-up/scale-down. A shift from trial and error approaches to model-based particle design helps to enhance control over product properties. To this end, process innovations and advanced manufacturing technologies are particularly welcomed.

  15. Increasing power generation for scaling up single-chamber air cathode microbial fuel cells

    KAUST Repository

    Cheng, Shaoan

    2011-03-01

    Scaling up microbial fuel cells (MFCs) requires a better understanding the importance of the different factors such as electrode surface area and reactor geometry relative to solution conditions such as conductivity and substrate concentration. It is shown here that the substrate concentration has significant effect on anode but not cathode performance, while the solution conductivity has a significant effect on the cathode but not the anode. The cathode surface area is always important for increasing power. Doubling the cathode size can increase power by 62% with domestic wastewater, but doubling the anode size increases power by 12%. Volumetric power density was shown to be a linear function of cathode specific surface area (ratio of cathode surface area to reactor volume), but the impact of cathode size on power generation depended on the substrate strength (COD) and conductivity. These results demonstrate the cathode specific surface area is the most critical factor for scaling-up MFCs to obtain high power densities. © 2010 Elsevier Ltd.

  16. Semantic Representation and Scale-Up of Integrated Air Traffic Management Data

    Science.gov (United States)

    Keller, Richard M.; Ranjan, Shubha; Wei, Mie; Eshow, Michelle

    2016-01-01

    Each day, the global air transportation industry generates a vast amount of heterogeneous data from air carriers, air traffic control providers, and secondary aviation entities handling baggage, ticketing, catering, fuel delivery, and other services. Generally, these data are stored in isolated data systems, separated from each other by significant political, regulatory, economic, and technological divides. These realities aside, integrating aviation data into a single, queryable, big data store could enable insights leading to major efficiency, safety, and cost advantages. In this paper, we describe an implemented system for combining heterogeneous air traffic management data using semantic integration techniques. The system transforms data from its original disparate source formats into a unified semantic representation within an ontology-based triple store. Our initial prototype stores only a small sliver of air traffic data covering one day of operations at a major airport. The paper also describes our analysis of difficulties ahead as we prepare to scale up data storage to accommodate successively larger quantities of data -- eventually covering all US commercial domestic flights over an extended multi-year timeframe. We review several approaches to mitigating scale-up related query performance concerns.

  17. gCUP: rapid GPU-based HIV-1 co-receptor usage prediction for next-generation sequencing.

    Science.gov (United States)

    Olejnik, Michael; Steuwer, Michel; Gorlatch, Sergei; Heider, Dominik

    2014-11-15

    Next-generation sequencing (NGS) has a large potential in HIV diagnostics, and genotypic prediction models have been developed and successfully tested in the recent years. However, albeit being highly accurate, these computational models lack computational efficiency to reach their full potential. In this study, we demonstrate the use of graphics processing units (GPUs) in combination with a computational prediction model for HIV tropism. Our new model named gCUP, parallelized and optimized for GPU, is highly accurate and can classify >175 000 sequences per second on an NVIDIA GeForce GTX 460. The computational efficiency of our new model is the next step to enable NGS technologies to reach clinical significance in HIV diagnostics. Moreover, our approach is not limited to HIV tropism prediction, but can also be easily adapted to other settings, e.g. drug resistance prediction. The source code can be downloaded at http://www.heiderlab.de d.heider@wz-straubing.de. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  18. Comparison of a Clinical Prediction Rule and a LAM Antigen-Detection Assay for the Rapid Diagnosis of TBM in a High HIV Prevalence Setting

    Science.gov (United States)

    Patel, Vinod B.; Singh, Ravesh; Connolly, Cathy; Kasprowicz, Victoria; Zumla, Allimudin; Ndungu, Thumbi; Dheda, Keertan

    2010-01-01

    Background/Objective The diagnosis of tuberculous meningitis (TBM) in resource poor TB endemic environments is challenging. The accuracy of current tools for the rapid diagnosis of TBM is suboptimal. We sought to develop a clinical-prediction rule for the diagnosis of TBM in a high HIV prevalence setting, and to compare performance outcomes to conventional diagnostic modalities and a novel lipoarabinomannan (LAM) antigen detection test (Clearview-TB®) using cerebrospinal fluid (CSF). Methods Patients with suspected TBM were classified as definite-TBM (CSF culture or PCR positive), probable-TBM and non-TBM. Results Of the 150 patients, 84% were HIV-infected (median [IQR] CD4 count = 132 [54; 241] cells/µl). There were 39, 55 and 54 patients in the definite, probable and non-TBM groups, respectively. The LAM sensitivity and specificity (95%CI) was 31% (17;48) and 94% (85;99), respectively (cut-point ≥0.18). By contrast, smear-microscopy was 100% specific but detected none of the definite-TBM cases. LAM positivity was associated with HIV co-infection and low CD4 T cell count (CD4200 cells/µl; p = 0.03). The sensitivity and specificity in those with a CD4<100 cells/µl was 50% (27;73) and 95% (74;99), respectively. A clinical-prediction rule ≥6 derived from multivariate analysis had a sensitivity and specificity (95%CI) of 47% (31;64) and 98% (90;100), respectively. When LAM was combined with the clinical-prediction-rule, the sensitivity increased significantly (p<0.001) to 63% (47;68) and specificity remained high at 93% (82;98). Conclusions Despite its modest sensitivity the LAM ELISA is an accurate rapid rule-in test for TBM that has incremental value over smear-microscopy. The rule-in value of LAM can be further increased by combination with a clinical-prediction rule, thus enhancing the rapid diagnosis of TBM in HIV-infected persons with advanced immunosuppression. PMID:21203513

  19. Adolescents’ experience of a rapid HIV self-testing device in youth-friendly clinic settings in Cape Town South Africa: a cross-sectional community based usability study

    Science.gov (United States)

    Smith, Philip; Wallace, Melissa; Bekker, Linda-Gail

    2016-01-01

    Abstract Introduction: Since HIV testing in South African adolescents and young adults is sub-optimal, the objective of the current study was to investigate the feasibility and acceptability of an HIV rapid self-testing device in adolescents and young people at the Desmond Tutu HIV Foundation Youth Centre and Mobile Clinic. Methods: Self-presenting adolescents and young adults were invited to participate in a study investigating the fidelity, usability and acceptability of the AtomoRapid HIV Rapid self-testing device. Trained healthcare workers trained participants to use the device before the participant conducted the HIV self-test with device usage instructions. The healthcare worker then conducted a questionnaire-based survey to assess outcomes. Results: Of the 224 enrolled participants between 16 and 24 years of age, 155 (69,2%) were female. Overall, fidelity was high; 216 (96,4%) participants correctly completed the test and correctly read and interpreted the HIV test result. There were eight (3,6%) user errors overall; six participants failed to prick their finger even though the lancet fired correctly. There were two user errors where participants failed to use the capillary tube correctly. Participants rated acceptability and usability highly, with debut testers giving significantly higher ratings for both. Younger participants gave significantly higher ratings of acceptability. Conclusions: Adolescents and young adults found HIV self-testing highly acceptable with the AtomoRapid and they used the device accurately. Further research should investigate how, where and when to deploy HIV self-testing as a means to accompany existing strategies in reaching the UNAIDS goal to test 90% of all individuals worldwide. PMID:28406597

  20. Adolescents' experience of a rapid HIV self-testing device in youth-friendly clinic settings in Cape Town South Africa: a cross-sectional community based usability study.

    Science.gov (United States)

    Smith, Philip; Wallace, Melissa; Bekker, Linda-Gail

    2016-12-23

    Introduction : Since HIV testing in South African adolescents and young adults is sub-optimal, the objective of the current study was to investigate the feasibility and acceptability of an HIV rapid self-testing device in adolescents and young people at the Desmond Tutu HIV Foundation Youth Centre and Mobile Clinic. Methods : Self-presenting adolescents and young adults were invited to participate in a study investigating the fidelity, usability and acceptability of the AtomoRapid HIV Rapid self-testing device. Trained healthcare workers trained participants to use the device before the participant conducted the HIV self-test with device usage instructions. The healthcare worker then conducted a questionnaire-based survey to assess outcomes. Results : Of the 224 enrolled participants between 16 and 24 years of age, 155 (69,2%) were female. Overall, fidelity was high; 216 (96,4%) participants correctly completed the test and correctly read and interpreted the HIV test result. There were eight (3,6%) user errors overall; six participants failed to prick their finger even though the lancet fired correctly. There were two user errors where participants failed to use the capillary tube correctly. Participants rated acceptability and usability highly, with debut testers giving significantly higher ratings for both. Younger participants gave significantly higher ratings of acceptability. Conclusions : Adolescents and young adults found HIV self-testing highly acceptable with the AtomoRapid and they used the device accurately. Further research should investigate how, where and when to deploy HIV self-testing as a means to accompany existing strategies in reaching the UNAIDS goal to test 90% of all individuals worldwide.

  1. A gp41-based heteroduplex mobility assay provides rapid and accurate assessment of intrasubtype epidemiological linkage in HIV type 1 heterosexual transmission Pairs.

    Science.gov (United States)

    Manigart, Olivier; Boeras, Debrah I; Karita, Etienne; Hawkins, Paulina A; Vwalika, Cheswa; Makombe, Nathan; Mulenga, Joseph; Derdeyn, Cynthia A; Allen, Susan; Hunter, Eric

    2012-12-01

    A critical step in HIV-1 transmission studies is the rapid and accurate identification of epidemiologically linked transmission pairs. To date, this has been accomplished by comparison of polymerase chain reaction (PCR)-amplified nucleotide sequences from potential transmission pairs, which can be cost-prohibitive for use in resource-limited settings. Here we describe a rapid, cost-effective approach to determine transmission linkage based on the heteroduplex mobility assay (HMA), and validate this approach by comparison to nucleotide sequencing. A total of 102 HIV-1-infected Zambian and Rwandan couples, with known linkage, were analyzed by gp41-HMA. A 400-base pair fragment within the envelope gp41 region of the HIV proviral genome was PCR amplified and HMA was applied to both partners' amplicons separately (autologous) and as a mixture (heterologous). If the diversity between gp41 sequences was low (<5%), a homoduplex was observed upon gel electrophoresis and the transmission was characterized as having occurred between partners (linked). If a new heteroduplex formed, within the heterologous migration, the transmission was determined to be unlinked. Initial blind validation of gp-41 HMA demonstrated 90% concordance between HMA and sequencing with 100% concordance in the case of linked transmissions. Following validation, 25 newly infected partners in Kigali and 12 in Lusaka were evaluated prospectively using both HMA and nucleotide sequences. Concordant results were obtained in all but one case (97.3%). The gp41-HMA technique is a reliable and feasible tool to detect linked transmissions in the field. All identified unlinked results should be confirmed by sequence analyses.

  2. Low knowledge and anecdotal use of unauthorized online HIV self-test kits among attendees at a street-based HIV rapid testing programme in Spain.

    Science.gov (United States)

    Belza, M José; Figueroa, Carmen; Rosales-Statkus, M Elena; Ruiz, Mónica; Vallejo, Fernando; de la Fuente, Luis

    2014-08-01

    The objectives of this study were to estimate the percentage of potential users who know that unauthorized HIV self-tests can be purchased online and the percentage of those who have already used them, and to determine socio-demographic and behavioural correlates. A self-administered questionnaire was employed to collect data from attendees at a street-based HIV testing programme. Logistic regression for rare events was performed. Of the 3340 participants, 5.3% (95% confidence interval (CI) 4.5-6.0%) had knowledge of self-tests being sold online and 7.5% (95% CI 6.6-8.5%) thought they existed but had never seen them; only 0.6% (95% CI 0.3-0.9%) had ever used one. Knowing that self-tests are sold online (odds ratio (OR) 3.6, 95% CI 2.4-5.4) and using them (OR 7.3, 95% CI 2.2-23.8) were associated with having undergone more than two previous HIV tests. Use was also associated with being neither Spanish nor Latin American (OR 3.8, 95% CI 1.2-12.0) and with having a university degree (OR 0.2, 95% CI 0.1-0.7). At the time of the study, the impact on the population of issues related to the use of unauthorized tests was very low. However, media coverage following the approval of self-testing in the USA might have changed the situation. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

  3. Measuring enzymatic HIV-1 susceptibility to two reverse transcriptase inhibitors as a rapid and simple approach to HIV-1 drug-resistance testing.

    Directory of Open Access Journals (Sweden)

    Dieter Hoffmann

    Full Text Available Simple and cost-effective approaches for HIV drug-resistance testing are highly desirable for managing increasingly expanding HIV-1 infected populations who initiate antiretroviral therapy (ART, particularly in resource-limited settings. Non-nucleoside reverse trancriptase inhibitor (NNRTI-based regimens with an NRTI backbone containing lamivudine (3TC or emtricitabine (FTC are preferred first ART regimens. Failure with these drug combinations typically involves the selection of NNRTI- and/or 3TC/FTC-resistant viruses. Therefore, the availability of simple assays to measure both types of drug resistance is critical. We have developed a high throughput screening test for assessing enzymatic resistance of the HIV-1 RT in plasma to 3TC/FTC and NNRTIs. The test uses the sensitive "Amp-RT" assay with a newly-developed real-time PCR format to screen biochemically for drug resistance in single reactions containing either 3TC-triphosphate (3TC-TP or nevirapine (NVP. Assay cut-offs were defined based on testing a large panel of subtype B and non-subtype B clinical samples with known genotypic profiles. Enzymatic 3TC resistance correlated well with the presence of M184I/V, and reduced NVP susceptibility was strongly associated with the presence of K103N, Y181C/I, Y188L, and G190A/Q. The sensitivity and specificity for detecting resistance were 97.0% and 96.0% in samples with M184V, and 97.4% and 96.2% for samples with NNRTI mutations, respectively. We further demonstrate the utility of an HIV capture method in plasma by using magnetic beads coated with CD44 antibody that eliminates the need for ultracentifugation. Thus our results support the use of this simple approach for distinguishing WT from NNRTI- or 3TC/FTC-resistant viruses in clinical samples. This enzymatic testing is subtype-independent and can assist in the clinical management of diverse populations particularly in resource-limited settings.

  4. Scaling-up Strategy as an Appropriate Approach for Sustainable New Town Development? Lessons from Wujin, Changzhou, China

    Directory of Open Access Journals (Sweden)

    Hao Chen

    2015-05-01

    Full Text Available China has achieved rapid urbanization and unprecedented economic booming over the past three decades. Numerous cities and towns dreamed of cloning the miracles of Shenzhen and Pudong, Shanghai, in terms of their international development. However, inappropriate development strategies have meant that the majority of fast expanding urban suburbs or newly developed towns suffer a high ratio of vacant dwellings in real estate markets and a massive loss of farmland. The frequent exposure of these empty cities to mass media or the public has urged urban governments to impose fiscal austerity. These unexpected and negative consequences of urban development have explicit conflicts with sustainability. This paper aims to provide a political economy view of these unsustainable outcomes of new development. To achieve this, the processes and agendas of new city or town planning in Wujin District, Changzhou City, are analyzed and evaluated from the perspective of scale theory. Extensive interviews conducted with local politicians at different levels, planners, real estate agents and local residents facilitate the interpretation of these processes and agendas. It is argued that the legends of Shenzhen and Pudong, Shanghai originate from a modified neoliberal capitalism intervention at the right time and place, with which other peer cities are not comparable. It is concluded that the scaling-up strategy is not appropriate for the local new town development of Wujin, which has led to unsustainable outcomes—empty cities and towns—and created important lessons for the sustainable development of Chinese cities.

  5. Méthodologie de l'extrapolation des réacteurs chimiques Methodology for Scaling Up Chemical Reactors

    Directory of Open Access Journals (Sweden)

    Trambouze P.

    2006-11-01

    Full Text Available Après un exposé général relatif à la méthodologie du développement des procédés, applicable à l'extrapolation des réacteurs, est présenté un rapide examen critique des deux principales techniques mises en oeuvre, à savoir : - la théorie de la similitude ; - l'élaboration de modèles mathématiques. Deux exemples pratiques, relatifs aux réacteurs homogènes et aux réacteurs catalytiques à lit fixe et deux phases fluides, sont ensuite examinés à la lumière des considérations générales précédentes. After giving a general description of process-development methodology applicable to scaling up reactors, this article makes a quick critical examination of the two main techniques involved, i. e. : (a the theory of similarity, and (b the compiling of mathematical models. Two practical examples relating to homogeneous reactors and trickle-bed catalytic reactors are then examined in the light of the preceding general considerations.

