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OBJECTIVE The aim of this study was to identify lessons learned from partnerships addressing the HIV/AIDS epidemic that can inform those needed to mitigate the noncommunicable diseases (NCDs) epidemic in low and middle-income countries (LMICs). DESIGN We selected and analysed a convenience sample of organizational partnerships developed to address the HIV/AIDS epidemic in LMICs, focusing on their specific strategies and contributions. METHODS A review of published literature and website information pertaining to a convenience sample of five global organizations and/or types of partnerships that provide support to fight the HIV/AIDS epidemic was qualitatively analysed to assess key areas of support provided to scale-up services in response to the HIV/AIDS epidemic. RESULTS Six topical areas of support were identified: HIV/AIDS service delivery; enhancing comprehensive health systems capacity; operational and implementation science research to improve care delivery; introducing and improving the availability of new products; political advocacy; and early-stage planning for sustainability and transition to more independent implementing-country delivery programmes. These six areas of support were qualitatively assessed for identify a focus, contributory or minimal contribution on the part of each of the organizations and/or types of partnerships reviewed. CONCLUSION No single global partnership addresses the range of support needed to respond to the HIV/AIDS epidemic, and this will likely be true for an effective response to the emerging NCD epidemic. A range of coordinated financial and/or technical support as well as lessons learned from global HIV/AIDS partnerships will be key to achieving an effective response to the global NCD epidemic.

The Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive (Global Plan) was transformative, helping drive a 60% reduction in new HIV infections among children in 21 priority countries in sub-Saharan Africa from 2009 to 2015. It mobilized unprecedented political, technical, and community leadership at all levels to accelerate progress toward its ambitious targets. This progress is well documented, many specific elements of which are explained in greater detail across this JAIDS supplement. What is often less well or widely understood are the critical aspects of the Global Plan that shaped its structure and determined its impact; the factors and forces that coalesced to form a deep and diverse coalition of contributing partners committed to catalyzing change and action; and the critical lessons that the Global Plan leaves behind, a living legacy to inform and improve ongoing efforts to achieve its ultimate goals.

Background Despite evidence of the impact of interprofessional education (IPE) strategies to improve the efficiency and quality of training, few undergraduate health professions education programmes in sub-Saharan Africa have implemented such approaches. Furthermore, few pre-service health professions educational institutions have developed educational interventions that target trainees during the transition between pre-service training and professional practice. We developed HIV-specific, interprofessional, team-based resources to better support trainees during the transition period. Methods Between April 1 and July 31, 2019 ten faculty members representing nine medical and nursing schools in Uganda and South Africa developed a training package focused on core clinical, public health, IPE, and quality improvement (QI) domains related to HIV service delivery. Using small-group learning principles, they developed 17 case-based modules to address a diverse set of HIV-related topics, including, but not limited to, HIV prevention, diagnosis, linkage to care, treatment, and management of opportunistic infections. All modules were aimed at newly, or nearly, qualified health-care professionals, including nurses, doctors, pharmacists, and laboratory scientists and were intended to be taught in workshops that will complement existing institution-specific HIV curricula. Findings Training resources were launched in August, 2019; in the following 6 months, 66 nursing and medical schools and their affiliated training sites in 14 countries in sub-Saharan Africa used the training modules to support interprofessional training for health professionals in training. In the first 6 months of the project, 3500 learners participated in the training. Interpretation Further evaluation of this project and its effects on pedagogical approaches, trainee competencies, as well as wider changes in the organisation and delivery of HIV care, are warranted. The collaborative, interinstitutional, interprofessional approach to curriculum development could provide a benchmark for how best-practice approaches to education can be rapidly disseminated and scaled up across training programmes in Africa. Funding Health Resources and Services Administration, HRSA

The urgency to scale-up sustainable programs for the prevention of mother-to-child transmission of HIV (PMTCT) prompted priority countries of the Global Plan Toward the Elimination of New HIV Infections Among Children by 2015 and Keeping Their Mothers Alive (Global Plan) to expand the delivery of PMTCT services through greater integration with sexual and reproductive health and child health services. Countries approached integration-what, where, and how services are provided-in diverse ways, with predominantly favorable results. Approaches to integrated services have increased access to a broader range of PMTCT interventions, and they also have proved to be largely acceptable to clients and providers. The integration of PMTCT interventions with maternal, newborn, and child health settings was supported by strategies to reconfigure service delivery to provide additional services, including shifting tasks to nurses (such as initiating antiretroviral therapy and providing long-term follow-up). This was complemented by supporting community outreach and integrating HIV and sexual and reproductive health services bidirectionally, including by providing family planning through antiretroviral therapy clinics and HIV testing in family planning clinics. A systematic and rigorous study of country experiences integrating HIV and maternal, newborn, and child health services, including maternal and pediatric TB services, cost analysis, could provide valuable lessons and demonstrate how such integration can improve systems for health care delivery.

