Latest Articles
- ARVs: The Next Generation. Going Boldly Together to New Frontiers of HIV Treatment
New antiretrovirals (ARVs), particularly the potentially “game-changing” ARV dolutegravir, offer major potential to meet the compelling need for simpler and better HIV treatment for tens of millions of people in the coming decade. Advantages include substantially lower manufacturing cost, fewer side effects, and less risk of resistance. But key obstacles must be addressed in order to develop and introduce new ARVs in specific combinations optimized for the needs of low- and middle-income countries. Strong leadership will be essential from the global health community to nurture more focused collaboration between the private and public sectors.
- Delivering High-Quality Family Planning Services in Crisis-Affected Settings II: Results
A family planning program in 5 crisis-affected settings reached more than 52,000 new contraceptive users in just 2.5 years. Long-acting reversible contraceptives (LARCs) made up 61% of the method mix, with implants predominating in most countries. IUD use also increased over time as the program intensified its efforts to improve provider skills and user awareness. These findings demonstrate the strong popularity of LARCs and the feasibility of providing them in fragile settings even though they require more training and infrastructure support than short-acting methods.
- Stunning Popularity of LARCs With Good Access and Quality: A Major Opportunity to Meet Family Planning Needs
Given true choice, a very high proportion of women, perhaps most, would select one of the long-acting reversible contraceptives (LARCs)—implants or IUDs—for contraception. If implemented on a wide scale, it would not only drastically alter the current method mix but also serve client needs much better and prevent unintended pregnancy more successfully.
- Trends in the Contraceptive Method Mix in Low- and Middle-Income Countries: Analysis Using a New “Average Deviation” Measure
Applying a standard measure of the method mix evenness suggests 4 patterns among 15 countries moving toward a more balanced mix: (1) rise of one previously underrepresented or new method, (2) replacement of traditional with modern methods, (3) continued but declining domination by a single method, and (4) general movement toward a balanced mix. Improving availability of underutilized or new methods can improve the method mix, although better implementation of more popular methods might increase contraceptive use more expeditiously.
- Predictors of Workforce Retention Among Malawian Nurse Graduates of a Scholarship Program: A Mixed-Methods Study
Several non-remuneration strategies may help improve retention of public-sector nurses: availability of supplies, adequate housing, advancement opportunities, and a positive work environment. A scholarship program with close follow-up of graduates may also help improve retention.
- Delivering High-Quality Family Planning Services in Crisis-Affected Settings I: Program Implementation
Extending access to a wide variety of contraceptive methods, including long-acting reversible methods, is feasible in crisis-affected countries by focusing on best practices such as competency-based training, supply chain support, systematic supervision, and community mobilization. Prudent use of data helps drive program improvements.
- Getting closer to people: family planning provision by drug shops in Uganda
Private drug shops can effectively provide contraceptive methods, especially injectables, complementing government services. Most drug shop clients in 4 peri-urban areas of Uganda were continuing users of DMPA; had switched from other providers, mainly government clinics, because the drug shops had fewer stock-outs and were more convenient (closer location, shorter waiting time, more flexible hours); and were satisfied with the quality of services. The drug shops provided a substantial part of the total market share for family planning services in their areas.
- A better future for injectable contraception?
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Provision of injectables though drug shops appears practicable and can contribute a marked share of family planning services.
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A potential longer-acting injectable providing at least 6 months of protection appeals to programmatic professionals.
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Subcutaneous administration of DMPA offers major injectable improvements over the current intramuscular approach.
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Ironically, while injectable use will inevitably grow, better choice and wider availability of other methods—especially of long-acting and permanent methods—will reduce injectables′ overall share.
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- Policy and programmatic considerations for introducing a longer-acting injectable contraceptive: perspectives of stakeholders from Kenya and Rwanda
Unique attributes of a longer-acting injectable would likely appeal to both existing injectable users and new clients, both for spacing and for limiting births, and allow health systems to operate more efficiently. Considerations for enhancing successful introduction of this potential new method include keeping the cost low, expanding access through community-based distribution, and training providers to improve practices about injectables in general.
- Caution on corticosteroids for preterm delivery: learning from missteps
An important new study in lower-level health facilities in low- and middle-income countries found an increased risk of neonatal deaths with corticosteroid use in pregnant women with imminent preterm birth, in contrast with the positive results previously found in high-income countries. The surprising finding demonstrates that context matters. The increase appears largely due to steroids administered in cases that were not actually preterm, probably due to inaccurate pregnancy dating and challenges with diagnostic capacity. Promoting public health often requires decisions based on less-than-perfect evidence, but we must be vigilant about gathering and assessing new evidence and ready to change strategies.