  6. Scaling up watershed model parameters--Flow and load simulations of the Edisto River Basin

    Science.gov (United States)

    Feaster, Toby D.; Benedict, Stephen T.; Clark, Jimmy M.; Bradley, Paul M.; Conrads, Paul

    2014-01-01

    The Edisto River is the longest and largest river system completely contained in South Carolina and is one of the longest free flowing blackwater rivers in the United States. The Edisto River basin also has fish-tissue mercury concentrations that are some of the highest recorded in the United States. As part of an effort by the U.S. Geological Survey to expand the understanding of relations among hydrologic, geochemical, and ecological processes that affect fish-tissue mercury concentrations within the Edisto River basin, analyses and simulations of the hydrology of the Edisto River basin were made with the topography-based hydrological model (TOPMODEL). The potential for scaling up a previous application of TOPMODEL for the McTier Creek watershed, which is a small headwater catchment to the Edisto River basin, was assessed. Scaling up was done in a step-wise process beginning with applying the calibration parameters, meteorological data, and topographic wetness index data from the McTier Creek TOPMODEL to the Edisto River TOPMODEL. Additional changes were made with subsequent simulations culminating in the best simulation, which included meteorological and topographic wetness index data from the Edisto River basin and updated calibration parameters for some of the TOPMODEL calibration parameters. Comparison of goodness-of-fit statistics between measured and simulated daily mean streamflow for the two models showed that with calibration, the Edisto River TOPMODEL produced slightly better results than the McTier Creek model, despite the significant difference in the drainage-area size at the outlet locations for the two models (30.7 and 2,725 square miles, respectively). Along with the TOPMODEL hydrologic simulations, a visualization tool (the Edisto River Data Viewer) was developed to help assess trends and influencing variables in the stream ecosystem. Incorporated into the visualization tool were the water-quality load models TOPLOAD, TOPLOAD-H, and LOADEST

  7. Scaling up cervical cancer screening in the midst of human papillomavirus vaccination advocacy in Thailand

    Directory of Open Access Journals (Sweden)

    Teerawattananon Yot

    2010-07-01

    Full Text Available Abstract Background Screening tests for cervical cancer are effective in reducing the disease burden. In Thailand, a Pap smear program has been implemented throughout the country for 40 years. In 2008 the Ministry of Public Health (MoPH unexpectedly decided to scale up the coverage of free cervical cancer screening services, to meet an ambitious target. This study analyzes the processes and factors that drove this policy innovation in the area of cervical cancer control in Thailand. Methods In-depth interviews with key policy actors and review of relevant documents were conducted in 2009. Data analysis was guided by a framework, developed on public policy models and existing literature on scaling-up health care interventions. Results Between 2006 and 2008 international organizations and the vaccine industry advocated the introduction of Human Papillomavirus (HPV vaccine for the primary prevention of cervical cancer. Meanwhile, a local study suggested that the vaccine was considerably less cost-effective than cervical cancer screening in the Thai context. Then, from August to December 2008, the MoPH carried out a campaign to expand the coverage of its cervical cancer screening program, targeting one million women. The study reveals that several factors were influential in focusing the attention of policymakers on strengthening the screening services. These included the high burden of cervical cancer in Thailand, the launch of the HPV vaccine onto the global and domestic markets, the country’s political instability, and the dissemination of scientific evidence regarding the appropriateness of different options for cervical cancer prevention. Influenced by the country’s political crisis, the MoPH’s campaign was devised in a very short time. In the view of the responsible health officials, the campaign was not successful and indeed, did not achieve its ambitious target. Conclusion The Thai case study suggests that the political crisis was a

  8. Scaling up cervical cancer screening in the midst of human papillomavirus vaccination advocacy in Thailand.

    Science.gov (United States)

    Yothasamut, Jomkwan; Putchong, Choenkwan; Sirisamutr, Teera; Teerawattananon, Yot; Tantivess, Sripen

    2010-07-02

    Screening tests for cervical cancer are effective in reducing the disease burden. In Thailand, a Pap smear program has been implemented throughout the country for 40 years. In 2008 the Ministry of Public Health (MoPH) unexpectedly decided to scale up the coverage of free cervical cancer screening services, to meet an ambitious target. This study analyzes the processes and factors that drove this policy innovation in the area of cervical cancer control in Thailand. In-depth interviews with key policy actors and review of relevant documents were conducted in 2009. Data analysis was guided by a framework, developed on public policy models and existing literature on scaling-up health care interventions. Between 2006 and 2008 international organizations and the vaccine industry advocated the introduction of Human Papillomavirus (HPV) vaccine for the primary prevention of cervical cancer. Meanwhile, a local study suggested that the vaccine was considerably less cost-effective than cervical cancer screening in the Thai context. Then, from August to December 2008, the MoPH carried out a campaign to expand the coverage of its cervical cancer screening program, targeting one million women. The study reveals that several factors were influential in focusing the attention of policymakers on strengthening the screening services. These included the high burden of cervical cancer in Thailand, the launch of the HPV vaccine onto the global and domestic markets, the country's political instability, and the dissemination of scientific evidence regarding the appropriateness of different options for cervical cancer prevention. Influenced by the country's political crisis, the MoPH's campaign was devised in a very short time. In the view of the responsible health officials, the campaign was not successful and indeed, did not achieve its ambitious target. The Thai case study suggests that the political crisis was a crucial factor that drew the attention of policymakers to the cervical

  9. Process engineering and scale-up of autotrophic Clostridium strain P11 syngas fermentation

    Science.gov (United States)

    Kundiyana, Dimple Kumar Aiyanna

    Scope and Method of Study. Biomass gasification followed by fermentation of syngas to ethanol is a potential process to produce bioenergy. The process is currently being researched under laboratory- and pilot-scale in an effort to optimize the process conditions and make the process feasible for commercial production of ethanol and other biofuels such as butanol and propanol. The broad research objectives for the research were to improve ethanol yields during syngas fermentation and to design a economical fermentation process. The research included four statistically designed experimental studies in serum bottles, bench-scale and pilot-scale fermentors to screen alternate fermentation media components, to determine the effect of process parameters such as pH, temperature and buffer on syngas fermentation, to determine the effect of key limiting nutrients of the acetyl-CoA pathway in a continuous series reactor design, and to scale-up the syngas fermentation in a 100-L pilot scale fermentor. Findings and Conclusions. The first experimental study identified cotton seed extract (CSE) as a feasible medium for Clostridium strain P11 fermentation. The study showed that CSE at 0.5 g L-1 can potentially replace all the standard Clostridium strain P11 fermentation media components while using a media buffer did not significantly improve the ethanol production when used in fermentation with CSE. Scale-up of the CSE fermentation in 2-L and 5-L stirred tank fermentors showed 25% increase in ethanol yield. The second experimental study showed that syngas fermentation at 32°C without buffer was associated with higher ethanol concentration and reduced lag time in switching to solventogenesis. Conducting fermentation at 40°C or by lowering incubation pH to 5.0 resulted in reduced cell growth and no production of ethanol or acetic acid. The third experiment studied the effect of three limiting nutrients, calcium pantothenate, vitamin B12 and CoCl2 on syngas fermentation. Results

  10. Application of Network Scale Up Method in the Estimation of Population Size for Men Who Have Sex with Men in Shanghai, China.

    Directory of Open Access Journals (Sweden)

    Jun Wang

    Full Text Available Men who have sex with men (MSM are at high risk of HIV infection. For developing proper interventions, it is important to know the size of MSM population. However, size estimation of MSM populations is still a significant public health challenge due to high cost, hard to reach and stigma associated with the population.We aimed to estimate the social network size (c value in general population and the size of MSM population in Shanghai, China by using the net work scale-up method.A multistage random sampling was used to recruit participants aged from 18 to 60 years who had lived in Shanghai for at least 6 months. The "known population method" with adjustment of backward estimation and regression model was applied to estimate the c value. And the MSM population size was further estimated using an adjusted c value taking into account for the transmission effect through social respect level towards MSM.A total of 4017 participants were contacted for an interview, and 3907 participants met the inclusion criterion. The social network size (c value of participants was 236 after adjustment. The estimated size of MSM was 36354 (95% CI: 28489-44219 for the male Shanghaies aged 18 to 60 years, and the proportion of MSM among the total male population aged 18 to 60 years in Shanghai was 0.28%.We employed the network scale-up method and used a wide range of data sources to estimate the size of MSM population in Shanghai, which is useful for HIV prevention and intervention among the target population.

  11. Costs and outcomes of VCT delivery models in the context of scaling up services in Indonesia

    NARCIS (Netherlands)

    Siregar, A.Y.M.; Komarudin, D.; Wisaksana, R.; Crevel, R. van; Baltussen, R.M.P.M.

    2011-01-01

    OBJECTIVE: To evaluate costs and outcomes of voluntary counselling and testing (VCT) service delivery models in urban Indonesia. METHODS: We collected primary data on utilization, costs and outcomes of VCT services in a hospital clinic (568 clients), HIV community clinic (28 clients), sexually

  12. Scale up and application of equal-channel angular extrusion for the electronics and aerospace industries

    International Nuclear Information System (INIS)

    Ferrasse, Stephane; Segal, V.M.; Alford, Frank; Kardokus, Janine; Strothers, Susan

    2008-01-01

    Two areas are critical to promote equal-channel angular extrusion beyond the stage of a laboratory curiosity: (i) tool/processing design and scale up; (ii) development of new submicrometer-grained products. Both goals are pursued at Honeywell. The first case is the successful commercialization of ECAE for the production of sputtering targets from single phase alloys in the electronic industry. Blank dimensions are significantly larger than those reported in the literature. Other described applications are targeted to the increase of tensile strength, high-cycle fatigue and toughness in medium-to-heavily alloyed Al materials used in aerospace. In these alloys, the optimal properties can be reached with better understanding of the interplay between plastic deformation and precipitation mechanisms

  13. Evaluation of liquid-fed ceramic melter scale-up correlations

    International Nuclear Information System (INIS)

    Koegler, S.S.; Mitchell, S.J.

    1988-08-01

    This study was conducted to determine the parameters governing factors of scale for liquid-fed ceramic melters (LFCMs) in order to design full-scale melters using smaller-scale melter data. Results of melter experiments conducted at Pacific Northwest Laboratory (PNL) and Savannah River Laboratory (SRL) are presented for two feed compositions and five different liquid-fed ceramic melters. The melter performance data including nominal feed rate and glass melt rate are correlated as a function of melter surface area. Comparisons are made between the actual melt rate data and melt rates predicted by a cold cap heat transfer model. The heat transfer model could be used in scale-up calculations, but insufficient data are available on the cold cap characteristics. Experiments specifically designed to determine heat transfer parameters are needed to further develop the model. 17 refs

  14. Teaching assistant-student interactions in a modified SCALE-UP classroom

    Science.gov (United States)

    DeBeck, George; Demaree, Dedra

    2012-02-01

    In the spring term of 2010, Oregon State University (OSU) began using a SCALE-UP style classroom in the instruction of the introductory calculus-based physics series. Instruction in this classroom was conducted in weekly two-hour sessions facilitated by the primary professor and either two graduate teaching assistants (GTAs) or a graduate teaching assistant and an undergraduate learning assistant (LA). During the course of instruction, two of the eight tables in the room were audio and video recorded. We examine the practices of the GTAs in interacting with the students through both qualitative and quantitative analyses of these recordings. Quantitatively, significant differences are seen between the most experienced GTA and the rest. A major difference in confidence is also observed in the qualitative analysis of this GTA compared to a less experienced GTA.

  15. Scaling up the production capacity of U-Mo powder by HMD process

    International Nuclear Information System (INIS)

    Pasqualini, E.E.; Lopez, M.; Helzel Garcia, L.J.; Echenique, P.; Adelfang, P.

    2002-01-01

    The recent discovery that uranium alloys in metastable gamma phase can be hydrided at low temperatures and pressures have allowed developing the method of commuting bulk materials by milling the hydride to desired size and then dehydriding the powder. This process is called HMD (hydriding-milling-dehydriding) and needs an initial step of hydrogen incorporation to allow the alloy to be hydrided. This four step process has been conveniently set up for the production of U-7Mo powder for its use in nuclear fuels. Low equipment investment and low man power are needed for this achievement. The process is being analyzed in its scaling up for one kilogram batches and a 50 kilogram per year production capacity of U-Mo powder. (author)

  16. Functionally graded hardmetals and cermets: preparation, performance and production scale up

    International Nuclear Information System (INIS)

    Dreyer, K.; Kassel, D.; Daub, H.-W.; Berg, H. van den; Lengauer, W.; Garcia, J.; Ucakar, V.

    2001-01-01

    Sintering experiments were carried out to establish graded microstructures in hardmetals and cermets. The formation of these microstructural features was investigated as a function of nitrogen pressure, sintering temperature, sintering period and sintering profile. The nitrogen pressure influences the formation of carbonitride layers at the surface. Decreasing sintering temperature yields similar results as increasing nitrogen pressure. Upon prolonged sintering time a small growth of the outer carbonitride layer can only be obtained if a substantial WC grain growth is accepted. Variation of the sintering profile after dense sintering does not principally change the type of the graded microstructure. The laboratory experiments were scaled up in an industrial sinter/HIP furnace and showing good correspondence with each other. First turning cutting tests with different alloys show excellent performance in comparison to ungraded materials. (author)

  17. Considerations for reducing food system energy demand while scaling up urban agriculture

    DEFF Research Database (Denmark)

    Mohareb, Eugene; Heller, Martin; Novak, Paige

    2017-01-01

    -income countries, considering UA classification, direct/indirect energy pressures, and interactions with other components of the food-energy-water nexus. This is followed by an exploration of ways in which these cities can plan for the exploitation of waste flows for resource-efficient UA...... with UA systems, highlighting that the literature is not yet sufficiently robust to make universal claims on benefits. This letter explores energy demand from conventional resource inputs, various production systems, water/energy trade-offs, alternative irrigation, packaging materials, and transportation...... of the proposed benefits of UA; however, explicit consideration of energy and resource requirements needs to be made in order to realize these anticipated environmental benefits. A literature review is undertaken here to provide new insight into the energy implications of scaling up UA in cities in high...

  18. Viscous flow features in scaled-up physical models of normal and pathological vocal phonation

    Energy Technology Data Exchange (ETDEWEB)

    Erath, Byron D., E-mail: berath@purdue.ed [School of Mechanical Engineering, Purdue University, 585 Purdue Mall, West Lafayette, IN 47907 (United States); Plesniak, Michael W., E-mail: plesniak@gwu.ed [Department of Mechanical and Aerospace Engineering, George Washington University, 801 22nd Street NW, Suite 739, Washington, DC 20052 (United States)

    2010-06-15

    Unilateral vocal fold paralysis results when the recurrent laryngeal nerve, which innervates the muscles of the vocal folds becomes damaged. The loss of muscle and tension control to the damaged vocal fold renders it ineffectual. The mucosal wave disappears during phonation, and the vocal fold becomes largely immobile. The influence of unilateral vocal fold paralysis on the viscous flow development, which impacts speech quality within the glottis during phonation was investigated. Driven, scaled-up vocal fold models were employed to replicate both normal and pathological patterns of vocal fold motion. Spatial and temporal velocity fields were captured using particle image velocimetry, and laser Doppler velocimetry. Flow parameters were scaled to match the physiological values associated with human speech. Loss of motion in one vocal fold resulted in a suppression of typical glottal flow fields, including decreased spatial variability in the location of the flow separation point throughout the phonatory cycle, as well as a decrease in the vorticity magnitude.

  19. Viscous flow features in scaled-up physical models of normal and pathological vocal phonation

    International Nuclear Information System (INIS)

    Erath, Byron D.; Plesniak, Michael W.