The nursing and midwifery workforce is key to improving the performance of the health system overall. Health workforce shortages are significantly influenced by the productive capacity of health professions education institutions. Long-standing underinvestment in preservice nursing and midwifery education severely limits the capacity of institutions to educate nurses and midwives in sufficient numbers, and with the necessary clinical skills, for current and anticipated population health needs. The Nursing Education Partnership Initiative (NEPI) was established in 2011 by the U.S. President's Emergency Plan for AIDS Relief in response to key capacity-building challenges facing preservice nursing and midwifery education in Sub-Saharan Africa. NEPI has formed partnerships with governments and key stakeholders in Ethiopia, Democratic Republic of Congo, Lesotho, Malawi, and Zambia and supports 19 nursing and midwifery education institutions and 1 nursing council. NEPI has been informed by activities that strengthen education systems, institutions, and organizations as well as faculty capacity building. Ministry of health-led advisory groups were established to provide strategic direction and oversight for the work, fostering intersectoral dialogue and ensuring country ownership and sustainability. Three illustrative examples of innovations at the system, institution, and workforce levels describe approaches for country ownership, for addressing the shortage of highly qualified faculty, and for remedying the inadequate teaching and learning infrastructure.

The President's Emergency Plan for AIDS Relief (PEPFAR) has spurred unprecedented progress in saving lives from AIDS, while also improving a broad range of health outcomes by strengthening country platforms for the delivery of basic health services. Now, a new endpoint is in sight--an AIDS-free generation--together with the opportunity to change the trajectory of global health through the investments made and lessons learned in doing this work. Less than a decade ago, many experts counseled against scaling up antiretroviral treatment in the developing world. They feared that patients would be unable to adhere to their regimens, that resistant strains of the virus would evolve and prevail, and that the need to sustain daily treatment for millions of people in poor settings would overwhelm fragile health systems. Today, over 6.6 million men, women, and children are on treatment, and incidence is dropping in many of the hardest-hit countries. By adopting a targeted approach to address one of the most complex global health issues in modern history, and then taking it to scale with urgency and commitment, PEPFAR has both forged new models and challenged the conventional wisdom on what is possible. In this article, PEPFAR and its partners are examined through new and evolving models of country ownership and shared responsibility that hold promise of transforming the future landscape of global health.

Suzanne L. Jed, MSN, FNP-BC, is instructor of clinical family medicine, Keck School of Medicine, University of Southern California, Los Angeles. Deborah von Zinkernagel RN, SM, MS, is vice president for policy and senior clinical expert, Pangaea Global AIDS Foundation, San Francisco. The risk of occupational exposure to bloodborne and airborne infectious diseases is well known, and nurses put themselves at risk every day they work in wards and clinics where inadequate infection control measures exist (World Health Organization [WHO], Joint United Nations Programme on HIV/AIDS [UNAIDS], United Nations Children’s Fund, 2008). Many nurses and other health care workers (HCW) provide care in settings with limited basic resources including lack of access to electricity, running water, gloves, tuberculosis masks, and occupational postexposure prophylaxis for HIV (Medicins Sans Frontieres, 2007). These unsafe working conditions create fear and further increase the risk of occupational exposure. Globally, WHO estimates that 2.5% of HIV cases among HCW are the result of needle-stick injuries, while also acknowledging that these exposures are likely to be grossly underreported (WHO, 2006). This situation is unacceptable and untenable because essential caregivers who are responding to HIV are themselves placed at risk, endangering their health and fostering a desire to leave unsafe workplaces. Occupational exposures are preventable; the tools for prevention are known and at hand. Standard infection control measures, also called universal precautions, have drastically reduced the risk of occupational exposure to HIV in the United States and most developed countries. The time is long overdue to make prevention of occupational exposure a worldwide standard of practice in every environment in which health care services are provided (Health Workforce Advocacy Initiative, 2007).

The Medical Education Partnership Initiative (MEPI) and Nursing Education Partnership Initiative (NEPI) are innovative approaches to strengthening the academic and clinical training of physicians and nurses in Sub-Saharan African countries, which are heavily burdened by HIV/AIDS. Begun in 2010 by the U.S. President's Emergency Plan for AIDS Relief with the National Institutes of Health, investments in curricula, innovative learning technologies, clinical mentoring, and research opportunities are providing a strong base to advance high-quality education for growing numbers of urgently needed new physicians and nurses in these countries. The MEPI and NEPI focus on strengthening learning institutions is central to the vision for expanding the pool of health professionals to meet the full range of a country's health needs. A robust network of exchange between education institutions and training facilities, both within and across countries, is transforming the quality of medical education and augmenting a platform for research opportunities for faculty and clinicians, which also serves as an incentive to retain professionals in the country. Excellence in patient care and a spirit of professionalism, core to MEPI and NEPI, provide a strong foundation for the planning and delivery of health services in participating countries.

