Search

Summary box Despite pledges from world leaders for equitable access and fair allocation of COVID-19 vaccines globally, vaccine nationalism and hoarding, in particular by wealthy countries, have left Africa largely side-lined in the race to start vaccinating the most vulnerable and effectively curb the pandemic (figure 1). The African Union and Africa centre for disease control and prevention (CDC) recently announced that they were able to secure 670 million doses,1 yet delivery times are unclear. South Africa, by far the hardest hit country on the continent, just received a first shipment of a last-minute procured 1.5 million doses. Unfortunetely they had to give the Astra Zeneca doses because of the high proportion of new variants on which this vaccine is performing poorly.2 Figure 1 Global distribution of COVID-19 vaccine doses administered (source: Coronavirus (COVID-19) Vaccinations—Statistics and Research—Our World in Data). Nevertheless, the public discourse from health experts and politicians including in Africa …

The 2007/2008 food prices hike has increased the interest in social safety nets programmes to fight food insecurity. Targeting the most in need is central to achieve effectiveness of such interventions. In 2009 in Ouagadougou, Burkina Faso, a food voucher (FV) programme targeted the 25 000 most vulnerable households (8.3% of the population). Targeting used a two-stage process: first geographical selection of poorest districts (similar to 90 000 households); then, in those districts, identification of the most vulnerable households according to a proxy-means test (PMT). Targeted households were entitled to receive FV for 1 year. A first survey was conducted at the beginning of the FV distribution on a representative sample of 2273 households drawn from the poorest districts. One year later a second survey, conducted on a subsample of same households (n = 901), identified those who actually received FV (beneficiary). The performance of the whole process was assessed against household food expenditure, used as the reference measure for vulnerability with a cut-off point of 1513 FCFA (corresponding to the 8.3th percentile of the distribution of expenditure). The 'normalized share of transfers going to vulnerable households' (NSTVH), i.e. proportion of FVs allocated to households below the cut-point, was the main criteria of judgement. Almost twice as many FV were allocated to vulnerable households as compared with a theoretical random distribution all over Ouagadougou (NSTVH = 1.85). When considering the sole targeted districts the NSTVH was only 0.84 (i.e. no more effective than a random distribution), meaning that the geographical stage was effective to select vulnerable districts while the PMT did not perform well to identify the most vulnerable households in those districts. Results could have been improved if only targeted households had received FV (NSTVH = 2.61 and 1.18 for the whole Ouagadougou and targeted districts, respectively). Improved targeting procedures or alternate targeting instruments are needed.

INTRODUCTION The tuberculin skin test (TST) can be used to identify HIV-infected people who would benefit the most from long-term isoniazid preventive therapy (IPT). However, in resource-constrained settings, implementation of the TST can be challenging. The objectives of this study were to assess the feasibility of implementing the TST for IPT initiation and to estimate the proportion of TST-positive incidence among HIV-positive patients in 2 high tuberculosis and HIV burden settings. METHODS Two prospective observational cohort studies were conducted under programmatic conditions in Mathare, an urban slum of Nairobi, Kenya, and in rural Shiselweni, Swaziland. HIV-positive adults with negative tuberculosis symptomatic screening underwent the TST. Those testing positive were started on 36-month IPT. RESULTS Of 897 and 1021 patients screened in Mathare and Shiselweni, 550 and 696, respectively, were included. Median age was 38 years, 67.7% were female, and 86.8% were on antiretroviral therapy. Among TST-eligible participants, 88.0% (491/558) and 81.8% (694/848) accepted TST and 74.2% (414/558) and 77.1% (654/858) returned for test reading in Mathare and Shiselweni, respectively. The TST was positive in 49.8% (95% confidence interval: 44.9 to 54.6) in Mathare and 33.2% (95% confidence interval: 29.6 to 36.8) in Shiselweni. The 36-month IPT was accepted by 96.1% (198/206) patients in Mathare and 99.5% (216/217) in Shiselweni. IPT implementation at the clinics was managed with no additional staff or extra space. CONCLUSION Implementing the TST for IPT initiation was feasible and acceptable in both urban and rural resource-constrained settings. This strategy allows patients who can benefit the most to receive long-term IPT and avoids unnecessarily treating a significant number of patients who do not stand to benefit.

Contexte L’epidemie d’Ebola de 2015 avait engendre une mefiance legitime vis-a-vis des fluides biologiques aussi bien dans la population qu’aupres des professionnels de sante a N’Zerekore. Le don de sang etait devenu difficile avec une inadequation entre l’offre et la demande au niveau de l’hopital regional. Plus de stock de sang, tout se limitait au don direct dans les situations d’urgence rendant ainsi inefficace la reponse aux urgences transfusionnelles sur l’hopital en general et en pediatrie en particulier. En 2015, dans ce contexte, 2071 donneurs ont ete testes avec une positivite au VIH de 4,1 %. Objectif Rendre disponible du sang securise pour les patients de l’hopital de N’Zerekore en general et particulierement ceux de la Pediatrie dans un contexte Ebola et post-Ebola. Methodologie Des janvier 2016, l’ONG Alima a lance une mobilisation sociale pour le don benevole de sang en collaboration avec le ministere de la sante et les autorites locales. Des campagnes de sensibilisation ont ete menees aupres des populations de N’Zerekore de janvier a avril 2016, apres lesquelles des collectes de sang ont ete effectuees. Resultats Un total de 208 personnes ont fait don benevolement amenant la proportion du don benevole a 26 % (n = 796). Chaque donneur a fait un seul don. Le ratio homme/femme a ete de 3,42, la prevalence VIH de 2 % pour les donneurs benevoles et de 2,4 % pour l’ensemble des donneurs. Commentaires Cette campagne a permis de creer un stock de sang facilitant ainsi l’amelioration de la reponse aux urgences transfusionnelles. En plus, la prevalence VIH passe de 4,1 % (n = 2071) en 2015 a 2,4 % (n = 796) pour les 4 premiers mois de 2016. L’action merite d’etre poursuivie jusqu’a satisfaction totale de besoins en sang par le don benevole. Ceci permettra d’ameliorer la securite transfusionnelle a N’Zerekore.