    2010-01-01

    Unilateral vocal fold paralysis results when the recurrent laryngeal nerve, which innervates the muscles of the vocal folds becomes damaged. The loss of muscle and tension control to the damaged vocal fold renders it ineffectual. The mucosal wave disappears during phonation, and the vocal fold becomes largely immobile. The influence of unilateral vocal fold paralysis on the viscous flow development, which impacts speech quality within the glottis during phonation was investigated. Driven, scaled-up vocal fold models were employed to replicate both normal and pathological patterns of vocal fold motion. Spatial and temporal velocity fields were captured using particle image velocimetry, and laser Doppler velocimetry. Flow parameters were scaled to match the physiological values associated with human speech. Loss of motion in one vocal fold resulted in a suppression of typical glottal flow fields, including decreased spatial variability in the location of the flow separation point throughout the phonatory cycle, as well as a decrease in the vorticity magnitude.

  20. Scaling up ATLAS Database Release Technology for the LHC Long Run

    International Nuclear Information System (INIS)

    Borodin, M; Nevski, P; Vaniachine, A

    2011-01-01

    To overcome scalability limitations in database access on the Grid, ATLAS introduced the Database Release technology replicating databases in files. For years Database Release technology assured scalable database access for Monte Carlo production on the Grid. Since previous CHEP, Database Release technology was used successfully in ATLAS data reprocessing on the Grid. Frozen Conditions DB snapshot guarantees reproducibility and transactional consistency isolating Grid data processing tasks from continuous conditions updates at the 'live' Oracle server. Database Release technology fully satisfies the requirements of ATLAS data reprocessing and Monte Carlo production. We parallelized the Database Release build workflow to avoid linear dependency of the build time on the length of LHC data-taking period. In recent data reprocessing campaigns the build time was reduced by an order of magnitude thanks to a proven master-worker architecture used in the Google MapReduce. We describe further Database Release optimizations scaling up the technology for the LHC long run.

  1. Scaling-up vaccine production: implementation aspects of a biomass growth observer and controller.

    Science.gov (United States)

    Soons, Zita I T A; van den IJssel, Jan; van der Pol, Leo A; van Straten, Gerrit; van Boxtel, Anton J B

    2009-04-01

    This study considers two aspects of the implementation of a biomass growth observer and specific growth rate controller in scale-up from small- to pilot-scale bioreactors towards a feasible bulk production process for whole-cell vaccine against whooping cough. The first is the calculation of the oxygen uptake rate, the starting point for online monitoring and control of biomass growth, taking into account the dynamics in the gas-phase. Mixing effects and delays are caused by amongst others the headspace and tubing to the analyzer. These gas phase dynamics are modelled using knowledge of the system in order to reconstruct oxygen consumption. The second aspect is to evaluate performance of the monitoring and control system with the required modifications of the oxygen consumption calculation on pilot-scale. In pilot-scale fed-batch cultivation good monitoring and control performance is obtained enabling a doubled concentration of bulk vaccine compared to standard batch production.

  2. Experimental and scale up study of the flame spread over the PMMA sheets

    Directory of Open Access Journals (Sweden)

    Mamourian Mojtaba

    2009-01-01

    Full Text Available To explore the flame spread mechanisms over the solid fuel sheets, downward flame spread over vertical polymethylmethacrylate sheets with thicknesses from 1.75 to 5.75 mm have been examined in the quiescent environment. The dependence of the flame spread rate on the thickness of sheets is obtained by one-dimensional heat transfer model. An equation for the flame spread rate based on the thermal properties and the thickness of the sheet by scale up method is derived from this model. During combustion, temperature within the gas and solid phases is measured by a fine thermocouple. The pyrolysis temperature, the length of the pyrolysis zone, the length of the preheating zone, and the flame temperature are determined from the experimental data. Mathematical analysis has yielded realistic results. This model provides a useful formula to predict the rate of flame spread over any thin solid fuel.

  3. Recommendations for scale-up of community-based misoprostol distribution programs.

    Science.gov (United States)

    Robinson, Nuriya; Kapungu, Chisina; Carnahan, Leslie; Geller, Stacie

    2014-06-01

    Community-based distribution of misoprostol for prevention of postpartum hemorrhage (PPH) in resource-poor settings has been shown to be safe and effective. However, global recommendations for prenatal distribution and monitoring within a community setting are not yet available. In order to successfully translate misoprostol and PPH research into policy and practice, several critical points must be considered. A focus on engaging the community, emphasizing the safe nature of community-based misoprostol distribution, supply chain management, effective distribution, coverage, and monitoring plans are essential elements to community-based misoprostol program introduction, expansion, or scale-up. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  4. Scaling up the health workforce in the public sector: the role of government fiscal policy.

    Science.gov (United States)

    Vujicic, Marko

    2010-01-01

    Health workers play a key role in increasing access to health care services. Global and country-level estimates show that staffing in many developing countries - particularly in Sub-Saharan Africa - is far leaner than needed to deliver essential health services to the population. One factor that can limit scaling up the health workforce in developing countries is the government's overall wage policy which sometimes creates restrictions on hiring in the health sector. But while there is considerable debate, the information base in this important area has been quite limited. This paper summarizes the process that determines the budget for health wages in the public sector, how it is linked to overall wage policies, and how this affects staffing in the health sector. The author draws mainly from a recent World Bank report.

  5. Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

    Science.gov (United States)

    Toyama, Mauricio; Castillo, Humberto; Galea, Jerome T.; Brandt, Lena R.; Mendoza, María; Herrera, Vanessa; Mitrani, Martha; Cutipé, Yuri; Cavero, Victoria; Diez-Canseco, Francisco; Miranda, J. Jaime

    2017-01-01

    Background: Mental, neurological, and substance (MNS) use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods: Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results: Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion: Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru has achieved a

  6. Manufacturing process scale-up of optical grade transparent spinel ceramic at ArmorLine Corporation

    Science.gov (United States)

    Spilman, Joseph; Voyles, John; Nick, Joseph; Shaffer, Lawrence

    2013-06-01

    While transparent Spinel ceramic's mechanical and optical characteristics are ideal for many Ultraviolet (UV), visible, Short-Wave Infrared (SWIR), Mid-Wave Infrared (MWIR), and multispectral sensor window applications, commercial adoption of the material has been hampered because the material has historically been available in relatively small sizes (one square foot per window or less), low volumes, unreliable supply, and with unreliable quality. Recent efforts, most notably by Technology Assessment and Transfer (TA and T), have scaled-up manufacturing processes and demonstrated the capability to produce larger windows on the order of two square feet, but with limited output not suitable for production type programs. ArmorLine Corporation licensed the hot-pressed Spinel manufacturing know-how of TA and T in 2009 with the goal of building the world's first dedicated full-scale Spinel production facility, enabling the supply of a reliable and sufficient volume of large Transparent Armor and Optical Grade Spinel plates. With over $20 million of private investment by J.F. Lehman and Company, ArmorLine has installed and commissioned the largest vacuum hot press in the world, the largest high-temperature/high-pressure hot isostatic press in the world, and supporting manufacturing processes within 75,000 square feet of manufacturing space. ArmorLine's equipment is capable of producing window blanks as large as 50" x 30" and the facility is capable of producing substantial volumes of material with its Lean configuration and 24/7 operation. Initial production capability was achieved in 2012. ArmorLine will discuss the challenges that were encountered during scale-up of the manufacturing processes, ArmorLine Optical Grade Spinel optical performance, and provide an overview of the facility and its capabilities.

  7. Scale up of 2,4-dichlorophenol removal from aqueous solutions using Brassica napus hairy roots

    Energy Technology Data Exchange (ETDEWEB)

    Angelini, Vanina A. [Departamento de Biologia Molecular, FCEFQN, Universidad Nacional de Rio Cuarto, 5800 Rio Cuarto, Cordoba (Argentina); Orejas, Joaquin [Facultad de Ingenieria, Universidad Nacional de Rio Cuarto, 5800 Rio Cuarto, Cordoba (Argentina); Medina, Maria I. [Departamento de Biologia Molecular, FCEFQN, Universidad Nacional de Rio Cuarto, 5800 Rio Cuarto, Cordoba (Argentina); Agostini, Elizabeth, E-mail: eagostini@exa.unrc.edu.ar [Departamento de Biologia Molecular, FCEFQN, Universidad Nacional de Rio Cuarto, 5800 Rio Cuarto, Cordoba (Argentina)

    2011-01-15

    Research highlights: {yields}B. napus hairy roots were effectively used for a large scale removal of 2,4-DCP. {yields} High removal efficiencies were obtained (98%) in a short time (30 min). {yields} Roots were re-used for six consecutive cycles with high efficiency. {yields} Post removal solutions showed no toxicity. {yields} This method could be used for continuous and safe treatment of phenolic effluents. - Abstract: Chlorophenols are harmful pollutants, frequently found in the effluents of several industries. For this reason, many environmental friendly technologies are being explored for their removal from industrial wastewaters. The aim of the present work was to study the scale up of 2,4-dichlorophenol (2,4-DCP) removal from synthetic wastewater, using Brassica napus hairy roots and H{sub 2}O{sub 2} in a discontinuous stirred tank reactor. We have analyzed some operational conditions, because the scale up of such process was poorly studied. High removal efficiencies were obtained (98%) in a short time (30 min). When roots were re-used for six consecutive cycles, 2,4-DCP removal efficiency decreased from 98 to 86%, in the last cycle. After the removal process, the solutions obtained from the reactor were assessed for their toxicity using an acute test with Lactuca sativa L. seeds. Results suggested that the treated solution was less toxic than the parent solution, because neither inhibition of lettuce germination nor effects in root and hypocotyl lengths were observed. Therefore, we provide evidence that Brassica napus hairy roots could be effectively used to detoxify solutions containing 2,4-DCP and they have considerable potential for a large scale removal of this pollutant. Thus, this study could help to design a method for continuous and safe treatment of effluents containing chlorophenols.

  8. UPC Scaling-up methodology for Deterministic Safety Assessment and Support to Plant Operation

    Energy Technology Data Exchange (ETDEWEB)

    Martínez-Quiroga, V.; Reventós, F.; Batet, Il.

    2015-07-01

    Best Estimate codes along with necessary nodalizations are widely used tools in nuclear engineering for both Deterministic Safety Assessment (DSA) and Support to Plant Operation and Control. In this framework, the application of quality assurance procedures in both codes and nodalizations becomes an essential step prior any significant study. Along these lines the present paper introduces the UPC SCUP, a systematic methodology based on the extrapolation of the Integral Test Facilities (ITF) post-test simulations by means of scaling analyses. In that sense, SCUP fulfills a gap in current nodalization qualification procedures, the related with the validation of NPP nodalizations for Design Basis Accidents conditions. Three are the pillars that support SCUP: judicial selection of the experimental transients, full confidence in the quality of the ITF simulations, and simplicity in justifying discrepancies that appear between ITF and NPP counterpart transients. The techniques that are presented include the socalled Kv scaled calculations as well as the use of two new approaches, ”Hybrid nodalizations” and ”Scaled-up nodalizations”. These last two methods have revealed themselves to be very helpful in producing the required qualification and in promoting further improvements in nodalization. The study of both LSTF and PKL counterpart tests have allowed to qualify the methodology by the comparison with experimental data. Post-test simulations at different sizes allowed to define which phenomena could be well reproduced by system codes and which not, in this way also establishing the basis for the extrapolation to an NPP scaled calculation. Furthermore, the application of the UPC SCUP methodology demonstrated that selected phenomena can be scaled-up and explained between counterpart simulations by carefully considering the differences in scale and design. (Author)

  9. Geriatric health policy in India: The need for scaling-up implementation

    Directory of Open Access Journals (Sweden)

    N Sherin Susan Paul

    2016-01-01

    Full Text Available In an anticipation of the rising geriatric population in India, the Central government constituted the National Policy for Older Persons in 1999 to promote the health and welfare of senior citizens in India. A major strategy of this policy is to encourage families to take care of their older family members. The policy also encourages voluntary organizations to supplement the care provided by the family and provide care and protection to vulnerable elderly people. The implementation of this policy, particularly in the rural areas, has been negligible and calls for a scaling-up of programs to address the physical, psychological, and social needs of the poor. Due to breakdown of the joint family system and the migration of the younger generation to the towns and cities, the elderly parents in the villages are left to fend for themselves. Too old to work and with little or no source of income, the elders are struggling even to satisfy their basic needs. This article primarily focuses on the various facets of elderly care in India. As a fledgling nation in elderly care, we should take cues from other nations who have pioneered in this field and should constantly evolve to identify and face the various challenges that come up, especially from rural India. The Rural Unit for Health and Social Affairs Department of a well-known Medical College in South India has developed a “senior recreation day care” model which proves to be a useful replicable model to improve the quality of life and nutritional status of the elderly in the lower rungs of society. More than a decade since its inception, it is now the right time to assess the implementation of our geriatric health policy and scale-up programs so that the elderly in our country, irrespective of urban and rural, will have a dignified and good quality life.

  10. Computational psychotherapy research: scaling up the evaluation of patient-provider interactions.

    Science.gov (United States)

    Imel, Zac E; Steyvers, Mark; Atkins, David C

    2015-03-01

    In psychotherapy, the patient-provider interaction contains the treatment's active ingredients. However, the technology for analyzing the content of this interaction has not fundamentally changed in decades, limiting both the scale and specificity of psychotherapy research. New methods are required to "scale up" to larger evaluation tasks and "drill down" into the raw linguistic data of patient-therapist interactions. In the current article, we demonstrate the utility of statistical text analysis models called topic models for discovering the underlying linguistic structure in psychotherapy. Topic models identify semantic themes (or topics) in a collection of documents (here, transcripts). We used topic models to summarize and visualize 1,553 psychotherapy and drug therapy (i.e., medication management) transcripts. Results showed that topic models identified clinically relevant content, including affective, relational, and intervention related topics. In addition, topic models learned to identify specific types of therapist statements associated with treatment-related codes (e.g., different treatment approaches, patient-therapist discussions about the therapeutic relationship). Visualizations of semantic similarity across sessions indicate that topic models identify content that discriminates between broad classes of therapy (e.g., cognitive-behavioral therapy vs. psychodynamic therapy). Finally, predictive modeling demonstrated that topic model-derived features can classify therapy type with a high degree of accuracy. Computational psychotherapy research has the potential to scale up the study of psychotherapy to thousands of sessions at a time. We conclude by discussing the implications of computational methods such as topic models for the future of psychotherapy research and practice. (PsycINFO Database Record (c) 2015 APA, all rights reserved).

  11. Peruvian Mental Health Reform: A Framework for Scaling-up Mental Health Services

    Directory of Open Access Journals (Sweden)

    Mauricio Toyama

    2017-09-01

    Full Text Available Background Mental, neurological, and substance (MNS use disorders are a leading cause of disability worldwide; specifically in Peru, MNS affect 1 in 5 persons. However, the great majority of people suffering from these disorders do not access care, thereby making necessary the improvement of existing conditions including a major rearranging of current health system structures beyond care delivery strategies. This paper reviews and examines recent developments in mental health policies in Peru, presenting an overview of the initiatives currently being introduced and the main implementation challenges they face. Methods Key documents issued by Peruvian governmental entities regarding mental health were reviewed to identify and describe the path that led to the beginning of the reform; how the ongoing reform is taking place; and, the plan and scope for scale-up. Results Since 2004, mental health has gained importance in policies and regulations, resulting in the promotion of a mental health reform within the national healthcare system. These efforts crystallized in 2012 with the passing of Law 29889 which introduced several changes to the delivery of mental healthcare, including a restructuring of mental health service delivery to occur at the primary and secondary care levels and the introduction of supporting services to aid in patient recovery and reintegration into society. In addition, a performance-based budget was approved to guarantee the implementation of these changes. Some of the main challenges faced by this reform are related to the diversity of the implementation settings, eg, isolated rural areas, and the limitations of the existing specialized mental health institutes to substantially grow in parallel to the scaling-up efforts in order to be able to provide training and clinical support to every region of Peru. Conclusion Although the true success of the mental healthcare reform will be determined in the coming years, thus far, Peru

  12. Minnesota wood energy scale-up project 1994 establishment cost data

    Energy Technology Data Exchange (ETDEWEB)

    Downing, M. [Oak Ridge National Lab., TN (United States); Pierce, R. [Champion International, Alexandria, MN (United States); Kroll, T. [Minnesota Department of Natural Resources-Forestry, St. Cloud, MN (United States)

    1996-03-18

    The Minnesota Wood Energy Scale-up Project began in late 1993 with the first trees planted in the spring of 1994. The purpose of the project is to track and monitor economic costs of planting, maintaining and monitoring larger scale commercial plantings. For 15 years, smaller scale research plantings of hybrid poplar have been used to screen for promising, high-yielding poplar clones. In this project 1000 acres of hybrid poplar trees were planted on Conservation Reserve Program (CRP) land near Alexandria, Minnesota in 1994. The fourteen landowners involved re-contracted with the CRP for five-year extensions of their existing 10-year contracts. These extended contracts will expire in 2001, when the plantings are 7 years old. The end use for the trees planted in the Minnesota Wood Energy Scale-up Project is undetermined. They will belong to the owner of the land on which they are planted. There are no current contracts in place for the wood these trees are projected to supply. The structure of the wood industry in the Minnesota has changed drastically over the past 5 years. Stumpage values for fiber have risen to more than $20 per cord in some areas raising the possibility that these trees could be used for fiber rather than energy. Several legislative mandates have forced the State of Minnesota to pursue renewable energy including biomass energy. These mandates, a potential need for an additional 1700 MW of power by 2008 by Northern States Power, and agricultural policies will all affect development of energy markets for wood produced much like agricultural crops. There has been a tremendous amount of local and international interest in the project. Contractual negotiations between area landowners, the CRP, a local Resource Conservation and Development District, the Minnesota Department of Natural Resources and others are currently underway for additional planting of 1000 acres in spring 1995.