Our response challenges a number of the conceptual assumptions of McKeganey’s commentary and suggests different rationales for its methodological critiques. We believe the commentary fails to clearly distinguish between the misapplication of RAR, and the inherent strengths and limitations of well-implemented projects. The contention that misapplication leads to bad science is certainly a strong argument for carefully employing the methodology only where appropriate. Rapid assessment proponents themselves caution against misapplied science when adapting RAR for research, as well as the development, implementation and evaluation of interventions. The commentary appears to be organized to compete rapid assessment methodologies against ‘‘traditional research in the behavioral sciences’’. However, the commentary acknowledges that rapid assessment methods are not new, but are part of the standard tool kit of qualitative and quantitative paradigms * Corresponding author. Fax: +1-301-480-4544.

30 years ago the disease now known as AIDS transfixed suffering and death on gay communities. The spread of AIDS transformed an entire generation, forging powerful connections between gay activists and their health professionals.1 AIDS activists reached beyond the picket lines to set up entirely new drug approval processes at the US Food and Drug Administration (FDA). At the same time, AIDS physicians adopted the cause of advocacy in ways hitherto unthinkable. Although the synergy between human rights and health continues to this day, these partial gains reveal an unfinished project. We define inclusive rights as civil, social, and health rights independent of sexual orientation or gender.2 Yet violence and discrimination against lesbian, gay, bisexual, and transgender (LGBT) individuals remain the norm in many regions.3 In 2012, 78 nations worldwide had laws discriminating against LGBT individuals.2 This harsh environment discourages LGBT individuals from seeking health services, disclosing sexual behaviours, reporting sexual violence, and, ultimately, from receiving antiretroviral therapy for those HIV-infected LGBT in need of treatment.4 In 2011, in recognition of the importance of an inclusive rights-based foreign policy, US President Barack Obama issued a memorandum that raised LGBT rights to the status of a foreign policy priority. Obama declared: “The struggle to end discrimination against LGBT persons is a global challenge, and one that is central to the United States commitment to promoting human rights. I am deeply concerned by the violence and discrimination targeting LGBT persons around the world whether it is passing laws that criminalize LGBT status, beating citizens simply for joining peaceful LGBT pride celebrations, or killing men, women, and children for their perceived sexual orientation. That is why I declared before heads of state gathered at the United Nations, ‘no country should deny people their rights because of who they love, which is why we must stand up for the rights of gays and lesbians everywhere.’”5 An inclusive rights-based foreign policy can improve the health and wellbeing of LGBT communities by several mechanisms. First, worldwide support for LGBT individuals’ human rights nurtures an environment that is conducive to stable, healthy same-sex partnerships. An analysis based on WHO data showed that after European nations introduced same-sex partnership laws, syphilis rates decreased by 43%.6 Second, an inclusive rights-based foreign policy decreases barriers for HIV-infected LGBT individuals to receive antiretroviral therapy. Finally, an inclusive foreign policy prioritises the safety of LGBT individuals. LGBT individuals have been murdered in many countries because of sexual orientation or gender identity. This inclusive foreign policy agenda has also elicited criticism, especially from local leaders. Religious practices that condemn homosexuality, entrenched heterosexual family norms, and widespread public disapproval in many regions7 challenge the expansion of an inclusive foreign policy in different parts of the world. Potential exists for conflict between religious groups and organisations supporting inclusive policies; however, faith leaders have also become powerful advocates for HIV prevention.7 This advocacy could be extended explicitly to include LGBT rights. Working in partnership with local religious organisations and other multisectoral partners will be crucial to the success of comprehensive initiatives in HIV control. Another common criticism against an inclusive foreign policy is the belief that paternalistic global forces misunderstand local cultures; yet the persistence and momentum of LGBT community-based organisations in the harshest environments cannot be ignored. Homosexuality is not a political ideology; rather, it is woven into the fabric of humanity. The UN Human Rights Council has unequivocally stated that LGBT rights are human rights.8 An inclusive foreign policy is gaining traction and could generate considerable health benefits. Although an inclusive foreign policy has advanced most rapidly in high-income nations where discrimination and violence are less common, 29 US states9 and 12 European countries2 still have laws that discriminate against homosexual individuals. Advancement of LGBT rights is about embracing health and wellness for all, irrespective of sexual orientation or gender.

Kumanan Rasanathan and colleagues explain how integrating action on determinants of women’s, children’s, and adolescents’ health beyond the health sector into core health strategies is crucial to achieving sustainable development goal targets to end preventable deaths and ensure healthy lives