  13. Scale up of 2,4-dichlorophenol removal from aqueous solutions using Brassica napus hairy roots

    International Nuclear Information System (INIS)

    Angelini, Vanina A.; Orejas, Joaquin; Medina, Maria I.; Agostini, Elizabeth

    2011-01-01

    Research highlights: →B. napus hairy roots were effectively used for a large scale removal of 2,4-DCP. → High removal efficiencies were obtained (98%) in a short time (30 min). → Roots were re-used for six consecutive cycles with high efficiency. → Post removal solutions showed no toxicity. → This method could be used for continuous and safe treatment of phenolic effluents. - Abstract: Chlorophenols are harmful pollutants, frequently found in the effluents of several industries. For this reason, many environmental friendly technologies are being explored for their removal from industrial wastewaters. The aim of the present work was to study the scale up of 2,4-dichlorophenol (2,4-DCP) removal from synthetic wastewater, using Brassica napus hairy roots and H 2 O 2 in a discontinuous stirred tank reactor. We have analyzed some operational conditions, because the scale up of such process was poorly studied. High removal efficiencies were obtained (98%) in a short time (30 min). When roots were re-used for six consecutive cycles, 2,4-DCP removal efficiency decreased from 98 to 86%, in the last cycle. After the removal process, the solutions obtained from the reactor were assessed for their toxicity using an acute test with Lactuca sativa L. seeds. Results suggested that the treated solution was less toxic than the parent solution, because neither inhibition of lettuce germination nor effects in root and hypocotyl lengths were observed. Therefore, we provide evidence that Brassica napus hairy roots could be effectively used to detoxify solutions containing 2,4-DCP and they have considerable potential for a large scale removal of this pollutant. Thus, this study could help to design a method for continuous and safe treatment of effluents containing chlorophenols.

  14. Geriatric health policy in India: The need for scaling-up implementation.

    Science.gov (United States)

    Paul, N Sherin Susan; Asirvatham, Mathew

    2016-01-01

    In an anticipation of the rising geriatric population in India, the Central government constituted the National Policy for Older Persons in 1999 to promote the health and welfare of senior citizens in India. A major strategy of this policy is to encourage families to take care of their older family members. The policy also encourages voluntary organizations to supplement the care provided by the family and provide care and protection to vulnerable elderly people. The implementation of this policy, particularly in the rural areas, has been negligible and calls for a scaling-up of programs to address the physical, psychological, and social needs of the poor. Due to breakdown of the joint family system and the migration of the younger generation to the towns and cities, the elderly parents in the villages are left to fend for themselves. Too old to work and with little or no source of income, the elders are struggling even to satisfy their basic needs. This article primarily focuses on the various facets of elderly care in India. As a fledgling nation in elderly care, we should take cues from other nations who have pioneered in this field and should constantly evolve to identify and face the various challenges that come up, especially from rural India. The Rural Unit for Health and Social Affairs Department of a well-known Medical College in South India has developed a "senior recreation day care" model which proves to be a useful replicable model to improve the quality of life and nutritional status of the elderly in the lower rungs of society. More than a decade since its inception, it is now the right time to assess the implementation of our geriatric health policy and scale-up programs so that the elderly in our country, irrespective of urban and rural, will have a dignified and good quality life.

  15. Is scale-up of community mobilisation among sex workers really possible in complex urban environments? The case of Mumbai, India.

    Science.gov (United States)

    Kongelf, Anine; Bandewar, Sunita V S; Bharat, Shalini; Collumbien, Martine

    2015-01-01

    In the last decade, community mobilisation (CM) interventions targeting female sex workers (FSWs) have been scaled-up in India's national response to the HIV epidemic. This included the Bill and Melinda Gates Foundation's Avahan programme which adopted a business approach to plan and manage implementation at scale. With the focus of evaluation efforts on measuring effectiveness and health impacts there has been little analysis thus far of the interaction of the CM interventions with the sex work industry in complex urban environments. Between March and July 2012 semi-structured, in-depth interviews and focus group discussions were conducted with 63 HIV intervention implementers, to explore challenges of HIV prevention among FSWs in Mumbai. A thematic analysis identified contextual factors that impact CM implementation. Large-scale interventions are not only impacted by, but were shown to shape the dynamic social context. Registration practices and programme monitoring were experienced as stigmatising, reflected in shifting client preferences towards women not disclosing as 'sex workers'. This combined with urban redevelopment and gentrification of traditional red light areas, forcing dispersal and more 'hidden' ways of solicitation, further challenging outreach and collectivisation. Participants reported that brothel owners and 'pimps' continued to restrict access to sex workers and the heterogeneous 'community' of FSWs remains fragmented with high levels of mobility. Stakeholder engagement was poor and mobilising around HIV prevention not compelling. Interventions largely failed to respond to community needs as strong target-orientation skewed activities towards those most easily measured and reported. Large-scale interventions have been impacted by and contributed to an increasingly complex sex work environment in Mumbai, challenging outreach and mobilisation efforts. Sex workers remain a vulnerable and disempowered group needing continued support and more

  16. Community-driven demand creation for the use of routine viral load testing: a model to scale up routine viral load testing.

    Science.gov (United States)

    Killingo, Bactrin M; Taro, Trisa B; Mosime, Wame N

    2017-11-01

    HIV treatment outcomes are dependent on the use of viral load measurement. Despite global and national guidelines recommending the use of routine viral load testing, these policies alone have not translated into widespread implementation or sufficiently increased access for people living with HIV (PLHIV). Civil society and communities of PLHIV recognize the need to close this gap and to enable the scale up of routine viral load testing. The International Treatment Preparedness Coalition (ITPC) developed an approach to community-led demand creation for the use of routine viral load testing. Using this Community Demand Creation Model, implementers follow a step-wise process to capacitate and empower communities to address their most pressing needs. This includes utlizing a specific toolkit that includes conducting a baseline assessment, developing a treatment education toolkit, organizing mobilization workshops for knowledge building, provision of small grants to support advocacy work and conducting benchmark evaluations. The Community Demand Creation Model to increase demand for routine viral load testing services by PLHIV has been delivered in diverse contexts including in the sub-Saharan African, Asian, Latin American and the Caribbean regions. Between December 2015 and December 2016, ITPC trained more than 240 PLHIV activists, and disbursed US$90,000 to network partners in support of their national advocacy work. The latter efforts informed a regional, community-driven campaign calling for domestic investment in the expeditious implementation of national viral load testing guidelines. HIV treatment education and community mobilization are critical components of demand creation for access to optimal HIV treatment, especially for the use of routine viral load testing. ITPC's Community Demand Creation Model offers a novel approach to achieving this goal. © 2017 The Authors. Journal of the International AIDS Society published by John Wiley & sons Ltd on behalf of

  17. Is scale-up of community mobilisation among sex workers really possible in complex urban environments? The case of Mumbai, India.

    Directory of Open Access Journals (Sweden)

    Anine Kongelf

    Full Text Available In the last decade, community mobilisation (CM interventions targeting female sex workers (FSWs have been scaled-up in India's national response to the HIV epidemic. This included the Bill and Melinda Gates Foundation's Avahan programme which adopted a business approach to plan and manage implementation at scale. With the focus of evaluation efforts on measuring effectiveness and health impacts there has been little analysis thus far of the interaction of the CM interventions with the sex work industry in complex urban environments.Between March and July 2012 semi-structured, in-depth interviews and focus group discussions were conducted with 63 HIV intervention implementers, to explore challenges of HIV prevention among FSWs in Mumbai. A thematic analysis identified contextual factors that impact CM implementation. Large-scale interventions are not only impacted by, but were shown to shape the dynamic social context. Registration practices and programme monitoring were experienced as stigmatising, reflected in shifting client preferences towards women not disclosing as 'sex workers'. This combined with urban redevelopment and gentrification of traditional red light areas, forcing dispersal and more 'hidden' ways of solicitation, further challenging outreach and collectivisation. Participants reported that brothel owners and 'pimps' continued to restrict access to sex workers and the heterogeneous 'community' of FSWs remains fragmented with high levels of mobility. Stakeholder engagement was poor and mobilising around HIV prevention not compelling. Interventions largely failed to respond to community needs as strong target-orientation skewed activities towards those most easily measured and reported.Large-scale interventions have been impacted by and contributed to an increasingly complex sex work environment in Mumbai, challenging outreach and mobilisation efforts. Sex workers remain a vulnerable and disempowered group needing continued support

  18. The Cost of Providing Comprehensive HIV Treatment in PEPFAR-Supported Programs

    Science.gov (United States)

    Menzies, Nicolas A; Berruti, Andres A; Berzon, Richard; Filler, Scott; Ferris, Robert; Ellerbrock, Tedd V; Blandford, John M

    2011-01-01

    PEPFAR, national governments, and other stakeholders are investing unprecedented resources to provide HIV treatment in developing countries. This study reports empirical data on costs and cost trends in a large sample of HIV treatment sites. In 2006–2007, we conducted cost analyses at 43 PEPFAR-supported outpatient clinics providing free comprehensive HIV treatment in Botswana, Ethiopia, Nigeria, Uganda, and Vietnam. We collected data on HIV treatment costs over consecutive 6-month periods from scale-up of dedicated HIV treatment services at each site. The study included all patients receiving HIV treatment and care at study sites (62,512 ART and 44,394 pre-ART patients). Outcomes were costs per-patient and total program costs, subdivided by major cost categories. Median annual economic costs were $202 (2009 USD) for pre-ART patients and $880 for ART patients. Excluding ARVs, per-patient ART costs were $298. Care for newly initiated ART patients cost 15–20% more than for established patients. Per-patient costs dropped rapidly as sites matured, with per-patient ART costs dropping 46.8% between first and second 6-month periods after the beginning of scale-up, and an additional 29.5% the following year. PEPFAR provided 79.4% of funding for service delivery, and national governments provided 15.2%. Treatment costs vary widely between sites, and high early costs drop rapidly as sites mature. Treatment costs vary between countries and respond to changes in ARV regimen costs and the package of services. While cost reductions may allow near-term program growth, programs need to weigh the trade-off between improving services for current patients and expanding coverage to new patients. PMID:21412127

  19. HIV Point-of-Care Testing in Canadian Settings: A Scoping Review.

    Science.gov (United States)

    Minichiello, Alexa; Swab, Michelle; Chongo, Meck; Marshall, Zack; Gahagan, Jacqueline; Maybank, Allison; Hot, Aurélie; Schwandt, Michael; Gaudry, Sonia; Hurley, Oliver; Asghari, Shabnam

    2017-01-01

    HIV point-of-care testing (POCT) was approved for use in Canada in 2005 and provides important public health benefits by providing rapid screening results rather than sending a blood sample to a laboratory and waiting on test results. Access to test results soon after testing (or during the same visit) is believed to increase the likelihood that individuals will receive their results and improve access to confirmatory testing and linkages to care. This paper reviews the literature on the utilization of HIV POCT across Canadian provinces. We searched OVID Medline, Embase, EBM Reviews, PsycINFO, CINAHL, and 20 electronic grey literature databases. All empirical studies investigating HIV POCT programs in Canada published in French or English were included. Searches of academic databases identified a total of 6,091 records. After removing duplicates and screening for eligibility, 27 records were included. Ten studies are peer-reviewed articles, and 17 are grey literature reports. HIV POCT in Canada is both feasible and accepted by Canadians. It is preferred to conventional HIV testing (ranging from 81.1 to 97%), and users are highly satisfied with the testing process (ranging between 96 and 100%). The majority of studies demonstrate that HIV POCT is feasible, preferred, and accepted by diverse populations in Canada. Losses to follow-up and linkage rates are also good. However, more research is needed to understand how best to scale up HIV POCT in contexts that currently have very limited or no access to testing.

  20. Guidelines for the scale-up of an aqueous ceramic process: a case study of statistical process control

    OpenAIRE

    Mortara, L.; Alcock, Jeffrey R.

    2011-01-01

    Process-scale up is the change from a feasibility study in a laboratory to a full-scale prototype production process. It is an important issue for the ceramics industry, but has been the subject of relatively little systematic research. This paper will show how certain manufacturing concepts used in a number of industries - can be applied to the scale up of a feasibility study level, aqueous tape casting process. In particular, it examines the elements of process standardisa...

  1. Simulation for scale-up of a confined jet mixer for continuous hydrothermal flow synthesis of nanomaterials

    OpenAIRE

    Ma, CY; Liu, JJ; Zhang, Y; Wang, XZ

    2015-01-01

    Reactor performance of confined jet mixers for continuous hydrothermal flow synthesis of nanomaterials is investigated for the purpose of scale-up from laboratory scale to pilot-plant scale. Computational fluid dynamics (CFD) models were applied to simulate hydrothermal fluid flow, mixing and heat transfer behaviours in the reactors at different volumetric scale-up ratios (up to 26 times). The distributions of flow and heat transfer variables were obtained using ANSYS Fluent with the tracer c...

  2. Rapidly Progressive Disseminated Sporotrichosis as the First Presentation of HIV Infection in a Patient with a Very Low CD4 Cell Count.

    Science.gov (United States)

    de Oliveira-Esteves, Isis Cristine Morávia Ribeiro; Almeida Rosa da Silva, Guilherme; Eyer-Silva, Walter de Araujo; Basílio-de-Oliveira, Rodrigo Panno; de Araujo, Luciana Ferreira; Martins, Carlos José; Neves-Motta, Rogério; Velho Mendes de Azevedo, Marcelo Costa; Signorini, Dario José Hart Pontes; Francisco da Cunha Pinto, Jorge; Moura, Lívia Machado; Laterça, Rafael Jacyntho; Pereira, Diogo Raphael Garcia de Oliveira; do Lago, Isabela Vieira; Raphael de Almeida Ferry, Fernando

    2017-01-01

    Sporotrichosis is a human and animal disease caused by species of the Sporothrix schenckii complex. It is classically acquired through traumatic inoculation of fungal elements. Most frequently, sporotrichosis presents as a fixed cutaneous or as a lymphocutaneous form. A much smaller number of cases occur as cutaneous disseminated and disseminated forms. These cases require immediate diagnosis and management to reduce morbidity and mortality. We present the case of a 34-year-old male patient in whom the first presentation of HIV infection was a rapidly progressive sporotrichosis with multiple cutaneous lesions, a high fungal burden in tissues, and pulmonary involvement. He had an extremely low CD4 cell count (06/mm 3 ). Treatment with amphotericin B deoxycholate led to complete clinical resolution. Sporotrichosis remains a neglected opportunistic infection among HIV-infected patients in Rio de Janeiro state, Brazil, and awareness of this potentially fatal infection is of utmost importance if treatment is not to be delayed and if potentially devastating complications are to be avoided.

  3. Considerations for reducing food system energy demand while scaling up urban agriculture

    Science.gov (United States)

    Mohareb, Eugene; Heller, Martin; Novak, Paige; Goldstein, Benjamin; Fonoll, Xavier; Raskin, Lutgarde

    2017-12-01

    There is an increasing global interest in scaling up urban agriculture (UA) in its various forms, from private gardens to sophisticated commercial operations. Much of this interest is in the spirit of environmental protection, with reduced waste and transportation energy highlighted as some of the proposed benefits of UA; however, explicit consideration of energy and resource requirements needs to be made in order to realize these anticipated environmental benefits. A literature review is undertaken here to provide new insight into the energy implications of scaling up UA in cities in high-income countries, considering UA classification, direct/indirect energy pressures, and interactions with other components of the food-energy-water nexus. This is followed by an exploration of ways in which these cities can plan for the exploitation of waste flows for resource-efficient UA. Given that it is estimated that the food system contributes nearly 15% of total US energy demand, optimization of resource use in food production, distribution, consumption, and waste systems may have a significant energy impact. There are limited data available that quantify resource demand implications directly associated with UA systems, highlighting that the literature is not yet sufficiently robust to make universal claims on benefits. This letter explores energy demand from conventional resource inputs, various production systems, water/energy trade-offs, alternative irrigation, packaging materials, and transportation/supply chains to shed light on UA-focused research needs. By analyzing data and cases from the existing literature, we propose that gains in energy efficiency could be realized through the co-location of UA operations with waste streams (e.g. heat, CO2, greywater, wastewater, compost), potentially increasing yields and offsetting life cycle energy demands relative to conventional approaches. This begs a number of energy-focused UA research questions that explore the

  4. The Student-Centered Active Learning Environment for Undergraduate Programs (SCALE-UP) Project

    Science.gov (United States)

    Beichner, Robert J.

    2011-04-01

    How do you keep a classroom of 100 undergraduates actively learning? Can students practice communication and teamwork skills in a large class? How do you boost the performance of underrepresented groups? The Student-Centered Active Learning Environment for Undergraduate Programs (SCALE-UP) Project has addressed these concerns. Because of their inclusion in a leading introductory physics textbook, project materials are used by more than 1/3 of all science, math, and engineering majors nationwide. The room design and pedagogy have been adopted at more than 100 leading institutions across the country. Physics, chemistry, math, astronomy, biology, engineering, earth sciences, and even literature classes are currently being taught this way. Educational research indicates that students should collaborate on interesting tasks and be deeply involved with the material they are studying. We promote active learning in a redesigned classroom for 100 students or more. (Of course, smaller classes can also benefit.) Class time is spent primarily on "tangibles" and "ponderables"--hands-on activities, simulations, and interesting questions. Nine students sit in three teams at round tables. Instructors circulate and engage in Socratic dialogues. The setting looks like a banquet hall, with lively interactions nearly all the time. Hundreds of hours of classroom video and audio recordings, transcripts of numerous interviews and focus groups, data from conceptual learning assessments (using widely-recognized instruments in a pretest/posttest protocol), and collected portfolios of student work are part of our rigorous assessment effort. Our findings (based on data from over 16,000 students collected over five years as well as replications at adopting sites) can be summarized as the following: 1) Female failure rate is 1/5 of previous levels, even though more is demanded of students. 2) Minority failure rate is 1/4 that seen in traditionally taught courses. 3) At-risk students are more

  5. From Buckets to Basins: Scaling up from the CZO to the NOAA National Water Model

    Science.gov (United States)

    Dugger, A. L.; Gochis, D.; Cosgrove, B.; Sampson, K. M.; McCreight, J. L.; Rafieeinasab, A.

    2017-12-01

    NOAA's National Water Model (NWM) is generating terabytes of data on current and future states of water in streams, soils, snowpacks, lakes, and floodplains across the U.S. Altogether there are approximately 2.7 million stream reaches in the NWM and land cells distributed every 250-m (soil moisture, inundation) and 1-km (snow, evapotranspiration). Water predictions span the next hour to the next 30 days. Flood forecasting is an obvious NWM priority in the near term, but longer-range plans extend to water supply planning, drought forecasting, and water quality. An obvious question posed to a model operating across this many dimensions of space, time, and variables is: are you including the right processes and parameterizations to capture the hydrologic behaviors you are designed for? To answer this question, we generally rely on networks of in-situ observations to constrain models via parameter estimation or evaluate alternate process representations. While this gets us part of the way there, the question remains how well these in-situ characterizations scale up in the context of a national-scale model. The WRF-Hydro community hydrologic modeling system provides the initial backbone for the NWM, driving simulation of water and energy within the critical zone - vertical energy and water fluxes, lateral redistribution of surface and subsurface water, simple deep groundwater dynamics, and channel routing. In this study, we first present baseline performance of the NWM over US-wide networks of streamflow (USGS), soil moisture (CRN, SCAN), and evapotranspiration (Ameriflux) observations at a range of spatial and temporal scales. We conduct a series of simple experiments using different submodel combinations of WRF-Hydro at high-resolution to predict water storage and partitioning behavior at 3 well-instrumented catchments, with the goal of optimizing combined performance of snowpack, soil moisture, ET, and streamflow prediction. We scale-up the optimal physics suites and

  6. Scaling up a Mobile Telemedicine Solution in Botswana: Keys to Sustainability.

    Science.gov (United States)

    Ndlovu, Kagiso; Littman-Quinn, Ryan; Park, Elizabeth; Dikai, Zambo; Kovarik, Carrie L

    2014-01-01

    Effective health care delivery is significantly compromised in an environment where resources, both human and technical, are limited. Botswana's health care system is one of the many in the African continent with few specialized medical doctors, thereby posing a barrier to patients' access to health care services. In addition, the traditional landline and non-robust Information Technology (IT) network infrastructure characterized by slow bandwidth still dominates the health care system in Botswana. Upgrading of the landline IT infrastructure to meet today's health care demands is a tedious, long, and expensive process. Despite these challenges, there still lies hope in health care delivery utilizing wireless telecommunication services. Botswana has recently experienced tremendous growth in the mobile telecommunication industry coupled with an increase in the number of individually owned mobile devices. This growth inspired the Botswana-UPenn Partnership (BUP) to collaborate with local partners to explore using mobile devices as tools to improve access to specialized health care delivery. Pilot studies were conducted across four medical specialties, including radiology, oral medicine, dermatology, and cervical cancer screening. Findings from the studies became vital evidence in support of the first scale-up project of a mobile telemedicine solution in Botswana, also known as "Kgonafalo." Some technical and social challenges were encountered during the initial studies, such as malfunctioning of mobile devices, accidental damage of devices, and cultural misalignment between IT and healthcare providers. These challenges brought about lessons learnt, including a strong need for unwavering senior management support, establishment of solid local public-private partnerships, and efficient project sustainability plans. Sustainability milestones included the development and signing of a Memorandum of Understanding (MOU) between the Botswana government and a private

  7. Scaling up and error analysis of transpiration for Populus euphratica in a desert riparian forest

    Science.gov (United States)

    Si, J.; Li, W.; Feng, Q.

    2013-12-01

    Water consumption information of the forest stand is the most important factor for regional water resources management. However, water consumption of individual trees are usually measured based on the limited sample trees , so, it is an important issue how to realize eventual scaling up of data from a series of sample trees to entire stand. Estimation of sap flow flux density (Fd) and stand sapwood area (AS-stand) are among the most critical factors for determining forest stand transpiration using sap flow measurement. To estimate Fd, the various links in sap flow technology have great impact on the measurement of sap flow, to estimate AS-stand, an appropriate indirect technique for measuring each tree sapwood area (AS-tree) is required, because it is impossible to measure the AS-tree of all trees in a forest stand. In this study, Fd was measured in 2 mature P. euphratic trees at several radial depths, 0~10, 10~30mm, using sap flow sensors with the heat ratio method, the relationship model between AS-tree and stem diameter (DBH), growth model of AS-tree were established, using investigative original data of DBH, tree-age, and AS-tree. The results revealed that it can achieve scaling up of transpiration from sample trees to entire forest stand using AS-tree and Fd, however, the transpiration of forest stand (E) will be overvalued by 12.6% if using Fd of 0~10mm, and it will be underestimated by 25.3% if using Fd of 10~30mm, it implied that major uncertainties in mean stand Fd estimations are caused by radial variations in Fd. E will be obviously overvalued when the AS-stand is constant, this result imply that it is the key to improve the prediction accuracy that how to simulate the AS-stand changes in the day scale; They also showed that the potential errors in transpiration with a sample size of approximately ≥30 were almost stable for P.euphrtica, this suggests that to make an allometric equation it might be necessary to sample at least 30 trees.

  8. Optimizing antiretroviral product selection: a sample approach to improving patient outcomes, saving money, and scaling-up health services in developing countries.

    Science.gov (United States)

    Amole, Carolyn D; Brisebois, Catherine; Essajee, Shaffiq; Koehler, Erin; Levin, Andrew D; Moore, Meredith C; Brown Ripin, David H; Sickler, Joanna J; Singh, Inder R

    2011-08-01

    Over the last decade, increased funding to support HIV treatment programs has enabled millions of new patients in developing countries to access the medications they need. Today, although demand for antiretrovirals continues to grow, the financial crisis has severely constrained funding leaving countries with difficult choices on program prioritization. Product optimization is one solution countries can pursue to continue to improve patient care while also uncovering savings that can be used for further scale up or other health system needs. Program managers can make procurement decisions that actually reduce program costs by considering additional factors beyond World Health Organization guidelines when making procurement decisions. These include in-country product availability, convenience, price, and logistics such as supply chain implications and laboratory testing requirements. Three immediate product selection opportunities in the HIV space include using boosted atazanavir in place of lopinovir for second-line therapy, lamivudine instead of emtricitabine in both first-line and second-line therapy, and tenofovir + lamivudine over abacavir + didanosine in second-line therapy. If these 3 opportunities were broadly implemented in sub-Saharan Africa and India today, approximately $300 million of savings would be realized over the next 5 years, enabling hundreds of thousands of additional patients to be treated. Although the discussion herein is specific to antriretrovirals, the principles of product selection are generalizable to diseases with multiple treatment options and fungible commodity procurement. Identifying and implementing approaches to overcome health system inefficiencies will help sustain and may expand quality care in resource-limited settings.

  9. Establishing and Scaling-Up Clinical Social Franchise Networks: Lessons Learned From Marie Stopes International and Population Services International

    Science.gov (United States)

    Thurston, Sarah; Chakraborty, Nirali M; Hayes, Brendan; Mackay, Anna; Moon, Pierre

    2015-01-01

    In many low- and middle-income countries, a majority of people seek health care from the private sector. However, fragmentation, poor economies of scale, inadequate financing, political opposition, a bias toward curative services, and weak regulatory and quality control systems pose serious challenges for the private sector. Social franchising addresses a number of these challenges by organizing small, independent health care businesses into quality-assured networks. Global franchisors Marie Stopes International (MSI) and Population Services International (PSI) have rapidly scaled their family planning social franchising programs in recent years, jointly delivering over 10.8 million couple-years of protection (CYPs) in 2014—up 26% from 8.6 million CYPs just 1 year prior. Drawing on experience across MSI’s 17 and PSI’s 25 social franchise networks across Africa, Asia, and Latin America and the Caribbean, this article documents the organizations’ operational approaches, challenges faced, and solutions implemented. The organizations provide intensive capacity building and support for private-sector providers, including clinical training, branding, monitoring quality of franchised services, and commodity support. In addition, franchising programs engage providers and clients through behavior change communication (BCC) and demand generation activities to raise awareness and to attract clients, and they implement initiatives to ensure services are affordable for the lowest-income clients. Social franchise programs offer the private sector a collective platform to better engage government in health policy advocacy and for integrating into new public health care financing and procurement mechanisms. The future of social franchising will require developing approaches to scale-up and sustain the model cost-effectively, selectively integrating other health services into the franchise package, and being responsive to evolving health care financing approaches with the

  10. Informing a Behavior Change Communication Strategy: Formative Research Findings From the Scaling Up Nutrition Movement in Mozambique.

    Science.gov (United States)

    Kodish, Stephen; Aburto, Nancy; Dibari, Filippo; Brieger, William; Agostinho, Saozinha P; Gittelsohn, Joel

    2015-09-01

    Nutrition interventions targeting the first 1000 days show promise to improve nutritional status, but they require effective implementation. Formative research is thus invaluable for developing such interventions, but there have been few detailed studies that describe this phase of work within the Scaling Up Nutrition (SUN) movement. To inform a stunting prevention intervention in Cabo Delgado, Mozambique, by describing the sociocultural landscape and elucidating characteristics related to young child food, illness, and health. This formative research utilized a rapid assessment procedures (RAP) approach with 3 iterative phases that explored local perceptions and behaviors around food and illness among the Macua, Mwani, and Maconde ethnic groups. Ethnographic methods, including in-depth interviews, direct observations, free lists, and pile sorts, were used to collect data from community leaders, caregivers, and children 6 to 23 months. Data were analyzed drawing from grounded theory and cultural domain analysis. Geographic differences drive sociocultural characteristics amid 3 ethnic groups that allow for segmentation of the population into 2 distinct audiences for behavior change communications. These 2 communities have similar classification systems for children's foods but different adult dietary patterns. Small-quantity lipid-based nutrient supplement did not fall into the existing food classification systems of either community, and participants preferred its promotion through community leader channels. Community members in both groups have little recognition of and perceived severity toward nutrition-related illnesses. Within Cabo Delgado, the cultural heterogeneity yields substantial differences related to food, illness, and health that are necessary to consider for developing an effective nutrition intervention. © The Author(s) 2015.

  11. Scale up of a Plasmodium falciparum elimination program and surveillance system in Kayin State, Myanmar [version 1; referees: 2 approved

    Directory of Open Access Journals (Sweden)

    Daniel M. Parker

    2017-10-01

    Full Text Available Background: Myanmar has one of the largest malaria burdens in Southeast Asia. Along the border with Thailand, Plasmodium falciparum parasites are increasingly showing reduced sensitivity to artemisinin combination therapies. Given that there are no current alternative treatment therapies, one proposed solution to the threat of untreatable P. falciparum malaria is to eliminate the parasite from the region. Several small-scale elimination projects have been piloted along the Myanmar-Thailand border. Following their success, this operational research aimed to scale up the elimination to a broad area of Eastern Kayin State, Myanmar. Methods: The project relied on geographic reconnaissance and a geographic information system, community engagement, generalized access to community-based early diagnosis and treatment, near real-time epidemiological surveillance, cross sectional malaria prevalence surveys and targeted mass drug administration in villages with high prevalence of P. falciparum malaria. Molecular markers of drug resistance were also monitored in individuals with symptomatic and asymptomatic infections. Discussion: This project illustrates the establishment of an elimination project and operational research in a remote, rural area encompassing several armed groups, multiple political organizations and a near-absent health care infrastructure. The establishment of the project relied on a strong rapport with the target community, on-the-ground knowledge (through geographic surveys and community engagement, rapid decision making and an approach that was flexible enough to quickly adapt to a complex landscape. The elimination project is ongoing, now over three years in operation, and assessment of the impact of this operational research will follow. This project has relevance not only for other malaria elimination projects but also for operational research aimed at eliminating other diseases.

  12. Scaling-up essential neuropsychiatric services in Ethiopia: a cost-effectiveness analysis.

    Science.gov (United States)

    Strand, Kirsten Bjerkreim; Chisholm, Dan; Fekadu, Abebaw; Johansson, Kjell Arne

    2016-05-01

    There is an immense need for scaling-up neuropsychiatric care in low-income countries. Contextualized cost-effectiveness analyses (CEAs) provide relevant information for local policies. The aim of this study is to perform a contextualized CEA of neuropsychiatric interventions in Ethiopia and to illustrate expected population health and budget impacts across neuropsychiatric disorders. A mathematical population model (PopMod) was used to estimate intervention costs and effectiveness. Existing variables from a previous WHO-CHOICE regional CEA model were substantially revised. Treatments for depression, schizophrenia, bipolar disorder and epilepsy were analysed. The best available local data on epidemiology, intervention efficacy, current and target coverage, resource prices and salaries were used. Data were obtained from expert opinion, local hospital information systems, the Ministry of Health and literature reviews. Treatment of epilepsy with a first generation antiepileptic drug is the most cost-effective treatment (US$ 321 per DALY adverted). Treatments for depression have mid-range values compared with other interventions (US$ 457-1026 per DALY adverted). Treatments for schizophrenia and bipolar disorders are least cost-effective (US$ 1168-3739 per DALY adverted). This analysis gives the Ethiopian government a comprehensive overview of the expected costs, effectiveness and cost-effectiveness of introducing basic neuropsychiatric interventions. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

  13. Progress in scale-up of second-generation HTS conductor

    International Nuclear Information System (INIS)

    Selvamanickam, V.; Chen, Y.; Xiong, X.; Xie, Y.; Zhang, X.; Qiao, Y.; Reeves, J.; Rar, A.; Schmidt, R.; Lenseth, K.

    2007-01-01

    Tremendous progress has been recently made in the achievement of high-performance, high-speed, long-length second-generation (2G) HTS conductors. Using ion beam assisted deposition (IBAD) MgO and metal organic chemical vapor deposition (MOCVD), SuperPower has scaled up tape lengths to 427 m with a minimum critical current value of 191 A/cm corresponding to a critical current x length performance of 81,550 m. Tape speeds up to 120 m/h have been reached with IBAD MgO, up to 80 m/h with buffer deposition and up to 45 m/h with MOCVD, all in single pass processing of 12 mm wide tape. Critical current value of 227 A/cm has been achieved in a 203 m long tape produced in an all-high-speed fabrication process. Critical current values have been raised to 721 A/cm, 592 A/cm and 486 A/cm in short, reel-to-reel processed tape, over 1 m length and over 11.1 m, respectively, using thicker MOCVD HTS films. Finally, over 10,000 m of copper-stabilized, 4 mm wide conductor has been produced and tested for delivery to the Albany Cable project. The average critical current of the 10,000 m lot was 81 A

  14. Progress in scale-up of second-generation HTS conductor

    Energy Technology Data Exchange (ETDEWEB)

    Selvamanickam, V. [SuperPower Inc., 450 Duane Avenue, Schenectady, NY 12304 (United States)], E-mail: vselva@igc.com; Chen, Y.; Xiong, X.; Xie, Y.; Zhang, X.; Qiao, Y.; Reeves, J.; Rar, A.; Schmidt, R.; Lenseth, K. [SuperPower Inc., 450 Duane Avenue, Schenectady, NY 12304 (United States)

    2007-10-01

    Tremendous progress has been recently made in the achievement of high-performance, high-speed, long-length second-generation (2G) HTS conductors. Using ion beam assisted deposition (IBAD) MgO and metal organic chemical vapor deposition (MOCVD), SuperPower has scaled up tape lengths to 427 m with a minimum critical current value of 191 A/cm corresponding to a critical current x length performance of 81,550 m. Tape speeds up to 120 m/h have been reached with IBAD MgO, up to 80 m/h with buffer deposition and up to 45 m/h with MOCVD, all in single pass processing of 12 mm wide tape. Critical current value of 227 A/cm has been achieved in a 203 m long tape produced in an all-high-speed fabrication process. Critical current values have been raised to 721 A/cm, 592 A/cm and 486 A/cm in short, reel-to-reel processed tape, over 1 m length and over 11.1 m, respectively, using thicker MOCVD HTS films. Finally, over 10,000 m of copper-stabilized, 4 mm wide conductor has been produced and tested for delivery to the Albany Cable project. The average critical current of the 10,000 m lot was 81 A.

  15. Scaling up the Fabrication of Mechanically-Robust Carbon Nanofiber Foams

    Directory of Open Access Journals (Sweden)

    William Curtin

    2016-02-01

    Full Text Available This work aimed to identify and address the main challenges associated with fabricating large samples of carbon foams composed of interwoven networks of carbon nanofibers. Solutions to two difficulties related with the process of fabricating carbon foams, maximum foam size and catalyst cost, were developed. First, a simple physical method was invented to scale-up the constrained formation of fibrous nanostructures process (CoFFiN to fabricate relatively large foams. Specifically, a gas deflector system capable of maintaining conditions supportive of carbon nanofiber foam growth throughout a relatively large mold was developed. ANSYS CFX models were used to simulate the gas flow paths with and without deflectors; the data generated proved to be a very useful tool for the deflector design. Second, a simple method for selectively leaching the Pd catalyst material trapped in the foam during growth was successfully tested. Multiple techniques, including scanning electron microscopy, surface area measurements, and mechanical testing, were employed to characterize the foams generated in this study. All results confirmed that the larger foam samples preserve the basic characteristics: their interwoven nanofiber microstructure forms a low-density tridimensional solid with viscoelastic behavior. Fiber growth mechanisms are also discussed. Larger samples of mechanically-robust carbon nanofiber foams will enable the use of these materials as strain sensors, shock absorbers, selective absorbents for environmental remediation and electrodes for energy storage devices, among other applications.

  16. Scaling-up permafrost thermal measurements in western Alaska using an ecotype approach

    Directory of Open Access Journals (Sweden)

    W. L. Cable

    2016-10-01

    Full Text Available Permafrost temperatures are increasing in Alaska due to climate change and in some cases permafrost is thawing and degrading. In areas where degradation has already occurred the effects can be dramatic, resulting in changing ecosystems, carbon release, and damage to infrastructure. However, in many areas we lack baseline data, such as subsurface temperatures, needed to assess future changes and potential risk areas. Besides climate, the physical properties of the vegetation cover and subsurface material have a major influence on the thermal state of permafrost. These properties are often directly related to the type of ecosystem overlaying permafrost. In this paper we demonstrate that classifying the landscape into general ecotypes is an effective way to scale up permafrost thermal data collected from field monitoring sites. Additionally, we find that within some ecotypes the absence of a moss layer is indicative of the absence of near-surface permafrost. As a proof of concept, we used the ground temperature data collected from the field sites to recode an ecotype land cover map into a map of mean annual ground temperature ranges at 1 m depth based on analysis and clustering of observed thermal regimes. The map should be useful for decision making with respect to land use and understanding how the landscape might change under future climate scenarios.

  17. Nb3Sn accelerator magnet technology scale up using cos-theta dipole coils

    Energy Technology Data Exchange (ETDEWEB)

    Nobrega, F.; Andreev, N.; Ambrosio, G.; Barzi, E.; Bossert, R.; Carcagno, R.; Chlachidze, G.; Feher, S.; Kashikhin, V.S.; Kashikhin, V.V.; Lamm, M.J.; /Fermilab

    2007-06-01

    Fermilab is working on the development of Nb{sub 3}Sn accelerator magnets using shell-type dipole coils and the wind-and-react method. As a part of the first phase of technology development, Fermilab built and tested six 1 m long dipole model magnets and several dipole mirror configurations. The last three dipoles and two mirrors reached their design fields of 10-11 T. The technology scale up phase has started by building 2 m and 4 m dipole coils and testing them in a mirror configuration in which one of the two coils is replaced by a half-cylinder made of low carbon steel. This approach allows for shorter fabrication times and extensive instrumentation preserving almost the same level of magnetic field and Lorentz forces in the coils as in a complete dipole model magnet. This paper presents details on the 2 m (HFDM07) and 4 m long (HFDM08) Nb{sub 3}Sn dipole mirror magnet design and fabrication technology, as well as the magnet test results which are compared with 1 m long models.

  18. Nb3Sn accelerator magnet technology scale up using cos-theta dipole coils

    International Nuclear Information System (INIS)

    Nobrega, F.; Andreev, N.; Ambrosio, G.; Barzi, E.; Bossert, R.; Carcagno, R.; Chlachidze, G.; Feher, S.; Kashikhin, V.S.; Kashikhin, V.V.; Lamm, M.J.; Fermilab

    2007-01-01

    Fermilab is working on the development of Nb 3 Sn accelerator magnets using shell-type dipole coils and the wind-and-react method. As a part of the first phase of technology development, Fermilab built and tested six 1 m long dipole model magnets and several dipole mirror configurations. The last three dipoles and two mirrors reached their design fields of 10-11 T. The technology scale up phase has started by building 2 m and 4 m dipole coils and testing them in a mirror configuration in which one of the two coils is replaced by a half-cylinder made of low carbon steel. This approach allows for shorter fabrication times and extensive instrumentation preserving almost the same level of magnetic field and Lorentz forces in the coils as in a complete dipole model magnet. This paper presents details on the 2 m (HFDM07) and 4 m long (HFDM08) Nb 3 Sn dipole mirror magnet design and fabrication technology, as well as the magnet test results which are compared with 1 m long models

  19. Vaccinium meridionale Swartz Supercritical CO2 Extraction: Effect of Process Conditions and Scaling Up

    Directory of Open Access Journals (Sweden)

    Alexis López-Padilla

    2016-06-01

    Full Text Available Vaccinium meridionale Swartz (Mortiño or Colombian blueberry is one of the Vaccinium species abundantly found across the Colombian mountains, which are characterized by high contents of polyphenolic compounds (anthocyanins and flavonoids. The supercritical fluid extraction (SFE of Vaccinium species has mainly focused on the study of V. myrtillus L. (blueberry. In this work, the SFE of Mortiño fruit from Colombia was studied in a small-scale extraction cell (273 cm3 and different extraction pressures (20 and 30 MPa and temperatures (313 and 343 K were investigated. Then, process scaling-up to a larger extraction cell (1350 cm3 was analyzed using well-known semi-empirical engineering approaches. The Broken and Intact Cell (BIC model was adjusted to represent the kinetic behavior of the low-scale extraction and to simulate the large-scale conditions. Extraction yields obtained were in the range 0.1%–3.2%. Most of the Mortiño solutes are readily accessible and, thus, 92% of the extractable material was recovered in around 30 min. The constant CO2 residence time criterion produced excellent results regarding the small-scale kinetic curve according to the BIC model, and this conclusion was experimentally validated in large-scale kinetic experiments.

  20. Stem Cell Spheroids and Ex Vivo Niche Modeling: Rationalization and Scaling-Up.

    Science.gov (United States)

    Chimenti, Isotta; Massai, Diana; Morbiducci, Umberto; Beltrami, Antonio Paolo; Pesce, Maurizio; Messina, Elisa

    2017-04-01

    Improved protocols/devices for in vitro culture of 3D cell spheroids may provide essential cues for proper growth and differentiation of stem/progenitor cells (S/PCs) in their niche, allowing preservation of specific features, such as multi-lineage potential and paracrine activity. Several platforms have been employed to replicate these conditions and to generate S/PC spheroids for therapeutic applications. However, they incompletely reproduce the niche environment, with partial loss of its highly regulated network, with additional hurdles in the field of cardiac biology, due to debated resident S/PCs therapeutic potential and clinical translation. In this contribution, the essential niche conditions (metabolic, geometric, mechanical) that allow S/PCs maintenance/commitment will be discussed. In particular, we will focus on both existing bioreactor-based platforms for the culture of S/PC as spheroids, and on possible criteria for the scaling-up of niche-like spheroids, which could be envisaged as promising tools for personalized cardiac regenerative medicine, as well as for high-throughput drug screening.

  1. Optimization and scale up of trickling bed bioreactors for degradation of volatile organic substances

    International Nuclear Information System (INIS)

    Schindler, I.

    1996-01-01

    For optimization and scale up of trickling bed bioreactors used in waste gas cleaning following investigations were made: the degradation of toluene was measured in reactors with various volumes and diameter to high ratios. The degradation of toluene was investigated in bioreactors with different carrier materials. It turned out, that the increase of the elimination capacity with the height of the reactor depends on the carrier material. At low gas velocities PU-foam allows higher elimination capacities than pallrings, VSP and DINPAC. On the other hand for PU-foam there is a permanent danger of clogging. The other materials allowed a stable operation for several months. Mass transfer of toluene was studied by absorption experiments in a 100 litre plant without microorganisms. The experiments lead to a henry coefficient of 0,23 (kg/m3)g/(kg/m3)l. Mass transfer coefficients were calculated between 3,6 and 5,2 depending an the space velocity of the gas and the trickling density of the water phase. The degradation of ethyl acetate, toluene and heptane was investigated considering the different water solubility of these substances. Further on degradation of toluene and heptane in several mixtures was investigated. (author)

  2. Transforming Global Health by Improving the Science of Scale-Up.

    Directory of Open Access Journals (Sweden)

    Margaret E Kruk

    2016-03-01

    Full Text Available In its report Global Health 2035, the Commission on Investing in Health proposed that health investments can reduce mortality in nearly all low- and middle-income countries to very low levels, thereby averting 10 million deaths per year from 2035 onward. Many of these gains could be achieved through scale-up of existing technologies and health services. A key instrument to close this gap is policy and implementation research (PIR that aims to produce generalizable evidence on what works to implement successful interventions at scale. Rigorously designed PIR promotes global learning and local accountability. Much greater national and global investments in PIR capacity will be required to enable the scaling of effective approaches and to prevent the recycling of failed ideas. Sample questions for the PIR research agenda include how to close the gap in the delivery of essential services to the poor, which population interventions for non-communicable diseases are most applicable in different contexts, and how to engage non-state actors in equitable provision of health services in the context of universal health coverage.

  3. Scaling-Up the Impact of Aflatoxin Research in Africa. The Role of Social Sciences

    Directory of Open Access Journals (Sweden)

    Francois Stepman

    2018-03-01

    Full Text Available At the interface between agriculture and nutrition, the aflatoxin contamination of food and feed touches on agriculture, health, and trade. For more than three decades now, the problem of aflatoxin has been researched in Africa. The interest of development cooperation for aflatoxin and the support to aflatoxin mitigation projects has its ups and downs. The academic world and the development world still seem to operate in different spheres and a collaboration is still challenging due to the complexity of the contamination sources at pre-harvest and post-harvest levels. There is a growing call by research funders and development actors for the impact of solutions at a scale. The solutions to mitigate aflatoxin contamination require new ways of working together. A more prominent role is to be played by social scientists. The role of social scientists in scaling-up the impact of aflatoxin research in Africa and the proposed mitigation solutions is to ensure that awareness, advantage, affordability, and access are systematically assessed. Aflatoxin-reduced staple foods and feed would be an agricultural result with a considerable health and food safety impact.

  4. Ensembl Genomes 2013: scaling up access to genome-wide data.

    Science.gov (United States)

    Kersey, Paul Julian; Allen, James E; Christensen, Mikkel; Davis, Paul; Falin, Lee J; Grabmueller, Christoph; Hughes, Daniel Seth Toney; Humphrey, Jay; Kerhornou, Arnaud; Khobova, Julia; Langridge, Nicholas; McDowall, Mark D; Maheswari, Uma; Maslen, Gareth; Nuhn, Michael; Ong, Chuang Kee; Paulini, Michael; Pedro, Helder; Toneva, Iliana; Tuli, Mary Ann; Walts, Brandon; Williams, Gareth; Wilson, Derek; Youens-Clark, Ken; Monaco, Marcela K; Stein, Joshua; Wei, Xuehong; Ware, Doreen; Bolser, Daniel M; Howe, Kevin Lee; Kulesha, Eugene; Lawson, Daniel; Staines, Daniel Michael

    2014-01-01

    Ensembl Genomes (http://www.ensemblgenomes.org) is an integrating resource for genome-scale data from non-vertebrate species. The project exploits and extends technologies for genome annotation, analysis and dissemination, developed in the context of the vertebrate-focused Ensembl project, and provides a complementary set of resources for non-vertebrate species through a consistent set of programmatic and interactive interfaces. These provide access to data including reference sequence, gene models, transcriptional data, polymorphisms and comparative analysis. This article provides an update to the previous publications about the resource, with a focus on recent developments. These include the addition of important new genomes (and related data sets) including crop plants, vectors of human disease and eukaryotic pathogens. In addition, the resource has scaled up its representation of bacterial genomes, and now includes the genomes of over 9000 bacteria. Specific extensions to the web and programmatic interfaces have been developed to support users in navigating these large data sets. Looking forward, analytic tools to allow targeted selection of data for visualization and download are likely to become increasingly important in future as the number of available genomes increases within all domains of life, and some of the challenges faced in representing bacterial data are likely to become commonplace for eukaryotes in future.

  5. Accelerated reforms in healthcare financing: the need to scale up private sector participation in Nigeria.

    Science.gov (United States)

    Ejughemre, Ufuoma John

    2014-01-01

    The health sector, a foremost service sector in Nigeria, faces a number of challenges; primarily, the persistent under-funding of the health sector by the Nigerian government as evidence reveals low allocations to the health sector and poor health system performance which are reflected in key health indices of the country.Notwithstanding, there is evidence that the private sector could be a key player in delivering health services and impacting health outcomes, including those related to healthcare financing. This underscores the need to optimize the role of private sector in complementing the government's commitment to financing healthcare delivery and strengthening the health system in Nigeria. There are also concerns about uneven quality and affordability of private-driven health systems, which necessitates reforms aimed at regulation. Accordingly, the argument is that the benefits of leveraging the private sector in complementing the national government in healthcare financing outweigh the challenges, particularly in light of lean public resources and finite donor supports. This article, therefore, highlights the potential for the Nigerian government to scale up healthcare financing by leveraging private resources, innovations and expertise, while working to achieve the universal health coverage.

  6. Polyethylene encapsulatin of nitrate salt wastes: Waste form stability, process scale-up, and economics

    International Nuclear Information System (INIS)

    Kalb, P.D.; Heiser, J.H. III; Colombo, P.

    1991-07-01

    A polyethylene encapsulation system for treatment of low-level radioactive, hazardous, and mixed wastes has been developed at Brookhaven National Laboratory. Polyethylene has several advantages compared with conventional solidification/stabilization materials such as hydraulic cements. Waste can be encapsulated with greater efficiency and with better waste form performance than is possible with hydraulic cement. The properties of polyethylene relevant to its long-term durability in storage and disposal environments are reviewed. Response to specific potential failure mechanisms including biodegradation, radiation, chemical attack, flammability, environmental stress cracking, and photodegradation are examined. These data are supported by results from extensive waste form performance testing including compressive yield strength, water immersion, thermal cycling, leachability of radioactive and hazardous species, irradiation, biodegradation, and flammability. The bench-scale process has been successfully tested for application with a number of specific ''problem'' waste streams. Quality assurance and performance testing of the resulting waste form confirmed scale-up feasibility. Use of this system at Rocky Flats Plant can result in over 70% fewer drums processed and shipped for disposal, compared with optimal cement formulations. Based on the current Rocky Flats production of nitrate salt per year, polyethylene encapsulation can yield an estimated annual savings between $1.5 million and $2.7 million, compared with conventional hydraulic cement systems. 72 refs., 23 figs., 16 tabs

  7. Context matters: Successes and challenges of intrapartum care scale-up in four districts of Afghanistan.

    Science.gov (United States)

    Tappis, Hannah; Koblinsky, Marge; Winch, Peter J; Turkmani, Sabera; Bartlett, Linda

    2016-01-01

    Reducing preventable maternal mortality and achieving Sustainable Development Goal targets for 2030 will require increased investment in improving access to quality health services in fragile and conflict-affected states. This study explores the conditions that affect availability and utilisation of intrapartum care services in four districts of Afghanistan where mortality studies were conducted in 2002 and 2011. Information on changes in each district was collected through interviews with community members; service providers; and district, provincial and national officials. This information was then triangulated with programme and policy documentation to identify factors that affect the coverage of safe delivery and emergency obstetric care services. Comparison of barriers to maternal health service coverage across the four districts highlights the complexities of national health policy planning and resource allocation in Afghanistan, and provides examples of the types of challenges that must be addressed to extend the reach of life-saving maternal health interventions to women in fragile and conflict-affected states. Findings suggest that improvements in service coverage must be measured at a sub-national level, and context-specific service delivery models may be needed to effectively scale up intrapartum care services in extremely remote or insecure settings.

  8. Fan-out Estimation in Spin-based Quantum Computer Scale-up.

    Science.gov (United States)

    Nguyen, Thien; Hill, Charles D; Hollenberg, Lloyd C L; James, Matthew R

    2017-10-17

    Solid-state spin-based qubits offer good prospects for scaling based on their long coherence times and nexus to large-scale electronic scale-up technologies. However, high-threshold quantum error correction requires a two-dimensional qubit array operating in parallel, posing significant challenges in fabrication and control. While architectures incorporating distributed quantum control meet this challenge head-on, most designs rely on individual control and readout of all qubits with high gate densities. We analysed the fan-out routing overhead of a dedicated control line architecture, basing the analysis on a generalised solid-state spin qubit platform parameterised to encompass Coulomb confined (e.g. donor based spin qubits) or electrostatically confined (e.g. quantum dot based spin qubits) implementations. The spatial scalability under this model is estimated using standard electronic routing methods and present-day fabrication constraints. Based on reasonable assumptions for qubit control and readout we estimate 10 2 -10 5 physical qubits, depending on the quantum interconnect implementation, can be integrated and fanned-out independently. Assuming relatively long control-free interconnects the scalability can be extended. Ultimately, the universal quantum computation may necessitate a much higher number of integrated qubits, indicating that higher dimensional electronics fabrication and/or multiplexed distributed control and readout schemes may be the preferredstrategy for large-scale implementation.

  9. Colour bio-factories: Towards scale-up production of anthocyanins in plant cell cultures.

    Science.gov (United States)

    Appelhagen, Ingo; Wulff-Vester, Anders Keim; Wendell, Micael; Hvoslef-Eide, Anne-Kathrine; Russell, Julia; Oertel, Anne; Martens, Stefan; Mock, Hans-Peter; Martin, Cathie; Matros, Andrea

    2018-06-08

    Anthocyanins are widely distributed, glycosylated, water-soluble plant pigments, which give many fruits and flowers their red, purple or blue colouration. Their beneficial effects in a dietary context have encouraged increasing use of anthocyanins as natural colourants in the food and cosmetic industries. However, the limited availability and diversity of anthocyanins commercially have initiated searches for alternative sources of these natural colourants. In plants, high-level production of secondary metabolites, such as anthocyanins, can be achieved by engineering of regulatory genes as well as genes encoding biosynthetic enzymes. We have used tobacco lines which constitutively produce high levels of cyanidin 3-O-rutinoside, delphinidin 3-O-rutinoside or a novel anthocyanin, acylated cyanidin 3-O-(coumaroyl) rutinoside to generate cell suspension cultures. The cell lines are stable in their production rates and superior to conventional plant cell cultures. Scale-up of anthocyanin production in small scale fermenters has been demonstrated. The cell cultures have also proven to be a suitable system for production of 13 C-labelled anthocyanins. Our method for anthocyanin production is transferable to other plant species, such as Arabidopsis thaliana, demonstrating the potential of this approach for making a wide range of highly-decorated anthocyanins. The tobacco cell cultures represent a customisable and sustainable alternative to conventional anthocyanin production platforms and have considerable potential for use in industrial and medical applications of anthocyanins. Copyright © 2018 The Authors. Published by Elsevier Inc. All rights reserved.

  10. Scale up of NiTi shape memory alloy production by EBM

    Science.gov (United States)

    Otubo, J.; Rigo, O. D.; Moura Neto, C.; Kaufman, M. J.; Mei, P. R.

    2003-10-01

    The usual process to produce NiTi shape memory alloy is by vacuum induction melting (VIM) using a graphite crucible, which causes contamination of the melt with carbon. Contamination with oxygen originates from the residual oxygen inside the melting chamber. An alternative process to produce NiTi alloys is by electron beam melting (EBM) using a water-cooled copper crucible that eliminates carbon contamination, and the oxygen contamination would be minimal due to operation in a vacuum of better than 10^{-2} Pa. In a previous work, it was demonstrated that the technique is feasible for button shaped samples weighing around 30g. The present work presents the results on the scale up program that enables the production of larger samples/ingots. The results are very promising in terms of chemical composition homogeneity as well as in terms of carbon contamination, the latter being four to ten times lower than the commercially-produced VIM products, and in terms of final oxygen content which is shown to depend primarily on the starting raw materials.

  11. Simulation for Supporting Scale-Up of a Fluidized Bed Reactor for Advanced Water Oxidation

    Directory of Open Access Journals (Sweden)

    Farhana Tisa

    2014-01-01

    Full Text Available Simulation of fluidized bed reactor (FBR was accomplished for treating wastewater using Fenton reaction, which is an advanced oxidation process (AOP. The simulation was performed to determine characteristics of FBR performance, concentration profile of the contaminants, and various prominent hydrodynamic properties (e.g., Reynolds number, velocity, and pressure in the reactor. Simulation was implemented for 2.8 L working volume using hydrodynamic correlations, continuous equation, and simplified kinetic information for phenols degradation as a model. The simulation shows that, by using Fe3+ and Fe2+ mixtures as catalyst, TOC degradation up to 45% was achieved for contaminant range of 40–90 mg/L within 60 min. The concentration profiles and hydrodynamic characteristics were also generated. A subsequent scale-up study was also conducted using similitude method. The analysis shows that up to 10 L working volume, the models developed are applicable. The study proves that, using appropriate modeling and simulation, data can be predicted for designing and operating FBR for wastewater treatment.

  12. Scale up of ethanol production using pulp mill wastewater sludge by cellulase and saccharomyces cerevisiae

    International Nuclear Information System (INIS)

    Kunchada Sangasintu; Petchporn Chawakitchareon

    2010-01-01

    This study aimed to evaluate the potential use of pulp mill wastewater sludge as substrate in ethanol production. The simultaneous saccharification and fermentation process was conducted by using Saccharomyces cerevisiae TISTR 5339 under optimum proportion of cellulase and pulp mill wastewater sludge. The ethanol production from cellulosic materials in simultaneous saccharification and fermentation needs cooperation between cellulase and yeast. The cellulase hydrolyzes cellulose to sugar while yeast utilizes sugar to produce ethanol. The pulp mill wastewater sludge has an average content of 73.3 % hemi cellulose, 67.1 % alpha cellulose, 4.7 % beta cellulose and 1.4 % gamma cellulose. The experimental results indicated that the volume of the ethanol tend to increase with time, providing the maximum ethanol yield of 0.69 g/g on the 7"t"h day, the last day of the experiment. The ethanol production was scaled up in 5 L fermentor under optimum proportion and increased the fermentation period. It was found that the ethanol production gave the maximum ethanol yield of 1.14 g/g on the 9"t"h day of the totally 13 days experimentation. These results showed that the cellulose from pulp mill wastewater sludge was as effective substrate for ethanol production and alternative energy for the future. (author)

  13. Engineering integrated digital circuits with allosteric ribozymes for scaling up molecular computation and diagnostics.

    Science.gov (United States)

    Penchovsky, Robert

    2012-10-19

    Here we describe molecular implementations of integrated digital circuits, including a three-input AND logic gate, a two-input multiplexer, and 1-to-2 decoder using allosteric ribozymes. Furthermore, we demonstrate a multiplexer-decoder circuit. The ribozymes are designed to seek-and-destroy specific RNAs with a certain length by a fully computerized procedure. The algorithm can accurately predict one base substitution that alters the ribozyme's logic function. The ability to sense the length of RNA molecules enables single ribozymes to be used as platforms for multiple interactions. These ribozymes can work as integrated circuits with the functionality of up to five logic gates. The ribozyme design is universal since the allosteric and substrate domains can be altered to sense different RNAs. In addition, the ribozymes can specifically cleave RNA molecules with triplet-repeat expansions observed in genetic disorders such as oculopharyngeal muscular dystrophy. Therefore, the designer ribozymes can be employed for scaling up computing and diagnostic networks in the fields of molecular computing and diagnostics and RNA synthetic biology.

  14. Time-resolved transglottal pressure measurements in a scaled up vocal fold model

    Science.gov (United States)

    Ringenberg, Hunter; Krane, Michael; Rogers, Dylan; Misfeldt, Mitchel; Wei, Timothy

    2016-11-01

    Experimental measurements of flow through a scaled up dynamic human vocal fold model are presented. The simplified 10x scale vocal fold model from Krane, et al. (2007) was used to examine fundamental features of vocal fold oscillatory motion. Of particular interest was the temporal variation of transglottal pressure multiplied by the volume flow rate through the glottis throughout an oscillation cycle. Experiments were dynamically scaled to examine a range of frequencies, 100 - 200 Hz, corresponding to the male and female voice. By using water as the working fluid, very high resolution, both spatial and temporal resolution, was achieved. Time resolved movies of flow through symmetrically oscillating vocal folds will be presented. Both individual realizations as well as phase-averaged data will be shown. Key features, such as randomness and development time of the Coanda effect, vortex shedding, and volume flow rate data have been presented in previous APS-DFD meetings. This talk will focus more on the relation between the flow and aeroacoustics associated with vocal fold oscillations. Supported by the NIH.

  15. Scale-up of industrial biodiesel production to 40 m3using a liquid lipase formulation

    DEFF Research Database (Denmark)

    Price, Jason; Nordblad, Mathias; Martel, Hannah H.

    2016-01-01

    In this work, we demonstrate the scale-up from an 80 L fed-batch scale to 40 m3 along with the design of a 4 m3continuous process for enzymatic biodiesel production catalysed by NS-40116 (a liquid formulation of a modified Thermomyces lanuginosus lipase). Based on the analysis of actual pilot plant...... the fed-batch and CSTR cases. Given similar operating conditions, the CSTR operation on average, has a reaction time which is 1.3 times greater than the fed-batch operation. We also showed how the process metrics can be used to quickly estimate the selling price of the enzyme. Assuming a biodiesel selling...... price of 0.6 USD/kg and a one-time use of the enzyme (0.1% (w/woil) enzyme dosage); the enzyme can then be sold for 30 USD/kg which ensures that that the enzyme cost is not more than 5% of the biodiesel revenue. This article is protected by copyright. All rights reserved...

  16. Scaling up high throughput field phenotyping of corn and soy research plots using ground rovers

    Science.gov (United States)

    Peshlov, Boyan; Nakarmi, Akash; Baldwin, Steven; Essner, Scott; French, Jasenka

    2017-05-01

    Crop improvement programs require large and meticulous selection processes that effectively and accurately collect and analyze data to generate quality plant products as efficiently as possible, develop superior cropping and/or crop improvement methods. Typically, data collection for such testing is performed by field teams using hand-held instruments or manually-controlled devices. Although steps are taken to reduce error, the data collected in such manner can be unreliable due to human error and fatigue, which reduces the ability to make accurate selection decisions. Monsanto engineering teams have developed a high-clearance mobile platform (Rover) as a step towards high throughput and high accuracy phenotyping at an industrial scale. The rovers are equipped with GPS navigation, multiple cameras and sensors and on-board computers to acquire data and compute plant vigor metrics per plot. The supporting IT systems enable automatic path planning, plot identification, image and point cloud data QA/QC and near real-time analysis where results are streamed to enterprise databases for additional statistical analysis and product advancement decisions. Since the rover program was launched in North America in 2013, the number of research plots we can analyze in a growing season has expanded dramatically. This work describes some of the successes and challenges in scaling up of the rover platform for automated phenotyping to enable science at scale.

  17. Vaccinium meridionale Swartz Supercritical CO2 Extraction: Effect of Process Conditions and Scaling Up

    Science.gov (United States)

    López-Padilla, Alexis; Ruiz-Rodriguez, Alejandro; Restrepo Flórez, Claudia Estela; Rivero Barrios, Diana Marsela; Reglero, Guillermo; Fornari, Tiziana

    2016-01-01

    Vaccinium meridionale Swartz (Mortiño or Colombian blueberry) is one of the Vaccinium species abundantly found across the Colombian mountains, which are characterized by high contents of polyphenolic compounds (anthocyanins and flavonoids). The supercritical fluid extraction (SFE) of Vaccinium species has mainly focused on the study of V. myrtillus L. (blueberry). In this work, the SFE of Mortiño fruit from Colombia was studied in a small-scale extraction cell (273 cm3) and different extraction pressures (20 and 30 MPa) and temperatures (313 and 343 K) were investigated. Then, process scaling-up to a larger extraction cell (1350 cm3) was analyzed using well-known semi-empirical engineering approaches. The Broken and Intact Cell (BIC) model was adjusted to represent the kinetic behavior of the low-scale extraction and to simulate the large-scale conditions. Extraction yields obtained were in the range 0.1%–3.2%. Most of the Mortiño solutes are readily accessible and, thus, 92% of the extractable material was recovered in around 30 min. The constant CO2 residence time criterion produced excellent results regarding the small-scale kinetic curve according to the BIC model, and this conclusion was experimentally validated in large-scale kinetic experiments. PMID:28773640

  18. Scaling up graph-based semisupervised learning via prototype vector machines.

    Science.gov (United States)

    Zhang, Kai; Lan, Liang; Kwok, James T; Vucetic, Slobodan; Parvin, Bahram

    2015-03-01

    When the amount of labeled data are limited, semisupervised learning can improve the learner's performance by also using the often easily available unlabeled data. In particular, a popular approach requires the learned function to be smooth on the underlying data manifold. By approximating this manifold as a weighted graph, such graph-based techniques can often achieve state-of-the-art performance. However, their high time and space complexities make them less attractive on large data sets. In this paper, we propose to scale up graph-based semisupervised learning using a set of sparse prototypes derived from the data. These prototypes serve as a small set of data representatives, which can be used to approximate the graph-based regularizer and to control model complexity. Consequently, both training and testing become much more efficient. Moreover, when the Gaussian kernel is used to define the graph affinity, a simple and principled method to select the prototypes can be obtained. Experiments on a number of real-world data sets demonstrate encouraging performance and scaling properties of the proposed approach. It also compares favorably with models learned via l1 -regularization at the same level of model sparsity. These results demonstrate the efficacy of the proposed approach in producing highly parsimonious and accurate models for semisupervised learning.

  19. Batch fermentation of black tea by kombucha: A contribution to scale-up

    Directory of Open Access Journals (Sweden)

    Malbaša Radomir V.

    2005-01-01

    Full Text Available Local domestic Kombucha was used in fermentation of 1.5 g L-1 of black tea (Indian tea, " Vitamin ", Horgoš, Serbia and Montenegro, sweetened with approximately 70 g L'1 of sucrose. Inoculation was performed either with 10% or 15% (v/v of fermentation broth from previous process. The fermentation was conducted in geometrically similar vessels with 0.4 L, 0.8 L, 4 L and 8 L of substrate, at 22±1 °C for 28 days. The samples were analyzed after 3, 4 5, 6, 7, 10, 14 and 28 days, so that their pH values, content of total acids sucrose, glucose and fructose contents, as well as contents of ethanol and vitamin C were determined. Based on the experiment design, the response surface for the product pH, as a function of time, beverage volume and inoculum concentration, was defined in the form of a second-order polynomial. From the obtained response surface, a formula for scaling-up of the process was derived.

  20. Optimization and Scale-Up of Coffee Mucilage Fermentation for Ethanol Production

    Directory of Open Access Journals (Sweden)

    David Orrego

    2018-03-01

    Full Text Available Coffee, one of the most popular food commodities and beverage ingredients worldwide, is considered as a potential source for food industry and second-generation biofuel due to its various by-products, including mucilage, husk, skin (pericarp, parchment, silver-skin, and pulp, which can be produced during the manufacturing process. A number of research studies have mainly investigated the valuable properties of brewed coffee (namely, beverage, functionalities, and its beneficial effects on cognitive and physical performances; however, other residual by-products of coffee, such as its mucilage, have rarely been studied. In this manuscript, the production of bioethanol from mucilage was performed both in shake flasks and 5 L bio-reactors. The use of coffee mucilage provided adequate fermentable sugars, primarily glucose with additional nutrient components, and it was directly fermented into ethanol using a Saccharomyces cerevisiae strain. The initial tests at the lab scale were evaluated using a two-level factorial experimental design, and the resulting optimal conditions were applied to further tests at the 5 L bio-reactor for scale up. The highest yields of flasks and 5 L bio-reactors were 0.46 g ethanol/g sugars, and 0.47 g ethanol/g sugars after 12 h, respectively, which were equal to 90% and 94% of the theoretically achievable conversion yield of ethanol.

  1. Voluntary Medical Male Circumcision: Logistics, Commodities, and Waste Management Requirements for Scale-Up of Services

    Science.gov (United States)

    Edgil, Dianna; Stankard, Petra; Forsythe, Steven; Rech, Dino; Chrouser, Kristin; Adamu, Tigistu; Sakallah, Sameer; Thomas, Anne Goldzier; Albertini, Jennifer; Stanton, David; Dickson, Kim Eva; Njeuhmeli, Emmanuel

    2011-01-01

    Background The global HIV prevention community is implementing voluntary medical male circumcision (VMMC) programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President’s Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. Methods and Findings This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. Conclusions Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in “Voluntary Medical

  2. Voluntary medical male circumcision: logistics, commodities, and waste management requirements for scale-up of services.

    Directory of Open Access Journals (Sweden)

    Dianna Edgil

    2011-11-01

    Full Text Available BACKGROUND: The global HIV prevention community is implementing voluntary medical male circumcision (VMMC programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President's Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. METHODS AND FINDINGS: This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. CONCLUSIONS: Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in

  3. Voluntary medical male circumcision: logistics, commodities, and waste management requirements for scale-up of services.

    Science.gov (United States)

    Edgil, Dianna; Stankard, Petra; Forsythe, Steven; Rech, Dino; Chrouser, Kristin; Adamu, Tigistu; Sakallah, Sameer; Thomas, Anne Goldzier; Albertini, Jennifer; Stanton, David; Dickson, Kim Eva; Njeuhmeli, Emmanuel

    2011-11-01

    The global HIV prevention community is implementing voluntary medical male circumcision (VMMC) programs across eastern and southern Africa, with a goal of reaching 80% coverage in adult males by 2015. Successful implementation will depend on the accessibility of commodities essential for VMMC programming and the appropriate allocation of resources to support the VMMC supply chain. For this, the United States President's Emergency Plan for AIDS Relief, in collaboration with the World Health Organization and the Joint United Nations Programme on HIV/AIDS, has developed a standard list of commodities for VMMC programs. This list of commodities was used to inform program planning for a 1-y program to circumcise 152,000 adult men in Swaziland. During this process, additional key commodities were identified, expanding the standard list to include commodities for waste management, HIV counseling and testing, and the treatment of sexually transmitted infections. The approximate costs for the procurement of commodities, management of a supply chain, and waste disposal, were determined for the VMMC program in Swaziland using current market prices of goods and services. Previous costing studies of VMMC programs did not capture supply chain costs, nor the full range of commodities needed for VMMC program implementation or waste management. Our calculations indicate that depending upon the volume of services provided, supply chain and waste management, including commodities and associated labor, contribute between US$58.92 and US$73.57 to the cost of performing one adult male circumcision in Swaziland. Experience with the VMMC program in Swaziland indicates that supply chain and waste management add approximately US$60 per circumcision, nearly doubling the total per procedure cost estimated previously; these additional costs are used to inform the estimate of per procedure costs modeled by Njeuhmeli et al. in "Voluntary Medical Male Circumcision: Modeling the Impact and Cost of

  4. Reconciling the science and policy divide: The reality of scaling up antiretroviral therapy in South Africa

    Directory of Open Access Journals (Sweden)

    Alan Whiteside

    2015-07-01

    Full Text Available With the world’s largest national treatment programme and over 340 000 incident casesannually, the response to HIV in South Africa is hotly contested and there is sometimes adissonance between activism, science and policy. Too often, policy, whilst well intentioned, isinformed only by epidemiological data. The state of the healthcare system and socioculturalfactors drive and shape the epidemic and its response. By analysis of the financial,infrastructural, human resources for health, and governance landscape in South Africa,we assess the feasibility and associated costs of implementing a universal test and treatprogramme. We situate a universal test and treat strategy within the governance, fiscal,human resources for health, and infrastructural landscape in South Africa. We argue that theresponse to the epidemic must be forward thinking, progressive and make the most of thebenefits from treatment as prevention. However, the logistics of implementing a universaltest and treat strategy mean that this option is problematic in the short term. We recommenda health systems strengthening HIV treatment and prevention approach that includes scalingup treatment (for treatment and prevention along with a range of other prevention strategies.

  5. Scaling-up Community-Based Program for Management of Child Malnutrition in Rural Thailand

    International Nuclear Information System (INIS)

    Winichagoon, Pattanee

    2014-01-01

    Full text: Despite efforts to address child malnutrition at scale since 1970s, management of child illnesses focused on treatment of common infections. In the fifth National Economic and Social Development Plan (NESDP) (1982-1987), effective scaled-up child nutrition policy and program was implemented, through Primary Health Care (PHC) and Poverty Alleviation Plan (PAP). The PAP provided the mechanism to streamline government resources to poverty stricken areas. Almost 300 districts were identified and sectoral programs implemented in the same priority areas. Provincial planning is the key to allocate the government budget, while the district level implemented and supervised actions at the community level. PHC was implemented with the principle of self-help care and nutrition was one of the PHC elements. Community participation was strengthened through manpower mobilization and capacity building, village financing and organization. As a result, there is an alignment of national resource allocations and micro-level actions. Scaling-up of community-based nutrition program was implemented by adopting the PHC principle, using community participation strategy, namely, mobilization and capacity building of village health volunteers, financing and organization. Growth monitoring, promotion of infant and young child feeding and joint financing via a ‘nutrition fund’ was implemented in rural areas, particularly in the poorest areas of the northeast and north. Child malnutrition was strategically managed at the community level, whereby differential actions were taken according to the severity of malnutrition. Management of severe and moderate malnutrition was by monitoring growth monthly, with support of basic health services to manage infections and other curative needs. Food assistance for complementary feeding using appropriate technology for village level processing was an integral part of child malnutrition management. Children with mild malnutrition or normal were

  6. Radio-isotope production scale-up at the University of Wisconsin

    Energy Technology Data Exchange (ETDEWEB)

    Nickles, Robert Jerome [Univ of Wisconsin

    2014-06-19

    Our intent has been to scale up our production capacity for a subset of the NSAC-I list of radioisotopes in jeopardy, so as to make a significant impact on the projected national needs for Cu-64, Zr-89, Y-86, Ga-66, Br-76, I-124 and other radioisotopes that offer promise as PET synthons. The work-flow and milestones in this project have been compressed into a single year (Aug 1, 2012- July 31, 2013). The grant budget was virtually dominated by the purchase of a pair of dual-mini-cells that have made the scale-up possible, now permitting the Curie-level processing of Cu-64 and Zr-89 with greatly reduced radiation exposure. Mile stones: 1. We doubled our production of Cu-64 and Zr-89 during the grant period, both for local use and out-bound distribution to ≈ 30 labs nationwide. This involved the dove-tailing of beam schedules of both our PETtrace and legacy RDS cyclotron. 2. Implemented improved chemical separation of Zr-89, Ga-66, Y-86 and Sc-44, with remote, semi-automated dissolution, trap-and-release separation under LabView control in the two dual-mini-cells provided by this DOE grant. A key advance was to fit the chemical stream with miniature radiation detectors to confirm the transfer operations. 3. Implemented improved shipping of radioisotopes (Cu-64, Zr-89, Tc-95m, and Ho-163) with approved DOT 7A boxes, with a much-improved FedEx shipping success compared to our previous steel drums. 4. Implemented broad range quantitative trace metal analysis, employing a new microwave plasma atomic emission spectrometer (Agilent 4200) capable of ppb sensitivity across the periodic table. This new instrument will prove essential in bringing our radiometals into FDA compliance needing CoA’s for translational research in clinical trials. 5. Expanded our capabilities in target fabrication, with the purchase of a programmable 1600 oC inert gas tube furnace for the smelting of binary alloy target materials. A similar effort makes use of our RF induction furnace, allowing

  7. Scaling-up watershed discharge and sediment concentrations to regional scale: The Blue Nile Basin

    Science.gov (United States)

    Steenhuis, T. S.; Tilahun, S. A.; MacAlister, C.; Ayana, E. K.; Tebebu, T. Y.; Bayabil, H. K.; Zegeye, A. D.; Worqlul, A. W.

    2012-12-01

    Since Hewlet and Hibbert's publication there is recognition that saturated excess overland land flow is one of the main runoff mechanisms in vegetated watersheds. Predicting discharge in these watersheds can be accomplished by use of simplified models where the landscape features are grouped in potentially runoff contributing zones and permeable hillsides where the water infiltrates (and become the source of interflow and base flow). In this way each watershed can be described with nine parameters: fractional area and available water content for each of the three zones and three parameters describing subsurface flow. The information parameter values can be derived directly from the outflow hydrograph. We show that this model performs well for discharge and sediment concentration (with three additional parameters) on a 1 to 10 day time scale in the Blue Nile Basin for watersheds ranging in in size from 100 ha to 170,000 km2. Thus scaling up from watershed to regional scale can be accomplished with nine parameters for the hydrology and three additional parameters for sediment concentrations. Our hypothesis, that the model works so well, is that after the watershed wets up it drains to a characteristic moisture content distribution that is invariant in time. Wetting up is similar each time and is as a function of effective rainfall. This gives rise to a unique relationship between total storm runoff and total precipitation and surprisingly can be described by a modified form of the well-known SCS runoff equation. This approach has a direct parallel with Darcy's law in that although the average flow over several pores is described well, flow in individual pores cannot predicted. In our case the discharge can be simulated by averaging over the different runoff source area and permeable hillside in the watersheds, but processes within the zones cannot be described. This is not to say that information within the various zones cannot be simulated, but will require detailed

  8. Gel compression considerations for chromatography scale-up for protein C purification.

    Science.gov (United States)

    He, W; Bruley, D F; Drohan, W N

    1998-01-01

    This work is to establish theoretical and experimental relationships for the scale-up of Immobilized Metal Affinity Chromatography (IMAC) and Immuno Affinity Chromatography for the low cost production of large quantities of Protein C. The external customer requirements for this project have been established for Protein C deficient people with the goal of providing prophylactic patient treatment. Deep vein thrombosis is the major symptom for protein C deficiency creating the potential problem of embolism transport to important organs, such as, lung and brain. Gel matrices for protein C separation are being analyzed to determine the relationship between the material properties of the gel and the column collapse characteristics. The fluid flow rate and pressure drop is being examined to see how they influence column stability. Gel packing analysis includes two considerations; one is bulk compression due to flow rate, and the second is gel particle deformation due to fluid flow and pressure drop. Based on the assumption of creeping flow, Darcy's law is being applied to characterize the flow through the gel particles. Biot's mathematical description of three-dimensional consolidation in porous media is being used to develop a set of system equations. Finite difference methods are being utilized to obtain the equation solutions. In addition, special programs such as finite element approaches, ABAQUS, will be studied to determine their application to this particular problem. Experimental studies are being performed to determine flow rate and pressure drop correlation for the chromatographic columns with appropriate gels. Void fraction is being measured using pulse testing to allow Reynolds number calculations. Experimental yield stress is being measured to compare with the theoretical calculations. Total Quality Management (TQM) tools have been utilized to optimize this work. For instance, the "Scatter Diagram" has been used to evaluate and select the appropriate gels and

  9. REACH: an effective catalyst for scaling up priority nutrition interventions at the country level.

    Science.gov (United States)

    Pearson, Brenda L; Ljungqvist, Björn

    2011-06-01

    Renewed Efforts Against Child Hunger (REACH) is the joint United Nations initiative to address Millennium Development Goal (MDG) 10, Target 3, i.e., to halve the proportion of underweight children under 5 years old by 2015. The United Nations Food and Agriculture Organization (FAO), the World Health Organization (WHO), the United Nations Children's Fund (UNICEF), the World Food Programme (WFP), and the International Fund for Agricultural Development (IFAD) developed and tested a facilitation mechanism to act as a catalyst for scaling up multisectoral nutrition activities. The UN-REACH partners developed pilot projects in Mauritania and Lao PDR from 2008 to 2010 and deployed facilitators to improve nutrition governance and coordination. Review missions were conducted in February 2011 to assess the REACH approach and what it achieved. The UN review mission members reviewed documents, assessed policy and management indicators, conducted qualitative interviews, and discussed findings with key stakeholders, including the most senior UN nutrition directors from all agencies. Among other UN-REACH achievements, the Prime Minister of Mauritania agreed to preside over a new National Nutrition Development Council responsible for high-level decision-making and setting national policy objectives. REACH facilitated the completion of Lao's first national Nutrition Strategy and Plan of Action and formation of the multistakeholder Nutrition Task Force. During the REACH engagement, coordination, joint advocacy, situation analysis, policy development, and joint UN programming for nutrition were strengthened in Lao PDR and Mauritania. Improvements in the nutrition governance and management mechanisms in Mauritania and Lao PDR were observed during the period of REACH support through increased awareness of nutrition as a key development objective, establishment of governmental multisectoral coordinating mechanisms, improved government capacity, and new joint UN-government nutrition